Professional Documents
Culture Documents
Medical Informatics
Medical Informatics
Lecture 2
Formalising clinical data and medical
knowledge, Clinical coding systems, Formal
knowledge representation
if time formalising research results
Develop
Develop
and test
and test
treatments
treatments
Health
Records
Service delivery,
Service delivery,
performance
performance
assessment
assessment
Ensure right
Ensure right
Patients receive
Patients receive
right
right
intervention
intervention
Develop
Develop
and test
and test
treatments
treatments
Health
Records
Service delivery,
Service delivery,
performance
performance
assessment
assessment
Ensure right
Ensure right
Patients receive
Patients receive
right
right
intervention
intervention
Coding systems
International Classification of Diseases (ICD)
Diagnosis Related Groups (DRGs)
Standard Nomenclature for Medicine (SNOMED)
Logical Observation Identifiers Names and Codes
(LOINC)
Medical Subject Headings (MeSH)
Specialised coding systems
WHO ICD
The International Classification of Diseases has
been used since 1853 to classify diseases and
other health problems recorded on many types
of records, including death certificates and
health records
In addition to enabling the storage and retrieval
of diagnostic information for clinical,
epidemiological and quality purposes, ICD also
provides a basis for the compilation of national
mortality and morbidity statistics by WHO
Member States (e.g. AIDS, swine flu).
Other
healthcare
related
classifications
3-character core
Speciality codes
Diagnoses
Symptoms
Abnormal Lab
findings
Injuries and
poisonings
External causes of
morbidity and
mortality
Factors influencing
health status
oncology
dentistry
dermatology
psychology
neurology
obstetrics & gynaecology
rheumatology &
orthopaedics
general medical practice
International
Nomenclature
of Diseases
ICD-10
Uses an alphanumeric code that indicates
the location of the concept within a
disease hierarchy.
L93 Lupus erythematosus.
Excludes exedens A18.4, vulgaris A18.4 . . .
Use additional external cause code, if drug
induced.
DRGs
1
2
24
25
26
1
HYPERTENSIVE ENCEPHALOPATHY
23NONTRAUMATIC STUPOR & COMA
SEIZURE & HEADACHE AGE >17 WITH COMPLICATIONS, COMORBIDITIES
(prior to 10-1-06)
SEIZURE & HEADACHE AGE >17 WITHOUT COMPLICATIONS,
COMORBIDITIES (prior to 10-1-06)
SEIZURE & HEADACHE AGE 0-17
TRAUMATIC STUPOR & COMA, COMA >1 HR
X-referencing
Tuberculosis
Bacterial infections
E = Infections or parasitic diseases
D = Disease or diagnosis
X-ref e.g. living organism, morphology, function
LOINC
LOINC currently includes over 58,000 terms
A unique 6-part name is given to each test or
observation.
Each database record includes six fields
Component- what is measured, evaluated, or observed
Kind of property - e.g. length, mass, volume, time stamp
Time interval over which observation or measurement made
System - or specimen type within which observation was made
Scale - quantitative, ordinal, nominal or narrative
Method procedure used to make measurement or observation
Develop
Develop
and test
and test
treatments
treatments
Health
Records
Service delivery,
Service delivery,
performance
performance
assessment
assessment
Ensure right
Ensure right
Patients receive
Patients receive
right
right
intervention
intervention
Rules
breast cancer IS_A
reproductive system and breast disorder
Relationships
Concepts
DF-400DB
Symbols
breast cyst
breast lump
breast cancer
SNOMED CT
All concepts (except the root) are the
source of at least one ISA(subtype)
relationships
Concept
Concept
A concept is described
in one or more
descriptions
Relationship
Relationship
A conceptId (25064002),
A set of descriptions
Description
Description
("headache", "pain in head", etc.)
A set of relationships ("is a"="pain",
"finding site"="head structure", etc.).
organisms,
anatomical structures,
biologic function,
chemicals,
events,
physical objects, and
concepts or ideas.
UMLS Meta-thesaurus
Uniform format for over 100 biomedical
vocabularies and classifications
Organised by concept as a web rather than a tree,
linking alternative names and views together and
identifying useful relationships.
UMLS
ICD-10
SNOMED
SNOMED CT
Chronic
ischaemic
heart disease
448589
125.9
14020
84537008
Rules
breast cancer is_a
reproductive system and breast disorder
Relationships
Concepts
DF-400DB
Symbols
breast cyst
breast lump
breast cancer
Rules
breast cancer is_a
reproductive system and breast disorder
Relationships
Concepts
DF-400DB
Symbols
breast cyst
breast lump
breast cancer
February 2010
Levels of evidence
February 2010
Evidence-based medicine
The practice of EBM has five steps:
1. Convert need for information about prevention,
diagnosis, prognosis, therapy, causation etc. into an
answerable question
2. Track down the best evidence to answer the question
3. Critically appraise the evidence for validity and
applicability
4. Integrate the critical appraisal with our clinical expertise
and our patients unique biology, values and
circumstances
5. Evaluate our performance.
Develop
Develop
and test
and test
treatments
treatments
Health
Records
Service delivery,
Service delivery,
performance
performance
assessment
assessment
Ensure right
Ensure right
Patients receive
Patients receive
right
right
intervention
intervention
Phase I
Ascertain Maximum
Tolerated Dose (MTD)
Phase III
Assess the effectiveness
of a new intervention
February 2010
Phase II
Estimate effect and rate of
adverse events
Phase IV
Long-term studies of
licensed interventions
February 2010
Develop
Develop
and test
and test
treatments
treatments
Health
Records
Service delivery,
Service delivery,
performance
performance
assessment
assessment
Lecture 3
Ensure right
Ensure right
Patients receive
Patients receive
right
right
intervention
intervention