Introduction to Biostatistics and Health Informatics

Introduction to Biostatistics and Health Informatics.

Stethoscope. Objectives and Learning Outcomes. Establish an understanding of data sources used in public health: Gain knowledge about various data sources, including vital records, census data, EHRs, and surveillance systems, and their importance in informing public health decisions. Compare biostatistics and health informatics: Understand the differences and similarities between biostatistics and health informatics, including their unique roles and how they complement each other in public health. Acquire an understanding of the application of statistical methods and technology in public health: Learn how biostatistics applies statistical methods to analyze health data and how health informatics utilizes technology to manage and analyze health data to improve healthcare outcomes..

Informatics. Health informatics is part of a larger subject referred to as Biomedical Informatics which includes bio-informatics and health informatics as its major sub-disciplines. Health informatics is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health and medical research..

Bioinformatics. Bioinformatics is defined as the application of computational and analysis tools to the capture and interpretation of biological data. It is an interdisciplinary field, which harnesses computer science, mathematics, physics, and biology especially for the field of genetics and genomics e.g DNA sequences of genes or full genomes; amino acid sequences of proteins; and three-dimensional structures of proteins, nucleic acids and protein–nucleic acid complexes. ..

What then is Health Informatics?. The practice of acquiring, studying and managing health data and applying medical concepts in conjunction with HIT systems to help clinicians provide better healthcare. Information engineering applied to the field of heath care essentially the management and use of patient healthcare information. Informatics is found at the intersection of healthcare and technology. It is where skills in both medical and computer sciences come together in an effort to improve healthcare and patient outcomes. Professionals in this hybrid field draw on expertise from both disciplines to put technology to its best use in patient care, clinical and research settings. health care informatics, medical informatics, nursing informatics, clinical informatics, or biomedical informatics.

Desk with stethoscope and computer keyboard. Health Information Technology.

Health Information Technology. Health informatics deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health..

Health Information Technology. Informatics is the heart of evidence-based, value-based medicine. Healthcare professionals are increasingly turning to mined data to support their decisions. Health informatics specialists help managers throughout the healthcare industry access the right information to produce actionable insights that can improve both therapeutic and institutional efficiency..

Informatics examples. Creating, maintaining or facilitating new ways for medical facilities and practices to keep EHR. Improving communication between healthcare providers and facilities to ensure the best patient outcomes e.g. billing, insurance (HMO like AAR, IAA etc) Storing, managing and analyzing data for research (methods that ensure data re-use for decision making)…..UgandaEMR, DHIS2, Clinic Master, OpenMRS, etc Interpretation of Medical Images using computing algorithms in absence of a radiologists. PHR, EHR, EMR, Tele-medicine, Tele-health……..

Personal Health Record. A personal health record, or PHR, is an electronic application through which patients can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment. It is operated by institutions (such as hospitals) and contains data entered by clinicians or billing data to support insurance claims. Intention of the PHR is to provide a complete and accurate summary of an individual’s medical history which is accessible online..

Types of PHR Systems. 1. Standalone systems: These are not tied to any healthcare system e.g Google Health PHR, Microsoft’s Health Vault. 2. Tethered systems: These are tied into a healthcare system. e.g My HealtheVet PHR 3. Networked systems: These access data from multiple locations.

Why is a PHR important?. It provides complete and accurate patient record documentation that is used to foster quality and continuity of care. It creates a means of communication between providers and members about health status, preventive health services, treatment, planning, and delivery of care. What does the patient do with the PHR? Email their doctor, track immunizations, transfer information to the new doctor, receive and track their test results..

Benefits of PHR. Improve Patient Engagement: Coordinate and combine information from multiple providers Helps to ensure that patient information is available Reduces administration cost Encourages family health management Enhance patient communication Track and assess one’s health Make the most of a doctor’s visit Manage your health between visits.

Tele-health. WHO: Tele-health involves the use of telecommunications and virtual technology to deliver health care outside of traditional health-care facilities. Tele-health, which requires access only to telecommunications, is the most basic element of “eHealth,” which uses a wider range of information and communication technologies (ICTs)..

Tele-medicine. Telemedicine is the remote delivery of healthcare services, such as health assessments or consultations, over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose and treat patients using common technology, such as video conferencing and smartphones, without the need for an in-person visit..

Types of telemedicine. Telemedicine can be classified into three main categories: 1. Remote patient monitoring: Also known as tele-monitoring, allows patients with chronic diseases to be monitored in their homes with mobile medical devices that collect data about blood sugar levels, blood pressure or other vital signs. Remote caregivers can review the data instantly. 2. Store-and-forward: Also known as asynchronous telemedicine, lets providers share patient information, such as lab results, with a physician at another location..

Types of telemedicine. 3. Interactive telemedicine: This allows physicians and patients to communicate in real time. Such sessions can be conducted in the patient's home or in a nearby medical facility and include telephone conversations or the use of video conferencing software that complies with HIPAA regulations. e.g TMCG.

Difference between Tele-health and Tele-medicine.

Tele-health example.

Tele Health. Well-designed tele-health schemes can improve health care access and outcomes, particularly for chronic disease treatment and for vulnerable groups. Not only do they reduce demands on crowded facilities, but they also create cost savings and make the health sector more resilient..

Examples of applications in HI. Brain Computer Interfaces(BCIs)-Direct interfaces between the human mind and technology . It is powered by AI and have been used to decode the neural activities associated with intended movements of the hand for people with neurological diseases and trauma to the nervous system that can take away some patients’ ability to speak, move and interact meaningfully. BCIs acquire brain signals, analyze them, and translates them into commands that are relayed to an output device to carry out a desired action. This can eventually improve the patient’s quality of life e.g strokes etc Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497935/.

Desk with stethoscope and computer keyboard. Artificial Intelligence.

Desk with stethoscope and computer keyboard. Analytics.

Stethoscope. Importance of Health Informatics. 1. Maintained Electronic Patient Records Patients visit more than one care provider and paper based records make it difficult to safely manage patients since these records do not get consolidated across physicians, specialists, laboratories and hospitals. Saves patient time since upon entering the hospital, medical staff already has much of the patient’s information available in an EHR thus less paper work, shorter and fewer forms for patients to fill out..

Desk with stethoscope and computer keyboard. Importance of HI cont’d.

Importance of HI cont’d. 4. Improved Ability to Self-Manage Illness: A patient’s success story often depends as much on their own application of a physician’s directions than on the actual medical advice and guidelines. e.g imagine a patient with a chronic illness e.g cancer, diabetes, HIV etc that is able to view a graph(weekly) that shows their progress in adherence to medication, able to input information in a mobile application regarding drug reactions (know when to rush to the hospital and when not to ).

Stethoscope. Importance of HI cont’d. 5. Increased Coordination: As care gets more specializations, patients receive care from different specialists in one hospital stay e.g pharmacy, laboratory, nutrition, physiotherapy, x-ray, discharge etc 6. Improved Outcomes: Electronic medical records result in higher quality care and safer care as coordinated teams provide better diagnoses and decrease the chance for errors. Doctors and nurses are able to increase efficiency, which frees up time to spend with patients, and previously manual jobs and tasks are automated, which saves time and money not just for hospitals, clinics, and providers, but for patients, insurance companies, and the state..

Importance of HI cont’d. 7. Improved Disaster recovery techniques: Disaster recovery techniques are techniques that are put in place to ensure business continuity in case of any disaster like fire, theft etc. A cold site: This is a site where there is little hardware set up. Provides power, simple server which waits in the event of a significant outage. Cold sites are the cheapest cost-recovery option for businesses to utilize. You’re saving a lot of money by not having equipment set up and running, but it will be challenging to get your site back online..

Importance of HI cont’d. A warm site: This is a site where you have hardware and network connections established from your site to a second site, but they are not equal. Your recovery will still be delayed while you retrieve your data from your remote backup site. Its like driving on the road and your extra car is following behind you but this may be several miles behind you, when the one you are driving gets a problem, it takes you time to catch up to where you are but in this car there is fuel, engine works which are the basics you need to start with- may not be as fancy as the one you are driving..

Importance of HI cont’d. A hot site: A hot site is a complete copy of your original site, including personnel, network systems, power grids and almost instant backups of your data. There is very minimal downtime when moving from the hot site to the backup one. Here you can’t afford any delays. So if your car breaks down, you’ve got your extra car right in the next lane next to you, driving at the same speed but this comes with costs of maintaining two cars to the same standard. Hot Site can be configured in a branch office, data center or even in cloud. Hot Site must be online and must be available immediately..

Importance of HI cont’d. Syncing Cloud. Data is regularly backed up or replicated to the hot site so that it can be made fully operational in a minimal amount of time in the event of a disaster at the original site. Hot Site must be located far away from the original site, in order to prevent the disaster affecting the hot site also..

Health Care applications. predictive Modelin: o Computational phend Patient Similarit y.

Predictive modelling. Using historical data to build a model for predicting future events/outcome(s). Example: You want to build a model to predict which patients are at risk of heart failure.

Motivation for predicting heart failure. Heart failure iS a complex discase. Reduces cost and hospitalization. garig intervention can stow down discase progression..

Heart failure iS a complex disease. Improves existing clinical guidelines of HF prevention. Reduces cost and hospitalization. garig intervention can slow down discase progression..

Computational phenotyping. (sadfpu9%d) SIJ9)u09 VPd mvy $!$oußwa.

Things to deal with. Magnifying glass showing decling performance.

Patient similarity(Case based reasoning). pocé0> 00 Patient o Patient Database-.

Group the patients(treatment and outcome). Podop oo O.

Stethoscope. HMIS. Health Management Information System(HMIS) is an integrated reporting system used by the MoH, Development Partners and Stakeholders to collect relevant and functional information on a routine basis to monitor the Health Sector Strategic Plan (HSSP) indicators to enable planning, decision making and M&E of the health care delivery system. It is designed to assist managers carry out evidence based decision making at all levels of the health care delivery. At the health Unit level, HMIS is used by the health unit in-charge and the Health Unit Management Committee to plan and coordinate health care services in their catchment area..

Desk with stethoscope and computer keyboard. Objectives of HMIS.

Uses of HMIS. Information from the HMIS can be used in the following ways: Planning Epidemic prediction Epidemic detection Designing Diseases specific Interventions Monitoring Work plan performance Resource allocation.

Advantages and Disadvantages of paper based records.

Light bulb on yellow background with sketched light beams and cord.

Disadvantages. Can only be used for one task at a time If 2 people need clinical notes, one has to wait. This can lead to long waits Records can get lost or out of order (effectively lost) Consume space Large individual records are hard to use Fragile and susceptible to damage Environmental cost.

Electronic Health Record. An electronic health record is a repository of information about a single person in a medical setting, including clinical, demographic and other data shared within and across different health facilities. A patient record system is the set of components that form the mechanism by which patient records are created, used, stored and retrieved..

Clinical documentatior Patient dem raphics Doctors' notes Nursin assessments Problem lists Medication lists Discharge summaries Advanced directives (livi wills: Clinical guidelines Clinical reminders Dru Decision support Comprehensive EHR Order ent Dru Dru Dru (requests) Test and ima in results -aller alerts -dru interaction alerts -laborato interaction alerts -dose support Radiology tests Laboratory tests Prescribin Consultant requests Nursin orders Clinical laboratory reports Radio y reports Radio y ima es Dia nostic test results Dia nostic test ima es Consultant reports.

Surveillance Systems. National Notifiable Diseases Surveillance System (NNDSS): Managed by the Centers for Disease Control and Prevention (CDC) in the United States. Collects and compiles data on diseases that are legally mandated to be reported by healthcare providers and laboratories. Behavioral Risk Factor Surveillance System (BRFSS): Conducted by the CDC. Collects data on health-related risk behaviors, chronic health conditions, and use of preventive services through telephone surveys. National Health and Nutrition Examination Survey (NHANES): Conducted by the National Center for Health Statistics (NCHS), part of the CDC. Combines interviews and physical examinations to assess the health and nutritional status of adults and children in the United States..

Surveillance Systems. National Healthcare Safety Network (NHSN): Managed by the CDC. Collects data on healthcare-associated infections (HAIs) to help facilities track and prevent these infections. Influenza Surveillance System (FluView): Conducted by the CDC. Tracks influenza activity, virus characteristics, and the impact of influenza on healthcare systems. Global Influenza Surveillance and Response System (GISRS): Managed by the World Health Organization (WHO). Monitors the spread of influenza globally and supports the development of vaccines..

Surveillance Systems. Global Health Observatory (GHO): Managed by the WHO. Provides access to data and analyses on global health priorities. European Surveillance System (TESSy): Managed by the European Centre for Disease Prevention and Control (ECDC). Collects and analyzes data on communicable diseases from EU member states..