15. CLINICAL INFORMATICS
It is an application of computers, communications and information technology and systems to all fields of medicine; medical care, medical education & medical research. In fact, it is a combination of medical sciences with several technologies and disciplines in the information and computer sciences and provides methodologies by which these can contribute to better use of medical knowledge and ultimately to better medical care. It is the national study of the way we think about patients, and the study of how medical knowledge is created, shaped, shared and applied. It needs understanding skills and tools that enable the sharing and use of information to deliver health care and its promotion. Although, the name ‘medical informatics only came into use around 1973, it is a study that is as old as medicine itself. It was born the day that a doctor first wrote down some impressions about a patients illness, and used these to learn how to treat their next patient. By the advances in computer technology, information has grown considerably as a medical discipline in recent years fuelled. Clinical Informatics tends to replace the previously commoner term ‘Medical Informatics’ reflecting a widespread concern to define an information agenda for health services which recognizes the role of citizens as agents in their own case as well as the major ‑ information ‑ handling roles of the non – medical health care professions. Health information and computer sciences, psychology, epidemiology and engineering intersect at one place for advancing and teaching knowledge about the better health care to the community.
Clinical Informatics helps deliver the
patient care, nursing and dentistry, electronic medical
records and improves the quality of health care at reduced cost. We can
create, give shape, show, promote and apply the health knowledge through
clinical informatics. The scope of clinical informatics it thus enormous. It
finds application in the design decision support systems for clinical
practitioners, in the development of computer tools for research, and in the
study of the very essence of medicine ‑ its corpus of knowledge. Yet the
modem discipline of Clinical Informatics is still relatively young.
Computer-based
patient record:
The
patient record used in a clinical setting generally contains the notes of
clinicians and other care providers which are often supplemented with data from
other sources for example biochemical & pathological reports, X-rays,
ultrasound, lung function, endoscopy etc. With the exception of
electrocardiograms, some images, or drawings, the majority of information in the
paper-based record involves the alphanumeric data. People have tried to develop
the Computer-based Patient Records (CPR) for more than 25 years, firstly in a
hospital setting and focused on those that were relatively easy to structure:
diagnosis & laboratory test results based, and medication data. History of
patient and the physical examination proved to be far more difficult to collect
in a structured format. There has been observed reluctance in the clinicians as
well the variation in them in phrasing the data. They feel probably this mode of
entering the data a time-consuming and unfriendly to the patients.
Factors
towards recent increase of Clinical Informatics:
Increase use of technology.
More data generated mobility of
population.
Need to communicate
specialization.
Need to communicate management
care systems.
Need to communicate rise in
health care cost.
Attempt to control care
improved hardware.
Faster and more memory improved
methods.
Acquisition transfer, retrieval
reduced computer costs increased awareness.
Approach:
Collect
data:
Patients
particulars
History
(Personal, Present, Past, Drug, Family etc)
Physical
examination (General, Systemic, Local etc)
Patients'
Lab supported information (Investigations
on body fluids, X‑ray, ECG, USG, Scan)
Analyze data
Interpret data
Create hypotheses (differential
diagnosis) and list out possible diseases
Based on hypotheses, collect
more data
Confirm diagnosis
Chart out treatment strategy
Try treatment strategy.
Revise hypotheses based on data
& outcome of treatment (Follow‑up, Monitoring)
Rules for the
documentation of patient data in computers:
Data acquired should be close to its source.
strict rules of standardization should be obeyed.
The original data should be stored, and if required, human interpretations should be stored.
Coding may be avoided possibly, in case required, it should preferably be done by the person making the observation.
For all data entered, there should preferably be an on-line feedback to the user to signal possible deviations from what should be expected.
Persons who enter the data should ideally be benefited, either because they will use the data later on or because it will improve the quality of their work.
Adding the coder's name and signature and time stamping of data authenticate and improve the data quality.
Goals:
Help people maintain good health through prevention and treatment structure and
use of medical data.
Purpose:
Organize / integrate data and develop relation among problems. Missing of
details can be avoided.
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