Medical Informatics, e-health

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2 Health Informatics Alain Venot Anita Burgun Catherine Quantin Editors Medical Informatics, e-health Fundamentals and Applications

3 Health Informatics For further volumes:

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5 Alain Venot Anita Burgun Catherine Quantin Editors Medical Informatics, e-health Fundamentals and Applications

6 Editors Alain Venot Université Paris 13 Paris France Anita Burgun Université Paris 5 Paris France Catherine Quantin Université de Bourgogne Dijon France ISSN ISBN ISBN (ebook) DOI / Springer Paris Heidelberg New York Dordrecht London Library of Congress Control Number: Translation from the French language edition Champs Informatique Médicale, e-santé Fondements et applications sous la direction de Alain Venot, avec la collaboration de Anita Burgun et Catherine Quantin, Springer-Verlag France, Paris, 2013; ISBN: Springer-Verlag France 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

7 Dedicated to François Grémy, successively Professor of Medical Informatics at the universities of Paris and Montpellier. As the first chairman and moderator of IFIP- TC4, François Grémy is widely held to be the first president of its renamed and refocused successor, the International Medical Informatics Association (IMIA). He played a major role in the development of medical informatics, particularly in France, and he received the first IMIA Medical Informatics Award of Excellence in 2004.

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9 Preface Medical informatics has matured into a true scientific discipline, with its own international conferences, journals, exhibitions, research laboratories, calls for proposals for national and international research funding, and master s courses for the training of students. Both basic and applied aspects are taught, not only in all areas of health (medicine, dentistry, pharmacy, health and social sciences, nursing, public health) but also in many other domains, including life sciences, engineering and economics. Medical informatics is a complex and rapidly changing discipline. Few books are published in this domain, and they rapidly become obsolete. This book is the fruit of collaboration between several authors, all of whom teach medical informatics in France and perform research in this field. It contains 18 chapters, all of which include learning objectives, recommendations for further reading and information retrieval, exercises and bibliographic references. Chapter 1 presents the main areas of medical informatics and links to other scientific domains, such as computer sciences, biostatistics, biomedical engineering and public health. Key scientific societies, journals, conferences and exhibitions are listed. Chapter 2 focuses on the broad terminological resources developed for health. These resources are an essential tool for the normalisation of concept expression and for information coding in health, both these operations being prerequisites to the use of health information. Chapter 3 presents the various types of knowledge resources available in the domain of health, the principles underlying their indexing, the means developed for accessing these documents and quality criteria for health information. Chapter 4 deals with the representation of patient data in health information systems. The problems posed by the computerisation of patient records are analysed, and ways of structuring and standardising data are presented. In Chapters 5 and 6, the reader is introduced to the principles of medical image processing and analysis. These chapters provide an understanding of the ways in vii

10 viii Preface which these methods and techniques can improve interventions, providing surgeons with the possibility of using robots and achieving higher-quality care. Chapters 7, 8, 9 and 10 concern individual and collective decision support. They provide the reader with an understanding of the theoretical foundations underlying computerised decision-making methods for diagnosis and treatment. Medical economic aspects of decision-making are presented to illustrate the way in which information systems have led to sophisticated methods for pricing activities in hospitals. The various methods and tools facilitating decision-making in the field of public health are explained to the reader. Chapter 11 deals with the respect of ethical and legal aspects during the collection, archiving and processing of health data, particularly in Europe. Methods for securing records and information exchanges are presented. Chapters 12, 13, 14, 15 and 16 deal with the principal applications of medical informatics, such as the development of hospital information systems, shared medical records and the computerisation of medical and dental offices. The concept of e-health is presented, together with telemedicine and telehealth, including teleservices for everyday life and social welfare. Chapter 17 explains how medical informatics can facilitate research, whether basic or clinical, in the domains of epidemiology and public health. Finally, Chapter 18 highlights the role of human factors and ergonomics in the applications of medical informatics. This book is designed to be a study tool. It contains many international comparisons of developments and actions in the field. The writing of this book was supported by the French College of Biostatistics and Medical Informatics Teachers, presided by Prof. Pascal Roy (Lyon 1 University). Paris 13 University, Bobigny, France Paris 5 University, Paris, France Burgundy University, Dijon, France Prof. Alain Venot Prof. Anita Burgun Prof. Catherine Quantin

11 Contents 1 Medical Informatics as a Scientific Discipline... 1 A. Venot, A. Burgun, S. Després, and P. Degoulet 2 Medical Vocabulary, Terminological Resources and Information Coding in the Health Domain C. Duclos, A. Burgun, J.B. Lamy, P. Landais, J.M. Rodrigues, L. Soualmia, and P. Zweigenbaum 3 Management and Dissemination of Health Knowledge A. Venot, J. Charlet, S. Darmoni, C. Duclos, J.C. Dufour, and L. Soualmia 4 Representation of Patient Data in Health Information Systems and Electronic Health Records M. Cuggia, P. Avillach, and C. Daniel 5 The Processing of Medical Images: Principles, Main Applications and Perspectives L. Legrand 6 Enhanced Medical Intervention: Surgetics and Robotics A. Moreau-Gaudry and P. Cinquin 7 Medical Diagnostic Decision Support B. Séroussi, P. Le Beux, and A. Venot 8 Computerized Drug Prescription Decision Support B. Séroussi, J. Bouaud, C. Duclos, J.C. Dufour, and A. Venot 9 Computerized Medico-Economic Decision Making: An International Comparison P. Landais, T. Boudemaghe, C. Suehs, G. Dedet, and C. Lebihan-Benjamin 10 Public Health Decision Support C. Jacquelinet, I. Belhadj, F. Bayer, E. Sauleau, P. Lévy, and H. Chaudet ix

12 x Contents 11 Security, Legal and Ethical Aspects of Computerised Health Data in Europe C. Quantin, F.-A. Allaert, C. Daniel, E. Lamas, and V. Rialle 12 Hospital Information Systems P. Degoulet 13 Sharing Data and Medical Records P. Staccini, C. Daniel, T. Dart, and O. Bouhaddou 14 Computerising the Doctor s Office A. Venot and M. Cuggia 15 Computerizing the Dental Office V. Bertaud-Gounot, B. Chaumeil, E. Ehrmann, M. Fages, and J. Valcarcel 16 E-health R. Beuscart, E. Chazard, J. Duchêne, G. Ficheur, J.M. Renard, V. Rialle, and N. Souf 17 Translational Bioinformatics and Clinical Research Informatics C. Daniel, E. Albuisson, T. Dart, P. Avillach, M. Cuggia, and Y. Guo 18 Human Factors and Ergonomics in Medical Informatics H. Chaudet, F. Anceaux, M.C. Beuscart, S. Pelayo, and L. Pellegrin Index

13 Chapter 1 Medical Informatics as a Scientific Discipline A. Venot, A. Burgun, S. Després, and P. Degoulet Abstract This chapter will provide a brief history of the birth and development of medical informatics, followed by a description of its principal domains. These domains include bioinformatics, which relates to molecular and cellular aspects of medicine, clinical informatics, which deals with patient data and medical knowledge relating to the care of individual patients, and public health informatics, which brings together the tools, techniques and applications for reasoning at the population level. Links with other disciplines, including subdisciplines of computer sciences, biostatistics and biomedical engineering, have also been developed. There are many scientific societies for medical informatics, operating at the national, continental and international levels. These societies are presented here, together with the principal journals, scientific conferences and exhibitions in this field. Keywords Medical informatics history Biomedical informatics Bioinformatics A. Venot (*) S. Després LIM&BIO EA 3969, UFR SMBH Université Paris 13, 74 rue Marcel Cachin, Bobigny Cedex 93017, France alain.venot@univ-paris13.fr A. Burgun P. Degoulet CRC INSERM U872 eq 22, René Descartes University, 15 rue de l Ecole de Médecine, Paris, France patrice.degoulet@egp.aphp.fr A. Venot et al. (eds.), Medical Informatics, e-health, Health Informatics, DOI / _1, Springer-Verlag France

14 2 A. Venot et al. After reading this chapter you should: Be able to explain what medical informatics is Be aware of the principal links between medical informatics and various other areas, such as scientific computing, biostatistics and biomedical engineering Be able to cite the major associations and national and international scientific societies in the field of medical informatics Be aware of the principal journals and international conferences for researchers to communicate their results and know how to submit articles and communications Be aware of some of the research structures and sources of funding for research in medical informatics. 1.1 Development of Medical Informatics Medical informatics has gradually established itself as a scientific discipline (Shortliffe and Blois 2006; Geissbuhler et al. 2011; McCray et al. 2011). In this chapter, we present a brief history of this discipline, its key areas and links with other disciplines. We describe the national and international societies for medical informatics and discuss the major journals and congresses in this field, together with sources of research funding. Interest in the potential value of computers for use in medicine first emerged in the 1960s and has rapidly grown ever since. From the outset, the goals were ambitious, including the replacement of paper medical records with electronic records and assisting or replacing doctors in diagnostic or therapeutic procedures. Early in the development of medical informatics, a number of key issues, such as terminology systems in health, medical knowledge modelling and reasoning, rapidly emerged. A new scientific community developed. In 1968, a working group of researchers working specifically in the field of medical informatics was established within the International Federation for Information Processing (IFIP). One of its notable participants was Professor François Grémy (Degoulet et al. 2005), a French researcher. This committee became increasingly powerful, leading to the creation in 1974 of an international scientific society, the International Medical Informatics Association (IMIA). In the same year, the IMIA organised the first world congress in this field, Medinfo. This medical informatics community has organised itself into a network of national and international associations. It has set up its own conventions, journals and standards bodies. In academia, research laboratories have been set up, together with specific Masters and Ph.D. programmes.

15 1 Medical Informatics as a Scientific Discipline 3 This research has generated a number of commercial products. Software vendors and database editors in the domain of health have set up companies developing products for the computerisation of hospitals, medical and dental offices, imaging departments and pharmacies. Public partners, firmly convinced of the potential value of information technology (IT) to improve health systems and reduce costs, have been established in many countries to provide research funding at the national or supranational level. IT management rapidly developed to reach a certain level of maturity, but the computerisation of healthcare processes proved complex. After 50 years of development, IT has spread throughout the health sector, but further progress and active research are required (Haux 2010). For example: Electronic medical records are widespread, but their routine use in everyday practice remains difficult and time-consuming for health professionals. Physicians, for example, continue to input many patient data in natural language, whereas the use of terminology systems to code these data would make more elaborate functions possible. Many clinical studies have shown that diagnostic errors are often made in the various medical specialities. Much effort has been made over the last 30 years to develop software to assist doctors with diagnosis, but these programs do not yet seem to have come of age. Many physicians appreciate computer assistance in the drafting of prescriptions, because it reduces the risk of unsafe prescriptions, but handwritten prescriptions are still very abundant. 1.2 The Main Areas of Medical Informatics Since the 2000s, the term medical informatics, which was originally coined in Europe, has spread to the United States and around the world, to describe this discipline. However, the term biomedical informatics has recently gained in popularity, as it ensures that rapid developments in bioinformatics are not obscured (Shortliffe and Blois 2006). This term encompasses bioinformatics as a subdomain. In this book, we have deliberately avoided including a chapter dealing explicitly with bioinformatics, although some concepts specific to this area are presented in Chap. 17. Our goal was to focus on the field of health, without including purely biological applications. The diagram below outlines the major areas of biomedical informatics and its various microscopic and macroscopic levels (Fig. 1.1). Bioinformatics deals with the molecular and cellular levels of medicine. Very sophisticated methods have been developed for the analysis of gene sequences. Bioinformatics gained prominence with the advent of functional genomics, proteomics, transcriptomics and high-throughput sequencing. Research is progressive and continually adding to our knowledge, and there is now a need for a rational