Medical Informatics is nothing but the science and art of processing (bio)medical information (where information is the processed data). In this age of “Information Explosion” choosing the useful one is rather difficult, and that brings in the scope of data management and research. The usefulness of a database can be assessed only by its proper management (building, indexing and updating). However, still many outstanding personnel related to the healthcare sector take pride in being “computer illiterate”. The onus of the best use lies on the end-user health care providers only. The importance of clinical informatics is no less. Another term tele-health encompasses all the e-health and telemedicine services.
Reaching a foolproof diagnosis is never an easy job for a clinician. Often, a simple diagnostic procedure or test is overlooked and the disease eludes diagnosis. Clinical reasoning and decision making are phased. Initially there is a clinical evaluation (history taking and physical examination), followed by precise laboratory investigations. Then integration of clinical findings and test results is done. After that, comparative benefits and risks are weighed among the alternative courses of actions, like drug interactions Finally, the patient’s preferences are taken into account, along with ethical and other considerations like cost of therapy, compliance expectations and a therapeutic plan is developed. Right from the first step (history taking) to the final one, computers can be of immense help to the clinician. Nevertheless, for computer-assisted diagnostic systems, a human clinician (“man in the loop” for “Intelligence Amplification”) must be a necessary component. Moreover, the clinician must understand completely the strengths and limitations of them. Computerized diagnostics and clinical acumen are not mutually exclusive; rather they should reinforce each other for the alleviation of psychosomatic suffering of mankind.
For medical diagnosis, there are scopes for ambiguities in inputs, like, history (patient’s description of the diseased condition), physical examinations (especially in cases of uncooperative or less intelligent patients), laboratory tests (faulty methods or equipment). Moreover, for treatment, there are chances of adverse drug reactions and specific allergies, patients’ non-compliance of the therapy due to cost or time or adverse reactions. Because of advent of new modalities of treatment, almost daily, decision making towards a particular treatment regime to be adopted for each individual patient becomes a complex process. More often, a large amount of information has to be processed, much of which is quantifiable. Intuitive thought processes involve rapid unconscious data processing and combines available information by law of average and therefore, has a low intra- and inter-person consistency. So, the clinician of today should move towards analytic decision making, which albeit typically slow, is conscious, consistent and clearly spells out the basis of decision. For selecting the appropriate alternative regime for a particular patient, there is no definitive method. Data sheets on various medicines purveyed by the pharmaceutical manufacturers are not of much help since they focus on only one particular (generic or brand) drug, while doctors require comparative data on all available treatment modalities. To overcome this problem, EBM (Evidence Based Medicine) is gradually becoming popular for managing both common and uncommon medical problems. EBM compiles data based on systematic review of RCTs (randomized control trials), involving all available therapies.
Connectionist Expert Systems (CES) are ANN (artificial neural network) based ES where f the ANN generates inferencing rules e.g fuzzy-MLP where linguistic and natural form of inputs are used. Apart from that, rough set theory may be used for encoding knowledge in the weights better and also GAs (genetic algorithms) may be used to optimize the search solutions better. Some of the practical uses of medical informatics could be as follows. An inventory can be maintained, in the PC, where the combined side effects of multiple drug usage can be described. In an elderly patient, there may be simultaneously hypertension (high blood pressure), diabetes mellitus, cardiac insufficiency (heart ailments) and arthritic (joint) pain with inflammation. Drugs against all these, in a person with inefficient liver and kidney functions, can multiply the adverse reactions. There may be some history of previous drug reactions as well. More often than not, elderly people tend to buy OTC (over the counter) drugs for self-medication. Even something as seemingly harmless as multi-vitamin pills can give rise to many serious problems in various parts of the body. To make things worse, the nutritional status of aging people is rather low and this very fact can aggravate drug reactions. So, if a user-friendly inventory is supplied, where the person can check in all the possible drug reactions, and stop taking harmful drugs before consulting the physician, this may be life saving. For adjusting the drug doses in accordance with the condition of the individual’s body and mind, AI (Artificial Intelligence) programs may be built up to assist the consultant.
Health or Hospital information System (HIS) is an integrated system encompassing the departmental systems (like radiology, pathology and pharmacy), as well as the clinical systems (like Intensive Care Unit or ICU). However, a proper definition is yet to evolve. Computer based patient records (CBPR or CPR) involves digitizing all data related to a patient being treated in a hospital (along with modifications and updates) and storing in an easily retrievable or searchable form.
CDSS (Clinical or Diagnostic Decision Support Systems) are Interactive computer programs, which directly assist physicians and other health professionals with decision making tasks. I have the pleasure of developing some CDSS. Nevertheless, for computer-assisted diagnostic systems, a human clinician (“man in the loop”) must be a necessary component.
Computer aided or assisted instruction (CAI) is a tutorial method using a computer as a base for managing the student’s progress (at the desired pace and time). Computer aided or assisted learning (CAL) is a computer based tutorial method that uses the computer to pose questions, provide remedial information and chart a student through a course. Now the emphasis, especially in medical related fields, is on problem based learning (PBL) and there CAI could be of utmost help if used judiciously.
’Medical science is advancing very rapidly, especially with the unexpected progress of technology, both related and unrelated to the healthcare delivery field directly.
Not very long back (many of the senior Professors here will recall), Biochemistry was accepted as a part of Physiology. Now the MCI is including Biophysics within Physiology. May be within a few years, Biophysics as a separate subject, will have its own standing in the Medical curriculum. Similarly, you can see that abroad, a person may be Professor in Physiology and Biomedical Engineering; or Biomedical Engineering and Anesthesiology; or even Medicine, Pathology and Pharmacology together. These are the pioneers who have actually advanced our understanding (Arthur C Guyton and William F Ganong are two notable examples).
Why is multidisciplinary interaction at all necessary? Is it just a fancy or buzz word? Certainly not! If we take a look at a novel diagnostic technique (EGG or electrogastrography), the two leading groups (McCallum and Chen; Mintchev and Bowes), have as core faculty one (electrical) engineer (Chen and Mintchev) and either a physiologist (McCallum) or surgeon (Bowes). Definitely the need has now arisen for a formal training in Medical Informatics to grasp the essential concepts of basic medical sciences (and thereby learn the applied aspects also much faster) in the shortest possible time. While, because of the information explosion, medical knowledge base is expanding very quickly, the time allowed for learning the basic medical sciences is continuously being reduced. The Medical Council of India proposes to offer subjects like Informatics, Genomics, Ethical aspects of biomedical research as audit courses (rather than credit courses where students are given marks which adds to the total) in the beginning of the MBBS Course itself.
Multimedia interaction including Medical Simulation using Virtual Reality is now becoming a powerful tool for education related to medical science and technology.
Basic Medical Education and Research lays the foundation for advancing and applying proper healthcare delivery systems. There is no doubt that an in-depth knowledge of anatomy is mandatory for successful surgery. Also, an incomplete knowledge of physiology will not be conducive for grasping the principles of pathology and pharmacology adequately, leading to incorrect and inadequate practice of medicine. Similarly, medical informatics is not just a subject to be learnt and forgotten after the first professional MBBS examination. The final aim of every student should not only be to become a good user but also an expert for advancing medical knowledge base through medical informatics.
We cannot afford to bury our head in the sand and presume ourselves not to be seen by others. Unless the competent authorities attach due importance and immediately introduce medical informatics as an essential component of basic medical education, we would soon be becoming isolated (ostracized!) and looked down upon in this global village.
(This article is republished (with permission) from Sarbadhikari, S.N. (2004) Basic medical science education must include medical informatics. Indian Journal of Physiology and Pharmacology, 48 (4). pp. 395-408. and the official version is available at Official URL:
http://www.ijpp.com/vol48_4/basic_medical_395.pdf and also at http://openmed.nic.in/203/)
School of Medical Science and Technology,
Indian Institute of Technology,
Email: [email protected]