1. BMIandCSE-1 An Overview of Biomedical Informatics and Computing Prof. Steven A. Demurjian, Sr. Computer Science & Engineering Department The University of Connecticut 371 Fairfield Road, Box U-255 Storrs, CT 06269-2155 steve@engr.uconn.edu http://www.engr.uconn.edu/~steve (860) 486 - 4818

2. BMIandCSE-2 What is Informatics?  Informatics is:  Management and Processing of Data  From Multiple Sources/Contexts  Involves Classification (Ontologies), Collection, Storage, Analysis, Dissemination  Informatics is Multi-Disciplinary  Computing (Model, Store, Process Information)  Social Science (User Interactions, HCI)  Statistics (Analysis)  Informatics Can Apply to Multiple Domains:  Business, Biology, Fine Arts, Humanities  Pharmacology, Nursing, Medicine, etc.

3. BMIandCSE-3 What is Informatics?  Heterogeneous Field – Interaction between People, Information and Technology  Computer Science and Engineering  Social Science (Human Computer Interface)  Information Science (Data Storage, Retrieval and Mining) People Information Technology Informatics Adapted from Shortcliff textbook

4. BMIandCSE-4 What is Biomedical Informatics (BMI)?  BMI is Information and its Usage Associated with the Research and Practice of Medicine Including:  Clinical Informatics for Patient Care  Medical Record + Personal Health Record  Bioinformatics for Research/Biology to Bedside  From Genomics to Proteomics  Public Health Informatics (State and Federal)  Tracking Trends in Public Sector  Clinical Research Informatics  Deidentified Repositories and Databases  Facilitate Epidemiological Research and Ongong Clinical Studies (Drug Trails, Data Analysis, etc.)  Clinical Informatics, Pharmacy Informatics, Consumer Health Informatics, Nursing Informatics

5. BMIandCSE-5 What is Biomedical Informatics (BMI)?  A Exciting Emerging Discipline  Biomedical Informatics/Health Information Technology Rapidly Emerging Discipline  Cutting Edge, Incredible Career and Research Opportunities  Wide Range of Data  Clinical Data on Patients  Diagnostic Data (Scans, Labs, EKG, etc.)  Population Data (Public Health Surveillance)  Research on Genomic and Biological Data  Any Data Involved in  Care of Patients  Medical and Clinical Research

6. BMIandCSE-6 Why is BMI/Clinical Practice Important?  Tracking all Information for Patient and his/her Care  Medical Record, Medical Tests (Lab, Diagnostic, Scans, etc.), Prescriptions  Dealing with Patients – Direct Medical Care  Hospital or Clinic, Physician’s Office  Testing Facility, Insurance/Reimbursement  Bringing Together Information for Different Sources  Health Information Exchange  Gather Data from MD Offices, Clinics, Hospitals  Informatics Support via:  Personal Health Records  Electronic Medical Record  Linking/Accessing Data Repositories  Collaborative and Secure (HIPPA) Web Portals

7. BMIandCSE-7 © T. Shortliffe 2006 Columbia University

8. BMIandCSE-8 © T. Shortliffe 2006 Columbia University

9. BMIandCSE-9 © T. Shortliffe 2006 Columbia University

10. BMIandCSE-10 BMI and Computer Science & Engineering  Significant Impact Across CS&E Fields Including:  Security and Data Protection/Privacy  Sensor Networks to Monitor Elderly  Artificial Intelligence &Clinical Decision Support  Software Architectures for Integrating Health Information  Bioinformatics (BI) to Process Biological Data  Supercomputing for Genomic and Clinical Data Analysis  Visualization to Conceptualize BMI/BI Data  Algorithms for BMI/Clinical Data Analysis  Mobile Computing to Impact Patient Health and Data Availability  Etc…

11. BMIandCSE-11 What is BMI Used to Support? Clinical Practice  Dealing with Patients – Direct Medical Care  Hospital or Clinic  Physician’s Office  Testing Facility  Insurance/Reimbursement  Tracking All Data Associated with Patients  Medical Record  Medical Tests (Lab, Diagnostic, Scans, etc.)  Prescriptions  Stringent Data Protection (HIPAA)  Distributed Repositories, Inability to Access Data in Emergent Situations, Competition, etc.

12. BMIandCSE-12 What is Medical Informatics?  Clinical Informatics, Pharmacy Informatics  Public Health Informatics  Consumer Health Informatics  Nursing Informatics  Systems and People Issues  Intended to Improve Clinical outcomes, Satisfaction and Efficiency  Workflow Changes, Business Implications, Implementation, etc…  Patient Centered – Personal Health Record and Medical Home  Care Centered – Pay for Performance, Improving Treatment Compliance

13. BMIandCSE-13 What is Bionformatics?  Focused on Research :  Genomic and Proteomic Tools, Evaluation Methods, Computing And Database Needs  Information Retrieval and Manipulation of Large Distributed (caBIG) Data Sets (cabig.cancer.gov/index.asp)  Often Requires Grid Computing  Includes Cancer and Immunology Research  Increasing Need to Tie These Separate Types of Systems Together = Personalized Medicine  Biology and the Bedside (www.i2b2.org) www.i2b2.org  Significant Expertise in BI in CS&E, MCB, Statistics, and UCHC

14. BMIandCSE-14 Where is Data/How is it Used?  Medical and Administrative Data Found in Clinical Information Systems (CIS) Such As:  Personal Health Records - Microsoft Healthvault  Electronic Medical Records – OpenEMR  Patient Portals  E Prescribing (electronic Rx)  Hospital Info. Systems  Laboratory, Imaging and Other Systems  Pharmacy, Nursing, Picture Archiving Systems  Complex Data Storage and Retrieval – Many Different Systems  Research Increasingly Reliant on CIS  Jump to PDF Presentation with Screenshots

15. BMIandCSE-15 What are Major Informatics Challenges?  Shortage of Trained People Nationally  Slows adoption of Health Information Technology  Results in Poor Planning and Coordination, Duplication of Efforts and Incomplete Evaluation  What are Critical Needs?  CS/CSE/CompE with Health/Medical Domain Knowledge  Dually Trained Clinicians or Researchers in Leadership of some Initiatives  Connect all folks with Informatics Roles across Institutions to Improve Efficiency  Multi-Disciplinary: CSE, Statistics, Biology, Medicine, Nursing, Pharmacy, etc.  Emerging Standards for Information Modeling and Exchange (www.hl7.org) based on XML www.hl7.org

16. BMIandCSE-16 Summary of Web Sites of Note:  AMIA (www.amia.org)  IHE (http://www.ihe.net/)  Smartplatform (http://www.smartplatforms.org/)  Mysis MOSS (http://www.misys.com/OpenSource) http://www.misys.com/OpenSource  NSF Clinical and Translational Science Program  http://www.ctsaweb.org/ http://www.ctsaweb.org/  Emerging Patient Data Standard  http://www.hl7.org/  Informatics for Integrating Biology & the Bedside.  https://www.i2b2.org/  Cancer Biomedical Informatics Grid  http://cabig.cancer.gov/index.asp

17. BMIandCSE-17 BMI in Computing: Interoperability  Need to Integrate Across Health Care Enterprise  Practice management systems (PMS) for management of non-medical patient information  Electronic medical records (EMR)  Decision Support Systems (both within and external to EMRs)  Medical laboratory information systems (MLIS)  Personal health records (PHR)  Electronic Prescribing  Patient Portal (Tests, Appointments, Refills)  Billing Systems   Employ Computing w.r.t. Standards, Interoperability, Software Architectures, Security, Privacy, Decision Support, etc.

18. BMIandCSE-18 Stakeholders for HIE and Virtual Chart

19. BMIandCSE-19 Who are the Major Stakeholders?  Patients that require short-term treatments, long-term treatments, emergency help, inpatient care, ambulatory care, home care, etc.  Providers that administer care (MDs, medical specialists, ER MDs, nurses, hospitals, long term care facilities, home health care, nurse practitioners, etc.)  Public health organizations that monitor health trends and include disease control and prevention organizations, medical associations, etc.  Researchers that explore new health treatments, medications, and medical devices  Laboratories that conduct tests and include chemistry, microbiology, radiology, blood, genome, etc.  Payers that are responsible for cost management

20. BMIandCSE-20 What are Interoperability Issues?  In Computing: For heterogeneous software systems, interoperability means exchanging information efficiently and without any additional effort of the user  For Medical Software Systems:

21. BMIandCSE-21 Syntactic Interoperability  Defined as the Ability to read and Write the Same File Formats and Communicate over Same Protocols  Available Solutions Include:  Custom Adapter Interfaces  XML  Web Services  Cloud Computing  Standards and their Usage  CDA and HL7 (both in XML)  OpenEHR (http://www.open-emr.org/)http://www.open-emr.org/  Continuity of Care Record (CCR http://www.ccrstandard.com/)

22. BMIandCSE-22 Semantic Interoperability  Defined as  Defined as ability of systems to exchange data and interpret information while automatically allowing said information to be used across the systems without user intervention and without additional agreements between the communicating parties   Must Understand the Data to be Integrated  In a PHR – Patient may refer to “Stroke”  In an EMR – Provider may indicate “cerebrovascular incident”  These need to be Reconciled Semantically   Available Technologies Include:  SNOMED  LOINC  NDC

23. BMIandCSE-23 BMI in Computing: SW Architectures  Can we Leverage Software Architectural Alternatives from Computing:  Data Warehouse  Service-Oriented Architectures  Grid Computing  Cloud Computing  Publisher-Subscriber Paradigm  Web-Architectures and Services  Objectives:  Understand their Capabilities in Support of Health Information Exchange  A Solution may Require a Combination of Approaches

24. BMIandCSE-24 Hybrid Architecture: Applied to Real Setting

25. BMIandCSE-25 Hybrid Architecture: Applied to Real Setting

26. BMIandCSE-26 Hybrid Architecture: Applied to Real Setting

27. BMIandCSE-27 Hybrid Architecture: Applied to Real Setting

28. BMIandCSE-28 Hybrid Architecture: Applied to Real Setting

29. BMIandCSE-29 Patients Providers Clinical Researchers BMI in Computing: Security Web Server Appl Server DB Server Firewall https Encryption https Encryption Secure Communication XML html Web Content GUI Look and Feel Patient GUI for RN vs. MD Web - Control Services Appl. – Control Methods

30. BMIandCSE-30 Security Issues for Patients  HIPPA Overriding Concern  All Patient Interfaces Web-Based  Secure Communication  To/From Web Server (https)  Among Discussion Group Members Is this https or Peer-to-Peer?  Role-Based Access Control to Authorize  Providers to Interact  PHR Data to Individual Providers Patients Providers Clinical Researchers Web-Based Portal(XML + HL7) Open Source XML DB

31. BMIandCSE-31 Security Issues for Providers Patients Providers Clinical Researchers EMR  HIPPA Concerns for any EMR Data Transmitted into Portal  Need to Consider Delegation  Provider P Access to Portal for Patient X  Provider Q on Call  Can P Delegate his Permission to Access Portal to Q?  Will Q’s Role (e.g., EMT) Limit Access Even with Delegation? Web-Based Portal(XML + HL7) Open Source XML DB

32. BMIandCSE-32 Motivation: General Concepts  Authentication  Proving you are who you are  Signing a Message  Is Client who s/he Says they are?  Authorization  Granting/Denying Access  Revoking Access  Does Client have Permission to do what s/he Wants?  Encryption  Establishing Communications Such that No One but Receiver will Get the Content of the Message  Symmetric Encryption and Public Key Encryption

33. BMIandCSE-33 Motivation: Type of Security Issues  Legal and Ethical Issues  Information that Must be Protected  Information that Must be Accessible  HIPPA vs. Emergent Health Situations  Policy Issues  Who Can See What Information When?  Applications Limits w.r.t. Data vs. Users?  System Level Enforcement  What is Provided by the DBMS? Programming Language? OS? Application? Web Server? Client?  How Do All of the Pieces Interact?  Multiple Security Levels/Organizational Enforcement  Mapping Security to Organizational Hierarchy  Protecting Information in Organization

34. BMIandCSE-34 BMI: Security  Security is Multi-Step, Multi-Discipline Process  Definition of Security Requirements  Realization of Security at Web, Application, and Database Levels  Integration of Security from Client to Web to Application to DB  Rigorous Definition of Security Policy  Dynamic Nature of Security Privileges  Enforcement of Defined Privileges Across and within Multiple Tiers  Overall, Security in Today’s World Integral Part of Everyday Life - Some Key Concerns  Confidentiality of an Individuals Data – PHR/EMR  Identity Theft  Protecting National Infrastructure

35. BMIandCSE-35 BMI Cell Phone Applications  Observations of Daily Living and PHRs  Passive – Once Initiated, Collects Data  Accelerometer  Pedometer  Pill Bottle that Sends a Time Stamp Message (over Bluetooth?) to SmartPhone  Active – Patient Initiated  Providing Information via Smartphone on: –Diabetes (Glucose, Weight, Insulin) –Asthma (Peak Flow, use of Inhaler) –Heart Disease (Pulse, BP, Diet) –Pain, Functional status, Fatigue, etc.  Medication/OTC/Supplement Tracking  http://www.engr.uconn.edu/~steve/Cse4904/cse4904.html

36. BMIandCSE-36 History of Mobile Computing 2009

37. BMIandCSE-37 History of Mobile Computing – Aug 2013

38. BMIandCSE-38 History of Mobile Computing - Tablets

39. BMIandCSE-39 Semester Project in CSE2102 – Fall 2013  Personal Health Assistant (PHA)  Patient Version for Medication and Chronic Disease Management and Authorizing Providers  Identify Overmedication, adverse interactions, and adverse reactions  Provider Version for Viewing Patient Data that has been Authorized  Personal Health Record Microsoft HealthVault  A Person Can Track Medical Information  Used as Backend Repository to PHA  OpenEMR Standalone version for Providers  Seek to Integrate into PHA  Support Medication Reconciliation

40. BMIandCSE-40 Software Architecture Diagram

41. BMIandCSE-41 Architecture for CSE2102 in Fall 2013

42. BMIandCSE-42 Four Part Semester Project in CSE2102  Part 1: Installing Technologies  Android SDK, EclipseUML, openEMR  Part 2a: Design and Implementation of Class Library  Meds, ODLs, Diseases, Exercise, Nutrition  Part 2b: Expansion of PHA Android Source to  Chronic Diseases,  Exercise, Nutrition  Part 3: Integrating PHA with MS HealthVault  Use of REST API – Linkage to Common Server  Read/Store Data from HealthVault  Part 4: Extending PHA and Integrating with openEMR  Medication Interactions – Use RxNorm, RxTerms, NDF-RT and other Federal REST APIs  Pull Medications from openEMR

43. BMIandCSE-43 Android SDK

44. BMIandCSE-44 Android SDK Manager

45. BMIandCSE-45 Android Virtual Device Manager

46. BMIandCSE-46 Android Virtual Device Manager

47. BMIandCSE-47 PHA in Andriod Emulator

48. BMIandCSE-48openEMR

49. BMIandCSE-49 iOS PHA – Patient Version

50. BMIandCSE-50 iOS PHA – Patient Version

51. BMIandCSE-51 iOS PHA – Patient Version

52. BMIandCSE-52 iOS PHA – Provider Version

53. BMIandCSE-53 Android PHA Screenshots

54. BMIandCSE-54 Android PHA Screenshots

55. BMIandCSE-55 Android PHA Screenshots

56. BMIandCSE-56Conclusions  Please Contact me with Questions on these Topics  Look for CSE Offerings in Coming Years  Undergrad Bioinformatics Course  CSE3800 – Usually each Fall Semseter  Undergrad Introduction to Biomedical Informatics  In Spring – Cross Listed with CSE5810!  Lab Based Courses  Software and Hardware Foci  Industry Sponsored Student Projects  Undergraduate Info and Data Security Course

57. BMIandCSE-57 CSE4904 – Spring 2010  Smartphone Projects on ODLs and Other Medical Data Tracking and Alerts  Three Platforms:  Google’s Android (Java)  Blackberry (Java)  iPhone (Objective C)  Three Teams of Three Students Each  Work ongoing this Semester  Joint CSE (4 students) and PharmD (4 students)  CSE Fac (Demurjian) and PharmD Fac (Smith)  CSE4939W in Spring 2012  Industry Sponsored Projects  Cell/Mobile Platform Based

58. BMIandCSE-58 Blackberry Team  Ability to Track Information on ODLs and Prescriptions  Login Screen  Connection to Google Health  Health Screen to Track ODLs  Charting of ODLs over Time  Loading Scripts from Google Health  Prescription Alarms  Adam Siena, Kristopher Collins, William Fidrych

59. BMIandCSE-59 Screen Shots

60. BMIandCSE-60 Screen Shots

61. BMIandCSE-61 Screen Shots

62. BMIandCSE-62 Screen Shots

63. BMIandCSE-63 Screen Shots

64. BMIandCSE-64 Android Team  Similar Capabilities to Blackberry Project  Wellness Diary and Medication Alarm  Integration with Google Health  Much Improved ODL Screens  Male and Female Faces  Change “Face” Based on Value  Tracking Prescriptions and Alarms  Reports via. Google Charts  Ishmael Smyrnow, Kevin Morillo, James Redway

65. BMIandCSE-65 Screen Shots

66. BMIandCSE-66 Screen Shots

67. BMIandCSE-67 Screen Shots

68. BMIandCSE-68 Screen Shots

69. BMIandCSE-69 iPhone Team  Similar Capabilities to Blackberry Project  Tracking of Conditions, Medications, and Allergies  ODLs for:  Blood-Glucose, Peak-Flow, and Hypertension  Generation of Reports  Synchronization with Google Health  Brendan Heckman, Ryan McGivern, Matthew Fusaro

70. BMIandCSE-70 PHA iOS Application

71. BMIandCSE-71 Main Menu & Settings Menu

72. BMIandCSE-72Profile

73. BMIandCSE-73Medications

74. BMIandCSE-74 Wellness Diary

75. BMIandCSE-75 Observations of Daily Living

76. BMIandCSE-76

77. BMIandCSE-77 Dietary Management

78. BMIandCSE-78 Screen Shots

79. BMIandCSE-79 Screen Shots

80. BMIandCSE-80 Screen Shots

81. BMIandCSE-81 Screen Shots