Edward h shortliffe James. cimino editors Biomedica Informatics Computer Applications in Health care and biomedicine Fourth edition a springer
Biomedical Informatics Edward H. Shortli e James J. Cimino Editors Computer Applications in Health Care and Biomedicine Fourth Edition 123
Dedicated to homer r. warner. mD. phD. FACMI A Principal Founder of the Field of Biomedical Informatics 1922-2012 The Fourth Edition of Biomedical Informatics: Computer Applications in Health Care and Biomedicine is dedicated to the memory and professional contributions of Homer R. Warner. Homer was not only a pioneer in biomedi- cal informatics but a sustained contributor who is truly one of the founders of the field that mourned his loss in November of 2012. Homer's publications on the use of computers in health care span 50 years, from 1963 to 2012, but he can claim an additional decade of informatics research that predated digital computer use, including the use of analog computers and mathematical models anging from details of cardiac function all the way up to medical diagnosis He is best known for his development of the Health Evaluation throu Logical Processing(HELP)system, which was revolutionary in its own right as a hospital information system, but was truly visionary in its inclusion of the logical modules for generating alerts and reminders. The HELP system Warner, H.R., Toronto, A. F, Veasey, L. G,& Stephenson, R. 1961. A mathematical approach to medical diagnosis. Application to congenital heart disease. JAMA: The Journal
Dedicated to Homer R. Warner, MD, PhD, FACMI A Principal Founder of the Field of Biomedical Informatics 1922–2012 The Fourth Edition of Biomedical Informatics : Computer Applications in Health Care and Biomedicine is dedicated to the memory and professional contributions of Homer R. Warner. Homer was not only a pioneer in biomedical informatics but a sustained contributor who is truly one of the founders of the fi eld that mourned his loss in November of 2012. Homer’s publications on the use of computers in health care span 50 years, from 1963 to 2012, but he can claim an additional decade of informatics research that predated digital computer use, including the use of analog computers and mathematical models ranging from details of cardiac function all the way up to medical diagnosis. 1 He is best known for his development of the Health Evaluation through Logical Processing (HELP) system, which was revolutionary in its own right as a hospital information system, but was truly visionary in its inclusion of the logical modules for generating alerts and reminders. The HELP system, 1 Warner, H. R., Toronto, A. F., Veasey, L. G., & Stephenson, R. 1961. A mathematical approach to medical diagnosis. Application to congenital heart disease. JAMA: The Journal of the American Medical Association, 177 , 177–183
begun in 1968, is still running today at the LDs Hospital in Salt Lake City innovations are continually added while commercial systems struggle to rep- licate functions that HELP has had for almost half a century. Homers other contributions are far too numerous to recount here, but you will find them described in no less than six different chapters of this book. Homer's contributions go far beyond merely the scientific foundation of bi medical informatics. He also provided extensive leadership to define informatics as a separate academic field. He accomplished this in many settings: locally by founding the first degree-granting informatics department at the University of Utah, nationally as the President of the American College of Medical Informatics, nd internationally as the founding editor of the well-known and influential jour- nal Computers and Biomedical Research (now the Joumal of Biomedical Informatics). But perhaps his greatest impact is the generations of researchers and trainees that he personally inspired who have gone on to mentor additional researchers and trainees who together are the life blood of biomedical i ics. Homer's true influence on the field is therefore incalculable. just consider the hows his lineage of professional influence on 52 of us.K convenience sample of this book's 60 chapter co-authors: the following diagram Both of us were privileged to have many professional and personal inter actions with Homer and we were always struck by his enthusiasm, energy, humor, generosity, and integrity. In 1994, Homer received the American College of Medical Informatics'highest honor, the Morris F Collen Award of Excellence. We are proud to have this opportunity to add to the recognition of Homers life and career with this dedication James j. cimino Edward h. shortliffe Puter Salvin Hadad Owe Jams Briey Douglas K On Paras Dev Pnip Payne Michad Chane 2 Paul Clayton and Peter Szolovits provide important connections between Homer Warmer and ten coauthors but, while they are informatics leaders in their own right, they are not contributors to this edition of this book
begun in 1968, is still running today at the LDS Hospital in Salt Lake City; innovations are continually added while commercial systems struggle to replicate functions that HELP has had for almost half a century. Homer’s other contributions are far too numerous to recount here, but you will fi nd them described in no less than six different chapters of this book. Homer’s contributions go far beyond merely the scientifi c foundation of biomedical informatics. He also provided extensive leadership to defi ne informatics as a separate academic fi eld. He accomplished this in many settings; locally by founding the fi rst degree-granting informatics department at the University of Utah, nationally as the President of the American College of Medical Informatics, and internationally as the founding editor of the well-known and infl uential journal Computers and Biomedical Research (now the Journal of Biomedical Informatics ). But perhaps his greatest impact is the generations of researchers and trainees that he personally inspired who have gone on to mentor additional researchers and trainees who together are the life blood of biomedical informatics. Homer’s true infl uence on the fi eld is therefore incalculable. Just consider the convenience sample of this book’s 60 chapter co-authors: the following diagram shows his lineage of professional infl uence on 52 of us. 2 Both of us were privileged to have many professional and personal interactions with Homer and we were always struck by his enthusiasm, energy, humor, generosity, and integrity. In 1994, Homer received the American College of Medical Informatics’ highest honor, the Morris F Collen Award of Excellence. We are proud to have this opportunity to add to the recognition of Homer’s life and career with this dedication. James J. Cimino Edward H. Shortliffe 2 Paul Clayton and Peter Szolovits provide important connections between Homer Warner and ten coauthors but, while they are informatics leaders in their own right, they are not contributors to this edition of this book. Homer R. Warner G. Octo Barnett Edward H. Shortliffe Paul C. Tang Blackford Middleton Mark A. Musen Daniel L. Rubin Nigam Shah Holly Jimison Robert A. Greenes Suzanne Bakken Patricia Dykes Kevin B. Johnson Russ B. Altman Jessica Tenenbaum Sean D. Mooney Parvati Dev Mark E. Frisse David W. Bates Robert Rudin Jonathan Silverstein William Hersh Peter Embi William A. Yasnoff James J. Cimino Vimla L. Patel David R. Kaufman Clement J. McDonald Paul D. Clayton Carol Friedman George Hripcsak Adam Wilcox Noémie Elhadad Justin B. Starren Philip Payne Michael Chiang Lynn Vogel Scott Narus Stanley M. Huff Reed M. Gardner Scott Evans David Vawdrey W. Edward Hammond Ian Foster Terry Clemmer Roger B. Mark Randolph A. Miller Judy G. Ozbolt Valerie Florance Charles P. Friedman Douglas K. Owens James Brinkley Peter Szolovits Issac Kohane Kenneth Mandl Kenneth W. Goodman
Preface to the fourth edition The world of biomedical research and health care has changed remarkably in the 25 years since the first edition of this book was undertaken. So too has the world of computing and communications and thus the underlying scientific issues that sit at the intersections among biomedical science, patient care, pub- lic health, and information technology. It is no longer necessary to argue that it has become impossible to practice modern medicine, or to conduct modern biological research, without information technologies. Since the initiation of the human genome project two decades ago, life scientists have been generat data at a rate that defies traditional methods for information management and data analysis. Health professionals also are constantly reminded that a large percentage of their activities relates to information management-for example, obtaining and recording information about patients, consulting col leagues, reading and assessing the scientific literature, planning diagnostic procedures, devising strategies for patient care, interpreting results of labora tory and radiologic studies, or conducting case-based and population-based research. It is complexity and uncertainty, plus societys overriding concern for patient well-being, and the resulting need for optimal decision making, that set medicine and health apart from many other information-intensive fields Our desire to provide the best possible health and health care for our society gives a special significance to the effective organization and management of the huge bodies of data with which health professionals and biomedical researchers must deal. It also suggests the need for specialized approaches and for skilled scientists who are knowledgeable about human biology, clinical care, information technologies, and the scientific issues that drive the eff ective Ise of such technologies in the biomedical context. Information Management in Biomedicine The clinical and research influence of biomedical-computing systems is remarkably broad Clinical information systems, which provide communica- tion and information-management functions, are now installed in essentiall all healthcare institutions. Physicians can search entire drug indexes in a few seconds, using the information provided by a computer program to anticipate harmful side effects or drug interactions. Electrocardiograms(ECGs)ar typically analyzed initially by computer programs, and similar techniques are being applied for interpretation of pulmonary-function tests and a variety of
vii The world of biomedical research and health care has changed remarkably in the 25 years since the fi rst edition of this book was undertaken. So too has the world of computing and communications and thus the underlying scientifi c issues that sit at the intersections among biomedical science, patient care, public health, and information technology. It is no longer necessary to argue that it has become impossible to practice modern medicine, or to conduct modern biological research, without information technologies. Since the initiation of the human genome project two decades ago, life scientists have been generating data at a rate that defi es traditional methods for information management and data analysis. Health professionals also are constantly reminded that a large percentage of their activities relates to information management—for example, obtaining and recording information about patients, consulting colleagues, reading and assessing the scientifi c literature, planning diagnostic procedures, devising strategies for patient care, interpreting results of laboratory and radiologic studies, or conducting case-based and population-based research. It is complexity and uncertainty, plus society’s overriding concern for patient well-being, and the resulting need for optimal decision making, that set medicine and health apart from many other information- intensive fi elds. Our desire to provide the best possible health and health care for our society gives a special signifi cance to the effective organization and management of the huge bodies of data with which health professionals and biomedical researchers must deal. It also suggests the need for specialized approaches and for skilled scientists who are knowledgeable about human biology, clinical care, information technologies, and the scientifi c issues that drive the effective use of such technologies in the biomedical context. Information Management in Biomedicine The clinical and research infl uence of biomedical-computing systems is remarkably broad. Clinical information systems, which provide communication and information-management functions, are now installed in essentially all healthcare institutions. Physicians can search entire drug indexes in a few seconds, using the information provided by a computer program to anticipate harmful side effects or drug interactions. Electrocardiograms (ECGs) are typically analyzed initially by computer programs, and similar techniques are being applied for interpretation of pulmonary-function tests and a variety of Preface to the Fourth Edition
v Preface to the Fourth Edition laboratory and radiologic abnormalities. Devices with embedded processors routinely monitor patients and provide warnings in critical-care settings, such as the intensive-care unit (ICU) or the operating room. Both biomedical researchers and clinicians regularly use computer programs to search the medical literature, and modern clinical research would be severely hampered without computer-based data-storage techniques and statistical analysis sys tems. Advanced decision-support tools also are emerging from research labo- ratories, are being integrated with patient-care systems, and are beginning to have a profound effect on the way medicine is practiced. Despite this extensive use of computers in healthcare settings and bio- medical research, and a resulting expansion of interest in learning more about biomedical computing, many life scientists, health-science students, and pro- fessionals have found it difficult to obtain a comprehensive and rigorous, but nontechnical, overview of the field. Both practitioners and basic scientists are recognizing that thorough preparation for their professional futures requires that they gain an understanding of the state of the art in biomedical comput- ing, of the current and future capabilities and limitations of the technology, and of the way in which such developments fit within the scientific, social, and financial context of biomedicine and our healthcare system. In turn, the future of the biomedical computing field will be largely determined by how well health professionals and biomedical scientists are prepared to guide and to capitalize upon the disciplines development. This book is intended to meet nis growing need for such well-equipped professionals. The first edition appeared in 1990(published by Addison-Wesley) and was used extensively in courses on medical informatics throughout the world. It was updated with a second edition(published by Springer) in 2000, responding to the remark able changes that occurred during the 1990s, most notably the introduction of the World Wide Web and its impact on adoption and acceptance of the Internet. The third edition(again published by Springer) appeared in 2006, reflecting rapid evolution of both technology and health-and biomedically-related applications, plus the emerging government recognition of the key role that health information technology would need to play in pro- moting quality, safety, and efficiency in patient care. With that edition the title of the book was changed from Medical Informatics to Biomedical Informatics reflecting(as is discussed in Chap. 1) both the increasing breadth of the basic discipline and the evolving new name for academic units, societies, research programs, and publications in the field. Like the first three editions, this new version provides a conceptual framework for learning about the science that underlies applications of computing and communications technology in bio- medicine and health care, for understanding the state of the art in computer pplications in clinical care and biology, for critiquing existing systems, and for anticipating future directions that the field may take In many respects, this new edition is very different from its predecessors, however. Most importantly, it reflects the remarkable changes in computing and communications that continue to occur, most notably in communications, networking, and health information technology policy, and the exploding interest in the role that information technology must play in systems integra tion and the melding of genomics with innovations in clinical practice and
viii laboratory and radiologic abnormalities. Devices with embedded processors routinely monitor patients and provide warnings in critical-care settings, such as the intensive-care unit (ICU) or the operating room. Both biomedical researchers and clinicians regularly use computer programs to search the medical literature, and modern clinical research would be severely hampered without computer-based data-storage techniques and statistical analysis systems. Advanced decision-support tools also are emerging from research laboratories, are being integrated with patient-care systems, and are beginning to have a profound effect on the way medicine is practiced. Despite this extensive use of computers in healthcare settings and biomedical research, and a resulting expansion of interest in learning more about biomedical computing, many life scientists, health-science students, and professionals have found it diffi cult to obtain a comprehensive and rigorous, but nontechnical, overview of the fi eld. Both practitioners and basic scientists are recognizing that thorough preparation for their professional futures requires that they gain an understanding of the state of the art in biomedical computing, of the current and future capabilities and limitations of the technology, and of the way in which such developments fi t within the scientifi c, social, and fi nancial context of biomedicine and our healthcare system. In turn, the future of the biomedical computing fi eld will be largely determined by how well health professionals and biomedical scientists are prepared to guide and to capitalize upon the discipline’s development. This book is intended to meet this growing need for such well-equipped professionals. The fi rst edition appeared in 1990 (published by Addison-Wesley) and was used extensively in courses on medical informatics throughout the world. It was updated with a second edition (published by Springer) in 2000, responding to the remarkable changes that occurred during the 1990s, most notably the introduction of the World Wide Web and its impact on adoption and acceptance of the Internet. The third edition (again published by Springer) appeared in 2006, refl ecting the ongoing rapid evolution of both technology and health- and biomedically-related applications, plus the emerging government recognition of the key role that health information technology would need to play in promoting quality, safety, and effi ciency in patient care. With that edition the title of the book was changed from Medical Informatics to Biomedical Informatics , refl ecting (as is discussed in Chap. 1) both the increasing breadth of the basic discipline and the evolving new name for academic units, societies, research programs, and publications in the fi eld. Like the fi rst three editions, this new version provides a conceptual framework for learning about the science that underlies applications of computing and communications technology in biomedicine and health care, for understanding the state of the art in computer applications in clinical care and biology, for critiquing existing systems, and for anticipating future directions that the fi eld may take. In many respects, this new edition is very different from its predecessors, however. Most importantly, it refl ects the remarkable changes in computing and communications that continue to occur, most notably in communications, networking, and health information technology policy, and the exploding interest in the role that information technology must play in systems integration and the melding of genomics with innovations in clinical practice and Preface to the Fourth Edition