Biomedical Informatics

Biomedical Informatics is a field involved in use of computers in collection and statistical analysis of information regarding patients suffering from various disorders, their treatments and preventive measures.

During epidemics of infectious diseases several children get fever. Initially most of us give them some medicine at home. Children abstain from schools. Some people buy "flu" medicine from medical store. If that does not work, help of family doctor is sought. If the illness continues, blood test or x ray examination is done. A paediatrician is consulted. By the time pneumonia is diagnosed the condition of the child may have become serious. Sometimes inspite of admission to intensive care unit, the child dies. When 5 or 6 patients succumb to death in an hospital, we realize that there is epidemic of pneumonia and preventive measures are activated. However, by that time many other people have already contracted the illness, hence it becomes difficult to control progress of epidemic.

Now let us see how we may be able to get information regarding epidemics of gastroenteritis, maleria, dengue etc. before they become serious threats to public life. Let us imagine that all homes, schools, medical stores, clinics, laboratories, xray clinics, consultants, hospitals, ICUs are connected to Internet. (Web : the network of computers). Names and addresses of all children are on a website. If parents record that their child has loose motions, cough, fever etc, the health department will come to know number of children suffering from various disorders on daily basis. The area in which more than usual number of children are suffering could be identified for preventive actions. Schools will mark absentism, and if there is no festival for cricket match, most probably the child will be ill. Medical stores will record medicines sold from their shops and we could observe increase in sales of different types of medicines. Family doctors will record diagnoses of various patients coming to them and consultants will give information regarding those visiting them. Laboratories and Radiologists will record their findings. Hospitals and intensive care units will report cases coming to them on day to day basis. Final diagnosis of patients discharged from hospitals will also be recorded. If the data so generated is analyzed on on-going basis, we will be able to control the epidemics before they take toll of lives. Maps generated from such information can be used to understand spread of diseases.

Now a days, students are using internet to play games, most of the schools are giving training on use of computers and they have to record absentism, medical stores are printing bills on computers, family doctors have to write OPD registers, hospitals have to maintain indoor registers, death certificates contain final diagnosis and most of the employers have to maintain health information of their employees. It is extremely easy for computer engineers to design database for all such information. If we can use networks of computers in our city, district and state; it will help to improve health of the nation! This is very big dream and developed countries have reached near its fulfilment. Now they are in the process of establishing networks to prevent epidemics coming from other countries.

Medical professionals have certain issues in gathering information in this manner. Most importance is secracy of medical information. However software systems can handle it using encryption. Next issue is medical terminology. Doctors will have to use standard terminology while storing the information in computers. I will give two examples for understanding of common man. Instead of writing 41 years old lady, 20 years old female or 12 year old girl, they will have to write Sex : F, age : ... (because computer does not understand that all these terms mean the same). Similarly DM, MODY, Type1, Type2 etc is used interchangeably for DIABETES MELLITUS leading to lot of confusion for the computer program. For this purpose, many organizations prepared standard terminologies. The confusion further increased because of more than 200 terminology lists started competing with each others. National Library of Medicine has developed a Metathesaurous by bringing together most commonly used terminology systems. They are encouraging all to use this Unified Medical Language System, but there are many difficulties in its use. Since UMLS comprises of many sets, some terms come repeatedly. It becomes difficult for the programs to find what you need from thousands of concepts and lacks of strings. If one has to add a new terminology to this thesaurous, it is a job by itself. So people prefer not to use terminology databases.

I have been developing software for storing medical information from 1997. I wanted to take formal training in this subject, but could not find any institute in India offering a course. In the meanwhile since I had done some work on terminology database, I applied to National Library of Medicine in 2004, 2006 and 2008. In 2004 my application was rejected. In next two years I had developed software for National Institute of Virology in Pune, and in 2006 I got place in waiting list of NLM. In 2007 I demonstrated use of web based software to connect a municiple hospital and its 10 subcenters, but unfortunately the proposal did not progress further. Information regarding this project was significant in my selection for Fellowship in 2008.
One patient suffers from many disorders in his lifetime and he visits many consultants and laboratories. If we can analyze information from many illnesses of many people collected by many consultants, it will be useful for medical research. With this view in mind I have developed a Single Software for all medical Specialties and Superspecialties. Professors working for 30-40 years in this field in the United States appreciated my work, helping me to gain confidence.
Development of software does not gurarntee achievement of the desired results. One needs to train medical students and consultants to record information in computer and how to use it for analysis. Their lack of interest and apprehensions have to be replaced by knowledge and interest in the field of biomedical informatics. Research society of B J Medical College, Pune had organized a workshop for introducing this interdisciplinary field to medical students, residents and faculty members which was attended by 80 participants. During the period from 24th August to 29th August, I gave lectures on controlled terminologies, database management, statistical analysis, internet, telemedicine, decision support. I also demonstrated various softwares and conducted practicals for better understanding of the field. Similar workshop was conducted for software engineers working in life sciences division of Persistend Systems on 16th and 17th of October. I feel that students of information technology, staff of institutional hospitals, volunteers working in NGO's in healthcare sector, and doctors and paramedical staff working 24x7 for treatment of patients should attend such training programs.

While giving certificates after the workshop to students and residents of medical college, I can feel the gush of young blood entering in this field. If senior medical professionals support the young talent, if consultants from various disciplines show willingness to share information, if hospitals agree to contribute to database and if political leaders take leadership in information technology, we will be able to do constructive work for society.
Professors in United States asked me why, India which has 16% of world population, is lacking behind in medical research. Medical professionals treating medical tourists from all over the world and software engineers working for international organizations need to come together to find out answers for this question. I am trying to rope in students from information technology to work on requirements of doctors working in government hospitals for their academic projects. I have also requested Director of Medical Education and Research to organize workshops in all medical colleges in Maharashtra State.

If one considers number of patients and available facilities, around 20% patients are treated in government clinics and hospitals while 80% patients are treated in private hospitals. So doctors working in private hospitals should discuss difficulties they may encounter in projects involving collection of medical information, and what could the benefits be if these difficulties are handled properly. NGO's working in the healthcare sector could inform what difficulties they get in getting required medical information and how they overcome them. Infotech experts working in the field of medical software can share their thought on issues involved in such database collection projects. Responses from staff in municiple clinics, hospitals, primary health centers and government hospitals can all be considered together to decide strategies for further course of action. Please communicating your response or write to rajeevdjoshi@gmail.com.