Health Management and Informatics

Health Management and Informatics

Health informatics (also called Health Information Systems,health care informatics, healthcare informatics, medical informatics, nursing informatics, clinical informatics, or biomedical informatics) is a discipline at the intersection of information science, computer science, and health care. It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health, occupational therapy, and (bio)medical research.

  • The international standards on the subject are covered by ICS 35.240.80 in which ISO 27799:2008 is one of the core components.
  • Molecular bioinformatics and clinical informatics have converged into the field of translational bioinformatics.

History

World wide use of computer technology in medicine began in the early 1950s with the rise of the computers. In 1949, Gustav Wager established the first professional organization for informatics in Germany. The prehistory, history, and future of medical information and health information technology are discussed in reference. Specialized university departments and Informatics training programs began during the 1960s in France, Germany, Belgium and The Netherlands. Medical informatics research units began to appear during the 1970s in Poland and in the U.S. Since then the development of high-quality health informatics research, education and infrastructure has been the goal of the U.S. and the European Union.

Early names for health informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering, and medical computer technology.

The health informatics community is still growing, it is by no means a mature profession, but work in the UK by the voluntary registration body, the UK Council of Health Informatics Professions has suggested eight key constituencies within the domain - information management, knowledge management, portfolio/programme/project management, ICT, education and research, clinical informatics, health records(service and business-related), health informatics service management. These constituencies accommodate professionals in and for the NHS, in academia and commercial service and solution providers.

Since the 1970s the most prominent international coordinating body has been the International Medical Informatics Association (IMIA).

Medical informatics in the United States

Even though the idea of using computers in medicine sprouted as technology advanced in the early twentieth century, it was not until the 1950s that informatics made a realistic impact in the United States.

The earliest use of computation for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.

The next step in the mid 1950s were the development of expert systems such as MYCIN and Internist-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. At this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science at Massachusetts General Hospital in Boston. In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. As of 2004, a descendent of this system is being used in the United States Veterans Affairs hospital system. The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 health care facilities.

In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exist, only a small number of health practitioners use fully featured electronic health care records systems.

Homer R. Warner, one of the fathers of medical informatics, founded the Department of Medical Informatics at the University of Utah in 1968. The American Medical Informatics Association (AMIA) has an award named after him on application of informatics to medicine.

Medical informatics in the UK

The broad history of health informatics has been captured in the book UK Health Computing : Recollections and reflections, Hayes G, Barnett D (Eds.), BCS (May 2008) by those active in the field, predominantly members of BCS Health and its constituent groups. The book describes the path taken as ‘early development of health informatics was unorganized and idiosyncratic’. In the early -1950s it was prompted by those involved in NHS finance and only in the early 1960s did solutions including those in pathology (1960), radiotherapy (1962), immunization (1963), and primary care (1968) emerge. Many of these solutions, even in the early 1970s were developed in-house by pioneers in the field to meet their own requirements. In part this was due to some areas of health services (for example the immunization and vaccination of children) still being provided by Local Authorities. Interesting, this is a situation which the coalition government propose broadly to return to in the 2010 strategy Equity and Excellence: Liberating the NHS (July 2010); stating:

"We will put patients at the heart of the NHS, through an information revolution and greater choice and control’ with shared decision-making becoming the norm: ‘no decision about me without me’ and patients having access to the information they want, to make choices about their care. They will have increased control over their own care records."

These types of statements present a significant opportunity for health informaticians to come out of the back-office and take up a front-line role supporting clinical practice, and the business of care delivery. The UK health informatics community has long played a key role in international activity, joining TC4 of the International Federation of Information Processing (1969) which became IMIA (1979). Under the aegis of BCS Health, Cambridge was the host for the first EFMI Medical Informatics Europe (1974) conference and London was the location for IMIA’s tenth global congress (MEDINFO2001).

Current state of health informatics and policy initiatives

Americas

Argentina

Since 1997, the Buenos Aires Biomedical Informatics Group, a nonprofit group, represents the interests of a broad range of clinical and non-clinical professionals working within the Health Informatics sphere. Its purposes are:

  • Promote the implementation of the computer tool in the healthcare activity, scientific research, health administration and in all areas related to health sciences and biomedical research.
  • Support, promote and disseminate content related activities with the management of health information and tools they used to do under the name of Biomedical informatics.
  • Promote cooperation and exchange of actions generated in the field of biomedical informatics, both in the public and private, national and international level.
  • Interact with all scientists, recognized academic stimulating the creation of new instances that have the same goal and be inspired by the same purpose.
  • To promote, organize, sponsor and participate in events and activities for training in computer and information and disseminating developments in this area that might be useful for team members and health related activities.

The Argentinian health system is very heterogeneous, because of that the informatics developments show a heterogeneous stage. Lots of private Health Care center have developed systems, such as the German Hospital of Buenos Aires, which was one of the first in developing an electronic health records system.

Brazil

The first applications of computers to medicine and healthcare in Brazil started around 1968, with the installation of the first mainframes in public university hospitals, and the use of programmable calculators in scientific research applications. Minicomputers, such as the IBM 1130 were installed in several universities, and the first applications were developed for them, such as the hospital census in the School of Medicine of Ribeirão Preto and patient master files, in the Hospital das Clínicas da Universidade de São Paulo, respectively at the cities of Ribeirão Preto and São Paulo campi of the University of São Paulo. In the 1970s, several Digital Corporation and Hewlett Packard minicomputers were acquired for public and Armed Forces hospitals, and more intensively used for intensive-care unit, cardiology diagnostics, patient monitoring and other applications. In the early 1980s, with the arrival of cheaper microcomputers, a great upsurge of computer applications in health ensued, and in 1986 the Brazilian Society of Health Informatics was founded, the first Brazilian Congress of Health Informatics was held, and the first Brazilian Journal of Health Informatics was published. In Brazil, two universities are pioneers in teaching and research in Medical Informatics, both the University of Sao Paulo and the Federal University of Sao Paulo offer undergraduate programs highly qualified in the area as well as extensive graduate programs (MSc and PhD)

Canada

Health Informatics projects in Canada are implemented provincially, with different provinces creating different systems. A national, federally-funded, not-for-profit organization called Canada Health Infoway was created in 2001 to foster the development and adoption of electronic health records across Canada. As of December 31, 2008 there were 276 EHR projects under way in Canadian hospitals, other health-care facilities, pharmacies and laboratories, with an investment value of $1.5-billion from Canada Health Infoway.

Provincial and territorial programmes include the following:

  • eHealth Ontario was created as an Ontario provincial government agency in September 2008. It has been plagued by delays and its CEO was fired over a multimillion-dollar contracts scandal in 2009.
  • Alberta Netcare was created in 2003 by the Government of Alberta. Today the netCARE portal is used daily by thousands of clinicians. It provides access to demographic data, prescribed/dispensed drugs, known allergies/intolerances, immunizations, laboratory test results, diagnostic imaging reports, the diabetes registry and other medical reports. netCARE interface capabilities are being included in electronic medical record products which are being funded by the provincial government.

United States

In 2004 the U.S. Department of Health and Human Services (HHS) formed the Office of the National Coordinator for Health Information Technology (ONCHIT). The mission of this office is widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. See quality improvement organizations for more information on federal initiatives in this area.

The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards for electronic health records (EHR) and supporting networks, and certify vendors who meet them. In July, 2006 CCHIT released its first list of 22 certified ambulatory EHR products, in two different announcements.

Europe

The European Union's Member States are committed to sharing their best practices and experiences to create a European eHealth Area, thereby improving access to and quality health care at the same time as stimulating growth in a promising new industrial sector. The European eHealth Action Plan plays a fundamental role in the European Union's strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services. The European Institute for Health Records is involved in the promotion of high quality electronic health record systems in the European Union.

UK

There are different models of health informatics delivery in each of the home countries (England, Scotland, Northern Ireland and Wales) but some bodies like UKCHIP (see below ) operate for those 'in and for' all the home countries and beyond.

England

The NHS in England has contracted out to several vendors for a national health informatics system 'NPFIT' that originally divided the country into five regions and is to be united by a central electronic medical record system nicknamed "the spine". The project, in 2010, is seriously behind schedule and its scope and design are being revised in real time. In 2010 a wide consultation was launched as part of a wider ‘Liberating the NHS’ plan. Many organisations and bodies (look on their own websites, as most have made their responses public in detail for information) responded to the consultation and a new strategy is expected in the second quarter of 2011. The degree of computerisation in NHS secondary care was quite high before NPfIT and that programme has had the unfortunate effect of largely stalling further development of the installed base. Almost all general practices in England and Wales are computerised and patients have relatively extensive computerised primary care clinical records. Computerisation is the responsibility of individual practices and there is no single, standardised GP system. Interoperation between primary and secondary care systems is rather primitive. A focus on interworking (for interfacing and integration) standards is hoped will stimulate synergy between primary and secondary care in sharing necessary information to support the care of individuals. Scotland has an approach to central connection under way which is more advanced than the English one in some ways. Scotland has the GPASS system whose source code is owned by the State, and controlled and developed by NHS Scotland. GPASS was accepted in 1984. It has been provided free to all GPs in Scotland but has developed poorly. Discussion of open sourcing it as a remedy is occurring.

Emerging Direction (European R&D)

The European Commission's preference, as exemplified in the 5th Framework as well as currently pursued pilot projects, is for Free/Libre and Open Source Software (FLOSS) for healthcare.

Asia and Oceania

In Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI) was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.

Australia

The Australasian College of Health Informatics (ACHI) is the professional association for health informatics in the Asia-Pacific region. It represents the interests of a broad range of clinical and non-clinical professionals working within the health informatics sphere through a commitment to quality, standards and ethical practice. Founded in 2002, ACHI is increasingly valued for its thought leadership, its trusted advisors and national and international experts in Health Informatics. ACHI is an academic institutional member of the International Medical Informatics Association (IMIA) and a full member of the Australian Council of Professions. ACHI is a sponsor of the "e-Journal for Health Informatics", an indexed and peer-reviewed professional journal. ACHI has also supported the "Australian Health Informatics Education Council" (AHIEC) since its founding in 2009.

Although there are a number of health informatics organisations in Australia, the Health Informatics Society of Australia (HISA) is regarded as the major umbrella group and is a member of the International Medical Informatics Association (IMIA). Nursing informaticians were the driving force behind the formation of HISA, which is now a company limited by guarantee of the members. The membership comes from across the informatics spectrum that is from students to corporate affiliates. HISA has a number of branches (Queensland, New South Wales, Victoria and Western Australia) as well as special interest groups such as nursing (NIA), pathology, aged and community care, industry and medical imaging (Conrick, 2006).

China

Hong Kong

In Hong Kong a computerized patient record system called the Clinical Management System (CMS) has been developed by the Hospital Authority since 1994. This system has been deployed at all the sites of the Authority (40 hospitals and 120 clinics), and is used by all 30,000 clinical staff on a daily basis, with a daily transaction of up to 2 millions. The comprehensive records of 7 million patients are available on-line in the Electronic Patient Record (ePR), with data integrated from all sites. Since 2004 radiology image viewing has been added to the ePR, with radiography images from any HA site being available as part of the ePR.

The Hong Kong Hospital Authority placed particular attention to the governance of clinical systems development, with input from hundreds of clinicians being incorporated through a structured process. The Health Informatics Section in Hong Kong Hospital Authority has close relationship with Information Technology Department and clinicians to develop healthcare systems for the organization to support the service to all public hospitals and clinics in the region.

The Hong Kong Society of Medical Informatics (HKSMI) was established in 1987 to promote the use of information technology in healthcare. The eHealth Consortium has been formed to bring together clinicians from both the private and public sectors, medical informatics professionals and the IT industry to further promote IT in healthcare in Hong Kong.

India

Apart from IAMI, India also has an country affiliate of HL7.

New Zealand

Health Informatics is taught at five New Zealand universities. The most mature and established is the Otago programme which has been offered for over a decade. Health Informatics New Zealand (HINZ), is the national organisation that advocates for Health Informatics.

Saudi Arabia

The Saudi Association for Health Information (SAHI) was established in 2006 to work under direct supervision of King Saud Bin Abdulaziz University for Health Sciences to practice public activities, develop theoretical and applicable knowledge, and provide scientific and applicable studies.

Health Informatics Law

Health informatics law deals with evolving and sometimes complex legal principles as they apply to information technology in health-related fields. It addresses the privacy, ethical and operational issues that invariably arise when electronic tools, information and media are used in health care delivery. Health Informatics Law also applies to all matters that involve information technology, health care and the interaction of information. It deals with the circumstances under which data and records are shared with other fields or areas that support and enhance patient care.

Clinical Informatics

Clinical Informatics is concerned with the use of information in health care by clinicians.

Clinical informaticians transform health care by analyzing, designing, implementing, and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship. Clinical informaticians use their knowledge of patient care combined with their understanding of informatics concepts, methods, and health informatics tools to:

  • assess information and knowledge needs of health care professionals and patients,
  • characterize, evaluate, and refine clinical processes,
  • develop, implement, and refine clinical decision support systems, and
  • lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems.

Clinicians collaborate with other health care and information technology professionals to develop health informatics tools which promote patient care that is safe, efficient, effective, timely, patient-centered, and equitable.

Translational bioinformatics

With the completion of the human genome and the recent advent of high throughput sequencing and genome-wise association studies of single nucleotide polymorphisms, the fields of molecular bioinformatics, biostatistiques, statistical genetics and clinical informatics are converging into the emerging field of translational bioinformatics.

Computational Health Informatics

Computational health informatics is a branch of Computer Science that deals specifically with computational techniques that are relevant in healthcare. Computational health informatics is also a branch of Health Informatics, but is orthogonal to much of the work going on in health informatics because computer scientist's interest is mainly in understanding fundamental properties of computation. Health informatics, on the other hand, is primarily concerned with understanding fundamental properties of medicine that allow for the intervention of computers. The health domain provides an extremely wide variety of problems that can be tackled using computational techniques, and computer scientists are attempting to make a difference in medicine by studying the underlying principles of computer science that will allow for meaningful (to medicine) algorithms and systems to be developed. Thus, computer scientists working in computational health informatics and health scientists working in medical health informatics combine to develop the next generation of healthcare technologies.

Examples of projects in computational health informatics include the COACH project.

Leading health informatics and medical informatics journals

Health Informatics\Information Systems Education\Research

Bangladesh

In Bangladesh, University of Dhaka has approved a Masters' program in Health Informatics (MHI) at Bangladesh Institute of Health Sciences with support from the Rockefeller Foundation.

Canada

Canada has a strong developing program of education in health informatics, with some of the key institutions and programs being:

  • University of Waterloo has a program in computational health informatics in the David R. Cheriton School of Computer Science. See also HI at UW.
  • Ryerson University Health Informatics
  • Dalhousie University Health Informatics in the Faculty of Computer Science
  • University of Victoria School of Health Information Science
  • University of Toronto Masters of Health Informatics

Also see the list at COACH.

Brazil

  • Federal University of São Paulo Technology in Health Informatics - São Paulo School of Medicine
  • University of São Paulo Health Informatic - College of Medical Sciences of Ribeirão Preto

Sweden

In Sweden there is a master education in Health Informatics.

India

In India some courses are offered on medical or health informatics.

Ireland

Health Information Systems Research Centre

USA

  • The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics
  • Professional Science Master's in Health Informatics at UNC Charlotte
  • Health Information Technology Certificate at UNC Charlotte
  • Recommend Us