Healthcare

Health informatics

Health informatics helps manage, analyze, and integrate patient data from physician to specialist and beyond.

Health informatics (also called health care informatics, healthcare informatics, medical informatics, nursing informatics, clinical informatics, or biomedical informatics) is a discipline at the intersection of , computer science, and health care. It deals with the resources, devices, and methods required to optimize the "collection, storage, retrieval, [and] communication ... of health-related data, information, and knowledge."[1] Health informatics is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health, occupational therapy, and biomedical research. Health informatics resources include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems.

Early names for health informatics included medical information data processing, medical information science, medical informatics[2][1], medical computer science, and medical computing.[3]

History

Worldwide use of technology in medicine began in the early 1950s with the rise of computers.[4] In 1949, Gustav Wager established the first professional organization for informatics in Germany.[5] The prehistory, history, and future of medical information and health information technology are discussed in reference.[6] Specialized university departments and informatics training programs began during the 1960s in France, Germany, Belgium and The Netherlands. Medical informatics research units then began to appear during the 1970s in Poland and in the U.S.[5], with medical informatics conferences springing up as early as 1974.[1] 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.[5][1]

By the mid-2000s, work in the U.K. by the voluntary registration body the U.K. Council of Health Informatics Professions led to the creation of eight key constituencies within the domain of health informatics: information and communication technologies; health records; information management; knowledge management; health informatics service and project management; clinical informatics; education, training, and development; and research.[7] Those constituencies—already based on U.K. National Health Service standards (NHS)—later found their way into the NHS' Health Informatics Career Framework in a slightly modified format.[8] As of 2020 tens of datasets, publications, guidelines, specifications, meetings, conferences, and organizations around the world continue to shape what health informatics is today.[9]

Health informatics in North America

Argentina

Since 1996, the International Medical Informatics Association's Latin America and the Caribbean regional group has sought to develop health informatics within the region, including Argentina's Asociación Argentina de Informática Médica (AAIM).[10]

From 1997 until about 2014, the not-for-profit Buenos Aires Biomedical Informatics Group also represented the interests of a broad range of clinical and non-clinical professionals working within the health informatics sphere. The group strove to promote informatics technology and related content within the research and health administration spheres, especially those relating to the biomedical field.[11]

Brazil

"In 1968 the Pan American Health Organization set up the Regional Library of Medicine and Health Sciences (BIREME) in the Paulista Medical School in São Paulo under an agreement with the Government of Brazil."[12] The library also made possible access to the MEDLINE and MEDLARS systems[13], and it would eventually go on to become the "hub of the Latin American network of biomedical and health information."[12]

In 1986, the Brazilian Society of Health Informatics (Sociedade Brasileira de Informática em Saúde) was founded to better expand the use of informatics technology within the country. The same year saw the first Brazilian Congress of Health Informatics held, and the first Brazilian Journal of Health Informatics was published.[14]

Since 1996, the International Medical Informatics Association's Latin America and the Caribbean regional group has sought to develop health informatics within the region, including Brazil's Sociedade Brasileira de Informática em Saúde (SBIS).[10]

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. In 2013, there were 380 health informatics projects under way in Canadian hospitals, health-care facilities, pharmacies, and laboratories, with an investment value of $2.1 billion since its inception.[15] Canada Health Infoway expected to see those projects finally come to completion by the 2019–2020 fiscal year.[16]

Provincial and territorial programs have included 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 multi-million dollar contract scandal in 2009.[17]
  • Alberta Netcare Portal was created in 2006 by the Government of Alberta. 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.[18]

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.[4] Robert Ledley led the charge in the 1950s with his early use of medical computation in his dental projects at the United States National Bureau of Standards.[19]

By the mid-1950s expert systems such as MYCIN and INTERNIST-I were developed, and the National Library of Medicine started using even the even more advanced MEDLINE and MEDLARS systems by 1965. Around this same time a flurry of activity occurred. At the University of Utah, Dr. Homer R. Warner, one of the fathers of medical informatics[20], was already offering graduate-level classes in medical computer applications. Meanwhile Neil Pappalardo, Curtis Marble, and Robert Greenes were developing the Massachusetts General Hospital Utility Multi-Programming System (MUMPS) in Octo Barnett's Laboratory of Computer Science at Massachusetts General Hospital in Boston.[21][22] Yet due to its advanced nature, fragmented use across multiple entities, and inherent difficulty in extracting and analyzing data from the database, development of healthcare and laboratory systems on MUMPS was sporadic at best.[23]

By the 1980s, however, the advent of Structured Query Language (SQL), relational database management systems (RDBMS), and Health Level 7 (HL7) allowed software developers to expand the functionality and interoperability of health informatics systems, including the application of business analytics and business intelligence techniques to clinical data.[24] By the early 2010s, web-based and database-centric internet applications of laboratory informatics software had further changed the way researchers and technicians interact with data, with web-driven data formatting technologies like Extensible Markup Language (XML) making interoperability of health and laboratory informatics software a much-needed reality.[25] SaaS and cloud computing technologies have further changed how informatics systems are implemented in the U.S and worldwide, while at the same time raising new questions about security and stability.[21]

Health informatics in 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 associated European eHealth programs play a fundamental role in the European Union's strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.[26] Additionally, the not-for-profit European Institute for Health Records or EuroRec has promoted the use of high quality electronic health record systems in the European Union since its foundation in late 2002.[27][28]

epSOS (European Patients - Smart Open Services) represented another key European initiative to "build and evaluate a service infrastructure that demonstrates cross-border interoperability between electronic health record systems in Europe."[29] Co-funded by the European Commission Competitiveness and Innovation Programme since 2008, the initiative—which finish on June 31, 2014—was devised with the vision of giving patients in Europe the opportunity to use cross-border electronic medical record services for healthcare-related activities in participating epSOS pilot countries.[29] A follow-up letter at the end of the project highlighted how it had encompassed "25 countries and about 50 beneficiaries," achieving the "development of a solid basis for the eprescription and patient summary services, considering: governance, use cases, data content, semantics, specifications, architecture, testing mechanisms, etc."[30]

In the United Kingdom

The U.K. health informatics community has long played a key role in international activity, joining Technical Committee Four (TC 4) of the International Federation of Information Processing in 1968[31], which eventually became the International Medical Informatics Association (IMIA) in 1979.[32][33] In 1978, the Medical Specialist Group of the British Computer Society organized the first European Federation for Medical Informatics (EFMI) Medical Informatics Europe (MIE) conference in Cambridge.[33]

In 2002, the idea of a profession of health informatics across the U.K. was first implemented as the U.K. Council for Health Informatics Professions (UKCHIP), which has a formal Code of Professional Conduct, standards for expressing competences which are used for entry, confirmation of fitness to practice, re-grading and personal development. Consistent standards express competences of health informatics professionals in both domain-specific and generic informatics professional areas. The consistency is intended to apply in operational care delivery organizations, academia, and the commercial service and solution providers.[7]

The broad history of health informatics in the U.K. has been captured in the 2008 book U.K. Health Computing : Recollections and Reflections by Glyn M. Hayes and Denise E. Barnett. The book describes the early development of health informatics in the country as "unorganized and idiosyncratic."

England

In 2002, the National Health Service (NHS) in England contracted several vendors for a national health informatics system called the National Programme for IT or "NPfIT." By 2010, however, the project drastically behind schedule, forcing a wide consultation to be launched as part of a wider "Liberating the NHS" plan. "Following three reports on the National Programme by both the National Audit Office and this Committee, and a review by the Major Projects Authority, the Government announced in September 2011 that it would dismantle the National Programme but keep the component parts in place with separate management and accountability structures."[34] The program was officially dismantled in September 2013, officially dubbed "one of the worst and most expensive contracting fiascos in the history of the public sector."[34]

Scotland

In 1984, Scotland saw the implementation of the General Practice Administration System (GPASS), developed and controlled by NHS Scotland.[35] It was provided free to all general practitioners in Scotland. However, an agreement was reached in 2008 to shut down the electronic system due to "a series of problems and critical reports."[36] The system was formally shut down in August 2012, with all practices having moved to new systems called EMIS and INPS.

Health informatics in Asia and Oceania

In Asia, Australia, and New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI) was established in 1993 and now consists of more than 15 member regions in the Asia Pacific Region.[37]

Australia

Founded in 2002, the Australasian College of Health Informatics (ACHI) was a professional association for health informatics in the Asia-Pacific region. It represented 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.[38] ACHI was also a sponsor of the e-Journal for Health Informatics[39], an indexed and peer-reviewed professional journal. ACHI had also supported the Australian Health Informatics Education Council (AHIEC) since its founding in 2009.[40]

Although many health informatics organizations have been active in Australia, the Health Informatics Society of Australia (HISA) was generally regarded as the major umbrella group and a member of the International Medical Informatics Association (IMIA). Nursing informaticians were the driving force behind the formation of HISA, with the membership coming from many parts of the informatics spectrum, from students to corporate affiliates. HISA had 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.[41]

In February 2020, ACHI and HISA announced that they had formally agreed to merge to form the Australsian Institute of Digital Health (AIDH). "Australasia’s leading organisations for health informatics and digital health ACHI and HISA were formed 25+ years ago in a different world. Imagine the challenges, the foresight and forward thinking required then to see the potential future of healthcare."[38] The new AIDH cited two primary factors for the merger: "meeting demand for education, training, professional pathways, certification and leadership development across digital health" and meeting the need for "a single unified voice from digital health leaders and experts at a time when consumers were looking for informed opinion, advice and guidance."[42]

China

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 (more than 40 hospitals and 120 clinics) and is used by some 79,000 staff on a daily basis.[43] The comprehensive records of seven million patients are available online 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 of the Hong Kong Hospital Authority has held a close relationship with the 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.[44]

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.[45]

New Zealand

Health Informatics has been taught at several New Zealand universities since the early 2000s. The most mature and established is the Otago program, which has been offered since the mid-1990s.[46] Also notable is Health Informatics New Zealand (HINZ), the national organization that advocates for health informatics. HINZ organizes a conference every year and also publishes the online journal Healthcare Informatics Review Online.[47]

Health informatics in the Middle East

Saudi Arabia

The Saudi Association for Health Information (SAHI) was established in 2006 to work under direct supervision of King Saud University for Health Sciences to practice public activities, develop theoretical and applicable knowledge, and provide scientific and applicable studies.[48]

Regulation and standards

The international standards on the subject are covered by ICS 35.240.80[49], in which ISO 27799:2016 is one of the core components.[50]

In the 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 U.S. within 10 years.

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.[51]

Clinical informatics

While health informatics and clinical informatics are often considered the same, some make a distinction between the two. The American Medical Informatics Association, for example, states clinical informatics is concerned with the use of information in health care by clinicians.[52] By extension, clinical informaticians analyze, design, implement, and evaluate 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
  • 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.

Further reading

See also

Notes

Some elements of this article are reused from the Wikipedia article.

References

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