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Health Informatics

Health Informatics is ... the use of computer technologies in healthcare to store, share, transmit and analyse clinical knowledge and data.

Definitions

Health or Medical Informatics is the "scientific field that deals with biomedical information, data, and knowledge - their storage, retrieval, and optimal use for problem solving and decision making. It accordingly touches on all basic and applied fields in biomedical science and is closely tied to modern information technologies, notably in the areas of computing and communication (medical computer science)"
[Stanford Medical Informatics].

"Medical information science is the science of using system-analytic tools . . . to develop procedures (algorithms) for management, process control, decision making and scientific analysis of medical knowledge."
[Shortliffe EH. The science of biomedical computing. Med Inform 1984;9:185-93.]

"Medical Informatics comprises the theoretical and practical aspects of information processing and communication, based on knowledge and experience derived from processes in medicine and health care."
[Van Bemmel JH. The structure of medical informatics. Med Inform 1984;9:175-80.]

"Information management constitutes a major activity of the health care professional. Currently a number of forces are together focusing attention on this function. Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks. It is an intrinsically interdisciplinary field, with a highly applied focus, but it also addresses a number of fundamental research problems as well as planning and policy issues. After many years of development of information systems to support the infrastructure of medicine, a new generation of systems and tools are aimed at physicians and other health care managers and professionals - to support education, decision making, communication, and may other aspects of professional activity. Health care institutions are beginning to make large-scale commitments to information systems and to services that will affect every aspect of their organization's function. Academic units of medical informatics are being established at a number of medical schools, medical informatics professionals are being sought to serve on faculties and hospital staffs, and medical informatics is emerging as a distinct academic entity. "
[R. A. Greenes & E. H. Shortliffe, Medical Informatics: An Emerging Discipline with Academic and Institutional Perspectives, Journal of the American Medical Association 263(8):1114-1120, 1990.]

"The rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how medical knowledge is created, shaped, shared and applied."
[Enrico Coiera]

Health Informatics literature
Trends in Medical Informatics literature:

  • "The volume of Medical Informatics literature has increased 5-fold since 1987, with around 320,000 potentially relevant papers published between 1987 and 2003.
  • "Among the research types classified by MeSH, reviews dominate and there are relatively few controlled trials. Most research is unclassified.
  • "Papers on most topics are rising but some areas, such as Clinical Laboratory Information Systems, have shown signs of decline, and others such as Computer-Assisted Diagnosis, have show a marked recent increase, reflecting a change in emphasis from systems & database architectures to support applications" [Claudia Pagliari, University of Edinburgh].
  • Links
     bullet   Clinical Informatics Wiki  bullet  Health Informatics World Wide - comprehensive sets of links maintained by Stefan Schulz and Rüdiger Klar at Freiburg University, Germany  bullet  History of Medical Informatics (on AMIA)  bullet  About Informatics (AMIA)  bullet   What is Medical Informatics, and why is it an important specialty? by Scot Silverstein

     bullet  Introduction to Medical Informatics - Online Lecture Notes by Robert Jenders, Robert Sideli and George Hripcsak, Columbia University  bullet  Extensive Glossary (Handbook of Medical Informatics)  bullet  Grand Challenges in Medical Informatics: an informal, interactive wish-list
    References: introductions to Health Informatics

    Frank Sullivan and Jeremy Wyatt. ABC of Health Informatics Blackwell BMJ Books, 2006

    []   [Blackwell Publishing]

    "This ABC focuses on how patient data, health knowledge, and local service information are managed during the routine tasks that make up clinical work. It looks at medical record keeping, how to use the information that records contain for clinical, quality improvement and research activities, how to use new media to communicate with clinical colleagues and patients, and the availability and uses of clinical knowledge resources.

    "After a short introduction to health informatics, each chapter is organised around a typical patient scenario that illustrates information dilemmas arising in clinical consultations. These case studies help make the link between prescribing and treatment.

    "A final chapter considers the implications of informatics and eHealth for the future of the health professions and their work."

    (Each chapter has been previously published in the BMJ in 2005.)

    Table of Contents:
    1. What is health information?  [Blackwell Publishing - sample chapter]
    2. Is a consultation needed?  [PubMed]
    3. Why is this patient here today?   [PubMed]
    4. How decision support tools help define clinical problems  [PubMed]
    5. How computers can help to share understanding with patients  [PubMed]
    6. How informatics tools help deal with patients' problems  [PubMed]
    7. How computers help make efficient use of consultations  [PubMed]
    8. Referral or follow-up?  [PubMed]
    9. Keeping up: learning in the workplace  [PubMed]
    10. Improving services with informatics tools  [PubMed]
    11. Communication and navigation around the healthcare system  [PubMed]
    12. eHealth and the future: promise or peril?   [PubMed]

    Paul Taylor, From Patient Data to Medical Knowledge - The Principles and Practice of Health Informatics, Blackwell Scientific, 2006

    [From Patient Data to Medical Knowledge (Blackwell Publishing)]
    [Free sample chapter: 1. Introduction]  

    Paul Taylor book cover The book is "aimed primarily at ... people who study Health Informatics in postgraduate courses."

    The book is in three parts. "The first consists of an introductory chapter and three further chapters each of which deals with one of [the Health Informatics] 'Grand Challenges'... The second part deals with various techniques used in Health Informatics and the theory behind some of them. A key element of this is the question of how we can represent clinical concepts in computer programs such as electronic health care records or decision support systems... The final part of the book explores attempts to apply health informatics in practice. "

    E. Coiera. The Guide to Health Informatics (2nd Edition). Arnold, London, October 2003.

    [Preface - coiera.com]   [Introduction (to health informatics) - coiera.com]

    Sample chapters:
    [Chapter 4 - Communicating]
    [Chapter 17 - Healthcare Terminologies and Classification Systems]
    [Chapter 25 - Clinical decision support systems]

    Coiera, 2nd Edition, 2003 Outline of structure of book: Part 1 - Basic Concepts in Informatics; Part 2 – Informatics Skills; Part 3 - Information Systems in Healthcare; Part 4 - Protocol-based Systems; Part 5 - Language, Coding and Classification in Healthcare; Part 6 - Communication Systems in Healthcare; Part 7 - The Internet; Part 8 - Intelligent Clinical Decision Support.

    Wyatt JC, Liu JL. Basic concepts in medical informatics. J Epidemiol Community Health. 2002 Nov;56(11):808-12.

    [PubMed]   [JECH Online]

    " This glossary defines terms used in the comparatively young science of medical informatics. It is hoped that it will be of interest to both novices and professionals in the field. "
    J.H. van Bemmel, M.A. Musen (Editors). The Handbook of Medical Informatics. Springer-Verlag, New York, 1998.

    [V3.3 on MIEUR website]

    E. H. Shortliffe G. Wiederhold, L. E. Perreault, L. M. Fagan (editors). Medical Informatics : Computer Applications in Health Care and Biomedicine (2nd Edition). Springer Verlag, New York, 2000.

    [Stanford]   [Preface]

    [Chapter One]

    Cover of Medical Informatics - Shortliffe


    References: challenges for Health Informatics
    Haux R. Aims and tasks of medical informatics. Int J Med Inf. 1997 Mar;44(1):9-20; discussion 39-44, 45-52, 61-6. Review.

    [PubMed]

    " Ten major long-term aims and tasks, so to speak 'grand challenges', for research in the field of medical informatics, including health informatics, are proposed and described. These are the further development of methods and tools of information processing for: (1) diagnostics ('the visible body'); (2) therapy ('medical intervention with as little strain on the patient as possible'); (3) therapy simulation; (4) early-recognition and prevention; (5) compensating physical handicaps; (6) health consulting ('the informed patient'); (7) health reporting; (8) health care information systems; (9) medical documentation and (10) comprehensive documentation of medical knowledge and knowledge-based decision support. Work is, in part, already in progress. To all these aims and tasks medical informatics can and may be should make substantial contributions. Prior to outlining the above aims and tasks, an account is given of the meaning of medical informatics, of the objective it pursues in general and of its achievements so far. The present paper intends to contribute to a broad public discussion of the aims and tasks for research in the field of medical informatics. "

    Gell G. The internal challenges of medical informatics. Int J Med Inf. 1997 Mar;44(1):67-74.

    [PubMed]   []

    " Haux's [7] basic assumption that the object of medical informatics is: "... to assure and to improve the quality of healthcare as well as the quality of research and education in medicine and in the health sciences ..." is taken as a starting point to discuss the three main topics: What is the meaning of medical informatics (i.e. what should be the main activities of medical informatics to bring maximum benefit to medicine)? What are the achievements and failures of medical informatics today (again considering the impact on the quality of healthcare)? What are the main challenges? Concerning the definition of medical informatics it is argued that one should not hide the link to basic informatics and, for that matter to computers, completely behind abstract definitions. After an analysis of the purposes of the definition of a discipline, a differentiated definition of the scope of medical informatics, rather general when concerning the field of scientific interest, more focused when concerning the practical (constructive) applications, is proposed. Contrasting Haux's chapter on achievements of medical informatics we concentrate on and analyse non fulfilled promises of medical informatics to derive lessons for the future and to propose 'generic' (or core) tasks of medical informatics to meet the challenges of the future. A set of 'internal challenges' of medical informatics to change priorities and attitudes within the discipline is put forward to enable medical informatics to meet the 'external challenges' listed by Haux. "

    Talmon JL, Hasman A. Medical informatics as a discipline at the beginning of the 21st century. Methods Inf Med. 2002;41(1):4-7.

    [PubMed]   []

    " OBJECTIVES: To analyse the present situation of the discipline medical informatics and to propose actions for change. METHODS: Evaluation of the current situation mainly based on anecdotal evidence. RESULTS: The difference between the scientific and the engineering aspects of medical informatics get blurred. Because of the requirements of European funding medical informatics focuses more on engineering than on science. Too many manuscripts are submitted that describe engineered artefacts without a scientific purpose. Some of the subjects (like security issues) that are studied in medical informatics are not considered important by medical faculties thus impeding support. CONCLUSIONS: The methodological underpinnings of our research should be strengthened, impact studies should be more frequently performed; the quality of results reporting should be increased. "

    Altman RB. Informatics in the care of patients: ten notable challenges. West J Med. 1997 Feb;166(2):118-22.

    [PubMed]   []

    " What is medical informatics, and why should practicing physicians care about it? Medical informatics is the study of the concepts and conceptual relationships within biomedical information and how they can be harnessed for practical applications. In the past decade, the field has exploded as health professionals recognize the importance of strategic information management and the inadequacies of traditional tools for information storage, retrieval, and analysis. At the same time that medical informatics has established a presence within many academic and industrial research facilities, its goals and methods have become less clear to practicing physicians. In this article, I outline 10 challenges in medical informatics that provide a framework for understanding developments in the field. These challenges have been divided into those relating to infrastructure, specific performance, and evaluation. The primary goals of medical informatics, as for any other branch of biomedical research, are to improve the overall health of patients by combining basic scientific and engineering insights with the useful application of these insights to important problems. "
    Sittig DF. Grand challenges in medical informatics? J Am Med Inform Assoc. 1994 Sep-Oct;1(5):412-3.

    [PubMed]   [PubMedCentral]

    " 'Grand challenges' are fundamental scientific or technologic problems whose solutions require significant increases in our current levels of scientific knowledge and/or technical capabilities. Their solutions should significantly improve both the quality and the delivery of health care while decreasing its costs. Finally, solutions to these problems should be achievable within a decade.
    Development of a list of the grand challenges facing the field of medical informatics could serve several purposes. First, it could attract support from funding agencies by identifying and prioritizing projects worthy of economic and political support. Second, it could serve as a method for drawing young people facing difficult career choices into the field by highlighting the key intellectual or technologic challenges within the field and the potential benefits that might accrue to society upon their solution. Third, it could provide an alternative definition of the field. ... "

    Greenes RA, Shortliffe EH. Medical informatics. An emerging academic discipline and institutional priority. JAMA. 1990 Feb 23;263(8):1114-20.

    [PubMed]   []

    " Information management constitutes a major activity of the health care professional. Currently, a number of forces are focusing attention on this function. After many years of development of information systems to support the infrastructure of medicine, greater focus on the needs of physicians and other health care managers and professionals is occurring--to support education, decision making, communication, and many other aspects of professional activity. Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks. An intrinsically interdisciplinary field, medical informatics has a highly applied focus, but also addresses a number of fundamental research problems as well as planning and policy issues. Medical informatics is now emerging as a distinct academic entity. Health care institutions are considering, and a few are making, large-scale commitments to information systems and services that will affect every aspect of their organizations' function. While academic units of medical informatics are presently established at only a few medical institutions in the United States, increasing numbers of schools are considering this activity and many traditional departments are seeking and attracting individuals with medical informatics skills. "
    Shahar Y. Medical informatics: between science and engineering, between academia and industry. Methods Inf Med. 2002;41(1):8-11.

    [PubMed]

    " OBJECTIVE: To analyze the nature and appropriate role of the Medical Informatics research and practice area in the 21st Century, and to determine its links to academic environments versus industrial companies and health-care organizations. METHODS: A qualitative analysis of the state of the art of Medical Informatics, based on observation of current medical informatics programs and research in academic and industrial sites. RESULTS AND CONCLUSIONS: Medical Informatics is definitely a scientific and technological area of endeavor, although somewhat ill-defined in scope. It is situated between science and engineering, but much closer to the engineering world, and its multidisciplinary nature fits well the engineering paradigm. It is better viewed as a specialization of the informatics field rather than as a basic medical science. However, there are good arguments as to why Medicine should be the first among equals to have its own informatics domain. Medical Informatics must have extensions to both academia and industry to survive. Medical informaticians, whether implicitly or explicitly, exist in three different environments: academic, clinical (user), and industrial (informatics developer); all three environments must be considered when trying to predict the future of this new multidisciplinary area. "

    Musen MA. Medical informatics: searching for underlying components. Methods Inf Med. 2002;41(1):12-9.

    [PubMed]   []

    " OBJECTIVE: To discuss unifying principles that can provide a theory for the diverse aspects of work in medical informatics. If medical informatics is to have academic credibility, it must articulate a clear theory that is distinct from that of computer science or of other related areas of study. RESULTS: The notions of reusable domain antologies and problem-solving methods provide the foundation for current work on second-generation knowledge-based systems. These abstractions are also attractive for defining the core contributions of basic research in informatics. We can understand many central activities within informatics in terms defining, refining, applying, and evaluating domain ontologies and problem-solving methods. CONCLUSION: Construing work in medical informatics in terms of actions involving ontologies and problem-solving methods may move us closer to a theoretical basis for our field. "

    Kaplan B, Brennan PF, Dowling AF, Friedman CP, Peel V. Toward an informatics research agenda: key people and organizational issues. J Am Med Inform Assoc. 2001 May-Jun;8(3):235-41.

    [PubMed]   [PubMed Central]

    " As we have advanced in medical informatics and created many impressive innovations, we also have learned that technologic developments are not sufficient to bring the value of computer and information technologies to health care systems. This paper proposes a model for improving how we develop and deploy information technology. The authors focus on trends in people, organizational, and social issues (POI/OSI), which are becoming more complex as both health care institutions and information technologies are changing rapidly. They outline key issues and suggest high-priority research areas. One dimension of the model concerns different organizational levels at which informatics applications are used. The other dimension draws on social science disciplines for their approaches to studying implications of POI/OSI in informatics. By drawing on a wide variety of research approaches and asking questions based in social science disciplines, the authors propose a research agenda for high-priority issues, so that the challenges they see ahead for informatics may be met better. "
    acknowledgements
     
    Entry on OpenClinical: 2001
    Redesigned: 1 January 2004   Last main update: 31 January 2004; 03 March 2005; 09 September 2005
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