Health Informatics

Imagination is more important than knowledge" Albert Einstein

Enricos view
If physiology literally means 'the logic of life', and pathology is 'the logic of disease', then medical informatics is the logic of healthcare. It is 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 1997

Health Informatics
Health Informatics is having a mid-life crisis, it is a 45 year old profession wandering around the desert to find itself
Yuval Shahar (2001) IMIA Invited Satellite Working Conference Challenges in Medical Informatics successes and failures , Madrid March 2001

1. Definitions
Informatics Medical Informatics Nursing Informatics Clinical Informatics Health Informatics

Informatics
the application of information
technologies to optimize the information management function within an organization

Informatics
information management information technology

Information management
assuring that the right information is
available to the right people, within and without an organization, at the right time and place, and for the right price

Information technology
any technology which processes and
communicates data, includes:
computers, voice, data and image sensing and communications devices, graphics devices, multi-media storage, etc. pen, paper, telephones and fax machines

Health or Medical Informatics

The terms 'medical informatics' and 'health informatics' have been variously defined, but can be best understood as the understanding, skills and tools that enable the sharing and use of information to deliver healthcare and promote health. 'Health informatics' is now tending to replace the previously commoner term 'medical informatics', reflecting a widespread concern to define an information agenda for health services which recognises the role of citizens as agents in their own care, as well as the major information-handling roles of the non-medical healthcare professions.
BMIS (2002)

Medical Informatics
"the science of analysis, documentation, steering, control and synthesis of information processes within the health care delivery system, especially in the classical environment and medical practice".
Recihertz P Protokoll der Klausurtagung Ausbildungsziele, Inhalte und Methoden in der Medizinischen Informatik Ulm: Reisenberg/b. 1973

Nursing Informatics
"A combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data and the delivery of nursing care".
Graves JR, Cocoran S The Study of Nursing Informatics Image: Journal of Nursing Scholarship Vol. 21, p. 227, 1989

Nursing Informatics
"Integration of nursing, its information and information management with information processing and communications technology to support world health".
IMIA Nursing Informatics 6th International Congress Stockholm, October 1997

Health Informatics
"The study of nature and principles of information and its applications within all aspects of health care delivery and promotion".
Protti DJ A New Undergraduate Program in Health/Medical Informatics AMIA Proceedings Masson Publishing, 1982

Health Informatics
Health informatics is seen as to be
concerned with the individual and group behaviour of health care personnel in their interaction with information and information technologies. Medical informatics is seen to be rooted in medicine and computer science the social, organizational, and policy

aspects of information technology are not usually taken into consideration

International view
Health informatics is concerned with the systematic processing of data, information and knowledge in medicine and healthcare. The domain covers computational and informational aspects of processes and structures, applicable to any clinical or managerial discipline within the health sector whether on a tele (remote) basis or not. Health informatics is delivered by operational health practitioners, academic researchers and educators, scientists and technologists in operational, commercial and academic domains Jean Roberts Medinfo2001

Bodies of knowledge
hard sciences
biology and clinical chemistry computer science engineering mathematics and physics soft sciences economics information science management science psychology sociology medicine and other health care professions

Areas of instruction and learning

A. Information 1. Management 2. Technology B. Healthcare Organizations 1. Clinical (Delivery) 2. Management

A. Information 1. Management
Data - Information - Wisdom Spectrum Power and value of information Data modeling and data standards Coding, classification, nomenclature Data analysis & statistical methods Systems analysis and design Information sources (local, national, international) Managing information resources

A. Information 2. Technology
Hardware processing and storage technologies Computer languages Software: operating systems, databases,
application Communications technologies Local Area Networks Intranets and the Internet Telematicss/telemedicine Infusion/diffusion theories Effectiveness metrics Security and Confidentiality

B. Healthcare Organizations 1. Clinical (Delivery)

History and culture of clinicians Clinical practice content and process Clinical practice guidelines and protocols Evidence-based decision making Decision support and expert systems Health outcomes and health status Epidemiology Population health

B. Healthcare Organizations 2. Management

organization theory and models communications theories management process and practice organizational development and change management health economics and fiscal management resource allocation models individual and group decision support systems ethics and legislation

Clinical Work

Information and Communication technologies

Organisation of medicine and health care (system)

Three Domains Needing an Effective Fit

Context: Health Care System

Organising and managing Clinical practice Learning from sets of patients Diagnosing and treating a patient

The three levels of clinical activity which should be the focus of information technology in a health care system

Failure to: understand the nature of different clinical practices and its

consequence for the use of technology; understand the nature of the relationship between clinical staff and management which might predispose clinical staff to oppose introduction of a clinical information system; recognise wider imperatives and set ill-conceived targets; choose robust, transferable, extendable and proven technologies which, for example, do not inhibit future developments; take into account research and evaluation of informational developments such as terming and classification systems; relate the technologies to the imperatives; recognise the clinical imperative need to treat more patients at least as well in less time using new systems;

Failure to: create an affordable and practical technology financial

plan from a high level strategy; involve the future users in such a way that their input is meaningful to determine system requirements and to gain their subsequent ownership prepare and develop individuals and the organisation to make effective use of information technologies; implement in an orderly and timely way; actually check whether the technologies are meeting expectations and requirements, whether the system is highly valued and to react accordingly

2.

Selects and prioritises opportunities, problems, imperatives and requirements for change

Assesses and understands the context & identifies consequences for clinical work and imperatives for change R espond
R espond Identify impact

Identify impac t

Health care Clinical

Organisation of clinic al work Sets ofpatients Single patient

Obs erve & enquire T ell

1. Assesses and understands what [and for what key reasons] activities occur at each level

3.
Knows of appropriate technological developm ents & relates them to inform ation requirem ents: knows of opportunities and imperatives for change

T ell

7.
Obs erve & enquire T ell

Obs erve & enquire

Work System
T ell R elate & check R elate & Chec k

Evaluates, reviews and assesses the impact and values it

T ell

R espond & Implement

4. Creates an information and technology strategy and financial plan

5. Involves, informs persuades, prepares for these technologies and other changes

R ealise

6. Plans and introduces new technologies with other changes

Stages of the model 1 to 4

Assesses and understands what and for what
reasons things happen Assesses and understands the context and identifies consequences for clinical work and imperatives for change Selects and prioritises opportunities, problems, imperatives and requirements for change Knows of appropriate technological developments and relates them to information requirements; knows of opportunities and imperatives for change

Stages of the model 5 to 8

Creates an information and technology and

strategy plan Involves, informs, persuades, prepares for these technologies and other changes Plans and introduces new technologies and other changes Evaluates, reviews and assesses the impact and values it

hybrid managers-informaticians
select the appropriate information and
communication technologies, involve perceived beneficiaries, identify the prospective benefits, successfully plan, implement and evaluate the impact of change