Health informatics

From LIMSWiki
Jump to: navigation, search
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 information science, 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 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 UK 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 2013 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]

Since 1997, the not-for-profit Buenos Aires Biomedical Informatics Group has represented the interests of a broad range of clinical and non-clinical professionals working within the health informatics sphere. The group strives 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. As of July 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]

Provincial and territorial programs 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 multi-million dollar contract scandal in 2009.[16]
  • 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.[17]

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.[18]

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[19], 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.[20][21] 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.[22]

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.[23] As of 2013 web-based and database-centric Internet applications of laboratory informatics software have 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.[24] 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.[20]

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 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.[25] 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.[26][27]

epSOS (European Patients - Smart Open Services) represents another key European initiative to "build and evaluate a service infrastructure that demonstrates cross-border interoperability between electronic health record systems in Europe."[28] Co-funded by the European Commission Competitiveness and Innovation Programme since 2008, the initiative (scheduled to finish on December 31, 2013) 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.[28]

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[29], which eventually became the International Medical Informatics Association (IMIA) in 1979.[30][31] 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.[31]

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."[32] 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."[32]

Scotland

In 1984, Scotland saw the implementation of the General Practice Administration System (GPASS), developed and controlled by NHS Scotland.[33] 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."[34] 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.[35]

Australia

Founded in 2002, 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.[36] ACHI is a sponsor of the e-Journal for Health Informatics[37], an indexed and peer-reviewed professional journal. ACHI has also supported the Australian Health Informatics Education Council (AHIEC) since its founding in 2009.[38]

Although there are a number of health informatics organizations 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.[39]

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 (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 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 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.[40]

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.[41]

New Zealand

Health Informatics is taught at five New Zealand universities. The most mature and established is the Otago program, which has been offered since the mid-1990s.[42] Health Informatics New Zealand (HINZ) is the national organization that advocates for health informatics. HINZ organizes a conference every year and also publishes the online journal Healthcare Informatics Review Online.

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.[43]

Regulation and standards

The international standards on the subject are covered by ICS 35.240.80[44] in which ISO 27799:2008 is one of the core components.[45]

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 US 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.[46]

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.[47] 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

  1. 1.0 1.1 1.2 1.3 Hovenga, Evelyn J. S., ed. (2010). "Chapter 2: Health Informatics - An Introduction". Health Informatics: An Overview. IOS Press. p. 9–15. ISBN 1607500922. http://books.google.com/books?id=eckD3fSrPagC. 
  2. Blum, Bruce I.; Kent, Allen (ed.); Williams, James G. (ed.) (1990). "Medical Informatics". Encyclopedia of Computer Science and Technology. 22. CRC Press. p. 205–224. ISBN 0824722728. http://books.google.com/books?id=L7NOABDqaMcC. 
  3. Dayyani, Basel; Griffiths, Paul (ed.) (2006). "Knowledge Informatics: A New Academic Discipline Underpinning Knowledge-based Organisations and Contributing to the Transformation from the Information Age to the Knowledge Age". Proceedings of the 3rd International Conference on Intellectual Capital and Knowledge Management. Academic Conferences Limited. p. 127–138. ISBN 1905305362. http://books.google.com/books?id=hD4I12296jYC. 
  4. 4.0 4.1 "The History of Health Informatics". Health Informatics Guide - The History of Health Informatics. University of Illinois at Chicago. Archived from the original on 26 November 2012. http://web.archive.org/web/20121126102550/http://healthinformatics.uic.edu/history-of-health-informatics/. Retrieved 05 January 2015. 
  5. 5.0 5.1 5.2 "NYU Graduate Training Program in Biomedical Informatics (BMI): A Brief History of Biomedical Informatics as a Discipline". www.nyuinformatics.org. NYU Langone Medical Center. http://www.nyuinformatics.org/education/degree-programs. Retrieved 11 November 2010. 
  6. Robson, B.; Baek, O. K. (2009). The engines of Hippocrates: From the Dawn of Medicine to Medical and Pharmaceutical Informatics. Hoboken, NJ: John Wiley & Sons. ISBN 9780470289532. 
  7. 7.0 7.1 "UK Council for Health Informatics Professions (UKCHIP): Registration Standards Mapping Update" (PDF). UKCHIP. 12 June 2006. http://www.bcs.org/upload/pdf/mappingupdate.pdf‎. Retrieved 30 October 2013. 
  8. "About the Health Informatics Career Framework (HICF)". National Health Service. https://www.hicf.org.uk/AboutHICF.aspx. Retrieved 30 October 2013. 
  9. "HSRIC: Health Informatics". U.S. National Library of Medicine. http://www.nlm.nih.gov/hsrinfo/informatics.html. Retrieved 30 October 2013. 
  10. 10.0 10.1 "IMIA LAC: Regional Federation of Health Informatics for Latin America and the Caribbean". International Medical Informatics Association. http://www.imia-medinfo.org/new2/node/159. Retrieved 30 October 2013. 
  11. "Grupo de Informática Biomédica de Buenos Aires - GIBBA". GIBBA. http://www.gibba.org.ar/GIBBAWEB2009/index.php. Retrieved 30 October 2013. 
  12. 12.0 12.1 Sonis, A. (1981). "The Latin American network of biomedical and health information: experience and future development". Educación Médica y Salud 15 (4): 474–493. PMID 7030712. http://www.ncbi.nlm.nih.gov/pubmed/7030712/. 
  13. Garcia, Maria Lúcia Andrade; Kent, Allen (ed.) (1987). "Brazil, The Organization Of Scientific and Technological Information In". Encyclopedia of Library and Information Science. 43. CRC Press. pp. 38–47. http://books.google.com/books?id=sFqds9V6heMC. 
  14. "A História da SBIS". Sociedade Brasileira de Informática em Saúde. http://www.sbis.org.br/site/site.dll/view?pagina=5. Retrieved 30 October 2013. 
  15. "Canada Health Infoway Annual Report 2012–13" (PDF). Canada Health Infoway. 26 July 2013. https://www.infoway-inforoute.com/index.php/resources/infoway-corporate/annual-reports/doc_download/1876-annual-report-2012-2013. Retrieved 30 October 2013. 
  16. "Head of eHealth Ontario is fired amid contracts scandal, gets big package". CBC News. 07 June 2009. http://www.cbc.ca/news/canada/head-of-ehealth-ontario-is-fired-amid-contracts-scandal-gets-big-package-1.797216. Retrieved 30 October 2013. 
  17. "Alberta Netcare: The History of the EHR". Government of Alberta. http://www.albertanetcare.ca/History.htm. Retrieved 30 October 2013. 
  18. Sittig, Dean F.; Ash, Joan S.; Ledley, Robert S. (2006). "The Story Behind the Development of the First Whole-body Computerized Tomography Scanner as Told by Robert S. Ledley". Journal of the American Medical Informatics Association 13 (5): 465–9. doi:10.1197/jamia.M2127. PMC 1561796. PMID 16799115. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1561796/. 
  19. Patton, Gregory A., Gardner, Reed M. (1999). "Medical Informatics Education: The University of Utah Experience". Journal of the American Medical Informatics Association 6 (6): 457–65. PMC 61389. PMID 10579604. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC61389/. 
  20. 20.0 20.1 Park, Seung Lyung; Pantanowitz, Liron; Sharma, Guarav; Parwani, Anil Vasdev (March 2012). "Anatomic Pathology Laboratory Information Systems: A Review". Advances in Anatomic Pathology 19 (2): 81–96. doi:10.1097/PAP.0b013e318248b787. http://ebookbrowse.com/anatomic-pathology-laboratory-information-systems-a-review-slpark-et-all-adv-anat-pathol-2012-pdf-d344405134. Retrieved 03 June 2013. 
  21. Reilly, Edwin D. (2003). Milestones in Computer Science and Information Technology. Greenwood Publishing Group. pp. 161. ISBN 9781573565219. http://books.google.com/books?id=JTYPKxug49IC. 
  22. Blum, Bruce I.; Duncan, Karen A. (1990). A History of Medical Informatics. ACM Press. pp. 141–53. ISBN 0201501287. http://books.google.com/books/about/A_History_of_medical_informatics.html?id=AR5rAAAAMAAJ. 
  23. Sinard, John H. (2006). Practical Pathology Informatics: Demstifying Informatics for the Practicing Anatomic Pathologist. Springer. pp. 393. ISBN 0387280588. http://books.google.com/books?id=WerUyK618fcC. 
  24. Kumar, Sameer; Aldrich, Krista (December 2010). "Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study". Health Informatics Journal 16 (4). doi:10.1177/1460458210380523. http://jhi.sagepub.com/content/16/4/306.abstract. Retrieved 03 June 2013. 
  25. "Digital Agenda for Europe: Research in eHealth". European Commission. http://ec.europa.eu/digital-agenda/en/research-ehealth. Retrieved 30 October 2013. 
  26. "Electronic Health Records for Europe". European Space Agency. 30 March 2005. http://www.esa.int/SPECIALS/Telemedicine_Alliance/SEMWC7SMD6E_0.html. Retrieved 30 October 2013. 
  27. Mennerat, François (10 October 2006). "The EuroRec Institute: Its Structure, Activities and New Services" (PPT). EuroRec. http://www.eurorec.org/files/filesPublic/EuroRec2006_FrancoisMennerat.ppt‎. Retrieved 30 October 2013. 
  28. 28.0 28.1 "About epSOS". European Commission. http://www.epsos.eu/home/about-epsos.html. Retrieved 30 October 2013. 
  29. Zemanek, H.; Brunnstein, K. (31 March 2011). "Chart 0: IFIP at a Glance". A Quarter Century of IFIP. IFIP. http://www.ifip.org/50th_anni/Chart0.htm. Retrieved 31 October 2013. 
  30. Nedkov, Plamen; Rosenfeld, Jack L. (ed.) (2002). "The IFIP Presidents". IFIP Newsletter 19 (1–3): 7. http://www.ifip.org/newsletters/News2002/News_Sep_2002.pdf‎. 
  31. 31.0 31.1 Dezelic, Gjuro; Adlassnig, Klaus-Peter (ed.) (2009). "After Three Decades of Medical Informatics Europe Congresses". Medical Informatics in a United and Healthy Europe. IOS Press. pp. 3–7. ISBN 1607500442. http://books.google.com/books?id=pGHWtG5_xIgC. 
  32. 32.0 32.1 "MPs publish report on the dismantled National Programme for IT in the NHS". U.K. Parliament. 18 September 2013. http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/npfit-report/. Retrieved 30 October 2013. 
  33. "Scotland’s doctors welcome review of GPASS". BMA Scotland. 11 June 2002. http://web.bma.org.uk/pressrel.nsf/wlu/GGRT-5AZK3T. Retrieved 01 November 2013. 
  34. Todd, Rebecca (20 August 2012). "Scotland's GPASS is no more". EHealth Insider. EHealth Media Limited. http://www.ehi.co.uk/news/ehi/8005/scotland's-gpass-is-no-more. Retrieved 01 November 2013. 
  35. "About Asia Pacific Association of Medical Informatics". APAMI. http://www.apami.org/about.html. Retrieved 01 November 2013. 
  36. "Australasian College of Health Informatics". ACHI. http://www.achi.org.au. Retrieved 01 November 2013. 
  37. "eJHI - Journal Sponsorship". eJHI. http://www.ejhi.net/ojs/index.php/ejhi/about/journalSponsorship. Retrieved 01 November 2013. 
  38. "Australian Health Informatics Education Council". AHIEC. http://www.ahiec.org.au/. Retrieved 01 November 2013. 
  39. "About Health Informatics Society of Australia". HISA. http://www.hisa.org.au/?about. Retrieved 01 November 2013. 
  40. "Hong Kong Hospital Authority and Health Informatics Section". Hong Kong Hospital Authority. http://www3.ha.org.hk/hi/Welcome.html. Retrieved 01 November 2013. 
  41. "eHealth Consortium". IPROA. http://www.iproa.org/index.php/en-GB/other-projects/227-ehealth-consortium.html. Retrieved 01 November 2013. 
  42. Karolyn Kerr; Cullen, Rowena; Duke, Jan; Holt, Alec; Kirk, Ray; Komisarczuk, Peter; Warren, Jim; Wilson, Shona (2006). "Health Informatics Capability Development In New Zealand - A Report to the Tertiary Education Commission" (PDF). National Steering Committee for Health Informatics Education in New Zealand. http://homepages.mcs.vuw.ac.nz/~peterk/healthinformatics/tec-hi-report-06.pdf. Retrieved 01 November 2013. 
  43. "Saudi Association for Health Informatics (SAHI)". SAHI. 25 May 2011. http://www.sahi.org.sa/objectives.php. Retrieved 01 November 2013. 
  44. "35.240.80: IT applications in health care technology". ISO. http://www.iso.org/iso/products/standards/catalogue_ics_browse.htm?ICS1=35&ICS2=240&ICS3=80&. Retrieved 01 November 2013. 
  45. Fraser, Ross (06 June 2006). "ISO 27799: Security management in health using ISO/IEC 17799" (PDF). Ross Fraser. http://sl.infoway-inforoute.ca/downloads/Ross_Fraser_-_ISO_27799.pdf. Retrieved 01 November 2013. 
  46. Certification Commission for Healthcare Information Technology (18 July 2006). "CCHIT Announces First Certified Electronic Health Record Products". Virtual Medical Worlds. http://www.hoise.com/vmw/06/articles/vmw/LV-VM-08-06-22.html. Retrieved 01 November 2013. 
  47. Gardner, Reed M.; Overhage J. Mark; Steen, Elaine B.; Holmes, John H.; Munger, Benson S.; Williamson, Jeffrey J.; Detmer, Don E. (2009). "Core content for the subspecialty of clinical informatics". Journal of the American Medical Informatics Association 16 (2): 153–7. doi:10.1197/jamia.M3045. PMC 2649328. PMID 19074296. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649328.