Difference between revisions of "Health informatics"

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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.<ref name="8HIConst">{{cite web |url=http://www.bcs.org/upload/pdf/mappingupdate.pdf‎ |format=PDF |title=UK Council for Health Informatics Professions (UKCHIP): Registration Standards Mapping Update |publisher=UKCHIP |date=12 June 2006 |accessdate=30 October 2013}}</ref> 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.<ref name="HICF">{{cite web |url=https://www.hicf.org.uk/AboutHICF.aspx |title=About the Health Informatics Career Framework (HICF) |publisher=National Health Service |accessdate=30 October 2013}}</ref> {{As of|2013|October}} tens of datasets, publications, guidelines, specifications, meetings, conferences, and organizations around the world continue to shape what health informatics is today.<ref name="HSRIC">{{cite web |url=http://www.nlm.nih.gov/hsrinfo/informatics.html |title=HSRIC: Health Informatics |publisher=U.S. National Library of Medicine |accessdate=30 October 2013}}</ref>
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.<ref name="8HIConst">{{cite web |url=http://www.bcs.org/upload/pdf/mappingupdate.pdf‎ |format=PDF |title=UK Council for Health Informatics Professions (UKCHIP): Registration Standards Mapping Update |publisher=UKCHIP |date=12 June 2006 |accessdate=30 October 2013}}</ref> 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.<ref name="HICF">{{cite web |url=https://www.hicf.org.uk/AboutHICF.aspx |title=About the Health Informatics Career Framework (HICF) |publisher=National Health Service |accessdate=30 October 2013}}</ref> {{As of|2013|October}} tens of datasets, publications, guidelines, specifications, meetings, conferences, and organizations around the world continue to shape what health informatics is today.<ref name="HSRIC">{{cite web |url=http://www.nlm.nih.gov/hsrinfo/informatics.html |title=HSRIC: Health Informatics |publisher=U.S. National Library of Medicine |accessdate=30 October 2013}}</ref>


===Medical informatics in the United States===
===Health informatics in North America===
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.<ref name="univ" /> 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.<ref name="Ledley">{{cite journal |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1561796/ |title=The Story Behind the Development of the First Whole-body Computerized Tomography Scanner as Told by Robert S. Ledley |author=Sittig, Dean F.; Ash, Joan S.; Ledley, Robert S. |journal=Journal of the American Medical Informatics Association |volume=13 |issue=5 |pages=465–9 |year=2006 |pmid=16799115 |pmc=1561796 |doi=10.1197/jamia.M2127}}</ref>


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<ref name="MedInfoEd">{{cite journal |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC61389/ |title=Medical Informatics Education: The University of Utah Experience |journal=Journal of the American Medical Informatics Association |author=Patton, Gregory A., Gardner, Reed M. |volume=6 |issue=6 |pages=457–65 |year=1999 |pmid=10579604 |pmc=61389}}</ref>, 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.<ref name="APLISReview">{{cite journal |url=http://ebookbrowse.com/anatomic-pathology-laboratory-information-systems-a-review-slpark-et-all-adv-anat-pathol-2012-pdf-d344405134 |journal=Advances in Anatomic Pathology |year=March 2012 |volume=19 |issue=2 |page=81–96 |title=Anatomic Pathology Laboratory Information Systems: A Review |author=Park, Seung Lyung; Pantanowitz, Liron; Sharma, Guarav; Parwani, Anil Vasdev |doi=10.1097/PAP.0b013e318248b787 |accessdate=03 June 2013}}</ref><ref name="MileCompSci">{{cite book |url=http://books.google.com/books?id=JTYPKxug49IC |title=Milestones in Computer Science and Information Technology |author=Reilly, Edwin D. |publisher=Greenwood Publishing Group |year=2003 |pages=161 |isbn=9781573565219}}</ref> 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.<ref name="HistMedInfo">{{cite book |url=http://books.google.com/books/about/A_History_of_medical_informatics.html?id=AR5rAAAAMAAJ |title=A History of Medical Informatics |author=Blum, Bruce I.; Duncan, Karen A. |publisher=ACM Press |year=1990 |pages=141–53 |isbn=0201501287}}</ref> 
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.<ref name="PractPathInfo">{{cite book |url=http://books.google.com/books?id=WerUyK618fcC |title=Practical Pathology Informatics: Demstifying Informatics for the Practicing Anatomic Pathologist |author=Sinard, John H. |publisher=Springer |year=2006 |pages=393 |isbn=0387280588}}</ref> {{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.<ref name="OverBarEMR">{{cite journal |url=http://jhi.sagepub.com/content/16/4/306.abstract |journal=Health Informatics Journal |year=December 2010 |volume=16 |issue=4 |title=Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study |author=Kumar, Sameer; Aldrich, Krista |doi=10.1177/1460458210380523 |accessdate=03 June 2013}}</ref> [[Software as a service|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.<ref name="APLISReview" />
===Americas===
====Argentina====
====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.
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.
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====United States====
====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 record]]s (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.<ref>Certification Commission for Healthcare Information Technology (July 18, 2006): [http://www.cchit.org/media/press+releases/CCHIT+Announces+First+Certified+Electronic+Health+Record+Products.htm CCHIT Announces First Certified Electronic Health Record Products]. Retrieved July 26, 2006.</ref>
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.<ref name="univ" /> 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.<ref name="Ledley">{{cite journal |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1561796/ |title=The Story Behind the Development of the First Whole-body Computerized Tomography Scanner as Told by Robert S. Ledley |author=Sittig, Dean F.; Ash, Joan S.; Ledley, Robert S. |journal=Journal of the American Medical Informatics Association |volume=13 |issue=5 |pages=465–9 |year=2006 |pmid=16799115 |pmc=1561796 |doi=10.1197/jamia.M2127}}</ref>
 
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<ref name="MedInfoEd">{{cite journal |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC61389/ |title=Medical Informatics Education: The University of Utah Experience |journal=Journal of the American Medical Informatics Association |author=Patton, Gregory A., Gardner, Reed M. |volume=6 |issue=6 |pages=457–65 |year=1999 |pmid=10579604 |pmc=61389}}</ref>, 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.<ref name="APLISReview">{{cite journal |url=http://ebookbrowse.com/anatomic-pathology-laboratory-information-systems-a-review-slpark-et-all-adv-anat-pathol-2012-pdf-d344405134 |journal=Advances in Anatomic Pathology |year=March 2012 |volume=19 |issue=2 |page=81–96 |title=Anatomic Pathology Laboratory Information Systems: A Review |author=Park, Seung Lyung; Pantanowitz, Liron; Sharma, Guarav; Parwani, Anil Vasdev |doi=10.1097/PAP.0b013e318248b787 |accessdate=03 June 2013}}</ref><ref name="MileCompSci">{{cite book |url=http://books.google.com/books?id=JTYPKxug49IC |title=Milestones in Computer Science and Information Technology |author=Reilly, Edwin D. |publisher=Greenwood Publishing Group |year=2003 |pages=161 |isbn=9781573565219}}</ref> 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.<ref name="HistMedInfo">{{cite book |url=http://books.google.com/books/about/A_History_of_medical_informatics.html?id=AR5rAAAAMAAJ |title=A History of Medical Informatics |author=Blum, Bruce I.; Duncan, Karen A. |publisher=ACM Press |year=1990 |pages=141–53 |isbn=0201501287}}</ref> 
 
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.<ref name="PractPathInfo">{{cite book |url=http://books.google.com/books?id=WerUyK618fcC |title=Practical Pathology Informatics: Demstifying Informatics for the Practicing Anatomic Pathologist |author=Sinard, John H. |publisher=Springer |year=2006 |pages=393 |isbn=0387280588}}</ref> {{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.<ref name="OverBarEMR">{{cite journal |url=http://jhi.sagepub.com/content/16/4/306.abstract |journal=Health Informatics Journal |year=December 2010 |volume=16 |issue=4 |title=Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study |author=Kumar, Sameer; Aldrich, Krista |doi=10.1177/1460458210380523 |accessdate=03 June 2013}}</ref> [[Software as a service|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.<ref name="APLISReview" />


===Europe===
===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 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.<ref>[http://ec.europa.eu/information_society/activities/health/policy_action_plan/index_en.htm European eHealth Action Plan]</ref><ref>[http://ec.europa.eu/information_society/eeurope/i2010/index_en.htm European eHealth Action Plan i2010]</ref> The European Institute for Health Records is involved in the promotion of high quality [[electronic health record]] systems in the European Union.<ref>{{cite web|title=Electronic Health Records for Europe|year=2005|url=http://www.esa.int/esaMI/Telemedicine_Alliance/SEMWC7SMD6E_0.html|publisher=European Space Agency|accessdate=2009-01-13}}</ref>
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.<ref>[http://ec.europa.eu/information_society/activities/health/policy_action_plan/index_en.htm European eHealth Action Plan]</ref><ref>[http://ec.europa.eu/information_society/eeurope/i2010/index_en.htm European eHealth Action Plan i2010]</ref> The European Institute for Health Records is involved in the promotion of high quality [[electronic health record]] systems in the European Union.<ref>{{cite web|title=Electronic Health Records for Europe|year=2005|url=http://www.esa.int/esaMI/Telemedicine_Alliance/SEMWC7SMD6E_0.html|publisher=European Space Agency|accessdate=2009-01-13}}</ref>
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The European Commission's preference, as exemplified in the 5th Framework<ref>[http://cordis.europa.eu/fp5/ Cordis FP5web]</ref> as well as currently pursued pilot projects,<ref>[http://www.epsos.eu European Patient Smart Open Services]</ref> is for Free/Libre and Open Source Software (FLOSS) for healthcare.
The European Commission's preference, as exemplified in the 5th Framework<ref>[http://cordis.europa.eu/fp5/ Cordis FP5web]</ref> as well as currently pursued pilot projects,<ref>[http://www.epsos.eu European Patient Smart Open Services]</ref> is for Free/Libre and Open Source Software (FLOSS) for healthcare.


===Asia and Oceania===
===Health informatics in Asia and Oceania===
In Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI)<ref>{{Cite web |url=http://www.apami.org |title=Asia Pacific Association of Medical Informatics}}</ref> was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.
In Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI)<ref>{{Cite web |url=http://www.apami.org |title=Asia Pacific Association of Medical Informatics}}</ref> was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.


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====New Zealand====
====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.<ref>{{cite web|url=http://homepages.mcs.vuw.ac.nz/~peterk/healthinformatics/tec-hi-report-06.pdf|title=Health Informatics Capability Development In New Zealand - A Report to the Tertiary Education Commission|author=Karolyn Kerr|coauthors=Rowena Cullen, Jan Duke, Alec Holt, Ray Kirk, Peter Komisarczuk, Jim Warren and Shona Wilson|year=2006|accessdate=2009-01-08}}</ref> Health Informatics New Zealand (HINZ)([http://www.hinz.org.nz www.hinz.org.nz]), is the national organisation that advocates for Health Informatics. HINZ organises a conference every year and also publishes an online journal- Healthcare Informatics Review Online [http://www.hinz.org.nz/journal www.hinz.org.nz/journal].
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.<ref>{{cite web|url=http://homepages.mcs.vuw.ac.nz/~peterk/healthinformatics/tec-hi-report-06.pdf|title=Health Informatics Capability Development In New Zealand - A Report to the Tertiary Education Commission|author=Karolyn Kerr|coauthors=Rowena Cullen, Jan Duke, Alec Holt, Ray Kirk, Peter Komisarczuk, Jim Warren and Shona Wilson|year=2006|accessdate=2009-01-08}}</ref> Health Informatics New Zealand (HINZ)([http://www.hinz.org.nz www.hinz.org.nz]), is the national organisation that advocates for Health Informatics. HINZ organises a conference every year and also publishes an online journal- Healthcare Informatics Review Online [http://www.hinz.org.nz/journal www.hinz.org.nz/journal].
===Health informatics in the Middle East===


====Saudi Arabia====
====Saudi Arabia====
The Saudi Association for Health Information (SAHI) was established in 2006<ref>{{cite web|url=http://www.imia.org/members/profiles/national.lasso?-Search=Action&-Table=CGI&-MaxRecords=1&-SkipRecords=27&-Database=organizations&-KeyField=Internal%20Record%20ID&-SortField=country&-SortOrder=ascending&-SortField=country&-SortOrder=ascending&type=national&type=national |title=Medical Pharmaceutical Information Association (MedPharmInfo) |publisher=Imia.org |date=2008-05-18 |accessdate=2010-07-29}}</ref> 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.<ref>{{Cite web|url=http://www.sahi.org.sa/objectives.php| title= Saudi Association for Health Informatics (SAHI)| work=www.sahi.org.sa/}}</ref>
The Saudi Association for Health Information (SAHI) was established in 2006<ref>{{cite web|url=http://www.imia.org/members/profiles/national.lasso?-Search=Action&-Table=CGI&-MaxRecords=1&-SkipRecords=27&-Database=organizations&-KeyField=Internal%20Record%20ID&-SortField=country&-SortOrder=ascending&-SortField=country&-SortOrder=ascending&type=national&type=national |title=Medical Pharmaceutical Information Association (MedPharmInfo) |publisher=Imia.org |date=2008-05-18 |accessdate=2010-07-29}}</ref> 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.<ref>{{Cite web|url=http://www.sahi.org.sa/objectives.php| title= Saudi Association for Health Informatics (SAHI)| work=www.sahi.org.sa/}}</ref>
==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.


==Regulation and standards==
==Regulation and standards==
The international standards on the subject are covered by ICS 35.240.80<ref name=itah>{{cite web| title = 35.240.80: IT applications in health care technology| publisher = ISO| url = http://www.iso.org/iso/products/standards/catalogue_ics_browse.htm?ICS1=35&ICS2=240&ICS3=80&| accessdate = 2008-06-15}}</ref> in which ISO 27799:2008 is one of the core components.<ref name=isosm>{{cite web| last = Fraser| first = Ross| title = ISO 27799: Security management in health using ISO/IEC 17799| url = http://sl.infoway-inforoute.ca/downloads/Ross_Fraser_-_ISO_27799.pdf| accessdate = 2008-06-15 }}</ref>
The international standards on the subject are covered by ICS 35.240.80<ref name=itah>{{cite web| title = 35.240.80: IT applications in health care technology| publisher = ISO| url = http://www.iso.org/iso/products/standards/catalogue_ics_browse.htm?ICS1=35&ICS2=240&ICS3=80&| accessdate = 2008-06-15}}</ref> in which ISO 27799:2008 is one of the core components.<ref name=isosm>{{cite web| last = Fraser| first = Ross| title = ISO 27799: Security management in health using ISO/IEC 17799| url = http://sl.infoway-inforoute.ca/downloads/Ross_Fraser_-_ISO_27799.pdf| accessdate = 2008-06-15 }}</ref>
===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 record]]s (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.<ref>Certification Commission for Healthcare Information Technology (July 18, 2006): [http://www.cchit.org/media/press+releases/CCHIT+Announces+First+Certified+Electronic+Health+Record+Products.htm CCHIT Announces First Certified Electronic Health Record Products]. Retrieved July 26, 2006.</ref>


==Clinical Informatics==
==Clinical Informatics==
Clinical Informatics is concerned with use information in health care by clinicians.<ref>{{cite journal |author=Gardner RM, Overhage JM, Steen EB, ''et al.'' |title=Core content for the subspecialty of clinical informatics |journal=Journal of the American Medical Informatics Association |volume=16 |issue=2 |pages=153–7 |year=2009 |pmid=19074296 |pmc=2649328 |doi=10.1197/jamia.M3045}}</ref><ref>{{cite journal |author=Safran C, Shabot MM, Munger BS, ''et al.'' |title=Program requirements for fellowship education in the subspecialty of clinical informatics |journal=Journal of the American Medical Informatics Association |volume=16 |issue=2 |pages=158–66 |year=2009 |pmid=19074295 |pmc=2649323 |doi=10.1197/jamia.M3046}}</ref>
Clinical informatics is concerned with use information in health care by clinicians.<ref>{{cite journal |author=Gardner RM, Overhage JM, Steen EB, ''et al.'' |title=Core content for the subspecialty of clinical informatics |journal=Journal of the American Medical Informatics Association |volume=16 |issue=2 |pages=153–7 |year=2009 |pmid=19074296 |pmc=2649328 |doi=10.1197/jamia.M3045}}</ref><ref>{{cite journal |author=Safran C, Shabot MM, Munger BS, ''et al.'' |title=Program requirements for fellowship education in the subspecialty of clinical informatics |journal=Journal of the American Medical Informatics Association |volume=16 |issue=2 |pages=158–66 |year=2009 |pmid=19074295 |pmc=2649323 |doi=10.1197/jamia.M3046}}</ref>


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 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.

Revision as of 17:27, 30 October 2013

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 October 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 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 shows an heterogeneous stage. Lot of private Health Care center have developed systems, as the German Hospital of Buenos Aires who was one of the first in develop the 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 amd 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.

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 electronic health record (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.[10]

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.[11]
  • 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

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.[12]

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[13], 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.[14][15] 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.[16]

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.[17] 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.[18] 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.[14]

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 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.[19][20] The European Institute for Health Records is involved in the promotion of high quality electronic health record systems in the European Union.[21]

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".[16] 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.[citation needed] Discussion of open sourcing it as a remedy is occurring. 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). In 2002, the idea of a profession of health informatics across the UK was first mooted and by 2004 a voluntary open register was established. The UK Council for Health Informatics Professions (UKCHIP) now 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. In 2011, self-assessment tools were introduced for use by any interested party. In addition, the principles and UKCHIP model are being considered internationally (as at 2011). UKCHIP certification is being considered for regulatory purposes. In conjunction with workforce development tools such as the NHS HI Career Framework it is possible for individuals to compare their skills against typical job roles, determine their professional level, and for employers to carry out detailed workforce analysis to meet the emerging requirements of the informatics strategies of all the home countries.

The European Commission's preference, as exemplified in the 5th Framework[22] as well as currently pursued pilot projects,[23] is for Free/Libre and Open Source Software (FLOSS) for healthcare.

Health informatics in Asia and Oceania

In Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI)[24] 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.[25] Founded in 2002, ACHI is increasingly valued[26] 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)[27] and a full member of the Australian Council of Professions.[28] ACHI is a sponsor of the "e-Journal for Health Informatics",[29] an indexed and peer-reviewed professional journal. ACHI has also supported the "Australian Health Informatics Education Council" (AHIEC) since its founding in 2009.[30]

Although there are a number of health informatics organisations in Australia, the Health Informatics Society of Australia[31] (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[32] 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.[33]

India

Religare Technova IT solutions is attempting a new service to improve the healthcare information system in India.

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.[34] Health Informatics New Zealand (HINZ)(www.hinz.org.nz), is the national organisation that advocates for Health Informatics. HINZ organises a conference every year and also publishes an online journal- Healthcare Informatics Review Online www.hinz.org.nz/journal.

Health informatics in the Middle East

Saudi Arabia

The Saudi Association for Health Information (SAHI) was established in 2006[35] 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.[36]

Regulation and standards

The international standards on the subject are covered by ICS 35.240.80[37] in which ISO 27799:2008 is one of the core components.[38]

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.[39]

Clinical Informatics

Clinical informatics is concerned with use information in health care by clinicians.[40][41]

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.[42][43][44]

See also

Standards/frameworks and governance

  • Health Metrics Network
  • HL7
  • LOINC
  • Omaha System
  • openEHR

References

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  19. European eHealth Action Plan
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  22. Cordis FP5web
  23. European Patient Smart Open Services
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External links