Health informatics
Encyclopedia
.
Health 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 acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools
include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health, occupational therapy, and (bio)medical research.
Early names for health informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software
engineering, and medical computer technology.
The health informatics community is still growing, it is by no means a mature profession, but work in the UK by the voluntary registration body, the UK Council of Health Informatics Professions has suggested eight key constituencies within the domain - information management, knowledge management, portfolio/programme/project management, ICT, education and research, clinical informatics, health records(service and business-related), health informatics service management. These constituencies accommodate professionals in and for the NHS, in academia and commercial service and solution providers.
Since the 1970s the most prominent international coordinating body has been the International Medical Informatics Association
(IMIA).
The earliest use of computation for medicine was for dental
projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.
The next step in the mid 1950s were the development of expert systems such as MYCIN
and Internist-I
. In 1965, the National Library of Medicine started to use MEDLINE
and MEDLARS. At this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS
(Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science at Massachusetts General Hospital
in Boston
. In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS
operating system was used to support MUMPS language specifications. , a descendent of this system is being used in the United States
Veterans Affairs
hospital system. The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA)
. A graphical user interface
known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 health care facilities.
In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exist, only a small number of health practitioners use fully featured electronic health care records systems.
Homer R. Warner
, one of the fathers of medical informatics, founded the Department of Medical Informatics at the University of Utah
in 1968. The American Medical Informatics Association
(AMIA) has an award named after him on application of informatics to medicine.
"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).
Its purposes are:
The Argentinian health system is very heterogeneous, because of that the informatics developments show a heterogeneous stage. Lots of private Health Care center have developed systems, such as the German Hospital of Buenos Aires, which was one of the first in developing an electronic health records system.
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 and other applications. In the early 1980s
, with the arrival of cheaper microcomputer
s, 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.
was created in 2001 to foster the development and adoption of electronic health records across Canada. As of December 31, 2008 there were 276 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.
Provincial and territorial programmes include the following:
(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.
is involved in the promotion of high quality electronic health record
systems in the European Union
.
) operate for those 'in and for' all the home countries and beyond.
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. Discussion of open sourcing it as a remedy is occurring.
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.
Accreditation of the service organisations that provide health informatics support to NHS operational units involves an NHS Benchmarking Club.
(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. Founded in 2002, ACHI is increasingly valued for its thought leader
ship, its trusted advisors and national and international experts in Health Informatics. ACHI is an academic institutional member of the International Medical Informatics Association
(IMIA) and a full member of the Australian Council of Professions.
ACHI is a sponsor of the "e-Journal for Health Informatics", an indexed and peer-reviewed professional journal. ACHI has also supported the "Australian Health Informatics Education Council
" (AHIEC) since its founding in 2009.
Although there are a number of health informatics organisations 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 (Conrick, 2006).
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 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.
by clinicians.
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:
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.
Information science
-Introduction:Information science is an interdisciplinary science primarily concerned with the analysis, collection, classification, manipulation, storage, retrieval and dissemination of information...
, computer science
Computer science
Computer science or computing science is the study of the theoretical foundations of information and computation and of practical techniques for their implementation and application in computer systems...
, and health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
. It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools
Health informatics tools
To provide the safe and effective delivery of medical care, virtually all clinical staff use a number of front-line Health Informatics Tools in their day-to-day operations. The need for standardization and refined development of these tools is underscored by the HITECH act and other efforts to...
include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health, occupational therapy, and (bio)medical research.
- The international standards on the subject are covered by ICS 35.240.80 in which ISO 27799ISO 27799ISO 27799 is an information security standard developed by the International Organization for Standardization . Its title is Health informatics -- Information security management in health using ISO/IEC 27002...
:2008 is one of the core components. - Molecular bioinformaticsBioinformaticsBioinformatics is the application of computer science and information technology to the field of biology and medicine. Bioinformatics deals with algorithms, databases and information systems, web technologies, artificial intelligence and soft computing, information and computation theory, software...
and clinical informatics have converged into the field of translational bioinformatics.
History
World wide use of technology in medicine began in the early 1950s with the rise of the computers. In 1949, Gustav Wager established the first professional organization for informatics in Germany. The prehistory, history, and future of medical information and health information technology are discussed in reference. 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. 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.Early names for health informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software
Medical software
In computers, medical software is a significant branch of software engineering. Many medical devices that monitor or control patients are predominantly controlled by software. Medical devices are frequently regulated and must comply with local and regional laws. In the European Union, these...
engineering, and medical computer technology.
The health informatics community is still growing, it is by no means a mature profession, but work in the UK by the voluntary registration body, the UK Council of Health Informatics Professions has suggested eight key constituencies within the domain - information management, knowledge management, portfolio/programme/project management, ICT, education and research, clinical informatics, health records(service and business-related), health informatics service management. These constituencies accommodate professionals in and for the NHS, in academia and commercial service and solution providers.
Since the 1970s the most prominent international coordinating body has been the International Medical Informatics Association
International Medical Informatics Association
IMIA or the International Medical Informatics Association is an independent organisation that plays a role in promoting and furthering the application of information science in modern society, particularly in the fields of healthcare, bioscience and medicine. It was established in 1967 as a...
(IMIA).
Medical informatics in the 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.The earliest use of computation for medicine was for dental
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.
The next step in the mid 1950s were the development of expert systems such as MYCIN
Mycin
In artificial intelligence, MYCIN was an early expert system designed to identify bacteria causing severe infections, such as bacteremia and meningitis, and to recommend antibiotics, with the dosage adjusted for patient's body weight — the name derived from the antibiotics themselves, as many...
and Internist-I
Internist-I
INTERNIST-I was a broad-based computer-assisted diagnostic tool developed in the early 1970s at the University of Pittsburgh as an educational experiment. The system was designed to capture the expertise of just one man, Jack D. Myers, MD, chairman of internal medicine in the University of...
. In 1965, the National Library of Medicine started to use MEDLINE
MEDLINE
MEDLINE is a bibliographic database of life sciences and biomedical information. It includes bibliographic information for articles from academic journals covering medicine, nursing, pharmacy, dentistry, veterinary medicine, and health care...
and MEDLARS. At this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS
MUMPS
MUMPS , or alternatively M, is a programming language created in the late 1960s, originally for use in the healthcare industry. It was designed for the production of multi-user database-driven applications...
(Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science at Massachusetts General Hospital
Massachusetts General Hospital
Massachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...
in Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
. In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS
MUMPS
MUMPS , or alternatively M, is a programming language created in the late 1960s, originally for use in the healthcare industry. It was designed for the production of multi-user database-driven applications...
operating system was used to support MUMPS language specifications. , a descendent of this system is being used in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
Veterans Affairs
United States Department of Veterans Affairs
The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
hospital system. The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA)
VistA
The Veterans Health Information Systems and Technology Architecture is an enterprise-wide information system built around an Electronic Health Record , used throughout the United States Department of Veterans Affairs medical system, known as the Veterans Health Administration .It's a collection...
. A graphical user interface
Graphical user interface
In computing, a graphical user interface is a type of user interface that allows users to interact with electronic devices with images rather than text commands. GUIs can be used in computers, hand-held devices such as MP3 players, portable media players or gaming devices, household appliances and...
known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 health care facilities.
In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exist, only a small number of health practitioners use fully featured electronic health care records systems.
Homer R. Warner
Homer R. Warner
Dr Homer R. Warner is one of the fathers of medical informatics.He has pioneered many aspects of computer applications to medicine. Author of the book, Computer-Assisted Medical Decision-Making, published in 1979, he served as CIO for the University’s Health Sciences Center, as president of the...
, one of the fathers of medical informatics, founded the Department of Medical Informatics at the University of Utah
University of Utah
The University of Utah, also known as the U or the U of U, is a public, coeducational research university in Salt Lake City, Utah, United States. The university was established in 1850 as the University of Deseret by the General Assembly of the provisional State of Deseret, making it Utah's oldest...
in 1968. The American Medical Informatics Association
American Medical Informatics Association
AMIA, formerly known as the American Medical Informatics Association, is an American non-profit organization dedicated to the development and application of biomedical and health informatics in the support of patient care, teaching, research, and health care administration.- History :AMIA is the...
(AMIA) has an award named after him on application of informatics to medicine.
Medical informatics in the UK
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).
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 show a heterogeneous stage. Lots of private Health Care center have developed systems, such as the German Hospital of Buenos Aires, which was one of the first in developing an 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 1130IBM 1130
The IBM 1130 Computing System was introduced in 1965. It was IBM's least-expensive computer to date, and was aimed at price-sensitive, computing-intensive technical markets like education and engineering. It succeeded the IBM 1620 in that market segment. The IBM 1800 was a process control variant...
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
Hospital das Clínicas da Universidade de São Paulo
The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo is a complex of health institutions, located in various regions of the city of São Paulo, Brazil...
, respectively at the cities of Ribeirão Preto
Ribeirão Preto
Ribeirão Preto is a municipality and city in the Northeastern region of the state of São Paulo in Brazil. It is nicknamed Brazilian California, because of a combination of an economy based on agrobusiness plus high technology, wealth and sunny weather all year long. With 605,114 inhabitants,...
and São Paulo
São Paulo
São Paulo is the largest city in Brazil, the largest city in the southern hemisphere and South America, and the world's seventh largest city by population. The metropolis is anchor to the São Paulo metropolitan area, ranked as the second-most populous metropolitan area in the Americas and among...
campi of the University of São Paulo
University of São Paulo
Universidade de São Paulo is a public university in the Brazilian state of São Paulo. It is the largest Brazilian university and one of the country's most prestigious...
. 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
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...
diagnostics, patient monitoring and other applications. In the early 1980s
1980s
File:1980s decade montage.png|thumb|400px|From left, clockwise: The first Space Shuttle, Columbia, lifted off in 1981; American President Ronald Reagan and Soviet leader Mikhail Gorbachev eased tensions between the two superpowers, leading to the end of the Cold War; The Fall of the Berlin Wall in...
, with the arrival of cheaper microcomputer
Microcomputer
A microcomputer is a computer with a microprocessor as its central processing unit. They are physically small compared to mainframe and minicomputers...
s, a great upsurge of computer applications in health ensued, and in 1986 the Brazilian Society of Health Informatics
Brazilian Society of Health Informatics
The Sociedade Brasileira de Informática em Saúde The Sociedade Brasileira de Informática em Saúde The Sociedade Brasileira de Informática em Saúde (Brazilian Society of Health Informatics in Portuguese, abbreviated as SBIS is a professional society created in November 1986 in Campinas, during the...
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 InfowayCanada Health Infoway
Canada Health Infoway is an independent, federally-funded, not-for-profit organization tasked with accelerating the development of electronic health records across Canada. As a strategic investor, they work with Canadian provinces and territories with the goal of creating an electronic health...
was created in 2001 to foster the development and adoption of electronic health records across Canada. As of December 31, 2008 there were 276 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.
Provincial and territorial programmes include the following:
- eHealth OntarioEHealth OntarioeHealth Ontario is the agency tasked with facilitating the development of Ontario's proposed public Electronic Health Record system. Health Informatics in Canada is run provincially, with different provinces creating different systems, albeit sometimes under voluntary Pan-Canadian guidelines...
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. - Alberta NetcareAlberta NetcareAlberta Netcare is the province of Alberta's public Electronic Health Record.-Users:There are three main categories of Netcare users:* Health service providers * Diagnostic laboratories...
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
In 2004 the U.S. Department of Health and Human Services (HHS) formed the Office of the National Coordinator for Health Information TechnologyOffice of the National Coordinator for Health Information Technology
The Office of the National Coordinator for Health Information Technology is a staff division of the Office of the Secretary, within the U.S. Department of Health and Human Services...
(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
Quality improvement organizations
Quality Improvement Organizations monitor the appropriateness, effectiveness, and quality of care provided to Medicare beneficiaries. They are private contractor extensions of the federal government that work under the auspices of the U.S...
for more information on federal initiatives in this area.
The Certification Commission for Healthcare Information Technology
Certification Commission for Healthcare Information Technology
The Certification Commission for Health Information Technology is an independent, 5013 nonprofit organization with the public mission of accelerating the adoption of robust, interoperable health 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
Electronic Health Record
An electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
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.
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. The European Institute for Health RecordsEuropean Institute for Health Records
The European Institute for Health Records or EuroRec Institute is a non-profit organization founded in 2002 as part of the ProRec initiative. On 13 May 2003, the institute was established as a non-profit organization under French law. Current President of EuroRec is Prof. Georges De Moor...
is involved in the promotion of high quality electronic health record
Electronic Health Record
An electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
systems in the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
.
UK
There are different models of health informatics delivery in each of the home countries (England, Scotland, Northern Ireland and Wales) but some bodies like UKCHIP (see below) operate for those 'in and for' all the home countries and beyond.
England
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. Discussion of open sourcing it as a remedy is occurring.
UK Council for Health Informatics Professions
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.
Accreditation of the service organisations that provide health informatics support to NHS operational units involves an NHS Benchmarking Club.
Emerging Direction (European R&D)
The European Commission's preference, as exemplified in the 5th Framework as well as currently pursued pilot projects, is for Free/Libre and Open Source Software (FLOSS) for healthcare.Asia and Oceania
In Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI) was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.Australia
The Australasian College of Health InformaticsAustralasian College of Health Informatics
The Australasian College of Health Informatics is the professional body for health informatics in the Asia-Pacific region.It consists of credentialed fellows and members as well as associate and student members. The college is an academic institutional member of the International Medical...
(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. Founded in 2002, ACHI is increasingly valued for its thought leader
Thought leader
Thought leader is business jargon for an entity that is recognized for having innovative ideas.The term was coined in 1994 by Joel Kurtzman, editor-in-chief of the Booz Allen Hamilton magazine, Strategy & Business. "Thought leader" was used to designate interview subjects for that magazine who had...
ship, its trusted advisors and national and international experts in Health Informatics. ACHI is an academic institutional member of the International Medical Informatics Association
International Medical Informatics Association
IMIA or the International Medical Informatics Association is an independent organisation that plays a role in promoting and furthering the application of information science in modern society, particularly in the fields of healthcare, bioscience and medicine. It was established in 1967 as a...
(IMIA) and a full member of the Australian Council of Professions.
ACHI is a sponsor of the "e-Journal for Health Informatics", an indexed and peer-reviewed professional journal. ACHI has also supported the "Australian Health Informatics Education Council
Australian Health Informatics Education Council
The Australian Health Informatics Education Council is the peak forum for the coordination of Health Informatics education in Australia.The Council includes the major stakeholders in health informatics education in Australia, including the senior e-health organisations, universities, etc...
" (AHIEC) since its founding in 2009.
Although there are a number of health informatics organisations in Australia, the Health Informatics Society of Australia
Health Informatics Society of Australia
The Health Informatics Society of Australia Ltd is a scientific society, established in 1992, for health informaticians and those with an interest in health informatics....
(HISA) is regarded as the major umbrella group and is a member of the International Medical Informatics Association
International Medical Informatics Association
IMIA or the International Medical Informatics Association is an independent organisation that plays a role in promoting and furthering the application of information science in modern society, particularly in the fields of healthcare, bioscience and medicine. It was established in 1967 as a...
(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).
Hong Kong
In Hong KongHong Kong
Hong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...
a computerized patient record system called the Clinical Management System (CMS) has been developed by the Hospital Authority
Hospital Authority
The Hospital Authority is a statutory body managing all the public hospitals and institutes in Hong Kong. It is managed by the Hospital Authority Board and is under the monitor of the Secretary for Food and Health of the Hong Kong Government. Its chairman is Mr...
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
Governance
Governance is the act of governing. It relates to decisions that define expectations, grant power, or verify performance. It consists of either a separate process or part of management or leadership processes...
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 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
Hong Kong Society of Medical Informatics
The Hong Kong Society of Medical Informatics, founded in April 1987 by a group of medical practitioners and informatics professionals with special interests in medical informatics and computing and communications....
(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.
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. 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.Saudi Arabia
The Saudi Association for Health Information (SAHI) was established in 2006 to work under direct supervision of King Saud Bin Abdulaziz University for Health Sciences to practice public activities, develop theoretical and applicable knowledge, and provide scientific and applicable studies.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.Clinical Informatics
Clinical Informatics is concerned with the use of information in health careHealth care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
by clinicians.
Clinical
Clinical research
Clinical research is a branch of medical science that determines the safety and effectiveness of medications, devices, diagnostic products and treatment regimens intended for human use...
informaticians transform health care by analyzing, designing, implementing, and evaluating information
Information
Information in its most restricted technical sense is a message or collection of messages that consists of an ordered sequence of symbols, or it is the meaning that can be interpreted from such a message or collection of messages. Information can be recorded or transmitted. It can be recorded as...
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
Health informatics tools
To provide the safe and effective delivery of medical care, virtually all clinical staff use a number of front-line Health Informatics Tools in their day-to-day operations. The need for standardization and refined development of these tools is underscored by the HITECH act and other efforts to...
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
Health informatics tools
To provide the safe and effective delivery of medical care, virtually all clinical staff use a number of front-line Health Informatics Tools in their day-to-day operations. The need for standardization and refined development of these tools is underscored by the HITECH act and other efforts to...
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.Leading health informatics and medical informatics journals
Related concepts
- BioinformaticsBioinformaticsBioinformatics is the application of computer science and information technology to the field of biology and medicine. Bioinformatics deals with algorithms, databases and information systems, web technologies, artificial intelligence and soft computing, information and computation theory, software...
- Continuity of care recordContinuity of Care RecordContinuity of Care Record is a health record standard specification developed jointly by ASTM International, the Massachusetts Medical Society , the Healthcare Information and Management Systems Society , the American Academy of Family Physicians , the American Academy of Pediatrics , and other...
(CCR) - eHealthEHealtheHealth is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999...
- Electronic health recordElectronic Health RecordAn electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
(EHR) - Electronic medical recordElectronic medical recordAn electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
(EMR) - Health information exchange (HIE)
- Health information managementHealth Information ManagementHealth information management is the practice of maintenance and care of health records by traditional and electronic means in hospitals, physician's office clinics, health departments, health insurance companies, and other facilities that provide health care or maintenance of health records...
(HIM) - Hospital information systemHospital information systemThere are various titles and acronyms which all declare similar approaches to managing the information flow and storage in hospital routine services, as*Hospital Information System , or*Healthcare Information System, or...
- Human resources for health (HRH) information systemHRHISA “Human Resource for Health Information System” — also known within the health care sector as “human resource information system” — is a system for collecting, processing, managing and disseminating data and information on human resource for health...
- Personal health recordPersonal health recordA personal health record or PHR is a health record where health data is curated by an individual user themselves. This stands in contrast with the more widely used electronic medical record which is held by institutions such as a hospital and contains data entered by clinicians or billing data in...
(PHR)
Standards/frameworks and governance
- Health Metrics NetworkHealth Metrics NetworkThe Health Metrics Network is a global partnership that facilitates better health information at country, regional and global levels. The Network was formally launched in May 2005 during the 58th session of the...
- HL7
- LOINCLOINCLogical Observation Identifiers Names and Codes is a database and universal standard for identifying medical laboratory observations. It was developed and is maintained by the Regenstrief Institute, a US non-profit medical research organization, in 1994...
- Omaha SystemOmaha SystemThe Omaha System is a standardized health care terminology consisting of an assessment component , an intervention component , and an outcomes component...
- openEHROpenehropenEHR is an open standard specification in health informatics that describes the management and storage, retrieval and exchange of health data in electronic health records . In openEHR, all health data for a person is stored in a "one lifetime", vendor-independent, person-centred EHR...
- SNOMED
External links
- Australasian College of Health Informatics
- e-Journal for Health Informatics
- Article about informatics
- UK Council for Health Informatics Professions, its principles, code and standards
- Healthcare Informatics Magazine
- Willison, Brian. Advancing Meaningful Use: Simplifying Complex Clinical Metrics Through Visual Representation.
- Clinfowiki
- The Informatics Review
- Global Health Informatics Partnership