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Health Informatics E.J.S. Hovenga et al. (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved. doi:10.3233/978-1-60750-476-4-9 9 2. Health Informatics – An Introduction Evelyn.J.S.HOVENGA1, RN, PhD (UNSW), FACHI, FACSa, Michael R KIDD, MBBS, MD, DCCH, DipRACOG, FRACGP, FACHI, FAFPM (Hon), FHKCFP (Hon), FRNZCGP (Hon), MAICDb, Sebastian GARDE Dr. sc. hum., Dipl.-Inform. Med., FACHIc, Carola HULLIN LUCAY COSSIO RN, BN, Hons, PhD (Melb.Uni)d a Director, eHealth Education, Consultant, openEHR Foundation, and Honorary Senior Research Associate, Centre for Health Informatics & Multiprofessional Education, University College London, Honorary Academic Fellow, Austin Health, Melbourne, Adjunct Professor, Central Queensland University Rockhampton, Queensland, and Victoria University, Melbourne, Australia b Executive Dean, Faculty of Health Sciences, Flinders University, Australia c Senior Developer, Ocean Informatics, Düsseldorf, Germany d Co-Founder eHealth Systems, Santiago, Chile, Melbourne, Australia Abstract. This chapter gives an educational overview of: • the scope of the health informatics discipline • health informatics and e-health definitions • health informatics professional networks • potential benefits of applying health informatics technologies Keywords. Medical Informatics, Information Systems, Health, Computer Systems, Knowledge Introduction Health Informatics is a highly interdisciplinary field that may be defined as “an evolving scientific discipline that deals with the collection, storage, retrieval, communication and optimal use of health related data, information and knowledge. The discipline utilises the methods and technologies of the information sciences for the purposes of problem solving, decision making and assuring highest quality health care in all basic and applied areas of the biomedical sciences” . 1. eHealth The term e-health only came into widespread usage a few years ago at the turn of the century. It was preceded by telemedicine, teleradiology or telehealth. As this became more common place most people realised that telemedicine or telehealth was simply 1 Corresponding Author: firstname.lastname@example.org 10 E.J.S. Hovenga et al. / Health Informatics – An Introduction about the delivery of health care via the use of telecommunications. With rapid advances and the convergence of these technologies with information technologies these terms became obsolete. There is no agreed definition for e-health, yet this term is widely used by many. Oh et al.  undertook a systematic review of 1209 abstracts and 430 citations and found 10 different definitions for the term eHealth, and from a Google search an additional 41 unique definitions were located ranging in length from 3 to 74 words. The most common universal themes were health and technology. In addition 6 less frequently mentioned themes emerged: commerce, stakeholders, outcomes, place and perspectives. The word Internet was mentioned in 27 of the 51 definitions and only one definition included the term integration. The adoption of technologies to better manage health information and communication within a nation’s health industry enables significant productivity and efficiency improvements to be achieved. It enables the provision of a more effective and efficient health workforce who are thus enabled to provide higher quality, safer and more accessible care in multiple locations producing better health outcomes. The adoption of health informatics or e-health is simply a requirement of doing business in 21st century healthcare . This requires educational organizations to build the necessary workforce capacity so that these technologies can be developed, implemented and used optimally. 2. Health Informatics Discipline The discipline of health informatics has arisen from the earlier established science of medical informatics   . The field of health informatics is very extensive. For example at the twelfth’s world congress on medical informatics held in Brisbane in 2007, Australia close to 300 papers and as many posters were presented and classified into any one of 71 different topics covering all aspects of the technology and many different applications by a vast array of health professionals in all types of health care related settings, including clinical, management, administrative, policy and research based in community and institutional settings. It is noted that the first world congress on medical informatics was held in 1974 in Stockholm, Sweden . Although the two disciplines share many concepts, and the terms are often interchangeable, in this textbook we have chosen to focus on the use of information technology in all areas of health care, rather than just focus on the delivery of medical services by medical practitioners. Informatics and Nursing Practice Discussion
The term health informatics is all embracing and medical informatics could be viewed as a subset of health informatics along with nursing or dental informatics. Many countries have established a health informatics group, society or association. Such organizations then choose to become a member of the International Medical Informatics Association (IMIA) and this organization hosts international conferences together with the local national member organization to promote the discipline, enable international networking to take place and to share experiences. IMIA has set about to define the health informatics discipline via its scientific map and the educational recommendations. Both are IMIA endorsed documents available from www.imia.org although they are both in the process of being updated. The current scientific map has seven categories as detailed in Table 1: 11 E.J.S. Hovenga et al. / Health Informatics – An Introduction Table 1 IMIA Scientific Map Categories Applied Technology Information Applications DataHumanEducation Technology and Products Infrastructure Organizational and Infrastructure Related Knowledge Clinical Disciplines These original IMIA Scientific Map categories have been extended to fourteen organizing concepts or categories in the latest draft, these are presented in the Table 2. Table 2– IMIA’s 2008 Draft Organizing Concepts of the Health Informatics Discipline 1. 2. 3. 4. 5. 6. 7. ICT (Computer Science) for Health Health & Social Care processes Health (Care) Records Health & Social Care industry Health Informatics Standards Knowledge Domains & Knowledge Discovery Legal & Ethical 8. People in Organisations 9. Politics & Policy 10. Technologies for Health 11. Terminology, Classification & Grouping 12. Uses of Clinical Information 13. Using Informatics to Support Clinical 14. Computer Systems Applications in Health (Toolkit) Numerous concepts fit within each category ranging from around 20 to more than 60 indicating the enormous scope of this discipline. This clearly demonstrates not only the scope of the Health Informatics discipline but also the needs from a healthcare system perspective. The discipline is very broad, has lots of depth and may be classified into computing (incl. all information and communications technologies) or health (incl. healthy living, population health, health service delivery, health policy) problem spaces. This means that no health informatician has the same set of knowledge and skills as another, each tends to focus on their own strengths and areas of interests in either problem space although all need to possess a basic set of competencies. The figures below show the key differences for each problem space . The shaded portion in Figure 1 represents Health Informatics in the problem space of computing. Health Informaticians need knowledge/skills throughout the spectrum in the computing space, from some practical knowledge in Computer Hardware and Architecture to a profound theoretical understanding as well as application skills on the organisational and information systems layer. Figure 1: The Overall Place of Health Informatics in the Problem Space of Computing 12 E.J.S. Hovenga et al. / Health Informatics – An Introduction The Health problem space is complex. For example, sharing electronic health records is a more complex task than sharing financial information or travel bookings. There are lots of different types of information; progress notes, appointments, documents, collections of images, laboratory results, registries etc. The variety of information is obvious in the paper world where there are hundreds or thousands of different forms in just one hospital, putting at risk people receiving healthcare services. Health care is constantly changing in three ways (breadth, depth, complexity): new information, information in finer-grained detail, and new relationships are always being discovered or becoming relevant complicating this space further. Therefore – more than in other computing discipline – in addition to an understanding of content in the computing problem space, an understanding of the health problem space content is fundamental for Health Informaticians. The shaded portion in Figure 2 represents Health Informatics in the health problem space which is essentially the reverse of the depth of skills and knowledge required from the computing space. Figure 2 The Overall Place of Health Informatics in the Health Problem Space Every health informatics project requires a team of people who collectively contribute the necessary set of skills and knowledge to that project, thus teamwork and the ability to work collaboratively with others are skills every health informatician requires. The difference between information systems specialists and health information systems specialists is that the latter place a greater emphasis on the application of the technology/systems in health care. They focus on solving very complex medical or health related problems using the information technology to the fullest extent as the tool to achieve that. This often means the need for a change in work practices.
3. Potential Benefits of Applying ICT in the Health Industry The application of cutting edge technologies pertaining to the computer, communication and information sciences has much to offer the health sciences. We are E.J.S. Hovenga et al. / Health Informatics – An Introduction 13 of the view that appropriate use of these technologies will result in improved health, lower costs and improved service delivery methods . To achieve this, healthcare professionals need to be aware of the possibilities today and in the future and participate in this discipline’s further development. Close to 40 years ago Martin and Norman [10p.222] predicted that in medicine the computer promised revolutionary changes. Today the same may be said about communications and knowledge management technologies. We have witnessed a convergence between communications, computing and television or broadcasting technologies enabling the merging of all types of data into integrated multimedia information, providing rapid interactions between people from any location. The speed by which these changes impact upon health service delivery is determined by and dependent upon how quickly the health professions accept the role of these new technologies in their workplace. It is they who need to identify the potential use of these technologies within the health care industry. The international network of health informaticians is growing rapidly. There is evidence of an approaching critical number such that the process of change is now self sustaining. This network could be compared with what Marilyn Ferguson describes as an Aquarian conspiracy where conspirators (read health informaticians) collude to change social institutions, modes of problem solving and distribution of power [11p.20].
They are characterised by rethinking everything, examining old assumptions, by looking differently at their work, relationships, health, political power, experts, goals and values. They are leading the way towards a paradigm shift; they have a new perspective towards health care. Ferguson [11p.28] notes that: “New paradigms are nearly always received with coolness, even mockery and hostility. Their discoveries are attacked for their heresy. (For historic examples, consider Copernicus, Galileo, Pasteur, Mesmer). The idea may appear bizarre, even fuzzy, at first because the discoverer made an intuitive leap and does not have all the data in place yet.” Many health informatics network members can no doubt identify with these sentiments. This book is dedicated to these pioneers who dared to be out of step with their peers and who have provided the building blocks for this paradigm shift. It has proved difficult for the discipline to gain acceptance from mainstream health professionals and recipients of health care. Also enabling procedures and legislations have been and continue to be slow to emerge. For example the European eHealth action plan developed in 2004 lists a number of activities associated with legal and regulatory issues that need to be completed by 2009 . In 2005 the World Health Organisation’s (WHO) world assembly adopted a resolution on e-health  recognising that eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research. All member states were urged to develop and implement an ehealth strategy. Health informatics is about data, information and knowledge and what we do with all this as health professionals. From a national perspective these technologies need to be used to support the implementation and performance monitoring of a country’s health policies. It is no accident that the advent of low cost easily accessible computer technology has occurred at the same time as the so-called information explosion that has affected all areas of modern life.
The problem of managing the ever increasing 14 E.J.S. Hovenga et al. / Health Informatics – An Introduction volume of information and developing methods to help keep abreast of important changes in knowledge is particularly applicable to those of us working in health care. It is becoming increasingly difficult to practice as a health professional without the use of information technologies to support daily practice. This challenge is going to continue as expectations of increasing quality of health care is demanded by the consumers of our services. Improved information management of health care data became an accepted essential element of the infrastructure of all contemporary health care systems some time ago [14p.2]. 4. Learning About Health Informatics Those of you who have had little past experience in the use of computers may be reticent about approaching this text. Information technology can be a daunting challenge for those of us who missed out on being part of the ‘computer generation’ currently graduating from our high schools and tertiary institutions. Remember that you don’t need to be a computer genius to use a computer effectively in your professional life. You just need to understand the basic concepts. It’s like driving a car; you don’t need to know exactly how the engine works but you do need to learn how to drive the machine, to identify when something is wrong and to understand the road rules so that you minimise the risk of getting into trouble. If you are already computer literate, you can enjoy applying your acquired skills to the health sciences and learn how to use information technology to support the provision of high quality health care. The computer age poses real challenges for us all. We hope that you find this text useful in assisting you to meet the challenges ahead. References          Graham I 1994 HISA – informatics enhancing health. Health Informatics Society of Australia, Melbourne Oh H, Rizo C, Enkin M, Jadad A. 2005 What Is eHealth (3):
A Systematic Review of Published Definitions, Journal of Medical Internet Research;7(1):e1 viewed June 2008 at http://www.jmir.org/2005/1/e1/ Australian Health Informatics Council (AHIC) 2007 eHealth Future Directions Briefing Paper for the Australian Health Ministers Advisory Council (AHMAC) meeting October 2007 http://www.health.gov.au/internet/main/publishing.nsf/Content/ehealth-futuredirections accessed 5 May 2008. Shortliffe E.H., Perreault L.E., Wiederhold G., Fagan L.M. (Eds) 1990 Medical informatics – computer applications in health care. Addison Wesley Hannan T 1991 Medical informatics – an Australian perspective. Australian and New Zealand Journal of Medicine 21: 363-378 Coiera E 1994 Medical informatics. Medical Journal of Australia 160: 438-440 International Medical Informatics Association (IMIA) – Scientific Map 2002 http://www.imia.org/2002_scientific_map.html accessed 5 May 2008 Garde S, Harrison D, Hovenga E 2005 Australian Skill Needs Analysis of Health Informatics Professionals, Research Report 1,2,3 &4 of the Health Informatics Research Group Central Queensland University, Rockhampton, Qld Chaudrey B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shelelle PG 2006 Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006 May 16; 144(10): 742-52 Accessed 7 May 2008 from: http://www.annals.org/cgi/reprint/144/10/742.pdf E.J.S. Hovenga et al. / Health Informatics – An Introduction 15  Martin J and Norman A R D 1970 The computerized society: an appraisal of the impact of computers over the next fifteen years. Prentice Hall, Englewood Cliffs, NJ p.222)  Ferguson M 1980 The Aquarian conspiracy. Paladin Grafton Books, London  European Commission 2004 “e-Health – making healthcare better for European citizens: An action plan for a European e-Health Area” [COM(2004) 356 final – not published in the Official Journal] Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions of 30 April 2004 accessed on 7 May 2008 fromInformatics and Nursing Practice Discussion http://europa.eu/scadplus/leg/en/lvb/l24226f.htm .  World Health Organisation (WHO), World Health Assembly resolution on eHealth (WHA58.28, May 2005), viewed June 2008 from http://www.euro.who.int/telemed/20060713_1  Dick R.S. and Steen E.B (Eds) 1991 The computer based patient record – an essential technology for health care. National Academy Press, Washington Review Questions 1. What is your understanding of the Health Informatics discipline? 2. Describe how the adoption of e-Health policy strategies are likely to impact upon: a. The population at large b. Health care providers (clinicians) 3. Explain how a health workforce with Health Informatics skills and knowledge are able to improve health services. 4. Identify changes required in your work environment to enable optimal use of available technologies. Copyright of Studies in Health Technology & Informatics is the property of IOS Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. Health Informatics E.J.S. Hovenga et al. (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved. doi:10.3233/978-1-60750-476-4-3 1. 3 History of Health Informatics: A Global Perspective Branko CESNIKa (deceased 2007, edited by Michael R KIDD1b) Co-editor of Health Informatics: an overview 1st edition, Past Associate Professor and Director of Medical Informatics, Faculty of Medicine, Monash University, Australia b MBBS, MD, DCCH, DipRACOG, FRACGP, FACHI, FAFPM (Hon), FHKCFP (Hon), FRNZCGP (Hon), MAICD Executive Dean, Faculty of Health Sciences, Flinders University, Australia a Abstra …Informatics and Nursing Practice Discussion