Health Informatics
Graham Wright
MSc Programme Director
Imagination is more important than
knowledge" –
Albert Einstein
Enrico’s view
If physiology literally means 'the logic of life', and
pathology is 'the logic of disease', then medical
informatics is the logic of healthcare.
It is the rational study of the way we think about
patients, and the way that treatments are defined,
selected and evolved.
It is the study of how medical knowledge is created,
shaped, shared and applied
Enrico Coiera 1997
Health Informatics
Health Informatics is having a mid-life
crisis, it is a 45 year old profession
wandering around the desert to find itself
Yuval Shahar (2001)
IMIA Invited Satellite Working Conference ‘Challenges in Medical
Informatics – successes and failures’ , Madrid March 2001
1. Definitions
• Informatics
• Medical Informatics
• Nursing Informatics
• Clinical Informatics
• Health Informatics
Informatics
• the application of information
technologies to optimize the
information management function
within an organization
Informatics
• information management
• information technology
Information management
• assuring that the right information is
available to the right people, within
and without an organization, at the
right time and place, and for the right
price
Information technology
• any technology which processes and
communicates data, includes:
– computers, voice, data and image
sensing and communications devices,
graphics devices, multi-media storage,
etc.
– pen, paper, telephones and fax
machines
Health or Medical Informatics
The terms 'medical informatics' and 'health informatics'
have been variously defined, but can be best understood as
the understanding, skills and tools that enable the sharing
and use of information to deliver healthcare and promote
health. 'Health informatics' is now tending to replace the
previously commoner term 'medical informatics',
reflecting a widespread concern to define an information
agenda for health services which recognises the role of
citizens as agents in their own care, as well as the major
information-handling roles of the non-medical healthcare
professions.
BMIS (2002)
Medical Informatics
"the science of analysis,
documentation, steering, control and
synthesis of information processes
within the health care delivery
system, especially in the classical
environment and medical practice".
Recihertz P
Protokoll der Klausurtagung Ausbildungsziele, Inhalte und
Methoden in der Medizinischen Informatik
Ulm: Reisenberg/b. 1973
Nursing Informatics
"A combination of computer science,
information science and nursing science
designed to assist in the management and
processing of nursing data and the
delivery of nursing care".
Graves JR, Cocoran S
The Study of Nursing Informatics
Image: Journal of Nursing Scholarship
Vol. 21, p. 227, 1989
Nursing Informatics
"Integration of nursing, its information
and information management with
information processing and
communications technology to
support world health".
IMIA Nursing Informatics
6th International Congress
Stockholm, October 1997
Health Informatics
"The study of nature and principles of
information and its applications
within all aspects of health care
delivery and promotion".
Protti DJ
A New Undergraduate Program in Health/Medical Informatics
AMIA Proceedings
Masson Publishing, 1982
Health Informatics
• Health informatics is seen as to be
concerned with the individual and group
behaviour of health care personnel in their
interaction with information and
information technologies.
• Medical informatics is seen to be rooted in
medicine and computer science
– the social, organizational, and policy
aspects of information technology are not
usually taken into consideration
International view
Health informatics is concerned with the systematic
processing of data, information and knowledge in
medicine and healthcare. The domain covers
computational and informational aspects of processes
and structures, applicable to any clinical or managerial
discipline within the health sector whether on a tele
(remote) basis or not. Health informatics is delivered by
operational health practitioners, academic researchers
and educators, scientists and technologists in
operational, commercial and academic domains
Jean Roberts – Medinfo2001
Bodies of knowledge
• hard sciences
– biology and clinical chemistry
– computer science
– engineering
– mathematics and physics
• soft sciences
– economics
– information science
– management science
– psychology
– sociology
• medicine and other health care professions
Areas of instruction and learning
A. Information
1. Management
2. Technology
B. Healthcare Organizations
1. Clinical (Delivery)
2. Management
A. Information
1. Management
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Data - Information - Wisdom Spectrum
Power and value of information
Data modeling and data standards
Coding, classification, nomenclature
Data analysis & statistical methods
Systems analysis and design
Information sources (local, national,
international)
– Managing information resources
A. Information
2. Technology
• Hardware processing and storage technologies
• Computer languages
• Software: operating systems, databases,
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application
Communications technologies
– Local Area Networks
– Intranets and the Internet
– Telematicss/telemedicine
Infusion/diffusion theories
Effectiveness metrics
Security and Confidentiality
B. Healthcare Organizations
1. Clinical (Delivery)
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History and culture of clinicians
Clinical practice content and process
Clinical practice guidelines and protocols
Evidence-based decision making
Decision support and expert systems
Health outcomes and health status
Epidemiology
Population health
B. Healthcare Organizations 2.
Management
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organization theory and models
communications theories
management process and practice
organizational development and change
management
health economics and fiscal management
resource allocation models
individual and group decision support systems
ethics and legislation
C linic a l W or k
I nf o rm a tio n
and
C om m u nic a tio n
t ec h n o lo g ies
O rg a nis a tio n o f
m e dic in e an d
h e a lt h c a re ( s y s te m )
T hr ee D o m a in s N e e d in g a n “ E ff e ct iv e F i t”
C o n t e x t: H e a lth C a r e S y s te m
O rg a ni s in g an d m a n a g in g
C l in ic a l p ra c t ic e
L e a rn in g f ro m s e t s
of pa t ie n ts
D ia g n os i n g a n d
t re a ti ng a p a ti e nt
T he th re e l ev e ls o f c l in i ca l a c ti vi ty w h ic h s h o u ld be th e
fo c u s o f in f or m a tio n te c hn o l og y i n a h e a lt h c a re s y st e m
Failure to:• understand the nature of different clinical practices and its
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consequence for the use of technology;
understand the nature of the relationship between clinical staff
and management which might predispose clinical staff to
oppose introduction of a clinical information system;
recognise wider imperatives and set ill-conceived targets;
choose robust, transferable, extendable and proven
technologies which, for example, do not inhibit future
developments;
take into account research and evaluation of informational
developments such as terming and classification systems;
relate the technologies to the imperatives;
recognise the clinical imperative need to treat more patients at
least as well in less time using new systems;
Failure to:• create an affordable and practical technology financial
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plan from a high level strategy;
involve the future users in such a way that their input
is meaningful to determine system requirements and
to gain their subsequent ownership
prepare and develop individuals and the organisation
to make effective use of information technologies;
implement in an orderly and timely way;
actually check whether the technologies are meeting
expectations and requirements, whether the system is
highly valued and to react accordingly
A s s e s s es a n d
u n d er s ta n d s t h e
c o n te x t & i de n t if ie s
c o n s e qu e n c e s f o r
c l in ic a l w o r k a n d
i m p e ra t iv e s f o r
c h a n ge
R e sp o n d
2.
S e le c ts a n d
p ri o rit is e s
o p p or tu n it ie s ,
p ro b le m s ,
i m p e ra t iv e s a n d
re q u ir e m e n ts
for change
1.
R e sp o n d
I d e n t if y i m p a c t
I d e n t if y
im p a c t
H ea l th c ar e
O b s er v e
& e n q u ir e
C li ni c a l
A s s e s s es a n d
u n d er s ta n d s w h a t
[ an d fo r w h a t k e y
re a s o n s ] a c ti vi ti e s
o c c u r at e a c h
l ev e l
T el l
O r g a n is a t io n o f
c l in ic al w o r k
3.
T el l
K n o w s o f a p p r o p ria t e
t e c h n o lo g ic a l
d e ve lo p m e n t s & r e la t e s
t h e m to in f o rm a t io n
re q u ir e m e n t s : k n o w s o f
o p p o r t u n it ie s a n d
im p e ra t ive s f o r c h a n g e
7.
S e t s o f p a t ie n t s
S in g l e p a t i en t
O b s er v e
&
e n q u ire
O b s er v e
& e n q u ir e
T el l
W o rk
S y s te m
T el l
T el l
R e la t e & c h e c k
4.
C re a te s a n
i nf o rm a ti o n a n d
t ec h n o lo g y
s t ra te g y a n d
f in a n c ia l p la n
R e s p o n d & I m p le m e n t
R e la t e & C h e c k
5.
I nv o l ve s , i n fo rm s
p e rs u a d es ,
p re p a re s f o r th e s e
t ec h n o lo g i es a n d
o th e r c h a ng e s
E v al u a te s ,
re v i ew s a n d
a s s e s s e s t he
im p a ct a n d
v a lu e s i t
R e al is e
6.
P la n s a n d
i nt ro d u c e s n e w
t ec h n o lo g i es
w i th ot h e r
c h a n ge s
Stages of the model
1 to 4
• Assesses and understands what and for what
reasons things happen
• Assesses and understands the context and identifies
consequences for clinical work and imperatives for
change
• Selects and prioritises opportunities, problems,
imperatives and requirements for change
• Knows of appropriate technological developments
and relates them to information requirements; knows
of opportunities and imperatives for change
Stages of the model
5 to 8
• Creates an information and technology and
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strategy plan
Involves, informs, persuades, prepares for
these technologies and other changes
Plans and introduces new technologies and
other changes
Evaluates, reviews and assesses the impact
and values it
‘hybrid’ managers-informaticians
• select the appropriate information and
communication technologies,
• involve perceived beneficiaries,
• identify the prospective benefits,
• successfully plan, implement and evaluate
the impact of change
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Health Informatics - Amirkabir University of Technology