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Revision as of 21:14, 17 August 2010

For the Journal, see Journal of Biomedical Informatics.
Electronic patient chart of a health information system

Health informatics, Health care informatics or medical informatics is 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 and (bio)medical research.

Aspects of the field

History

Medical informatics began to take off in the US in the 1950s with the rise of computers.

Early names for medical 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.

Since the 1970s the coordinating body has been the International Medical Informatics Association (IMIA)

Medical informatics in the United States

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.[3]

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 [4] at Massachusetts General Hospital in Boston.[5] 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. As of 2004, 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,[6] founded the Department of Medical Informatics at the University of Utah in 1968, and the American Medical Informatics Association (AMIA) has an award named after him on application of informatics to medicine.

Health Informatics and Policy Initiatives Today

Health Informatics in 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 has develop system, as the German Hospital of Buenos Aires who was one of the first in develop the electronic health records system.

Brazil

Main article: Brazilian Society of Health Informatics

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.

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 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.[7]

Canada

Health Informatics in Canada is run provincially, with different provinces creating different systems.

  • eHealth Ontario was created in September 2008. It has been plagued by delays and its CEO was fired over a multimillion-dollar contracts scandal in 2009.[8]
  • In Alberta, Alberta Netcare was created in 2003. 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.

European health informatics

Further information: European Federation for Medical Informatics

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.[9][10] The European Institute for Health Records is involved in the promotion of high quality electronic health record systems in the European Union.[11]

The NHS in England has contracted out to several vendors for a National Medical Informatics system 'NPFIT' that divides the country into five regions and is to be united by a central electronic medical record system nicknamed "the spine".[12] The project, in 2010, is seriously behind schedule and its scope and design are being revised in real time. The degree of computerisation in NHS secondary 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.

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. 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 European Commission's preference, as exemplified in the 5th Framework[13] as well as currently pursued pilot projects,[14] is for Free/Libre and Open Source Software (FLOSS) for healthcare.

Clinical informatics in Asia

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.

Health informatics in Australasia and Oceania

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.[15] Founded in 2002, ACHI is increasingly valued[16] 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)[17] and a full member of the Australian Council of Professions.[18] ACHI is a sponsor of the "e-Journal for Health Informatics",[19] an indexed and peer-reviewed professional journal. ACHI has also supported the "Australian Health Informatics Education Council" (AHIEC) since its founding in 2009.[20]

Although there are a number of health informatics organisations in Australia, the Health Informatics Society of Australia[21] (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).

Health Informatics is taught at four New Zealand universities. The most mature and established is the Otago programme which has been offered for over a decade.[22]

China

Main article: Health informatics in 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[23] 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.[24]

India

Main article: Indian Association for Medical Informatics

Saudi Arabia

The Saudi Association for Health Information (SAHI) was established in 2006[25] 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 and .[26]

Health informatics law

Further information: Health 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 use information in health care by clinicians.[27][28]

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.

Physicians who are board-certified in clinical informatics 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.[29][30][31]

Leading health informatics and medical informatics journals

Main article: List of medical and health informatics journals

See also

References

  1. ^ "35.240.80: IT applications in health care technology". ISO. Retrieved 2008-06-15.
  2. ^ Fraser, Ross. "ISO 27799: Security management in health using ISO/IEC 17799" (PDF). Retrieved 2008-06-15.
  3. ^ Sittig DF, Ash JS, Ledley RS (2006). "The story behind the development of the first whole-body computerized tomography scanner as told by Robert S. Ledley". Journal of the American Medical Informatics Association. 13 (5): 465–9. doi:10.1197/jamia.M2127. PMC 1561796. PMID 16799115.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ MGH - Laboratory of Computer Science
  5. ^ Edwin D. Reilly (2003). Milestones in Computer Science and Information Technology. Greenwood Press. p. 161. ISBN 978-1573565219.
  6. ^ Patton GA, Gardner RM (1999). "Medical informatics education: the University of Utah experience". Journal of the American Medical Informatics Association. 6 (6): 457–65. PMC 61389. PMID 10579604.
  7. ^ Certification Commission for Healthcare Information Technology (July 18, 2006): CCHIT Announces First Certified Electronic Health Record Products. Retrieved July 26, 2006.
  8. ^ "Head of eHealth Ontario is fired amid contracts scandal, gets big package". Retrieved 2009-08-26.
  9. ^ European eHealth Action Plan
  10. ^ European eHealth Action Plan i2010
  11. ^ "Electronic Health Records for Europe". European Space Agency. 2005. Retrieved 2009-01-13.
  12. ^ National Programme for IT in the NHS
  13. ^ Cordis FP5web
  14. ^ European Patient Smart Open Services
  15. ^ "Australasian College of Health Informatics". Retrieved 3 May 2010.Australasian College of Health Informatics
  16. ^ University of Sydney Current Developments in Health Informatics
  17. ^ "International Medical Informatics Association - Academic Institutional Members - Australia - Australian College of Health Informatics". 12 August 2009. Retrieved 22 February 2010.
  18. ^ ACHI Memberships ACHI memberships: Professions Australia
  19. ^ eJHI - electronic Journal of Health Informatics (open access journal)
  20. ^ Australian Health Informatics Education Council (AHIEC) AHIEC Auspicing Organisations
  21. ^ "Health Informatics Society of Australia Ltd". Retrieved 3 April 2010.
  22. ^ Karolyn Kerr (2006). "Health Informatics Capability Development In New Zealand - A Report to the Tertiary Education Commission" (PDF). Retrieved 2009-01-08. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  23. ^ Health Informatics Section in Hong Kong Hospital Authority
  24. ^ eHealth Consortium
  25. ^ "Medical Pharmaceutical Information Association (MedPharmInfo)". Imia.org. 2008-05-18. Retrieved 2010-07-29.
  26. ^ [1][dead link]
  27. ^ Gardner RM, Overhage JM, Steen EB; et al. (2009). "Core content for the subspecialty of clinical informatics". Journal of the American Medical Informatics Association. 16 (2): 153–7. doi:10.1197/jamia.M3045. PMC 2649328. PMID 19074296. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  28. ^ Safran C, Shabot MM, Munger BS; et al. (2009). "Program requirements for fellowship education in the subspecialty of clinical informatics". Journal of the American Medical Informatics Association. 16 (2): 158–66. doi:10.1197/jamia.M3046. PMC 2649323. PMID 19074295. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  29. ^ Butte, AJ (2009). "Translational bioinformatics applications in genome medicine". Genome medicine. 1 (6): 64. doi:10.1186/gm64. PMC 2703873. PMID 19566916.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  30. ^ Kann, M. G. (2009). "Advances in translational bioinformatics: computational approaches for the hunting of disease genes". Briefings in Bioinformatics. 11 (1): 96. doi:10.1093/bib/bbp048. PMC 2810112. PMID 20007728.
  31. ^ Lussier, YA; Butte, AJ; Hunter, L (2010). "Current methodologies for translational bioinformatics". Journal of biomedical informatics. 43 (3): 355–7. doi:10.1016/j.jbi.2010.05.002. PMC 2894568. PMID 20470899.

External links

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