Health informatics

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Electronic patient chart of a health information system

Health informatics or medical informatics is the intersection of information science, medicine 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.

Subdomains of (bio)medical or health care informatics include: clinical informatics, nursing informatics, imaging informatics, consumer health informatics, public health informatics, dental informatics, clinical research informatics, bioinformatics and pharmacy informatics.

A list of Health Informatics Publications is being developed at Health_Informatics_Publications.

1 Aspects of the field
2 Development
3 See also
4 External links
5 References

[edit] Aspects of the field

A health information system's automatic immunization data entry in the patient's admission module.

architectures for electronic medical records and other health information systems used for billing, scheduling or research
decision support systems in healthcare
standards (e.g. DICOM, HL7) and integration profiles (e.g. Integrating the Healthcare Enterprise) to facilitate the exchange of information between healthcare information systems - these specifically define the means to exchange data, not the content
controlled medical vocabularies (CMVs) such as the Standardized Nomenclature of Medicine, Clinical Terms (SNOMED-CT), Logical Observation Identifiers Names and Codes (LOINC), OpenGALEN Common Reference Model or the highly complex UMLS - used to allow a standard, accurate exchange of data content between systems and providers
use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-making

[edit] Development

Medical informatics began to take off in the US in the 1950s with the rise of the microchip and 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)

[edit] Medical informatics in North America

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. 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 or 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 healthcare facilities.

In the United States in 1996, HIPAA regulations concerning privacy and medical record transmission created the impetus for large numbers of physicians to move towards using EMR software, primarily for the purpose of secure medical billing.

In the US, progress towards a standardized health information infrastructure is underway. In 2004, the US Department of Health and Human Services (HHS) formed the Office of the National Coordinator for Health Information Technology (ONCHIT), headed by David J. Brailer, M.D., Ph.D. The mission of this office is to achieve widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. For more information regarding federal initiatives in this area, see QIOs. Brailer, whose reputation included an appreciation of the merits of Free (Libre) and Open Source software (FLOSS) resigned from the post in April 2006. ^[1]

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. ^[2] ^[3]

[edit] European health 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 of healthcare 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 i2010 strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.

In the United Kingdom, moves towards registration and regulation of those involved in Health Informatics have begun with the formation of the UK Council for Health Informatics Professions (UKCHIP)

The NHS in England has also contracted out to several vendors for a National Medical Informatics system that divides the country into five regions and is to be united by a central electronic medical record system nicknamed "the spine". National Programme for IT in the NHS. The project, in 2006, is well behind schedule and its scope and design are being revised in real time.

In 2006, 60% of residents in England and Wales have more or less extensive clinical records and their prescriptions generated on 4000 installations of one system (EMIS) written in 'M' (MUMPS as was). The other 40% predominantly have records stored on assorted SQL or file-based systems.

Scotland has a similar 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[1]. Discussion of open sourcing it as a remedy is occurring.

The European Commission's preference, as exemplified in the 5th Framework, is for Free/Libre and Open Source Software (FLOSS) for healthcare.

[edit] Clinical Informatics in Asia

In Asia and Australia-New Zealand, the regional group called the APAMI Asia Pacific Association for Medical Informatics was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.

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.

In the Hospital Authority particular attention has been placed on 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 work closely with Information Technology Department to develop healthcare systems for the organization.

The Hong Kong Society of Medical Informatics (HKSMI) was established in 1987 to promote the use of information technology in healthcare. Recently 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.

The Indian Association for Medical Informatics (IAMI) was established in 1993 [2]. IAMI has been publishing the Indian Journal of Medical Informatics since 2004.

[edit] Health informatics in Oceania

In 2002 the Australian College of Health Informatics (ACHI) was formed as a professional association and peak health informatics professional body. 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. ACHI works to enhance the national capacity in health informatics in research, education and training, policy and system implementation.

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 an incorporated company. 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 and Western Australia) as well as special interest groups such as nursing (NIA), pathology, aged and community care, industry and medical imaging (Conrick, 2006).