Health 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

• architectures for electronic medical records and other health information systems used for billing, scheduling, and research
• decision support systems in healthcare, including clinical decision support systems
• 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 Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT), MEDCIN, 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, sometimes called mHealth.
• The international standards on the subject are covered by ICS 35.240.80 in which ISO 27799:2008 is one of the core components.

History

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)

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.

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 (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, 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

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.

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

The NHS in England has also 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". 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. Discussion of open sourcing it as a remedy is occurring.

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.

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.

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 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.

Health informatics in Australasia & 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.

Although there are a number of health informatics organisations in Australia, the Health Informatics Society of Australia Ltd (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.

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.
• In Alberta, Alberta Netcare was created in 2003. Toda 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.

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.

Leading health informatics and medical informatics journals

Main article: List of medical and health informatics journals

For a more comprehensive list, see List of medical journals.

See also

• Arden syntax
• Brazilian Society of Health Informatics
• Continuity of Care Record (CCR)
• eHealth
• Electronic medical record (EMR)
• Enterprise bookmarking
• Health information exchange (HIE)
• Health information management (HIM)
• Indian Association for Medical Informatics
• Health Metrics Network
• Hospital information system
• HL7
• LOINC
• mHealth
• Personal health record
• Telehealth
• Telemedicine

External links

• Health Informatics World Wide
• Healthcare Informatics Community
• BioCaster Global Health Monitor
• Health Informatics Capability Development In New Zealand ,a Report to the Tertiary Education Commission, November 2006
• Electrical safety Regulatory Affairs for Medical IT in Europe (CE)