Health InformaticsHealth Informatics

Graham WrightGraham Wright

MSc Programme DirectorMSc Programme Director

Imagination is more important than knowledge" –

Albert Einstein

Enrico’s viewEnrico’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 InformaticsHealth Informatics

Health Informatics is having a mid-life crisis, it Health Informatics is having a mid-life crisis, it is a 45 year old profession wandering around is a 45 year old profession wandering around the desert to find itselfthe desert to find itself

Yuval Shahar (2001)Yuval Shahar (2001)

IMIA Invited Satellite Working Conference ‘Challenges in IMIA Invited Satellite Working Conference ‘Challenges in Medical Informatics – successes and failures’ , Madrid March Medical Informatics – successes and failures’ , Madrid March 2001 2001

1. Definitions1. Definitions

• InformaticsInformatics

• Medical InformaticsMedical Informatics

• Nursing InformaticsNursing Informatics

• Clinical InformaticsClinical Informatics

• Health InformaticsHealth Informatics

InformaticsInformatics

• the application of information the application of information technologies to optimize the technologies to optimize the information management information management function within an organizationfunction within an organization

InformaticsInformatics

• information managementinformation management

• information technologyinformation technology

Information management Information management

• assuring that the right assuring that the right information is available to the information is available to the right people, within and without right people, within and without an organization, at the right time an organization, at the right time and place, and for the right priceand place, and for the right price

Information technology Information technology

• any technology which processes any technology which processes and communicates data, includes:and communicates data, includes:– computers, voice, data and image computers, voice, data and image

sensing and communications sensing and communications devices, graphics devices, multi-devices, graphics devices, multi-media storage, etc.media storage, etc.

– pen, paper, telephones and fax pen, paper, telephones and fax machinesmachines

Health or Medical Health or Medical InformaticsInformatics

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 InformaticsMedical Informatics

"the science of analysis, "the science of analysis, documentation, steering, control and documentation, steering, control and synthesis of information processes synthesis of information processes within the health care delivery within the health care delivery system, especially in the classical system, especially in the classical environment and medical practice".environment and medical practice".

Recihertz PRecihertz P

Protokoll der Klausurtagung Ausbildungsziele, Inhalte und Protokoll der Klausurtagung Ausbildungsziele, Inhalte und Methoden in der Medizinischen InformatikMethoden in der Medizinischen Informatik

Ulm: Reisenberg/b. 1973Ulm: Reisenberg/b. 1973

Nursing InformaticsNursing Informatics

"A combination of computer science, "A combination of computer science, information science and nursing information science and nursing science designed to assist in the science designed to assist in the management and processing of management and processing of nursing data and the delivery of nursing data and the delivery of nursing care". nursing care".

Graves JR, Cocoran SGraves JR, Cocoran SThe Study of Nursing InformaticsThe Study of Nursing Informatics

Image: Journal of Nursing ScholarshipImage: Journal of Nursing ScholarshipVol. 21, p. 227, 1989Vol. 21, p. 227, 1989

Nursing InformaticsNursing Informatics

"Integration of nursing, its "Integration of nursing, its information and information information and information management with information management with information processing and communications processing and communications technology to support world health".technology to support world health".

IMIA Nursing InformaticsIMIA Nursing Informatics

6th International Congress6th International Congress

Stockholm, October 1997Stockholm, October 1997

Health InformaticsHealth Informatics

"The study of nature and principles "The study of nature and principles of information and its applications of information and its applications within all aspects of health care within all aspects of health care delivery and promotion".delivery and promotion".

Protti DJProtti DJ

A New Undergraduate Program in Health/Medical InformaticsA New Undergraduate Program in Health/Medical Informatics

AMIA ProceedingsAMIA Proceedings

Masson Publishing, 1982 Masson Publishing, 1982

Health InformaticsHealth Informatics

• Health informatics is seen as to be Health informatics is seen as to be concerned with the concerned with the individual and group individual and group behaviour behaviour of health care personnel in of health care personnel in their interaction with information and their interaction with information and information technologies.information technologies.

• Medical informatics is seen to be rooted Medical informatics is seen to be rooted in medicine and computer sciencein medicine and computer science– the social, organizational, and policy the social, organizational, and policy

aspects of information technology are aspects of information technology are not usually taken into consideration not usually taken into consideration

International viewInternational 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 knowledgeBodies of knowledge

• hard scienceshard sciences– biology and clinical chemistrybiology and clinical chemistry– computer science computer science – engineeringengineering– mathematics and physicsmathematics and physics

• soft sciencessoft sciences– economicseconomics– information scienceinformation science– management sciencemanagement science– psychologypsychology– sociologysociology

• medicine and other health care professionsmedicine and other health care professions

Areas of instruction and Areas of instruction and learninglearning

A. InformationA. Information

1. Management1. Management

2. Technology2. Technology

B. Healthcare OrganizationsB. Healthcare Organizations

1. Clinical (Delivery)1. Clinical (Delivery)

2. Management2. Management

A. Information A. Information 1. Management1. Management

– Data - Information - Wisdom SpectrumData - Information - Wisdom Spectrum– Power and value of informationPower and value of information– Data modeling and data standardsData modeling and data standards– Coding, classification, nomenclatureCoding, classification, nomenclature– Data analysis & statistical methodsData analysis & statistical methods– Systems analysis and designSystems analysis and design– Information sources (local, national, Information sources (local, national,

international)international)– Managing information resourcesManaging information resources

A. Information A. Information 2. Technology2. Technology

• Hardware processing and storage Hardware processing and storage technologiestechnologies

• Computer languages Computer languages • Software: operating systems, databases, Software: operating systems, databases,

applicationapplication• Communications technologiesCommunications technologies

– Local Area NetworksLocal Area Networks– Intranets and the InternetIntranets and the Internet– Telematicss/telemedicineTelematicss/telemedicine

• Infusion/diffusion theoriesInfusion/diffusion theories• Effectiveness metricsEffectiveness metrics• Security and ConfidentialitySecurity and Confidentiality

B. Healthcare B. Healthcare OrganizationsOrganizations

1. Clinical (Delivery)1. Clinical (Delivery)• History and culture of cliniciansHistory and culture of clinicians

• Clinical practice content and processClinical practice content and process

• Clinical practice guidelines and Clinical practice guidelines and protocolsprotocols

• Evidence-based decision makingEvidence-based decision making

• Decision support and expert systemsDecision support and expert systems

• Health outcomes and health statusHealth outcomes and health status

• EpidemiologyEpidemiology

• Population healthPopulation health

B. Healthcare B. Healthcare Organizations 2. Organizations 2.

ManagementManagement• organization theory and modelsorganization theory and models• communications theoriescommunications theories• management process and practicemanagement process and practice• organizational development and change organizational development and change

managementmanagement• health economics and fiscal managementhealth economics and fiscal management• resource allocation modelsresource allocation models• individual and group decision support individual and group decision support

systemssystems• ethics and legislationethics and legislation

Clinical Work

InformationandCommunicationtechnologies

Organisation ofmedicine andhealth care (system)

Three Domains Needing an “Effective Fit”

Context: Health Care System

Organising and managing Clinical practice

Learning from sets of patients

Diagnosing andtreating a patient

The three levels of clinical activity which should be thefocus of information technology in a health care system

Failure to:-Failure to:-• understand the nature of different clinical practices and its understand the nature of different clinical practices and its

consequence for the use of technology;consequence for the use of technology;

• understand the nature of the relationship between clinical staff and understand the nature of the relationship between clinical staff and management which might predispose clinical staff to oppose management which might predispose clinical staff to oppose introduction of a clinical information system;introduction of a clinical information system;

• recognise wider imperatives and set ill-conceived targets;recognise wider imperatives and set ill-conceived targets;

• choose robust, transferable, extendable and proven technologies choose robust, transferable, extendable and proven technologies which, for example, do not inhibit future developments;which, for example, do not inhibit future developments;

• take into account research and evaluation of informational take into account research and evaluation of informational developments such as terming and classification systems;developments such as terming and classification systems;

• relate the technologies to the imperatives;relate the technologies to the imperatives;

• recognise the clinical imperative need to treat more patients at least recognise the clinical imperative need to treat more patients at least as well in less time using new systems;as well in less time using new systems;

Failure to:-Failure to:-

• create an affordable and practical technology financial create an affordable and practical technology financial plan from a high level strategy;plan from a high level strategy;

• involve the future users in such a way that their input involve the future users in such a way that their input is meaningful to determine system requirements and is meaningful to determine system requirements and to gain their subsequent ownershipto gain their subsequent ownership

• prepare and develop individuals and the organisation prepare and develop individuals and the organisation to make effective use of information technologies;to make effective use of information technologies;

• implement in an orderly and timely way;implement in an orderly and timely way;

• actually check whether the technologies are meeting actually check whether the technologies are meeting expectations and requirements, whether the system is expectations and requirements, whether the system is highly valued and to react accordinglyhighly valued and to react accordingly

Involves, informspersuades,prepares for thesetechnologies andother changes

Creates aninformation andtechnologystrategy andfinancial plan

Plans andintroduces newtechnologieswith otherchanges

Evaluates,reviews andassesses theimpact andvalues it

Knows of appropriatetechnologicaldevelopments & relatesthem to informationrequirements: knows ofopportunities andimperatives for change

System

Health care

Organisation ofclinical work

Sets ofpatients

Single patient

Clinical

Work

Selects andprioritisesopportunities,problems,imperatives andrequirements for change

Assesses andunderstands thecontext & identifiesconsequences forclinical work andimperatives forchange Assesses and

understands what[and for what keyreasons] activitiesoccur at each level

Respond

Identify impact

Respond

Observe& enquire

Tell

Observe&enquire

Tell

Relate & CheckTell

Relate & check

Tell

Observe& enquire

Tell

Identify impact

4.

3.

5. 6.

7.

Realise

Respond & Implement

2.

1.

Stages of the modelStages of the model1 to 41 to 4• Assesses and understands what and for what Assesses and understands what and for what

reasons things happenreasons things happen

• Assesses and understands the context and identifies Assesses and understands the context and identifies consequences for clinical work and imperatives for consequences for clinical work and imperatives for changechange

• Selects and prioritises opportunities, problems, Selects and prioritises opportunities, problems, imperatives and requirements for changeimperatives and requirements for change

• Knows of appropriate technological developments Knows of appropriate technological developments and relates them to information requirements; knows and relates them to information requirements; knows of opportunities and imperatives for changeof opportunities and imperatives for change

Stages of the modelStages of the model5 to 85 to 8• Creates an information and technology and Creates an information and technology and

strategy planstrategy plan

• Involves, informs, persuades, prepares for Involves, informs, persuades, prepares for these technologies and other changesthese technologies and other changes

• Plans and introduces new technologies and Plans and introduces new technologies and other changesother changes

• Evaluates, reviews and assesses the impact Evaluates, reviews and assesses the impact and values itand values it

‘ ‘hybrid’ managers-informaticians hybrid’ managers-informaticians

• select the appropriate information and select the appropriate information and communication technologies,communication technologies,

• involve perceived beneficiaries, involve perceived beneficiaries,

• identify the prospective benefits, identify the prospective benefits,

• successfully plan, implement and evaluate successfully plan, implement and evaluate the impact of changethe impact of change