Health informatics

  Health 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.

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, veterinary informatics, and pharmacy informatics.

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Aspects of the field

• architectures for electronic medical records and other health information systems used for billing, scheduling or 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), 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

Development

There is a patent pending for a Medical Informatics Public Utility which would serve as the "common platform" of communication for all existing provincial software products as well as the safe repository for the public's medical records. The potential for the reduction of medical errors, fraud and reduction of duplication is staggering. The number of lives saved could exceed a minimum of 100,000 per year according to the Institute of Medicine's current medical error mortality statistics.

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 Public Utility

Both political parties continue to squabble without solutions about the escalating costs of health care as benefits erode and more and more working Americans lose coverage. The problem with controlling health care costs is that the health care system itself is out of control because it lacks controls. Health information management is in a chaotic state of affairs as it is a collage of paper records, and medical practice software which do not record clinical encounters. Instead they capture charges. And electronic medical records software companies are incapable of communicating across their provincial software platforms. The solution to this grave problem is actually rather simple.

Public utilities have historically been established to protect the health, safety, and welfare of the public at large. Public utilities are funded by bond issues, deliver a return on investment, and are subject to public review and oversight. A Medical Informatics Public Utility, which would serve as the repository for the real time medical records of the public, would offer a quality and efficiency of care that can potentially free up 25% of the health care spending in the United States alone to meet the growing needs of the aging population. Many studies have concluded that a centralized repository of information can achieve these goals but have not offered a solution.

A Medical Informatics Public Utility would serve as the "common platform" of communication for all existing provincial software products as well as the safe repository for the public's medical records. The potential for the reduction of medical errors, fraud and reduction of duplication is staggering. The number of lives saved could exceed a minimum of 100,000 per year according to the Institute of Medicine's current medical error mortality statistics.

Most importantly, a Medical Informatics Public Utility would serve as a tremendous economic engine in that: the real time database developed would create a platform to get new treatments to market more quickly and more effectively evaluated, spot epidemiological events faster, induce software developers to develop products for the new total repository environment, free up funds to utilize more hands on care, allow for patient centered care and patient control of their health care, and allow physician to physician access of the patient's complete medical record.

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 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 1970's a growing number of commercial vendors began to market practice management and electronic medical records systems. Although a profusion of products exists, currently only a minority of health practitioners use fully featured electronic healthcare records systems.

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) ^[1], 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 quality improvement organizations. Brailer resigned from the post in April 2006. ^[2]

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. ^{[3] [4]}

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 strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.^{[5] [6]}

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).^[7]

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" ^[8]. 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^[9]. 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.

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.^[10]

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^[11] 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.^[12] 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.^[13]

The Indian Association for Medical Informatics (IAMI) was established in 1993 ^[14]. IAMI has been publishing the Indian Journal of Medical Informatics since 2004.^[15]

Health informatics in Australia & 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.^[16]

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).^[17] 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 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.

See also

References

1. ^ US Office of the National Coordinator for Health Information Technology (ONCHIT)
2. ^ http://www.linuxmednews.org Linux Medical News
3. ^ Certification Commission for Healthcare Information Technology (July 18, 2006): CCHIT Announces First Certified Electronic Health Record Products Retrieved July 26, 2006
4. ^ Certification Commission for Healthcare Information Technology (July 31, 2006):CCHIT Announces Additional Certified Electronic Health Record Products Retrieved July 31, 2006
5. ^ European eHealth Action Plan
6. ^ European eHealth Action Plan i2010
7. ^ UK Council for Health Informatics Professions (UKCHIP)
8. ^ National Programme for IT in the NHS
9. ^ [1]
10. ^ APAMI Asia Pacific Association for Medical Informatics
11. ^ Health Informatics Section in Hong Kong Hospital Authority
12. ^ Hong Kong Society of Medical Informatics
13. ^ eHealth Consortium
14. ^ [2]
15. ^ Indian Journal of Medical Informatics
16. ^ Australian College of Health Informatics
17. ^ Health Informatics Society of Australia