1. Health Informatics.ppt

Editor's Notes

• #2: This introductory lecture will define information management, information system (technology), and informatics, describe the fundamental theorem of informatics, explain the meaning of biomedical and health informatics as a field of study, offer definitions of the major biomedical informatics areas of applications, and provide an overview of informatics drivers and trends. Let’s begin with defining information management, information system (technology), and informatics. According to the American Health Information Management Association (AHIMA), information management is “The generation, collection, organization, validation, analysis, storage, and integration of data as well as the dissemination, communication, presentation, utilization, transmission, and safeguarding of the information” (AHIMA, 2012, p. 181). If the type of information were health, then health information management would entail acquisition, organization, storage, retrieval, and dissemination of health information from a multitude of places. The purpose is ensuring availability, accuracy, and protection of health information that is needed by a variety of individuals in the delivery of health care services and to support decision-making activities. An example of information management would be deploying a content or document management system.
• #12: The next definition in the series of terms closely related to information management and informatics is information system or technology. AHIMA defines information system as “An automated system that uses computer hardware and software to record, manipulate, store, recover, and disseminate data (that is, a system that receives and processes input and provides output); often used interchangeably with information technology (IT)” (AHIMA, 2012, p. 181). When you think of information technology, some things that should come to mind are computer networks, database and systems administration, security, and programming. Therefore, information technology could be used in the management of information. Connecting information technology to health, consider the following defintion by the Office of the National Coordinator for Health Information: “Health Information Technology (HIT) – The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (U.S. Department of Health and Human Services, 2009, para. 8). An example of health information technology would be administrative and financial systems that facilitate billing, accounting, and other administrative tasks.
• #13: The final definition in this “information” series comes from authors Elmer Bernstam, Jack Smith, and Todd Johnson in their article, What is Biomedical Informatics? Based on their research they determined data, information, and knowledge were central to informatics. Their literature review and subsequent analysis concluded in the following definition of informatics: “Informatics is the science of information, where information is defined as data with meaning” (Bernstam, Smith, & Johnson, 2009, p. 106). Thus, the similarity between all three terms is that all involve information in some way. However a critical difference between information management, information technology, and informatics is in the object of study where information management focuses on the organization and dissemination of information, information technology on the tools and machines, and informatics on the optimal use of meaningful data.
• #14: In order to gain a better understanding of informatics, one needs to learn the differences between data, information, knowledge, and wisdom. As explained on the previous slide, the research performed by Bernstam, Smith, & Johnson (2009) showed that data, information, and knowledge were central to informatics. In their article, they referenced Ackoff’s Data, Information, Knowledge, and Wisdom (DIKW) hierarchy. Jennifer Rowley, explored further the DIKW hierarchy. Rowley states, “The hierarchy is used to contextualize data, information, knowledge, and sometimes wisdom, with respect to one another and to identify and describe the processes involved in the transformation of an entity at a lower level in the hierarchy…to an entity at a higher level in the hierarchy (e.g. information). The implicit assumption is that data can be used to create information; information can be used to create knowledge, and knowledge can be used to create wisdom” (Rowley, 2007, p. 164). Data are simple symbols, isolated facts, and measurements. When such data are processed, put into a context, and combined within a structure, information emerges. Information provides the answers to “who, what, when and where.” When information is given meaning by interpreting it, that is there is an application of data, information becomes knowledge. Knowledge answers the “how” questions. Finally, wisdom is evaluated understanding and answers the “why” questions. Central to informatics is the processing of data so it becomes meaningful.
• #16: Now that you have a better understanding of informatics, let’s look at where one would find this science applied. As one would expect there is not just one segment or domain for informatics. Any domain where there is a need for analysis of data and dissemination of information through the use of computer applications is a possible application domain. These include a wide range of industries including entertainment, hotel management, law and law enforcement, health care, and many other fields where computer technology interfaces with people. As the focus of this unit is “What is Health Informatics?,” informatics and its application to health care will be explored further.
• #17: While various perspectives of informatics and its application to health care have been published, two have been chosen for review and discussion because of their significance within the field. The first definition comes from the American Medical Informatics Association or AMIA. AMIA is a non-profit organization dedicated to the development and application of medical informatics in the support of patient care, teaching, research, and health administration. This organization is seen as the prominent informatics organization in the US. According to their web site, “AMIA is the professional home of leading informaticians: clinicians, scientists, researchers, educators, students, and other informatics professionals who rely on data to connect people, information, and technology” (AMIA, 2011, para. 2). AMIA’s definition, therefore, is essential to understand. Accordingly, “Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health” (AMIA's Academic Forum, n.d., para. 3). The second definition comes from another highly respected source for biomedical informatics material, the textbook Biomedical Informatics: Computer Applications in Health Care and Biomedicine. Shortliffe and Blois define biomedical informatics as “the scientific field that deals with biomedical information, data, and knowledge – their storage, retrieval, and optimal use for problem solving and decision making” (Shortliffe & Blois, 2001, p. 24). As a field of study, Shortliffe and Blois state biomedical informatics is “concerned with the broad range of issues in the management and use of biomedical information, including biomedical computing and the study and nature of biomedical information itself” (Shortliffe & Blois, 2001, p. 920).
• #18: Another term you may come across is health informatics. It has various interpretations but each one connects information science to health care in some fashion. For example, AMIA’s perspective is “The informatics community typically uses the term health informatics to refer to applied research and practice of informatics across the clinical and public health domain” (AMIA, 2011, para. 3). While AHIMA defines health care informatics as “The field of information science concerned with the management of all aspects of health data and information through the application of computers and computer technologies” (AHIMA, 2012, pp. 154-155). As you can imagine, applying information science to health care requires health informatics standards to define acceptable methods for collecting, organizing, maintaining, and exchanging data among health management information systems.
• #19: Shortliffe & Blois (2001) view biomedical informatics as four subfields which is represented by Figure 1.2 shown on the slide: Public health informatics, clinical informatics, imaging informatics, and bioinformatics each with a specific focus as represented by the left-hand side. The right hand side lists the component sciences in biomedical informatics which includes computer science, clinical science, basic biomedical science, cognitive science, bioengineering, management science, and epidemiology and statistics. The next few slides explain Figure 1.2 further.
• #20: Let’s now explore what is a driving force in health care, that is fueling the need for informatics applications. The American Recovery and Reinvestment Act or ARRA is officially Public Law 111-5 signed into law February 2009. The Health Information Technology for Economic and Clinical Health, often referred to as HITECH, is a provision of the American Recovery and Reinvestment Act. The HITECH section of ARRA deals with many of the health information communication and technology provisions. ARRA, and specifically HITECH, has become a major driver of health informatics through its many different stimulus opportunities, one of which is $19.2 billion for health information technology. The Office of the National Coordinator for Health Information Technology defines health information technology (HIT) as “The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (U.S. Department of Health and Human Services, 2009, para. 8). The funding is expected to assist providers and states in adopting and utilizing health IT in order to achieve widespread adoption of health IT and enable electronic exchange of health information.
• #21: Why else are informatics applications a growing need? Trends which are stimulating the need for health informatics applications include: the focus on eHealth, the adoption and implementation of electronic medical records or EMRs, and electronic health records or EHRs, and the growing desire to be able to electronically exchange health information across organizations within a region, community or hospital system. The application of information technology to health care is a critical tool in achieving the benefits of eHealth, EMRs, EHRs, and health information exchange. As you will learn later in this unit, practitioners of informatics known as informaticians use information technology to advance cost-effective care, high-quality care, and patient safety. But first, let’s review the connection informatics has to eHealth, electronic medical records, electronic health records, and health information exchange.
• #22: A general direction with regards to health IT relates to the global environment. The World Health Organization or WHO, a United Nations agency responsible for directing and coordinating international health activities, recognized a trend involving the use of information and communication technologies and its impact on health care delivery, public health, research and health-related activities. With this recognition, WHO set about defining eHealth and developing a WHO eHealth strategy to help direct WHO’s activities on eHealth. As defined by the WHO, “eHealth is the use of information and communication technologies (ICT) for health to, for example, treat patients, pursue research, educate students, track diseases and monitor public health” (WHO, 2011). The HIMSS definition is “The application of Internet and other related technologies in the healthcare industry to improve the access, efficiency, effectiveness, and quality of clinical and business processes utilized by healthcare organizations, practitioners, patients, and consumers to improve the health status of patients” (HIMSS, 2003, p.4). Thus, there is a very close connection between eHealth and informatics as it is the combined use of electronic communication and information technology in the health segment. Some in the industry see eHealth as a sub-discipline of health informatics. Certainly, the application of information and communication technology to health care is a critical tool in achieving the benefits of eHealth, such as improving health care delivery. An example of eHealth is telemedicine which is delivery of health care at a distance most often via the Internet.
• #23: Another trend of health IT which is impacting the field of health informatics is the adoption of electronic medical records or EMRs, and electronic health records or EHRs. These applications could be thought of as centerpieces of health informatics. The report, Defining Key Health Information Technology Terms defines an EMR as “an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization” (NAHIT, 2008, p. 6). An electronic medical record is a record of medical care created, managed, and maintained by one health care organization. EMRs, being an electronic equivalent of an individual’s legal medical record for use by providers and staff within one health care organization, are part of the health information technology infrastructure and have a direct tie to health informatics.
• #24: A related trend driving the health IT market, and the direction the health care industry is going, is the implementation of electronic health records. As with electronic medical records, EHRs could be considered to be the center of health informatics. In the report, Defining Key Health Information Technology Terms, is this definition: “An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization” (NAHIT, 2008, p. 6). Key components of electronic health records include: administrative system components, laboratory system components, radiology system components, pharmacy system components, computerized provider order entry, and clinical documentation. Being a repository of individual health records that reside in numerous information systems and locations, EHRs are intended to support efficient, high-quality integrated health care, independent of the place and time of health care delivery. Consequently, EHRs, too, are part of a health information technology infrastructure, and therefore, linked to health informatics.
• #25: The final trend is the utilization of health IT, in order to achieve widespread adoption of health IT and enable electronic exchange of health information. Included in the report, Defining Key Health Information Technology Terms, is the following definition for health information exchange (HIE): “The electronic movement of health-related information among organizations according to nationally recognized standards” (NAHIT, 2008, p. 6). HIE involves networks that give providers the ability to electronically transmit in a secure manner an individual’s health records. Through the utilization of EHRs, HIE supports the sharing of health-related information to facilitate coordinated care. EHRs draw information from many sources through health information exchange. Thus, the process of health information exchange is another piece of the health information technology infrastructure and informatics. There are many local, state, and national HIE initiatives going on throughout the U.S.
• #26: To begin to gain an understanding of the individuals involved with informatics applications and the type of work they do, let’s first settle on what is the practice of informatics? According to the report Training the Next Generation of Informaticians, “The practice of informatics, most generally requires the presence of two components: (1) a set of skills and methodologic tools derived from knowledge of the basic informational and computing sciences and (2) knowledge, experience, and activity in one or more application domains. The coexistence of, and interactions between, these key components give meaning and significance to informatics as a field” (Friedman, et al., 2004, p.169) For example, many who practice informatics have training in the subject of human-computer interaction, an application domain covering how people use computers and how to design computer systems that help people use them more effectively.
• #27: Taking into consideration the first component, a set of skills and methodological tools derived from knowledge of the basic informational and computing sciences, let’s review the list of component sciences. Shortliffe & Blois (2001) state that the sciences biomedical informatics draws on and contributes to include computer science, clinical science, basic biomedical science, cognitive science, bioengineering, management science, epidemiology and statistics. Individuals working in the informatics field possess cognitive skills in logical and analytical thinking and have a technical understanding of the computing environment that is the basis for informatics work.
• #28: The report Training the Next Generation of Informaticians also identified a second component to the practice of informatics as the knowledge, experience, and activity in one or more application domains. Some examples of domains identified by (Friedman, et al., 2004) include: Cognitive/human factors and interfaces Data structures Database design Information retrieval Knowledge representation Networking/architecture Ontology/vocabulary Software engineering For example, a review of coursework at several universities on knowledge representation indicated the course covers how knowledge can be represented in a computer system and what kinds of reasoning can be done with the use of the knowledge.
• #29: So, given the definition of the practice of informatics, who would be involved in this field of study? Practitioners of informatics. These individuals are known as informaticians. Members of the team vary in the types of skills, roles, and responsibilities which in turn are tied to their level of education and experience gained through stages of career progression. For example, the team might consist of individuals with an Associate’s degree whose role is clinical data analyst; individuals with a Bachelor’s degree whose role is research and development scientist; an individual with a Master’s degree taking on the role of nursing informatics officer, and an individual with a Doctorate whose role is chief medical informatics officer. Health informaticians use information technology to advance cost-effective care, high-quality care, and patient safety. Therefore, no matter their level of education or experience, all health informaticians need to know how to efficiently and responsibly use information and communication technology. However, a professional with a Bachelor’s degree right out of school uses information differently, compared to a professional with the same degree who has been in the field for 10 years. Likewise, a professional with a two-year degree uses information differently compared to a professional with a Master’s degree.
• #30: Just as there are subdisciplines of biomedical informatics there are subdisciplines of the informaticians. As expected, the informatics applications utilized and the type of work they do will vary. For example, the University of Minnesota’s Institute for Health Informatics Web site states “bioinformaticians develop, and apply computational tools and approaches for expanding the use of biological data, including those to acquire, store, organize, archive, analyze, or visualize such data” (University of Minnesota, 2011, para. 4). The type of work would involve analysis/modeling of genomic datasets. The health care industry requires all types of informaticians to meet the ever-increasing information needs.
• #31: From a more general view, health informaticians are professionals in health care who acquire knowledge in the component sciences and skills in information processing and information and communication technology. To perform the duties of a health informatician, they must have training in the processes associated with the acquisition, storage, retrieval, privacy and security, presentation, and use of information in health and biomedicine.
• #32: Health informaticians may have a varied assortment of responsibilities. Some of those functions include “health informaticians help to design software for patient care, build and maintain research systems for clinical research, purchase and implement information systems that support health care, provide training and assistance to health care providers in using health information technology, conduct analyses of large health datasets, conduct research and development to advance the science of health informatics” (University of Minnesota, 2011, para. 2).
• #33: Health informaticians are in great demand and may work in many different environments including colleges and universities, research facilities, health care delivery organizations, local, state and federal government agencies, medical software firms, medical information services companies, and other private industries such as insurance or medical device companies to name a few. Roles for the health informaticians in the first three environments are discussed in the next few slides.
• #34: A role for health informaticians working in colleges and universities is that of a professor where the focus is on teaching and research. Health informaticians with an academic role have two main responsibilities. They are to: - Educate those interested in the field of health informatics and - Conduct research to improve the acquisition, storage, retrieval, representation, and use of information in health and biomedicine.
• #35: While a health informatician working in a college or university may conduct research to improve the acquisition, storage, retrieval, and use of information in health and biomedicine, there is a research role outside of the academic setting. Research facilities hire health informaticians to focus on informatics applications in clinical and translational research for the purpose of advancing medical science and public health. Other responsibilities for researchers include conducting research in informatics in order to: - Expand the scope of the discipline of health informatics - Research and evaluate new regions or domains in health informatics, and - Lead interdisciplinary teams in the search for solutions to health informatics problems.
• #36: As mentioned earlier, clinical informatics is often further broken down into specific fields or subareas. The term clinical informatician is usually associated with physicians. Other clinical personnel involved in health informatics science are called informaticians as well, and their field of study distinguishes them from each other, that is, nursing informaticians, dentistry informaticians, or pharmacy informaticians. The health care delivery role for clinical personnel focuses on the patient care domain. These individuals combine the knowledge of computer science, information science, cognitive science, and clinical science to assist in the management and processing of clinical data, information, and knowledge to support clinical practice. For example, a role for an informatician whose background is in medicine might be a chief medical informatics officer who’s managing clinical data, information, and knowledge to support clinical practice and who’s involved in the design, implementation, maintenance, and the evaluation of EMRs.
• #37: Other roles for clinical informaticians involve the use of their knowledge of patient care combined with their understanding of informatics science 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, and implementation, management, evaluation, and continuous improvement of clinical information systems such as electronic health records and order-entry systems” (AMIA, 2011, para. 2).
• #38: Besides clinical personnel, there are other health care professionals involved in informatics applications in relation to health care delivery. Sometimes referred to as applied health informatics, those often found in this subarea include, but are not limited to, health information management professionals, health information exchange specialists, programmers and software engineers, and privacy and security specialists. Individuals involved with applied informatics applications provide a vital link between clinicians, technology designers, and information technology. These health information professionals focus on the strategic and operational relevance and robustness of clinical information resources, workflow, end-user support, and connectivity within the health care industry and public heath sectors. Their responsibilities include such things as: constructing computer health information systems by studying the needs of doctors, nurses, patients, and health care organizations; producing requirements and use case documents for EMRs/EHRs; building health networks that allow doctors and nurses to share knowledge and best practices; designing new methods of information delivery that motivate patients to follow treatment recommendations; and working with the vendor to implement the builds which form the documentation, order entry, and data repository system.
• #39: In conclusion, let’s take a final look at informatics as a field of study and how health informaticians process data into information and knowledge for health care tasks with the support of information technology to improve patient care. First consider the application domains as described by the National Library of Medicine: “Health care/clinical informatics: Applications of informatics principles and methods to direct patient care, such as advanced clinical decision support systems and multimedia electronic health records, and to the provision of informational support to health care consumers. Bioinformatics and/or computational biology: Applications of informatics principles and methods to support basic research in such areas as genomics, proteomics, cheminformatics, systems biology, and simulation/modeling of biological systems. Clinical research and translational informatics: Applications of informatics principles and methods to “bench to bedside” translational research exploring genome-phenome relationships, to pharmacogenomics, to drug discovery, and to the support of clinical trials. Public health informatics: Applications of informatics principles and methods to build public health infrastructure, to “intelligent” support of public health agencies and practitioners, to support of research in health behavior and health literacy, and to syndromic surveillance” (NLM, 2011).
• #40: Second, individuals working in the informatics field possess cognitive skills in logical and analytical thinking, and have a technical understanding of the computing environment that is the basis for informatics work. They also possess an awareness of privacy and security policies around health informatics such as the secure collection, management, retrieval, exchange, and/or analysis of information in electronic form. Given the different backgrounds, experience, and education, along with varied roles and skills described previously, who is better equipped to transform data into information and information into knowledge than health informaticians? Third, health informatics is an interdisciplinary, interrelated discipline, undergoing rapid change. As issues in health care become more complex, the amount of data collected and stored escalates. There is a widespread, generally acknowledged need for health informaticians who understand data, information, and knowledge.