3. Enrico’s view
Enrico’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
4. Health Informatics
Health Informatics
Health Informatics is having a mid-life crisis,
Health Informatics is having a mid-life crisis,
it is a 45 year old profession wandering
it is a 45 year old profession wandering
around the desert to find itself
around the desert to find itself
Yuval Shahar (2001)
Yuval Shahar (2001)
IMIA Invited Satellite Working Conference ‘Challenges in Medical
IMIA Invited Satellite Working Conference ‘Challenges in Medical
Informatics – successes and failures’ , Madrid March 2001
Informatics – successes and failures’ , Madrid March 2001
5. 1. Definitions
1. Definitions
• Informatics
Informatics
• Medical Informatics
Medical Informatics
• Nursing Informatics
Nursing Informatics
• Clinical Informatics
Clinical Informatics
• Health Informatics
Health Informatics
6. Informatics
Informatics
• the application of information
the application of information
technologies to optimize the
technologies to optimize the
information management function
information management function
within an organization
within an organization
8. Information management
Information management
• assuring that the right information is
assuring that the right information is
available to the right people, within
available to the right people, within
and without an organization, at the
and without an organization, at the
right time and place, and for the right
right time and place, and for the right
price
price
9. Information technology
Information technology
• any technology which processes and
any technology which processes and
communicates data, includes:
communicates data, includes:
– computers, voice, data and image
computers, voice, data and image
sensing and communications devices,
sensing and communications devices,
graphics devices, multi-media storage,
graphics devices, multi-media storage,
etc.
etc.
– pen, paper, telephones and fax machines
pen, paper, telephones and fax machines
10. Health or Medical Informatics
Health or Medical Informatics
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)
11. Medical Informatics
Medical Informatics
"the science of analysis, documentation,
"the science of analysis, documentation,
steering, control and synthesis of
steering, control and synthesis of
information processes within the
information processes within the
health care delivery system, especially
health care delivery system, especially
in the classical environment and
in the classical environment and
medical practice".
medical practice".
Recihertz P
Recihertz P
Protokoll der Klausurtagung Ausbildungsziele, Inhalte und
Protokoll der Klausurtagung Ausbildungsziele, Inhalte und
Methoden in der Medizinischen Informatik
Methoden in der Medizinischen Informatik
Ulm: Reisenberg/b. 1973
Ulm: Reisenberg/b. 1973
12. Nursing Informatics
Nursing Informatics
"A combination of computer science,
"A combination of computer science,
information science and nursing science
information science and nursing science
designed to assist in the management and
designed to assist in the management and
processing of nursing data and the
processing of nursing data and the
delivery of nursing care".
delivery of nursing care".
Graves JR, Cocoran S
Graves JR, Cocoran S
The Study of Nursing Informatics
The Study of Nursing Informatics
Image: Journal of Nursing Scholarship
Image: Journal of Nursing Scholarship
Vol. 21, p. 227, 1989
Vol. 21, p. 227, 1989
13. Nursing Informatics
Nursing Informatics
"Integration of nursing, its information
"Integration of nursing, its information
and information management with
and information management with
information processing and
information processing and
communications technology to support
communications technology to support
world health".
world health".
IMIA Nursing Informatics
IMIA Nursing Informatics
6th International Congress
6th International Congress
Stockholm, October 1997
Stockholm, October 1997
14. Health Informatics
Health Informatics
"The study of nature and principles of
"The study of nature and principles of
information and its applications
information and its applications
within all aspects of health care
within all aspects of health care
delivery and promotion".
delivery and promotion".
Protti DJ
Protti DJ
A New Undergraduate Program in Health/Medical Informatics
A New Undergraduate Program in Health/Medical Informatics
AMIA Proceedings
AMIA Proceedings
Masson Publishing, 1982
Masson Publishing, 1982
15. Health Informatics
Health 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 their
of health care personnel in their
interaction with information and
interaction with information and
information technologies.
information technologies.
• Medical informatics is seen to be rooted in
Medical informatics is seen to be rooted in
medicine and computer science
medicine and computer science
– the social, organizational, and policy aspects
the social, organizational, and policy aspects
of information technology are not usually
of information technology are not usually
taken into consideration
taken into consideration
16. International view
International 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
17. Bodies of knowledge
Bodies of knowledge
• hard sciences
hard sciences
– biology and clinical chemistry
biology and clinical chemistry
– computer science
computer science
– engineering
engineering
– mathematics and physics
mathematics and physics
• soft sciences
soft sciences
– economics
economics
– information science
information science
– management science
management science
– psychology
psychology
– sociology
sociology
• medicine and other health care professions
medicine and other health care professions
18. Areas of instruction and learning
Areas of instruction and learning
A. Information
A. Information
1. Management
1. Management
2. Technology
2. Technology
B. Healthcare Organizations
B. Healthcare Organizations
1. Clinical (Delivery)
1. Clinical (Delivery)
2. Management
2. Management
19. A. Information
A. Information
1. Management
1. Management
– Data - Information - Wisdom Spectrum
Data - Information - Wisdom Spectrum
– Power and value of information
Power and value of information
– Data modeling and data standards
Data modeling and data standards
– Coding, classification, nomenclature
Coding, classification, nomenclature
– Data analysis & statistical methods
Data analysis & statistical methods
– Systems analysis and design
Systems analysis and design
– Information sources (local, national,
Information sources (local, national,
international)
international)
– Managing information resources
Managing information resources
20. A. Information
A. Information
2. Technology
2. Technology
• Hardware processing and storage technologies
Hardware processing and storage technologies
• Computer languages
Computer languages
• Software: operating systems, databases,
Software: operating systems, databases,
application
application
• Communications technologies
Communications technologies
– Local Area Networks
Local Area Networks
– Intranets and the Internet
Intranets and the Internet
– Telematicss/telemedicine
Telematicss/telemedicine
• Infusion/diffusion theories
Infusion/diffusion theories
• Effectiveness metrics
Effectiveness metrics
• Security and Confidentiality
Security and Confidentiality
21. B. Healthcare Organizations
B. Healthcare Organizations
1. Clinical (Delivery)
1. Clinical (Delivery)
• History and culture of clinicians
History and culture of clinicians
• Clinical practice content and process
Clinical practice content and process
• Clinical practice guidelines and protocols
Clinical practice guidelines and protocols
• Evidence-based decision making
Evidence-based decision making
• Decision support and expert systems
Decision support and expert systems
• Health outcomes and health status
Health outcomes and health status
• Epidemiology
Epidemiology
• Population health
Population health
22. B. Healthcare Organizations 2.
B. Healthcare Organizations 2.
Management
Management
• organization theory and models
organization theory and models
• communications theories
communications theories
• management process and practice
management process and practice
• organizational development and change
organizational development and change
management
management
• health economics and fiscal management
health economics and fiscal management
• resource allocation models
resource allocation models
• individual and group decision support systems
individual and group decision support systems
• ethics and legislation
ethics and legislation
24. Context: Health Care System
Organising and managing
Clinical practice
Learning from sets
of patients
Diagnosing and
treating a patient
The three levels of clinical activity which should be the
focus of information technology in a health care system
25. 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;
26. 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 ownership
to 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 accordingly
highly valued and to react accordingly
27. Involves, informs
persuades,
prepares for these
technologies and
other changes
Creates an
information and
technology
strategy and
financial plan
Plans and
introduces new
technologies
with other
changes
Evaluates,
reviews and
assesses the
impact and
values it
Knows of appropriate
technological
developments & relates
them to information
requirements: knows of
opportunities and
imperatives for change
System
Health care
Organisation of
clinical work
Sets ofpatients
Single patient
Clinical
Work
Selects and
prioritises
opportunities,
problems,
imperatives and
requirements
for change
Assesses and
understands the
context & identifies
consequences for
clinical work and
imperatives for
change Assesses and
understands what
[and for what key
reasons] activities
occur at each
level
Respond
Identify impact
Respond
Observe
& enquire
Tell
Observe
&
enquire
Tell
Relate & Check
Tell
Relate & check
Tell
Observe
& enquire
Tell
Identify
impact
4.
3.
5. 6.
7.
Realise
Respond & Implement
2.
1.
28. Stages of the model
Stages of the model
1 to 4
1 to 4
• Assesses and understands what and for what reasons
Assesses and understands what and for what reasons
things happen
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
change
change
• Selects and prioritises opportunities, problems,
Selects and prioritises opportunities, problems,
imperatives and requirements for change
imperatives and requirements for change
• Knows of appropriate technological developments and
Knows of appropriate technological developments and
relates them to information requirements; knows of
relates them to information requirements; knows of
opportunities and imperatives for change
opportunities and imperatives for change
29. Stages of the model
Stages of the model
5 to 8
5 to 8
• Creates an information and technology and
Creates an information and technology and
strategy plan
strategy plan
• Involves, informs, persuades, prepares for
Involves, informs, persuades, prepares for
these technologies and other changes
these technologies and other changes
• Plans and introduces new technologies and
Plans and introduces new technologies and
other changes
other changes
• Evaluates, reviews and assesses the impact
Evaluates, reviews and assesses the impact
and values it
and values it
30. ‘
‘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 change
the impact of change
Editor's Notes
#19:This definition is a catch-all (hopefully) and is understandable across all the 50plus countries of the International Medical Informatics association.
But it is a bit unwieldy and highlights much of the fragmentation and divisiveness that exists. How many of you do not agree with all of the components or can think of others who would not fit under it but are active in our field??
Its worth saying - we are not the only country with problems, and neither are the problems nationalistic - the current issue of Methods in … contains articles which explore the international challenges -- from both he academic and the operational perspectives
![Involves, informs
persuades,
prepares for these
technologies and
other changes
Creates an
information and
technology
strategy and
financial plan
Plans and
introduces new
technologies
with other
changes
Evaluates,
reviews and
assesses the
impact and
values it
Knows of appropriate
technological
developments & relates
them to information
requirements: knows of
opportunities and
imperatives for change
System
Health care
Organisation of
clinical work
Sets ofpatients
Single patient
Clinical
Work
Selects and
prioritises
opportunities,
problems,
imperatives and
requirements
for change
Assesses and
understands the
context & identifies
consequences for
clinical work and
imperatives for
change Assesses and
understands what
[and for what key
reasons] activities
occur at each
level
Respond
Identify impact
Respond
Observe
& enquire
Tell
Observe
&
enquire
Tell
Relate & Check
Tell
Relate & check
Tell
Observe
& enquire
Tell
Identify
impact
4.
3.
5. 6.
7.
Realise
Respond & Implement
2.
1.](https://image.slidesharecdn.com/whatishealthinformatics-250719002947-2bd7ae28/85/health-information-in-the-context-of-delivery-27-320.jpg)
