What is Health Informatics? Tamim Alganam

Data, Information, Knowledge, Wisdom Hierarchy Symbols, facts, measurements Information Data processed to be useful Provides the “who, what, when, where” Knowledge Application of data and information Provides the “how” Wisdom Evaluated understanding Provides the “why” 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.

Data, Information, Knowledge, Wisdom Hierarchy 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.

Fundamental Theorem of Informatics Building on what has been learned so far, Dr. Friedman’s proposed fundamental theorem of informatics will be reviewed next. Other theories, such as Bayes’ Theorem, also apply to informatics but will not be addressed in this unit. Merriam-Webster’s Online Dictionary defines a theorem as “an idea accepted or proposed as a demonstrable truth often as a part of a general theory” (Merriam-Webster, 2011). Dr. Friedman utilized Figure 1.1 to represent the theorem. The picture is that of parentheses, picture of a head of a person, a plus sign, picture of a computer, parentheses, greater than symbol, picture of a head of a person. According to Dr. Friedman, this figure is to be interpreted to mean “A person working in partnership with an information resource is ‘better’ than that same person unassisted” (Friedman, 2009, p. 169). He further explains, “the metaphoric ‘person’ depicted in the theorem can be a clinician, a scientist, a student, a patient or an administrator. The “person” can also be a team or group, or even an organization. The ‘information resource’ is any mechanism capable of providing information or knowledge or advice to support the person's completion of a task. Information resources are usually, but do not have to be, computer-based. The ‘plus’ in the figure is intended to convey interaction between the person and the resource, the outcome of which is determined by what the information resource is capable of, as well as how the person elects to use it. The ‘plus’ symbol is employed because of its universal recognition, but is not to be read literally in the sense of mathematical addition. The parentheses further connote a bonding between the person and resource, and suggest that the person-resource interaction is shaped by its environment or organizational context. ‘Better’ and the ‘greater than’ inequality are used loosely by intention, so as not to convey specific requirements for testing the theorem” (Friedman, 2009, p. 169). Figure 1.1 A “Fundamental Theorem” of Informatics: (Friedman, 2009).

Application Domains for Informatics Any area of human endeavor supportable by information technology Such as Entertainment Law and law enforcement Health care Other fields where computer technology interfaces with people 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.

Health Informatics Health informatics is the discipline concerned with management of healthcare data and information through the application of computers and other information technologies. It is more about applying information in the healthcare field than it is about technology per se. 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).

Biomedical Informatics 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. Figure 1.2 Biomedical Informatics: Modified by Dr. Jiajie Zhang, The University of Texas at Houston, School of Biomedical Informatics from Shortliffe & Blois, 2001

Current Trends in Health Informatics Electronic medical records Electronic health records Health information exchange AI Data Analytics mHealth Telemedicine 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.

Electronic Medical Record (EMR) Electronic record of health-related information on an individual Within one health care organization 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.

Electronic Health Record (EHR) Electronic record of health-related information on an individual Across more than one health care organization 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.

Health Information Exchange (HIE) Electronic movement of health-related information among organizations Involves networks Local, state, and national HIE initiatives 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.

Health Data Sources

Motivations Driving Adoption • Increase the efficiency of healthcare (improve physician, nurse and overall healthcare productivity) • Improve the quality (patient outcomes) of healthcare, resulting in improved patient safety • Reduce healthcare costs

Motivations Driving Adoption Improve healthcare access • Improve communication, coordination and continuity of care • Improve medical education for clinicians and patients • Standardization of medical care

Barriers To Adoption Inadequate time Inadequate information Inadequate expertise and workforce Inadequate cost and return on investment data High cost to adopt Change in workflow Behavioral change

Gartner Hype Cycle of Emerging Technology 2017

Key Users of Healthcare Technology • Patient – the individual who receives healthcare, • Provider – those who “provide” healthcare • Purchaser – those who buy healthcare • Payor – those who “pay” the healthcare system • Public health – protectors of the public’s health

What is Health Informatics? References Altman, R. B. , & Mooney, S. D. (2001). Bioinformatics. In Shortliffe. E., & Cimino, J.J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine (3rd ed) (p. 763. New York, NY: Springer Science + Business Media. American Health Information Management Association. (2012). Pocket glossary for health information management and technology (3rd ed.). Chicago, IL: Author. AMIA. (2011). About AMIA. Retrieved from http://www.amia.org/about-amia AMIA's Academic Forum. (n.d.). Definition of biomedical informatics. Retrieved from http://www.amia.org/biomedical-informatics-core-competencies Bernstam E., Smith J., & Johnson T. (2009, August). What is biomedical Informatics. Journal of Biomedical Informatics, 43(1). doi: 10.1016/j.jbi.2009.08.006 Friedman, C. (2009). A "fundamental theorem" of biomedical informatics. Journal of the American Medical Informatics Association, 16(2), 169-170. doi: 10.1197/jamia.M3092 Healthcare Information and Management Systems Society. (2003, May 5). HIMSS E-Health SIG white paper. Retrieved from http://www.himss.org/content/files/ehealth_whitepaper.pdf Merriam-Webster Online. (2011). Retrieved from http://www.merriam-webster.com/dictionary/theorem Rowley, J. (2007, February). The wisdom hierarchy: Representations of the DIKW hierarchy. Journal of Information Science, 44. doi: 10.1177/0165551506070706

What is Health Informatics? References Shortliffe, E., & Blois, M. (2006). The computer meets medicine and biology: Emergence of a discipline. In Shortliffe. E., & Cimino, J.J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine (3rd ed) (pp. 3-45). New York, NY: Springer Science + Business Media. The National Alliance for Health Information Technology. (2008, April 28). Defining key health information technology terms. Retrieved from healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf UMDNJ-Robert Wood Johnson Medical School, UMDNJ-School of Health Related Professions Department of Health Informatics & New Jersey Institute of Technology. (n.d.). MD/MS in Biomedical Informatics. [Brochure]. Retrieved from http://rwjms.umdnj.edu/education/current_students/academics/mdms_biomedicalinformatics.pdf U.S. Department of Health and Human Services, The Office of the National Coordinator for Health Information Technology. (2009, December 4). Health IT terms. Retrieved from http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&cached=true&objID=1256&PageID=15726 World Health Organization. (2011). eHealth. Retrieved from http://www.who.int/topics/ehealth/en/ Charts, Tables, Figures 1.1 Figure: Friedman, C. (2009). A "fundamental theorem" of biomedical informatics. Journal of the American Medical Informatics Association, 16(2), 169-170. doi: 10.1197/jamia.M3092 1.2 Figure: Biomedical Informatics: Modified by Dr. Jiajie Zhang, The University of Texas at Houston, School of Biomedical Informatics from Shortliffe, E., & Blois, M. (2006). The computer meets medicine and biology: Emergence of a discipline. In Shortliffe. E., & Cimino, J.J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine (3rd ed) (pp. 3-45). New York, NY: Springer Science + Business Media. This material Comp6_Unit1 was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.