Health Informatics Graham Wright MSc Programme Director

Imagination is more important than knowledge" – Albert Einstein

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

Health Informatics Health Informatics is having a mid-life crisis, it is a 45 year old profession wandering around the desert to find itself Yuval Shahar (2001) IMIA Invited Satellite Working Conference ‘Challenges in Medical Informatics – successes and failures’, Madrid March 2001

1. Definitions Informatics Informatics Medical Informatics Medical Informatics Nursing Informatics Nursing Informatics Clinical Informatics Clinical Informatics Health Informatics Health Informatics

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

Informatics information management information management information technology information technology

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

Information technology any technology which processes and communicates data, includes: any technology which processes and communicates data, includes: –computers, voice, data and image sensing and communications devices, graphics devices, multi-media storage, etc. –pen, paper, telephones and fax machines

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)

Medical Informatics "the science of analysis, documentation, steering, control and synthesis of information processes within the health care delivery system, especially in the classical environment and medical practice". Recihertz P Protokoll der Klausurtagung Ausbildungsziele, Inhalte und Methoden in der Medizinischen Informatik Ulm: Reisenberg/b. 1973

Medical Informatics "Comprises the theoretical and practical aspects of information processing and communication, based on knowledge and experience derived from medicine". "Comprises the theoretical and practical aspects of information processing and communication, based on knowledge and experience derived from medicine". –Van Bemmel J –The Structure of Medical Informatics –Methods of Information in Medicine, 1984, 9:175-79

Clinical Informatics "Integrating the processes of designing of redesigning with information sciences and information technology". Ball MJ et al Clinical Informatics: A New Paradigm M.D. Computing, Vol. 14, No. 1, p. 18, 1997

Nursing Informatics "A combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data and the delivery of nursing care". "A combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data and the delivery of nursing care". Graves JR, Cocoran S The Study of Nursing Informatics Image: Journal of Nursing Scholarship Vol. 21, p. 227, 1989

Nursing Informatics "Integration of nursing, its information and information management with information processing and communications technology to support world health". IMIA Nursing Informatics 6th International Congress Stockholm, October 1997

Health Informatics "The study of nature and principles of information and its applications within all aspects of health care delivery and promotion". Protti DJ A New Undergraduate Program in Health/Medical Informatics AMIA Proceedings Masson Publishing, 1982

Health Informatics Health informatics is seen as to be concerned with the individual and group behaviour of health care personnel in their interaction with information and information technologies. Health informatics is seen as to be concerned with the individual and group behaviour of health care personnel in their interaction with information and information technologies. Medical informatics is seen to be rooted in medicine and computer science Medical informatics is seen to be rooted in medicine and computer science –the social, organizational, and policy aspects of information technology are not usually taken into consideration

Medical Informatics "the theory and practice of using information responsibly in the context of healthcare". Kay S, et al Medical Informatics Education at the University of Manchester Yearbook of Medical Informatics Schattauer, 1997

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

Domains of health informatics Domains of health informatics delivery of care and promotion of health delivery of care and promotion of health information management and technology information management and technology organizational settings of health care organizational settings of health care

Bodies of knowledge hard sciences hard sciences –biology and clinical chemistry –computer science –engineering –mathematics and physics soft sciences soft sciences –economics –information science –management science –psychology –sociology medicine and other health care professions medicine and other health care professions

Areas of instruction and learning A. Information 1. Management 2. Technology B. Healthcare Organizations 1. Clinical (Delivery) 2. Management

A. Information 1. Management –Data - Information - Wisdom Spectrum –Power and value of information –Data modeling and data standards –Coding, classification, nomenclature –Data analysis & statistical methods –Systems analysis and design –Information sources (local, national, international) –Managing information resources

A. Information 2. Technology Hardware processing and storage technologies Hardware processing and storage technologies Computer languages Computer languages Software: operating systems, databases, application Software: operating systems, databases, application Communications technologies Communications technologies –Local Area Networks –Intranets and the Internet –Telematicss/telemedicine Infusion/diffusion theories Infusion/diffusion theories Effectiveness metrics Effectiveness metrics Security and Confidentiality Security and Confidentiality

B. Healthcare Organizations 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

B. Healthcare Organizations 2. 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 management organizational development and change 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

Failure to:- understand the nature of different clinical practices and its consequence for the use of technology; understand the nature of different clinical practices and its consequence for the use of technology; understand the nature of the relationship between clinical staff and management which might predispose clinical staff to oppose introduction of a clinical information system; understand the nature of the relationship between clinical staff and management which might predispose clinical staff to oppose 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 which, for example, do not inhibit future developments; choose robust, transferable, extendable and proven technologies which, for example, do not inhibit future developments; take into account research and evaluation of informational developments such as terming and classification systems; take into account research and evaluation of informational 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 as well in less time using new systems; recognise the clinical imperative need to treat more patients at least as well in less time using new systems;

Failure to:- create an affordable and practical technology financial plan from a high level strategy; create an affordable and practical technology financial plan from a high level strategy; involve the future users in such a way that their input is meaningful to determine system requirements and to gain their subsequent ownership involve the future users in such a way that their input is meaningful to determine system requirements and to gain their subsequent ownership prepare and develop individuals and the organisation to make effective use of information technologies; prepare and develop individuals and the organisation 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 expectations and requirements, whether the system is highly valued and to react accordingly actually check whether the technologies are meeting expectations and requirements, whether the system is highly valued and to react accordingly

Stages of the model 1 to 4 Assesses and understands what and for what reasons things happen Assesses and understands what and for what reasons things happen Assesses and understands the context and identifies consequences for clinical work and imperatives for change Assesses and understands the context and identifies consequences for clinical work and imperatives for change Selects and prioritises opportunities, problems, imperatives and requirements for change Selects and prioritises opportunities, problems, imperatives and requirements for change Knows of appropriate technological developments and relates them to information requirements; knows of opportunities and imperatives for change Knows of appropriate technological developments and relates them to information requirements; knows of opportunities and imperatives for change

Stages of the model 5 to 8 Creates an information and technology and strategy plan Creates an information and technology and strategy plan Involves, informs, persuades, prepares for these technologies and other changes Involves, informs, persuades, prepares for these technologies and other changes Plans and introduces new technologies and other changes Plans and introduces new technologies and other changes Evaluates, reviews and assesses the impact and values it Evaluates, reviews and assesses the impact and values it

‘hybrid’ managers-informaticians ‘hybrid’ managers-informaticians select the appropriate information and communication technologies, select the appropriate information and communication technologies, involve perceived beneficiaries, involve perceived beneficiaries, identify the prospective benefits, identify the prospective benefits, successfully plan, implement and evaluate the impact of change successfully plan, implement and evaluate the impact of change