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Health informatics

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Electronic patient chart of a health information system

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, pharmacy informatics and healthcare management informatics.

Aspects of the field

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 duplication is staggering. The number of lives saved could exceed 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 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 health care facilities.

In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exists only a small number of health practitioners use fully featured electronic health care records systems.

Homer R. Warner, one of the Fathers of Medical Informatics, founded the Department of Medical Informatics at the University of Utah in 1968, and the American Medical Informatics Association (AMIA) has a award named after him on application of informatics to medicine[1].

The US HIPAA of 1996, regulating 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.

The US is making progress towards a standardized health information infrastructure. In 2004 the US Department of Health and Human Services (HHS) formed the Office of the National Coordinator for Health Information Technology (ONCHIT) [2], headed by David J. Brailer, M.D., Ph.D. The mission of this office is widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. See quality improvement organizations for more information on federal initiatives in this area. Brailer resigned from the post in April, 2006. [3]

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. [4] [5]

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 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.[6] [7]. The European Institute for Health Records is involved in the promotion of high quality Electronic Health Record systems in the European Union.

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).[8]

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" [9]. 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[10]. 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.[11]

China

Main article: Health informatics in China

Hong Kong

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[12] 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.[13] 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.[14]

India

The Indian Association for Medical Informatics (IAMI) was established in 1993 [15]. IAMI has been publishing the Indian Journal of Medical Informatics since 2004.[16]

Health informatics in Australasia & 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.[17]

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).[18] 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 in New Zealand

Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. It emerged in September 2000 from two health informatics organisations: Nursing Informatics New Zealand (NINZ) and New Zealand Health Informatics Foundation (NZHiF). Nursing Informatics was originally formed in 1990 and NZHiF was originally formed in 1994.[19]

The New Zealand Health IT Cluster is a alliance of organisations interested in health IT, comprising software and solution developers, consultants, health policy makers, health funders, infrastructure companies, healthcare providers, and academic institutions - who have agreed to work collaboratively.[20]

Programmes in Health Informatics are taught at four New Zealand universities. The University of Otago and the University of Auckland offer a Postgraduate Diploma in Health Informatics, the University of Canterbury a Postgraduate Diploma in Health Sciences, with a specialism in Health Information Management, and Massey a Postgraduate Diploma in Health Service Management or a Postgraduate Diploma in Business Administration with a specialisation in Health Informatics. Courses offered at the other universities are less mature and established than the Otago programme [21], which has been offered for over a decade, and Auckland has recently made structural changes to its programme". See page 33 of [22]

Healthcare Management Informatics

Healthcare Management Informatics (HMI) can be defined as that subset of health informatics dedicated to the study, design and implementation of information technology solutions in support of the practice of healthcare management in all its forms - including, but not limited to, primary care and general practice, sub acute and rehabilitation care, and hospital care. Furthermore, HMI involves the study of the needs of healthcare management practitioners, including in information presentation and in decision support. The Australasian based Special Interest Group in Healthcare Management Informatics and Computing (SHMIC), hosted as a web based group, has a specific focus on this topic, and has members from multiple disciplines from across the Australian and Asian regions interested in developing further the discipline of HMI.

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.

Health informatics standards

The international standards on the subject are covered by ICS 35.240.80 [23] in which ISO 27799:2008 is one of the core components [24].

Leading Health Informatics and Medical Informatics Journals

Ranking of ISI/SCI listed e-Health and Medical Informatics Journals

Footnotes: (i) Impact Factors rounded to one decimal point. Source: Medical Informatics Category, ISI/SCI Journal Citation Reports, published June 2008

(ii) PMC= Pubmed Central. Note that starting in 2008, all NIH grantees must make their manuscripts available in Pubmed Central

(iii) not ranked in the Medical Informatics category

Rank Abbrev Journal Title Impact Factor (i) Open Access In PMC (ii) Editor in Chief Publisher ISSN Focus (keywords or quotes from instructions for authors)
TOP Journals 1 J Am Med Inform Assn 3.1 No after 6 months R. Miller Elsevier 1067-5027 clinical informatics, US-focus
2 J Med Internet Res 3.0 Yes immediately G. Eysenbach Eysenbach 1438-8871 Web, consumer health, ehealth innovations, interdisciplinary, clinical Internet applications, intl ICT policy, public health, telecare
Good Journals 3 Med Decis Making 2.2 No No M. Helfand Sage 0272-989X clinical decision making
4 J Biomed Inform 2.0 No No E.H. Shortliffe Elsevier 1532-0464 "methods that generalize across biomedical domains"
Middle of the Pack 5 Artif Intell Med 1.8 No No K.P. Adlassnig Elsevier 0933-3657 artificial intelligence
6 Int J Med Inform 1.6 No No C. Safran, J. Talmon Elsevier 1386-5056 clinical systems
7 J Eval Clin Pract 1.6 No No A. Miles Blackwell 1356-1294 evaluation of clinical practice
8 Stat Med 1.5 No No 0277-6715 statistical methods in medicine
9 Stat Methods Med Res 1.5 No No B. Everitt Sage 0962-2802 statistical methods in medicine
10 Method Inform Med 1.5 No No R. Haux Schattauer 0026-1270 "scientific fundamentals of processing data, information"
11 IEEE T Inf Technol B 1.4 No No IEEE 1089-7771 telemedicine, clinical networks, broadband technologies
12 Int J Technol Assess 1.4 No No E.Jonsson Cambridge 0266-4623 development, evaluation, diffusion and use of health technology
Low-Impact Journals 13 IEEE Eng Med Biol 1.1 No No IEEE 0739-5175 biomedical and clinical engineering (technical)
14 CIN-Comput Inform Nu 1.0 No No L. Nicoll Lippincott 1538-2931 use of computers in nursing practice
15 Med Biol Eng Comput 0.9 No No J.A.S. Spaan Springer 0140-0118 biomedical and clinical engineering, incl cellular engineering and molecular imaging
16 Comput Meth Prog Bio 0.9 No No T. Groth Elsevier 0169-2607 computing methodology and software systems derived from computing science
(iii) J Telemed Telecare 0.9 No No R. Wootton RSM telemedicine and telecare
(iii) Telemed J E-Health 0.9 No No R.C. Merrell Liebert 1530-5627 clinical telemedicine practice, US-focus
"Throw-Away" Journals 17 Biomed Tech 0.6 No 0013-5585
18 Med Inform Internet 0.5 No 1463-9238
19 J Med Syst 0.5 No No R.R. Grams Springer 0148-5598
20 J Cancer Educ 0.3 No

Based on: Impact Factors Medical Informatics Journals

Not listed / ranked in ISI/SCI

  • BMC Med Dec Mak Med Informatics

See also

References

  1. ^ Hall of Fame of Utah Technology Council, retrieved March 17 2008
  2. ^ US Office of the National Coordinator for Health Information Technology (ONCHIT)
  3. ^ http://www.linuxmednews.org Linux Medical News
  4. ^ Certification Commission for Healthcare Information Technology (July 18, 2006): CCHIT Announces First Certified Electronic Health Record Products Retrieved July 26, 2006
  5. ^ Certification Commission for Healthcare Information Technology (July 31, 2006):CCHIT Announces Additional Certified Electronic Health Record Products Retrieved July 31, 2006
  6. ^ European eHealth Action Plan
  7. ^ European eHealth Action Plan i2010
  8. ^ UK Council for Health Informatics Professions (UKCHIP)
  9. ^ National Programme for IT in the NHS
  10. ^ [1]
  11. ^ APAMI Asia Pacific Association for Medical Informatics
  12. ^ Health Informatics Section in Hong Kong Hospital Authority
  13. ^ Hong Kong Society of Medical Informatics
  14. ^ eHealth Consortium
  15. ^ Indian Association for Medical Informatics
  16. ^ Indian Journal of Medical Informatics
  17. ^ Australian College of Health Informatics
  18. ^ Health Informatics Society of Australia
  19. ^ Health Informatics New Zealand
  20. ^ NZ Heath IT cluster
  21. ^ Otago University Health Informatics Programme
  22. ^ Health Informatics Capability Development In New Zealand - A Report to the Tertiary Education Commission
  23. ^ ISO. "35.240.80: IT applications in health care technology". Retrieved 15 June. {{cite web}}: Check date values in: |accessdate= (help); Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  24. ^ Fraser, Ross. "ISO 27799: Security management in health using ISO/IEC 17799" (PDF). Retrieved 15 June. {{cite web}}: Check date values in: |accessdate= (help); Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)

Official reports

Associations

Journals

Institutions

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