1 Health informatics Health informatics is the subject concerned with the application of information and communications technologies (ICT) to the acquisition, processing, interpreting, storage, transmission and retrieval of health -related and healthcare data, and using the derived information and knowledge in healthcare delivery, education, management and research. The further paper discusses the advantages and disadvantages of health informatics, identifies some of the opportunities to improve health care delivery through increased use of information technology, and discusses how these technologies are being used to communicate clinical information, simplify administration of health care delivery, assess the quality of health care, inform the decision making process of providers and administrators, and support delivery of health care at a distance. Health informatics encompasses the capturing, processing and modeling of health-related information. It is the integration of computer science, information science, networking and communication with the aim of improving health (Curry, 2000). Researchers in the field of health informatics study the effectiveness of health information systems, both to compare various systems and to improve existing systems. They also investigate to how effectively health information is communicated to end users, whether the messages are understood, and have the desired effect. Health informatics includes devices, methods and the resources required to optimize the acquisition, storage, retrieval and use of information in health care system. Not only computers, but also clinical guidelines, formal medical terminologies, information and communication systems are part of health informatics tools that all together serve to improve the healt h care service. Health informatics consists of the following subcategories like consumer health informatics, 2 clinical informatics, perioperative nursing informatics, clinical research informatics, public health informatics, dental informatics, bioinformati cs, veterinary informatics, imaging informatics, and pharmacy informatics. Consumer health informatics has been defined as “the study, development, and implementation of computer and telecommunications applications and interfaces designed to be used by hea lth consumers” (Curry, 2000). The basic principle is that of empowering people to play a greater role in their own health care and to be active participants in decision affecting their health. The advantages of Health Informatics Information technology of Health informatics is transforming the way health care is delivered. Innovations such as computer-based patient records, hospital information systems, computer-based decision support tools, community health information networks, telemedicine, and new ways of distributing health information to consumers are beginning to affect the cost, quality, and accessibility of health care. The health care delivery system is currently undergoing many changes, including the emergence of managed health care and integrat ed delivery systems that have stood between care providers, insurers, medical researchers, and public health professionals. Taking measures to prevent illness and disease, by adjusting lifestyles or taking safety precautions could have a positive impact on the health care delivery system and allow people to lead healthier lives. Health informatics encompasses the capturing, processing and modeling of health-related information. It is the integration of computer science, information science, networking and communication with the aim of improving health. Researchers in the field of health informatics study the effectiveness of health information systems, both to compare various systems and to improve existing 3 systems. They also investigate to how effectively health information is communicated to end users, whether the messages are understood, and have the desired effect. The disadvantages of Health Informatics An area such as health informatics is under constant evolution, so technologies, applications and areas of use will always be in a state of continuing change. Health care law addresses the privacy, ethical and operational issues that invariably arise when electronic tools, information and media are used in health care delivery. So the main disadvantages or better to say challenges of health informatics, including online health support, are the following: (1) No or insufficient guarantee for high quality of online health information. In reality, most people judge the quality of information online the same way do when buying a book. They use their common sense, they might have some sense of the author’s reputation or might ask other people interested in the subject; (2) Computers are widely deployed, but not widely connected, thus, clinical and administrativ e health information are rarely commingled; (3) Computer-based patient record (CPR) systems are difficult to implement since they require close integration between many different systems; and others. Though, despite all these disadvantages, challenges and other possible obstacles, implementation of computer-based and online health informatics is inevitable in such rapidly growing hi-tech societies where more and more people use the Internet and computers for the majority of their daily tasks. The important challenges of health informatics Recently one of the most important challenges in health care delivery system is that some patients are finding more help in cyberspace than in their own doctors' offices. A physician explains why and discusses exciting ne w directions for the 4 future. Patients, not doctors, are leading a revolution in health care by establishing self-help communities in cyberspace. As the Internet has expanded, about 70 percent of Internet users in Australia browse it to find health informat ion. Three kinds of people use the Internet for health information: “the worried well”, “the newly diagnosed”, and “the chronic stables” (Curry, 2000). The first group of people uses it occasionally and sporadically since they look up a symptom or a common illness. They use it as an extended searchable reference work, and they are looking mostly for traditional linear information written by doctors. About 60 percent of the Australian people who use the Internet to find health information are worried well, but they only account for 5 to 10 percent of the overall use. The newly diagnosed are the heaviest users. They are only 3 to 5 percent of Australian users, but they account for 35 percent of the use. Chronic stables account for the rest of the use. They regularly take part in discussions on mailing lists, or web -based online support groups. If to ask them whether they could find what they needed online, and whether it was satisfactory, over 90 percent say yes. Though, if to ask physicians whether patients can find good information online, most of them say no. Thus, different views on health care service provided online and lack of trust between patients and “online doctors” still exist. Though, this challenge will be solved sooner or later since computer- and Internet-based services tend to increase greatly in the next several years. Another important challenge of health informatics in Australia today is that there is still no common computer-based system for all the hospitals, clinics, private cabinets and other medical institutions so that all doctors, nurses and patients have access to the information they need for more efficient, rapid and appropriate medical treatment. Certainly, majority of hospitals already have shared documentation and 5 health records of patients, though to provide high-quality medical treatment all the medical institutions should have access to necessary information, be able to analyze it and conduct the appropriate researches. In Australia and New Zealand, the regional group called the APAMI Asia Pacific Association for Medical Informatics was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region. 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. The Health Informatics Society of Australia (HISA) is regarded as the major umbrella group in Australia and is a member of the International Medical Informatics Association (IMIA). Nursing informaticians were the driving force behind the formation of HISA, which is now an incorporated company. 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 and Western Australia) as well as special interest groups such as perioperative nursing (NIA), pathology, aged and community care, industry and medical imaging. The sources of inaccuracy of clinical information Clinical Information system (CIS) is an integral part of the Hospital Information System that presumes direct interaction of nurses and doctors with the system for data entry and retrieval, pertaining to all activities d irectly related to patient care. The source of inaccuracy of clinical information might be if it is 6 improperly integrated into the complex HIS organizational environment with a common computerized patient record (CPR). The system is not likely to be confirmed and accepted by doctors and nurses if it fails to provide direct benefits to users. It is vitally important for nurses or other responsible people to include patient’s information correctly since CPR facilitates the reporting, organization and location of patient data and real-time computerization charting care plans and medications using bedside terminals or terminals at Nursing Stations. The key security and privacy issues Australian legislation covers the privacy of patient records and data security of online and computer-based information shared between the patient and the doctor. Thus, privacy, confidentiality and security of electronic data are areas of great concern because of the sensitivity of health information. People reveal highly sensitive information to health professionals. If clinicians or institutions misuse or record the confidential information incorrectly, it might be used to restrict or revoke a person’s health insurance or in other cases. The key to privacy is disclosure, letting patients know what kind of information doctors capture, and with whom they share it, so that patients can make informed choices and decisions. Any new health data recordkeeping system must ensure that information is used appropriately or people will avoid using it. Many hospitals in Australia allow fairly broad access to patient records by authorized caregivers, and they usually have security systems to keep track of each access. To protect transferred health information, many hospitals and medical institutions can use authentication techniques which are the use of passwords, keys, and other automated identifiers. They are used to verify the identity of the person sending or receiving information. Without uniform privacy and confidentiality laws, 7 it is extremely difficult to expedite the development of health records transfer. To protect privacy Australian hospitals and other medical institutions should do the following: (1) ensure that the patient has authorized release of health information to an insurer by signing the release contained on the insurance form; (2) ensure that they release information in strict compliance with the written release; (3) ensure that they have complied with any relevant laws governing the disclosure to insurers; (4) establish security policies for employees who have access to and process patient health information; and (5) establish security protocols for computer systems used to process claims. The benefits nurses can expect when using decision-support systems Shared decision support systems are designed to inform patient/provider decisions regarding prevention, diagnosis, management, and treatment, and ultimately to improve the quality of care and reduce costs (Hunt & Haynes, 1998). Perioperative Nursing Informatics is a specialty of Health care informatics which deals with the support of nursing by information systems in delivery, documentation, administration and evaluation of patient care and prevention of diseases. Nursing Informatics is defined as a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice (Nurses Association's Scope and Standards for Nursing Informatics Practice (2006). Computer-based systems transform the culture of the health care system to one in which patients, physicians, and other providers play equal roles in decision-making process. While using decision-making systems nurses collect and manage data, process data into information and knowledge, make knowledge-based decisions and inferences for patient care, and use this empirical and experiential knowledge in order to broaden the scope and enhance the quality of 8 their professional practice. According to Henry (1995), the scientific methods central to perioperative nursing are focused on: 1. Using a discourse about motives for computerized systems, 2. Analyzing, formalizing and modeling nursing information processing and nursing knowledge for all components of nursing practice: clinical practice, management, education and research, 3. Investigating determinants, conditions, elements, models and processes in order to design, and implement as well as test the effectiveness and efficiency of computerized information, (tele)communication and network systems for nursing practice, and 4. Studying the effects of these systems on nursing practice. Recently there exists a debate concerning preference of electronic records over the paper records which are considered old and inefficient anymore (Buckovich, 2001). The supporters of the first type of records insist that the data recorded in the electronic format can be shared among the clinicians and care providers; can be used for a wide spectrum of research studies; provides support for hospital management in aspects of billing and reimbursement, healthcare financing and budgeting. In addition, simultaneous access is possible from multiple locations; decision support system is compatible; data exchange is easier; data is presented legibly; and variety of view of data is possible. There are various systems that allow patients to access information about their illnesses and to support one another using home terminals. Among such systems are the Connect System (a computer and voice-mail system used to monitor inner cit y drug-using pregnant women), ComputerLink (project supporting the caregivers of persons with Alzheimer’s disease and AIDS by delivering information, 9 communication, and decision support accessed through home terminals), the CHESS system (electronic support group for patients with different diseases) and many others (Buckovich, 2001). The following actions are needed to foster greater electronic health resources for consumers: 1. support research and development; 2. insist on good needs assessment for consumer applications; 3. incorporate medical informatics into the medical education curriculum; 4. support clinical trials of different ways of sharing health data; 5. facilitate the use of technology by managed care organizations; 6. educate, support, and train users; and 7. provide grassroots technology “set-asides”. The central event of successful health care is the presentation of health or the healing of an infirmity through employment of medical expertise for the benefit of a patient. All the medical personnel, including nurses, administrators in addition to insurance companies should work within information systems that are often poorly organized to answer complex questions as they compete for customers, comply with shifting regulatory policy, optimize use of resources, and provide high-quality health care. 10 References: Henry, S. 1995. Informatics: essential infrastructure for quality assessment and improvement in nursing. JAMIA, vol. 2, pp. 169-182. Buckovich, S. 2001. Essentials of computers for nurses-informatics for the new millennium. Chapter 9: Privacy, confidentiality, and security. V. Saba and k. McCormick (eds), 3rd edition, McGraw hill, New York, pp. 155 -165. Hunt, D.L. and Haynes, R.B. et al. 1998. Effects of computer based clinical decision support systems on physician performance and patient outcomes . JAMA, vol. 280, pp. 1339-1346. Curry, B. 2000. Organizational intervention to encourage guideline implementation. Chest, vol. 118, pp. 40s-46s.
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