Health Informatics by sammyc2007

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									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
• Medical Informatics
• Nursing Informatics
• Clinical Informatics
• Health Informatics

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

• information management
• 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
Information technology

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

                               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.
• 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
  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
Bodies of knowledge
  • hard sciences
     – biology and clinical chemistry
     – computer science
     – engineering
     – mathematics and physics
  • soft sciences
     – economics
     – information science
     – management science
     – psychology
     – sociology
  • 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,
 – Managing information resources
A. Information
    2. Technology
• Hardware processing and storage technologies
• Computer languages
• Software: operating systems, databases,
•   Communications technologies
     – Local Area Networks
     – Intranets and the Internet
     – Telematicss/telemedicine
•   Infusion/diffusion theories
•   Effectiveness metrics
•   Security and Confidentiality
    B. Healthcare Organizations
        1. Clinical (Delivery)
•   History and culture of clinicians
•   Clinical practice content and process
•   Clinical practice guidelines and protocols
•   Evidence-based decision making
•   Decision support and expert systems
•   Health outcomes and health status
•   Epidemiology
•   Population health
B. Healthcare Organizations 2.
•   organization theory and models
•   communications theories
•   management process and practice
•   organizational development and change
•   health economics and fiscal management
•   resource allocation models
•   individual and group decision support systems
•   ethics and legislation
             Clinical Work

and                     Organisation of
Communication           medicine and
technologies            health care (system)

   Three Domains Needing an “Effective Fit”
      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
    Failure to:-
• 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;
•   recognise wider imperatives and set ill-conceived targets;
•   choose robust, transferable, extendable and proven
    technologies which, for example, do not inhibit future
•   take into account research and evaluation of informational
    developments such as terming and classification systems;
•   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;
    Failure to:-
• 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
•   prepare and develop individuals and the organisation
    to make effective use of information technologies;
•   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
                                               Assesses and
                  2.                           understands the
                                               context & identifies
                                               consequences for
                                               clinical work and
    Selects and                                imperatives for                                            1.
    prioritises                                change             R espond                          Assesses and
    opportunities,            R espond                                                              understands what
    problems,                                                                                       [and for what key
                                               Identify impact
    imperatives and                                                                                 reasons] activities
    requirements                                                                                    occur at each
    for change                                                                     Obs erve         level
                                                                                   & enquire
                            Identify           Health care
                            impac t
                                                 Clinical                                   T ell
                                                          Organisation of
                                                          clinic al work
      3.                     T ell
Knows of appropriate
                                                      Sets ofpatients                                      7.
technological                                      Single patient
                                                                                   Obs erve
developm ents & relates
them to inform ation
                                                                                   &                  reviews and
requirem ents: knows of                                                                               assesses the
                            Obs erve
opportunities and           & enquire                                               T ell
                                                                                                      impact and
imperatives for change                                                                                values it
                    T ell
                                                             R elate & Chec k          R espond & Implement
                                                  T ell

                             R elate & check
        4.                                                 5.                   R ealise                        6.
   Creates an                                  Involves, informs                                      Plans and
   information and                             persuades,                                             introduces new
   technology                                  prepares for these                                     technologies
   strategy and                                technologies and                                       with other
   financial plan                              other changes                                          changes
Stages of the model
1 to 4
• Assesses and understands what and for what
  reasons things happen
• Assesses and understands the context and identifies
  consequences for clinical work and imperatives for
• 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
Stages of the model
5 to 8
• Creates an information and technology and
    strategy plan
•   Involves, informs, persuades, prepares for
    these technologies and other changes
•   Plans and introduces new technologies and
    other changes
•   Evaluates, reviews and assesses the impact
    and values it
‘hybrid’ managers-informaticians

• select the appropriate information and
  communication technologies,
• involve perceived beneficiaries,
• identify the prospective benefits,
• successfully plan, implement and evaluate
  the impact of change

• select the appropriate information and
  communication technologies,
• involve perceived beneficiaries,
• identify the prospective benefits,
• successfully plan, implement and evaluate
  the impact of change

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