Introduction to Health Information Technology Systems and Nursing InformaticsWhat brought you to the nursing profession and what are your strengths as a nurse? Many times, nurses are called upon to use skills that do not relate to the reasons that made them enter their profession. What is your attitude toward change, especially the increased reliance on technology in health care? Organizations such as TIGER are developing computer competency resources to improve nursing professionals’ understanding of health care informatics. How might nursing informatics and competencies increase quality, patient safety, and job satisfaction?To prepare:Review this week’s media presentation, focusing on the benefits and challenges of health informatics.Reflect on your professional nursing experiences and how informatics has impacted or changed your practice.Examine the TIGER and ANA informatics competencies presented in the Learning Resources. What insights do these give you with regard to:
How these competencies influence nursing informatics, improve quality of care and patient safety, and promote excellence in nursing practiceWays in which nursing practices have changed and/or will change as a result of informaticsYour personal skills, strengths, and preferences related to informaticsPotential challenges or areas in which you need to strengthen your capabilities, and at least one strategy for accomplishing professional growth in this areaBy Day 3 post a cohesive response that addresses the following:Briefly share your nursing background and professional interests.Summarize how informatics has impacted or changed nursing practice. Provide an example from your professional experience.Evaluate how established informatics competencies influence quality of care, safety improvements, and excellence in nursing practice.Assess your informatics strengths and preferences, as well as potential challenges and areas for development. (Be sure to refer to specific TIGER and ANA competencies.)Describe one strategy for enhancing your informatics skills and competencies.
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Health Informatics
E.J.S. Hovenga et al. (Eds.)
IOS Press, 2010
© 2010 The authors and IOS Press. All rights reserved.
doi:10.3233/978-1-60750-476-4-9
9
2. Health Informatics – An Introduction
Evelyn.J.S.HOVENGA1, RN, PhD (UNSW), FACHI, FACSa, Michael R KIDD,
MBBS, MD, DCCH, DipRACOG, FRACGP, FACHI, FAFPM (Hon), FHKCFP
(Hon), FRNZCGP (Hon), MAICDb, Sebastian GARDE Dr. sc. hum., Dipl.-Inform.
Med., FACHIc, Carola HULLIN LUCAY COSSIO RN, BN, Hons, PhD (Melb.Uni)d
a
Director, eHealth Education, Consultant, openEHR Foundation, and Honorary
Senior Research Associate, Centre for Health Informatics & Multiprofessional
Education, University College London, Honorary Academic Fellow, Austin Health,
Melbourne, Adjunct Professor, Central Queensland University Rockhampton,
Queensland, and Victoria University, Melbourne, Australia
b
Executive Dean, Faculty of Health Sciences, Flinders University, Australia
c
Senior Developer, Ocean Informatics, Düsseldorf, Germany
d
Co-Founder eHealth Systems, Santiago, Chile, Melbourne, Australia
Abstract. This chapter gives an educational overview of:
• the scope of the health informatics discipline
• health informatics and e-health definitions
• health informatics professional networks
• potential benefits of applying health informatics technologies
Keywords. Medical Informatics, Information Systems, Health, Computer Systems,
Knowledge
Introduction
Health Informatics is a highly interdisciplinary field that may be defined as “an
evolving scientific discipline that deals with the collection, storage, retrieval,
communication and optimal use of health related data, information and knowledge. The
discipline utilises the methods and technologies of the information sciences for the
purposes of problem solving, decision making and assuring highest quality health care
in all basic and applied areas of the biomedical sciences” [1].
1. eHealth
The term e-health only came into widespread usage a few years ago at the turn of the
century. It was preceded by telemedicine, teleradiology or telehealth. As this became
more common place most people realised that telemedicine or telehealth was simply
1
Corresponding Author: e.hovenga@ehealtheducation.net
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E.J.S. Hovenga et al. / Health Informatics – An Introduction
about the delivery of health care via the use of telecommunications. With rapid
advances and the convergence of these technologies with information technologies
these terms became obsolete. There is no agreed definition for e-health, yet this term is
widely used by many. Oh et al. [2] undertook a systematic review of 1209 abstracts and
430 citations and found 10 different definitions for the term eHealth, and from a
Google search an additional 41 unique definitions were located ranging in length from
3 to 74 words. The most common universal themes were health and technology. In
addition 6 less frequently mentioned themes emerged: commerce, stakeholders,
outcomes, place and perspectives. The word Internet was mentioned in 27 of the 51
definitions and only one definition included the term integration.
The adoption of technologies to better manage health information and
communication within a nation’s health industry enables significant productivity and
efficiency improvements to be achieved. It enables the provision of a more effective
and efficient health workforce who are thus enabled to provide higher quality, safer and
more accessible care in multiple locations producing better health outcomes. The
adoption of health informatics or e-health is simply a requirement of doing business in
21st century healthcare [3]. This requires educational organizations to build the
necessary workforce capacity so that these technologies can be developed,
implemented and used optimally.
2. Health Informatics Discipline
The discipline of health informatics has arisen from the earlier established science of
medical informatics [4] [5] [6]. The field of health informatics is very extensive. For
example at the twelfth’s world congress on medical informatics held in Brisbane in
2007, Australia close to 300 papers and as many posters were presented and classified
into any one of 71 different topics covering all aspects of the technology and many
different applications by a vast array of health professionals in all types of health care
related settings, including clinical, management, administrative, policy and research
based in community and institutional settings. It is noted that the first world congress
on medical informatics was held in 1974 in Stockholm, Sweden . Although the two
disciplines share many concepts, and the terms are often interchangeable, in this
textbook we have chosen to focus on the use of information technology in all areas of
health care, rather than just focus on the delivery of medical services by medical
practitioners. The term health informatics is all embracing and medical informatics
could be viewed as a subset of health informatics along with nursing or dental
informatics.
Many countries have established a health informatics group, society or association.
Such organizations then choose to become a member of the International Medical
Informatics Association (IMIA) and this organization hosts international conferences
together with the local national member organization to promote the discipline, enable
international networking to take place and to share experiences. IMIA has set about to
define the health informatics discipline via its scientific map and the educational
recommendations. Both are IMIA endorsed documents available from www.imia.org
although they are both in the process of being updated[7]. The current scientific map
has seven categories as detailed in Table 1:
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E.J.S. Hovenga et al. / Health Informatics – An Introduction
Table 1 IMIA Scientific Map Categories
Applied
Technology
Information Applications DataHumanEducation
Technology and Products Infrastructure Organizational and
Infrastructure
Related
Knowledge
Clinical
Disciplines
These original IMIA Scientific Map categories have been extended to fourteen
organizing concepts or categories in the latest draft, these are presented in the Table 2.
Table 2– IMIA’s 2008 Draft Organizing Concepts of the Health Informatics Discipline
1.
2.
3.
4.
5.
6.
7.
ICT (Computer Science) for Health
Health & Social Care processes
Health (Care) Records
Health & Social Care industry
Health Informatics Standards
Knowledge Domains & Knowledge Discovery
Legal & Ethical
8. People in Organisations
9. Politics & Policy
10. Technologies for Health
11. Terminology, Classification & Grouping
12. Uses of Clinical Information
13. Using Informatics to Support Clinical
14. Computer Systems Applications in Health
(Toolkit)
Numerous concepts fit within each category ranging from around 20 to more than
60 indicating the enormous scope of this discipline. This clearly demonstrates not only
the scope of the Health Informatics discipline but also the needs from a healthcare
system perspective.
The discipline is very broad, has lots of depth and may be classified into
computing (incl. all information and communications technologies) or health (incl.
healthy living, population health, health service delivery, health policy) problem
spaces. This means that no health informatician has the same set of knowledge and
skills as another, each tends to focus on their own strengths and areas of interests in
either problem space although all need to possess a basic set of competencies. The
figures below show the key differences for each problem space [8]. The shaded portion
in Figure 1 represents Health Informatics in the problem space of computing. Health
Informaticians need knowledge/skills throughout the spectrum in the computing space,
from some practical knowledge in Computer Hardware and Architecture to a profound
theoretical understanding as well as application skills on the organisational and
information systems layer.
Figure 1: The Overall Place of Health Informatics in the Problem Space of Computing
12
E.J.S. Hovenga et al. / Health Informatics – An Introduction
The Health problem space is complex. For example, sharing electronic health
records is a more complex task than sharing financial information or travel bookings.
There are lots of different types of information; progress notes, appointments,
documents, collections of images, laboratory results, registries etc. The variety of
information is obvious in the paper world where there are hundreds or thousands of
different forms in just one hospital, putting at risk people receiving healthcare services.
Health care is constantly changing in three ways (breadth, depth, complexity): new
information, information in finer-grained detail, and new relationships are always being
discovered or becoming relevant complicating this space further. Therefore – more
than in other computing discipline – in addition to an understanding of content in the
computing problem space, an understanding of the health problem space content is
fundamental for Health Informaticians. The shaded portion in Figure 2 represents
Health Informatics in the health problem space which is essentially the reverse of the
depth of skills and knowledge required from the computing space.
Figure 2 The Overall Place of Health Informatics in the Health Problem Space
Every health informatics project requires a team of people who collectively
contribute the necessary set of skills and knowledge to that project, thus teamwork and
the ability to work collaboratively with others are skills every health informatician
requires. The difference between information systems specialists and health
information systems specialists is that the latter place a greater emphasis on the
application of the technology/systems in health care. They focus on solving very
complex medical or health related problems using the information technology to the
fullest extent as the tool to achieve that. This often means the need for a change in
work practices.
3. Potential Benefits of Applying ICT in the Health Industry
The application of cutting edge technologies pertaining to the computer,
communication and information sciences has much to offer the health sciences. We are
E.J.S. Hovenga et al. / Health Informatics – An Introduction
13
of the view that appropriate use of these technologies will result in improved health,
lower costs and improved service delivery methods [9]. To achieve this, healthcare
professionals need to be aware of the possibilities today and in the future and
participate in this discipline’s further development.
Close to 40 years ago Martin and Norman [10p.222] predicted that in medicine the
computer promised revolutionary changes. Today the same may be said about
communications and knowledge management technologies. We have witnessed a
convergence between communications, computing and television or broadcasting
technologies enabling the merging of all types of data into integrated multimedia
information, providing rapid interactions between people from any location. The speed
by which these changes impact upon health service delivery is determined by and
dependent upon how quickly the health professions accept the role of these new
technologies in their workplace. It is they who need to identify the potential use of
these technologies within the health care industry.
The international network of health informaticians is growing rapidly. There is
evidence of an approaching critical number such that the process of change is now self
sustaining. This network could be compared with what Marilyn Ferguson describes as
an Aquarian conspiracy where conspirators (read health informaticians) collude to
change social institutions, modes of problem solving and distribution of power [11p.20].
They are characterised by rethinking everything, examining old assumptions, by
looking differently at their work, relationships, health, political power, experts, goals
and values. They are leading the way towards a paradigm shift; they have a new
perspective towards health care. Ferguson [11p.28] notes that:
“New paradigms are nearly always received with coolness, even mockery
and hostility. Their discoveries are attacked for their heresy. (For historic
examples, consider Copernicus, Galileo, Pasteur, Mesmer). The idea may appear
bizarre, even fuzzy, at first because the discoverer made an intuitive leap and does
not have all the data in place yet.”
Many health informatics network members can no doubt identify with these
sentiments. This book is dedicated to these pioneers who dared to be out of step with
their peers and who have provided the building blocks for this paradigm shift. It has
proved difficult for the discipline to gain acceptance from mainstream health
professionals and recipients of health care. Also enabling procedures and legislations
have been and continue to be slow to emerge. For example the European eHealth action
plan developed in 2004 lists a number of activities associated with legal and regulatory
issues that need to be completed by 2009 [12]. In 2005 the World Health
Organisation’s (WHO) world assembly adopted a resolution on e-health [13]
recognising that eHealth is the cost-effective and secure use of information and
communications technologies in support of health and health-related fields, including
health-care services, health surveillance, health literature, and health education,
knowledge and research. All member states were urged to develop and implement an ehealth strategy.
Health informatics is about data, information and knowledge and what we do with
all this as health professionals. From a national perspective these technologies need to
be used to support the implementation and performance monitoring of a country’s
health policies. It is no accident that the advent of low cost easily accessible computer
technology has occurred at the same time as the so-called information explosion that
has affected all areas of modern life. The problem of managing the ever increasing
14
E.J.S. Hovenga et al. / Health Informatics – An Introduction
volume of information and developing methods to help keep abreast of important
changes in knowledge is particularly applicable to those of us working in health care.
It is becoming increasingly difficult to practice as a health professional without the
use of information technologies to support daily practice. This challenge is going to
continue as expectations of increasing quality of health care is demanded by the
consumers of our services. Improved information management of health care data
became an accepted essential element of the infrastructure of all contemporary health
care systems some time ago [14p.2].
4. Learning About Health Informatics
Those of you who have had little past experience in the use of computers may be
reticent about approaching this text. Information technology can be a daunting
challenge for those of us who missed out on being part of the ‘computer generation’
currently graduating from our high schools and tertiary institutions. Remember that you
don’t need to be a computer genius to use a computer effectively in your professional
life. You just need to understand the basic concepts. It’s like driving a car; you don’t
need to know exactly how the engine works but you do need to learn how to drive the
machine, to identify when something is wrong and to understand the road rules so that
you minimise the risk of getting into trouble.
If you are already computer literate, you can enjoy applying your acquired skills to
the health sciences and learn how to use information technology to support the
provision of high quality health care. The computer age poses real challenges for us
all. We hope that you find this text useful in assisting you to meet the challenges
ahead.
References
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
Graham I 1994 HISA – informatics enhancing health. Health Informatics Society of Australia,
Melbourne
Oh H, Rizo C, Enkin M, Jadad A. 2005 What Is eHealth (3): A Systematic Review of Published
Definitions, Journal of Medical Internet Research;7(1):e1 viewed June 2008 at
http://www.jmir.org/2005/1/e1/
Australian Health Informatics Council (AHIC) 2007 eHealth Future Directions Briefing Paper for the
Australian Health Ministers Advisory Council (AHMAC) meeting October 2007 http://www.health.gov.au/internet/main/publishing.nsf/Content/ehealth-futuredirections accessed 5
May 2008.
Shortliffe E.H., Perreault L.E., Wiederhold G., Fagan L.M. (Eds) 1990 Medical informatics – computer
applications in health care. Addison Wesley
Hannan T 1991 Medical informatics – an Australian perspective. Australian and New Zealand Journal
of Medicine 21: 363-378
Coiera E 1994 Medical informatics. Medical Journal of Australia 160: 438-440
International
Medical
Informatics
Association
(IMIA)
–
Scientific
Map
2002
http://www.imia.org/2002_scientific_map.html accessed 5 May 2008
Garde S, Harrison D, Hovenga E 2005 Australian Skill Needs Analysis of Health Informatics
Professionals, Research Report 1,2,3 &4 of the Health Informatics Research Group Central
Queensland University, Rockhampton, Qld
Chaudrey B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shelelle PG 2006 Systematic
review: impact of health information technology on quality, efficiency, and costs of medical care. Ann
Intern Med 2006 May 16; 144(10): 742-52 Accessed 7 May 2008 from:
http://www.annals.org/cgi/reprint/144/10/742.pdf
E.J.S. Hovenga et al. / Health Informatics – An Introduction
15
[10] Martin J and Norman A R D 1970 The computerized society: an appraisal of the impact of computers
over the next fifteen years. Prentice Hall, Englewood Cliffs, NJ p.222)
[11] Ferguson M 1980 The Aquarian conspiracy. Paladin Grafton Books, London
[12] European Commission 2004 “e-Health – making healthcare better for European citizens: An action
plan for a European e-Health Area” [COM(2004) 356 final – not published in the Official Journal] Communication from the Commission to the Council, the European Parliament, the European
Economic and Social Committee and the Committee of the Regions of 30 April 2004 accessed on 7
May 2008 from http://europa.eu/scadplus/leg/en/lvb/l24226f.htm .
[13] World Health Organisation (WHO), World Health Assembly resolution on eHealth (WHA58.28, May
2005), viewed June 2008 from http://www.euro.who.int/telemed/20060713_1
[14] Dick R.S. and Steen E.B (Eds) 1991 The computer based patient record – an essential technology for
health care. National Academy Press, Washington
Review Questions
1. What is your understanding of the Health Informatics discipline?
2. Describe how the adoption of e-Health policy strategies are likely to impact
upon:
a. The population at large
b. Health care providers (clinicians)
3. Explain how a health workforce with Health Informatics skills and knowledge
are able to improve health services.
4. Identify changes required in your work environment to enable optimal use of
available technologies.
Copyright of Studies in Health Technology & Informatics is the property of IOS Press and its content may not
be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written
permission. However, users may print, download, or email articles for individual use.
Health Informatics
E.J.S. Hovenga et al. (Eds.)
IOS Press, 2010
© 2010 The authors and IOS Press. All rights reserved.
doi:10.3233/978-1-60750-476-4-3
1.
3
History of Health Informatics: A
Global Perspective
Branko CESNIKa (deceased 2007, edited by Michael R KIDD1b)
Co-editor of Health Informatics: an overview 1st edition, Past Associate
Professor and Director of Medical Informatics, Faculty of Medicine, Monash
University, Australia
b
MBBS, MD, DCCH, DipRACOG, FRACGP, FACHI, FAFPM (Hon), FHKCFP
(Hon), FRNZCGP (Hon), MAICD
Executive Dean, Faculty of Health Sciences, Flinders University, Australia
a
Abstra …
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