MODUL

FUNDAMENTALS OF HEALTH
INFORMATICS
The Concepts of Health
Informatics
Seth Afa
 Objectives

By the end of this lecture, students should be able to:

Explain Health Information Technology
Define Health Informatics
Identify the fields of health informatics
Acquire knowledge on the background disciplines of health
informatics
Explain the basic theoretical principles that underlies
informatics practice.
Explain the evolution/history of health informatics
Explain the benefits of health informatics on healthcare delivery
Identify the role of HI in contemporary healthcare delivery
 Health Information Technology

When you think of IT some things that should

come to mind are:
 Computer
networking
 Database and systems administration
Security
 Programming
 What is Health Information
Technology (HIT)?
 Brailer and Thompson in describing the national
Health IT strategic framework in 2004 defined
health IT as
“the application of information processing involving
both computer hardware and software that deals
with the storage, retrieval, sharing, and use of health
care information, data, and knowledge for
communication and decision making.”
 What is Health Information
Technology (HIT)?....
 Health information technology (HIT) is the area of IT
involving the design, development, creation, use and
maintenance of information systems for the
healthcare industry.
 Automated and interoperable healthcare information
systems are expected to lower costs, improve
efficiency and reduce error, while also providing
better consumer care and service.

Margaret Rouse-WhatIs.com
 Health IT Infrastructure
 EHR - The electronic health record is the central component of the
health IT infrastructure. An EHR is an individual's official, digital
health record and is shared among multiple facilities and agencies.

 EMR - Electronic medical record, which is an individual's health

record within a healthcare provider's facility.

 PHR - The personal health record, which is an individual's self-

maintained health record.

 RHIO - Regional Health Information Organization, which oversees

communications among the other elements and unifies them
geographically.
 Information Science
Main Entry: information science

The collection, classification, storage, retrieval,

and dissemination of recorded knowledge treated
both as a pure and as an applied science.

1960
 Medical Information Science

"the study of the nature and principles of

information and its application to the science
and art of diagnosing, treating, curing and
prevention of disease.“

1974
 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."
 Health Information Science
"the study of the nature and principles of
information and its application within all
aspects of health care delivery."
 Informatics

• “Informatics is the science of information, where information is defined as

data with meaning.”-Elmer Bernstam, Jack Smith, and Todd Johnson

Any domain where there is a need for analysis of data and dissemination of
information through the use of computer applications is a possible
application domain.

These include a wide range of industries including entertainment, hotel

management, law and law enforcement, health care, and many other fields
where computer technology interfaces with people
 What is Health Informatics?
 "The study of nature and principles of information and its
application and impact within a health care delivery system.“

 Shortliffe defines biomedical/health informatics as “the

scientific field that deals with biomedical information, data,
and knowledge – their storage, retrieval, and optimal use for
problem solving and decision making.

 "The study of nature and principles of information and its

application and impact within a health care delivery
system."Protti DJ
What is Health Informatics? Cont.
Health 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.
 What is Health Informatics?
Cont.
Health informatics is the science of how to use data,
information, and knowledge to improve both human
health and the delivery of health services.

Health informatics is a field that involves collecting,

analyzing and transmitting medical information to
make the delivery of health care more efficient
fiscally, administratively and clinically.
 Health vrs Medical Informatics
 Health informatics is seen as to be concerned with the
individual and group behavior of all healthcare
stakeholders’ interaction with information and
information technologies.
 Medical informatics is seen to be rooted in medicine
and computer science to primarily support physicians
in the care of individuals (the delivery of services)
 Managerial, social, and organizational impacts of
information technology have not historically been taken
into consideration in medical informatics
 Why Health Informatics?
1. Health Informatics provides information to make
decisions
2. Better information leads to better decisions,
healthcare, management, planning and policy all
need good information
3. “medicine is a humanly impossible task”
4. Doctors and other health professionals staying
abreast
5. High population expectations
6. New era of medicine and healthcare
 Health Informatics provides information to
make decisions
Clinicians can use informatics to:
 integrate the information they learn from patients with their
medical knowledge and data resources to improve patient care
 provide a mechanism for a patient to provide his or her
clinician(s) with critical information about him or herself
 help patients share information with their family and friends, and
with other patients
 help multiple members of their care team update and share
critical information about them
 Better information leads to better
decisions
 Health Informatics ensures
 Secure networking
 interoperability across platforms
 Data standards
 Precision of data
 Data quality
 Health informatics focused on providing the
best information possible. So you can make
the best decisions possible
 “medicine is a humanly impossible
task”
“It is now humanly impossible for unaided healthcare professionals
to deliver patient care with the efficacy, consistency and safety that
the full range of current knowledge could support”
http://www.openclinical.org/
Exponential growth in knowledge and techniques, e.g. over past 20
years:
 New imaging modalities CT, MRI, PET, fMRI, MEG
 Entirely new drug therapies, particularly for cancer and brain
disease
Molecular medicine
 Doctors and other health
professionals staying abreast
Keeping Up with Advancements in Health IT:
 Virtual professional meetings
• social media colleagues
• Online-journals
• webinars, vendors, and more
 Doctors are already working to their limits,
and beyond, never mind staying abreast
 Continuing education is vital yet requirements are
spotty
 High population expectations
 Less and less prepared to accept, without
challenge, expert pronouncements
 Press reports fuel expectation of average
treatment that cannot be satisfied easily particularly for a
greying population
 More people expect more, high quality treatment, want
to participate in management of their condition, want
access to specialised
 knowledge, and they want it now!
 New era of medicine and
healthcare
 Move to evidence-based medicine
 Reasoning becomes explicit
 Based on signals, images, clinical signs, …(team-based) decision making
under uncertainty
 Treatment of disease to anticipation of disease
 Early diagnosis, better prognosis
 Prophylactic medicine – the positive role of insurance companies
 Opportunities arising from genomics (and proteomics)
to detect and unravel individual variation, stratify
patients into disease and treatment groups
 “Personalised medicines”
Structure of Health /Biomedical Informatics
 Historical 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
 Health Informatics subject domains
A. Health System and Real World Perspectives
 Ethical, Privacy and Social Impacts of ICT
 Health Care and Privacy Legislation
 History and Future of Health Care
 National, Provincial and Regional Policy,
Governance and Financing Models
B. Organizational/Communication/Team Skills
 Change Management
 English, Writing Skills
 Information System/Technology Procurement and
Implementation
 Marketing and Negotiating Skills
 Project, Program and Portfolio Management
 Systems and Communications Theory
 Working in Groups Skills
C. Analytical/Critical Thinking Skills
 Accounting and Economics
 Business Case Development
 Data Analysis, Interpretation and Policy Development
 Evaluation, Quality Improvement and Operations
Research
 First Year Mathematics
 Logic, Statistics and Numeracy
 Problem Solving Analysis
 Root Cause Analysis
D. Health Care Delivery
 Biomedical Fundamentals and Terminology
 Clinical Methodologies and Workplace Analysis
 Epidemiology and Public Health
 Existing and Evolving Delivery Models
 Organization Theory and Cultures
 Promotion and Wellness
 Sources of Knowledge and Best Evidence Practices
 Health Informatics subject domains
E. ICT – Information and Communications F. Integration of IM & ICT & Health Care
Technology Delivery
 Communication Technologies and Protocols  Consumer, Provider, Organization and
 Computer Science Society Information Needs
 Database Design and Architectures  Health/Medical Informatics History and
 Decision Support Methodologies Applications
 Electronic Records and Repositories  IM&T Strategic Planning in Health Care
 Existing and Evolving Technologies and Standards
 Health Information Management and Systems
 Human-Computer Interaction and User Interface
Design
 Systems Analysis and Design
 Systems Architectures and Networks
 Workflow Analysis
SUBFIELDS OF HEALTH INFORMATICS

 Medical informatics
 Bioinfomatics
 Public health informatics
 Clinical informatics
 Consumer health informatics
 Dental informatics
 Nursing informatics
 Imaging informatics
HEALTH INFORMATICS VIEWED AS FOUR SUBFIELDS
 Bioinformatics

Bioinformatics is the study of how information is represented and

transmitted in biological systems, starting at the molecular level.
Bioinformatics is molecular and cellular processes focused.
An example of bioinformatics applications is genomic sequencing.
 Imaging Informatics

 It relates to the acquisition of image and its conversion to, digital form, and the analysis, manipulation, and use of those images once they are in digital
form

Imaging informatics is tissues- and organs-focused.

An example is a CT scanner, which uses software algorithms to recreate a
three-dimensional image of the body parts.
 Clinical Informatics

Clinical informatics is designed to assist in the management and processing of

clinical data, information, and knowledge to support clinical practice
Clinical informatics is individual (patient-oriented) focused.
An example of clinical informatics applications would be the electronic medical
record(emr)
 Public Health Informatics

Public health informatics is designed to promote the health of populations as

opposed to the health of specific individuals
It is also to prevent disease and injury by altering the conditions or the
environment that put populations of individuals at risk.
 History of Health Informatics
World wide use of computer technology in medicine
began in the early 1950s with the rise of the
computers.
In 1949, Gustav Wagner established the first
professional organization for informatics in Germany.
Specialized university departments and Informatics
training programs began during the 1960s in France,
Germany, Belgium and The Netherlands.
Medical informatics research units began to appear
during the 1970s in Poland and in the U.S
 Late 40’S and 50’s
Health informatics, as a discipline rather than a
theoretical concept, traces back to Europe.

New York University reports the Deutsche

Gesellschaft fur Medizinische Dokumentation,
Informatik und Statistik (German Society for Medical
Documentation, Computer Science and Statistics),
established by Gustav Wagner in 1949, was the first
organization dedicated to health informatics.
 ’60 – ‘70’s
Systems Orientation
From ‘Manual’ to ‘Data Processing’
Financial focus
Outsourced payroll
Shared systems (associations)
Use of computers generally “discouraged” in individual facilities
Statistical abstracting data comparison reporting (PAS, HMRI)
In-house developments
Data processing systems
Mainframes
Few clinical systems
Start of laboratory (pathology) systems
Duke University Hospital Information System (DHIS)

1965 Development of Clinical Decision Support System

1973 Development of Hospital Information System

Computer based Patient Record (CPR)
Admission, Discharge, Transfer (ADT)
Order Entry, Results Reporting (laboratory)
Accounting and billing functions

Kings College London

1969 The first patient medical record in the world to be used
by nurses at Kings College London
 Canadian Pioneers
1966 – Saskatoon Hospital System Study Group
 Management Engineering, Nursing Classification,
 Pharmacy Unit Dose, Laboratory Information System s
1969 – University of Alberta Hospital
 Laboratory and Pharmacy
1970 – Manitoba Hospital Association
 Data Centre services
1971 – Misericordia Hospital
 Payroll, General Ledger/ Statistics, Accounts Payable, Materials
Management, Patient Registry, ADT, Patient Receivables, PAS
reporting, Management Reporting
1972 – York Central Hospital
 ’70’s – ’80’s
Professional orientation
1974 – 1st World Congress of Medical
Informatics in Amsterdam
1975 - COACH is formed
1979 - International Medical Informatics
Association (IMIA) established as an
independent organization
 Separating from the International Federation of
Information Processing Societies (IFIPS)
 ’70’s – ’80’s
Systems orientation
From ‘Data Processing’ to ‘Computing Systems’
Focus continues to be primarily financial system
Lab systems became more common
Major hospitals move to “on-line” technology
supported by mainframe computers
Provincial governments recognize that IT is here to
stay and reorganize to develop expertise and
control mechanisms
 ’80’s – ’90’s
Professional Orientation
1981 - School of Health Information Science at the
University of Victoria is founded
1986 - HIMSS Healthcare Information &
Management Systems Society founded
 Now has membership in excess of 15,000 and sponsors the largest
conference of its type in the world

1987 - First Canadian Industry magazine,

“Healthcare Computing & Communications
Canada”
 ’80’s – ’90’s
Systems Orientation
From Computing Systems to Management Information
Systems (MIS)
Micro computers
Continuing financial focus
More clinical systems (Pharmacy, Radiology) stand alone
systems (best of breed)
Turnkey/integrated systems (e.g., Meditech
 ’90s – 00’s
Professional Orientation
1990 - American Medical Informatics Association
(AMIA) is formed
merger of three organizations:
 American Association for Medical Systems and Informatics(AAMSI)

 American College of Medical Informatics (ACMI)

 Symposium on Computer Applications in Medical Care(SCAMC)

1994 - Canadian Institute for Health

Information (CIHI) launches its operations.
 ’90s – 00’s

Systems orientation
From ‘Information Systems’ to ‘Electronic Health
Records’
Personal computers
Networks
Enterprise-wide – ‘integrated’ - systems
Office automation
Shift to clinical focus from financial focus
Clinical data repositories
Order entry/results reporting systems
Early decision support systems
 Where Are We Now
(Infrastructure)
 Networks (LAN & WAN)
Simple Broadcast LANs (10 Mbps)
Fast Ethernet (100 Mbps)
Asynchronous Transfer Mode (150 - 600Mbps)
 PC Workstation platforms
e.g. Microsoft NT
 Office Automation (e.g. MS Office)
 E-mail Standards
 Database Standard (e.g. Oracle)
 Internet/Intranets
 Where Are We Now
(Financial Systems)
ERP – a few but growing
Payroll and Human Resources
Materials Management/Logistics
Purchasing
Inventories
Accounts Payable
Accounts Receivable/Billings
General Ledger
Budgeting
Facilities Management
Cost Accounting - limited
 Where Are We Now
(Management Reporting Systems)
Management reports from Transaction
Processing Systems (TPS)

Financial reporting
actual vs. budget
productivity management

Contract Management – especially RHAs

 Where Are We Now
(Decision Support)
Case Mix Analysis
cost per procedure
Utilization Review
estimated and actual LOS
Quality Assurance
retro > prospective analyses
Clinical Paths /Protocols
standard treatments for similar cases
Outcomes Management
health status evaluation
 Where Are We Now
(Administrative Systems)
 ADT/Central Registration
• Master/Central Patient Index (MPI/CPI)
• Enterprise Master Patient Index (EMPI)
 Registries: Patient, Staff, Location
 Scheduling/Booking
• Staff / Patients
 Health/Medical Records
• Chart Tracking
• Coding & Abstracting
 Document Imaging
 Dietetics, Central Supplies, etc..
 Where Are We Now
(Clinical Systems)
 Big 3
• Laboratory
• Diagnostic Imaging (Radiology/X-ray)
• Pharmacy
 Patient Monitoring (ICU, etc.)
 Nursing
 Other Clinical Departments (ECG, Physio, OR, etc.)
 Order Entry and Results Reporting
 “Electronic Health Records”
 The Maturing Years 21st Century
Systems Orientation
From ‘Electronic Health Records’ to ‘e-Health’
Telematics - Telehealth/ telemedicine
Internet
Wireless and other emerging technologies
• Home PC’s, PDAs and like technology enable access from
“where you are”
Infostructure and infohighways
Regional EHRs
Patient Safety Focus
Genomics and Proteomics
 Future of Health Informatics
 As technology continues advancing, the field of
health informatics grows. The health care industry
has embraced informatics as an important analytical
tool with numerous potential applications across the
field of medicine, and health informatics technology
continues evolving.

 In 2010, the U.S. Bureau of Labor Statistics cited

health information technology as one of the 20
fastest-growing job categories in US.
 Benefits of health informatics
Cost saving
Improved efficiency
Reduce error
Providing better consumer care and service
Role of HI in contemporary healthcare
delivery
Health informatics professionals address the
security and privacy concerns of electronic
records and work to reduce health care
disparities among various demographic groups.

A degree in health informatics offers multiple

benefits for individuals who want to enter the
growing health care field and who enjoy
working with computers
 Health Informatics Workforce
Segmentation
Front Line Staff
Senior Level Staff (Senior Level Technical Staff)
Supervisory and Management Staff
 Front Line Staff

 Individuals who carry out the bulk of day-to-day tasks

(e.g., sanitarians, counselors, nurses and other
clinicians, investigators, lab technicians, health
educators).

 Responsibilities may include basic data collection and

analysis, fieldwork, program planning, outreach
activities, programmatic support, and other
organizational tasks.
 Senior Level Staff (Senior Level
Technical Staff)
 Individuals with a specialized staff function but not serving as
managers (e.g. epidemiologists, attorneys, biostatisticians, health
planners, health policy analysts).

 They have increased technical knowledge of principles in areas

such as epidemiology, program planning and evaluation, data
collection, budget development, grant writing, and so on, and
may be responsible for coordination and oversight of pieces of
projects or programs.
 Supervisory and Management Staff
 Individuals responsible for major programs or
functions of an organization, with staff who report to
them.
 Increased skills can be expected in program
development, program implementation, program
evaluation, community relations, writing, public
speaking, managing timelines and work plans,
presenting arguments and recommendations on policy
issues
 Career Options
 With the emergence of emphasis on the electronic health record,
degree holders in health informatics have multiple career options
in managing health information to ensure patient safety and
quality.
 These opportunities are available in many settings, such as:
• Nursing homes
• Hospitals and doctors' offices
• Outpatient care centers
• Home health care agencies
• Research institutions
• Educational institutions
• Government agencies
 Health Informatics Challenges
Health informatics faces some challenges:
The security of electronic information poses a major concern,
given the highly sensitive nature of the records. Privacy laws, such
as HIPAA (Health Insurance Portability and Accountability Act), limit
the amount and kinds of information health care providers can
disseminate, even to each another.
As many of the existing systems developed at different times or for
different reasons, the ability of the systems to communicate varies.
Ensuring patient information security, coordinating policy and
setting standards for health informatics products are huge health
informatics challenges
 PAY
 Median annual wages of medical records and health information
technicians as at November 2011 were $30,610, according to the
BLS.
 The highest 10 percent of employees in this field earned more
than $50,060.
 However, average health care informatics manager salaries at the
time of publication were $68,000, while the figure was $70,000
for health care informatics directors, reports SimplyHired.com.

 Position advancements in the growing health care informatics

field can result in substantial pay increases.
THANK YOU