Dr. Raju Kr.

Mandal
PhD (Molecular Epidemiology & Urological Cancer)
Assistant Professor
 Introduction

Health informatics began as a new field of study in the 1950s-1960s time

frame but only recently gained recognition as an important component of
many aspects of healthcare. Its emergence is partly due to the multiple
challenges facing the practice of medicine today.
 clinicians need to be able to access medical information expeditiously,
regardless of location or time of day. Technology has the potential to help
with each of those areas. With the advent of the internet, high speed
computers, voice recognition, wireless and mobile technology healthcare
professionals today have many more tools available at their disposal.
Thus, there is a mismatch between what clinicians need (i.e. something to
help us manage meaningful data = information) and what they have
(ineffective ways to manage information). Additionally, given the volume
of data and rapidly changing technologies, there is a great need for ongoing
informatics education of all healthcare workers.
 Data, Information, Knowledge,
Wisdom Hierarchy

• Informatics is the science of information

and the blending of people,
biomedicine and technology.
• Individuals who practice informatics are
known as informaticians or
informaticists, such as, a nurse
informaticist.
• There is an information hierarchy that is
important in the information sciences,
• Data can be defined as a representation of facts, concepts, or instructions
in a formalized manner, which should be suitable for communication,
interpretation, or processing by computer or human.
• Important concept to understand about data is that there are different levels
of data
• Paper forms would be considered level 1 with serious limitations, in
regards to haring, storing and analyzing.
• Level 2 data could be scanned-in documents.
• Level 3 data are entered into a computer and are data that are structured
and retrievable, but not computable between different computers.
• Level 4 data are computable data. That means the data are electronic,
capable of being stored in data fields and computable because it is in a
format that disparate computers can share (interoperable) and interpret
(analyzable).
• Enterprise systems have been developed that: integrate disparate
information (clinical, financial and administrative); archive data; provide
the ability to data mine using business intelligence and analytic tools.
 Levels of data

Sources of health data

Input − In this step, the input data is prepared in some convenient form for
processing.
Processing − In this step, the input data is changed to produce data in a more
useful form.
Output − At this stage, the result of the proceeding processing step is collected.
• Information is meaningful data or facts from which conclusions can be
drawn by humans or computers. For example, five fingers has meaning in
that it is the number of fingers on a normal human hand. Modern
computers do not process information, they process data. This is a
fundamental problem and challenge in informatics.
• Knowledge is information that is justifiably considered to be true. For
example, a rising prostate specific antigen (PSA) level suggests an increased
likelihood of prostate cancer.
• Wisdom is the critical use of knowledge to make intelligent decisions and to
work through situations of signal versus noise. For example, a rising PSA
could mean prostate infection and not cancer.
• Health information technology provides the tools to generate information
from data that humans (clinicians and researchers) can turn into knowledge
and wisdom
 Definition
• Health informatics is the field of information science
concerned with management of healthcare data and
information through the application of computers and
other technologies.
• Health informatics is also known as clinical informatics or
medical informatics and biomedical informatics in some
circles. If the information science deals primarily with
actual applications and programs and not theory, it can be
referred to as applied informatics.
• Includes data standards (such as HL7) and controlled
medical vocabularies (such as SNOMED)
• Biomedical informatics “the
interdisciplinary field that studies and pursues
the effective uses of biomedical information
and knowledge for scientific inquiry, problem
solving and decision making, motivated by
efforts to improve human health
• Bioinformatics is sub-field of biomedical
informatics that is concerned with biological
data, particularly DNA and genomic
information.
• Health information technology (HIT or
healthIT) is defined as the application of
computers and technology in healthcare
settings.
•Health information management (HIM)
traditionally focused on the paper medical
record and coding. With the advent of the
electronic health record HIM specialists now
have to deal with a new set of issues, such as
privacy and multiple new concepts such as
voice recognition.
 Translational bioinformatics

• Focuses on the development of storage, analytic and interpretive

methods to optimize the transformation of increasingly voluminous
biomedical data into proactive, predictive, preventive and
participatory health
• Metagenomics is the analysis of genetic material derived from
complete microbial communities harvested from natural
environments
 Goal to use genetic information
• New indications for an old drug (drug repurposing)
• New targets for existing drugs
• Drugs to work better in certain patient groups (gender,
age, race, ethnicity, etc.) with possible genetic variants
• Knowing ahead of time what drugs to avoid due to
higher incidence of side effects that are genetically
modulated
• Develop clinical decision support in electronic health
records based on pharmacogenomics
• Human Genome Project. In 2003 the Human
Genome Project (HGP) was completed after thirteen
years of international collaborative research
• Finalizing a draft of the genome is the first step.
What remains is making sense of the data. In other
words, we need to understand the difference
between data (the code), information (what the
code means) and knowledge (what we do with the
information)
Human Microbiome Project (HMP)
• The HMP is an NIH- sponsored initiative that catalogued the myriad
of organisms that co-exist with humans and have been rarely
studied (e.g., flora from oral, nasal, skin, and the gastrointestinal
tract).
• Goals were as follows:
• Determine whether individuals share a core human microbiome
• Understand whether changes in the human microbiome can be
correlated with changes in human health
• Develop new technological and bioinformatic tools needed to
support these goals
• Address the ethical, legal and social implications raised by human
microbiome research
NCBI Databases (Courtesy National Library of Medicine)
• Health information technology (HIT) facilitates
the processing, transmission and analysis of
information and HIT interacts with many
important functions in healthcare
organizations and serves as a common thread
• Many aspects of health informatics are
interconnected. To accomplish data collection
and analysis there are hospital information
systems (HISs) that collect financial,
administrative and clinical information and
subsystems such as the laboratory (LISs) and
radiology information systems (RISs).
• The web-based portal involves consumer
(patient) informatics and telemedicine.
 Nursing Informatics

• “a combination of computer science,

information science, and nursing science
designed to assist in the management and
processing of nursing data, information, and
knowledge to support nursing practice,
education, research, and administration“ (Graves
& Corcoran, 1989)

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 Public Health Informatics

• “The systematic application of information and computer science

and technology to public health practice, research and learning”
• Activities may include:
– Collection and storage of vital statistics
– Collection and reporting of communicable diseases
– Disease surveillance
– Display disease statistics and trends
– Immunization
– Hospital statistics
(O’Carroll et al., 2002)
• German scientist Gustav Wagner developed the first professional
organization for informatics in 1949.
• Computers were first theorized to be useful for medical diagnosis and
treatment by Ledley and Lusted in the 1950’s.
• The programming language known as Massachusetts General Hospital
Multi-Programming System (MUMPS) was developed in Octo Barnett’s
lab at Massachusetts General Hospital in the 1970s.
• MUMPS exists today in the popular electronic health record known as
VistA used by the Veterans Affairs medical system and Epic Systems
Corporation
• It is thought that the origin of the term medical informatics dates back to
the 1960’s in France (“Informatique Medicale”)
• MEDLINE. In the mid-1960s MEDLINE and MEDLARS were created to
organize the world’s medical literature.
Adoption of health information technology
• There are multiple forces driving the adoption of health
information technology, but the major ones are the need to:
• Increase the efficiency of healthcare (improve physician, nurse and
overall healthcare productivity)
• Improve the quality (patient outcomes) of healthcare, resulting in
improved patient safety
• Reduce healthcare costs
• Improve healthcare access with technologies such as telemedicine
• Improve communication, coordination and continuity of care
• Improve medical education for clinicians and patients
• Standardize of medical care
 Health information technology (HIT) is
important to multiple players in the field of medicine.

• Patients
• Online searches for health information and research choice of
physician, hospital or insurance plan
• Smartphone technology for test message reminders, health and
fitness apps, internet access, etc.
• Web portals for storing personal medical information, making
appointments, checking lab results, e-visits, drug refills, etc.
• Online patient surveys
• Online chat, blogs, podcasts, vodcasts and support groups and
Web 2.0 social networking
• Telemedicine and home telemonitoring
 Physicians and Nurse
• Online searches with PubMed, Google and other search engines
• Online resources and digital libraries
• Patient web portals, secure e-mail and evisits, telehomecare
• Physician web portals
• Clinical decision support, e.g. reminders and alerts
• Electronic medication administration record (eMAR) and bar coding medications
• Electronic health records (EHRs)
• Smartphones loaded with medical software and remote access to EHRs
• Telemedicine and telehomecare
• Voice recognition software
• Online continuing medical education (CME)
• Electronic prescribing
• Disease registries
• Support Staff
• Patient enrollment
• Electronic appointments
• Electronic coding and billing
• EHRs
• Web-based credentialing
• Web-based claims clearinghouses
• Telehomecare monitoring
• Practice management software
• Secure patient-office e-mail communication
• Online educational resources and CME
• Disease registries
• Medical Educators
• Online medical resources for clinicians,
• Patients and staff
• Online CME
• PubMed searches
• Telehealth via video teleconferencing,
podcasts, etc.
• Insurance Companies (Payers)
• Electronic claims transmission
• Trend analysis through data analytics
• Physician profiling
• Information systems for quality improvement initiatives
• Monitor adherence to clinical guidelines
• Monitor adherence to preferred formularies
• Promote claims-based personal health records and information
exchanges
• Reduce litigation by improved patient safety through fewer
medication errors
• Hospitals
• Electronic health records
• Electronic coding and billing
• Information systems to monitor outcomes, length of stay, disease
management, etc.
• Patient and physician portals
• E-prescribing
• Member of health information organizations (HIOs)
• Telemedicine
• Picture archiving and communication systems (PACS)
• Bar coding and radio frequency identification (RFID) to track patients,
medications, assets, etc.
• Medical Researchers
• Database creation to study populations, genetics and disease
states
• Online collaborative research web sites
• Electronic case report forms (eCRFs)
• Software for statistical analysis of data e.g. SPSS
• Literature searches with multiple search engines
• Randomization using software programs
• Improved subject recruitment using EHRs and e-mail
• Smartphones to monitor research
• Online submission of grants
• The Patient Protection and Affordable Care Act (PPACA) was enacted into law in March
2010 and is commonly known as the Affordable Care Act.
• Its primary goals were to increase insurance coverage and improve patient outcomes.
The primary focus of the Act is to expand private insurance and Medicaid coverage.
• Health IT Policy Committee (HITPC). The main goal of this committee is to set priorities
regarding what standards are needed for information exchange and establish the policy
framework for the development and adoption of national health information exchange.
• Health IT Standards Committee (HITSC). Is responsible to look at standards,
implementation specifications and certification criteria for the exchange of health
information.
• Centers for Disease Control and Prevention (CDC). Although not a primary information
technology agency, the CDC has used HIT to promote population health-related issues.
• The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was created
initially for the portability, privacy and security of personal health information (PHI) that
was largely paper-based.
• National Institute of Standards and Technology (NIST) is a
physical science laboratory that is part of the U.S. Department of
Commerce, and serves to promote and verify measurements and
standards. This federal agency makes EHR testing
recommendations.
• The following is a list of some of the pertinent publications related
to EHRs:
• (NISTIR 7741) NIST Guide to the Processes Approach for Improving
the Usability of
• Electronic Health Records
• (NISTIR 7742) Customized Common Industry Format Template for
Electronic Health Record Usability Testing
 Barriers to Health
Information Technology Adoption
• Inadequate time
• Inadequate information
• Inadequate expertise and workforce
• High cost to adopt
• Lack of interoperability
• Change in workflow
• Privacy concerns
• Legal Issue
 Health informatics organization
• AMIA
• American Association for Medical Systems and
Informatics, the American College of Medical Informatics
and the Symposium on Computer Applications in Medical
Care
• They support five main domains: translational
bioinformatics, clinical research informatics, health
informatics, consumer health informatics and public health
informatics
• International Medical Informatics Association (IMIA)
• Asia Pacific Association for Medical Informatics
(APAMI)
• Current members include informatics societies
from: Australia, China, Hong Kong, Indonesia,
Japan, Korea, Malaysia, New Zealand, Philippines,
Singapore, Taiwan, Thailand and Vietnam
• Healthcare Information and Management
Systems Society (HIMSS)
• Alliance for Nursing Informatics (ANI)
 In the kingdom
• Masters program in Health Informatics at King Saud
bin Abdulaziz University for Health Sciences (KSAU-
HS) was started in 2005 which was first of its kind in
the middle east.
• Saudi Association for Health Informatics - 2005

• Regular conferences are being held creating

awareness.

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 MOH’s Patient Centered Strategy

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 Health informatics resources
• Books
• E-journals
• Informatics related E-newsletters