Ebook: Health Informatics

This text was originally published in Australia in 1996. Since then, the world has changed significantly. The emergence of the Internet and World Wide Web with its enormous possibilities had just begun, standardisation was in its infancy, broadband was unheard of, we had just started thinking about the Y2K bug, supply chain management was more theory than practice, Google wasn't even founded, nor would anybody have had dreams or nightmares about Google Health or Microsoft HealthVault to store your personal health information and make it accessible when needed. To say it with the words of Thomas Friedman [1], since 1996, the world has been flattened in the sense that many people have been empowered significantly and now have a far more equal opportunity to achieve, create, collaborate and compete with each other than used to be the case, in healthcare as well as in any other business.

Thus, this second edition has been extensively reviewed, updated and a number of new topics have been included in order to meet contemporary issues and challenges. The text has a strong focus on health viewed from a computing perspective. It was compiled primarily for health professionals who now require knowledge about how these new technologies of information and communication may be used to enhance their practice. It aims to provide an overview of the health informatics discipline. The contents reflect what we consider are the basics for continuing education purposes and for inclusion into any curriculum which prepares a student for practice in any of the health professional disciplines. It is suitable for use as a basic text in both undergraduate and post graduate curricula. Each chapter can be expanded upon as required. Guidelines for health informatics education are provided in the last few chapters of this text.

This text is not all inclusive or exhaustive; most of the chapters could be expanded individually into a book on its own.

This text deliberately avoids a focus on any one of the health professions. Health care has become more and more integrated between the various sectors ranging from primary care to hospitals, as well as becoming more interdisciplinary between the various health professions. Also there is a trend to empowering the patient to play a more active part in decision making. All this requires clinical information to be available across sectors and across professions and necessitates integrated clinical (computer) systems such as ‘professional’ or ‘clinician’ workstations that support the focus on the patient as the centre of care rather than a discipline or departmental focus. Clinical data from multiple sources are integrated and support multiple types of clinical decision making. This also has implications for the language or terminology used and may well influence changes in how individuals practice their profession at the point of care.

The book is divided into six sections, an overview of the discipline, basic health informatics concepts, the application of health informatics supporting clinical practice, health care service delivery management, clinical research and health informatics education. We first present the history of computing in health followed by an overview of the discipline and outline some of the basic principles underlying this health discipline, including the need to balance the technology with our underlying commitment to patient care. In section two we discuss the basic concepts which need to be grasped about computing and explain how these apply to the health professions to best meet the needs as detailed in section 1. The next four sections demonstrate how these new technologies can assist our daily work, in clinical practice, management, education and research enabling us to realize our global e-health vision.

We thank the Spanish language editorial team, Carola Hullin Lucay Cossio, Erika Caballero Muñoz, Lorena Camus, Alejandro Gigoux Múller, Antonio Jose Ibarra Fernandez, and Maria Pilar Marin Villasante who managed the translation process prior to this book's publication by Mediterraneo, Santiago, Chile.

Reference

[1] Friedman T.L. 2006 The world is flat: The globalised world in the twenty-first century. 2nd expanded edition. Penguin Books Ltd., London UK.

In considering a ‘history’ of Health Informatics it is important to be aware that the discipline encompasses a wide array of activities, products, research and theories. Health Informatics is as much a result of evolution as planned philosophy, having its roots in the histories of information technology and medicine. The process of its growth continues so that today's work is tomorrow's history. A ‘historical’ discussion of the area is its history to date, a report rather than a summation.

As well as its successes, the history of Health Informatics is populated with visionary promises that have failed to materialise despite the best intentions. For those studying the subject or working in the field, the experiences of others' use of Information Technologies for the betterment of health care can provide a necessary perspective. This chapter starts by noting some of the major events and people that form a technological backdrop to Health Informatics and ends with some thoughts on the future. This chapter gives an educational overview of:

• The history of computing

• The beginnings of the health informatics discipline

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

This chapter gives an educational overview of:

• many competing characteristics within national health systems

• national primary information and knowledge flows between health care entities

• the role of information technologies in assisting health organizations become sustainable enterprises

• the business of maintaining healthy populations for any nation

• desirable e-health strategy objectives

This chapter gives an educational overview of:

• Data collected, stored in health records and used for multiple purposes

• Electronic health records and how these are likely to influence our future

• Personal health records

• Clinical systems and their relationship to national data collections

• Potential future use of new technologies

This chapter gives an educational overview of:

• the roles that ontology and process play in interoperability

• the processes that can be employed to realise interoperability and their supporting technologies

• interoperability solutions employed in the health informatics sector within the conceptual model presented in the chapter

• directions for future research in the area of interoperability for health informatics

This chapter gives an educational overview of:

• The difference between actual patient information and information structure and metadata

• The purpose of defining health information concepts

• How health concepts are defined

• The components used to define health concepts and their relationship to expressing meaning clearly and safely

This chapter gives an educational overview of:

• What a clinical terminology is

• How clinical terminology is constructed and used

• The concept of mapping terminologies

• Why clinical terminology is an essential component of electronic health records and clinical decision support systems

• The issues that relate to good use of terminologies and the need for governance and standardisation to support health information quality and the linkage to safe/consistent clinical decision support

This chapter gives an educational overview of:

• commonly used modelling methods what they represent

• the importance of selecting the tools and methods suited to the health information system being designed

• how the quality of the information or knowledge model is determined by the quality of the system requirements specification

• differentiating between the purpose of information models and knowledge models

• the benefits of the openEHR approach for health care data modeling

This chapter gives an educational overview of:

• The difference between informal and formal ontologies

• The primary objectives of ontology design, re-use, extensibility, and interoperability

• How formal ontologies can be used to map terminologies and classification systems

• How formal ontologies improve semantic interoperability

• The relationship between a well-formed ontology and the development of intelligent decision support

This chapter gives an educational overview of:

1. The significance of having a formal ontology of health care data

2. How openEHR has used an ontological approach to designing an electronic health record

3. The phases of archetype development and key steps in the process

4. The openEHR architecture and integrated development environment

This chapter gives an educational overview of:

• The relationship between standards and a national e-health strategy

• National and international standards development processes

• The Development of a national HI standards roadmap

• The benefits of standards adoption

This chapter gives an educational overview of:

• The purpose of health information systems (HIS).

• The characteristics of health information systems for the future.

• System interoperability as an essential feature in a modern HIS.

• Why user requirements must be established before an HIS is designed.

• How to transform a requirements specification into a request for tender.

This chapter gives an educational overview of:

• Confidentiality issues and the challenges faced;

• The fundamental differences between privacy and security;

• The different access control mechanisms;

• The challenges of Internet security;

• How ‘safety and quality’ relate to all the above.

This chapter gives an educational overview of:

• An awareness of the legal issues involved in health informatics

• The need for the privacy and security of the patient record

• The legal consequences of a breach of the security of the patient record

• The concept of privacy law and what precautions ought to be taken to minimize legal liability for a breach of privacy and/or confidentiality

This chapter gives an educational overview of:

• The concept of consumer health informatics

• Technologies being used to empowered consumers today

• The impact of these new technologies on the health care delivery models

This chapter gives an educational overview of:

• The importance of the engagement of clinicians within a health informatics project

• Strategies required for an effective involvement of clinicians throughout a change management process within a clinical context for the implementation of a health informatics project

• The critical aspects for a successful implementation of a health informatics project that involves clinicians as end users

• Key factors during the administration of changes during the implementation of an informatics project for an information system in clinical practice

This chapter gives an educational overview of:

• the evolution of commercial physiological monitoring over the years

• the importance of physiological monitoring in an electronic health record (EHR)

• issues to be addressed to enable an integrated EHR

• benefits and future perspectives of physiological monitoring and its relevance to an EHR for patient care

This chapter gives an educational overview of:

• various digital imaging technologies, systems and standards

• key components of a Picture Archiving and Communication Systems (PACS)

• advantages of a digital medical imaging service over a film-based service

• standards used in PACS

• how PACS integrates with an image-enabled electronic health record

• future trends in digital imaging

This chapter gives an educational overview of:

• concepts concerning the nature and usage of Telehealth systems in some common clinical settings

• the expected structure of typical interactive (synchronous) and non-interactive (asynchronous) Telehealth scenarios

• various characteristics of human usage and physical infrastructure pertaining to typical Telehealth systems

This chapter gives an educational overview of:

• The biopsychosocial model of primary health care and longitudinal relationships;

• Management of undifferentiated problems and chronic illness within the clinical relationship;

• Patient–centred care in the context of health promotion, early detection and effective care of patients with chronic illness;

• Inter-professional networks, connectedness, connectivity and interoperability;

• Record linkage and health information sharing/exchange for clinical, audit, quality assurance, professional development and research purposes.

This chapter gives an educational overview of:

• using information technology in medication management

• where is the adoption of electronic medication useful and its benefits

• what is required to implement these systems beyond the application requirements