Ebook: Textbook in Health Informatics

Preparing a textbook in Health Informatics it was an initial thought that came into our mind when at late 80's we were developing a postgraduate course in Health Informatics at the University of Athens as an interdisciplinary, inter-University across Europe effort. Even at that time we were thinking that no one faculty could achieve this endevour alone. The initiative came into reality when the European Commission financed our effort to develop curriculum for the area of computer applications in health care. In 1987 six representatives of European organizations met in Athens to discuss the way to achieve a European curriculum at postgraduate level that would allow students from European Universities to study this discipline and receive the Master's degree. One of the main tasks from the beginning of the meeting was to give a name to that discipline. Names such as computer applications in medicine / health care, medical informatics, and all related and current at that time were discussed but only one name remained on the table and had been unanimously approved. That was Health Informatics, which is the discipline that is multi-disciplinary and covers applications of computers in Medicine, Nursing, Dentistry, Pharmacy, and Biology. Specialties of Health Informatics can be considered for example the disciplines of Nursing Informatics, Dental Informatics, or Bio-Informatics. The prevailing term for many years of Medical Informatics now coincides with the new term of Health Informatics. Nowadays, ISO/TC215 and CEN/TC251 both are using instead the term Health Informatics.

The effort of 1987 was successful and from early 1990's the MSc course in Health Informatics started being funded by the European Commission under the Erasmus programme with good acceptance among European students. As a spin-off of that effort two European projects were approved in 1995, IT-Eductra and Nightingale. The IT-Eductra project had as an objective to develop educational material in information technologies that would initiate physicians, nurses and hospital administrators to the advantages of the health informatics discipline. The material would be distributed through a CD-ROM storing all the educational material. The Nightingale project was focusing more on the educational needs of nurses in the field of Nursing Informatics. The outcome of the Nightingale project was to develop multimedia CD-ROMs emphasizing the need of IT technology and developing educational material in nursing informatics, developing a nursing informatics curriculum for undergraduate and postgraduate nursing schools, and publishing a textbook in health informatics with emphasis on nursing applications. This book that you are now reading is the textbook of the Nightingale project.

The book follows the structure of the curriculum of Nursing Informatics as it was approved by the ‘users group’, which was comprised mainly by the representatives of the EFMI WG on Nursing Informatics. There are four sections: Introduction to health care, Data analysis, Health information and Knowledge representation, and Organizational impact.

In the first section introductory notions of health care and nursing are introduced giving the reader the spectrum of the health care in which the technical aspects can be applied. A discipline in order to have scientific basis must be able to define in an appropriate manner the terms it uses in everyday practice. The next two chapters by Saba and Mortensen cover the importance of defining and classifying the terms of Nursing describing all efforts made until today with emphasis on nursing practice. The use of a minimum set of nursing terms in facilitating the health management and nursing research is given in the next chapter.

As Health Informatics deals with all aspects of collection, processing, storage, and exploitation of data, information, and knowledge in the health domain, the next two sections are focused on those streams.

The second section starts with an overview of the data analysis methods, whereas the second chapter discusses more the particular study design methods appropriate for health. A detailed description of the most popular tool in dealing with data analysis, that is statistics, is given on the next chapter. A comparison on the most useful statistical methods especially of the advanced techniques is depicted on this chapter and those techniques used in classification processes are described in a more mathematical formulation in the next chapter.

The core technological issues of health informatics are dealt with in the next section. General definitions are presented by Hasman in the first chapter of this section introducing in a way the next chapters to the reader. The main theme of Health Informatics, the Hospital Information Systems, is presented in the next chapter engulfing the most current information whereas the next chapter gives an example of departmental information for diabetes care. Even if the traditional hospital information systems were dealing only with administrative applications the most recent ones are now focusing on the electronic health record. The following chapter describes the architecture and implementation issues of such a system. An important application of the patient record system with particular importance in this book is the nursing information system chapter. In the next three chapters issues of human interaction, electronic data interchange, and communication issues such as telecare are discussed. An overview of image processing and analysis principles is presented giving the groundwork for imaging techniques for those interested to pursue further. An important chapter follows focusing on the particular area of knowledge representation as occurs in nursing. The final chapter discusses the multimedia technologies as applied in educational software applications in the nursing and health domain.

The introduction of technological innovations in the traditional dominated health care field creates a number of changes and reactions prior and after the implementation especially of the hospital information systems. Those issues are discussed in the following section. The organization of the health care systems differs from country to country and from continent to continent. Those differences are discussed in the first chapter of the fourth section. The next two chapters are dealing with the organizational impact of the health informatics and of technology in the healthcare environment. The fourth chapter discusses the particular nursing issues. One of the major factors for implementing information systems in the healthcare domain is the quality assurance of the medical and nursing procedures. Data protection, confidentiality and security policy is discussed in the next chapter following the description of the communication requirements needed to be ensured among health care professionals. The section closes with discussion for the need in introducing the subject of health informatics in the nursing schools at both undergraduate and postgraduate level. The book ends with a glossary of terms in health informatics as it was compiled by the Nightingale project.

The reader can read the chapters with the order presented by the editors. However, if a particular chapter is of more interest to the reader he can skip previous chapters without any particular gaps, since the authors prepared the chapters based on the independence of authoring, including in each chapter all required elements.

Athens 2001

John Mantas, The Editor

This chapter illustrates the study designs most frequently encountered in the medical literature. In medical research, either subjects are observed or experiments are undertaken. Experiments involving humans are called trials. Experimental studies may also use animals and tissue, although we did not discuss them as a separate category; the comments pertaining to clinical trials are relevant to animal and tissue studies as well. Each type of study discussed has advantages and disadvantages. Randomized, controlled clinical trials are the most powerful designs possible in medical research, but they are often expensive and time-consuming. Well-designed observational studies can provide useful insights on disease causation, even though they do not constitute proof of causes. Cohort studies are best for studying the natural progression of disease or risk factors for disease; case-control studies are much quicker and less expensive. Cross-sectional studies provide a snapshot of a disease or condition at one time, and we must be cautious in inferring disease progression from them. Surveys, if properly done, are useful in obtaining current opinions and practices. Case-series studies should be used only to raise questions for further research.

The purpose of this chapter is to present a conceptual framework that applies to almost all statistical procedures discussed so far in this text. We also describe briefly, using a conceptual framework only, some of the more advanced techniques used in medicine.

This chapter describes all the recent advances in statistical and syntactic pattern recognition, along with a number of the most important hybrid efforts in pattern recognition methodology, which together with structural pattern recognition, are the future trends in pattern recognition applications' schemes.

This chapter describes some of the ways in which IT can be applied to the clinical management of diabetes, considering both clinical information management and decision support. At a methodological level issues addressed range from requirements analysis and specification to evaluation. From a clinical perspective the benefits that can arise and the challenges still to be faced are discussed. It is clear from practice that the dominant feature determining success is ‘clinical usefulness’ combined with ‘safety’ - the methods of evaluating clinical systems are in their infancy and need further development. Creating clinically useful and effective systems is more difficult than is commonly anticipated. The poor level of investment in this area is reflected in the relatively poor penetration of IT into clinical practice.

The chapter covers the electronic health record and electronic health record system that facilitates the use of EHR. The EHR is compared with the traditional handwritten health care record. Definition of Electronic Health Records and its association with the terminology, classification and coding is presented. The architecture of the Electronic Health Record is of strong significance as well as its attributes. Strategic approaches of designing systems supporting the use of electronic health records are depicted. A short presentation of current state of implementation and the obstacles for further implementation are given in the final part of the chapter.

Nursing Information System (NIS) is a part of a health care information system that deals with nursing aspects, particularly the maintenance of the nursing record. The several objectives that a Nursing Information system should meet in order to succeed its aims, cover the users' needs and operate properly are described. The functions of such systems, which combine with the basic tasks of the nursing care process, are examined. As Nursing Information System is part of the health care and hospital information system, the different strategies and approaches for designing and developing Hospital Information Systems followed from the decade of 1970 until the recent decade of 1990, are presented. The three main approaches followed were the “centralized approach”, the “departmental approach”, and the “distributed approach”. The advantages and drawbacks of each different approach are examined. For the implementation or upgrade of Nursing Information System a NIS committee comprised by different health care professionals, is necessary to be formed. The implementation and upgrade of a Nursing Information System follows some specific phases. These steps, include planning phase, analysis phase, design phase, development phase, implementation phase, and upgrade phase. A paragraph at the end of this chapter summarizes the future trends of Nursing Information Systems.

In general multimedia is the combination of visual and audio representations. These representations could include elements of texts, graphic arts, sound, animation, and video. However, multimedia is restricted in such systems where information is digitalized and is processed by a computer. Interactive multimedia and hypermedia consist of multimedia applications that the user has more active role. Education is perhaps the most useful destination for multimedia and the place where multimedia has the most effective applications, as it enriches the learning process. Multimedia both in nursing education and in medical informatics education has several applications as well. A multimedia project can be developed even as a “stand alone” application (on CD-ROM), or on World Wide Web pages on Internet. However several technical constraints exist for developing multimedia applications on Internet. For developing multimedia projects we need hardware and software, talent and skill. The software requirements for multimedia development consist of one or more authoring systems and various editing applications for text, images, sounds and video. In this chapter different software tools for creating multimedia applications are presented. In the last part of this chapter, two examples of multimedia educational training programs are discussed. Both are “stand alone” applications (CD-ROMs). The first, examines several aspects of the electronic patient record by using videos, audio descriptions, lectures and glossary, while the second one presents several topics regarding epidemiology and epidemiological research by using graphics, sound and animation.