Medical informatics is the study and application of methods to improve

the management of patient data, clinical knowledge, population data, and

other information relevant to patient care and community health. It is a
young science, which emerged in the decades after the invention of the
digital computer in the 1940s. Mechanical computing in medicine had a
much earlier origin, in the 19th century, with Herman Hollerith’s “punched-
card data-processing system” originally used for the US census and
subsequently developed to support surveys in public health and
epidemiology.1 This example reflects the multidisciplinary nature of
medical informatics, which interacts with various fields, including the
clinical sciences, the public health sciences (for example, epidemiology
and health services research) as well as cognitive, computing, and
information sciences.
Given the diversity of backgrounds of medical informatics workers,
newcomers can easily be confused by the jargon used in the field. An
introduction to basic concepts would therefore be useful to those
interested in learning more about medical informatics. In recent years,
various branches of the discipline have appeared, including public health
informatics, consumer health informatics, and clinical informatics. In a
debate on whether medical informatics and these branches are distinct
disciplines, Shortliffe and Ozbolt argued that “informatics is built on a re-
usable and widely applicable set of methods that are common to all
health science disciplines, and that ‘medical informatics’ continues to be a
useful name for a composite core discipline that should be studied by all
students, regardless of their health profession orientation.”2,3 Our
definitions of the various branches of medical informatics below reflect
this.
One or more of the following criteria were used to select terms included in
this list of concepts:
 The term is likely to be novel to epidemiologists and public health
professionals.
 An existing word may have a widely accepted meaning but is used
in a specific way in the medical informatics field.
 The term is relevant to epidemiology and public health.
 It is essential to understanding medical informatics.
 It is enduring—that is, not about some transient technology.
 There is general agreement on what the term means and how it is
used.
 There is value in attempting to define the term, even though there
may be debate about it.
We trust this list of terms will be informative for novices and encourage
discussion among medical informatics professionals, particularly on terms
for which there is no widespread agreement*. For readers who are
interested in pursuing the subject further, additional resources are cited at
the end of the list.

ALGORITHM
A process for carrying out a complex task broken down into simple
decision and action steps. Often assists the requirements
analysis process carried out before programming.

BIOINFORMATICS
The use of medical informatics methods to facilitate research in molecular
biology.

CHECKLIST
A type of clinical decision tool: a form listing one or more items of patient
data to be collected before, during or after an encounter; can be paper or
computer based.

CLINICAL CODING SYSTEM (CLINICAL

THESAURUS, CONTROLLED VOCABULARY)
A limited list of preferred terms from which the user can draw one or more
to express a concept such as patient data, a disease or drug name, etc.
An alphanumeric code corresponding to the term is then stored by the
computer. Synonyms or close matches to each preferred term are usually
available and map onto the same internal codes. This approach makes it
easier for a computer to analyse data than the use of free text words or
phrases. Examples of clinical coding systems include SNOMED-CT
(divergent codes used to capture patient data), MeSH (terms used to
index biomedical literature) and ICD-10 (convergent disease codes for
international comparisons, with specific rules to guide coders). Clinical
coding systems play a key part in epidemiological studies and health
service research, from the use of MeSH terms to conduct literature
searches for systematic reviews to studies that use ICD codes to classify
and compare diseases. To prevent information loss, it is vital that the
terms and codes are never changed or dropped, only added to. Obsolete
terms can be marked as such to deter inappropriate use. Continuing
maintenance is needed to incorporate new terms and codes for new
concepts and synonyms as they arise.

CLINICAL DATA SYSTEM

Any information system concerned with the capture, processing, or
communication of patient data.4
CLINICAL DECISION TOOL
Any mechanical, paper, or electronic aid that collects or processes data
from an individual patient to generate output that aids clinical decisions
during the doctor-patient encounter.5 Examples include decision support
systems, paper or computer reminders and checklists, which are
potentially useful tools in public health informatics, as well as other
branches of medical informatics.

CLINICAL INFORMATION
Organised patient data or medical knowledge used to make clinical
decisions (adapted from Shortliffe et al6); may also include directory
information. Many activities in public health and epidemiology (for
example, surveillance systems, cohort studies to assess the effects of a
risk factor of disease, and clinical trials to estimate efficacies of new
treatments) entail the organisation of such data (for example, case report
forms for individual patients) into useable information (for example,
incidence of notifiable cases of disease from surveillance programmes
and summary evidence from cohort studies or clinical trials, expressed as
odds ratios for certain harmful and beneficial outcomes). See
also: information.

CLINICAL INFORMATICS
The use of medical informatics methods to aid management of patients
using an interdisciplinary approach, including the clinical and information
sciences.6

COMMUNICATION
The exchange of information between agents (human or automated) face
to face or using paper or electronic media.7 Requires the use of a shared
language and understanding or common ground.

COMPUTER VISION (IMAGE INTERPRETATION)

The use of computer techniques to assist in the interpretation of images,
such as mammograms.

CONFIDENTIALITY (PROTECTING PRIVACY)

The policies restricting access to a person’s data to those whom the
patient agrees need access to them, except rarely in emergency and for
the public good (for example, to contain epidemics, allow important
research to be undertaken, or solve serious crime). In addition, other
regulatory and institutional approval may be needed (for example, the
need to seek consent from medical ethics committees or relevant national
authorities). In recent years, leading public health researchers have
warned that legislation enacted to protect patients’ medical data in the
UK, Europe, and US could potentially hamper observational research and
medical record linkage studies.8,9

CONSUMER HEALTH INFORMATICS

The use of medical informatics methods to facilitate the study and
development of paper or electronic systems that support public access to
and use of health and lifestyle information. For additional discussion on
the scope of consumer health informatics, see Eysenbach.10 See
also eHealth.

DATA QUALITY
The degree to which data items are accurate, complete, relevant, timely,
sufficiently detailed, appropriately represented (for example, consistently
coded using a clinical coding system), and retain sufficient contextual
information to support decision making.

DATABASE
A collection of data in machine readable format organised so that it can
be retrieved or processed automatically by computer. A flat file database
is organised like a card file, with many records (cards) each including one
or more fields (data items). A relational database is organised as one or
more related tables, each containing columns and rows. Data are
organised in a database according to a schema or data model; some
items are often coded using a clinical coding system.

DECISION SUPPORT SYSTEM (COMPUTER

DECISION AID)
A type of clinical decision tool: a computer system that uses two or more
items of patient data to generate case specific or encounter specific
advice.11 Examples include computer risk assessors to estimate
cardiovascular disease risk12 and the Leeds Acute Abdominal Pain
system, which aided the diagnosis of conditions causing such
pain.13 Evidence adaptive decision support systems are a type of decision
aid with a knowledge base that is constructed from and continually adapts
to new research based and practice based evidence.14

DECISION TREE
A way to model a complex decision process as a tree with branches
representing all possible intermediate states or final outcomes of an
event. The probabilities of each intermediate state or final outcome and
the perceived utilities of each are combined to attach expected utilities to
each outcome. The science of drawing decision trees and assessing
utilities is called decision analysis.
DEMONSTRATION STUDY
Study that establishes a relation—which may be associational or causal—
between a set of measured variables. In epidemiology, cohort studies,
randomised trials, and blind comparisons of a test with a gold standard
are typical demonstration studies.6,15 See also measurement studies.

DIRECTORY INFORMATION
Information specific to an organisation or service that is useful in
managing public health services, health care services, or patients.
Examples include a phone directory, a lab handbook listing available tests
and specimens to use, and a list of drugs in the local formulary.
eHealth
The use of internet technology by the public, health workers, and others
to access health and lifestyle information, services and support; it
encompasses telemedicine, telecare, etc. For discussion on the scope
and security issues of eHealth, see a recent report by the National
HealthKey Collaborative.16

ELECTRONIC HEALTH RECORD (EHR)

In the UK, the lifelong summary of a person’s health episodes, assembled
from summaries of individual electronic patient records and other relevant
data.17

ELECTRONIC PATIENT RECORD (EPR)

A computer based clinical data system designed to replace paper patient
records.

EXPLICIT KNOWLEDGE
Knowledge that can be communicated on paper or electronically, without
person to person contact.18 Public health workers and physicians cannot
use explicit knowledge if they cannot access it. There is thus a need to
identify, capture, index, and make available explicit knowledge for
professionals, a process called codification. Much of the work done by the
Cochrane Collaboration entails codification of explicit knowledge. See
also: tacit knowledge.

GEOGRAPHICAL INFORMATION SYSTEM (GIS)

Computer software that captures, stores, processes, and displays
location as well as other data. The display may preserve distance ratios
between data objects (for example, true scale maps) or link similar
objects, ignoring distance (for example, topological maps such as that
distributed to the public for the London Underground). GIS software is
used in many ecological studies of disease. A famous example is Peto’s
study of diet, mortality, and lifestyle in rural China.19 Disease mapping
studies have also been conducted to assess childhood leukaemia in
areas with different radon levels,20 the clustering of respiratory cancer
cases in areas with a steel foundry,21 and socioeconomic gradients in
infant mortality.22 GIS are also used for public health planning and
surveillance purposes at local or national health departments. Care
should be taken by policy makers in interpreting maps produced by GIS
software, particularly in regard to the ecologic fallacy.23

INFORMATION
Organised data or knowledge used by human and computer agents to
reduce uncertainty, take decisions, and guide actions (adapted from
Shortliffe et al6 and Wyatt24). See also: clinical information, patient data,
medical knowledge.

INFORMATION DESIGN
The science and practice of designing forms, reports, computer screens,
etc, so that the information they contain can be found rapidly and
interpreted without error (adapted from Sless25). Information design is
based on psychological and graphical design theories and empirical
studies of human perception and decision making using alternative
formats for information.25a

KNOWLEDGE BASE
A store of knowledge represented explicitly so that a computer can
search and reason with it automatically; often uses a clinical coding
system to label the concepts. See also decision support system.

KNOWLEDGE BASED SYSTEM (EXPERT

SYSTEM)
A computer decision support system with an explicit knowledge base and
separate reasoner program that uses this to give advice or interpret data,
often patient data.

KNOWLEDGE MANAGEMENT
The identification, mobilisation and use of knowledge to improve
decisions and actions. In public health and medicine, much of this work
involves the management of medical knowledge (from epidemiological
studies, randomised controlled trials, and systematic reviews) so that it is
actually used by the physician. This entails practice innovation26 or
narrowing the gap between what we know and what we do. The NHS is
developing a program of knowledge codification to inform routine problem
solving, for example, through the National Electronic Library of Health,
guidelines from the National Institute of Clinical Excellence (NICE), and
care pathways and triage algorithms used in the NHS Direct Clinical
Advice System.27

MEASUREMENT STUDY
Study of the reliability, validity, or ease of use of a measurement
instrument or method in a defined population.15 See also demonstration
study.

MEDICAL INFORMATICS (HEALTH

INFORMATICS)
The study and application of methods to improve the management
of patient data, medical knowledge, population data and
other information relevant to patient care and community health. Unlike
some other definitions of medical informatics (or example, Greenes and
Shortliffe28), this definition puts the emphasis on information management
rather than technology. Branches of medical informatics
include bioinformatics, clinical informatics, consumer health
informatics and public health informatics.

MEDICAL KNOWLEDGE (CLINICAL KNOWLEDGE)

Information about diseases, therapies, interpretation of lab tests, etc,
which is potentially applicable to decisions about multiple patients and
public health policies, unlike patient data. This information should where
possible be based on sound evidence from clinical and epidemiological
studies, using valid and reliable methods. See also: explicit knowledge,
tacit knowledge, knowledge management.

MINIMUM DATASET
A list of the names, definitions and sources of data items needed to
support a specific purpose, such as surveillance of the health of a
community, investigation of a research hypothesis or monitoring the
quality of care in a registry.

OBJECTIVISTIC EVALUATION
An evaluation approach that uses experimental designs and statistical
analyses of quantitative data.6,15 Such an approach is never completely
objective. See also subjectivistic study.

ONTOLOGY
A description of the concepts and relations in a domain, such as drug
prescribing. Sample concepts here would be “patient”, “prescriber”, and
“drug”; relevant relations might include “prescribes to”, “requests
prescription from”, and “causes side effects to”. A taxonomy or hierarchy
is a simple kind of ontology in which concepts are arranged according to
only one relation: “is a kind of”. Note that ontology as used here has a
different meaning from its use in the philosophy of science, an area of
interest to theoretical epidemiologists.

PATIENT DATA
Information about an individual patient and potentially relevant to
decisions about her current or future health or illness. Patient data should
be collected using methods that minimise systematic and random error.
See also: medical knowledge, data quality.

PRACTICE INNOVATION (RESEARCH

IMPLEMENTATION, BEHAVIOUR CHANGE)
Applying usually explicit knowledge to innovate in public health and
clinical practice by identifying barriers to change and applying
appropriate practice innovation methods to overcome these (adapted
from Wyatt26). See also: knowledge management.

PRACTICE INNOVATION METHODS (RESEARCH

IMPLEMENTATION, BEHAVIOUR CHANGE
METHODS)
A range of methods that can potentially overcome barriers to change in
the practice innovation process, such as clinical audit, outreach visits
or clinical decision tools.

PUBLIC HEALTH INFORMATICS

The use of medical informatics methods to promote public health practice,
research, and learning, using an interdisciplinary approach, including the
public health sciences, for example, epidemiology and health services
research, and the information sciences, for example, computing science
and technology (adapted from Yasnoff et al29). In a recent paper outlining
an agenda for developing this branch of informatics, Yasnoff et
al30 argued for the need to construct, implement, and integrate public
health surveillance systems at national and local levels, to enable rapid
identification and response to disease hotspots (and more topically,
bioterrorism). As Yasnoff rightly points out, methods of assessing costs
and benefits of such systems are needed. Public health informatics can
also contribute in other areas, for example, reminders have played an
important part in prevention programmes such as smoking cessation
advice to smokers31 and the use of preventive care for patients.32

REGISTRY
A database and associated applications that collects a minimum
dataset on a specified group of patients (often those with a certain
disease or who have undergone a specific procedure), health
professionals, organisations, or even clinical trials. Registries can be used
to explore and improve the quality of care or to support research, for
example to monitor long term outcomes or rare complications of
procedures. Key issues in registries are maintaining confidentiality,
coverage of the target population, and data quality.

REMINDER
A type of clinical decision tool that reminds a doctor about some item
of patient data or clinical knowledge relevant to an individual patient that
they would be expected to know. Can be paper based or computer
based; includes checklists, sticky labels on front of notes, an extract from
a guideline placed inside notes, or computer based alerts. There has
been much interest in reminders as a practice innovation method recently
because of the poor uptake of practice guidelines, even those based on
good quality evidence. An example is the treatment of dyslipidaemia in
primary care, where there is a big gap between recommendations and
actual practice.33

REQUIREMENTS ANALYSIS
The process of understanding and capturing user needs, skills, and
wishes before developing an information system (adapted from
Somerville34). See also software engineering.

SECURITY
The technical methods by which confidentiality is achieved.16

SOFTWARE ENGINEERING
The process of system development, documentation, implementation,
and upgrading (adapted from Somerville34). In the classic or “waterfall”
model of software engineering, requirements analysis leads to a
document that serves as the basis for a system specification
and database schema, from which programmers work to develop the
software. However, increasingly, users and software designers work
together from the start to develop and refine a prototype system. This
helps to engage the users, educate the software development team,
brings the requirements documents alive, and allows users to explore
how their requirements might change as a result of interaction with the
new software.

SUBJECTIVISTIC EVALUATION
An evaluation approach that relies primarily on qualitative data derived
from observation, interview, and analysis of documents and other
artefacts.6,15 The focus of such studies is on description and explanation;
they tend to evolve rather than be prescribed in advance. As we can
never truly understand another person’s feelings, such studies always
approximate the subjective. See also objectivistic study.

TACIT KNOWLEDGE (INTUITION)

Knowledge that requires person to person contact to transfer and cannot
be communicated on paper or electronically.18,27 Over time, some tacit
knowledge can be analysed, decomposed, and made explicit. See
also: explicit knowledge.

TELECARE
A kind of telemedicine with the patient located in the community (for
example, their own home); see also eHealth.

TELEMEDICINE
The use of any electronic medium to mediate or augment clinical
consultations. Telemedicine can be simultaneous (for example,
telephone, videoconference) or store and forward (for example, an email
with an attached image). See also eHealth.
Additional resources
Readers who are interested in general coverage of the field of medical
informatics are encouraged to refer to standard texts.15,35,36 Those who
are interested in alternative or complementary definitions of the above
terms can look up various sources.6,7,37–39

Acknowledgments
We thank Ameen Abu Hanna (Department of Medical Informatics,
University of Amsterdam) and the JECH anonymous referees, who all
provided useful comments on drafts.