Foundation of Health Informatics

Chapter 1: Basics of Health

Informatics

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 Learning Objectives

 Explain DIKW
 Define Health Informatics and sub- disciplines
 Identify Health Informatics Models
 Discuss history and current trends of Health
Informatics
 List the benefit and barriers to health
information technology adoption
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 Brainstorming

 What do you think

about the reason that
triggers the
introduction of health
information
technology? (2min)

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 Introduction

 Health informatics began as a new field of

study in the 1950s-1960s
 Its emergence is partly due to the multiple
challenges facing the practice of medicine
today.
 And, the growth in the volume of medical
knowledge and patient information that has
occurred due to better understanding of human
health
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 Introduction ….

 the increase in specialization has also created

the need to share and coordinate patient
information.
 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.
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 Introduction …

 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.
 However, in general, technology is advancing
faster than healthcare professionals can
assimilate it into their practice of medicine.

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 Introduction …

 given the volume of data and rapidly

changing technologies, there is a great
need for ongoing informatics education of all
healthcare workers.

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 Data, Information, Knowledge,
Wisdom Hierarchy

 Data are symbols or observations reflecting

differences in the world.
 Data are the plural of datum (singular).
 Thus, a datum is the lowest level of abstraction, such
as a number in a database (e.g. 5), or packets sent
across a network (e.g. 10010100).
 That there is no meaning associated with data; the 5
could represent five health workers, five minutes or
have no real meaning at all.
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 Information is meaningful data or facts, for example,
five informaticians has meaning
 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. For example, a rising PSA could
mean prostate infection and not cancer.
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DIKW Pyramid

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 A Sequential Process of Knowing

Understanding supports the transition from one stage to the next, it is not a
separate level in its own right
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 From tacit to articulate knowledge

“We know more than we can tell.”

Michael Polanyi, 1966
MANUAL
How to
play
soccer

High Low
Codifiability

Articulated Tacit
“We know more than we can tell.”
 Explicit Knowledge

 Formal and systematic:

◼easily communicated & shared in product
specifications, scientific formula or as computer
programs;
 Management of explicit knowledge:
◼management of processes and information
 Tacit Knowledge Examples

 Highly personal:
◼hard to formalize;
◼difficult (but not impossible) to articulate;
◼often in the form of know how.
 Management of tacit knowledge is the
management of people:
 Health Informatics Definition

• Informatics is the union of information, people and

science/process/technology
• Individuals who practice informatics are known as
informaticians or informaticists
• Health informatics is the interdisciplinary study of the
design, development, adoption, and application of
information and technology-based innovations in
public health and healthcare services delivery,
management, and planning

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 Health Informatics Subsets
Health Informatics is the overarching theme for all informatics used in
healthcare.
The sub-disciplines are:
Sub-desciplines of Health Informatics
include:

– Clinical Informatics – Pharmacy Informatics

– Medical informatics (MI) – Biomedical informatics
– Public Health informatics – Translational bioinformatics
– Consumer health informatics – Computational health
– Nursing informatics (NI) informatics (CHI)
– Dental Informatics – Clinical research informatics
(CRI)
– Nutrition Informatics

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 Clinical Informatics

• Clinical Informatics is the application of informatics and

information technology to deliver health care services
• It is concerned with information use in health care by clinicians.
• It is the collection, evaluation, and application of information
technology to deliver healthcare services and improve care
provided by healthcare organizations.
• Clinical informatics refers to informatics as practiced within a
health organization, usually focusing on applications that are used
by clinicians.
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 Clinical Informatics …
EHRs

 Epic

 ModMed

• SmartCare
• TenaCare
• OrbitHealth
 NextGen
Healthcare HER

 EHR Your Way

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 Public Health Informatics

• Public Health informatics is the

systematic application of information and Public Health Practice
computer science and technology to
public health practice, research, and
learning.
Public health informatics uses technology
and information systems to advance
strategies such as;
• surveillance,
• prevention, preparedness and outbreak
management,
• electronic laboratory reporting,
• predictive modeling and health
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promotions.
 Public Health Informatics …
Examples

 IVR (Interactive Voice Response System)

 Epi-Info
 GIS
 Electronic Integrated Disease Surveillance
Information System
 Mobile-based surveillance …
 Spatiotemporal Epidemiologic Modeler (STEM):
An Open Source Tool for Disease Modeling

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 Consumer Health Informatics

• Consumer health informatics analyses consumers’ needs for

information; studies and implements methods of making
information accessible to consumers; and models and integrates
consumers’ preferences into medical information systems.
• Consumer informatics stands at the crossroads of other
disciplines, such as nursing informatics and public health
• It helps bridge the gap between patients and health resources.
• It looks at informatics from multiple consumer or patient views.

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 Medical Informatics

• The collection and evaluation of

medical knowledge and patient data to
facilitate and improve patient care.
• Medical informatics is informatics as
practiced by medical doctors.
 Areas of Medical Informatics

Knowledge Clinical Information

Management Management

Communication Decision Support

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 Medical Informatics ...

 Communication  Decision Support

◼ Telemedicine ◼ Reminder systems
◼ Tele-radiology ◼ Diagnostic Expert Systems
◼ Patient e-mail
◼ Drug Interaction
◼ Presentations
 Information Management
 Knowledge management
◼ Electronic Medical Records
◼ Journals
◼ Consumer Health information ◼ Billing transactions
◼ Evidence-based medical ◼ Ordering Systems
information

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 Medical Informatics Changing Medicine
… in the future applications are merged into one seamless system

Knowledge Information
Management Management

Communication Decision Support

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 Nursing Informatics

• Nursing informatics (NI) is the specialty that

integrates nursing science with multiple
information management and analytical
sciences to identify, define, manage, and
communicate data, information, knowledge,
and wisdom in nursing practice
 Biomedical Informatics

• Biomedicine is medicine based on the application of

the principles of the natural sciences, especially
biology and biochemistry
• Biomedical informatics focuses on using
computational and traditional methods in biology
and medicine and on research in genomics,
proteomics (the large-scale study of protein),
pharmacology and other disciplines that cut across
medical disciplines.
 Bioinformatics:

•is used to develop tools and methods (usually

software) for understanding biological data
•is related to research in molecular biology
•can include fields from signal processing to
biology, combining statistical and mathematical
techniques to compute results

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 Translational Bioinformatics

• It is the development of storage,

analytic, and interpretive methods to
optimize the transformation of
increasingly voluminous biomedical
data, and genomic data, into;
• proactive, predictive, preventive, and
participatory health.
• It is the integration of biological and
clinical data where the end product
is newly found knowledge
 Computational Health
Informatics

• Computational health informatics (CHI) specifically

integrates computer science techniques that are relevant
in healthcare.
• Informaticists in this area study the underlying principles
of computer science that allow for medically related
algorithms and systems to be developed.
• This subspecialty of health informatics frequently analyze
“big data”.
• It involves health and computer scientists working in
unison to develop the next generation of healthcare
technologies through computational informatics
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 Key Models in Health Informatics

• There are models in health informatics that

approach how to effectively integrate technology
systems and people

• These include:
– Technology Acceptance Model
– Disruptive Innovation
– Diffusion of Innovation
– Sociotechnical Theory
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 Technology Acceptance Model
(TAM)
• It is an information systems’ theory that models how users come to
accept and use a new technology when presented.
• Because new technologies are constantly introduced to healthcare, the
rate of user acceptance depends heavily on perceived purpose and
accessibility of the technology
– introduced by Fred Davis in 1986

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 Disruptive Innovation Model

• Disruptive Innovation is an information systems’ theory

that realizes how a groundbreaking innovation can disrupt
the current standard and eventually become the new
industrial norm.

• Healthcare technologies can be introduced that become so

popular as to change the current model.
– Developed by Clayton M. Christensen 1995

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 In business theory, disruptive innovation is
innovation that creates a new market and value
network or enters at the bottom of an existing market
and eventually displaces established market-leading
firms, products, and alliances.

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 Diffusion of Innovation Model

• Diffusion of innovations is one of the oldest social

science theories that seeks to explain how, why, and at
what rate new ideas and technology spread.
• developed by E.M. Rogers in 1962

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 Diffusion of Innovation Model …

 The way in which innovations are communicated

to different parts of society and the subjective
opinions associated with the innovations are
important factors in how quickly diffusion—or
spreading—occurs.
 This theory is frequently referred to in the
marketing of new products.

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 DIM …
Sections of Adopters

 Innovators (2.5%): People who are open to risks

and the first to try new ideas.
 Early adopters (13.5%): People who are
interested in trying new technologies and
establishing their utility in society.
 Early majority (34%): Those who pave the way
for use from the population.

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 Late majority (34%): the set of people who follow
the early majority into adopting the innovation as
part of their daily life.
 Laggards (16%): People who lag the general
population in adopting innovative products and new
ideas.
◼ they are risk-averse
◼ the sweep of an innovation through mainstream society
makes it impossible for them to conduct their daily life
◼ So, they are forced to begin using it.
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 Sociotechnical Theory Model

• It is an information systems’ model that recognizes

the interaction between social and technical sub-
systems.
• Put simply, the sociotechnical system perspective
states that organizations are made up of people that
produce products or services using some
technology.
Developed by Tavistock Institute, London

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Sociotechnical Theory Model …

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 The History of Health Informatics

 The history of health informatics begins in 1950s,

almost 70 years ago. In the wake of World War II,
 Several doctors and researchers were examining the
role that computers could play in helping to
diagnose medical disease.
 They used logic and probabilistic reasoning to
tackle specific healthcare problems in biology and
medicine.

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 A 1959 article by Drs. Lee Lusted and Robert
Ledley promoted formalizing statistical
approaches for modeling medical decision-
making as a way of reducing errors, among other
benefits.
 However, computers were not yet advanced
enough to provide individual care providers and
hospital systems with the tools to conduct these
analyses.
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 1960 to 2000: The Evolution of
Computing and Data Analysis

 Initially, the discipline went by many

different names, including:
⚫ Computer medicine
⚫ Medical automatic data processing
⚫ Medical information science
⚫ Medical software engineering etc …

 They all meant essentially the same thing, and often the terms were used
interchangeably and eventually settled on health informatics.
 The 1960s brought significant advances where researchers built the first
operational electronic medical records system, called Health
Evaluation through Logical Programming (HELP),
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 In the 1970s and 1980s, computers became
smaller and more portable, with desktop and
laptop models becoming realistic,
 And, digital patient scheduling and
computerized order entry systems were
introduced,

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 The Move to Digitize Healthcare:
2000 to Today

 By the 2000s, many leaders recognized the

potential HI.
 In 2004, President George W. Bush included
a goal for broad adoption of computerized
health records to “avoid dangerous medical
mistakes, reduce costs, and improve care.”

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 The Move to …..
Health Information Technology for Economic and Clinical
Health (HITECH) Act

 In 2009 HITECH Act, was signed into law by

President Barack Obama on February 17, 2009, to
promote the adoption and meaningful use of health
information technology.
 This is the first national effort to incentivize
physicians and care providers to adopt EHRs as the
primary means of storing and sharing patient
treatment data.

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 It provided benefits for those willing to be
‘early adopters,’ with a future provision to
punish clinics that did not adopt an EHR
within a specified timeframe.

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Discuss about the current and
future movement of health
informatics in the Health care
organization.

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 Current Trends of Health
Informatics
1. Interoperability
 One of the primary issues in healthcare was that
electronic health records (EHR) could not effectively
communicate with several people simultaneously.
 Traditional methods lack the efficiency and
compatibility to achieve optimum coordination.
 Interoperability is the ability of a system or device to
exchange, access, cooperatively use and integrate
data within and beyond the organizational level.
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 1. Interoperability …

 It ensures seamless records and information

exchange and optimizes services and
operations.
 It also help reduce operational costs and
ensure better outcomes by improving
efficiency.

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 2. Consumerization

 Proactive, open, and easy two-way

communication channel between two
parties.
⚫ These parties can be the hospitals, healthcare
providers, patients, vendors, stakeholders, etc.
 More accessible to each stakeholder.

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 3. Artificial Intelligence (AI) products

 Use of machine learning, deep

learning, and AI
⚫ For example, AI is now able to make
an automated diagnosis for STAT
imaging.
 It is also able to highlight and
report any incidental findings in
the test reports and much more.

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 AI ….

 These aspects help in speeding up the

process of patient diagnosis
 AI also can search the patient data and sort it
in specific areas and categories.
 This simplifies how professionals look at and
interpret data drastically, meaning healthcare
professionals don’t have to sort
through unrelated data anymore.
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 AI ….
Use Cases for Artificial Intelligence in Medical
Imaging

 Identifying cardiovascular abnormalities

 Detecting fractures and other musculoskeletal
injuries
 Detecting fractures and other musculoskeletal
injuries
 Flagging thoracic complications and conditions
 Screening for common cancers

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 4. Cybersecurity

 The healthcare system relying on internet and electronic

devices, and hackers are stepping up their game to attack the
industry.
 As a result, hospitals and healthcare facilities are taking
necessary preventative measures to ensure proper security.
◼ For example, cutting off all the external mails and

increasing the screening rates.

 The industry is also massively investing in establishing a
secure and safe data storage system.

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 5. Telehealth and remote care

 Telehealth became a massive part of the healthcare

industry during the pandemic.
 the pandemic also promoted remote monitoring of
patients who suffer from different chronic conditions.
 Combining telehealth and remote monitoring for
patients in addition to traditional healthcare services has
enabled the industry to establish a hybrid healthcare
model.

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 6. Analytics and well-being

 The latest healthcare trends are shifting from treatment

and rehabilitation towards the overall well-being of the
patient.
 The industry now realizes the importance of promoting
a healthy lifestyle to the masses amplifying the
“prevention is better than cure” ideology.
 Informatics and data play an analytical role, pinpointing
the issues by sifting through patients’ histories and
family information to create a roadmap for optimal care
and well-being.
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 Use cases for Digital Wellness

 The health and wellness tracking software on

your smartphone,
 coaching software,
 wellness calendar software, or
 some other healthcare technologies that
support you in everyday life is only a small
part of all the software.

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 Benefits of Health Informatics

1. Reduces Errors and Costs

 Clinical Decision Support System (CDSS) and
Computer Provider Order Entry Systems (CPOE)
2. Improved Coordination: b/n different units of the
health system
3. Efficiently Store Patient Records
4. Patient Empowerment: Patients can keep track of
their health status and to reach the right healthcare
experts
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5. Better Outcomes
6. Improved Healthcare Marketing: healthcare
experts can check more patients and track their details
from anywhere.
7. Consistent Monitoring of Cases: Wearable
devices; wireless monitoring with Internet of Medical
Things
8. Robotic Services: Robot Surgeons
9. No Data Breaches
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 The Case of Betsy A. Lehman

“How long, Oh Lord, must  An e-mail message posted

this continue?” soon after Boston Globe
journalist Betsy Lehman
…That’s 21 years ago… died due to a massive
overdose of a powerful anti-
Isn’t it time that basic cancer drug is a powerful
computerization be part of case in point.
the expected, and required,
care at medical facilities?  The message was posted
by a University of Michigan
bioengineer:

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 Barriers in Adoption of Health
Information Technology

A. Barriers Related To Infrastructure

◼ Poor or Inadequate Infrastructure
◼ Provision of Computer Hardware and Software
◼ Poor Internet Availability
◼ Lack of Professional Human Resource and
Lack of Trainings to Produce this Workforce
B. Cost and Time Barriers

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 Barriers …

C. National Policies towards HIT

D. Social and Cultural Barriers:
⚫ lack of stakeholder’s interest,
⚫ less motivation, to adapt and use new technology.
⚫ more comfortable with their conventional approach
and routine practice
E. Educational Barriers: Professional education in health
informatics is badly ignored

F. Organizational Barriers
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