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Health Informatics: a rant to begin the new year

I was woken by the sound of a text message arriving on my mobile phone. Ahh, I thought, a message from my old university chum who lives in Mauritius. Or, maybe my Mother has learned to text and is about to impress me with a New Year's greeting.

No such luck. A message from my accountant telling me that my VAT (UK sales tax) return is due. Brought down to earth with a bleep and a buzz. As Bono sings: “Nothing changes on New Year's day”.

Suitably grumpy, I thought I would write about this field of Health Informatics that has been on my mind.

I took a partial sabbatical from health to work in other areas of the UK public sector, thinking to expand my experience and skills. During my time away from full-time engagement in healthcare IT, Health Informatics in the UK seems to have grown from an egg into an assertive fledgling.

I looked up a definition of it on Wikipedia:

“Health Informatics or sometimes Medical Informatics is the intersection of information science, medicine and health care. It deals with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems.”

Now, having worked for about 15 years in healthcare IT and led three major Electronic Patient Record Implementations I became used to walking the tightrope between the views of clinicians and NHS IT professionals. In general, over the years these two poles have learned to co-exist.

Into that polarization—for me uneasily—come the Health Informaticians. Are they clinicians, healthcare IT professionals or a new breed of academic? Why are there no fields called Finance Informatics or Supermarket Informatics..?

Wikipedia's entry did little to help me, giving the following as aspects of the field:


  • architectures for electronic medical records and other health information systems used for billing, scheduling or research

  • decision support systems in healthcare

  • messaging standards for the exchange of information between health care information systems (e.g., through the use of the HL7 data exchange standard) - these specifically define the means to exchange data, not the content

  • controlled medical vocabularies such as the Standardized Nomenclature of Medicine, Clinical Terms (SNOMED-CT), Logical Observation Identifiers Names and Codes (LOINC) or OpenGALEN Common Reference Model - used to allow a standard, accurate exchange of data content between systems and providers

  • use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-making.

If this is a correct description (it is subject to the democratic nature of Wikipedia) it sits firmly on the IT professional stretch of my conceptual tightrope.

Having read the Wikipedia description and having looked at a HI text book it seems to me that this field misses “best half of our affair”: the integration of IT into, and the transformation of, medical practice.

To succeed, it is essential that healthcare IT become fully integrated into care. Is “Health Informatics” the best way to bring that about?

Only joking about the grumpiness. In fact, it is a lovely day here in London and I enjoyed my run!

I wish you all a happy and successful 2006.

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Comments

I'm looking for a job as a health metainformatician now so I can think hard about what health informaticians should be doing

Thanks Alasdair and Welcome,

Wow! Now you have me even more baffled than I was on New Year's day!

If you want to tell us more--maybe contribute "a day in the life of a (aspiring) meta-informatician". Please let me know!

Oy vey - The "Informatician" question. Here's what I've learned about this here in the US, where Informaticians are almost always coming from the Healthcare side of the equation:

1) Doctors and Nurses see Informaticians as kindred spirits who speak their language and can get amazing things accomplished in their IT departments.

2) IT professionals see Informaticians as Healthcare Providers who have lost their desire to practice medicine and are instead invading IT with little actual skill, promising clinicians the world and delivering nothing.

Harsh? Sure, but a reality I've come accross nonetheless. If an ex-charge nurse or physician walks into the room with the words "Health Informatics" on their name-tag, most of the salty IT folks will roll their eyes and try to ignore them.

Its no different than a programmer deciding to try and practice medicine. If I went into the OR and said "I think that I can bring my experience with interfacing EMRs to bear in this gallbladder removal" I would no doubt garner the same reaction.

Pete,
Thanks for your comment and welcome.

Some of what you say applies to the UK as well, though HI is probably not as estalished here as in the US.

I have a business background and changed careers into IT after an MSc. I intended to become a business/IT hybrid.

That plan worked for me very well and I now consider myself a healthcare/IT hybrid (I have a degree in Biochemistry and worked for 10 years in health-reated fields.)

I think that HI has been popularised in the UK to encourage clinicians to take more interest in IT--a worthy goal.

Nontheless, I think is has a rather bookish orientation--often seeming more like research or information science to me.

What we need are health IT hybrids: staff who have been clinicians and have taken time to acquire an *in depth* understanding of IT--particularly the human aspects of its implementation. (Of course, IT to clinical is another route.)

At this stage, the human effects are given little or no priority by the HIs I have met. A big shortcoming of the field.

Sorry, Colin, with apologies to any real health metainformaticians out there, I was only joking.

But I guess if I was one, I would be trying to figure out what health informatics is. I've seen a trust that was planning a health informatics department, and came across the problem of who should be in it? The Information Deparment, Medical Records, IT? So what are the boundaries of HI?

Second, what is the point of it ? UKCHIP has a stated aim of introducing professionalisation, which is always sold as a way of ensuring quality output, but also always involves restricting some people from practising the profession unless they've jumped through various hoops. Is this area of work sufficiently mature for one group to define the criteria for admission to all others?

Alasdair,

An interesting point. I applaud any attempt to make healthcare IT more effective.

But does creating a professional body do that? The analogy I have heard (usually as a throw away line that I have promised myself I will challenge next time I hear it) is to engineering. It has a professional body: so why doesn't IT?

I haven't yet heard a justification, with evidence, that an central organisation makes fields more professional and effective.

Challenger, Concorde and the Titanic--weren't engineering defects at least partly to blame for these disasters? Even IK Brunel made some bloopers...

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