Overview of Health Informatics: survey of fundamentals of health information technology, Identify the forces behind health informatics, educational and career opportunities in health informatics.

1. Health
Informatics
BCA-2020: Semester-V

2. Module 1:
Chapter 1
OVERVIEW OF HEALTH
INFORMATICS
HEALTHCARE DATA,
INFORMATION AND
KNOWLEDGE
SIGNIFICANCE OF
INFORMATION SYSTEMS

3. Module
Content
 Overview of Health Informatics: survey of
fundamentals of health information technology,
Identify the forces behind health informatics,
educational and career opportunities in health
informatics.
 Healthcare Data, Information and Knowledge: How
to use healthcare data to fuel modern health care
organizations.
 Significance of Information Systems: how
information technology enables patient care, how
information technology is used by healthcare
providers.

4. SurveyOf FundamentalsOf
Health InformationTechnology
 Health informatics began as a new field of study in
the 1950s-1960s but only recently gained
recognition as an important component of many
aspects of healthcare.
 Its emergence is partly due to the multiple
challenges facing the practice of medicine today.
 The growth in the volume of medical knowledge
and patient information that has occurred due to
better understanding of human health has
resulted in more treatments and interventions
that produce more information.
 Likewise, the increase in specialization has also
created the need to share and coordinate patient
information.
 Furthermore, 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.

5. Data,
Information,
Knowledge,
Wisdom
Hierarchy
 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.
 Additionally, the volume of data and
rapidly changing technologies, there is
a great need for ongoing informatics
education of all healthcare workers.
 Informatics is the science of
information and the blending of people,
biomedicine and technology.
Individuals who practice informatics are
known as informaticians or
informaticists, such as, a nurse
informaticist.There is an information
hierarchy that is important in the
information sciences.

6. Data,
Information,
Knowledge,
Wisdom
Hierarchy
 As data are consumed and analyzed the amount of knowledge and
wisdom produced is much smaller.The following are definitions to
better understand the hierarchy:
 Data are symbols or observations reflecting differences in the world.
Note that there is no meaning associated with data; the ‘5’ could
represent five fingers, five minutes or have no real meaning at all.
 Information is meaningful data or facts from which conclusions can be
drawn by humans or computers. For example, five fingers has meaning
in that it is the number of fingers on a normal human hand. Modern
computers do not process information, they process data.This is a
fundamental problem and challenge in informatics.
 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
and to work through situations of signal versus noise. For example, a
rising PSA could mean prostate infection and not cancer.

7. Informatics
Definitions
 Health informatics is the field of information science concerned with
management of healthcare data and information through the
application of computers and other technologies.
 The definition of health informatics is dynamic because the field is
relatively new and rapidly changing.The following are several definitions
frequently cited:
 “science of information, where information is defined as data with
meaning. Biomedical informatics is the science of information applied to, or
studied in the context of biomedicine. Some, but not all of this information
is also knowledge”
 “scientific field that deals with resources, devices and formalized methods
for optimizing the storage, retrieval and management of biomedical
information for problem solving and decision making”
 “application of computers, communications and information technology
and systems to all fields of medicine - medical care, medical education and
medical research”

8. Health DataSources
EHR=Electronic Health Records,
PHR=Personal Health Record,
HIE=Health Information Exchange
Health information technology (HIT) facilitates the
processing, transmission and analysis of information
and HIT interacts with many important functions in
healthcare organizations and serves as a common
thread
Health information management (HIM)
traditionally focused on the paper medical record
and coding.With the advent of the electronic health
record HIM specialists now have to deal with a new
set of issues, such as privacy and multiple new
concepts such as voice recognition.

9. Forces behind
health
informatics
 There are multiple forces driving the adoption of health
information technology, but the major ones are the need to:
 Increase the efficiency of healthcare (improve physician,
nurse and overall healthcare productivity)
 Improve the quality (patient outcomes) of healthcare,
resulting in improved patient safety
 Reduce healthcare costs
 Improve healthcare access with technologies such as
telemedicine
 Improve communication, coordination and continuity of care
 Improve medical education for clinicians and patients
 Standardize of medical care

10. HealthIndicatorsWarehouse:
ACaseStudy
Subject: Medicare, population statistics, administrat
Topics: chronic disease and conditions, demographics, disabilities, geography, health behaviors, health care, health care resources, health
outcomes, health risk factors, hospital referral region, infectious disease initiative, injury and violence, maternal and infant health, mental
health and substance abuse, occupational health and safety, oral health, physical environment, population, prevention through healthcare,
public health infrastructure, social determinants of health and women's health
Geography: state or county
Initiative: County Health Rankings, 2008 Community Health Status Indicators, Healthy People 2020, CMS Community Indicators
Data is available to developers via an open application programming interface (API).
ive, safety, health care providers, other, health care cost, biomedical research, epidemiology, children’s health, Medicaid, quality
measurement, treatments
Agency: Department of Health and Human Services, National Institutes of Health
Sub-agency: Centers for Medicare & Medicaid Services, Department of Health & Human Services, Centers for Disease Control and
Prevention, national Library of Medicine, Administration for Children and Families, U.S. Food and Drug Administration, Agency for
Healthcare Research and Quality, National Institutes of Health, Administration for Community Living, National Cancer Institute, National
Institute on Drug Abuse, NewYork State Department of Health
Date coverage period start: 1984-2013
Collection frequency: annually, semi-annually, quarterly, monthly, weekly, daily
Geography: ZIP code, country, state, county, city, street address, MSA, sub-national region, Latitude/Longitude Coordinate
Media format: CSV, query tool, API, XLS, Widget, Text, XML, Feed, RDF, query tool 1

11. Historical
Highlights
 The following are some of the more noteworthy developments
related to health information technology:
 Computers.The first general purpose computer (ENIAC) was
released in 1946 and required 1,000 sq. ft. of floor space.
 It is thought that the origin of the term medical informatics dates
back to the 1960’s in France (“Informatique Medicale”).
 MEDLINE. In the mid-1960s MEDLINE and MEDLARS were created
to organize the world’s medical literature.
 Artificial intelligence (AI) medical projects such as MYCIN
(Stanford University) and INTERNIST-1 (University of Pittsburg)
appeared in the 1970s and 1980s.
 Human Genome Project. In 2003 the Human Genome Project (HGP)
was completed after thirteen years of international collaborative
research.
 Nationwide Health Information Network (NwHIN).The concept
was developed in 2004 as the National Health Information
Infrastructure and renamed the Nationwide Health Information
Network (NwHIN). It was again renamed the eHealth Exchange in
late 2012.

12. HumanGenomeProject:
ACaseStudy
 In 2003 the Human Genome Project (HGP) was completed after thirteen
years of international collaborative research.
 Mapping all human genes was one of the greatest accomplishments in
scientific history.
 Finalizing a draft of the genome is the first step.What remains is making
sense of the data.
 In other words, we need to understand the difference between data (the
code), information (what the code means) and knowledge (what we do
with the information).
 Data from mega-databases will likely change the way we practice
medicine in the future.
https://youtu.be/MvuYATh7Y74

13. Key Players in
Health
Information
Technology
 Patients:
 Online searches for health information and research
choice of physician, hospital or insurance plan
 Smartphone technology for test message reminders,
health and fitness apps, internet access, etc.
 Web portals for storing personal medical information,
making appointments, checking lab results, e-visits,
drug refills, etc.
 Online patient surveys
 Online chat, blogs, podcasts, vodcasts and support
groups andWeb 2.0 social networking
 Personal health records
 Limited access to electronic health records and health
information exchanges (HIEs)
 Telemedicine and home telemonitoring

14. Key Players in
Health
Information
Technology
 Physicians and Nurses:
 Online searches with PubMed, Google and other search engines
 Online resources and digital libraries
 Patient web portals, secure e-mail and e-visits, telehomecare
 Physician web portals
 Clinical decision support, e.g. reminders and alerts
 Electronic medication administration record (eMAR) and bar coding
medications
 Electronic health records (EHRs)
 Smartphones loaded with medical software and remote access to EHRs
 Telemedicine and telehomecare
 Voice recognition software
 Online continuing medical education (CME)
 Electronic prescribing
 Disease registries
 Picture archiving and communication systems (PACS)
 Pay-for-performance (P4P)
 Health information organizations (HIOs)
 E-research
 Electronic billing and coding

15. Key Players in
Health
Information
Technology
 Support Staff:
 Patient enrolment
 Electronic appointments
 Electronic coding and billing
 EHRs
 Web-based credentialing
 Web-based claims clearinghouses
 Telehomecare monitoring
 Practice management software
 Secure patient-office e-mail communication
 Online educational resources and CME
 Disease registries

16. Key Players in
Health
Information
Technology
 Public Health:
 Incident reports
 Syndromic surveillance as part of bio-terrorism
program and Meaningful Use program criteria
 Establish link to all public health departments
 Geographic information systems to link disease
outbreaks with geography
 Telemedicine
 Disease registries as part of EHRs or health
information exchanges
 Remote reporting using mobile technology

17. Key Players in
Health
Information
Technology
 Federal and State Governments:
 Nationwide Health Information Network (HealtheWay)
 Financial support for EHR adoption and health information
exchange
 Development of standards, services and policies for HIT
 Information technology pilot projects and grants
 Disease management
 Pay-for-performance
 Electronic health records and personal health records
 Electronic prescribing
 Telemedicine
 Broadband adoption
 Health information organizations (HIOs)
 Regional extension centers
 Health IT workforce development

18. Key Players in
Health
Information
Technology
 Medical Educators:
 Online medical resources for clinicians, patients and
staff
 Online CME
 PubMed searches
 Telehealth via video teleconferencing, podcasts, etc.

19. Key Players in
Health
Information
Technology
 Insurance Companies (Payers):
 Electronic claims transmission
 Trend analysis through data analytics
 Physician profiling
 Information systems for quality improvement
initiatives
 Monitor adherence to clinical guidelines
 Monitor adherence to preferred formularies
 Promote claims-based personal health records and
information exchanges
 Reduce litigation by improved patient safety through
fewer medication error

20. Key Players in
Health
Information
Technology
 Hospitals:
 Electronic health records
 Electronic coding and billing
 Information systems to monitor outcomes, length of stay,
disease management, etc.
 eMARs
 Bar coding and radio frequency identification (RFID) to
track patients, medications, assets, etc.
 Wireless technology
 E-intensive care units (eICUs)
 Patient and physician portals
 E-prescribing
 Member of health information organizations (HIOs)
 Telemedicine
 Picture archiving and communication systems (PACS)

21. Key Players in
Health
Information
Technology
 Medical Researchers:
 Database creation to study populations, genetics and
disease states
 Online collaborative research web sites
 Electronic case report forms (eCRFs)
 Software for statistical analysis of data e.g. SPSS
 Literature searches with multiple search engines
 Randomization using software programs
 Improved subject recruitment using EHRs and e-mail
 Smartphones to monitor research
 Online submission of grants

22. Key Players in
Health
Information
Technology
 TechnologyVendors:
 Applying new technology innovations in the field of
medicine: hardware, software, genomics, etc.
 Data mining
 Interoperability
 Certification

23. Educational
and career
opportunities
in health
informatics
 The timing is excellent for a career
in health informatics.With the
emphasis on increasing adoption of
electronic health records and
health information exchange,
coupled with support from the
HITECH Act there has been
tremendous interest in health
informatics.
 Healthcare organizations and HIT
vendors will be looking for workers
who are knowledgeable in both
technology and healthcare.

24. Barriers to
Health
Information
Technology
Adoption
 Inadequate time. This complaint is a common thread that runs
throughout most discussions of technology barriers. Busy
clinicians complain that they don't have enough time to read,
learn new technologies or research vendors.They are also not
reimbursed to become technology experts.They usually have to
turn to physician champions, local IT support, Regional HIT
ExtensionCenters or others for technology advice.
 Inadequate information. Clinicians need information, not data.
Current HIT systems are data rich but information poor.This is
discussed in detail in the Healthcare Data, Information and
Knowledge chapter.
 Inadequate expertise and workforce. In order for the United
States to experience widespread HIT adoption and
implementation, it will require education of all healthcare workers.

25. Barriers to
Health
Information
Technology
Adoption
 Inadequate cost and return on investment data. The literature on
the economic aspects of HIT adoption and implementation is mixed
and based on different assumptions and methods.
 High cost to adopt. It is estimated that a Nationwide Health
Information Network (eHealth Exchange) will cost $156 billion dollars
over five years and $48 billion annually in operating expenses.74
Technologies such as picture archiving and communications systems
(PACS) and electronic health records are also very expensive.
 Lack of interoperability. Electronic health records and the NwHIN
cannot share medical information until data standards are adopted
and implemented nationwide. Interoperability and data standards are
covered in more detail in other chapters.
 Change in workflow. Significant changes in workflow will be required
to integrate technology into the inpatient and outpatient setting. As
an example, clinicians may be accustomed to ordering lab or x-rays by
giving a handwritten request to a nurse who actually places the order.
Now they have to learn to use computerized physician order entry
(CPOE).

26. Barriers to
Health
Information
Technology
Adoption
 Privacy concerns. The Health Insurance Portability and
AccountabilityAct (HIPAA) of 1996 was created initially for the
portability, privacy and security of personal health information
(PHI) that was largely paper-based. HIPAA regulations were
updated in 2009, and again in 2013, to better cover the electronic
transmission of PHI or (ePHI).
 Legal issues. The Stark andAnti-kickback laws prevent hospital
systems from providing or sharing technology such as computers
and software with referring physicians.
 Behavioral change. Perhaps the most challenging barrier is
behavior. InThe Prince by Machiavelli, it was stated “there is
nothing more difficult to be taken in hand, more unsafe to
conduct, or more uncertain in its success, than to take the lead in
the introduction of a new order of things.”

27. Key Points
 Health informatics focuses on the science of information, as
applied to healthcare and biomedicine
 Health information technology (HIT) holds promise for improving
healthcare quality, reducing costs and expediting the exchange of
information
 Barriers to widespread adoption of HIT include: time, cost, privacy,
change in workflow, legal, behavioral barriers and lack of high
quality studies
 Many new degree and certificate programs are available in health
informatics
 A variety of health informatics resources are available for a wide
audience
 Interoperability and health information exchange is a major
priority of the federal government but is challenged by sustainable
issues.

28. ThankYou!