Dr Ebtissam M. Al-Madi

– Different definitions of Health informatics, medical informatics and Dental informatics
– History of Health and Informatics
– The discipline of Health Informatics
– Scope of Health informatics
– Scope of Dental Informatics
– Uses of health & dental informatics
– Current issues in health informatics

Different definitions of Health informatics, medical informatics and Dental informatics

"Medical informatics is the application of computers, communications and information technology and systems to all fields of medicine - medical care, medical education and medical research .“
– definition by MF Collen (MEDINFO '80,
Tokyo, later extended)

"Medical informatics is a developing body of knowledge and a set of techniques concerning the organizational management of information in support of medical research, education, and patient care.... Medical informatics combines medical science with several technologies and disciplines in the information and computer sciences and provides methodologies by which these can contribute to better use of the medical knowledge base and ultimately to better medical care .“
– Definition by Asso. of American Medical Colleges (AAMC) 1986

• Health informatics , Health care informatics or medical informatics is the intersection of information science , computer science , 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. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health and (bio)medical research.

• patient care, research, and education
• combination of and interface between several disciplines
• not just computers but information in general (eg DA)
• practical goal: to provide better health care

Origin of term "Medical
Informatics"
• Russian = informatika 1968 structure and properties of scientific information
• French = informatique de medecine
1968 university departments established with this title
• English = first appeared in 1970s
Name changed from Medical Information
Science

• Dental informatics is the application of computer and information science to improve dental practice, research, education and management.

• interface among disciplines
• initially: computer science (AI) applied to medicine
• later: biostatistics, DA, economics, cognitive psychology

Appearance of computers in medicine
• 1960s - practical = early use only in departmental research = early ECG and diagnosis
• 1970s - practical = Huge size- administrative & departmental, imaging (CT), early bibliographic retrieval & research
• 1980s - practical = results reporting, outpatient services growth of clinical systems and databases research = Artificial Intelligence,
Information Retrieval
• 1990s - practical = integration, communication research = vocab, interfaces, coding, evaluation
Note how medicine lags computer hardware

Computers have been slow to enter clinical care:
• # hosp with billing, Administrative vs lab
+ clinical, Artificial Intelligence.
• # offices with clinical systems.
• but clinical care is largely the management of info.
• primarily in the background: practice mgmt, libraries, billing, financial

• recent increase of medical informatics
• not new field but marked increase in popularity, funding, publication
• eg 1984 AAMC recommended formation of MI academic units (first done in Europe, esp France, in the
1960s)

• increase in use of technology - more data generated
• mobility of population - need to communicate
• specialization - need to communicate
• managed care systems - need to communicate
• rise in health care costs - attempt to control care
• improved hardware - faster and more memory
• improved methods - acquisition, transfer, retrieval
• reduced computer costs
• increased awareness

Factors in lack of use of computers in clinical care
• involves complex organisms
(unlike physical processes)
• if over-simplify, not useful (vs bank transaction)
• therefore need sophisticated abstraction + detail
• technology for gathering complex info. just emerging, eg low use of QMR or Dxplain therefore providers have not entered info.
• reimbursement has not been linked to clinical info., therefore many admin. systems but few clinical
• health care administered by individuals, small groups
• less need for coordination
• inertia
• fear: "cookbook medicine"
• liability
• ignorance
• money
• security, integrity
• lack of standards
• language
• previous failures
• rapid turnover of technology

• Why need a new discipline?
– often cannot get credit in related fields for work at the interface of related disciplines
– few were championing clinical applications
• Medical informatics as a science
– broad spectrum (theory to practice)
– basic science (knowledge for itself, models)
– experimental science (hypothesis, experiment, analysis)
– applied science, engineering (practical goals)

• Composition of medical informatics groups
– MDs, RNs, dentists, other health care workers
– PhDs, esp computer science (also physics, ...)
– Administrators, policy planners
– Masters, PhD programs in medical informatics
– Industry
– Part-time vs full-time
• Institutional organization
– Division within medicine
– Aspect of computer science
– Inter-disciplinary center
– Department (like biostatistics): relatively unusual in
USA

• Health informatics encompasses all the areas where technology and information contribute to the support of health care delivery, management, planning and research.
• Related to the core areas are themes such as ethics, attitudes learning, coping with third party interactions – all ‘into and utilizing’ health informatics.
• Other research has been identified into content provision, generating an evidence base and knowledge management.

• Information Science:
– is the collection, classification, storage, retrieval, and dissemination of recorded knowledge treated both as a pure and as an applied science.
• Computer science:
– is a discipline that involves the understanding and design of computers and computational processes. Here, the emphasis is not on information, but how it is represented, processed, manipulated, and managed in computing systems.

• Cognitive science:
– is a research area that draws on several fields
(such as psychology, artificial intelligence, linguistics, and philosophy) to develop theories of perception, thinking, and learning.
– Cognitive science relates to information science as we try to understand how information is represented in the human mind.
– Computer science relates to information science as try to simulate our mental processes in computing environments.
– Biomedicine is replete with complex cognitive processes (such as diagnosis, treatment planning, and evaluation).

• Telecommunications:
– Is the science that deals with communication at a distance.
– Transmission of digital images efficiently resulted in new approaches to image compression and transmission .
– Another example is aggregating information from many different sources, such as information about the same patient from different healthcare providers.

Current Issues in Health
Informatics
• Current issues in clinical care
– Cost
– Accessibility of health care
– Coordinating care and setting policy
– Standards of terminology
– Acquisition and retrieval of data (eg across inst.)
– Data Privacy, confidentiality and security
– Acquisition and sharing of knowledge (eg specialist).

Current Issues in Health
Informatics
• Medical informatics research mirrors clinical issues
– Data acquisition
– Data storage - databases, modeling
– Vocabularies - format, content
– Organization of data
– Machine interfaces - standards like HL7, security
– Data retrieval - query languages
– Knowledge acquisition
– Knowledge representation
– Application of knowledge when needed –
– Decision analysis, alerts, diagnosis
– Education
– Care plans and practice guidelines

Current Issues in Health
Informatics
• General research questions in medical informatics
– Knowledge extraction from databases
– Structuring knowledge: impact on acquisition, storage and retrieval
– Linking different classes of knowledge
– Using knowledge to make decisions
– Human factors in computing
– Taxonomy
– Linking disparate systems

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• Thank you
– Dr Ebtissam Al-Madi
– ealmadi@ksu.edu.sa