Department of Medical Informatics and Medical Education
4th MB Informatics Course
Handout 1: What is Medical Informatics?
Medical informatics is located at the intersection of information technology and the
different disciplines of medicine and health care. Medical informatics has both
distinctly applied features and more fundamental characteristics. Just as medicine
itself is multidisciplinary, so is medical informatics. The main reason for this
convergence of disciplines is that, in principle, medical informatics deals with the
whole field of medicine and health care. Blois(1) summarized the heterogeneity of
medical science quite eloquently and related the multidisciplinary nature of medicine
directly to the basis of medical informatics:
It is sometimes asserted that medical science is no different than any
other science. I would strongly disagree with this view; medical
science (human biology) in its describing, reasoning, explaining, and
predicting, necessarily draws upon a number of lower-level sciences,
while physics, for example, does not. This obvious state of affairs (that
medicine rests upon a hierarchy of natural sciences) has profound
consequences. Because medicine derives its experimental content from
a set of sciences (including both "hard" and "soft" sciences), the
processing of the observational data of medicine faces a number of
problems. This is one of the reasons why there is a "medical'
information science, and why there is not a "physics" information
science.
The health care process is very different from medical science. The former is more
related to the art of medicine, whereas the latter is closely connected to the academic
aspects and the basic disciplines of medicine. A synonym for art is, for instance, skill.
Science is related to knowledge, as expressed by Webster's Dictionary:
Science is accumulated and accepted knowledge that has been
systematized and formulated with reference to the discovery of general
truths or the operation of general laws.
Specialization can be accomplished in both art and science. The more specialized
one's health care (the art of practicing health care), the more detailed must be one's
medical knowledge (the science of medicine). What is the origin and the nature of the
scientific knowledge that lies at the root of health care? How and where is that
knowledge acquired? The latter appears to happen in two different locations:
1. in the medical research laboratory and
2. in clinical practice.
From the foregoing we may conclude the following: Scientific research in medical
informatics is multidisciplinary because
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we deal with medicine and health care as a whole, and
it is done by investigators who come from different scientific disciplines.
Research in medical informatics aims not only at the incorporation of
Department of Medical Informatics and Medical Education
4th MB Informatics Course
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knowledge from the natural sciences, but also of
special knowledge or clinical experience.
Finally, research in medical informatics must deal with the normative aspects of our
knowledge.
It is appropriate to ask whether medical informatics has a research domain of its own
and a specific methodology or whether it borrows its methods from other disciplines
and just applies these methods to medicine and health care. Is medical informatics, for
instance, different from statistics or epidemiology? Are the methods of medical
informatics different from those of computer science or physics? Furthermore, if in
medical informatics we deal with the whole of medicine and health care, in what
respect are its methods different from those that are used in medicine and health care?
In addition, how should we reckon with ethical aspects in applying the results from
medical informatics research?
We may state that if medical informatics is a science, then some of the following
properties should be applicable:
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It contains a domain where a theory is developed.
It is not merely applied science.
It is not solely determined by technology.
Models are developed to illustrate and prove theories.
Problems are solved in a methodical way, following scientific principles of
abstraction and generalization.
The domain of medical informatics is determined by the intersection of the terms
"medicine" and "informatics" (or "health" and "information") The first term indicates
the area of research, the second one its methodology. Medical informatics has both
applied and theoretical aspects; models are developed both in applications and in
theoretical activities. As in all science, in medical informatics research we strive for
the collection of generally applicable knowledge, so that we may use it within a
particular domain: health care.
In summary:
In medical informatics we develop and assess methods and systems for the
acquisition, processing, and interpretation of patient data with the help of knowledge
that is obtained in scientific research.
Computers are the vehicles used to realize these goals. In medical informatics, we
deal with the entire domain of medicine and health care, from computer-based patient
records to image processing and from primary care practices to hospitals and regions
of health care. Some areas of the field are relatively fundamental; others have an
applied character. The challenge in developing methods and systems in medical
informatics is that once the systems have been made operational for one medical
specialty, they can also be transferred to some other specialty.
Related to the two types of knowledge, medical treatment consists of indisputable
conclusions on the one hand and responsible decisions on the other. The conclusions
Department of Medical Informatics and Medical Education
4th MB Informatics Course
are, within the domain and the limitations of scientific a prioris, absolute and
objective in nature. At the same time, they are of limited scope, since they are based
on the application of scientific research. Although the final diagnostic decision is
based on such conclusions, it is still oriented toward the individual patient and his or
her personal circumstances and expectations. The final decision is, for all that, not
absolute, but is made in freedom and under the responsibility of the treating clinician
(and, it is hoped, in agreement with the patient). The decision also takes into account
those aspects of patient care that cannot be formalized. Therefore, the final decision
regarding the therapy to be selected requires experience and insight, but it also has
ethical and legal aspects and foremost should be a wise decision. These last qualities
are unsuitable for formalization, let alone fit for delegation to a computer.
In conclusion:
Medical informatics is both an Art and a Science.
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Science: where methods are conceived and experimentally validated by means
of computer models and formalisms.
Art: where computer processing systems are built and assessed.
Research in medical informatics is multidisciplinary and follows scientific methods;
applications have a technological foundation.
Research and applications in medical informatics should take into account the
responsibilities of investigators and users.
Several definitions of medical informatics (medical information science, health
informatics) have been given. Some of these take into account both the scientific and
the applied sides of the field; other definitions are more pragmatic. We cite only two
definitions:
1
Blois MS. Information and Medicine: The Nature of Medical Descriptions. Berkeley, CA: Univ of
California Press, 1984
This handout is taken from A Handbook of Medical Informatics by Von Bemmel
The handbook is available at the following URL:
http://www.mieur.nl/mihandbook/r_3_3/handbook/home.htm