Basic concepts of medical informatics

Medical informatics is the study and application of methods to improve the

management of patient data, clinical knowledge, population data, and other
information relevant to patient care and community health. It is a young science,
which emerged in the decades after the invention of the digital computer in the 1940s.
Mechanical computing in medicine had a much earlier origin, in the 19th century,
with Herman Hollerith’s “punched-card data-processing system” originally used for
the US census and subsequently developed to support surveys in public health and
epidemiology. This example reflects the multidisciplinary nature of medical
informatics, which interacts with various fields, including the clinical sciences, the
public health sciences (for example, epidemiology and health services research) as
well as cognitive, computing, and information sciences.
Healthcare informatics combines the fields of information technology and
health to develop the systems required to administer the expansion of information,
advance clinical work flow, and improve the security of the healthcare system. It
involves the integration of information science, computer technology, and medicine
to collect, organize, and secure information systems and health–related data. The
extraordinary explosion of medical knowledge, technologies, and ground-breaking
drugs may vastly improve healthcare delivery to consumers, and keeping the
information related to these advancements organized and accessible is key.
Healthcare informatics utilizes computer hardware, specialized software, and
communication devices to form complex computer networks to collect, analyze, and
transmit medical processes. The tools for creating health information systems are not
limited just to information technology. These systems should also allow for the
assimilation of clinical directives, understanding of formal medical jargon, storage of
data, and transmission of clear communication. Medical informatics can be applied in
all types of health environments, including primary care, general practice, hospital
care, and rehabilitation. It is also inclusive of many of the specialties within the
healthcare field.
 Information systems may used to create greater operating efficiencies in three
basic functions of healthcare: clinical, administrative, and financial. For example,
healthcare informatics is pivotal in the movement to cut costs and enhance patient
care by implementing a standardized system for electronic medical records. It is also
a key to expanding the development health information systems for billing, clinical
research, client scheduling, and the exchange of medical information.
Physicians can avail themselves of the growing knowledge base and make
better decisions bolstered by computer software called clinical decision support
systems (CDSS). Other computer systems, called electronic prescribing systems,
eliminate the need for hand-written prescriptions and minimize errors. Informatics
also allow for data mining to determine the effectiveness of drugs. This may reduce
the cost of treatments, lessen mistakes, and help further advancements in the quality
of care.
One of the major objectives of healthcare informatics is to formulate a standard
approach for healthcare internationally. The idea is for researchers, providers, and
patients to benefit from the informatics tools, techniques, concepts, and protocols that
transform healthcare delivery, and to promote best practices in the healthcare field.
As a result of evolving and complex legal issues related to information technology
and health-related fields, healthcare informatics is also important in health law as it
relates to ethical, operational, and privacy concerns.
Many experts agree that one of the main challenges of healthcare informatics is
to get medical providers committed to the widespread implementation of the various
information technology components. Healthcare informatics may not only create a
seamless and comprehensive healthcare system, but can assist industry professionals
to solve problems, make decisions, and provide better customer service. It may help
professionals process multiple functions that will enable them to perform their duties
more effectively and efficiently.
 Biomedical and Health Informatics

While various perspectives of informatics and its application to health care

have been published, two have been chosen for review and discussion because of
their significance within the field.
The first definition comes from the American Medical Informatics Association
or AMIA. AMIA is a non-profit organization dedicated to the development and
application of medical informatics in the support of patient care, teaching, research,
and health administration. They are seen as the prominent informatics organization in
the US.
According to their Web site, “AMIA is the professional home for biomedical
and health informatics. For over thirty years the members of AMIA and its honorific
college, the American College of Medical Informatics (ACMI), have sponsored
meetings, education, policy and research programs. The federal government
frequently calls upon AMIA as a source of informed, unbiased opinions on policy
issues relating to the national health information infrastructure, uses and protection of
personal health information, and public health considerations, among others.”
AMIA’s definition therefore is essential to understand. Accordingly, “Biomedical and
health informatics has to do with all aspects of understanding and promoting the
effective organization, analysis, management, and use of information in health care.
While the field of biomedical and health informatics shares the general scope
of these interests with some other health care specialties an disciplines, biomedical
and health informatics has developed its own areas of emphasis and approaches that
have set it apart from other disciplines and specialties.”
 Biomedical Informatics

The second definition comes from another highly respected source for
biomedical informatics material, the textbook Biomedical informatics: computer
applications in health care and biomedicine. Shortliffe defines biomedical
informatics as “”the scientific field that deals with biomedical information, data, and
knowledge – their storage, retrieval, and optimal use for problem solving and
decision making.” As a field of study, Shorliffe states biomedical informatics is
“concerned with the broad range of issues in the management and use of biomedical
information, including biomedical computing and the study and nature of biomedical
information itself.”
The chapter The computer meets medicine and biology: the emergence of a
discipline, from the textbook Biomedical informatics: computer applications in
health care and biomedicine edited by Edward Shortliffe with James Cimino as
associate editor contains a description of biomedical informatics which is represented
by the diagram shown above.
 Informatics is viewed as four subfields, public health informatics, clinical
informatics, imaging informatics, and bioinformatics each with a specific focus as
represented by the left hand side. The right hand side lists the component sciences in
biomedical informatics which includes computer science, clinical science, basic
biomedical science, cognitive science, bioengineering, management science,
epidemiology, and statistics.
To begin, Shortliffe defines biomedical informatics as “the scientific field that
deals with biomedical information, data, and knowledge – their storage, retrieval, and
optimal use for problem solving and decision making.”
As a field of study, Shorliffe states biomedical informatics is “concerned with
the broad range of issues in the management and use of biomedical information,
including biomedical computing and the study and nature of biomedical information
itself.”

Biomedical informatics encompasses public health, clinical, and imaging

informatics as well as the biological and biomolecular informatics domains.
 Some examples of a biomedical informatics application drawn from a brochure
published by the University of Medicine & Dentistry of New Jersey include:
 Reducing diagnostic uncertainties and improving clinical decision-making
by using computing techniques and information technologies.
 Utilizing computational approaches and modern computer-based techniques
in drug design, molecular genetics and cellular genetics to solve complex clinical
problems.
 Designing large databases of digitized medical images for use in medical
decision-making, teleradiology, or teleconsultation.
These four subfields, public health informatics, clinical informatics, imaging
informatics, and bioinformatics where the informatics applications are geared toward
a specific area such as the individual in the case of clinical informatics.
The following sections provide additional information for each subfield.

Public Health Informatics

The first informatics segment is public health informatics. As defined in the

textbook Biomedical informatics: computer applications in health care and
biomedicine, public health informatics is an application area of biomedical
informatics in which the field’s methods and techniques are applied to problems
drawn from the domain of public health.
Public health informatics is population- and society-focused.
Examples of public health informatics applications include:
 National Notifiable Disease Surveillance System
o The National Electronic Telecommunications System for Surveillance
(NETSS)
 Immunization registries
o Immunization information systems
 Homeland Security
o Bioterrorism

Clinical Informatics

The second informatics segment is clinical informatics. As defined in the

textbook Biomedical informatics: computer applications in health care and
biomedicine, clinical informatics is the application of biomedical informatics in the
patient care domain. It is a combination of computer science, information science,
and clinical science designed to assist in the management and processing of clinical
data, information, and knowledge to support clinical practice.
Clinical informatics is individual (patient-oriented) focused.
An example of clinical informatics applications would be the electronic
medical record.

Imaging Informatics

The third informatics segment is imaging informatics. As defined in the

textbook Biomedical informatics: computer applications in health care and
biomedicine, imaging informatics is concerned with the common issues that arise in
all image modalities, relating to the acquisition of image in, or conversion to, digital
form, and the analysis, manipulation, and use of those images once they are in digital
form.
Imaging informatics is tissues- and organs-focused.
An example of imaging informatics applications is a CT scanner, which uses
software algorithms to recreate a three-dimensional image of the body parts. Another
example are Picture Archiving and Communication Systems (PACS) which are a
combination of hardware and software dedicated to the short- and long-term storage,
retrieval, management, distribution, and presentation of images.

Biomedical Informatics

The final informatics segment is bioinformatics. As defined in the textbook

Biomedical informatics: computer applications in health care and biomedicine,
bioinformatics is the study of how information is represented and transmitted in
biological systems, starting at the molecular level.
Bioinformatics is molecular and cellular processes focused.
An example of bioinformatics applications is genomic sequencing.
 Biomedical Informatics

Having covered the subdiciplines of biomedical informatics, Shortliffe

addresses the component sciences that biomedical informatics draws on and
contributes to. These include computer science, clinical science, basic biomedical
science, cognitive science, bioengineering, management science, epidemiology, and
statistics.
Following are some brief definitions of each. All are from Answers.com
 Computer science: The study of computation and computer technology,
hardware, and software.
 Clinical science: the practical study of medical principles or
investigations using controlled procedures to evaluate results.
 Biomedical science: the application of information technology to the
fields of biomedical research and health care.
  Cognitive science: The study of the nature of various mental tasks and
the processes that enable them to be performed.
 Bioengineering: The application of engineering principles to the fields of
biology and medicine, as in the development of aids or replacements for defective or
missing body organ.
 Management science: school of management emphasizing the use of
mathematics and statistics as an aid in resolving production and operations problems.
 Epidemiology & Statistics: the branch of medical science dealing with
the transmission and control of disease and the mathematics of the collection,
organization, and interpretation of numerical data, especially the analysis of
population characteristics by inference from sampling.

Course outcomes

The outcomes for this course are to enable you to gain:

– An understanding of the basic informatics principles.
– Knowledge on how to structure, record and model clinical data in a form
appropriate for the clinical task, for communication with colleagues, or for
communication with computer application developers.
– Essential information skills and ability to use information technology to
access, assess, select and apply available information.
– Knowledge of some existing computerized systems in health care and how
they improve health care delivery.
– An understanding of the advantages, capabilities and limitations of
information technologies when applied to health.
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