Chapter 1: Overview of Health
Informatics
Robert Hoyt MD
Elmer V Bernstam MD
William R Hersh MD
Learning Objectives
After reviewing these slides, the viewer should be able to:
∗ State the definition and origin of health informatics
∗ Identify the drivers behind health informatics
∗ Describe the key players involved in health informatics
∗ State the impact of the HITECH Act and Affordable Care Act
on health informatics in the United States
∗ List the barriers to health information technology (HIT)
adoption
∗ Describe educational and career opportunities in health
informatics
Introduction
∗ With the advent of the internet, high speed
computers, voice recognition, mobile technology, etc.
healthcare professionals today have many more tools
at their disposal
∗ But, technology is advancing faster than healthcare
professionals can assimilate it into practice
∗ Therefore, there is a new need for education and
translation of emerging technologies and the
data/information they generate into healthcare
Information Hierarchy
∗ There are lots of data but less
information, knowledge and
wisdom. Information is data
with meaning, e.g., the number
10 could be anything but a
prostate specific antigen (PSA)
of 10 is important information.
Humans provide knowledge and
wisdom
Sources of Healthcare Data
∗ The advent of electronic health
records (EHRs) and multiple
other healthcare information
systems provided the ability
and the need to collate and
analyze large amounts of data
to improve health and financial
decisions.
∗ As genetic information
collection grows, datasets are
huge (big data) and part of
EHRs
Mining the Data
∗ All large healthcare
organizations will collect
and analyze a variety of
clinical, financial and
administrative data to
make wise clinical and
business decisions
∗ Therefore, data analytics
is very important
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
∗ In reality, it is more about applying information in the healthcare field
than it is about technology
∗ Technology can generate, transport and analyze useful healthcare
data
∗ “Technology is the transportation, not the destination”
Dr. Safran
Definitions
∗ Health informatics is also known as clinical informatics,
medical informatics and biomedical informatics leading to
confusion
∗ The most inclusive term is biomedical informatics because
it encompasses bioinformatics as well as medical, dental,
nursing, public health, pharmacy, medical imaging and
veterinary informatics
∗ Bioinformatics is concerned with biological data,
particularly DNA and genomic information
American Medical Informatics
Association Perspective
www.amia.org
©AMIA 2013
Other Definitions
∗ Health information technology (HIT or health IT) is
defined as the application of computers and technology
in healthcare settings
∗ 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 (HIPAA) and legal implications of
electronic data
Background
∗ Healthcare has been slow to adopt technology,
compared to other industries such as banking
∗ Health informatics emphasizes information brokerage;
the sharing of a variety of information back and forth
between people and healthcare entities
∗ Informaticians (or informaticists) harness the power
of information technology to expedite the transfer
and analysis of data, leading to improved efficiencies
and knowledge
Background
∗ Informatics training must be expansive to include IT
knowledge about networks and systems, usability,
process re-engineering, workflow analysis and
redesign, quality improvement, project management,
leadership, teamwork, implementation and training
∗ Many of the newest technologies are interrelated
such as EHRs, patient portals, mobile technology,
telemedicine, etc.
Driving Forces Behind Health
Informatics
∗ Increase healthcare efficiency and productivity
∗ Improve healthcare quality (patient outcomes) resulting in
improved patient safety
∗ Reduce healthcare costs
∗ Improve healthcare access with technologies such as
telemedicine and online scheduling
∗ Improve coordination and continuity of care
∗ Improve medical education of clinicians and patients
∗ Standardize medical care
Technology Freight Train
∗ Technological innovations appear at a startling pace as
stated by Moore’s Law:
“the number of transistors on a chip will double approximately
every two years.” Gordon Moore, co-founder Intel Corporation
1965
∗ The healthcare field is also subject to “disruptive
innovations (technologies)” which are innovations that
just appear and soon take over mainstream
technologies, e.g., smartphones, LED lights & solid state
hard drives
Avalanche of Healthcare Data
∗ HealthData.gov makes federal datasets available to
healthcare organizations, developers and researchers
∗ Datasets are available in categories: health, state,
national, Medicare, hospital, quality, community and
inpatient
∗ Users can use filters: data type, subject, agency, date
updated, coverage period, collection frequency,
geographic area, release date and output format
Healthdata.gov
∗ Community Health Status ∗ Fourth National Survey of
Indicators Older Americans
∗ Child Growth Charts ∗ Health Indicators
∗ Health Data Interactive Warehouse
∗ Behavioral Risk Factor ∗ Population (census) (CDC)
Surveillance System (CDC) ∗ Cancer Profiles
∗ Births (CDC) ∗ Archimedes data modeling
∗ Mortality (CDC) and analytics tool
Historical Highlights
∗ Computers: the first general purpose computer
(ENIAC)(1946) required 1,000 sq. ft. of floor space
∗ Term “medical informatics” appeared in the 1960s
∗ Computer technologies and early EHRs appeared in 1970s
at the VA and Massachusetts General Hospital
∗ MEDLINE reorganized medical literature searches (1960s)
∗ Artificial intelligence in medicine appeared in 1970s
∗ Internet appeared in 1969 as Defense project; World Wide
Web in about 1990
Historical Highlights
∗ Mobile technology. The PalmPilot PDA appeared in
1996 as the first truly popular handheld computing
device, but rapidly evolved to the smartphone
∗ Human Genome Project. Complete human genome
sequencing was finished in 2003. Now comes the hard
part, making sense of the huge datasets
∗ Data from large databases will likely change the way
we practice medicine in the future
Key Players Involved with HIT
∗ Physicians and nurses ∗ Public health
∗ Patients ∗ HIT vendors
∗ Hospitals and healthcare ∗ Insurance companies
organizations ∗ Federal and state
∗ Support staff governments
∗ Medical educators ∗ Medical research
Organizations Involved with HIT
∗ Institute of Medicine ∗ HHS (cont.)
∗ Department of Health and ∗ Centers for Medicare and
Medicaid (CMS)
Human Services (HHS)
∗ Centers for Disease Control
∗ Office of the National and Prevention (CDC)
Coordinator (ONC)
∗ Health Resources and Services
∗ Agency for Healthcare Administration (HRSA)
Research and Quality ∗ National Institute of Standards
(AHRQ)
and Technology (NIST)
* Academic
* Federal government
Institute of Medicine (IOM)
∗ Evaluates policy relevant to healthcare and provides
feedback to the Federal Government and the public
∗ In their two pioneering books To Err is Human (1999) and
Crossing the Quality Chasm (2001), they reported
approximately 98,000 deaths occur yearly in the US due to
medical errors. It is their belief that adopting health
information technology will help promote “safe, effective,
patient centered, timely, efficient and equitable medical
care”
∗ They recommended 12 types of HIT that would help move
healthcare into the 21st Century
US Federal Government
∗ American Recovery and Reinvestment Act (ARRA) 2009
∗ ARRA had five broad goals: (a) improve medical quality,
patient safety, healthcare efficiency and reduce health
disparities; (b) engage patients and families; (c) improve
care coordination; (d) ensure adequate privacy and
security of personal health information; (e) improve
population and public health
∗ From ARRA came the Health Information Technology for
Economic and Clinical Health Act (HITECH)
US Federal Government
∗ The HITECH Act included financial support for:
∗ Reimbursement for use of certified EHRs
∗ State health information exchange
∗ Comparative effectiveness research
∗ 62 Regional Extension Centers to support HIT
∗ Health Informatics curricula at the community college and
university level
∗ Beacon Communities to highlight and share “best HIT
practices”
∗ Other less well-known programs
US Federal Government
∗ The Patient Protection and Affordable Care Act of 2010
∗ Expanded Medicaid coverage for the uninsured
∗ Created the Patient Centered Outcomes Research Initiative
(PCORI)
∗ Created the CMS Innovation Center that will evaluate new
healthcare delivery models
∗ Created a Readmission Reduction Program that will penalize
hospitals with too many readmissions
∗ Other less well-publicized programs
Office of the National Coordinator for
Health Information Technology
(ONC)
∗ Reports directly to Secretary of HHS. Strategic Plan (2015-
2020):
∗ Goal 1: Advance person-centered and self-managed health
∗ Goal 2: Transform healthcare delivery and community health
∗ Goal 3: Foster research, scientific knowledge and innovation
∗ Goal 4: Enhance nation’s health IT and infrastructure
∗ ONC established in 2015 the Health Information
Technology Advisory Committee (HITAC)
Agency for Healthcare Research and
Quality
∗ Charged with improving the quality, safety, efficiency,
and effectiveness of health care for all Americans
∗ Supports medical research to include health IT
∗ They support and maintain:
∗ HIT Knowledge Library
∗ National Resource Center for HIT
∗ HIT Portfolio Program to study HIT impact
∗ Multiple other related programs at
http://healthit.ahrq.gov/health-it-tools-and-resources
Centers for Medicare and Medicaid
Services (CMS)
∗ An insurer for about 100 million Americans
∗ CMS reimburses for “meaningful use” of certified EHRs
by clinicians and hospitals under Medicare or Medicaid
∗ As of April 2014 they have paid out about $22 billion to
clinicians and hospitals as part of the HITECH Act
meaningful use program
∗ They have a CMS Data Navigator that provides
healthcare data from over 300 federal sources
Centers for Disease Control and
Prevention (CDC)
∗ They support the Public Health Information Network
∗ They use HIT to improve and maintain public health
using a variety of surveillance programs
∗ They have a Data and Statistics section and a Health
Data Interactive program
∗ They have a variety of HIT-related projects, such as
text messaging health education to patients
International Health Informatics
∗ The United States is not unique. Other developed and
developing countries share the same concern about the
rise in chronic diseases, such as diabetes, and the high
price tag generated
∗ Most countries have implemented electronic health
records and other technologies in a hope to better track
chronic diseases. Paper charts are grossly inadequate
for public or population health
∗ Most countries are teaching Health Informatics
Barriers to HIT Adoption
∗ Not enough time
∗ Not enough expertise, as few have formal training in
informatics
∗ Not enough financial resources
∗ Lack of interoperability between technologies
∗ Inadequate cost and return on investment data
∗ Privacy concerns
∗ New legal concerns: who owns the electronic data?
∗ Need for behavioral changes: about 50% of staff will be slow
to adopt any new changes
Barriers to HIT Adoption
∗ Hype versus Fact: there have been many overly
optimistic predictions by vendors, academicians, the
government and early adopters that HIT will
revolutionize healthcare
∗ While we are still early in the game, the reviews are
mixed whether adoption today has improved quality,
safety or reduced medical costs
∗ The most recent review by the RAND Corp. in 2014
was positive about HIT, but was funded by ONC
Health Informatics Programs
∗ Sharp rise in Health Informatics courses offered over
the past 5-10 years; assisted by the HITECH Act
∗ Most common degree is a Masters level but PhD,
associate, undergraduate and certificate programs
are widely available
∗ Many programs are completely online
∗ The AMIA.org web site hosts a majority of the
available HI programs with a search engine and filters
American Medical Informatics
Association (AMIA)
∗ Founded in 1989 and now has about 5000 members
∗ Largely represents physicians and researchers involved
with the biomedical sciences
∗ They have about 20 working groups that focus of all
aspects of Health Informatics
∗ Membership includes subscription to the Journal of
the American Medical Informatics Association (JAMIA)
and Applied Clinical Informatics (ACI)
Health Information and Management
Systems Society (HIMSS)
∗ They have 50,000 individual and 570 corporate members
∗ Provides multimedia educational material
∗ Maintains a Health IT Body of Knowledge resource site
∗ Annual meeting attracts over 40,000 attendees and 1,000
vendors in exhibition hall
∗ The have a separate HIMSS Analytics section
American Health Information
Management Association (AHIMA)
∗ Founded in 1928 primarily for paper-based medical
record librarians
∗ In 2016 they had 103,000 members
∗ They focus on coding, health information
management, privacy and analysis
∗ With the advent of electronic health records, their
role has been expanded
∗ They maintain an HIT resource library
Health Informatics Careers
∗ Job postings have tripled since 2009 largely due to
widespread adoption of EHRs and the necessary skill set
for implementation, project management, workflow
redesign, training, etc.
∗ In reality what most HIT vendors and healthcare
organizations are looking for individuals with good IT and
clinical skills and involvement in IT projects. In other
words, someone ready to hit the ground running
∗ Job sites can be found on the AMIA, HIMSS, AHIMA and
the HealthInformaticsForum.org web sites
Nurse Informaticians
∗ There are about 3 million nurses in the US (2016 Bureau of
Labor) so a large labor pool for an informatics education
∗ Multiple nursing programs in the US offer a nursing
informatics program with certification
∗ There has been a certification program for nurse
informaticians available since 1995 and in 2016 there were
2040 certified nurse informaticians (ANCC 2016 data)
∗ Nurses are extremely valuable given their clinical experience
and exposure to quality and project management as part of
the nursing experience
Chief Medical Informatics Officer
∗ Usually a physician or nurse who reports to the CIO, or CEO
∗ CMIOs are less technology oriented and more tasked to help
implement newer technologies and gain staff acceptance
∗ The are therefore involved with training and adoption
strategies, as well as the development of a variety of policies
to include privacy/security
∗ Most have a Master’s degree in an information science and
often are Certified Professional in Health Information
Management Systems (CPHIMS)
Clinician Informatician
∗ Smaller organizations may have a “go to” nurse or physician
who is an early adopter and has much more IT experience; a
clinician informatician
∗ In 2013 physicians could become board certified in Clinical
Informatics for the first time. Details are on the AMIA web
site
∗ AMIA is working on an Advanced Interprofessional
Informatics Certification that non-physicians can attain and
be similar to board certification in Clinical Informatics
Health Informatics Resources
∗ Resources Listed in the Textbook:
∗ Books
∗ Journals
∗ E-journals
∗ E-newsletters
∗ Blogs
Conclusions
∗ Health Informatics is a relatively new and exciting field
with many new educational and job opportunities
∗ Research in health informatics is being published at an
increasing rate so hopefully new approaches and tools
will be evaluated more often and more objectively.
∗ Although technology holds great promise, it is not the
solution for every problem facing medicine today. We
must continue to focus on improved patient care as the
single most important goal of this new field.
