Chapter seven

Health Informatics Terminologies

 Lesson objectives
At the end of this lesson students should:
• Define health informatics
• Understand terminologies like computer science,
information science and information technology
• Know the sub domains of health informatics
• Recognize the activities of public health informatics
• Define compare data and information
• Understand the information pyramid
• Know the type of information needed by different level of
management in an organization
• In 1957 the German computer scientist Karl
Steinbuch coined the word Informatik by publishing a
paper called Informatik: "Informatics: Automatic
Information Processing"
 Definitions
• Informatics is the science of information, the practice
of information processing, and the engineering
of information systems. (Wikipedia)

• Informatics - the sciences concerned with gathering,

manipulating, storing, retrieving, and classifying recorded
information.

• Informatics - the application of information technologies

to optimize the information management function within
an organization.
 HI
• How does it differ from
> Information Technology?
> Information Science?
> Computer Science?
 Information Technology
• “is the study, design, development,
implementation, support or management of
computer-based information systems,
particularly software applications and computer
hardware’’
 Information Science
• “is an interdisciplinary science primarily
concerned with the analysis, collection,
classification, manipulation, storage, retrieval
and dissemination of information”
(Merriam-Webster and American Heritage Dictionary)
 Computer Science
• “is the study of the theoretical foundations of
information and computation and of practical
techniques for their implementation and
application in computer systems”
(Denning et al., 1989)
Information System
• Is any combination of information technology
and people's activities using that technology to
support operations, management, and decision
making
– In a broad sense, refers to the interaction between
people, algorithmic processes, data and technology
– In a narrow sense, refers to the specific application
software that is used to store data records in a
computer system and automate activities
 Information management
• Assuring that the right information is available to
the right people, within and outside an organization,
at the right time and place, and with Affordable
price.
 Health Informatics
Health informatics, Health care informatics is the intersection
of information science, computer science, and health care.

It deals with the resources, devices, and methods required to

optimize the in putting , 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.
 Sub-domains of health informatics
• Clinical informatics
• Nursing informatics
• Imaging informatics
• Consumer health informatics
• Public health informatics
• Dental informatics
• Clinical research informatics
• Translational research informatics
• Bioinformatics
• Veterinary informatics
• Pharmacy informatics
• Healthcare management informatics, etc…
 Public health informatics
• Public health informatics is the systematic
application of information and computer
science and technology to public health
practice, research and learning.(wikipedia)
Activities may include
• Collection and storage of vital statistics
• Collection and reporting of communicable diseases
• Disease surveillance
• Display disease statistics and trends
• Immunization
• Hospital statistics, etc…
 Clinical Informatics
• Use of information in health care by clinicians
• Clinical informaticians use their knowledge of patient care
combined with their understanding of informatics concepts,
methods, and health informatics tools to:
– Assess information and knowledge needs of health care
professionals and patients
– Develop, implement, and refine clinical decision support systems
– Develop health informatics tools which promote patient care that
is safe, efficient, effective, timely, patient-centered, and equitable
(Gardner RM, Overhage JM, Steen EB, et al., 2009)
 Medical Informatics
• “Medical Informatics is the branch of science
concerned with the use of computers and
communication technology to acquire, store,
analyze, communicate, and display medical
information and knowledge to facilitate
understanding and improve the accuracy,
timeliness, and reliability of decision making”
(Warner, Sorenson and Bouhaddou, 1997)
 Nursing Informatics
• “a combination of computer science,
information science, and nursing science
designed to assist in the management and
processing of nursing data, information, and
knowledge to support nursing practice,
education, research, and administration“
(Graves & Corcoran, 1989)
 Bioinformatics
• The scientific field that deals with biomedical information,
data, and knowledge – their storage, retrieval, and optimal
use for problem solving and decision making. (Shortliffe, 2006)
• Common activities in bioinformatics include:
– Mapping and analyzing DNA and protein sequences
– Aligning different DNA and protein sequences to
compare them and
– Creating and viewing 3-D models of protein
structures
 Imaging Informatics
• Also called Radiology Informatics or Medical
Imaging Informatics
• It is devoted to the study of how information
about and contained within medical images is
retrieved, analyzed, enhanced, and exchanged
throughout the medical enterprise
(Branstetter, 2007)
 Pharmacy Informatics
• Is a sub-discipline of Health Informatics that
deals with the integration of information
technology and its applications into the
pharmaceutical practice
(University of Illinois at Chicago, 2009)
• Focuses on leveraging technology systems to
ensure optimal patient safety, compliance, and
health outcomes
– Medication selection
– Use and
–
 Dental Informatics
• Is the application of computer and information science to
improve dental practice, research, and program administration.
• Dental Informatics improves patient care by improving efficiency
and effectiveness in different areas of a common dental practice.
• These areas can include administration, clinical care, charting
records, and patient education.
• Similar to how doctors and hospitals have begun using electronic
medical records (EMRs), dentists have begun developing
electronic dental records (EDRs). EDRs will allow dentists to
interact with 3D models of a patient's teeth.

(Eisner 1992)
 Veterinary Informatics
• “Is the discipline concerned with the applications of
information science, engineering, and computer
technology to support veterinary teaching, research, and
practice”
• Many health technologies for humans are utilized in
veterinary science; in fact most of them work the same
way they work in a traditional health facility.
• Veterinary clinics make uses of electronic medical
records and computerized billing and scheduling systems.
(Association for Veterinary Informatics)
 Consumer Health Informatics
• “the branch of medical informatics that analyses consumers’
needs for information; studies and implements methods of
making information accessible to consumers; and models and
integrates consumers’ preferences into medical information
systems” (Eysenbach, 2000)

– A subspecialty of medical informatics

– Studies from a patient/consumer perspective the use
of electronic information
– Focuses on patients as the primary users of health
information
 eHealth
• eHealth is also written “e-health”

• “is defined as the use of emerging interactive technologies (e.g.,

Internet, CD-ROMs, personal digital assistants, interactive
television and voice response systems, computer kiosks, and
mobile computing) to enable health improvement and health
care services”
(Ahern et al., 2006)
 Electronic Medical Records (EMR)
• “A longitudinal collection of electronic health
information for and about persons
• Immediate Electronic access to person- and
population-level information by authorized
users
• Provision of knowledge and decision-support
systems [that enhance the quality, safety, and
efficiency of patient care] and
• Support for efficient processes for health care
delivery" (IOM, 2003)
 mHealth
• “…the provision of health-related services via
mobile communications”
(Vital Wave Consulting, 2009)

• mHealth applications include:

– the use of mobile devices in collecting
community and clinical health data
– delivery of healthcare information to
practitioners, researchers, and patients
– real-time monitoring of patient vital signs and
direct provision of care (via mobile telemedicine)
 Telemedicine
• “the use of electronic signals to transfer medical data
from one site to another via the internet, telephones,
PCs, satellites, or videoconferencing equipment in
order to improve access to health care”
(Brown, 1996)
• telemedicine can be
– As simple as two doctors talking about a patient through the
telephone or
– As complex as a sophisticated global hospital enterprise
network that supports real-time remote surgical operations
 Different Types of Telemedicine
• Telesurgery: the ability for a doctor to perform surgery on
a patient even though they are not physically in the same
location
(Wikipedia)
• Teleradiology: the transmission of radiological patient
images, such as x-rays, CTs, and MRIs, from one location to
another for the purposes of interpretation and/or
consultation
• Telecare: The use of telecommunication systems to provide
remote assistance in therapy to patients (Mantas &
Hasman, 2002)
 Different types of telemedicine
TeleHealth
• The delivery of health-related services and
information via telecommunications technologies
• Could be:
– As simple as two health professionals discussing a
case over the telephone, or
– As sophisticated as using videoconferencing between
providers at facilities in two countries, or
as complex as robotic technology
 This is health informatics!

Bioinformatics
1. Biological structure informatics
2. Computational biology
3. Expression profiling and microarrays
Imaging and Signal Organizational Issues
4. Genomic ontologies
5. Genomics
6. Linking the genotype and phenotype
Analysis 66. Careflow management systems
67. Care delivery systems
68. Cooperative design and development
7. Neuroinformatics 36. Image processing and transmission
8. Pharmacogenomics 69. Economics of care
37. Image recognition, registration, and segmentation methods 70. Ethical and legal issues
9. Proteomics 38. Imaging and signal standards 71. Health services evaluation: performance and quality
39. Knowledge representation and ontologies for imaging 72. Organizational impact of information systems

Clinical Informatics 40. Model-based imaging 73. Quality assessment and improvement
74. System implementation and management issues
41. Signal processing and transmission 75. Technology assessment
10. Barriers to clinical system implementation 42. Virtual reality and active vision methods and applications
11. Clinical systems in ambulatory care

Innovative Technologies Patient Record

12. Clinical systems in high intensity care
13. Careflow and process improvement systems
14. Disease management 76. Cryptography, database security, and anonymization
15. E-health and clinical communication
16. Evaluation of health information systems
17. Health data warehousing in Health Care
43. Computer-communication infrastructures
77. Database access and delivery
78. Database design and construction
79. Data standards and enterprise data sharing
18. Health information systems 80. Patient record management
19. Integrated health and financial systems 44. Internet applications 81. Privacy, confidentiality, and information protection
45. Mobile computing and communication 82. Standard medical vocabularies
46. Portable patient records
Education and Training
83. Standards for coding
47. Security and data protection 84. Standards for data transfer
48. Software agents and distributed systems
20. Computer-assisted medical education 49. Telemedicine
21. Consumer health information
22. E-learning or distance learning
50. Virtual reality
51. Wireless applications and handheld devices
Knowledge Management
Public Health
23. Education and training
24. Library information systems
25. Medical informatics teaching
52. Automated learning and discovery
53. Clinical guidelines and protocols Informatics
85. Administrative/financial systems
26. Patient education and self-care 54. Controlled terminology, vocabularies, and ontologies
27. Professional education 55. Intelligent data analysis and data mining 86. Biosurveillance
56. Decision support systems 87. Consumer health informatics
57. Knowledge management 88. Emergency and disaster response

Human Information Processing and 58. Knowledge representation

59. Neural network techniques
60. Pattern recognition/classification
89. Genetic epidemiology
90. Health intervention systems
91. Health promotion systems
Organizational Behavior 92. Health outcomes assessment
93. Patient self-care and patient-provider interaction
28. Cognitive models and problem solving
29. Data visualization
Nursing Informatics
61. Nursing informatics
30. Natural language understanding and text generation
31. Human factors and usability 62. Nursing care systems
32. Human factors and user interfaces 63. Nursing vocabulary and terminology
33. Human-computer interaction 64. Nursing education/Curriculum in nursing informatics
34. Models of social and organizational behavior 65. Nursing documentation
35. Natural language processing

29
 Data, information,
knowledge,wisdom
 Data
• Data can be divided into three categories.
1. Raw data
• this could be “85” – doesn’t have meaning when it stands
alone.
2. Related raw data
• Group of organized raw data that can be tied together
• E.g., it could be a group of birth weights or birth dates
3. Cleaned raw data
• all the above after being validated or processed
• Such a process might ensure that birth weights are
between ___ and ___ kg(accidentally 8 kg)
 Information
• Information is produced by processing data
• Information is used to reveal the meaning of
data.
• Category Definition
• Data Symbols
• Information Data that are processed to be
useful, providing answers to
• “who,” “what,” “where,” and “when” questions
• Knowledge Application of data and information,
providing answers to
• “how” questions
Category Definition
Data Symbols
Information Data that are processed to be useful,
providing answers to “who,” “what,”
“where,” and “when” questions
Knowledge Application of data and information,
providing answers to “how” questions
 Data
• Data refer to a collection of facts usually collected as the
result of experience, observation or experiment, or processes
within a computer system, or a set of premises.
data is raw.
It simply exists and has no significance beyond its existence
(in and of itself).
It can exist in any form, usable or not.
 It does not have specific meaning of itself.
Raw data is a relative term; data processing commonly occurs
by stages, and the "processed data" from one stage may be
considered the "raw data" of the next.
 Information
Information is data that has been given meaning by
way of relational connection. This "meaning" can be
useful, but does not have to be.

Information: Aggregation of data that makes

decision making easier.
Meaning is attached and contextualized
Answers questions: what, who, when, where)
 Knowledge
Knowledge is an elusive concept which is difficult to
define.
Knowledge: includes facts about the real world
entities and the relationship between them. It is an
Understanding gained through experience
Answer ‘how’ question
Knowledge is a deterministic process. When
someone "memorizes" information (as less-aspiring
test-bound students often do), then they have
amassed knowledge.
 Wisdom
Wisdom: embodies principles, insight and moral by
integrating knowledge
Answer ‘why’ question
Wisdom is not a product of schooling but of the
lifelong attempt to acquire it." Albert Einstein.
Wisdom is an extrapolative and nondeterministic,
non-probabilistic process. It calls upon all the
previous levels of consciousness, and specifically
upon special types of human programming (moral,
ethical codes, etc.).
 Data, Information, Knowledge and Wisdom

Wisdom
Understanding
Increasing Context

Principles
Knowledge
Understanding
Information Patterns

Understanding
Relationships
Data

Increasing Complexity

39
 Data, Information, Knowledge, Wisdom & Truth

• What is Data and Information? Are they different from

Knowledge? Wisdom? Truth?
• fact != data != information != knowledge != wisdom != truth

• Data: Unorganized and unprocessed facts; static; a set of

discrete facts about events
–No meaning attached to it as a result of which it may have
multiple meaning
–Example: what does “Alex” mean?
• Information: Aggregation of data that makes decision making
easier.
–Meaning is attached and contextualized
–Answers questions: what, who, when, where)
 Data, Information, Knowledge, Wisdom & Truth

• What is Data and Information? Are they different from

Knowledge? Wisdom? Truth?
• fact != data != information != knowledge != wisdom != truth

• Knowledge: includes facts about the real world entities and the
relationship between them. It is an Understanding gained
through experience
– Answer ‘how’ question
• Wisdom: embodies principles, insight and moral by integrating
knowledge
– Answer ‘why’ question
• Truth: making the mind think and belief in doing what is true
for all not for narrow
Example 1
 Example 2
• Data represents a fact or statement of event without
relation to other things.
– Ex: It is raining.
• Information embodies the understanding of a
relationship of some sort, possibly cause and effect.
– Ex: The temperature dropped 15 degrees and then it
started raining.
• Knowledge represents a pattern that connects and
generally provides a high level of predictability as to
what is described or what will happen next.
 Example 2 Cont…
– Ex: If the humidity is very high and the temperature drops
substantially the atmospheres is often unlikely to be able to hold the
moisture so it rains.

• Wisdom embodies more of an understanding of fundamental

principles embodied within the knowledge that are essentially
the basis for the knowledge being what it is. Wisdom is
essentially systemic.
– Ex: It rains because it rains. And this encompasses an understanding of
all the interactions that happen between raining, evaporation, air
currents, temperature gradients, changes, and raining.
 Example 3

Given the numbers 2000 and 10%. Is it data, info or what?

It is Data: since it is out of context.
 The number 2000 has multiple meanings: it may be salary, year, amount
deposited, etc…
Information: needs to establish context, like “bank saving
account”
 Principal: 2000 and Interest rate: 10% per annum
Knowledge: relate facts to help, for instance, in decision
making and planning
If I put 2000 in my saving account and bank pays 10% interest yearly, then
at the end of one year I will have 2200 in the bank.
What about Wisdom? What will happen to the bank/customers
if my deposit increase or decrease?
45
 Example 3

Manpower Planning: How can the manager decide about the

need for recruitment of new employees?
Information: can we decide based on the information we get
about vacant positions (by comparing total manpower
requirement and occupied positions)?

Knowledge: can we also relate the available vacant positions

with the available budget, works to be done, etc.?

Wisdom? What if we recruit new employee? Are we affecting

the company and its employee (like, morale of other
employees, expense of the company?)

46
Where are we: information, knowledge or
wisdom?
Where is the Life we have lost in living?
Where is the wisdom we have lost in knowledge?
Where is the knowledge we have lost in
information?
T.S. Elliot, “The Rock”, Faber & Faber 1934
 Issues in Knowledge Management
Definitions

The Knowledge Hierarchy: the conventional view

The Knowledge Hierarchy . Reproduced from Tom Knight and Trevor Howes, Knowledge Management: a
blueprint for delivery. Butterworth - Heinemann , 2002
The Information Pyramid
 Operational information
• This is information needed by those at the bottom
of the corporate hierarchy.

• It is detailed information relating to the day-to-day

running of the divisions of the corporation.

• Within the health care arena this can be considered

to be the few clinical, and many administrative,
systems that exist in health facilities.
 Tactical Information:
• This is the information needed by those part-way up the
corporate hierarchy (who will usually be the managers of the
ones at the bottom)

• It is not as detailed as type '1' information.

• In fact, it frequently summarizes it (by group, perhaps, or over

time period).

• For this reason, it is often termed derived data, and the

systems which provide it are termed feeder systems.
 Strategic Information:
• This is information needed by those at
the top of the corporate hierarchy.

• It is highly abstracted and summarized,

and typically relates to the organization
as a whole rather than to its individual
divisions.
 Exercise - Information types

Consider which category of information (operational, tactical or

Strategic) each of the following belong to and to whom the
information would be most appropriate?
1. Present pulse rate of a patient
2. Occupancy on a daily basis for a single hospital ward over the past month
3. Total number of admissions to the pediatric department at the UoG for diarrhoea
and vomiting by month for the past year
4. Total number of infant deaths in each of the Regions in the past year
5. Daily urine output for a ward based renal patient
6. Total reported number of new HIV infected individuals in Ethiopia in the past year