Developments in Nursing Practice Introduction to Health Informatics

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Developments in Nursing Practice Introduction to
Health Informatics

• Paula Hicks
• Centre for Health Informatics
• Dept. of Computer Science, College
• Email paula.hicks_at_cs.tcd.ie
• Office Oriel House, Room 4.14
• Tel [phone]

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Module Overview

• Introduction to Health Informatics
• Introduction to Computers
• Database Management Systems
• Telecommunications, Networks Information
  Exchange
• Electronic Healthcare Record
• Computer Applications in Healthcare
• E-Health
• IT and Society
• Impact of IT on health Professionals Patients

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Presentation Overview

• 1. What is health informatics?
• 2. History of health informatics
• 3. Why bother?
• 4. Health sector today
• 5. Modelling the healthcare environment
• 6. Some Challenges

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1. What is health informatics?

• From the French informatique
• Medical informatics, medical computing, computers
  in medicine,.
• Interdisciplinary field combining health
  sciences, computer science, statistics,
  engineering, management sciences,
• Many definitions.

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Some definitions of health informatics

• an umbrella term referring to the application of
  the methodologies and techniques of information
  science, computing, networking and communications
  to support health and health related disciplines
  such as medicine, nursing, pharmacy, dentistry
  etc WHO
• the field that concerns itself with the
  cognitive, information processing, and
  communication tools of medical practice,
  education, and research including the information
  science and the technology to support these
  tasks (Shortliffe)
• comprises the theoretical and practical aspects
  of information processing and communication,
  based on knowledge and experience derived from
  processes in medicine and health (van Bemmel)
• encompasses every possible aspect of information
  science and technology used in a health delivery
  system (DeDombal)

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Who does health informatics serve?

• Patient
• Medical Profession
• Government Bodies
• Primary Care/GPs
• National Agencies
• Finance/Admin. Management in Hospitals
• Tax Payers
• General Population
• The public
• Policy makers (strategic management)
• Regional managers/tactical management
• Facility management/operational management
• Health care providers
• Healthcare researchers
• Healthcare educators and their students
• Will one solution suit all?

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What services does Health Informatics involve?

• Data processing (health is a data intense
  industry)
• Includes collection, processing, transformation,
  presentation use
• Communication main emphasis should be on
  supporting communication between people
• Knowledge based services
• Includes computerised bibliographic services,
  on-line collections on non-numerical information
  such as practice guidelines, pharmacopoeias,
  essential drug lists, telephone directories,
  expert, decision-support and reminder systems

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What technologies does it employ?

• Computers and networks
• But dont forget paper-based information
  systems, including input to and output from the
  computer

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Applications of Health Informatics

• For recording accurate data
• To have data available in a timely manner
• Support and inform managers to make better
  decisions
• Resource allocation and planning
• Email therapy
• Risk management
• Training
• Support for shared care
• Patient Assessment
• Evaluation of patient care
• Monitoring patients
• Staff coordination
• Tracking patients in hospital
• Stock management
• Tracking sterile supplies
• Integration engines
• EHCR
• Mobile computing

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Applications of Health Informatics contd.

• Drug control medication dispensing/ordering
• Purchasing equipment
• Payroll
• Clinical Pathways
• Labour management
• Patient scheduling
• Budget analysis
• Research
• Word processing
• National database
• Quality Assurance
• Donor databases
• Devices
• Monitors
• Analysers
• Imaging equipment

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2. History of Health Informatics

• Information revolutions
• First revolution invention of writing
• Second revolution invention of the printing
  press
• Third revolution digital information
• Healthcare is information intensive
• Other information intensive industries rely
  totally on computers eg. banking, airlines
• Where are the role models for best practice in
  health computing?

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Growth of IT

• We have a computer here in Cambridge, there is
  one in Manchester and one in the National
  Physical Laboratory. I suppose there ought to be
  one in Scotland, but thats about all. Douglas
  Hartree, an English mathematician and physicist,
  1948
• 6 computers would be sufficient to meet the
  needs of the entire USA. Howard Aiken, an
  American mathematician, 1948
• if the car industry had developed at the same
  rate as the computer industry then a Ferrari
  would cost 4.40, drive 5 million kilometres on
  one litre of petrol, and park comfortably on the
  head of a pin and would need a 500 page
  instruction manual to explain to its owner how to
  open the door!!

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The development of Health Informatics

• Initial focus on administrative support
• Payroll
• Personnel
• Finance
• Stock control
• I.e. traditional business functions
• Why?
• Traditional business applications driving IT
  development
• But
• Health sector also drove technology e.g. in
  Artificial Intelligence and in imaging
• Difficult to codify how the human body works
• Protocol systems rule based AI system (must be
  agreed between IT and Clinician)

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Artificial Intelligence in Health

• One of the major first expert systems was MYCIN
  for the diagnosis and treatment of bacterial
  infections of the blood
• Many, many other examples of expert/decision
  support systems in health
• But they are mainly confined to the research
  laboratory very few have made it into routine
  clinical use
• Why?
• Complexity (differenct work practices)
• Integration (not compatible / difficult to
  transfer)
• acceptability

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Imaging systems in Health

• Impossible without the use of computers
• Computers are used to
• Construct an image from measurements
• Obtain an image reconstructed for optimal
  extraction of a particular feature from an image
• Present images
• Improve image quality by image processing
• Store and retrieve images
• Ulstrasound, x-rays, computed tomography, MRI,
  nuclear imaging etc. .

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3. Why bother?

• Information Technology is now an integral and
  essential part of health delivery
• IT systems are prevalent in society
• Training and education in the appropriate
  application of IT in healthcare essential -
  Council of Europe Recommendation 1990 recommends
  that the governments of all member states
• Ensure that, as soon as possible, those staff
  involved in healthcare receive appropriate,
  multidisciplinary training, both theoretical and
  practical, for health information systems within
  an overall public health context
• Develop training strategies for health
  information systems, which take account of their
  overall development and of the organisation and
  circumstances of local health, teaching and
  research establishments and commercial producers
• Establish international co-operation through a
  network of reference centres, in order to
  facilitate the exchange of knowledge and
  resources in a new and rapidly changing field

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4. Health sector today(citizen-centred care)

• Health and education are two major consumers of
  the public purse
• Situation in the sector
• Cost containment
• Information overload (data doubles every five
  years)
• Shared care (team based care)
• Technological push vs. demand pull (users driving
  it)
• Clinical focus - Should be driven by supporting
  clinical needs and not financial management
  (otherwise solutions in search of problems)
• Cost containment is major driving force
  planning resources (eg. cost of care for
  diabetes)
• Improving quality of care equally important

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Health sector today contd.

• Distributed organisational structures
  (independent clinics/labs) strong local
  autonomy
• Accountability
• Increased dependence on automation
• Emphasis is moving from administrative to
  clinical information systems
• Public has more knowledge about healthcare (NLM,
  Medline, Web)
• Tension between demand for increased quality of
  care vs. reduction in costs
• Efficiency vs. cost-effectiveness

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Health sector today contd.

• Information overload nos., text, x-rays,
  ultrasounds
• Complex (narrative)
• Distributed
• Multi-vendor (heterogeneous) no one vendor can
  support all the processing needs of all systems,
  GP, AE
• Strong autonomy (need to relinguish a certain
  amount of automony to share data)
• Data intensive

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Implications for healthcare organisations

• Unnecessary duplication of tests and
  investigatons
• Valuable time wasted trying to track down
  relevant information
• Studies have shown that at least 20 of
  healthcare professionals time is spent reading,
  writing, sorting and searching through notes (up
  to 70 has been claimed by some)
• gtAppropriate healthcare not provided as
  efficiently and cost effectively as possible

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The strategy to improve the situation should
include the following ideas..

• Patient care requirements prime
• Secure, reliable, on-line clinical information
  systems
• Facilitate cost-effective use of IT
• Establish stewardship for implementation of
  enterprise-wide solutions and standards
• Connect and manage distributed information
  systems
• Delivering healthcare today is no longer the sole
  responsibility of a single professional
• Movement away from hospital (tertiary) to
  community (primary) based shared care (Access
  to records by GPs)

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This implies.

• Ability to share information between care
  providers is key
• The right information in the right place, in the
  right format and at the right time
• IT is key-enabling technology for shared care
• Tension between demand for increased quality of
  care vs. reduction in costs
• Efficiency vs. cost-effectiveness

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The key issue is

• Efficient and cost-effective application of ICT
  in the health sector

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5. Modelling the Healthcare Environment

• IT is all about developing a model of the real
  world
• Models are the basis of the way we learn about
  and interact with the physical world
• Models that copy the world are abstractions of
  the real words
• Models are less detailed than the real world
• Models are abstractions of the real world,
  ignoring aspects that are not considered
  essential (I.e. they impose a point of view upon
  the observed world)
• Many models can be created of any given physical
  object depending upon the level of detail and
  point of view selected
• The point of view used to build a model is based
  upon the use to which the model will be put
• There is no such thing as the most correct model
  models are simply better or worse suited to
  accomplishing a particular task

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Models and Systems

• Systems are vital to human reasoning because they
  take us beyond simple cause and effect to allow
  us to look at complex relationships
• Examples of an information system include
• The routine way in which a clinician records
  patient details in a notebook
• The way a triage nurse assess patients on arrival
  in AE
• Complex computer-based system for handling the
  finances of a large hospital
• Modeling is required to appropriately automate
  these Systems

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6. Challenges.

• Legacy information systems (older systems)
• Problems
• Maintenance 80 of IT costs (eg Y2K problems)
• Inflexible and brittle (cannot interface with
  newer systems can crash/old code not properly
  documented (cannot interface with new systesm)
• Fear
• Challenge
• Migrate/evolve
• IT gets in the way sometimes

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Technical Challenges contd.

• Complex nature of medical data
• Alphnumberic (lab results)
• Text (discharge summary)
• Signals (monitors)
• Images (x-rays)
• Video (endoscopy, ultrasound)
• User interfaces data entry
• Highly reliable, efficient and secure information
  management
• Integration of IT into routine clinical practice
  paperless hospital
• Co-operative hospital computing
• Multi-vendor

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What are the Organisational Challenges

• Integrating IT into the business process
• Understanding the domain to which the application
  is being applied
• Training Staff on the new systems
• Introducing the new systems to patients
• Maintenance of the systems
• Resources location, staff, money

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References

• Lecture Notes - Jane Grimson TCD and Gaye
  Stephens TCD
• Guide to medical informatics, the internet and
  telemedicine, Enrico Coiera, Chapman Hall
  Medical, 1997 (610.28 N73)
• Medical Informatics the essentials, F T de
  Dombal, Butterworth heinemann, 1996 (JB-2-337)
• Handbook of Medical Informatics, J H van Bemmel
  and M A Musen, Springer, 1997
• Health informatics an overview, Evelyn Hovenga,
  Michael Kidd and Branko Cesnik (eds), Churchill
  Livingstone, 1996 (610 N69)