Evolution of Medical Informatics

Much of the technological development leading to computers as we know them today has occurred in just over the last 50 years. The resulting advances in information storage, retrieval, and processing would seem a natural fit for healthcare, but as Shortliffe and Blois (2006, p.4) point out, "[m]any observers cite the health care system as being slow to understand information technology, to exploit it for its unique practical and strategic functionalities, and to incorporate it effectively into the work environment." Substantial increases in the amount of clinical data, now unmanageable by traditional paper-based methods, have created an inefficient, repetitive, and costly healthcare system. The growing realization that knowledge retrieval and clinical decision making are critical to both the function and advance of modern medicine, along with health information technology (HIT)'s ability to exponentially improve these processes, has led to major technological advances and drastic changes in national health policy. These developments have fueled the evolution of the field of biomedical informatics.

Biomedical informatics is an interdisciplinary field encompassing computer and information sciences, cognitive and decision making sciences, medicine and epidemiology, telecommunications, business management, education sciences, and a collaboration of a number of other fields. In short, biomedical informatics is the intersection of healthcare, technology, and people, with the implicit goals of improving the quality and safety of the world's healthcare systems while reducing cost.

As terminology continues to evolve along with the field itself, the more broadly encompassing term "biomedical informatics" can generally be broken down into three more distinct levels; bioinformatics, medical informatics, and public health informatics.

At the molecular level, incorporating things such as gene sequencing research and pharmaceutical development, bioinformatics looks to change the way biological data is stored, retrieved, organized, and analyzed, ultimately producing new tools/methods for generating valuable biological knowledge.

Medical informatics, at an individual patient level, can further be divided into a number of more specific areas including nursing informatics, imaging informatics, pharmacy informatics, dental informatics, and consumer health informatics.

Medical informatics aims to manage an individual's health data, their storage, retrieval, sharing, and optimal use, with the goals of providing safer, more efficient, and more affordable healthcare. Integration of advanced clinical information systems into the health care decision making process allows health care professional to accomplish tasks in a more competent and effective manner. Furthermore, it also affords development of novel tasks producing new knowledge and allowing providers to begin thinking like epidemiologists in addition to providing patient care.

At a population level, public health informatics aims to apply information technology advances to traditional public health research and practice. Detection, management, and prevention of disease across populations, through the collection and analysis of vital statistics and health data, have the potential to be significantly influenced and advanced through the auspices of evolving information technology.

In the U.S., the 2004 creation of the Office of the National Coordinator for Health Information Technology (ONC), described as "the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information," began to provide a nationwide focus for medical informatics (The Office of the National Coordinator for Health Information Technology, n.d.a). That focus was further refined in 2009 when the goals of the ONC were legislatively mandated through the Health Information Technology for Economic and Clinical Health (HITECH) Act. "The provisions of the HITECH Act are specifically designed to work together to provide the necessary assistance and technical support to [healthcare] providers, enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of certified Electronic Health Records (EHRs)" (The Office of the National Coordinator for Health Information Technology, n.d.d). More specifically, HITECH provides funding for:

• Health Information Technology (HIT) adoption programs including those funding
  • Development and implementation of advanced infrastructure
  • Consumer access to personal health information
  • Establishment of and innovation in health information exchange (HIE)
  • Provision of technical assistance, guidance, and information regarding adoption of electronic health records (EHRs) to healthcare providers
  • Research on documented problems impeding EHR adoption
  • HIT workforce development 'Äì Includes both community college and university level training, curriculum development, and competency examination development for a non-degree HIT educated workforce
• Federal Advisory Committees including
  • A Health IT Policy Committee that is tasked with making "recommendations to the National Coordinator for Health IT on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information" (The Office of the National Coordinator for Health Information Technology, n.d.c).
  • A Health IT Standards Committee that is tasked with "making recommendations to the National Coordinator for Health IT on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information" (The Office of the National Coordinator for Health Information Technology, n.d.c).
• A State Health Information Exchange Cooperative Agreement Program that "funds states' efforts to rapidly build capacity for exchanging health information across the health care system both within and across states" and includes a grant program funding innovative research in nationwide HIE (The Office of the National Coordinator for Health Information Technology, n.d.f).
• An Exemplar HIE Governance Entities Program that "will allow ONC to work collaboratively with entities already involved in governance of health information exchange to encourage the continued development and adoption of policies, interoperability requirements, and business practices that will increase the ease of electronic health information exchange, reduce implementation costs, and assure the privacy and security of data being exchanged" (The Office of the National Coordinator for Health Information Technology, n.d.b).

In addition to funding these programs, HITECH provides the Department of Health & Human Services (HHS) "with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT, including electronic health records and private and secure electronic health information exchange" (The Office of the National Coordinator for Health Information Technology, n.d.e). This authority has led to the establishment of a system of Medicare and Medicaid financial incentives to providers for adoption of EHR technology and its "meaningful use." Specific objectives defining what constitutes meaningful use have been developed along with certification criteria for EHR systems that identify them as having the capability to meet these objectives. Meaningful use objectives are to be met in three stages outlined as:

• Stage 1 - Data capture and sharing
• Stage 2 - Advance clinical processes
• Stage 3 - Improved outcomes

As the timeline for stage 1 comes to a close and we near the start of stage 2, the focus of meaningful use moves from basic implementation and refinement of systems able to capture and store electronic health data, towards more sophisticated and effective exchange and use of this data to create advanced knowledge, improve medical practice, and redefine the role of healthcare systems worldwide. This forward progress along with the inevitable advances made through ongoing research in biomedical informatics ensure that the evolution of this field will continue to provide infinite possibilities to the future of HIT.

References

Shortliffe, E. H., & Cimino, J. J. (2006). Biomedical informatics: Computer applications in health care and biomedicine. New York, NY: Springer Science + Business Media, LLC.

The Office of the National Coordinator for Health Information Technology (n.d.a). About ONC. Retrieved from http://www.healthit.gov/newsroom/about-onc

The Office of the National Coordinator for Health Information Technology (n.d.b). Exemplar HIE governance entities program. Retrieved from http://www.healthit.gov/policy-researchers-implementers/exemplar-hie-governance-entities-program

The Office of the National Coordinator for Health Information Technology (n.d.c). Federal advisory committees (FACAS). Retrieved from http://www.healthit.gov/policy-researchers-implementers/federal-advisory-committees-facas?tid=125

The Office of the National Coordinator for Health Information Technology (n.d.d). HITECH act. Retrieved from http://www.healthit.gov/policy-researchers-implementers/hitech-act-0

The Office of the National Coordinator for Health Information Technology (n.d.e). Meaningful use. Retrieved from http://www.healthit.gov/policy-researchers-implementers/meaningful-use

The Office of the National Coordinator for Health Information Technology (n.d.f). State Health Information Exchange. Retrieved from http://www.healthit.gov/policy-researchers-implementers/state-health-information-exchange