Healthcare informatics - Option Matrix

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Healthcare Informatics

A field of study concerned with the broad range of issues in the management and use of biomedical information, including medical computing and the study of the nature of medical information itself. If physiology literally means 'the logic of life', and pathology is 'the logic of disease', then health informatics is the logic of healthcare. It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how clinical knowledge is created, shaped, shared and applied. Ultimately, it is the study of how we organize ourselves to create and run healthcare organizations

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Contents

	Overview
	Health Science Approaches & Knowledge
	The Transformation of Healthcare
	The Managed Care Era
	Future Challenges

Overview

Health care informatics or Health informatics or medical informatics is the intersection of information science, computer science, and health care. It deals with the resources, devices, and methods required tooptimize the acquisition, 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.

Subdomains of (bio)medical or health care informatics include: clinical informatics, nursing informatics, imaging informatics, consumer health informatics, public health informatics, dental informatics, clinical research informatics, bioinformatics, veterinary informatics, and pharmacy informatics.

Aspects of the field

A health information system's automatic immunization data entry in the patient's admission module.

architectures for electronic medical records and other health information systems used for billing, scheduling, and research

decision support systems in healthcare, including clinical decision support systems

standards (e.g. DICOM, HL7) and integration profiles (e.g. Integrating the Healthcare Enterprise) to facilitate the exchange of information between healthcare information systems - these specifically define the means to exchange data, not the content

controlled medical vocabularies (CMVs) such as the Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT), Logical Observation Identifiers Names and Codes (LOINC), OpenGALEN Common Reference Model or the highly complex UMLS - used to allow a standard, accurate exchange of data content between systems and providers

use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-making

Development

There is a patent pending for a Medical Informatics Public Utility which would serve as the "common platform" of communication for all existing provincial software products as well as the safe repository for the public's medical records. The potential for the reduction of medical errors, fraud, and duplication is staggering. The number of lives saved could exceed 100,000 per year according to the Institute of Medicine's current medical error mortality statistics.

Medical informatics began to take off in the US in the 1950s with the rise of the microchip and computers.

Early names for medical informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering, and medical computer technology.

Since the 1970s the coordinating body has been the International Medical Informatics Association (IMIA)

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Health science approaches & knowledge

Health science is the applied science dealing with health, and it includes many sub disciplines.

There are two approaches to health science: the study and research of the human body and health-related issues to understand how humans (and animals) function, and the application of that knowledge to improve health and to prevent and cure diseases.

Health research builds upon the basic sciences of biology, chemistry, and physics as well as a variety of multidisciplinary fields (for example medical sociology). Some of the other primarily research-oriented fields that make exceptionally significant contributions to health science are biochemistry, epidemiology, and genetics.

Applied health sciences also endeavor to better understand health, but in addition they try to directly improve the health of individuals and of people in general. Some of these are: biomedical engineering, biotechnology, nursing, nutrition, pharmacology, pharmacy, public health, psychology, physical therapy, and medicine. The provision of services to improve people's health is referred to as health care The health sciences industry, a multi-billion dollar business sector, is a cross-section of the life sciences and the health care and medical diagnostics industries.

Acquisition of health-related knowledge

Medical research is basic and applied research conducted to improve the evaluation of new treatments for both safety and efficacy in what are termed clinical trials, or to develop new treatments (referred to as preclinical research).

The increased longevity of humans over the past century is due in large part to medical research. Among the major advancements in medicine have been vaccines for measles and polio, insulin treatment for diabetes, classes of antibiotics for treating a host of maladies, medication for high blood pressure, improved treatments for AIDS, statings and other treatments for atherosclerosis, new surgical techniques such as microsurgery, and increasingly successful treatments for cancer. New, beneficial tests and treatments are expected as a result of the human genome project. Many challenges remain, however, including the appearance of antibiotic resistance and the obesity epidemic.

Application of health-related knowledge (health care)

Health care is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions. According to the World Health Organization, health care embraces all the goods and services designed to promote health, including "preventive, curative and palliative interventions, whether directed to individuals or to populations". The organized provision of such services may constitute a health care system. This can include a specific governmental organization such as the National Health Service in the UK, or cooperation across the National Health Service and Social Services as in Shared Care.

There are a large number of health professions. The terms medicine or biomedicine, and medical doctor or M.D. refer to the dominant conventional practices in the West. There are a wide range of traditional areas of health care. The most common areas are: medicine, nursing, midwifery, and various forms of therapy to supplement the healing process and restore proper activity (e.g. Dietetics, recreational, physical, occupational, speech, and respiratory).

Like health science in general, health care includes both the study and application of preventing and curing human diseases and disorders. Medical doctors include physicians and surgeons.

There are many different branches of medicine; the other health care professions also have specialties or focus on specific populations or settings of care. Public health studies the effect of environmental factors such as available health care resources on the health of the general population, often focusing on particular populations, such as mothers and children. Dietitians educate people about proper nutrition, particularly specific dietary needs of populations such as people with diabetes, breastfeeding women, and people with celiac disease. Other less common medical areas include first aid and triage.

Dental health has grown in importance in recent decades making dentistry a major field of health sciences. Counselling, hospice care, home care, nutrition, medical social work, alternative medicine, pharmacology, and toxicology are all considered part of health science.

Veterinary medicine is the health science dedicated exclusively to the care of animals. Veterinary medicine is involved in preventing and curing animal diseases and disorders, inspecting animal originated food (like milk and meat) and animal husbandry.

Health practices

Conventional Western practices

Evidence-based medicine

Athletic training

Dentistry

Dietetics

Epidemiology

Genetic counseling

Medical physics

Medicine

Medical technology

Nursing

Nutrition

Occupational therapy

Optometry

Osteopathic medicine (Note: Osteopathy, as practiced in most countries other than the USA, is listed under complementary and alternative practices below)

Pharmacology

Physical therapy (physiotherapy)

Prosthetics and Orthotics

Psychology, including

Psychoanalysis

Psychotherapy, including Cognitive therapy

Public health

Physical education

Speech-Language Pathology

Surgery, including anaesthesiology

Veterinary medicine

Traditional or folk medicine

Shamanism

Ayurveda

Medical herbalism

Traditional Chinese medicine, including acupuncture

Traditional Korean medicine

Complementary and alternative medicine

Alexander Technique

Chiropractic

Dorn method

Herbalism

Holistic health

Homeopathy

Hypnosis

Massage therapy

Natural medicine

Naturopathic medicine

Orthomolecular medicine

Osteopathy (Note: Osteopathic medicine as practiced in the USA is listed under traditional western practices above)

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The Transformation of Health Care

The four decades following World War II witnessed even more extraordinary advances in the ability of medical care to prevent and relieve suffering. Powerful diagnostic tools were developed, such as automated chemistry analyzers, radioimmunoassays, computerized tomography, and nuclear magnetic resonance imaging. New vaccines, most notably the polio vaccine, were developed. Equally impressive therapeutic procedures came into use, such as newer and more powerful antibiotics, antihypertensive drugs, corticosteroids, immunosuppressants, kidney dialysis machines, mechanical ventilators, hip replacements, open-heart surgery, and a variety of organ transplantations. In 1900, average life expectancy in the United States was forty-seven years, and the major causes of death each year were various infections. By midcentury, chronic diseases such as cancer, stroke, and heart attacks had replaced infections as the major causes of death, and by the end of the century life expectancy in the United States had increased about 30 years from that of 1900. Most Americans now faced the problem of helping their parents or grandparents cope with Alzheimer's disease or cancer rather than that of standing by helplessly watching their children suffocate to death from diphtheria.

These exceptional scientific accomplishments, together with the development of the civil rights movement after World War II, resulted in profound changes in the country's health care delivery system. Before the war, most American physicians were still general practitioners; by 1960, 85 to 90 percent of medical graduates were choosing careers in specialty or subspecialty medicine. Fewer and fewer doctors were engaged in solo practice; instead, physicians increasingly began to practice in groups with other physicians. The egalitarian spirit of post-World War II society resulted in the new view that health care was a fundamental right of all citizens, not merely a privilege. This change in attitude was financed by the rise of "third-party payers" that brought more and more Americans into the health care system. In the 1940s, 1950s, and 1960s, private medical insurance companies like Blue Cross/Blue Shield began providing health care insurance to millions of middle-class citizens. In 1965, the enactment of the landmark Medicare (a federal program for individuals over 65) and Medicaid (joint federal and state programs for the poor) legislation extended health care coverage to millions of additional Americans. Medicare and Medicaid also brought to an end the era of segregation at U.S. hospitals, for institutions with segregated wards were ineligible to receive federal payments. Third-party payers of this era continued to reimburse physicians and hospitals on a fee-for-service basis. For providers of medical care, this meant unprecedented financial prosperity and minimal interference by payers in medical decision-making.

Despite these accomplishments, however, the health care system was under increasing stress. Tens of millions of Americans still did not have access to health care. (When President Bill Clinton assumed office in 1993, the number of uninsured Americans was estimated at 40 million. When he left office in 2001, that number had climbed to around 48 million.) Many patients and health policy experts complained of the fragmentation of services that resulted from increasing specialization; others argued that there was an overemphasis on disease treatment and a relative neglect of disease prevention and health promotion. The increasingly complicated U.S. health care system became inundated with paperwork and "red tape," which was estimated to be two to four times as much as in other Western industrialized nations. And the scientific and technological advances of medicine created a host of unprecedented ethical issues: the meaning of life and death; when and how to turn off an artificial life-support device; how to preserve patient autonomy and to obtain proper informed consent for clinical care or research trials.

To most observers, however, the most critical problem of the health care system was soaring costs. In the fifteen years following the passage of Medicare and Medicaid, expenditures on health care in dollars increased nearly sixfold, and health care costs rose from 6 percent to 9 percent of the country's gross domestic product (GDP). Lee Iacocca, while president of Chrysler in the late 1970s, stunned many Americans by pointing out that U.S. automobile companies were spending more per car on health premiums for workers than for the steel that went into the automobiles. Public opinion polls of the early 1980s revealed that 60 percent of the population worried about health care costs, compared with only 10 percent who worried about the quality of care. Millions of Americans became unwillingly tied to their employers, unable to switch to a better job because of the loss of health care benefits if they did so. Employers found their competitiveness in the global market to be compromised, for they were competing with foreign companies that paid far less for employee health insurance than they did. In the era of the soaring federal budget deficits of the Reagan administration, these problems seemed even more insurmountable.

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The Managed Care Era

In the mid-1980s, soaring medical care costs, coupled with the inability of federal regulations and the medical profession on its own to achieve any meaningful cost control, led to the business-imposed approach of "managed care." "Managed care" is a generic term that refers to a large variety of reimbursement plans in which third-party payers attempt to control costs by limiting the utilization of medical services, in contrast to the "hands off" style of traditional fee-for-service payment. Examples of such cost-savings strategies include the requirement that physicians prescribe drugs only on a plan's approved formulary, mandated preauthorizations before hospitalization or surgery, severe restrictions on the length of time a patient may remain in the hospital, and the requirement that patients be allowed to see specialists only if referred by a "gatekeeper." Ironically, the first health maintenance organization, Kaiser Permanente, had been organized in the 1930s to achieve better coordination and continuity of care and to emphasize preventive medical services. Any cost savings that were achieved were considered a secondary benefit. By the 1980s, however, the attempt to control costs had become the dominant force underlying the managed care movement.

Unquestionably, the managed care movement has brought much good. It has forced the medical profession for the first time to think seriously about costs; it has encouraged greater attention to patients as consumers (for example, better parking and more palatable hospital food); and it has stimulated the use of modern information technologies and business practices in the U.S. health care system. In addition, the managed care movement has encouraged physicians to move many treatments and procedures from hospitals to less costly ambulatory settings, when that can be done safely.

However, there have been serious drawbacks to managed care that in the view of many observers have outweighed its accomplishments. Managed care has not kept its promise of controlling health care costs, and in the early years of President George Walker Bush's administration, the country once again faced double-digit health care inflation. In the view of many, the emphasis on cost containment has come at the erosion of the quality of care, and the dollar-dominated medical marketplace has been highly injurious to medical education, medical schools, and teaching hospitals. Managed care has also resulted in a serious loss of trust in doctors and the health care system-creating a widespread fear that doctors might be acting as "double agents," allegedly serving patients but in fact refusing them needed tests and procedures in order to save money for the employing organization or insurance company. As a result, the twenty-first century has opened with a significant public backlash against managed care and a vociferous "patients' rights movement."

Ironically, many of the perceived abuses of managed care have less to do with the principles of managed care than with the presence of the profit motive in investor-owned managed care organizations. Nonprofit managed care organizations, such as Kaiser Permanente, retain about 5 percent of the health premiums they receive for administrative and capital expenses and use the remaining 95 percent to provide health care for enrollees. For-profit managed care companies, in contrast, seek to minimize what they call the "medical loss"-the portion of the health care premium that is actually used for health care. Instead of spending 95 percent of their premiums on health care (a "medical loss" of 95 percent), they spend only 80, 70, or even 60 percent of the premiums on health services, retaining the rest for the financial benefit of executives and investors. Some astute observers of the U.S. health care system consider the for-profit motive in the delivery of medical services-rather than managed care per se-the more serious problem. However, since 90 percent of managed care organizations are investor-owned companies, the for-profit problem is highly significant.

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Future Challenges

The U.S. health care system has three primary goals: the provision of high-quality care, ready access to the system, and affordable costs. The practical problem in health care policy is that the pursuit of any two of these goals aggravates the third. Thus, a more accessible system of high-quality care will tend to lead to higher costs, while a low-cost system available to everyone is likely to be achieved at the price of diminishing quality.

Certain causes of health care inflation are desirable and inevitable: an aging population and the development of new drugs and technologies. However, other causes of soaring health care costs are clearly less defensible. These include the high administrative costs of the U.S. health care system, a litigious culture that results in the high price of "defensive medicine," a profligate American practice style in which many doctors often perform unnecessary tests and procedures, the inflationary consequences of having a "third party" pay the bill (thereby removing incentives from both doctors and patients to conserve dollars), and the existence of for-profit managed care organizations and hospital chains that each year divert billions of dollars of health care premiums away from medical care and into private wealth. Clearly, there is much room to operate a more efficient, responsible health care delivery system in the United States at a more affordable price.

Yet the wiser and more efficient use of resources is only one challenge to our country's health care system. In the twenty-first century, the country will still face the problem of limited resources and seemingly limitless demand. At some point hard decisions will have to be made about what services will and will not be paid for. Any efforts at cost containment must continue to be appropriately balanced with efforts to maintain high quality and patient advocacy in medical care. Better access to the system must also be provided. Medical insurance alone will not solve the health problems of a poor urban community where there are no hospitals, doctors, clinics, or pharmacies. Lastly, the American public must be wise and courageous enough to maintain realistic expectations of medicine. This can be done by recognizing the broad determinants of health like good education and meaningful employment opportunities, avoiding the "medicalization" of social ills like crime and drug addiction, and recognizing that individuals must assume responsibility for their own health by choosing a healthy lifestyle. Only when all these issues are satisfactorily taken into account will the United States have a health care delivery system that matches the promise of what medical science and practice have to offer.

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