1. Introduction to Health Informatics:
Health Informatics in Low- and Middle-Income Countries
Short Course for Health Information System Professionals
Introduction to Health Informatics:
Introduction and Overview

2. Global Evaluation and Monitoring Network for Health (GEMNet-Health)
I will begin with a brief introduction to GEMNet-Health – the Global Evaluation and Monitoring Network for Health. GEMNet-Health is a global consortium of 9 regional training institutions that have come together to collaborate on activities related to Monitoring and Evaluation.
The Global Evaluation and Monitoring Network for Health (GEMNet-Health) was launched in 2012 by MEASURE Evaluation.
Currently there are nine member institutions as shown on the map above:
Addis Ababa University (AAU), Ethiopia
Addis Continental Institute of Public Health (ACIPH), Ethiopia
Centre Africain d’Etudes Supérieures en Gestion (CESAG), Senegal
Instituto Nacional de Salud Pública (INSP), Mexico
Kenyatta University, School of Public Health
Mahidol University’s Institute for Population and Social Research (IPSR), Thailand
Public Health Foundation of India (PHFI), India
University of Ghana (UG), Ghana
University of Pretoria (UP), South Africa
MEASURE Evaluation serves as the Secretariat for GEMNet-Health. MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) to monitor and evaluate a wide range of activities to improve human health and well-being. MEASURE Evaluation has a long history of establishing capacity building partnerships with regional training institutions to develop and conduct joint training programs on M&E of health programs. MEASURE Evaluation launched GEMNet-Health in 2012 as a consortium of its current and former regional training partner institutions.
By investing in consolidating the Network’s infrastructure while simultaneously building technical capacity of member institutions in rigorous evaluation and health information systems, GEMNet-Health will be well-positioned as a key resource and instrument for providing M&E services at the local, regional and global levels, while also providing a platform for information sharing and collaboration among member institutions.
Details about the scope of GEMNet-Health’s activities are described in the briefing document that’s available. (copies of the briefing document will be available for distribution)

3. GEMNet-Health’s Purpose
To foster organizational growth, collaboration, and mutual support for monitoring and evaluation (M&E) of health programs globally through institutional linkages among members
The purpose of GEMNet-Health is to foster organizational growth, collaboration, and peer-to-peer support for monitoring and evaluation (M&E) of health programs globally through ongoing and future institutional linkages among members, beginning with a core of MEASURE Evaluation's current and former training partners. The aim is for GEMNet-Health to serve as a stable, sustainable, and independent global network for M&E training, technical assistance, and research.
GEMNet-Health’s Steering Committee provides strategic guidance and monitoring of the implementation of its strategic plan. There is also a standing committee for overseeing coordination and collaboration activities among member institutions such as faculty exchange, collaborative research, webinars, and engaging with external stakeholders.
The platform of GEMNet-Health facilitates interaction among member institutions, promoting sharing of information, collaborative research and conducting joint training programs. The member institutions that make up the network have well-established programs in the M&E of health programs. GEMNet-Health’s current strategic plan identifies evaluation as the primary area of focus for the network’s activities.

4. GEMNet-Health Activities
Impact evaluation workshop
Qualitative evaluation ToT
Joint Training
CLEAR
3ie
Links with External Stakeholders
Formal
Informal
Coordination and Collaboration
Competency development
Mapping existing curricula
Curriculum Harmonization
To foster organizational growth, collaboration, and mutual support for monitoring and evaluation (M&E) of health programs globally through institutional linkages among members
GEMNet-Health is involved in a range of activities , all of which work toward achieving the network mission
- (Read through the list on the slide)
I will talk briefly about the first three activity areas and then focus more on the curriculum harmonization activities which is the focus of our session today.

5. Health Informatics Course
Rationale
Growing interest for health informatics in low- and middle- income countries (LMICs)
Reduce inefficiencies, improve access, reduce costs, increase quality
Need for skilled workforce
Technology spreading faster than skills
Sustainability of digital health investments is in doubt

6. Outcomes of a Strong Health Information System
Image source: MEASURE Evaluation

7. Better Health Outcomes
Improved health system
Strong health information system

8. 2018 World Health Assembly Resolution on Digital Health

9. 2018 World Health Assembly Resolution on Digital Health
Has a role in advancing the Sustainable Development Goals
Complements integrated, people-centered health services
Helps contribute to improved population health and health equity, including gender equality

10. Role of Member States on Digital Health
Use digital technologies in health delivery
Prioritize development, evaluation, implementation, scale‑up, and greater use of digital technologies
Work toward and support the interoperability of digital technologies using international and open standards
Build capacity for human resources for digital health
Build public trust and support for digital health solutions and applications

11. Course Development Process
Rapid assessment:
Understand distribution of institutions offering health informatics in LMICs
Review the content in the health informatics programs
Understand modes of delivery
Assess skills gaps

12. General Findings Seven Common Courses Analytics and statistics
Data management, information, and information system governance
Health information systems applications
Data ethics and health law, regulation, accreditation, and certification
Human resource management, training
Strategic planning, organization, management, and leadership

13. Findings—Africa Seven Common Courses Analytics and statistics
Data management, information, and information system governance
Health information systems applications
Data ethics, regulation, accreditation, and certification
Human resource management, training, and development
Strategic planning, organization, management, and leadership
Health informatics standards

14. Findings—India Seven Common Courses Analytics and statistics
Data management, information, and information system governance
Health information systems applications
Data ethics and health law, regulation, accreditation, and certification
Human resource management training
Strategic planning, organization, management, and leadership
Health informatics standards

15. Course Contributors Developed in 2017 Adapted existing material
Collaboration among:
MEASURE Evaluation
Public Health Foundation India
University of Pretoria, South Africa
Kenyatta University, Kenya
University of Ghana

16. Course Content Health informatics overview Computer hardware
Clinical decision support
Telehealth
Privacy, security, and confidentiality
Workflow process improvement
Technology, people, and processes
Process engineering
Quality process improvement and health information technology
Computer hardware
Software
Databases
Data warehousing
Information networks
Information systems
Information exchange
Data analytics
Usability methods

17. Definition of terms

18. Health Information System

19. Introduction to Health Informatics
What is health informatics?

20. Health Informatics Learning Objectives
Define information management, information system (technology), and informatics
Explain the basic theoretical concept that underlies informatics practice
Define the meaning of health informatics as a field of study and practice
Describe the health informatics areas of applications
Summarize the informatics drivers and trends
The Objectives for this lecture are to:
Define information management, information system (technology) and informatics;
Explain the basic theoretical concept that underlies informatics practice;
Define the meaning of health informatics as a field of study;
Describe the informatics areas of applications; and
Summarize the informatics drivers and trends.

21. Information Management
Data
Generate
Collect
Organize
Validate
Analyze
Store
Integrate
Information
Disseminate
Communicate
Present
Use
Transmit
Safeguard
This introductory lecture will define information management, information system (technology), and informatics, describe the fundamental theorem of informatics, explain the meaning of biomedical and health informatics as a field of study, offer definitions of the major biomedical informatics areas of applications, and provide an overview of informatics drivers and trends.
Let’s begin with defining information management, information system (technology), and informatics.
According to the American Health Information Management Association (AHIMA), information management is “The generation, collection, organization, validation, analysis, storage, and integration of data as well as the dissemination, communication, presentation, utilization, transmission, and safeguarding of the information” (AHIMA, 2012, p. 181).
If the type of information were health, then health information management would entail acquisition, organization, storage, retrieval, and dissemination of health information from a multitude of places. The purpose is ensuring availability, accuracy, and protection of health information that is needed by a variety of individuals in the delivery of health care services and to support decision-making activities.
An example of information management would be deploying a content or document management system.

22. Information System (Technology)
Interchangeable terms
Information system
Information technology
Automated system
Computer hardware and software
- Receives and stores data
- Processes data
- Outputs data
The next definition in the series of terms closely related to information management and informatics is information system or technology. AHIMA defines information system as “An automated system that uses computer hardware and software to record, manipulate, store, recover, and disseminate data (that is, a system that receives and processes input and provides output); often used interchangeably with information technology (IT)” (AHIMA, 2012).
When you think of information technology, some things that should come to mind are computer networks, database and systems administration, security, and programming.
Therefore, information technology could be used in the management of information.
Connecting information technology to health, consider the following definition by the Office of the National Coordinator for Health Information:
“Health Information Technology (HIT) – The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (U.S. Department of Health and Human Services, 2009, para. 8).
An example of health information technology would be administrative and financial systems that facilitate billing, accounting, and other administrative tasks.

23. Informatics The science of information Information = data with meaning
Definition based on:
Data
Information
Knowledge
“Informatics is the science of information, where information is defined as data with meaning” (Bernstam, Smith, & Johnson, 2009, p. 106).
The final definition in this “information” series comes from authors Elmer Bernstam, Jack Smith, and Todd Johnson in their article, What is Biomedical Informatics? Based on their research they determined data, information, and knowledge were central to informatics. Their literature review and subsequent analysis concluded in the following definition of informatics: “Informatics is the science of information, where information is defined as data with meaning” (Bernstam, Smith, & Johnson, 2009, p. 106).
Thus, the similarity between all three terms is that all involve information in some way. However a critical difference between information management, information technology, and informatics is in the object of study where information management focuses on the organization and dissemination of information, information technology on the tools and machines, and informatics on the optimal use of meaningful data.

24. Data, Information, Knowledge, Wisdom Hierarchy
Symbols, facts, measurements
Information
Data processed to be useful
Provides the “who, what, when, where”
Knowledge
Application of data and information
Provides the “how”
Wisdom
Evaluated understanding
Provides the “why”
In order to gain a better understanding of informatics, one needs to learn the differences between data, information, knowledge, and wisdom.
As explained on the previous slide, the research performed by Bernstam, Smith, & Johnson (2009) showed that data, information, and knowledge were central to informatics. In their article, they referenced Ackoff’s Data, Information, Knowledge, and Wisdom (DIKW) hierarchy. Jennifer Rowley, explored further the DIKW hierarchy. Rowley states, “The hierarchy is used to contextualize data, information, knowledge, and sometimes wisdom, with respect to one another and to identify and describe the processes involved in the transformation of an entity at a lower level in the hierarchy…to an entity at a higher level in the hierarchy (e.g. information). The implicit assumption is that data can be used to create information; information can be used to create knowledge, and knowledge can be used to create wisdom” (Rowley, 2007, p. 164).
Data are simple symbols, isolated facts, and measurements. When such data are processed, put into a context, and combined within a structure, information emerges. Information provides the answers to “who, what, when and where.” When information is given meaning by interpreting it, that is there is an application of data, information becomes knowledge. Knowledge answers the “how” questions. Finally, wisdom is evaluated understanding and answers the “why” questions.
Central to informatics is the processing of data so it becomes meaningful.

25. Categories of Health Informatics
Medical informatics
Clinical informatics
Biomedical informatics
Nursing informatics
Imaging informatics
Public health informatics
And many more ….
Clinical Informatics is concerned with information use in health care by clinicians.
Biomedical informatics (BMI) : interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health.
Medical informatics: This field deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine

26. Fundamental Theorem of Informatics
Building on what has been learned so far, Dr. Friedman’s proposed fundamental theorem of informatics will be reviewed next. Other theories, such as Bayes’ Theorem, also apply to informatics but will not be addressed in this unit.
Merriam-Webster’s Online Dictionary defines a theorem as “an idea accepted or proposed as a demonstrable truth often as a part of a general theory” (Merriam-Webster, 2011).
Dr. Friedman utilized Figure 1.1 to represent the theorem. The picture is that of parentheses, picture of a head of a person, a plus sign, picture of a computer, parentheses, greater than symbol, picture of a head of a person.
According to Dr. Friedman, this figure is to be interpreted to mean “A person working in partnership with an information resource is ‘better’ than that same person unassisted” (Friedman, 2009, p. 169).
He further explains, “the metaphoric ‘person’ depicted in the theorem can be a clinician, a scientist, a student, a patient or an administrator. The “person” can also be a team or group, or even an organization. The ‘information resource’ is any mechanism capable of providing information or knowledge or advice to support the person's completion of a task. Information resources are usually, but do not have to be, computer-based. The ‘plus’ in the figure is intended to convey interaction between the person and the resource, the outcome of which is determined by what the information resource is capable of, as well as how the person elects to use it. The ‘plus’ symbol is employed because of its universal recognition, but is not to be read literally in the sense of mathematical addition. The parentheses further connote a bonding between the person and resource, and suggest that the person-resource interaction is shaped by its environment or organizational context. ‘Better’ and the ‘greater than’ inequality are used loosely by intention, so as not to convey specific requirements for testing the theorem” (Friedman, 2009, p. 169).
A “Fundamental Theorem” of Informatics (Friedman, 2009)

27. Application Domains for Informatics
Any area of human endeavor that can be supported by information technology, such as:
Entertainment
Law and law enforcement
Healthcare
Other fields in which computer technology interfaces with people
Now that you have a better understanding of informatics, let’s look at where one would find this science applied.
As one would expect there is not just one segment or domain for informatics. Any domain where there is a need for analysis of data and dissemination of information through the use of computer applications is a possible application domain. These include a wide range of industries including entertainment, hotel management, law and law enforcement, health care, and many other fields where computer technology interfaces with people.
As the focus of this unit is “What is Health Informatics?,” informatics and its application to health care will be explored further.

28. Health Informatics Centers for Disease Control and Prevention
Public health informatics is “defined as the systematic application of information and computer science and technology to public health practice, research, and learning.”
Modified for health informatics
“… the systematic application of information and computer science and technology to health care practice, research, and learning.”
While various perspectives of informatics and its application to health care have been published, two have been chosen for review and discussion because of their significance within the field.
The first definition comes from the American Medical Informatics Association or AMIA. AMIA is a non-profit organization dedicated to the development and application of medical informatics in the support of patient care, teaching, research, and health administration. This organization is seen as the prominent informatics organization in the US. According to their web site, “AMIA is the professional home of leading informaticians: clinicians, scientists, researchers, educators, students, and other informatics professionals who rely on data to connect people, information, and technology” (AMIA, 2011, para. 2).
AMIA’s definition, therefore, is essential to understand. Accordingly, “Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health” (AMIA's Academic Forum, n.d., para. 3).
The second definition comes from another highly respected source for biomedical informatics material, the textbook Biomedical Informatics: Computer Applications in Health Care and Biomedicine.
Shortliffe and Blois define biomedical informatics as “the scientific field that deals with biomedical information, data, and knowledge – their storage, retrieval, and optimal use for problem solving and decision making” (Shortliffe & Blois, 2001, p. 24). As a field of study, Shortliffe and Blois state biomedical informatics is “concerned with the broad range of issues in the management and use of biomedical information, including biomedical computing and the study and nature of biomedical information itself” (Shortliffe & Blois, 2001, p. 920).

29. Health Informatics
Informatics applied to healthcare and population health
Includes
Management and use of data and information in healthcare
Involves
Information technology
Requires
Standards
Another term you may come across is health informatics. It has various interpretations but each one connects information science to health care in some fashion.
For example, AMIA’s perspective is “The informatics community typically uses the term health informatics to refer to applied research and practice of informatics across the clinical and public health domain” (AMIA, 2011, para. 3). While AHIMA defines health care informatics as “The field of information science concerned with the management of all aspects of health data and information through the application of computers and computer technologies” (AHIMA, 2012, pp ).
As you can imagine, applying information science to health care requires health informatics standards to define acceptable methods for collecting, organizing, maintaining, and exchanging data among health management information systems.

30. Drivers of Health Informatics

31. Current Trends in Health Informatics
eHealth
mHealth
Electronic client-level systems
Health administration information systems (e.g., logistics, human resources, aggregate-level information systems)
Health information exchange
Interoperability
Why else are informatics applications a growing need?
Trends which are stimulating the need for health informatics applications include: the focus on eHealth, the adoption and implementation of electronic medical records or EMRs, and electronic health records or EHRs, and the growing desire to be able to electronically exchange health information across organizations within a region, community or hospital system.
The application of information technology to health care is a critical tool in achieving the benefits of eHealth, EMRs, EHRs, and health information exchange.
As you will learn later in this unit, practitioners of informatics known as informaticians use information technology to advance cost-effective care, high-quality care, and patient safety.
But first, let’s review the connection informatics has to eHealth, electronic medical records, electronic health records, and health information exchange.

32. Digital Health Categories
Source: Broadband Commission, 2017

33. eHealth World Health Organization definition:
Use of information and communication technologies for health for different purposes
Healthcare Information and Management Systems Society definition:
Application of the Internet and other technologies to healthcare for various goals and objectives
A general direction with regards to health IT relates to the global environment. The World Health Organization or WHO, a United Nations agency responsible for directing and coordinating international health activities, recognized a trend involving the use of information and communication technologies and its impact on health care delivery, public health, research and health-related activities.
With this recognition, WHO set about defining eHealth and developing a WHO eHealth strategy to help direct WHO’s activities on eHealth. As defined by the WHO, “eHealth is the use of information and communication technologies (ICT) for health to, for example, treat patients, pursue research, educate students, track diseases and monitor public health” (WHO, 2011).
The HIMSS definition is “The application of Internet and other related technologies in the healthcare industry to improve the access, efficiency, effectiveness, and quality of clinical and business processes utilized by healthcare organizations, practitioners, patients, and consumers to improve the health status of patients” (HIMSS, 2003, p.4).
Thus, there is a very close connection between eHealth and informatics as it is the combined use of electronic communication and information technology in the health segment. Some in the industry see eHealth as a sub-discipline of health informatics. Certainly, the application of information and communication technology to health care is a critical tool in achieving the benefits of eHealth, such as improving health care delivery.
An example of eHealth is telemedicine which is delivery of health care at a distance most often via the Internet.

34. Digital Health
Digital health and eHealth: Umbrella terms to encompass all concepts and activities at the intersection of health and information and communications technologies (ICTs), including mHealth, health information technology, electronic health records, and telehealth, and encompassing three main functions:
Delivery of health information, for health professionals and health consumers, through the Internet and telecommunications media
Use of ICTs to improve public health services (e.g., through the education and training of health workers)
Use of health information systems to capture, store, manage, or transmit information on patient health or health facility activities
Broadband Commission report: Digital Health: A Call for Government Leadership and Cooperation between ICT and Health

35. Health Information Exchange
Electronic movement of health-related information among organizations
Involves networks
Local, state, and national health information initiatives
Through the utilization of electronic health records, Health Information Exchange supports the sharing of health- related information to facilitate coordinated care
The final trend is the utilization of health IT, in order to achieve widespread adoption of health IT and enable electronic exchange of health information. Included in the report, Defining Key Health Information Technology Terms, is the following definition for health information exchange (HIE):
“The electronic movement of health-related information among organizations according to nationally recognized standards” (NAHIT, 2008, p. 6).
HIE involves networks that give providers the ability to electronically transmit in a secure manner an individual’s health records.
Through the utilization of EHRs, HIE supports the sharing of health-related information to facilitate coordinated care. EHRs draw information from many sources through health information exchange. Thus, the process of health information exchange is another piece of the health information technology infrastructure and informatics. There are many local, state, and national HIE initiatives going on throughout the U.S.

36. Interoperability
In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.
Data exchange schema and standards should permit data to be shared across clinician, lab, hospital, pharmacy, and patient regardless of the application or application vendor.
The final trend is the utilization of health IT, in order to achieve widespread adoption of health IT and enable electronic exchange of health information. Included in the report, Defining Key Health Information Technology Terms, is the following definition for health information exchange (HIE):
“The electronic movement of health-related information among organizations according to nationally recognized standards” (NAHIT, 2008, p. 6).
HIE involves networks that give providers the ability to electronically transmit in a secure manner an individual’s health records.
Through the utilization of EHRs, HIE supports the sharing of health-related information to facilitate coordinated care. EHRs draw information from many sources through health information exchange. Thus, the process of health information exchange is another piece of the health information technology infrastructure and informatics. There are many local, state, and national HIE initiatives going on throughout the U.S.

37. Principles for Digital Development
The foundation on which this course is built

38. What is Health Informatics?
Summary
Defined terms
Described theorem
Explained field of study related to biomedical and health informatics
Provided an overview of drivers and trends
This concludes Lecture A of What is Health Informatics?.
This lecture defined information management, information technology, and informatics, described the fundamental theorem of informatics. It also provided an overview of informatics drivers and trends in the health care field.

39. What is Health Informatics?
References
Altman, R. B. , & Mooney, S. D. (2001). Bioinformatics. In Shortliffe. E., & Cimino, J. J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine (3rd edition) (p. 763). New York, NY: Springer Science + Business Media.
American Health Information Management Association. (2012). Pocket glossary for health information management and technology (3rd edition). Chicago, IL: American Health Information Management Association.
American Medical Informatics Association. (2016). About AMIA. Retrieved from
American Medical Informatics Association’s Academic Forum. (n.d.). Definition of biomedical informatics. Retrieved from
Bernstam E., Smith J., & Johnson T. (2009). What is biomedical Informatics. Journal of Biomedical Informatics, 43(1). doi:  /j.jbi
Friedman, C. (2009). A "fundamental theorem" of biomedical informatics. Journal of the American Medical Informatics Association, 16(2), doi: /jamia.M3092
Healthcare Information and Management Systems Society. (2003). HIMSS e-health SIG white paper. Retrieved from
Merriam-Webster. (2011). Theorem. Retrieved from webster.com/dictionary/theorem
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40. What is Health Informatics?
References
Rowley, J. (2007). The wisdom hierarchy: Representations of the DIKW hierarchy. Journal of Information Science, 44. doi: /
Shortliffe, E., & Blois, M. (2006). The computer meets medicine and biology: Emergence of a discipline. In Shortliffe. E., & Cimino, J.J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine (3rd edition) (pp. 3-45). New York, NY: Springer Science + Business Media.
The National Alliance for Health Information Technology. (2008). Defining key health information technology terms. Retrieved from content/uploads/2013/05/NAHIT-Definitions2008.pdf
UMDNJ-Robert Wood Johnson Medical School, UMDNJ-School of Health Related Professions Department of Health Informatics & New Jersey Institute of Technology. (n.d.). MD/MS in Biomedical Informatics. [Brochure]. Retrieved from ocuments//mdms_biomedicalinformatics.pdf
U.S. Department of Health and Human Services, The Office of the National Coordinator for Health Information Technology. (2016, September 8). Health IT terms.
World Health Organization. (n.d.). eHealth. Retrieved from
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41. This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated by Normandale Community College, funded under Award Number 90WT0003.
This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government.
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