1. Computational Methods and Imaging in Medicine HEALTH INFORMATICS MODULE INTRODUCTION Dr Jeremy Rogers MD MRCGP Senior Clinical Fellow in Health Informatics Northwest Institute of Bio-Health Informatics

2. Outline ►What Health Informatics is ►Who wants Health Informatics ►A history of Health Informatics

3. What Health Informatics is

4. What is health informatics ? Informatics, as applied to healthcare, of course!

5. What’s Informatics, then? ►Jargon term, even in 2005 ►Some dictionaries xRefer to ‘Information Science’ ►= librarianship ‘The creation, recognition, representation, collection, organization, transformation, communication, evaluation and control of information in a system… The art, science and human dimensions of information technologies.’ Indiana University School of Journalism 2002

6. What is ‘Healthcare’? United Kingdom Infrastructure Hospitals Doctors Nurses Annual Cost (2002) UK USA Western World Population GP Consultations per year A&E Consults per year Hospital Admissions New OPD referrals SUPPLYDEMAND (UK) 59 Million 300 Million (95% of population) 2000 91,000 (1:650) 500,000 $130 billion (£1200 per citizen) $1.5 trillion (£3000 per citizen) $3 trillion (£1500 per citizen) ~14% of population ~23% of population ~18% of population

7. What health informatics is #1 The understanding, skills and tools that enable the sharing and use of information to deliver healthcare and promote health. British Health Informatics Society

8. What health informatics is #2 The knowledge, skills and tools which enable information to be collected, managed, used and shared to support the delivery of healthcare and promote health (qv BMIS) Lead, promote and manage use of resources to improve health care delivery Identify, collect, analyse, disseminate and maintain data and information to improve health care delivery Enable, develop and manage knowledge to improve health care delivery Plan, implement, sustain and review the provision of ICT to support and improve health care delivery NHS National Occupational Standards for Health Informatics 2004

9. What health informatics is #3 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 organise ourselves to create and run healthcare organisations. Enrico Coiera, U New South Wales Guide to Health Informatics 2nd Edition

10. What health informatics is #4 The scientific field that deals with the storage, retrieval, sharing, and optimal use of biomedical information, data, and knowledge for problem solving and decision making. It touches on all basic and applied fields in biomedical science and is closely tied to modern information technologies, notably in the areas of computing and communication. The emergence of medical informatics as a new discipline is due in large part to rapid advances in computing and communications technology, to an increasing awareness that the knowledge base of biomedicine is essentially unmanageable by traditional paper-based methods, and to a growing conviction that the process of informed decision making is as important to modern biomedicine as is the collection of facts on which clinical decisions or research plans are made. Ted Shortliffe, Columbia University

11. What health informatics is #5 Survey of 16 MSc courses 15 in the UK, one in the USA Superset of advertised module contents INFRASTRUCTURE Database resources Internet and communications Metadata and provenance Standards TECHNICAL CHALLENGES Decision Support Terminology Information Governance & Security Biosignal Processing Information Models Electronic Patient Records Natural Language Processing Telemedicine USERS & BENEFITS Healthcare Management Evidence Based Medicine Clinical Research Patient Empowerment INFORMATICS IN PRACTICE Strategy Evaluation Change Management Human Computer Interaction

12. Influences Health Informatics Specialties e.g. nursing informatics Regulation Computer Science Biomedical Engineering Medical specialties Other basic and applied sciences

13. Health Informatics: Broad Themes Complexity – systems (Coiera) Human factors Standards Ownership of data Data entry Integration Ethics Evaluation

14. Who wants Health Informatics?

15. Who wants health informatics? The Clinicians’ Story ►11% of lab tests repeated ►Because result is lost ►30% of treatment orders are undocumented ►70% of acutely ill patients get right treatment ►30% get contraindicated treatment ►500% growth in number of new drugs in a decade

16. One doctor’s clinic…. …one patient’s notes

17. Who wants health informatics? The Clinicians’ Story ►Increasing patient expectation and education ►Increasing litigation ►Demand for transparent processes ►Clinical governance and audit ►Unmanageable cognitive burden ►Approx 100 articles published in 1966 from RCTs; ►Over 10,000 annually by 1995 (Chassin, 1998) ►‘The scarcely tolerable burden of information that is imposed taxes the memory but not the intellect’ (GMC 1993)

18. Who wants health informatics? The Accountants’ Story ►Spiralling health care costs ►Developed world in 2002: USD $3 Trillion on 1.2 billion people ►11% of GDP ►e.g. $5.5M in 37 Days on one patient (Duke University) ►Per capita health cost inflation: 8% per year ►Population expansion ►Demographic shift ►New advances ►No visible means of control

19. Who wants health informatics? The Accountants’ Story www.irdes.fr/ecosante/OCDE/411010.html

20. A Convergence of Need Post genomic research Need for more and better clinical information Clinical trials recruitment Clinical Practice, Audit & Governance Management & Policy Evidence based health care

21. Who wants health informatics? Stakeholders ►Health professionals ►Doctors (Primary / secondary care) ►Nurses ►Allied professions ►Administrators / Government ►Researchers ►Pharmaceutical Companies ►IT professionals ►Patients ?????????

22. Health Informatics: A History

23. Computers 1950 Prototypes 1960 Transistors 1970 Integrated circuits 1980 Microcomputer; Windows. 1990 Internet; Web 2000 Google

24. 1965: Moore’s Law “The density of transistors on a chip will double every 2 years” Gordon E. Moore, INTEL co-founder

25. Health informatics A History: The 50s & 60s 1959Ledley “Reasoning foundations of medical diagnosis” 1960’s onward – Barnett “Mumps” First version had 4k core and 1k for each of 4 users. Everything stored on tape (1 per patient). ‘Great day’ when got first hard disk, storing 30kMumps 1961 Methods Inf Medicine Vol 1 1964NLM adopts Medlars / Index Medicus 1969Weed “Problem-oriented medical record” 1969World’s first EPR Nursing system, Kings College London Systems predominantly for payroll, or pathology High volume Repetitious Rule-based processing (of numerical data) Systems predominantly for payroll, or pathology High volume Repetitious Rule-based processing (of numerical data)

26. Health informatics A History: The 70s 1970World’s first real-time GP system (Whipton, Essex) 19711972de Dombal “Computer-aided diagnosis of abdominal pain”. Anderson King’s College Hospital record system. 1974First Medinfo conference, Stockholm. 1976EMI scanner 1979Founding of IMIA International Medical Informatics Association Systems still mainly finance or pathology Data Processing becomes ‘computer systems’ Early steps to manage and control IT in healthcare First hints at potential for better information to upset apple cart: Protti told by CEO not to collect prescribing data at physician level Systems still mainly finance or pathology Data Processing becomes ‘computer systems’ Early steps to manage and control IT in healthcare First hints at potential for better information to upset apple cart: Protti told by CEO not to collect prescribing data at physician level

27. 1970: A moment in history… 1970 Delivery of fastranII main backing store for 418/III at The London Hospital: Capacity 132 Mb.

28. Health informatics A History: 80s and 90s 1981 BCS PHCSG Founded 1982Micros for GPs scheme 1983 READ codes 1983BJHC Launched 1984Korner report, UK 1986 HIMMS 1986BMIS Founded 1990AMIA Founded 1990 Wessex IT Scandal (£63M) 1990HL7 v 2.1 1991First steps to HL7 v 3.0 1991GP system RFA1 1992 London Ambulance Despatch System Disaster 1993 Cochrane collaboration 1994UMLS 1994JAMIA 1999 Information for Health 1990s1980s First integrated Hospital Information Systems Shift to clinical systems Goal now to improve quality of care First integrated Hospital Information Systems Shift to clinical systems Goal now to improve quality of care

29. Health informatics Recent History ►2000 ►Electronic Record Development and Implementation Programme ►2002-2003 ►Wanless Report ►SNOMED CT ►National Programme for NHS IT (CfH) ►Integrated Care Record Service ►UK Council for Health Informatics Professionals (UKCHIP) ►2005 ►NHS Faculty of Health Informatics

30. Health Informatics Best Practice in 2005 ►Denmark ►85% of health sector integrated within single system ►2 million messages a month ►Central database of all prescriptions and all lab tests ►New Zealand ►75% of health sector integrated ►3 million messages a month ►Veterans Administration ►$21 billion, covering 25 million servicemen & families ►Highest score in every category of quality assessment in 2003 ►Care based on VISTA, enabling Continuous Quality Control ►Cost per patient static over last decade (all other US providers  50%)

31. Health Informatics Into the future ►New Focus ►Clinical Data Repositories ►Surrounded by rule-based alerts and DSS ►New Technologies ►Designer Drugs and Bioinformatics ►Wearable Computing and RFID ►Wireless Connectivity and New portable formats ►New Users ►Patient Empowerment and Intelligent Agents ►New Drivers ►Patient Safety ►Regulation and Accountability of Solutions

32. Recap ►Medicine is broken ►Medicine is expensive ►IT hasn’t helped yet despite 40 years ►But we live in hope