Key Advances in Clinical Informatics

Transforming Health Care through Health Information Technology

Aziz Sheikh, David W. Bates, Adam Wright, Kathrin Cresswell, Aziz Sheikh, David W. Bates, Adam Wright, Kathrin Cresswell

• Publisher: Academic Press
• Year: 2017
• ISBN:
  9780128095256
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Key Advances in Clinical Informatics: Transforming Health Care through Health Information Technology provides a state-of-the-art overview of the most current subjects in clinical informatics. Leading international authorities write short, accessible, well-referenced chapters which bring readers up-to-date with key developments and likely future advances in the relevant subject areas.

This book encompasses topics such as inpatient and outpatient clinical information systems, clinical decision support systems, health information technology, genomics, mobile health, telehealth and cloud-based computing. Additionally, it discusses privacy, confidentiality and security required for health data.

Edited by internationally recognized authorities in the field of clinical informatics, the book is a valuable resource for medical/nursing students, clinical informaticists, clinicians in training, practicing clinicians and allied health professionals with an interest in health informatics.

• Presents a state-of-the-art overview of the most current subjects in clinical informatics.
• Provides summary boxes of key points at the beginning of each chapter to impart relevant messages in an easily digestible fashion
• Includes internationally acclaimed experts contributing to chapters in one accessible text
• Explains and illustrates through international case studies to show how the evidence presented is applied in a real world setting

Part I

An Introduction to Clinical Informatics

Outline

Chapter 1 An Overview of Clinical Informatics

Chapter 2 Inpatient Clinical Information Systems

Chapter 3 Outpatient Clinical Information Systems

Chapter 4 Electronic Clinical Documentation

Chapter 5 Interoperability

Chapter 6 Privacy and Security

Chapter 1

An Overview of Clinical Informatics

Kathrin M. Cresswell¹, David W. Bates², Adam Wright³ and Aziz Sheikh^1,4, ¹The University of Edinburgh, Edinburgh, United Kingdom, ²Harvard Medical School; Harvard School of Public Health, Boston, MA, United States, ³Harvard Medical School; Partners HealthCare, Boston, MA, United States, ⁴Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, United States

Abstract

This chapter sets the scene for the book, beginning with a brief history of clinical informatics, followed by an outline of key concepts and definitions, discussion of the overall existing empirical evidence base, and consideration of contextual and evaluation factors that are important to consider when approaching the field. It concludes with a section on key future developments. Throughout, reference is made to more detailed discussions of key issues discussed in subsequent chapters.

Keywords

Clinical informatics; eHealth; medical informatics; health information technology

Introduction: The Evolving and Expanding Role of Information Technology

Information technology (IT) is increasingly pervading everything we do. For instance, worldwide statistics show that more people have access to a mobile phone than to working toilets (Times Magazine, 2013), and while the existence of genome editing may have seemed unimaginable just a few years ago, tools have now equipped scientists with the ability to genetically modify human embryos (Liang et al., 2015). Such developments are occurring exponentially with an increasing array of technological features, designs, and data generated from applications impacting on all aspects of human life including food, health, energy, and the environment. The first personal computer was released in 1974, and within a mere seven decades, by 2045 computing power is expected to exceed that of all human brains combined. This “technological singularity” is a widely debated hypothetical moment in time where artificial intelligence (AI) will surpass our cognitive limitations (Kurzweil, 2005).

Not surprisingly, most industries have drawn heavily on technological developments to transform their services, and although somewhat lagging behind, healthcare is following suit, driven by increasing pressures on health systems to improve quality, reduce errors, and increase efficiency (Travis et al., 2004). This chapter will provide an overview of past, present, and future developments in the area of clinical informatics. It will introduce the most important concepts and definitions, provide a high-level perspective of the existing empirical evidence base in relation to the effectiveness of health IT (HIT), and provide a contextual overview of the chapters in this book.

The following three sections serve as an overall structure: Section 1 introduces clinical informatics as a discipline, outlining key terms and tensions; Section 2 tackles issues surrounding the impact of clinical informatics applications on quality, safety, and efficiency of care; and Section 3 delves deeper into future developments that are likely to dominate the sector in the foreseeable future, though undoubtedly many other developments will occur that cannot yet be predicted.

A Brief History of the Field of Clinical Informatics

The first use of HIT in a clinical setting can be traced back to 1952, when Dr. Arthur Rappoport reported his experiences with using the McBee Manual Punch Card in a pathology laboratory setting (Porth and Lübke, 1996). This was followed by the emergence of hospital information systems in the 1960s, with the Latter Day Saints Hospital in Utah (USA, now Intermountain) being the first to implement this in 1967. Others, including The COmputer STored Ambulatory Record and the Regenstrief Medical Record System, followed. The Health Evaluation through Logical Programming system had the ability to collect demographic and clinical data with decision support features. It is used to the present day, but may be replaced by Cerner in the near future (Gardner et al., 1999; Healthcare IT News, 2015). The development of clinical specialty systems for laboratory, radiology, pathology, radiotherapy, pharmacy, and primary care followed. Integration of these was not possible until the 1980s, when larger integrated medical information systems emerged, facilitated by the development of high-speed communication networks. In 1985, the first patient scheduling software called “Cadence” was launched by Epic Systems, followed by EpicCare in 1992. Subsequent developments in the 21st century have been characterized by growing clinical uses of technologies drawing on an ever increasing array of data sources (including patients and various care settings), mobile applications that allow patients and providers to gather and view data “on the go”, and the exploitation of digital data generated for reuse (Cresswell and Sheikh, 2016). An overview of key historical developments is provided in Box 1.1.

Box 1.1

Key Historical Developments in Clinical Informatics^1,2,3

1949: establishment of the German Society for Medical Documentation, Computer Science and Statistics (first professional informatics organization)

1950s: first time IT applied to the field of medicine in biomedical context

1952: Arthur Rappoport reported on using the McBee Manual Punch Card in a laboratory setting

1960s: first peer-reviewed informatics journals launched

1960s: emergence of hospital information systems that included digital patient information

1967: Latter Day Saints Hospital in Utah first hospital to use an Electronic Health Record (EHR)

1970s: first mention of English term “medical informatics”

1960s/70s: clinical specialty systems were developed for laboratory, radiology, pathology, radiotherapy, pharmacy, and primary care

1970: first Computerized Physician Order Entry system used in El Caminio Hospital, California

1980s: development of local, national, and worldwide high-speed communication networks

1980s: emergence of larger integrated medical information systems

1985: first patient scheduling software launched (Cadence)

1988: creation of the American Medical Informatics Association

1990s: emergence of the internet facilitating exchange of clinical data

1992: EpicCare launched

2000s: clinical users could use IT to view/order tests/medications from various databases

2010s: emergence of cloud networks and integration of data across multiple locations

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¹Collen, M.F., 2015. A History of Medical Informatics in the United States. Ball, M.J. (Ed.), Springer, New York.

²Hayes, G.M., Barnett, D.E. (Eds.), 2008. UK Health Computing: Recollections and Reflections. British Computer Society.

³http://www.healthworkscollective.com/frankie-xavier/162251/long-road-digitization-history-healthcare-informatics

What Is Clinical Informatics?

Clinical informatics represents a highly interdisciplinary field that involves “analyzing, designing, implementing, and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship (Gardner et al., 2009).” As such, the field can be positioned at the intersection of clinical care, the health system, and information and communication technology. Its interdisciplinary nature is a core feature, and it includes clinical providers such as physicians, nurses, and pharmacists, but also medical librarians, information scientists, and communication specialists, to name just a few of the types of professionals involved.

Related terms that are sometimes used interchangeably include health informatics, medical informatics, and eHealth. There are a range of published definitions with varying understandings of the field in the published literature—the exponential development of applications and increasing convergence of functionalities complicates navigating the area further (Boogerd et al., 2015; Oh et al., 2005). Various chapters of this book will delve deeper into specific applications and associated concepts. These begin with overviews of inpatient systems, outpatient systems, and clinical documentation in Chapters 2, 3, and 4, respectively.

Overall, existing applications can broadly be divided into three categories (Black et al., 2011): (1) systems informing and supporting decisions (see Chapter 10 on medication, laboratory, and radiology testing; and Chapter 12 on knowledge management and computerized guidelines); (2) storage and management of data (Chapter 11 on bioinformatics and precision medicine); and (3) delivery of expertise and care at a distance (see Chapter 13 on mobile health).

There has been an increasing emergence of clinical informatics as a discipline (Greenes and Shortliffe, 1990). Associated activity includes the growing demand for organizational capacity in this area, but also the need for academic expertise to develop new educational trajectories and evaluate ongoing implementation, adoption, and optimization activities associated with the increasing range of technologies. Formal accreditation and certification of clinical informatics expertise are closely associated activities that are presently receiving attention (Fridsma, 2015; Gadd et al., 2016; Shortliffe et al., 2016), particularly in the United States (Middleton, 2014), but also many other countries.

Empirical Evidence Surrounding Effectiveness of Clinical Informatics Applications

Clinical informatics applications have been shown to result in a number of benefits including, among others, the pr...