Biomedical informatics | Wikipedia audio article



health informatics also called healthcare informatics healthcare informatics medical informatics nursing informatics clinical informatics or biomedical informatics is information engineering applied to the field of healthcare essentially the management and use of patient health care information it is a multidisciplinary field that uses health information technology here to improve healthcare via any combination of higher quality higher efficiency spurring lower cost and thus greater availability and new opportunities the disciplines involved include information science computer science social science behavioral science management science and others the NLM defines health informatics as the interdisciplinary study of the design development adoption and application of IT based innovations in health care services delivery management and planning it deals with the resources devices and methods required to optimize the acquisition storage retrieval and use of information in health and biomedicine health informatics tools include computers clinical guidelines formal medical terminologies and information and communication systems among others it is applied to the areas of Nursing clinical medicine dentistry pharmacy Public Health occupational therapy physical therapy biomedical research and alternative medicine all of which are designed to improve the overall of effectiveness of patient care delivery by ensuring that the data generated is of a high quality the international standards on the subject are covered by ICS thirty five point two four zero point eight zero in which ISO 27000 799 to 2008 is one of the core components topic sub-speciality z– healthcare informatics includes subfields of clinical informatics such as pathology informatics clinical research informatics see section below imaging informatics public health informatics community health informatics home health informatics nursing informatics medical informatics consumer health informatics clinical bioinformatics and informatics for education and research in health and medicine pharmacy informatics topic Healthcare Informatics topic clinical informatics clinical informatics is concerned with the use of information in healthcare by and for clinicians clinical implementations also known as clinical informaticists transform healthcare by 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 clinical implementations use their knowledge of patient care combined with their understanding of informatics concepts methods and health informatics tools to assess information and knowledge needs of healthcare professionals patients and their families characterized evaluate and refine clinical processes develop implement and refine clinical decision support systems and lead or participate in the procurement customization development implementation management evaluation and continuous improvement of clinical information systems clinicians collaborate with other healthcare and information technology professionals to develop health informatics tools which promote patient care that is safe efficient effective timely patient-centered and equitable many clinical informaticists are also computer scientists in October 2011 American Board of Medical Specialties ibms the organization overseeing the certification of specialist MDS in the United States announced the creation of MD only physician certification in clinical informatics the first examination for board certification in the subspecialty of clinical informatics was offered in October 2013 by American Board of preventive medicine a BPM with 432 passing to become the 2014 inaugural class of deployments in clinical informatics fellowship programs exist physicians who wish to become board certified in clinical informatics physicians must have graduated from a Medical School in the United States or Canada or a school located elsewhere that is approved by the a bpm in addition they must complete a primary residency program such as internal medicine or any of the twenty-four sub specialties recognized by the ABMS and be eligible to become licensed to practice medicine in the state where their fellowship program is located the fellowship program is 24 months in length with fellows dividing their time between informatics rotations didactic method research and clinical work in their primary specialty topic integrated data repository one of the fundamental elements of biomechanical and translation research is the use of integrated data repositories a survey conducted in 2010 defined integrated data repository IDR as a data warehouse incorporating various sources of clinical data to support queries for a range of research like functions integrated data repositories are complex systems developed to solve a variety of problems ranging from identity management protection of confidentiality semantic and syntactic comparability of data from different sources and most importantly convenient and flexible query development of the field of clinical informatics led to the creation of large datasets with electronic health record data integrated with other data such as genomic data types of data repositories include operational data stores OD s's clinical data warehouses CDW's clinical data Mart's and clinical registries operational data stores established for extracting transferring and loading before creating warehouse or data Mart's clinical registries repositories have long been in existence but their contents are disease specific and sometimes considered archaic clinical data stores and clinical data warehouses are considered fast and reliable though these large integrated repositories have impacted clinical research significantly it still faces challenges and barriers one big problem is the requirement for ethical approval by the institutional review board IRB for each research analysis meant for publication some research resources do not require IRB approval for example CDW's with data of deceased patients have been – identified and IRB approval is not required for their usage another challenge is data quality methods that are just for bias such as using propensity score matching methods assume that a complete health record is captured tools that examine data quality eg point to missing data help in discovering data quality problems topic clinical research informatics clinical research informatics Cree is a subfield of health informatics that tries to improve the efficiency of clinical research by using informatics methods some of the problems tackled by Korea creation of data warehouses of healthcare data that can be used for research support of data collection in clinical trials by the use of electronic data capture systems streamlining ethical approvals and renewals in u.s. the responsible entity is the local institutional review board maintenance of repositories of past clinical trial data de-identified Cree is a fairly new branch of informatics and has met growing pains as any up-and-coming field does some issue Cree faces is the ability for the statisticians and the computer system architects to work with the clinical research staff in designing a system and lack of funding to support the development of a new system researchers and the informatics team have a difficult time coordinating plans and ideas in order to design a system that is easy to use for the research team yet fits in the system requirements of the computer team the lack of funding can be a hindrance to the development of the kree many organizations who are performing research are struggling to get financial support to conduct the research much less invest that money in an informatics system that will not provide them any more income or improve the outcome of the research EMB I 2009 topic common data elements CDEs in clinical research ability to integrate data from multiple clinical trials is an important part of clinical research informatics initiatives such as Fein and patient reported outcomes measurement information system triggered a general effort to improve secondary use of data collected in past human clinical trials CDE initiatives for example try to allow clinical trial designers to adopt standardized research instruments electronic case report forms topic data sharing platforms for clinical study data a parallel effort to standardizing how data is collected our initiatives that offer to identified patient level clinical study data to be downloaded by researchers who wish to reuse this data examples of such platforms are project data sphere dbgap import or clinical study data request informatics issues in data formats for sharing results plain CSV files FDA endorsed formats such as CD ISC study data tabulation model are important challenges within the field of clinical research informatics topic human bioinformatics topic translational bioinformatics with the completion of the human genome and the recent advent of high-throughput sequencing and genome wide Association studies of single nucleotide polymorphisms the fields of molecular bioinformatics biostatistics statistical genetics and clinical informatics are converging into the emerging field of translational bioinformatics the relationship between bioinformatics and health informatics while conceptually related under the umbrella of biomedical informatics has not always been very clear the TBI community is specifically motivated with the development of approaches to identify linkages between fundamental biological and clinical information along with complementary areas of emphasis such as those focused on developing systems and approaches within clinical research contexts insights from TBI may enable a new paradigm for the study and treatment of disease translational bioinformatics TBI is a relatively new field that surfaced in the year of 2000 when human genome sequence was released the commonly used definition of TBI is lengthy and could be found on the AMIA website in simpler terms TBI could be defined as a collection of colossal amounts of health-related data biomedical and genomic and translation of the data into individually tailored clinical entities today TBI field is categorized into four major themes that are briefly described below clinical big data clinical big data is a collection of electronic health records that are used for innovations the evidence-based approach that is currently practiced in medicine is suggested to be merged with the practice based medicine to achieve better outcomes for patients as CEO of california-based cognitive computing firm 'epic CEO Darren scheudle explains that the care can be better fitted to the patient if the data could be collected from various medical records and analyzed further the combination of similar profiles can serve as a basis for personalized medicine pointing to what works and what does not for certain condition ma 2016 jimmy king clinical care genomic data are used to identify the genes involvement in unknown or rare conditions syndromes currently the most vigorous area of using genomics is oncology the identification of genomic sequencing of cancer may define reasons of drug sensitivity and resistance during oncological treatment processes omics for drugs discovery and repurposing gree purposing of the drug is an appealing idea that allows the pharmaceutical companies to sell an already approved drug to treat a different condition disease that the drug was not initially approved for by the FDA the observation of molecular signatures in disease and compare those two signatures observed in cells points to the possibility of a drug ability to cure and/or relieve symptoms of a disease personalized genomic testing in the USA several companies offer direct-to-consumer DTC genetic testing the company that performs the majority of testing is called 23andme utilizing genetic testing in healthcare raises many ethical legal and social concerns one of the main questions is whether the healthcare providers are ready to include patients applied genomic information while providing care that is unbiased despite the intimate genomic knowledge and a high quality the documented examples of incorporating such information into a healthcare delivery showed both positive and negative impacts on the overall healthcare related outcomes topic computational health informatics computational health informatics is a branch of computer science that deals specifically with computational techniques that are relevant in healthcare computational health informatics is also a branch of health informatics but is orthogonal to much of the work going on in health informatics because computer scientists interest is mainly in understanding fundamental properties of computation health informatics on the other hand is primarily concerned with understanding fundamental properties of Medicine that allow for the intervention of computers the health domain provides an extremely wide variety of problems that can be tackled using computational techniques and computer scientists are attempting to make a difference in medicine by studying the underlying principles of computer science that will allow for meaningful to medicine algorithms and systems to be developed thus computer scientists working in computational health informatics and health scientists working in medical health informatics combined to develop the next generation of healthcare technologies using computers to analyze health data has been around since the 1950s but it wasn't until the 1990s that the first sturdy models appeared the development of the Internet has helped develop computational health informatics over the past decade computer models are used to examine various topics such as how exercise affects obesity healthcare costs and many more examples of projects in computational health informatics include the Coache project topic informatics for education and research in health and medicine topic clinical research informatics clinical research informatics Cree is an amalgamation of clinical and research informatics featuring both clinical and research informatics Cree has a vital role in clinical research patient care and the building of health care system Katzen and rudik 2012 Cree is one of the rapidly growing subdivisions of biomedical informatics which plays an important role in developing new informatics theories tools and solutions to accelerate the full transitional continuum Khan and Wang 2012 evolution of Cree was extremely important in informatics as there was an extraordinary increase in the scope and pace of clinical and translational science advancements Katzen and rudik 2012 clinical research informatics takes the core foundations principles and technologies related to health informatics and applies these to clinical research contexts as such Cree is a sub-discipline of health informatics and interest and activities increased greatly in recent years given the overwhelming problems associated with the explosive growth of clinical research data and information there are a number of activities within clinical research that Cree supports including more efficient and effective data collection and acquisition improved recruitment into clinical trials optimal protocol design and efficient management patient recruitment and management event reporting gila tori compliance data storage transfer processing and analysis repositories of data from completed clinical trials for secondary analyses topic history worldwide use of computer technology in medicine began in the early 1950s with the rise of the computers in 1949 Gustav Vagner established the first professional organization for informatics in Germany the prehistory history and future of medical information and health information technology are discussed in reference specialized university departments and informatics training programs began during the 1960's in France Germany Belgium and the Netherlands medical informatics research units began to appear during the 1970s in Poland and in the u.s. since then the development of high-quality health informatics research education and infrastructure has been a goal of the US and the European Union early names for health informatics included medical computing biomedical 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 the health informatics community is still growing it is by no means a mature profession but work in the UK by the voluntary registration body the UK Council of health informatics professions has suggested eight key constituencies within the domain information management knowledge management portfolio program project management ICT education and research clinical informatics health records service and business related health informatics service management these constituencies accommodate professionals in and for the NHS in academia and commercial service and solution providers since the 1970s the most prominent international coordinating body has been the International Medical Informatics Association IMI a topic in the United States even though the idea of using computers in medicine emerged as technology advanced in the early 20th century it was not until the 1950s that informatics began to have an effect in the United States the earliest use of electronic digital computers for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley during the mid-1950s the United States Air Force USAF carried out several medical projects on its computers while also encouraging civilian agencies such as the National Academy of Sciences National Research Council nas NRC and the National Institutes of Health NIH to sponsor such work in 1959 led Lee and Lee B lusted published reasoning foundations of medical diagnosis a widely read article in science which introduced computing especially operations research techniques to medical workers led Lee and Lustig's article has remained influential for decades especially within the field of medical decision making guided by led Lee's late 1950s survey of computer use in biology and medicine carried out for the NAS NRC and by his in Lustig's articles the NIH undertook the first major effort to introduce computers to biology and medicine this effort carried out initially by the nih a–'s Advisory Committee on computers in research a CCR chaired by lusted spent over 40 million dollars between 1960 and 1964 in order to establish dozens of large and small biomedical research centers in the u.s. one early 1969 a CCR use of computers was to help quantify normal human movement as a precursor to scientifically measuring deviations from normal and design of prosthesis the use of computers IBM 650 1620 and 7040 allowed analysis of a large sample size and of more measure and subgroups than had been previously practical with mechanical calculators thus allowing an objective understanding of how human locomotion varies by age and body characteristics a study co-author was Dean of the Marquette University College of Engineering this work led to discrete biomedical engineering departments there and elsewhere the next steps in the mid-1960s where the development sponsored largely by the NIH of expert systems such as my CIN and internist I in 1965 the National Library of Medicine started to use MEDLINE and meddlers around this time Neil Pappalardo Curtis marble and Robert greens developed mumps Massachusetts General Hospital utility multi-programming system in October Nets Laboratory of computer science at Massachusetts General Hospital in Boston another center of biomedical computing that received significant support from the NIH in the 1970s and 1980s it was the most commonly used programming language for clinical applications the mumps operating system was used to support mumps language specifications as of 2004 a descendant of this system is being used in the United States Veterans Affairs hospital system the VA has the largest enterprise-wide health information system that includes an electronic medical record known as the veteran's health information systems and technology architecture Vista a graphical user interface known as the computerized patient record system CPRS allows healthcare providers to review and update a patient's electronic medical record at any of the VA s over 1,000 health care facilities during the 1960's Morris Coughlin a physician working for Kaiser Permanente's division of research developed computerized systems to automate many aspects of multi-phased health check-ups these systems became the basis the larger medical databases Kaiser Permanente developed during the 1970s and 1980s the American College of medical informatics Acme has since 1993 annually bestowed the Morris F Coughlin MD medal for outstanding contributions to the field of medical informatics Kaiser Permanente in the 1970s a growing number of commercial vendors began to market practice management and electronic medical record systems although many products exist only a small number of health practitioners use fully featured electronic healthcare records systems in 1970 Warner V slack MD and Howard L bleak MD co-founded the academic division of clinical informatics at Beth Israel Deaconess Medical Center and Harvard Medical School Warner slack is a pioneer of the development of the electronic patient medical history and in 1977 dr. Blake created the first user-friendly search engine for the world's biomedical literature in 2002 dr. slack and dr. bleak were awarded the Morris F Coughlin award for their pioneering contributions to medical informatics computerized systems involved in patient care have led to a number of changes such changes have led to improvements in electronic health records which are now capable of sharing medical information among multiple healthcare stakeholders Zahabi caber and swang Mehta 2015 thereby supporting the flow of patient information through various modalities of care computer use today involves a broad ability which includes but isn't limited to physician diagnosis and documentation patient appointment scheduling and billing many researchers in the field have identified an increase in the quality of health care systems decreased errors by healthcare workers and lastly savings in time and money Sahabi caber and swang Mehta 2015 the system however is not perfect and will continue to require improvement frequently cited factors of concern involve usability safety accessibility and user friendliness Zahabi kaiba and swag Netta 2015 as leaders in the field of medical informatics improve upon the aforementioned factors of concern the overall provision of health care will continue to improve Homer R Warner one of the fathers of medical informatics founded the department of medical informatics at the university of utah in 1968 the American Medical Informatics Association amia has an award named after him on application of informatics to medicine topic informatics certifications like other IT training specialties there are informatics certifications available to help informatics professionals stand out and be recognized the American Nurses credentialing Center ancc offers a board certification in nursing informatics for radiology informatics the CI IP certified imaging informatics professional certification was created by ABI I the American Board of imaging informatics which was founded by s IIM the Society for imaging informatics in medicine and AR RT the american Registry of radiologic technologists in 2005 the CI IP certification requires documented experience working in imaging informatics formal testing and is a limited-time credential requiring renewal every five years the exam tests for a combination of IT technical knowledge clinical understanding and project management experience thought to represent the typical workload of a PACs administrator or other radiology IT clinical support role certifications from Parc a PACs administrators registry and certifications Association are also recognized the five Parc a certifications are tiered from entry-level to architect level the American Health Information Management Association offers credentials in medical coding analytics and data administration such as registered health information administrator and certified coding associate certifications are widely requested by employers in health informatics and overall the demand for certified informatics workers in the United States is outstripping supply the American Health Information Management Association reports that only 68% of applicants pass certification exams on the first try in 2017 a consortium of health informatics trainers composed of measure evaluation public health foundation India University of Pretoria Yatta University and the University of Ghana identified the following areas of knowledge as a curriculum for the digital health workforce especially in low and middle income countries clinical decision support tele health 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 and usability methods topic in the UK the broad history of health informatics has been captured in the book UK health computing recollections and reflections Hayes G Barnet D Ed's BCS May 2008 by those active in the field predominantly members of BCS health and its constituent groups the book describes the path taken as early development of health informatics was unorganized and idiosyncratic in the early 1950s it was prompted by those involved in NHS finance and only in the early 1960s did solutions including those in pathology 1960 radiotherapy 1962 immunisation 1963 and primary-care 1968 emerge many of these solutions even in the early 1970s were developed in-house by pioneers in the field to meet their own requirements in part this was due to some areas of health services for example the immunization and vaccination of children still being provided by local authorities interesting this is a situation which the coalition government proposes broadly to return to in the 2010 strategy equity and excellence liberating the NHS July 2010 stating we will put patients at the heart of the NHS through an information revolution and greater choice and control with shared decision-making becoming the norm no decision about me without me and patients having access to the information they want to make choices about their care they will have increased control over their own care records these types of statements present a significant opportunity for health informations to come out of the back office and take up a frontline role in supporting clinical practice and the business of care delivery the UK health informatics community has long played a key role in the international activity joining tc4 of the International Federation of information processing 1969 which became IMI a 1979 under the aegis of BCS Health Cambridge was the host for the first EF mi Medical Informatics Europe 1974 conference and London was the location for IMI A's 10th global Congress M EDI & fo 200 1 topic current state and policy initiatives topic Argentina since 1997 the Buenos Aires biomedical informatics group a non-profit group represents the interests of a broad range of clinical and non-clinical professionals working within the health informatics sphere its purposes are promote the implementation of the computer tool in the healthcare activity scientific research health administration and in all areas related to health sciences and biomedical research support promote and disseminate content related activities with the management of health information and tools they used to do under the name of biomedical informatics promote cooperation and exchange of actions generated in the field of biomedical informatics both in the public and private national and international level interact with all scientists recognized academic stimulating the creation of new instances that have the same goal and be inspired by the same purpose to promote organize sponsor and participate in events and activities for training in computer and information and disseminating developments in this area that might be useful for team members and health related activities the Argentinian Health System is heterogeneous in its function and because of that the informatics developments show a heterogeneous stage many private health care center have developed systems such as the hospital ailment of Buenos Aires or the hospital italiano de buenos aires that also has a residence program for health informatics topic Brazil the first applications of computers to medicine and healthcare in Brazil started around 1968 with the installation of the first mainframes in public university hospitals and the use of programmable calculators in scientific research applications many computers such as the IBM 1130 were installed in several universities and the first applications were developed for them such as the hospital census in the School of Medicine of ribeirão Preto and patient master files in the hospital das clinicas da université de Sao Paulo respectively at the cities of ribeirão Preto and Sao Paolo campuses of the University of Sao Paulo in the 1970s several digital corporation and hewlett-packard mini computers were acquired for public and armed forces hospitals and more intensively used for intensive care unit cardiology Diagnostics patient monitoring and other applications in the early 1980s with the arrival of Cheaper microcomputers a great upsurge of computer applications in health in shoot and in 1986 the Brazilian society of health informatics was founded the first brazilian congress of health informatics was held and the first brazilian journal of health informatics was published in brazil two universities are pioneers in teaching and research in medical informatics both the University of Sao Paulo and the Federal University of Sao Paulo offer undergraduate programs highly qualified in the area as well as extensive graduate programs MSC and PhD in 2015 the universidad federal Dickens's da saw de porto alegre rio grande do sul also started to offer undergraduate program topic Canada health informatics projects in Canada are implemented provincially with different provinces creating different systems a national federally funded not-for-profit organization called Canada health info Way was created in 2001 to foster the development and adoption of electronic health records across Canada as a December 31st 2008 there were 276 EHR projects underway in Canadian hospitals other health care facilities pharmacies and laboratories with an investment value of 1.5 billion dollars from Canada health info a provincial and territorial programs include the following he health Ontario was created as an Ontario provincial government agency in September 2008 it has been plagued by delays and its CEO was fired over a multi-million dollar contract scandal in 2009 Alberta net care was created in 2003 by the government of Alberta today the net care portal is used daily by thousands of clinicians it provides access to demographic data prescribed dispensed drugs known allergies intolerances immunizations laboratory test results diagnostic imaging reports the diabetes registry and other medical reports Netcare interface capabilities are being included in electronic medical record products which are being funded by the provincial government topic United States in 2004 President George W Bush signed executive order 13502 ordinator for health information technology Oh in Ch IT as a division of the US Department of Health and Human Services HHS the mission of this office is widespread adoption of interoperable electronic health records EHRs in the u.s. within 10 years see quality improvement organizations for more information on federal initiatives in this area in 2014 the Department of Education approved an advanced health informatics undergraduate program that was submitted by the University of South Alabama the program is designed to provide specific health informatics education and is the only program in the country with a health informatics lab the program is housed in the School of Computing in Shelby Hall a recently completed 50 million dollars state-of-the-art teaching facility the University of South Alabama awarded David L Loza on May 10th 2014 with the first health informatics degree the program currently is scheduled to have 100-plus students awarded by 2016 the certification Commission for healthcare information technology CCH IT a private nonprofit group was funded in 2005 by the US Department of Health and Human Services to develop a set of standards for electronic health records EHR and supporting networks and certify vendors who made them in July 2006 CCH IT released its first list of 22 certified ambulatory EHR products in two different announcements Harvard Medical School added a department of biomedical informatics in 2015 the University of Cincinnati in partnership with Cincinnati Children's Medical Center created a biomedical informatics BMI graduate certificate program in 2015 began a BMI ph.d program the joint program allows for researchers and students to observe the impact their work has on patient care directly as discoveries are translated from bench to bedside topic Europe the European Union's member states are committed to sharing their best practices and experiences to create a European a health area thereby improving access to in quality healthcare at the same time as stimulating growth in a promising new industrial sector the European health action plan plays a fundamental role in the European Union strategy work on this initiative involves a collaborative approach among several parts of the Commission services the European Institute for health records is involved in the promotion of high-quality electronic health record systems in the European Union topic UK there are different models of health informatics delivery in each of the home countries England Scotland Northern Ireland and Wales but some bodies like UK CH IP ref greater than UK CH IP C below operate for those in and for all the home countries and beyond topic England NHS informatics in England was contracted out to several vendors for national health informatics solutions under the National Programme for information technology npf IT label in the early to mid-2000s under the auspices of NHS connecting for health part of the Health and Social Care Information Center as of the 1st of April 2013 npf IT originally divided the country into five regions with strategic systems integration contracts awarded to one of several local service providers LSP the various specific technical solutions were required to connect securely with the NHS spine a system designed to broker data between different systems and care settings npf IT fell significantly behind schedule and its scope and design were being revised in real time exacerbated by media and political lambasting of the programme spent past and projected against the proposed budget in 2010 a consultation was launched as part of the new conservative Liberal Democrat coalition government's white paper liberating the NHS this initiative provided little in the way of innovative thinking primarily restating existing strategies within the proposed new context of the coalition's vision for the NHS the degree of computerization in NHS secondary care was quite high before npf IT and the programme stagnated further development of the install base the original NP F IT regional approach provided neither a single nationwide solution nor local health community agility or autonomy to purchase systems but instead tried to deal with a hinterland in the middle almost all general practices in England and Wales are computerised under the GP systems of choice GP SOC programme and patients have relatively extensive computerized primary care clinical records system choice is the responsibility of individual general practices and while there is no single standardised GP system GPS OC sets relatively rigid minimum standards of performance and functionality for vendors to adhere to interoperation between primary and secondary care systems is rather primitive it is hoped that a focus on interworking for interfacing and integration standards will stimulate synergy between primary and secondary care in sharing necessary information to support the care of individuals notable successes to date are in the electronic requesting and viewing of test results and in some areas GPS have access to digital x-ray images from secondary care systems topic scotland scotland has an approach to the central connection underway which is more advanced than the english one in some ways scotland has the GP a SS system whose source code is owned by the state and controlled and developed by NHS Scotland GP a SS was accepted in 1984 it has been provided free to all GPS in Scotland but has developed pulley discussion of open sourcing it as a remedy is occurring topic Wales Wales has a dedicated health informatics function that supports NHS Wales in leading on the new integrated digital information services and promoting health informatics as a career topic Netherlands in the Netherlands health informatics is currently a priority for research and implementation the Netherlands Federation of university medical centers nfu has created the citroen funds which includes the program's a health and registration at the source the Netherlands also has the national organizations Society for Healthcare Informatics V MBR and Nick T's the national center for standardization any health topic emerging directions European R&D the European Commission's preference as exemplified in the fifth framework as well as currently pursued pilot projects is for free Libre and open source software floss for healthcare another stream of research currently focuses on aspects of big data in health information systems for background information on data related aspects in health informatics EEG the book biomedical informatics by andreas holes in jar topic Asia and Oceania in Asia and Australia New Zealand the regional group called the asia-pacific Association for medical informatics APA mi was established in 1994 and now consists of more than 15 member regions in the asia-pacific region topic Australia the Australasian college of health informatics Archy is the professional association for health informatics in the asia-pacific region it represents the interests of a broad range of clinical and non-clinical professionals working within the health informatics sphere through a commitment to quality standards and ethical practice a qi is an academic institutional member of the International Medical Informatics Association IMI a and a full member of the Australian Council of Professions a Qi is a sponsor of the a journal for health informatics an indexed and peer reviewed professional journal a Qi has also supported the Australian health informatics education council a hie C since its founding in 2009 although there are a number of health informatics organizations in Australia the health informatics Society of Australia H is a is regarded as the major umbrella group and is a member of the International Medical Informatics Association IMI a nursing informations were the driving force behind the formation of H is a which is now a company limited by guarantee of the members the membership comes from across the informatics spectrum that is from students to corporate affiliates h is a has a number of branches Queensland New South Wales Victoria and Western Australia as well as special interest groups such as nursing Nia pathology age and community care industry and medical imaging conrick 2006 topic China after 20 years China performed a successful transition from its planned economy to a socialist market economy along this change China's health care system also experienced a significant reform to follow and adapt to this historical revolution in 2003 the data released from Ministry of Health of the People's Republic of China MOH indicated that the national healthcare involved expenditure was up to RMB 662 point three three billion totally which accounted for about five point five six percent of nationwide gross domestic products before the 1980s the entire healthcare costs were covered in central government annual budget since that the construct of healthcare expanded support has started to change gradually most of the expenditure was contributed by health insurance schemes and private spending which corresponded to 40 percent and forty five percent of total expenditure respectively meanwhile the financially governmental contribution was decreased to ten percent only on the other hand by 2004 up to two hundred and ninety six thousand 492 healthcare facilities were recorded in statistic summary of MOH and an average of 2.4 clinical beds per 1000 people were mentioned as well topic in China along with the development of information technology since the 1990s health care providers realized that the information could generate significant benefits to improve their services by computerized cases and data for instance of gaining the information for directing patient care and assessing the best patient care for specific clinical conditions therefore substantial resources were collected to build China's own health informatics system most of these resources were arranged to construct Hospital information system his which was aimed to minimize unnecessary waste and repetition subsequently to promote the efficiency and quality control of healthcare by 2004 China had successfully spread his through approximately 35 to 40 percent of nationwide hospitals however the dispersion of hospital owned his varies critically in the East part of China over 80 percent of hospitals constructed his in Northwest of China the equivalent was no more than 20 percent moreover all of the Centers for Disease Control and Prevention CDC above rural level approximately 80% of healthcare organizations above the rural level and 27 percent of hospitals over town level have the ability to perform the transmission of reports about real-time epidemic situation through public health information system and to analysis infectious diseases by dynamic statistics China has four tiers in its health care system the first tier is street health and workplace clinics and these are cheaper than hospitals in terms of medical billing and act as prevention centers the second tier is district and enterprise hospitals along with specialist clinics and these provide the second level of care the third tier is provisional and municipal general hospitals and teaching hospitals which provided the third level of care in a tier of its own is the national hospitals which are governed by the Ministry of Health China has been greatly improving its health informatics it finally opened its doors to the outside world and joined the World Trade Organization WTO in 2001 it was reported that China had three hundred and twenty four thousand three hundred and eighty medical institutions and the majority of those were clinics the reason for that is that clinics are prevention centers and Chinese people like using traditional Chinese medicine as opposed to Western medicine and it usually works for the minor cases China has also been improving its higher education in regards to health informatics at the end of 2002 there were 77 medical universities and medical colleges there were 48 university medical colleges which offered bachelor master and Doctorate degrees in medicine there were 21 higher medical specialty institutions that offered diploma degrees so in total there were 147 higher medical and educational institutions since joining the WTO China has been working hard to improve its education system and bring it up to international standards SARS played a large role in China quickly improving its health care system back in 2003 there was an outbreak of SARS and that made China hurry to spread his oar hospital information system and more than 80 percent of hospitals had his China had been comparing itself to Korea's health care system and figuring out how it can better its own system there was a study done that surveyed six hospitals in China that had his the results were that doctors didn't use computers as much so it was concluded that it wasn't used as much for clinical practice than it was for administrative purposes the survey asked if the hospitals created any websites and it was concluded that only four of them had created websites and that three had a third-party company created for them and one was created by the hospital staff in conclusion all of them agreed or strongly agreed that providing health information on the Internet should be utilized topic standards in China collected information at different times by different participants or systems could frequently lead to issues of misunderstanding dis comparing or dis exchanging to design an issues – system health care providers realized that certain standards were the basis for sharing information and interoperability however a system lacking standards would be a large impediment to interfere the improvement of corresponding information systems given that the standardization for health informatics depends on the authorities standardization events must be involved with government and the subsequently relevant funding and supports were critical in 2003 the Ministry of Health released the development layout of national health informatics 2003 to 2010 indicating the identification of standardization for health informatics which is combining adoption of international standards and development of national standards in China the establishment of standardization was initially facilitated with the development of vocabulary classification and coding which is conducive to reserved and transmitted information for premium management at national level by 2006 fifty-five international domestic standards of vocabulary classification and coding have served in hospital information system in 2003 the tenth revision of the international statistical classification of diseases and related health problems icd-10 and the icd-10 clinical modification icd-10-cm were adopted as standards for diagnostic classification and acute care procedure classification simultaneously the International classification of primary care ICPC were translated and tested in China s local applied environment another coding standard named logical observation identifies names and codes L Oh aye and see was applied to serve as general identifiers for clinical observation in hospitals personal identifier codes were widely employed in different information systems involving name sex nationality family relationship educational level and job occupation however these codes within different systems are inconsistent when sharing between different regions considering this large quantity of vocabulary classification and coding standards between different jurisdictions the healthcare provider realized that using multiple systems could generate issues of resource wasting and a non conflicting national level standard was beneficial and necessary therefore in late 2003 the health informatics group in ministry of health released free projects to deal with issues of lacking national health information standards which were the Chinese national health information framework and standardization the basic data set standards of hospital information system and the basic data set standards of public health information system topic comparison between China's EHR standard and segments of the ASTM e 1384 standard recently researchers from local universities evaluated the performance of China's electronic health record EHR standard compared with the American Society for testing and materials standard practice for content and structure of electronic health records in the United States ASTM e 1384 standard the table above demonstrates details of this comparison which indicates certain domains of improvement for future revisions of EHR standard in China meticulously these deficiencies are listed in the following the lack of supporting on privacy and security the iso/ts 18000 308 specifies the EHR must support the ethical and legal use of personal information in accordance with established privacy principles and frameworks which may be culturally or jurisdictionally specific iso 18000 308 health informatics requirements for an electronic health record architecture 2004 however this china's EHR standard did not achieve any of the 15 requirements in the subclass of privacy and security the shortage of supporting on different types of data and reference considering only ICD 9 is referenced as China's external international coding systems other similar systems such as SN ome DCT in clinical terminology presentation cannot be considered as familiar for Chinese specialists which could lead to internationally information sharing deficiency the lack of more generic and extensible lower level data structures China's large and complex EHR standard was constructed for all medical domains however the specific and time frequent attributes of clinical data elements value sets and templates identified that this once-for-all purpose cannot lead to practical consequence topic Hong Kong in Hong Kong a computerized patient record system called the clinical management system CMS has been developed by the hospital authority since 1994 this system has been deployed at all the sites of the authority 40 hospitals and 120 clinics it is used for up to 2 million transactions daily by 30,000 clinical staff the comprehensive records of 7 million patients are available online in the electronic patient record EPR with data integrated from all sites since 2004 radiology image viewing has been added to the EPR with radiography images from any higher site being available as part of the EPR the Hong Kong Hospital Authority placed particular attention to the governance of clinical systems development with input from hundreds of clinicians being incorporated through a structured process the health informatics section in the Hospital Authority has a close relationship with the information technology department and clinicians to develop healthcare systems for the organization to support the service to all public hospitals and clinics in the region the Hong Kong society of medical informatics HKS mi was established in 1987 to promote the use of information technology in healthcare the eHealth consortium has been formed to bring together clinicians from both the private and public sectors medical informatics professionals and the IT industry to further promote IT in healthcare in Hong Kong topic India eh CF school of medical informatics he Healthcare Foundation topic Malaysia since 2010 the Ministry of Health MOH has been working on the Malaysian health data warehouse my hdw project my hdw aims to meet the diverse needs of timely health information provision and management and acts as a platform for the standardization and integration of health data from a variety of sources health informatics Center 2013 the ministry has embarked on introducing the electronic hospital information systems is in several public hospitals including Sarang hospital selling hospital and university Kabang son Malaysia Medical Center UK MMC under the Ministry of Higher Education mohe a hospital information system his is a comprehensive integrated information system designed to manage the administrative financial and clinical aspects of a hospital as an area of medical informatics the aim of hospital information system is to achieve the best possible support of patient care and administration by electronic data processing his plays a vital role in planning initiating organizing and controlling the operations of the subsystems of the hospital and thus provides a synergistic organisation in the process topic New Zealand health informatics is taught at five New Zealand universities the most mature and established program has been offered for over a decade at a target health informatics New Zealand Keynes is the national organization that advocates for health informatics Hinn's organizes a conference every year and also publishes a journal healthcare informatics review online topic Saudi Arabia the Saudi Association for health information SAH I was established in 2006 to work under direct supervision of King Saud bin Abdulaziz University for Health Sciences to practice public activities develop theoretical and applicable knowledge and provide scientific and applicable studies topic post-soviet countries topic the Russian Federation the Russian healthcare system is based on the principles of the Soviet healthcare system which was oriented on mass prophylaxis prevention of infection and epidemic diseases vaccination and immunization of the population on a socially protected basis the current government healthcare system consists of several directions preventive healthcare primary health care specialized medical care obstetric and gynecological care pediatric medical care surgery rehabilitation health resort treatment own of the main issues of the post-soviet medical healthcare system was the absence of the United system providing optimization of work for medical Institute's with one single database and structured appointment schedule and hence hours long lines efficiency of medical workers might have been also doubtful because of the paperwork administrating or lost book records along with the development of the information systems IT and health care departments in Moscow agreed on design of a system that would improve public services of health care Institute's tackling the issues appearing in the existing system the Moscow government ordered that the design of a system would provide simplified electronic booking to public clinics and automate the work of medical workers on the first level the system designed for that purposes was called EMI AS united medical information and analysis system and presents an electronic health record EHR with the majority of other services set in the system that manages the flow of patients contains our patient card integrated in the system and provides an opportunity to manage consolidated managerial accounting and personalized list of medical help besides that the system contains information about availability of the medical institutions and various doctors the implementation of the system started in 2013 with the organization of one computerized database for all patients in the city including a front-end for the users emia Hesse was implemented in Moscow in the region and it is planned that the project should extend to most parts of the country topic law health informatics law deals with evolving and sometimes complex legal principles as they apply to information technology in health related fields it addresses the privacy ethical and operational issues that invariably arise when electronic tools information and media are used in healthcare delivery health informatics law also applies to all matters that involve information technology health care and the interaction of information it deals with the circumstances under which data and records are shared with other fields or areas that support and enhance patient care as many healthcare systems are making an effort to have patient records more readily available to them via the Internet it is important that providers implement security standards in order to ensure that the patient's information is safe they have to be able to assure confidentiality integrity and security of the people process and technology since there is also the possibility of payments being made through this system it is vital that this aspect of their private information will also be protected through cryptography the use of technology in healthcare settings has become popular and this trend is expected to continue various healthcare facilities had instigated different kinds of health information technology systems in the provision of patient care such as electronic health records EHRs computerised charting etc the growing popularity of health information technology systems and the escalation in the amount of health information that can be exchanged and transferred electronically increased the risk of potential infringement in patients privacy and confidentiality this concern triggered the establishment of strict measures by both policymakers and individual facility to ensure patient privacy and confidentiality one of the federal laws enacted to safeguard patient's health information medical record billing information treatment plan etc and to guarantee patient's privacy is the Health Insurance Portability and Accountability Act of 1996 or HIPAA HIPAA gives patients the autonomy and control over their own health records furthermore according to the US Department of Health and Human Services n D this law enables patients to do the following allows patients to view their own health records permits patients to request for a copy of their own medical records modify any incorrect health information provides patients with the right to know who has access to their health record grants patients the right to request who can and cannot view access their health information topic health and medical informatics journals computers in biomedical and research published in 1967 was one of the first dedicated journals to health informatics other early journals included computers and medicine published by the American Medical Association Journal of Clinical Computing published by Gallagher printing Journal of medical systems published by plenum press and m.d. computing published by Springer varying in 1984 Lippincott published the first nursing specific journal titled journal computers in nursing which is now known as computers informatics nursing CIN Journal today there are many health and medical informatics journals as of September 7 2016 there are roughly 235 informatics journals listed in the National Library of Medicine NLM catalog of journals here is a list of some of the top health and medical informatics journals Journal of medical internet research JM IRM health and new health j mir medical informatics j mir human factors j mir public health and surveillance Journal of the American Medical Informatics Association Jamia International Journal of medical informatics implementation science medical image analysis medical decision-making Journal of biomedical informatics BMC medical research methodology artificial intelligence in medicine CIN computers informatics nursing topic C also topic related concepts topic standards frameworks and governance DICOM Health metrics Network hl7 fast healthcare interoperability resources fhir integrating the healthcare enterprise oh I and see Omaha system open-air Sno Hemi D X DT topic algorithms data fly algorithm

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