Informatics: What does it mean for JMU?
by Jennifer McCabe, Health Sciences Librarian
 

Robert Greenes and Edward Shortliffe coined the official definition of medical informatics in 1990:   “Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education and research including the information science and technology to support these tasks.” In the same article they went on to describe the teaching of informatics in medical schools, stressing its intrinsically interdisciplinary nature.  Originally it was called “computers in medicine"; however that definition quickly became outdated when it was understood what was really being studied was information and that health care is more than simply the practice of medicine.  The simplest and broadest definition may be “the application of information technology to enhance patient care.”

Here at JMU we don’t have a medical school, but we do have a number of programs that prepare students for work in medical settings, either as clinicians, administrators, or in the information technology arena.  Doctors are not the only practitioners who interact with patients (or health care consumers); nurses, therapists, physician assistants, social workers, and frequently billing personnel and other administrators all make up the team that delivers health care services.  Behind the scenes are the network administrators and information systems staff that manage the flow of data and information.  All of these people need to work together to manage the vast amounts of information involved in the delivery of health care services, information needed for diagnosis and monitoring, decision support, patient education, billing and reimbursement.  With this need in mind, a course was created that would prepare students to work in interdisciplinary teams to meet health care challenges.   The course was developed in 2001, first offered in the spring of 2002, and is being offered again this fall.  Informatics for Health Care Professionals is an interdisciplinary class, cross-listed with nursing, health sciences, social work and ISAT.

The conceptual components of Health Care Informatics include database design; human-computer interaction; medical vocabularies; coding systems; clinical information systems; decision support and analysis (evidence based medicine); use of biomedical and genomic sequencing databases; government regulation of medical information; health literacy and evaluation studies.  The following is a description of some of these components of the class currently being offered:

• Medical Vocabularies & Coding:  Currently there are multiple controlled vocabularies and coding schema being used in health care.  The literature of medicine is accessed and described through the medical subject headings (MeSH), procedures get CPT codes, diagnoses get ICD-9 codes, nursing interventions have various codes, and mental health diagnoses get DSM-IV codes.  Because health information is collected in and retrieved from different kinds of systems there is a need for a thesaurus so that the codes can be understood by disparate systems.  The National Library of Medicine has developed the Unified Medical Language System to do just this.
  
• Evidence Based Medicine:  One of the advantages of our technology capabilities is that clinical evidence can be quickly gathered and applied to individual situations.  For example, the data regarding the use of a drug in a particular population can be used to support the decision to prescribe or not prescribe that drug to an individual.  Decision support involves the judicious use of data to assist in diagnostic and treatment decisions.  Informatics studies both the capture and application of data.
  
• Human Computer Interaction:  Computer hardware and software in health care must be carefully designed since lives can depend on their functioning.  Database design, interface design, and ergonomics are all things to consider when implementing new systems or devices in any facility.  What works for administrators for example, may be ineffective or even dangerous to nurses.  HCI must be approached from a team perspective in order to design, select, and implement the best systems.
  
• Government Regulation:  The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a piece of legislation that regulates medical records privacy and the electronic transmission of health care information.  Although the law is several years old, the regulations are just beginning to take effect, and they will touch almost every kind of health care facility in which our students will work. 
  
• Health Literacy:  Studies of literacy in America have revealed that nearly 90 million Americans are functionally or marginally illiterate.  Low health literacy can lead to increased health care costs, increased hospitalization, and poor management of chronic conditions.  The Internet offers great potential to provide access to health information, but information literacy skills must be taught in order for consumers to choose quality resources on which to base health care decisions.

Libraries and librarians are involved in the study and teaching of health and medical informatics for a number of reasons.  Librarians have expertise in classifying information, retrieving information, using databases, teaching information literacy and retrieval, and using controlled vocabularies.  The National Library of Medicine has been a leader in educational efforts and financial support for research and teaching in Informatics.  Librarians in health sciences and medical libraries and hospitals around the country are creating innovative ways of integrating the vast amount of health related information on the Internet into patient care.  At Vanderbilt University there is a service called Patient Informatics Consult Service (PICS) where patients are given “information prescriptions” by their doctors.  These prescriptions are taken to the library where they are “filled” by librarians who are uniquely qualified to assist the patient in finding appropriate information for them and their health condition.  This information prescription is integrated into the patient record, in an effort to empower the patient to make informed decisions about their care.  This is just one of many ways librarians are involved in the study and application of informatics in the health care arena.

Because Informatics is intrinsically interdisciplinary and intertwined with technology, it is a constantly evolving discipline.  In addition to health care informatics, there are separate disciplines of nursing informatics, dental informatics, public health informatics, and consumer health informatics, just to name a few.  As health care evolves so will the study of informatics.  There are many opportunities for expansion of course offerings and for future research in informatics. 

Jennifer McCabe, Health Sciences Librarian, is a member of the teaching team for Informatics for Health Care Professionals.--ed.