The term health informatics (HI) is defined broadly as "A study of how we organise ourselves to create and run healthcare organisations to deliver the best possible healthcare information system" [1]. Health informatics is essential to bridge the research-practice gap that keeps widening with exploding medical knowledge; human brain power cannot keep pace with this explosion. Every developed nation is facing serious difficulties in the delivery of healthcare to its citizens. The causes are universal: the rise in the proportion of elderly people requiring care, the increasing cost of medical technology, patients' expectations of services and quality, and economic and social changes that reduce the state's ability to fund healthcare while increasing its involvement. All of these factors drive up costs and reduce equity of access [4].
But some World developed countries have taken initiatives to invest in and promote HI to improve health care. The United Kingdom National Programme for I.T in the National Health Service (NHS) may be the biggest health informatics project undertaken to connect more than
30,000 general practitioners and approximately 300 hospitals in a single country [2]. In 1999, the Australian government decided to double health and medical research (HMR) expenditure every 4 years [3]. Health informatics is an emerging discipline with no firm boundaries but the information processes and types intrinsic to healthcare define its scope. These processes and types encompass a broad spectrum of clinical, administrative and managerial functions & Information Systems(I.S) and Technology drives and contributes to healthcare development by facilitating the acquisition, storage, and management of health information, and by improving its flow and shown in the following diagram 1.0. These are three main spectrums in Health information [4].
This figure is determining the 3 major spectrums in the health informatics field, from managerial spectrum towards the clinical care & informatics path.
The National Health Service (NHS) in United Kingdom (UK) recently adopted a policy to improve the information quality of patient electronic records (EPR). Governing bodies like the British NHS have requirements for accountability in governance; an effective method for organizations to support their decisions is the analysis of good quality clinical information.
Informatics has been the tool for transforming pen and paper patient records into a manageable database. In a similar example of its usefulness, although the Hellenic National Health Service in Greece has a treelike managerial structure in which regional areas maintain autonomy, informatics enables effective communication within the system [13]. Informatics can also assist with education in health care. Exploring that possibility, a recent medical conference featured delegates from 18 different countries who sought the advice of medical professionals on the role of informatics in their practices. It was explained that informatics is efficient for rapid retrieval of information, scheduling appointments and monitoring repeat prescriptions [14].
Motivation:
Healthcare informatics stands at crossroads of other disciplines like (e.g.: nursing informatics, public health programs, health policy, health education, and communication science) and it is one of the most challenging and indeed most rapidly expanding field in medical sciences; it is improving its way for health care in this information technology age. Many research and survey has shown that patients are willing to use computer systems & communication technologies for health purposes. It is slow but a steady progress is helping to resolve the technological challenges, issues and organizational boundaries that interfere with providing the information technology support needed by patients in the community. Patients are playing a vital and important roles in a health care sector. There is growing recognition of understanding patient`s preferences for healthcare in making treatment decisions and in carrying out treatment schedule and action plans [10] . Patient preferences for treatment options may become a deciding factor in selecting among successful clinical treatments. These preferences also serve as guidelines for action and advising clinical care providers of the patient's wishes for life support measures [11].
Patients play an essential role in treatment, carrying out clinical directives in the home and monitoring for changes in their health states. It is logical and timely that our information technologies focus directly on the patient as an active user of informatics developments and an active beneficiary of their products. Patients require information technology to aid them as they engage in self-help, self-care and disease management activities. Some self help activities like the health learning and coaching support needed by patients to live in as healthy a way as possible and may include a social support, a general health education, and a life style modification strategy [12]. Informatics can also be used by the chronically ill via information and communication technology (ICT). Using an ICT system, the chronically ill can monitor their health (like : blood pressure, sugar levels, etc) at home while participating in a telemedicine videophone consultation with a qualified health professional. Besides identifying medical events, informatics can now guide the development of infrastructure. The Healthcare Cost and Utilization Project (HCUP), a public-private partnership, is using informatics to assemble a health care data system across the entire United States [13].
Healthcare Informatics in the current era:
Actually H.I is the field that is concerns itself with cognitive, information processing, communication tasks of medical practice and education [5]. Until the healthcare informatics focused on developing applications for health sector and medical informaticians looked at medical practice mainly through the eyes of health professionals rather than through the eyes of patients.
Round about fifteen years ago in [5] it is said that "After many years of development of information systems to support the infrastructure of medicine, greater focus on the needs of physicians and other health care managers and professionals is occurring to support education, decision making, communication, and many other aspects of professional activity". The increasing availability of interactive information that is accessible to patient most notably through the internet and related technologies such as web T.V and satellite radio coincides with the desire of most consumers to assume more responsibility for their health and the pressures of costs on health systems, the emphasis on the health of populations and on prevention, and the growing desire of health professionals to realize the potential of patients and their families [7, 8].
In diagram 1.1 we can clearly see that the focus of traditional medical informatics is shifting towards the modern professionals, technologist and other stakeholders.
Recent Enhancement in HI
The computer technology is not always the most effective medium for delivering information; it is a source in health informatics that is concerned with;
Analyzing consumer preferences, information needs, and information use [6].
Developing; evaluating methods and applications to support consumers in obtaining health information [6].
Developing; evaluating methods and applications to integrate into information management systems in clinical practice, education, and research [6].
Investigating determinants, conditions, elements, models, and processes to design, implement, and maximize the effectiveness of computerized information & telecommunication and network systems for consumers; and health professionals [6].
Although the information society offers tremendous potential for reducing the knowledge gap between a health care professionals and patients, it also brings a risk of a widening of gap between those who have access to improved communication and computer technology and those who have been excluded [9]. Following are some major enhancement in the field of health informatics;
Several initiatives are addressing about the quality of healthcare information on the internet are being developed, including programmes to educate the patients and the stakeholders [9].
Software designed to help users clarify their values and computer based decision aids can help patients to make informed choices [9].
Existing systems aimed at professionals are being adapted to be used at home by patients.
E.H.R that is accessible to patients empowers stakeholders and can be used to tailor health information to individuals [9].
Research for a better Healthcare Informatics Systems
The health care sector is an important part of our society and, regarding informatics research & the ICT industry, it represents a considerable economic and financially attractive area of application. First, I would like to characterize the current state of ICT in general followed by health care in particular;
The percentage of ICT in health care on the world-wide ICT market is difficult to estimate. The following numbers may, however, indicate the significance of ICT in health care. The estimated size of the overall health care ICT market in the US was about 16.5 billion D in 1998 [16]. Around 3 billion $ were spent in the US just for hospital information systems, compared to 2.6 billion € in the European Union (EU) [17]. In 1999, the German Research Association funded hardware & software investments for 36 German university hospitals with 27 million €. The total amount of investments for hardware and software of these hospitals was estimated to be in the range of 100 to 200 million €. In 1996, in the EU the costs for health care, including the costs for the approx. 14,000 hospitals, amounted to 814 billion € which is 8.7% of the total GDP of all EU countries [18]. In 1998, the costs for the approx. 2,200 German hospitals with their 570,000 beds amounted to 107 billion €. 1.1 million People worked in these institutions in Germany, and 16 million in-patients were treated [19]. There is a significant and increasing economic relevance of ICT in general and also in medicine and in health care. It even has an enormous significance for national economies.
Applications of healthcare Informatics:
There is a variety of different applications of health informatics; but the main and most visible application is an Electronic Medical Record.
Electronic Medical Records
A core application using patient`s specific information is the electronic medical record [20]. The paper based medical record has its tradition and virtues; however, research has shown it can be illegible, incomplete, difficult to access in more than one place, and insecure from unauthorized uses and users [20]. Although the EMR overcomes some of these problems, there are challenges to implementing the EMR at the levels of the individual and the organization. The main challenge to individual use of the EMR has been its integration into the busy clinical workflow. The few studies that have been performed show computerized physician order entry (CPOE) adds time for the clinician, although other time savings are usually gained elsewhere through error reduction or the automation brought about by other features of the EMR (example: accessing test results) [21]. A related challenge is determination of the optimal computing device for the clinical setting. Handheld computers (also called PDA- personal digital assistants) are increasingly popular, as documented by their use by internal medicine and family practice physicians [22]. At the organizational level, the key challenges have been managing complex informatics applications and the computer networks upon which they run. Although individual computers are relatively inexpensive, maintaining large networks of them and training the myriad of health care workers is not an easy job. A final challenge to all involved with the EMR the protection of patient privacy and confidentiality, with the Health Insurance Portability & Accountability Act legislating their protection at substantial cost and efforts [23].
The Grand Challenges' in healthcare Informatics:
Discovery of proper management and information tools
Most of the health informatics applications employed today was conceived with the user model of a professional user. These applications presuppose knowledge levels, motivation & skill levels more commonly found in health care workers, not health care consumers. Yet, as health services become more specialized, patients themselves must assume many of information processing and knowledge integration activities. In absence of cross-institutional records and communication systems, it is up to the patient to convey the treatment plan of one clinician to another. Furthermore, the reduction in the time available for professional service places time urgency on the encounter, reducing the opportunity for patient teaching and coaching activities [12].
Literacy for all the stakeholders
Access to health information via the Web or other H.I application is only as useful as the patient's ability to comprehend and interpret it. Beyond the functional literacy needed for daily living, patients require the capacity to seek out, acquire & interpret both general health information and that specific to their own situation. Educational strategies that help improve the scientific literacy of the general population provide a modicum of assistance; still required for all citizens is basic skill in understanding body processes, disease models, and their relevance in an individual's life [12].
Good Modelling for Clinical practices to capitalise patients
For every problem the technology is not the answer. As patients develop the knowledge, skill and motivation to participate in their care, and have better access to information technologies to support their participation, clinical practice will need to change. Re-examination of the activities within the clinical encounter will facilitate highlighting of activities that have become redundant or which could be moved to a time prior to, or following the clinical encounter. Additionally, as the perspective of health services moves from the episode of encounter to the context of the patient, new elements may need to be added to the clinical encounter. To fully capitalize on the patient as collaborator requires an individualization of treatment presently not accounted for in the system. Patients with the capacity for high levels of participation will require a different constellation of services than those with more restricted capacities for participation [12].
Recommendations for Health care Professions:
Health professions should retool their skills and develop a healthcare informatics infrastructure. That will aid the efforts to improve patient safety, reduce costs, and enhance both the effectiveness and the quality of health care. Different Events and programs in educating health services administrators, establishing an interdisciplinary training and research in informatics and performance improvement should result in a framework at professional level. The formation of partnerships with leaders in the health care industry who may want to shape the research and educational agendas will yield fruitful results. Healthcare informatics is an interdisciplinary field that draws upon knowledge from computer, information, cognitive, management and health care sciences. The field of healthcare informatics is defined as the study of computer and information science applications within the context of health care management to compile, manage, and process data and knowledge for delivering quality health care and improving the performance of health care organizations. The health care system will then deal more effectively with significant medical events, infrastructure support and the exploration of information technologies [15]. Finally raising a scope and providing a quality of education in the field of health & medical informatics and having well educated health professionals worldwide would considerably help to raise the quality & efficiency in healthcare.
Conclusion:
Although considerable challenges remain, the impact of medical informatics will certainly grow. The improvement in medical documentation, reducing error, and empowering patients would continue to motivate use of information technology in health care. There is plenty of evidence that healthcare informatics applications can address these imperatives to enhance patient outcomes, reduce costs, and provide access to knowledge. In the year 1990 [24] the author has mentioned a good point for health professionals that "it is increasingly difficult to practice modern medicine without information technologies". However in these days there is an additional trend that it is also increasingly unlikely that health professionals will encounter patients who have not used information technology to influence their health knowledge, health behavior and perception of symptoms. Healthcare professionals should understand that consumer health applications are important but also ensure that these applications are effectively developed, applied and evaluated properly. The optimal use of health informatics applications will require some reengineering of the health care system. It will be crucial for the medical informatics field to account for the needs and concerns of all parties who participate in the process: patients, clinicians, payers, and governments. Clinicians will have to accept some impact on their practices, particularly as the individual physician becomes more accountable to document increasingly expensive care and demonstrate avoidance of error. The key challenge across all applications will be adherence to the basic goals of the science of medical informatics: developing systems that are easy to use and provide demonstrable benefit.
