Informatics hold the key to more efficient, reliable and safer healthcare.
Computer technology in the medical sector has in recent years tended to occupy opposite ends of the IT spectrum - from highly advanced patient treatment systems, to more workaday healthcare administration applications.
However, there has been a limitation common to both of these extremes: they have been built up using systems that are tailor-made for healthcare environments, rather than more transferrable mainstream packages.
This means that, although such systems perform optimally within their specific field, they are less adept at joining up to share data and functionality.
A realisation of the benefits of greater integration between systems has pushed the case for a redefinition of health informatics that defines a unified approach to key objectives. Medical centres and disparate NHS trusts can be given more flexible, usable approaches to such staples as patient care, treatment support, resource allocation, and medical research and development.
It is possible: the business sector has made significant progress towards resolving its informatics issues between proprietary systems. However, the challenge facing healthcare systems remains - as ever - more complex than mere business. Healthcare IT has to contend with a range of issues that have limited the extent to which its core systems can embrace the interconnected world. Many medical systems are, for instance, supporting life-critical operations every day, and this places constraints on how systems can be reconfigured or upgraded. And there remains a significant legacy investment in hospital systems. There are fewer standards for potential vendors to refer to.
According to the UK Health Informatics Society, the term 'health/healthcare informatics' is replacing the previously more common term 'medical informatics'. This reflects a concern to define an agenda for health services that "recognises the role of citizens as agents in their own care, as well as the major information-handling roles of the non-medical healthcare professions".
Evolution of terms
Medical informatics has evolved as a new field in a relatively short period of time, according to the authors of the 'Practical Guide for the Healthcare Professional' (MDs Robert Hoyt, Melanie Sutton, and Ann Yoshihashi). Its emergence is partly due to the multiple problems now facing the practice of medicine, they say, as clinicians need to be more efficient, reduce medical error rates, migrate to fully-digital records systems, and have reference information and patient data easily and speedily accessible.
Establishing these skills is the primary challenge for the industry, the book points out, as "Healthcare workers need to be 'bilingual' in both technology and medicine… With the increasing use of technology, more skilled healthcare workers will be needed for implementation and training".
Among the primary impetuses driving what some pundits are already calling 'health informatics 2.0' are the need to reduce costs, improve patient safety, and improve the quality of medical care.
Part of the drive for cost-efficiency is aimed at maximising return on investment (ROI) - an objective that has long been lauded in the commercial world. Integrated systems make possible metrics that can validate ROI as a result of capital upgrades to primary systems.
"Moving information from proprietary platform to proprietary platform is expensive, risky, and slow," says John Crawford of IBM's Healthcare Solutions Healthcare & Life Sciences division. "A major goal of improved health informatics is to enable and support operational efficiencies in healthcare processes, in a similar way to that already seen in other sectors."
Patient safety is part of this, both because it minimises any problems that might prolong patients' contact with the healthcare process, but also because, each year, compensation claims due to malpractice or negligence is costing medical bodies millions in compensation payouts.
As IBM's John Crawford observes, "The better the information available to them, the better informed the decisions physicians can make, and this will reduce instances of misdiagnosis, and so the number of claims for compensation brought by dissatisfied patients."
A number of trailblazing projects - such as the Electronic Health Record scheme - are structured to exemplify the ideals of a fully-integrated informatics. This can fulfill a number of different aspirations of healthcare informatics of the future.
The 'h' word
Next-generation health informatics is also about ensuring that IT systems in medicine support the multi-disciplinary ethos that shapes current thought in how healthcare should best be practiced. The dreaded 'h' word - holistic - means that, instead of patients being passed from specialist to specialist, healthcare workers should collaborate more closely in delivering such a holistic treatment programme.
Interest is growing in the multi-disciplinary approach to patient care in health services, and this is partly engendered by ageing populations. Many elderly patients suffer conditions that include multiple ailments which, previously, would have been treated as singular disorders by respective specialists. "Now doctors are realising that multiple ailments are often - indeed usually - interrelated, so it make sense to address treatment collaboratively," says IBM's John Crawford. "Unified informatics does much to help break down the barriers between different medical disciplines, and facilitate a single point of treatment."
The cross-disciplinary ethos is central to the UK National Programme for IT (NPfIT), and is an initiative by the Department of Health to move the NHS towards a single, centrally-mandated electronic care record for patients, and to connect 30,000 general practitioners to 300 hospitals. The Department of Health agency NHS Connecting for Health is delivering this agenda. In the longer term it is planned that patients will also have access to their records online via a service called HealthSpace. The NHS CFH agency claims NPiIT to be "the world's biggest civil IT programme", and its remit includes a number of specific deliverables.
One such flagship project is The NHS Care Records Service, a secure electronic health records service that links patient information from different parts of the NHS electronically, so that authorised NHS staff and patients have the data needed to make care decisions.
However, though there is no shortage of potential, implementing it across such a diverse user base will take a lot longer than rolling-out new applications to, say, consumers or enterprise users.
"Technology has advanced tremendously, but there are still some obstacles," says Shushma Patel, professor of information systems at London South Bank University's Faculty of Business, Computing & Information Management, who is investigating clinical guidelines and how they can be used to manage knowledge in healthcare. "Security, of course, is as much a psychological issue as a technical one. Patients read the headlines about hacking and lost data. We have to prove that the IT security in healthcare is better than that."
"Standardisation is a pressing question in healthcare IT," says IBM's John Crawford. "If you look at systems found in different departments of a hospital, such as radiology, pathology, oncology and surgery - in most cases they were implemented as departmental solutions, not designed to share data and functionality with each other, so introducing interoperability is daunting.
"Furthermore, different medical departments use systems from many different suppliers, so broad industry support for consistent adoption of standards, as promoted by the IHE (Integrating the Healthcare Enterprise) for example, is absolutely essential."
IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as Digital Imaging and Communications in Medicine (DICOM) and Health Level 7 (HL7) to address specific clinical needs in support of optimal patient care. DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition, and a communications protocol that acts as an application protocol that uses TCP/IP to communicate between networked systems. DICOM files can be exchanged between two platforms that are capable of receiving image and patient data in DICOM format. HL7, meanwhile, is a global organisation involved in the development of international healthcare standards. HL7 also refers to some of the specific standards created by the organisation (such as HL7 v2.x, -v3.0, HL7 RIM).
More patients needed
But it is not just medicos' requirements that are directing informatics in healthcare: input from patients is of high importance. Patients are increasingly encouraged to take a proactive interest in their own conditions.
This can take the form of simply educating themselves about their conditions and treatments on the Internet, through to making appointments and checking test results online, and more sophisticated applications like telemedicine and telemonitoring, where parties assist doctors in remotely gathering and transmitting data monitoring their symptoms and metabolism.
These enhanced levels of care need to be administrated. Patients entering and leaving hospital, providing collateral documentation, responding to performance surveys - all this needs to be captured and processed, and related to other aspects of patients' information profile. Elsewhere on the system the aggregated data could provide vital data to researchers and clinicians who are engaged to research projects, pharmaceutical trials, and such like.
And patient record systems need to be as portable as the patients are, believes London South Bank University's Professor Shushma Patel: "Remember that patients travel around even when they are unwell, and may be availing themselves to healthcare in other EU countries - as they are entitled to do. This mandates that healthcare informatics need to facilitate an element of portability, and this is another important challenge."
From the bigger picture, all this data can feed into databases that can be analysed to provide statistics that show where new informatics processes are making a difference, and where they are not. Public health metrics enable governors to allocate resources and direct attention on the wider scale.
Big-picture views of national and regional trends can also make a crucial contribution to reacting to health-related emergencies: natural and man-made disasters, acts of terrorism, and infection outbreaks, as demonstrated by initiatives like MECIDS (see panel, right).
Lastly, healthcare informatics is a global issue - both in terms of ensuring that health bodies in developed nations establish consensus in respect to best practice, but also to use experience in developing nations to assist them in tackling their own specific healthcare issues.