A stimulus to define informatics and health information technology

Researching big IT in the UK National Health Service: A systematic review of theory-based studies

OBJECTIVE

To identify and discuss theory-based studies of large-scale health information technology programs in the UK National Health Service.

MATERIALS AND METHODS

Using the PRISMA systematic review framework, we searched Scopus, PubMed and CINAHL databases from inception to March 2022 for theory-based studies of large-scale health IT implementations. We undertook detailed full-text analyses of papers meeting our inclusion criteria.

RESULTS

Forty-six studies were included after assessment for eligibility, of which twenty-five applied theories from the information systems arena (socio-technical approaches, normalization process theory, user acceptance theories, diffusion of innovation), twelve from sociology (structuration theory, actor-network theory, institutional theory), while nine adopted other theories. Most investigated England's National Program for IT (2002-2011), exploring various technologies among which electronic records predominated. Research themes were categorized into user factors, program factors, process outcomes, clinical impact, technology, and organizational factors. Most research was qualitative, often using a case study strategy with a longitudinal or cross-sectional approach. Data were typically collected through interviews, observation, and document analysis; sampling was generally purposive; and most studies used thematic or related analyses. Theories were generally applied in a superficial or fragmentary manner; and articles frequently lacked detail on how theoretical constructs and relationships aided organization, analysis, and interpretation of data.

CONCLUSION

Theory-based studies of large NHS IT programs are relatively uncommon. As large healthcare programs evolve over a long timeframe in complex and dynamic environments, wider adoption of theory-based methods could strengthen the explanatory and predictive utility of research findings across multiple evaluation studies. Our review has confirmed earlier suggestions for theory selection, and we suggest there is scope for more explicit use of such theoretical constructs to strengthen the conceptual foundations of health informatics research. Additionally, the challenges of large national health informatics programs afford wide-ranging opportunities to test, refine, and adapt sociological and information systems theories.

Health information science and technology education: An analysis of health informatics undergraduate and postgraduate programs in arab countries

Rapid advancements in information technology have laid the basis for the move to information management job positions and health informatics education. In fact, information technology becomes an essential component of different healthcare educational programs worldwide. However, scholarly research about health informatics, particularly, in developing countries is still limited. This study is the first investigation to assess and compare health informatics (HI) educational programs across different Arab countries. Websites of all universities and colleges in the Arab world were surveyed and examined. 35 programs in 9 countries have been identified. To systematically collect and evaluate data, a categorization of different variables to assess and compare HI programs has been developed. HI programs in Saudi Arabia and Egypt represent the largest proportion of programs. Most programs are offered by public institutions and belong to medical faculties. 69% of HI educational offerings are undergraduate programs while only 31% are postgraduate programs. HI programs vary in terms of their titles. However, these programs have used the titles 'health informatics', and ' health information management' more frequently. There has also been an uneven distribution in terms of the total hours of programs. The structure of the study plan of 51% of HI programs are built on compulsory courses only. The study has presented a framework that indicates strengths, weaknesses, and emerging trends of HI programs and highlights potential challenges, opportunities, and recommendations to improve such programs.

Reflections Towards the Future of Medical Informatics

OBJECTIVE

To provide guidance on the future development and role of medical informatics, or biomedical and health informatics, in form of reflections.

METHOD

To report on the author's previous activities as a medical informatician, which spans almost half a century. It began in 1973 when he started to study medical informatics. In 1978, more than four decades ago, his professional work started. He retired at the end of summer semester 2021. This was the occasion to prepare this farewell lecture.

RESULTS

In twenty reflections, thoughts are presented on professional careers (R1 - 'places'), on medical informatics as discipline (R2 - 'interdisciplinarity', R3 - 'focuses', R4 - 'affiliations'), on research (R5 - 'duality', R6 - 'confluences', R7 - 'correlations', R8 - 'collaboration'), on education (R9 - 'community', R10 - 'competencies', R11 - 'approaches'), on academic self-governance (R12 - 'autonomy'), on engagement (R13 - 'Sisyphos', R14 - 'professional societies', R15 - 'respect', R16 - 'tightrope walk'), and on good scientific practice (R17 - 'time invariants', R18 - 'Zeitgeist', R19 - 'knowledge gain', R20 - 'exercising').

CONCLUSIONS

It has been a pleasure for me to participate in medical informatics activities for almost fifty years. During that time, there have been significant advances, including in medicine and in informatics, and also in medical informatics itself. And now it is the turn of others. While keeping in mind that tradition is not preserving the ashes, but passing on the fire, this report with its reflections may be of some help.

The Role of Health Information Technology in Improving Awareness of Human Papillomavirus and Human Papillomavirus Vaccine Among U.S. Adults

Objective: Although human papillomavirus (HPV) vaccines prevent cancer-causing HPV infections and cervical precancers, there is suboptimal awareness and limited global accessibility of HPV and HPV vaccine. Emerging evidence suggests that health information technology (HIT) may influence HPV-related awareness and improve vaccine adoption. The objective of this study was to evaluate the link between HIT and HPV-related awareness Methods: Data were obtained from 1,866 U.S. adults aged 18-45 years who completed the 2017 and 2018 Health Information National Trends Survey. We conducted multivariable logistic regression to analyze the association between HIT utilization and HPV-related awareness. Results: Awareness of HPV and HPV vaccine were 72.7% and 67.5%, respectively. Participants who used electronic means to look up health information (adjusted odds ratio [aOR] = 3.05; p = 0.001), communicate with health care provider (aOR = 1.68; p = 0.026), look up test results (aOR = 1.94; p = 0.005), and track health costs (aOR = 1.65; p = 0.04) were more likely to report HPV awareness than those who did not. Participants who used an electronic device to look up health information (aOR = 3.10; p = 0.003), communicate with clinicians (aOR = 1.72; p = 0.008), look up test results (aOR = 1.63; p = 0.021), and track health care charges (aOR = 1.90; p = 0.006) were more likely to report HPV vaccine awareness than those who did not. Discussion and Conclusion: Our findings suggest a positive association between HIT utilization and HPV-related awareness. Given the rapid and exponential increase in mobile technology access globally, these results are encouraging and offer a potential opportunity to leverage digital technology in primary cancer prevention for HPV-related cancers, especially in low- and middle-income countries with unsophisticated health infrastructures.

Biomedical and health informatics teaching in Portugal: Current status

Background

The domain of Biomedical and Health Informatics (BMHI) lies in the intersection of multiple disciplines, making it difficult to define and, consequently, characterise the workforce, training needs and requirements in this domain. Nevertheless, to the best of our knowledge, there isn't any aggregated information about the higher education programmes in BMHI currently being delivered in Portugal, and which knowledge, skills, and competencies these programmes aim to develop.

Aim

Our aim is to map BMHI teaching in Portugal. More specifically, our objective is to identify and characterise the: a.) programmes delivering relevant BMHI teaching; b.) geographical distribution and chronological evolution of such programmes; and c.) credit distribution and weight.

Methods

We conducted a descriptive, cross-sectional study to systematically identify all programmes currently delivering any core BMHI modules in Portugal. Our population included all graduate-level programmes being delivered in the 2021/2022 academic year in any Portuguese higher education institution.

Results

We identified 23 programmes delivering relevant teaching in BMHI in Portugal. Of these, eight (35%) were classified as dedicated educational programmes in BMHI, mostly delivered in polytechnic institutes at a master's level (5; 63%) and located preferentially in the northern part of the country (7). Currently, there are four programmes with potential for accreditation but still requiring some workload increase in certain areas in order to be eligible.

Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics: Second Revision

BACKGROUND

The purpose of educational recommendations is to assist in establishing courses and programs in a discipline, to further develop existing educational activities in the various nations, and to support international initiatives for collaboration and sharing of courseware. The International Medical Informatics Association (IMIA) has published two versions of its international recommendations in biomedical and health informatics (BMHI) education, initially in 2000 and revised in 2010. Given the recent changes to the science, technology, the needs of the healthcare systems, and the workforce of BMHI, a revision of the recommendations is necessary.

OBJECTIVE

The aim of these updated recommendations is to support educators in developing BMHI curricula at different education levels, to identify essential skills and competencies for certification of healthcare professionals and those working in the field of BMHI, to provide a tool for evaluators of academic BMHI programs to compare and accredit the quality of delivered programs, and to motivate universities, organizations, and health authorities to recognize the need for establishing and further developing BMHI educational programs.

METHOD

An IMIA taskforce, established in 2017, updated the recommendations. The taskforce included representatives from all IMIA regions, with several having been involved in the development of the previous version. Workshops were held at different IMIA conferences, and an international Delphi study was performed to collect expert input on new and revised competencies.

RESULTS

Recommendations are provided for courses/course tracks in BMHI as part of educational programs in biomedical and health sciences, health information management, and informatics/computer science, as well as for dedicated programs in BMHI (leading to bachelor's, master's, or doctoral degree). The educational needs are described for the roles of BMHI user, BMHI generalist, and BMHI specialist across six domain areas - BMHI core principles; health sciences and services; computer, data and information sciences; social and behavioral sciences; management science; and BMHI specialization. Furthermore, recommendations are provided for dedicated educational programs in BMHI at the level of bachelor's, master's, and doctoral degrees. These are the mainstream academic programs in BMHI. In addition, recommendations for continuing education, certification, and accreditation procedures are provided.

CONCLUSION

The IMIA recommendations reflect societal changes related to globalization, digitalization, and digital transformation in general and in healthcare specifically, and center on educational needs for the healthcare workforce, computer scientists, and decision makers to acquire BMHI knowledge and skills at various levels. To support education in BMHI, IMIA offers accreditation of quality BMHI education programs. It supports information exchange on programs and courses in BMHI through its Working Group on Health and Medical Informatics Education.

A Framework for Automatic Clustering of EHR Messages Using a Spatial Clustering Approach

Although Health Level Seven (HL 7) message standards (v2, v3, Clinical Document Architecture (CDA)) have been commonly adopted, there are still issues associated with them, especially the semantic interoperability issues and lack of support for smart devices (e.g., smartphones, fitness trackers, and smartwatches), etc. In addition, healthcare organizations in many countries are still using proprietary electronic health record (EHR) message formats, making it challenging to convert to other data formats-particularly the latest HL7 Fast Health Interoperability Resources (FHIR) data standard. The FHIR is based on modern web technologies such as HTTP, XML, and JSON and would be capable of overcoming the shortcomings of the previous standards and supporting modern smart devices. Therefore, the FHIR standard could help the healthcare industry to avail the latest technologies benefits and improve data interoperability. The data representation and mapping from the legacy data standards (i.e., HL7 v2 and EHR) to the FHIR is necessary for the healthcare sector. However, direct data mapping or conversion from the traditional data standards to the FHIR data standard is challenging because of the nature and formats of the data. Therefore, in this article, we propose a framework that aims to convert proprietary EHR messages into the HL7 v2 format and apply an unsupervised clustering approach using the DBSCAN (density-based spatial clustering of applications with noise) algorithm to automatically group a variety of these HL7 v2 messages regardless of their semantic origins. The proposed framework's implementation lays the groundwork to provide a generic mapping model with multi-point and multi-format data conversion input into the FHIR. Our experimental results show the proposed framework's ability to automatically cluster various HL7 v2 message formats and provide analytic insight behind them.

The Understanding of Medical Informatics among Dental and Medical Students

Background

Current medical care deeply relies on informatics during all stages of patient care, which is significantly enhanced due to its use. The healthcare professional's formation in medical informatics results crucial for their everyday practice. However, healthcare study programs not always provide education about the use of this wide variety of systems, and young professionals find that they need to learn about it over the experience. The aim of this study was to assess the understanding of medical and dental students regarding medical informatics and ICTs.

Materials and Methods

A questionnaire was produced with 3 sections and a total of 24 questions. Students replied to the survey before and after taking the medical informatics course.

Results

A total of 719 students from second year of medical and dental school were recruited for the study between the period of September of 2017-May 2018, September 2018-May 2019, September 2019-May 2020, and September 2020-May 2021. Medical and dental students showed a good level of understanding regarding medical informatics, as well as a good perception of the relevance of ICT learning for the professional practice. Course attendance increased the percentage of students that felt confident of their knowledge about medical informatics. However, most students felt that little or no medical informatics education was lectured at their schools and that the University should adapt the academic program to include it. After taking the course, the student's perception on this matter was improved.

Conclusion

Medical and dental students find medical informatics learning useful for their future professional practice and feel inclined to use it. However, they feel that Universities need to adapt their programs in order to include medical education courses and trainings; partly because they are not completely aware of the use of ICTs that already are established in their courses.

On the Current Connection and Relation Between Health Informatics and Social Informatics

Scholars from the health and medical sciences have recently proposed the term social informatics (SI) as a new scientific subfield of health informatics (HI). However, SI is not a new academic concept; in fact, it has been continuously used in the social sciences and informatics since the 1970s. Although the dominant understanding of SI was established in the 1990s in the United States, a rich international perspective on SI has existed since the 1970s in other regions of the world. When that perspective is considered, the fields of understanding can be structured into 7 SI schools of thought. Against that conceptual background, this paper contributes to the discussion on the relationship between SI and HI, outlining possible perspectives of SI that are associated with health, medical, and clinical aspects. This paper argues against the multiplication and inconsistent appearance of the term SI when newly used in health and medical sciences. A more explicit name for the area that uses health and social data to advance individual and population health might be helpful to overcome this issue; giving an identity to this new field would help it to be understood more precisely and bring greater separation. This labeling could be fruitful for further segmentation of HI, which is rapidly expanding.

Competency analysis and educational strategies to meet the demand for a learning health system workforce

Learning Health Systems (LHS) require a workforce with specific knowledge and skills to identify and address healthcare quality issues, develop solutions to address those issues, and sustain and spread improvements within and outside the organization. Educational programs are tasked with designing learning opportunities that can meet these organizational needs. This manuscript explores different mechanisms for addressing challenges to creating educational programs to prepare individuals who can work in and lead LHS. Strategies and recommendations for educational programs to support the LHS include the creation of a new program, collaborating across existing programs, and producing a set of instructional materials.

Characterization of doctor of pharmacy/health informatics dual degrees in the United States

INTRODUCTION

Health care is trending towards an increasing reliance on data management, technology, analytics, and automation which is also reflected in pharmacy education. This study aimed to identify and characterize doctor of pharmacy (PharmD)/master of science in health informatics (MSHI) dual-degree offerings at pharmacy institutions within the United States (US).

METHODS

A list of PharmD/MSHI programs was obtained from the American Association of Colleges of Pharmacy and the Pharmacy College Application Service. Furthermore, websites of the 143 accredited schools and colleges of pharmacy in the US were inspected to identify additional PharmD/MSHI dual degrees not identified with the previous sources and to verify that the dual degree was being actively offered at each institution. A 26-item questionnaire focusing on program structure, admissions, and output was developed and administered to program representatives via phone interview. Descriptive statistics were calculated.

RESULTS

Thirteen schools offering a PharmD/MSHI dual degree were identified, of which 10 participated (response rate = 77%). All programs were created within the last 10 years. Programs were similar in terms of admission requirements such as grade point average thresholds and standardized testing. Variances existed in program structure and output, such as accreditation status and number of enrollees/graduates.

CONCLUSIONS

Although health informatics has become more prominent in health care, health informatics education is not yet as pervasive in the pharmacy field. The information collected may be useful for schools considering implementing or modifying their own dual degree program or for students who are interested in health informatics-specialized educational opportunities.

The Case for the Anesthesiologist-Informaticist

Health care has been transformed by computerization, and the use of electronic health record systems has become widespread. Anesthesia information management systems are commonly used in the operating room to maintain records of anesthetic care delivery. The perioperative environment and the practice of anesthesia generate a large volume of data that may be reused to support clinical decision-making, research, and process improvement. Anesthesiologists trained in clinical informatics, referred to as informaticists or informaticians, may help implement and optimize anesthesia information management systems. They may also participate in clinical research, management of information systems, and quality improvement in the operating room or throughout a health care system. Here, we describe the specialty of clinical informatics, how anesthesiologists may obtain training in clinical informatics, and the considerations particular to the subspecialty of anesthesia informatics. Management of perioperative information systems, implementation of computerized clinical decision support systems in the perioperative environment, the role of virtual visits and remote monitoring, perioperative informatics research, perioperative process improvement, leadership, and change management are described from the perspective of the anesthesiologist-informaticist.

THE SYMBIOTIC RELATIONSHIP BETWEEN HEALTH INFORMATION MANAGEMENT AND HEALTH INFORMATICS: OPPORTUNITIES FOR GROWTH AND COLLABORATION

Health information management (HIM) and health informatics (HI) are two similar but distinct disciplines. They share a common goal in terms of using information technologies and information power to improve the quality and efficiency of patient care; contribute to disease prevention and treatment; and improve overall population health. HIM professionals are primarily focused on managing health information, and HI professionals are primarily focused on the technologies and systems that make health information management possible. The right combination of the breadth of knowledge HIM professionals possess and the depth of knowledge HI professionals bring into the various areas constituting the scopes of the two disciplines can strengthen an organization's potential and growth in a complex, fast-changing healthcare environment.

Keep Moving Forward: Health Informatics and Information Management beyond the COVID-19 Pandemic

Objectives: To identify gaps and challenges in health informatics and health information management during the COVID-19 pandemic. To describe solutions and offer recommendations that can address the identified gaps and challenges.

Methods: A literature review of relevant peer-reviewed and grey literature published from January 2020 to December 2020 was conducted to inform the paper.

Results: The literature revealed several themes regarding health information management and health informatics challenges and gaps: information systems and information technology infrastructure; data collection, quality, and standardization; and information governance and use. These challenges and gaps were often driven by public policy and funding constraints.

Conclusions: COVID-19 exposed complexities related to responding to a world-wide, fast moving, quickly spreading novel virus. Longstanding gaps and ongoing challenges in the local, national, and global health and public health information systems and data infrastructure must be addressed before we are faced with another global pandemic.

What it means to be a woman in the field of biomedical informatics: exploring the lived experiences of women managers in the kingdom of Saudi Arabia

OBJECTIVE

Although women in the field of biomedical informatics (BMI) are part of a golden era, little is known about their lived experiences as informaticians. Guided by feminist standpoint theory, this study aims to understand the impact of social change in the Kingdom of Saudi Arabia- in the form of new policies supporting women and health technological advancements-in the field of BMI and its women informaticians.

MATERIALS AND METHODS

We conducted semistructured telephone interviews with 7 women managers in the field of BMI, identified through LinkedIn. We analyzed interview transcripts to generate themes about their lived experiences, how they perceived health information technology tools, identified challenges that may hinder the advancement of the field, and explored the future of BMI from their perspectives. During our analysis, we utilized a feminist theoretical approach.

RESULTS

Women managers in the field of BMI shared similar experiences and perspectives. Our analysis generated 10 themes: (1) career beginning, (2) opportunities given, (3) career achievements, (4) gender-based experiences, (5) meaning of BMI, (6) meaning of health information technology tools, (7) challenges, (8) overcoming challenges, (9) future and hopes, and (10) meaning of "2030 Saudi vision." Early in their careers, participants experienced limited opportunities and misperceptions in understanding what the field of informatics represents. Participants did not feel that gender was an issue, despite what feminist theory would have predicted.

CONCLUSIONS

Recognizing the lived experiences of women in the field of BMI contributes to our collective understanding of how these experiences may enhance our knowledge of the field.

What Industry Wants: An Empirical Analysis of Health Informatics Job Postings

OBJECTIVES

To describe the education, experience, skills, and knowledge required for health informatics jobs in the United States.

METHODS

Health informatics job postings (n = 206) from Indeed.com on April 14, 2020 were analyzed in an empirical analysis, with the abstraction of attributes relating to requirements for average years and types of experience, minimum and desired education, licensure, certification, and informatics skills.

RESULTS

A large percentage (76.2%) of posts were for clinical informaticians, with 62.1% of posts requiring a minimum of a bachelor's education. Registered nurse (RN) licensure was required for 40.8% of posts, and only 7.3% required formal education in health informatics. The average experience overall was 1.6 years (standard deviation = 2.2), with bachelor's and master's education levels increasing mean experience to 3.5 and 5.8 years, respectively. Electronic health record support, training, and other clinical systems were the most sought-after skills.

CONCLUSION

This cross-sectional study revealed the importance of a clinical background as an entree into health informatics positions, with RN licensure and clinical experience as common requirements. The finding that informatics-specific graduate education was rarely required may indicate that there is a lack of alignment between academia and industry, with practical experience preferred over specific curricular components. Clarity and shared understanding of terms across academia and industry are needed for defining and advancing the preparation for and practice of health informatics.

Clinical informatics during the COVID-19 pandemic: Lessons learned and implications for emergency department and inpatient operations

In response to a pandemic, hospital leaders can use clinical informatics to aid clinical decision making, virtualizing medical care, coordinating communication, and defining workflow and compliance. Clinical informatics procedures need to be implemented nimbly, with governance measures in place to properly oversee and guide novel patient care pathways, diagnostic and treatment workflows, and provider education and communication. The authors’ experience recommends (1) creating flexible order sets that adapt to evolving guidelines that meet needs across specialties, (2) enhancing and supporting inherent telemedicine capability, (3) electronically enabling novel workflows quickly and suspending noncritical administrative or billing functions in the electronic health record, and (4) using communication platforms based on tiered urgency that do not compromise security and privacy.

Evaluating health information technologies: A systematic review of framework recommendations

OBJECTIVE

Evaluating Health Information Technologies (HITs) can be challenging, but studies are necessary so that the most beneficial interventions can be identified. Our objective was to systematically review the available recommendations for improving the methods used in HIT evaluations.

METHODS

HIT evaluation frameworks were identified from database (MEDLINE, EMBASE, CINAHL) and grey literature searches. Outcome measures included framework recommendations and characteristics. Recommendations were coded and organised using thematic analysis methods. A scoring instrument was used to measure framework quality.

RESULTS

The search identified 23 frameworks and 272 recommendations. These were organised into five evaluation domains and 42 themes. The themes included recommendations for improving the evaluation of technical aspects of HITs (e.g. describing aspects of HIT functionality) and suggestions for improving the evaluation of complex factors that may influence the overall effects of HITs (e.g. careful reporting of whether the HIT became integrated into existing working patterns). The frameworks were not generally developed in association with healthcare professionals, or with input from patients. The frameworks tended not to have been developed using systematic methods designed to reduce the risk of bias.

DISCUSSION

HIT evaluations are important but they are challenging to conduct and appraise. This review was conducted using systematic methods enabling the organisation of framework recommendations into key themes. These findings may help investigators to successfully plan, conduct and appraise HIT evaluations. The quality appraisal demonstrated that HIT evaluation research may be improved by using more systematic methods and the involvement of participants from a range of differing backgrounds.

Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services

Background: Health information technology (HIT) use in home- and community-based services (HCBS) has been hindered by inadequate resources and incentives to support modernization. We sought to understand the ways the Medicaid Balancing Incentive Program (BIP) facilitated increased use of HIT to increase access to HCBS. Method: Qualitative analysis of interviews with 30 Medicaid administrators, service agency providers, and consumer advocates. Results: Although stakeholders perceived several benefits to greater HIT use, they highlighted critical challenges to effective adoption within the long-term services and supports (LTSS) system, including lack of extant expertise/knowledge about HIT, the limited reach of HIT among rural and disabled beneficiaries, burdensome procurement processes, and the ongoing resources required to maintain up-to-date HIT solutions. Conclusion: The structural reforms required by BIP gave states an opportunity to modernize their HCBS systems through use of HIT. However, barriers to HIT adoption persist, underscoring the need for continued support as part of future rebalancing efforts.

Current Approaches and Trends in Graduate Public Health Informatics Education in the United States: Four Case Studies from the Field

Background:Public Health Informatics (PHI) has taken on new importance in recent years as health and well-being face a number of challenges, including environmental disasters, emerging infectious diseases, such as Zika, Ebola and SARS-CoV-2, the growing impact of the Influenza virus, the opioid epidemic, and social determinants of health. Understanding the relationship between climate change and the health of populations adds further complexity to global health issues. Objectives: To describe four examples of curricula that exist in U.S. based graduate-level public and population health informatics training programs. Methods: Biomedical informatics educators are challenged to provide learners with relevant, interesting, and meaningful educational experiences in working with and learning from the many data sources that comprise the domain of PHI. Programs at four institutions were reviewed to examine common teaching practices that stimulate learners to explore the field of public health informatics. Results: Four case studies represent a range of pedagogical approaches to meeting the requirements of three established accreditation/certification agencies relevant to PHI education. Despite their differences, each program achieved the established learning objectives along with a substantive record of student learning achievements. Conclusion: The overarching goal of empowering learners to serve an active and dynamic role in enhancing preventive measures, informing policy, improving personal health behaviors, and clarifying issues such as quality, cost of care, and the social determinants of health, are essential components of PHI education and training, and must receive additional consideration now and in the future by educators, policy makers, administrators, and government officials.

Education Into Policy: Embedding Health Informatics to Prepare Future Nurses-New Zealand Case Study

Background

Preparing emerging health professionals for practicing in an ever-changing health care environment along with continually evolving technology is an international concern. This is particularly pertinent for nursing because nurses make up the largest part of the health workforce.

Objective

This study aimed to explore how health informatics can be included in undergraduate health professional education.

Methods

A case study approach was used to consider health informatics within undergraduate nursing education in New Zealand. This has led to the development of nursing informatics guidelines for nurses entering practice.

Results

The process used to develop nursing informatics guidelines for entry to practice in New Zealand is described. The final guidelines are based on the literature and are refined using an advisory group and an iterative process.

Conclusions

Although this study describes the development of nursing informatics guidelines for nurses entering practice, the challenge is to move these guidelines from educational rhetoric to policy. It is only by ensuring that health informatics is embedded in the undergraduate education of all health professionals can we be assured that future health professionals are prepared to work effectively, efficiently, and safely with information and communication technologies as part of their practice.

AMIA Board White Paper: AMIA 2017 core competencies for applied health informatics education at the master's degree level

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master's level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.

Contradictions in information technology mediated work in long-term care: An activity theoretic ethnographic study

BACKGROUND

The growing demand for aged care services coupled with a global shortage of skilled nursing staff has hindered long-term care facilities' ability to provide necessary services to their residents. Healthcare information technology is expected to mitigate this challenge by streamlining nursing work, while also improving quality of care and productivity.

OBJECTIVES

This study set out to examine how nurses and care workers work, the role of information technology (IT) in their work and what contradictions they face in their IT mediated work.

DESIGN

Ethnographic study informed by six components of activity theory: subject, object, tool, rule, community and division of labor.

SETTING

Eight care units in two long-term care facilities in Australia.

PARTICIPANTS

Eleven staff from two long-term care facilities including registered nurses (n = 2), endorsed enrolled nurses (n = 5) and personal care workers (n = 4) participated in this study.

METHODS

Participants were shadowed during morning shifts (6:30 am to 3:00 pm). A total of 24 morning shifts were observed over four months. Field notes were created based on observational data and informal interviews, in addition to document review.

RESULTS

Through the lens of activity theory, the work activity system of nurses and care workers in the long-term care facilities consisted of the subject (nurses and care workers), their object (resident care), tools used for work including IT, rules of work, community, and division of labor. These components interacted through work processes; therefore, a "process" component was added in the activity system. Special attention was given to the role of IT as the conduit of information in the work processes. Although IT helped track medication rounds, automated documentation and communication among the staff, it introduced contradictions. Seven contradictions involving IT were identified, including contradictions within the IT tool, between the IT tool and the object of work, between the subjects and documentation rules, between the work activity system using paper records and the system using IT, and between the activity system within the long-term care facility and the pharmacists' work activity system outside the facility.

CONCLUSIONS

Activity theory provided a theoretic framework to model the work activity system of nurses and care workers. Information technology played an important role in supporting information flow in this system, however it also caused contradictions.

Deploying unqualified personnel in health records practice: Role substitution or quackery? Implications for health services delivery in Nigeria

Healthcare professionals are obliged to work collaboratively regardless of their professional differences in order to provide the highest possible standard of care to patients. However, this type of collaboration can also lead to role substitution and, in effect, engagement of unqualified personnel in all health professions, including the health information management profession. This is a particular problem in developing nations such as Nigeria, where this trend has the potential to undermine the delivery of health services, the quality and the confidentiality of health information and trust between patients and healthcare professionals. To clarify and protect the professional identity of qualified health information management professionals in Nigeria and to prevent other experts who also work in health facilities (e.g. IT specialists, librarians) from claiming membership of the profession, the nomenclature for the health information management profession has been changed to health records and information management profession.

Development and delivery of an interdisciplinary course in mobile health (mHealth)

BACKGROUND

Interdisciplinary practice is a primary focus within the United States health care system. Despite the existence of interdisciplinary educational efforts in pharmacy for many years, the practice only recently entered mainstream health care education. Informatics offers interdisciplinary educational opportunities. Mobile health (mHealth), an informatics sub-discipline, is the use of mobile devices for health and wellness activities. We used the mHealth domain as the context for an interdisciplinary learning experience for pharmacy and computer science and software engineering (CSSE) students.

EDUCATIONAL ACTIVITY

Educational activities focused on creating an mHealth course sequence and an mHealth application (app). Students worked in teams to complete various assignments, including developing and presenting a course proposal, building a purchase plan for mHealth equipment, developing an mHealth app prototype, delivering a disease state presentation (pharmacy students only), developing use case scenarios (CSSE students only), and completing peer evaluations.

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

Course evaluations were only available from pharmacy students. They indicated an overall favorable rating (mean 3.27-3.55; 4=strongly agree). Survey data collected after students entered the workforce indicated that students felt better prepared than their colleagues to work with individuals from other disciplines (mean 4.82; 5=strongly agree). Students also indicated using the knowledge from course proposal development in their careers (mean 4.27; 5=strongly agree). Through team interactions, students learned from each other while overcoming challenges related to terminology and content areas. Skills learned through team interactions reflect real-world processes and are expected to support students' future professional responsibilities.

Balancing volume and duration of information consumption by physicians: The case of health information exchange in critical care

BACKGROUND

The realization of the potential benefits of health information exchange systems (HIEs) for emergency departments (EDs) depends on the way these systems are actually used. The attributes of volume of information and duration of information processing are important for the study of HIE use patterns in the ED, as cognitive load and time constraints may result in a trade-off between these attributes. Experts and non-experts often use different problem-solving strategies, which may be consequential for their system use patterns. Little previous research focuses on the trade-off between volume and duration of system use or on the factors that affect it, including user expertise.

OBJECTIVES

This study aims at exploring the trade-off of volume and duration of use, examining whether this relationship differs between experts and non-experts, and identifying factors that are associated with use patterns characterized by volume and duration.

METHODS

The research objectives are pursued in the context of critically-ill patients, treated at a busy ED in the period 2010-2012. The primary source of internal and external data is an HIE linked to 14 hospitals, over 1300 clinics, and other clinical facilities. We define four use profiles based on the attributes of duration and volume: quick and basic, quick and deep, slow and basic, and slow and deep. The volume and duration of use are computed using HIE log files as the number of screens and the time per screen, respectively. Each session is then classified into a specific profile based on distances from predefined profile centroids. Experts are physicians that are board-certified in emergency medicine. We test the distribution of use profiles and their associations with multiple variables that describe the patient, physician, situation, information available in the HIE system, and use dynamics within the encounter.

RESULTS

The quick and basic profile is the most prevalent. While available admission summaries are associated with quick and basic use, lab and imaging results are associated with slower or deeper use. Physicians who are the first to use the system or are sole users during an encounter are less inclined to quick and deep use. These effects are intensified for experts.

DISCUSSION

A trade-off between volume and duration is identified. While system use is overall similar for experts and non-experts, the circumstances in which a certain profile is more likely to be observed vary across these two groups. Information availability and multiple-physician dynamics within the encounter emerge as important for the prediction of use profiles. The findings of this study provide implications for the design, implementation, and research of HIE use.

An Approach for All in Pharmacy Informatics Education

Computerization is transforming health care. All clinicians are users of health information technology (HIT). Understanding fundamental principles of informatics, the field focused on information needs and uses, is essential if HIT is going to support improved patient outcomes. Informatics education for clinicians is a national priority. Additionally, some informatics experts are needed to bring about innovations in HIT. A common approach to pharmacy informatics education has been slow to develop. Meanwhile, accreditation standards for informatics in pharmacy education continue to evolve. A gap remains in the implementation of informatics education for all pharmacy students and it is unclear what expert informatics training should cover. In this article, we propose the first of two complementary approaches to informatics education in pharmacy: to incorporate fundamental informatics education into pharmacy curricula for all students. The second approach, to train those students interested in becoming informatics experts to design, develop, implement, and evaluate HIT, will be presented in a subsequent issue of the Journal.

IBM Watson Analytics: Automating Visualization, Descriptive, and Predictive Statistics

Background

We live in an era of explosive data generation that will continue to grow and involve all industries. One of the results of this explosion is the need for newer and more efficient data analytics procedures. Traditionally, data analytics required a substantial background in statistics and computer science. In 2015, International Business Machines Corporation (IBM) released the IBM Watson Analytics (IBMWA) software that delivered advanced statistical procedures based on the Statistical Package for the Social Sciences (SPSS). The latest entry of Watson Analytics into the field of analytical software products provides users with enhanced functions that are not available in many existing programs. For example, Watson Analytics automatically analyzes datasets, examines data quality, and determines the optimal statistical approach. Users can request exploratory, predictive, and visual analytics. Using natural language processing (NLP), users are able to submit additional questions for analyses in a quick response format. This analytical package is available free to academic institutions (faculty and students) that plan to use the tools for noncommercial purposes.

Objective

To report the features of IBMWA and discuss how this software subjectively and objectively compares to other data mining programs.

Methods

The salient features of the IBMWA program were examined and compared with other common analytical platforms, using validated health datasets.

Results

Using a validated dataset, IBMWA delivered similar predictions compared with several commercial and open source data mining software applications. The visual analytics generated by IBMWA were similar to results from programs such as Microsoft Excel and Tableau Software. In addition, assistance with data preprocessing and data exploration was an inherent component of the IBMWA application. Sensitivity and specificity were not included in the IBMWA predictive analytics results, nor were odds ratios, confidence intervals, or a confusion matrix.

Conclusions

IBMWA is a new alternative for data analytics software that automates descriptive, predictive, and visual analytics. This program is very user-friendly but requires data preprocessing, statistical conceptual understanding, and domain expertise.

Discussion of "The New Role of Biomedical Informatics in the Age of Digital Medicine"

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "The New Role of Biomedical Informatics in the Age of Digital Medicine" written by Fernando J. Martin-Sanchez and Guillermo H. Lopez-Campos [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of Martin-Sanchez and Lopez-Campos. In subsequent issues the discussion can continue through letters to the editor.

Health informatics and analytics - building a program to integrate business analytics across clinical and administrative disciplines

Health care organizations must develop integrated health information systems to respond to the numerous government mandates driving the movement toward reimbursement models emphasizing value-based and accountable care. Success in this transition requires integrated data analytics, supported by the combination of health informatics, interoperability, business process design, and advanced decision support tools. This case study presents the development of a master's level cross- and multidisciplinary informatics program offered through a business school. The program provides students from diverse backgrounds with the knowledge, leadership, and practical application skills of health informatics, information systems, and data analytics that bridge the interests of clinical and nonclinical professionals. This case presents the actions taken and challenges encountered in navigating intra-university politics, specifying curriculum, recruiting the requisite interdisciplinary faculty, innovating the educational format, managing students with diverse educational and professional backgrounds, and balancing multiple accreditation agencies.

Dental Informatics in India: Time to Embrace the Change

Dental informatics is comparatively a juvenile and new field that has noteworthy potential for supporting clinical care, research, education and management. This field utilizes computer science, information sciences and the application of same to espouse dentistry. However, in the under-developed and developing countries almost most of the dentists are unacquainted about dental informatics, its goals, what it is capable of achieving and by what means they can get involved into it. Despite of emerging advances, certain conflicts also go along with it such as, professional under representation, security issues of the stored information due to universal access to computers high speed internet connections. Endnote software was used as resource material to collect literature which was carefully arranged in a synchronized way. Hence, the purpose of this review was to give an overall scenario of dental informatics, its applications, challenges and recommendations for further enhancement in this area.

Feasibility and acceptability of SMS text messaging in a prostate cancer educational intervention for African American men

African Americans' greater access to mobile phones makes short messaging service technology a promising complement to health promotion interventions. Short messaging service text messages were added to the Men's Prostate Awareness Church Training project, a men's health intervention for African American men. We report on the feasibility and acceptability of the use of short messaging service text messages in the intervention. Short messaging service text messages served as (1) workshop reminders; (2) post-workshop message reinforcement; (3) spiritual/motivational messages; and (4) participant retention. At workshop 4, over 65 percent of participants wished to continue receiving the messages. While there was an increase in recall over time, more than one-third of the participants did not recall receiving the 53 text messages. However, recall was considerably greater among men who attended the Men's Prostate Awareness Church Training workshops. Overall, the inclusion of text messages in health promotion interventions targeting mature African American men was found to be feasible and acceptable.

*informatics: Identifying and Tracking Informatics Sub-Discipline Terms in the Literature

OBJECTIVE

To identify the breadth of informatics sub-discipline terms used in the literature for enabling subsequent organization and searching by sub-discipline.

METHODS

Titles in five literature sources were analyzed to extract terms for informatics sub-disciplines: 1) United States (U.S.) Library of Congress Online Catalog, 2) English Wikipedia, 3) U.S. National Library of Medicine (NLM) Catalog, 4) PubMed, and 5) PubMed Central. The extracted terms were combined and standardized with those in four vocabulary sources to create an integrated list: 1) Library of Congress Subject Headings (LCSH), 2) Medical Subject Headings (MeSH), 3) U.S. National Cancer Institute Thesaurus (NCIt), and 4) EMBRACE Data and Methods (EDAM). Searches for terms in titles from each literature source were conducted to obtain frequency counts and start years for characterizing established and potentially emerging sub-disciplines.

RESULTS

Analysis of 6,949 titles from literature sources and 67 terms from vocabulary sources resulted in an integrated list of 382 terms for informatics sub-disciplines mapped to 292 preferred terms. In the last five decades, "bioinformatics", "medical informatics", "health informatics", "nursing informatics", and "biomedical informatics" were associated with the most literature. In the current decade, potentially emerging sub-disciplines include "disability informatics", "neonatal informatics", and "nanoinformatics" based on literature from the last five years.

CONCLUSIONS

As the field of informatics continues to expand and advance, keeping up-to-date with historical and current trends will become increasingly challenging. The ability to track the accomplishments and evolution of a particular sub-discipline in the literature could be valuable for supporting informatics research, education, and training.

Convergent evolution of health information management and health informatics: a perspective on the future of information professionals in health care

Clearly defined boundaries are disappearing among the activities, sources, and uses of health care data and information managed by health information management (HIM) and health informatics (HI) professionals. Definitions of the professional domains and scopes of practice for HIM and HI are converging with the proliferation of information and communication technologies in health care settings. Convergence is changing both the roles that HIM and HI professionals serve in their organizations as well as the competencies necessary for training future professionals. Many of these changes suggest a blurring of roles and responsibilities with increasingly overlapping curricula, job descriptions, and research agendas. Blurred lines in a highly competitive market create confusion for students and employers. In this essay, we provide some perspective on the changing landscape and suggest a course for the future. First we review the evolving definitions of HIM and HI. We next compare the current domains and competencies, review the characteristics as well as the education and credentialing of both disciplines, and examine areas of convergence. Given the current state, we suggest a path forward to strengthen the contributions HIM and HI professionals and educators make to the evolving health care environment.

Information technology skills and training needs of health information management professionals in Nigeria: a nationwide study

There is a lack of effective health information management systems in Nigeria due to the prevalence of cumbersome paper-based and disjointed health data management systems. This can make informed healthcare decision making difficult. This study examined the information technology (IT) skills, utilisation and training needs of Nigerian health information management professionals. We deployed a cross-sectional structured questionnaire to determine the IT skills and training needs of health information management professionals who have leadership roles in the nation's healthcare information systems (n=374). It was found that ownership of a computer, level of education and age were associated with knowledge and perception of IT. The vast majority of participants (98.8%) acknowledged the importance and relevance of IT in healthcare information systems and many expressed a desire for further IT training, especially in statistical analysis. Despite this, few (8.1 %) worked in settings where such systems operate and there exists an IT skill gap among these professionals which is not compatible with their roles in healthcare information systems. To rectify this anomaly they require continuing professional development education, especially in the areas of health IT. Government intervention in the provision of IT infrastructure in order to put into practice a computerised healthcare information system would therefore be a worthwhile undertaking.

The future of public health informatics: alternative scenarios and recommended strategies

Background:

In October 2013, the Public Health Informatics Institute (PHII) and Institute for Alternative Futures (IAF) convened a multidisciplinary group of experts to evaluate forces shaping public health informatics (PHI) in the United States, with the aim of identifying upcoming challenges and opportunities. The PHI workshop was funded by the Robert Wood Johnson Foundation as part of its larger strategic planning process for public health and primary care.

Workshop Context:

During the two-day workshop, nine experts from the public and private sectors analyzed and discussed the implications of four scenarios regarding the United States economy, health care system, information technology (IT) sector, and their potential impacts on public health in the next 10 years, by 2023. Workshop participants considered the potential role of the public health sector in addressing population health challenges in each scenario, and then identified specific informatics goals and strategies needed for the sector to succeed in this role.

Recommendations and Conclusion:

Participants developed recommendations for the public health informatics field and for public health overall in the coming decade. These included the need to rely more heavily on intersectoral collaborations across public and private sectors, to improve data infrastructure and workforce capacity at all levels of the public health enterprise, to expand the evidence base regarding effectiveness of informatics-based public health initiatives, and to communicate strategically with elected officials and other key stakeholders regarding the potential for informatics-based solutions to have an impact on population health.

Open source EMR software: profiling, insights and hands-on analysis

BACKGROUND

The use of open source software in health informatics is increasingly advocated by authors in the literature. Although there is no clear evidence of the superiority of the current open source applications in the healthcare field, the number of available open source applications online is growing and they are gaining greater prominence. This repertoire of open source options is of a great value for any future-planner interested in adopting an electronic medical/health record system, whether selecting an existent application or building a new one. The following questions arise. How do the available open source options compare to each other with respect to functionality, usability and security? Can an implementer of an open source application find sufficient support both as a user and as a developer, and to what extent? Does the available literature provide adequate answers to such questions? This review attempts to shed some light on these aspects.

OBJECTIVE

The objective of this study is to provide more comprehensive guidance from an implementer perspective toward the available alternatives of open source healthcare software, particularly in the field of electronic medical/health records.

METHODS

The design of this study is twofold. In the first part, we profile the published literature on a sample of existent and active open source software in the healthcare area. The purpose of this part is to provide a summary of the available guides and studies relative to the sampled systems, and to identify any gaps in the published literature with respect to our research questions. In the second part, we investigate those alternative systems relative to a set of metrics, by actually installing the software and reporting a hands-on experience of the installation process, usability, as well as other factors.

RESULTS

The literature covers many aspects of open source software implementation and utilization in healthcare practice. Roughly, those aspects could be distilled into a basic taxonomy, making the literature landscape more perceivable. Nevertheless, the surveyed articles fall short of fulfilling the targeted objective of providing clear reference to potential implementers. The hands-on study contributed a more detailed comparative guide relative to our set of assessment measures. Overall, no system seems to satisfy an industry-standard measure, particularly in security and interoperability. The systems, as software applications, feel similar from a usability perspective and share a common set of functionality, though they vary considerably in community support and activity.

CONCLUSION

More detailed analysis of popular open source software can benefit the potential implementers of electronic health/medical records systems. The number of examined systems and the measures by which to compare them vary across studies, but still rewarding insights start to emerge. Our work is one step toward that goal. Our overall conclusion is that open source options in the medical field are still far behind the highly acknowledged open source products in other domains, e.g. operating systems market share.

The digital health divide: evaluating online health information access and use among older adults

OBJECTIVE

Innovations in health information technology (HIT) provide opportunities to reduce health care spending, improve quality of care, and improve health outcomes for older adults. However, concerns relating to older adults' limited access and use of HIT, including use of the Internet for health information, fuel the digital health divide debate. This study evaluated the potential digital health divide in relation to characteristic and belief differences between older adult users and nonusers of online health information sources.

METHODS

A cross-sectional survey design was conducted using a random sample of older adults. A total of 225 older adults (age range = 50-92 years, M = 68.9 years, SD = 10.4) participated in the study.

RESULTS

Seventy-six percent of all respondents had Internet access. Users and nonusers of online health information differed significantly on age (M = 66.29 vs. M = 71.13), education, and previous experience with the health care system. Users and nonusers of online health information also differed significantly on Internet and technology access, however, a large percentage of nonusers had Internet access (56.3%), desktop computers (55.9%), and laptop computers or netbooks (43.2%). Users of online health information had higher mean scores on the Computer Self-Efficacy Measure than nonusers, t(159) = -7.29, p < .0001.

CONCLUSION

This study found significant differences between older adult users and nonusers of online health information. Findings suggest strategies for reducing this divide and implications for health education programs to promote HIT use among older adults.

Big Data: Are Biomedical and Health Informatics Training Programs Ready? Contribution of the IMIA Working Group for Health and Medical Informatics Education

OBJECTIVE

The growing volume and diversity of health and biomedical data indicate that the era of Big Data has arrived for healthcare. This has many implications for informatics, not only in terms of implementing and evaluating information systems, but also for the work and training of informatics researchers and professionals. This article addresses the question: What do biomedical and health informaticians working in analytics and Big Data need to know?

METHODS

We hypothesize a set of skills that we hope will be discussed among academic and other informaticians.

RESULTS

The set of skills includes: Programming - especially with data-oriented tools, such as SQL and statistical programming languages; Statistics - working knowledge to apply tools and techniques; Domain knowledge - depending on one's area of work, bioscience or health care; and Communication - being able to understand needs of people and organizations, and articulate results back to them.

CONCLUSION

Biomedical and health informatics educational programs must introduce concepts of analytics, Big Data, and the underlying skills to use and apply them into their curricula. The development of new coursework should focus on those who will become experts, with training aiming to provide skills in "deep analytical talent" as well as those who need knowledge to support such individuals.

Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education

Physicians in the 21st century will increasingly interact in diverse ways with information systems, requiring competence in many aspects of clinical informatics. In recent years, many medical school curricula have added content in information retrieval (search) and basic use of the electronic health record. However, this omits the growing number of other ways that physicians are interacting with information that includes activities such as clinical decision support, quality measurement and improvement, personal health records, telemedicine, and personalized medicine. We describe a process whereby six faculty members representing different perspectives came together to define competencies in clinical informatics for a curriculum transformation process occurring at Oregon Health & Science University. From the broad competencies, we also developed specific learning objectives and milestones, an implementation schedule, and mapping to general competency domains. We present our work to encourage debate and refinement as well as facilitate evaluation in this area.

Gap analysis of biomedical informatics graduate education competencies

Graduate training in biomedical informatics (BMI) is evolving rapidly. BMI graduate programs differ in informatics domain, delivery method, degrees granted, as well as breadth and depth of curricular competencies. Using the current American Medical Informatics Association (AMIA) definition of BMI core competencies as a framework, we identified and labeled course offerings within graduate programs. From our qualitative analysis, gaps between defined competencies and curricula emerged. Topics missing from existing graduate curricula include community health, translational and clinical research, knowledge representation, data mining, communication and evidence-based practice.