The true and noble purpose of health informatics

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I was asked this week to provide a succinct definition of health informatics. I am aware that this is something of a minefield. There are many learned organisations who provide definitions, and probably there are as many other definitions as there are health informaticians. It did however cause me to consider whether my view of health informatics has changed in the 30 years that I have been working in the field.

So my personal view (I don’t presume to call it a definition) is that:

Health informatics is the management of information to support optimal decision-making in order to achieve optimal health outcomes.

Please note, there is no reference to technology in this statement. However, for practical purposes my description needs to be amplified by an additional statement:

Whilst this is generally enabled by the use of technology, effective health informatics is achieved through an optimum balance of information management, technology and governance.

The first part of my description is probably what I would’ve said 30 years ago. The second part represents the distillation of my experience since. Very often, the frustrations and failures of health informatics to achieve the desired outcomes may be seen as an imbalance between these three key elements.

On a recent visit to an urgent care facility located with in my local hospital, I noted that the primary care doctor treating me was not able to access either my primary care record or the records of my recent care in the same building provided by the hospital consultant. This was not a technological failure, but rather a failure of information management and governance preventing the implementation of a technological solution.

There is increasing excitement about the use of highly sophisticated technology by the NHS in the IT field. Over the last decade, the use of high sophisticated digital imaging systems has become pretty much the norm within the NHS. Increasingly, artificial intelligence systems are entering practical use in many areas.

One of the reasons why digital imaging has been a success story is that the new technology is pretty much a plug and play replacement for the old. The management and governance implications of achieving at least most of the benefits are quite straightforward.

By contrast, providing a basic health record that follows the patient on their journey through the healthcare system has proved much more difficult. The technology is self-evidently available. It is the technology that supports almost every aspect of modern life. The management and governance of this patient centred electronic record are the aspects that continue to challenge our health care system.

There are some structural factors which do not help us. The NHS is not a single large organisation. Indeed in the past I have described it as a collection of cottage industries. Our information systems are inevitably focused on those component organisations, and our efforts then become about joining up systems designed to meet the needs of organisations and trying to bend them to meet the needs of patients.

In the education of health informatics professionals, too often we see the equivalent where courses are constructed from health and IT modules which exist for the convenience of the education providers but fail to provide the specific learning outcomes required by our health informatics professionals. The greatest advantage that we had at UCLAN 20 years ago was that the course team were able to start with a blank piece of paper in creating an MSc in health informatics and were not required to adopt generic modules In the interests of so-called organisational efficiency. The advantage to the University was that we were able to create a program which is still meeting the needs of health informatics professionals today.

In the field of information governance, the recent introduction of GDPR threatens to unbalance the equilibrium once again. Protecting sensitive personal information is crucial.
However, effective information governance requires balancing the need to protect the privacy of patients with the need to provide the right information at the right time to support clinicians in making the right decision. Once again, this is about the correct balance. Once again, this is dependent on both effective information management and the best use of technology.

The new Secretary of State for Health is an enthusiastic supporter of the continued and increasing adoption of new technology to support the NHS. Whilst this is to be applauded, it will only truly bear fruit if the technology is matched by effective information management and governance. Without this, scarce resources may be wasted.
Achieving the optimum balance of technology, management and governance is the true and noble purpose of health informatics.

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