Health Information

Even though the idea of using computers in medicine emerged as technology advanced in the early 20th century, it was not until the 1950s that informatics began to have an effect in the United States.[32]

The earliest use of electronic digital computers for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.[33] During the mid-1950s, the United States Air Force (USAF) carried out several medical projects on its computers while also encouraging civilian agencies such as the National Academy of Sciences – National Research Council (NAS-NRC) and the National Institutes of Health (NIH) to sponsor such work.[34] In 1959, Ledley and Lee B. Lusted published "Reasoning Foundations of Medical Diagnosis," a widely read article in Science, which introduced computing (especially operations research) techniques to medical workers. Ledley and Lusted's article has remained influential for decades, especially within the field of medical decision making.[35]

Guided by Ledley's late 1950s survey of computer use in biology and medicine (carried out for the NAS-NRC), and by his and Lusted's articles, the NIH undertook the first major effort to introduce computers to biology and medicine. This effort, carried out initially by the NIH's Advisory Committee on Computers in Research (ACCR), chaired by Lusted, spent over $40 million between 1960 and 1964 in order to establish dozens of large and small biomedical research centers in the US.[34]

One early (1960, non-ACCR) use of computers was to help quantify normal human movement, as a precursor to scientifically measuring deviations from normal, and design of prostheses.[36] The use of computers (IBM 650, 1620, and 7040) allowed analysis of a large sample size, and of more measurements and subgroups than had been previously practical with mechanical calculators, thus allowing an objective understanding of how human locomotion varies by age and body characteristics. A study co-author was Dean of the Marquette University College of Engineering; this work led to discrete Biomedical Engineering departments there and elsewhere.

The next steps, in the mid-1960s, were the development (sponsored largely by the NIH) of expert systems such as MYCIN and Internist-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. Around this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science[37] at Massachusetts General Hospital in Boston, another center of biomedical computing that received significant support from the NIH.[38] In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. As of 2004, a descendant of this system is being used in the United States Veterans Affairs hospital system. The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient's electronic medical record at any of the VA's over 1,000 health care facilities.

During the 1960s, Morris Collen, a physician working for Kaiser Permanente's Division of Research, developed computerized systems to automate many aspects of multi-phased health checkups. These systems became the basis the larger medical databases Kaiser Permanente developed during the 1970s and 1980s.[39] The American College of Medical Informatics (ACMI) has since 1993 annually bestowed the Morris F. Collen, MD Medal for Outstanding Contributions to the Field of Medical Informatics.[40] Kaiser permanente

In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exist, only a small number of health practitioners use fully featured electronic health care records systems. In 1970, Warner V. Slack, MD, and Howard Bleich, MD, co-founded[41] the academic division of clinical informatics (DCI)[42] at Beth Israel Deaconess Medical Center and Harvard Medical School. Warner Slack is a pioneer of the development of the electronic patient medical history,[43] and in 1977 Dr. Bleich created the first user-friendly search engine for the worlds biomedical literature.[44] In 2002, Dr. Slack and Dr. Bleich were awarded the Morris F. Collen Award for their pioneering contributions to medical informatics.[45]

Computerised systems involved in patient care have led to a number of changes. Such changes have led to improvements in electronic health records which are now capable of sharing medical information among multiple health care stakeholders (Zahabi, Kaber, & Swangnetr, 2015); thereby, supporting the flow of patient information through various modalities of care. One opportunity for electronic health records (EHR) to be even more effectively used is to utilize natural language processing for searching and analyzing notes and text that would otherwise be inaccessible for review. These can be further developed through ongoing collaboration between software developers and end-users of natural language processing tools within the electronic health EHRs.[46]

Computer use today involves a broad ability which includes but is not limited to physician diagnosis and documentation, patient appointment scheduling, and billing. Many researchers in the field have identified an increase in the quality of health care systems, decreased errors by health care workers, and lastly savings in time and money (Zahabi, Kaber, & Swangnetr, 2015). The system, however, is not perfect and will continue to require improvement. Frequently cited factors of concern involve usability, safety, accessibility, and user-friendliness (Zahabi, Kaber, & Swangnetr, 2015). As leaders in the field of medical informatics improve upon the aforementioned factors of concern, the overall provision of health care will continue to improve.[47]

Homer R. Warner, one of the fathers of medical informatics,[48] founded the Department of Medical Informatics at the University of Utah in 1968. The American Medical Informatics Association (AMIA) has an award named after him on application of informatics to medicine.

The American Medical Informatics Association created a,[49] board certification for medical informatics from the American Board of Preventive Medicine.[50] The American Nurses Credentialing Center offers a board certification in Nursing Informatics.[51] For Radiology Informatics, the CIIP (Certified Imaging Informatics Professional) certification was created by ABII (The American Board of Imaging Informatics) which was founded by SIIM (the Society for Imaging Informatics in Medicine) and ARRT (the American Registry of Radiologic Technologists) in 2005. The CIIP certification requires documented experience working in Imaging Informatics, formal testing and is a limited time credential requiring renewal every five years.

The exam tests for a combination of IT technical knowledge, clinical understanding, and project management experience thought to represent the typical workload of a PACS administrator or other radiology IT clinical support role.[52] Certifications from PARCA (PACS Administrators Registry and Certifications Association) are also recognized. The five PARCA certifications are tiered from entry-level to architect level. The American Health Information Management Association offers credentials in medical coding, analytics, and data administration, such as Registered Health Information Administrator and Certified Coding Associate.[53] Certifications are widely requested by employers in health informatics, and overall the demand for certified informatics workers in the United States is outstripping supply.[54] The American Health Information Management Association reports that only 68% of applicants pass certification exams on the first try.[55]

In 2017, a consortium of health informatics trainers (composed of MEASURE Evaluation, Public Health Foundation India, University of Pretoria, Kenyatta University, and the University of Ghana) identified the following areas of knowledge as a curriculum for the digital health workforce, especially in low- and middle-income countries: clinical decision support; telehealth; privacy, security, and confidentiality; workflow process improvement; technology, people, and processes; process engineering; quality process improvement and health information technology; computer hardware; software; databases; data warehousing; information networks; information systems; information exchange; data analytics; and usability methods.[56]

In 2004, President George W. Bush signed Executive Order 13335,[57] creating the Office of the National Coordinator for Health Information Technology (ONCHIT) as a division of the U.S. Department of Health and Human Services (HHS). The mission of this office is widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. See quality improvement organizations for more information on federal initiatives in this area. In 2014 the Department of Education approved an advanced Health Informatics Undergraduate program that was submitted by the University of South Alabama. The program is designed to provide specific Health Informatics education, and is the only program in the country with a Health Informatics Lab. The program is housed in the School of Computing in Shelby Hall, a recently completed $50 million state of the art teaching facility. The University of South Alabama awarded David L. Loeser on May 10, 2014, with the first Health Informatics degree.

The program currently is scheduled to have 100+ students awarded by 2016. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards for electronic health records (EHR) and supporting networks, and certify vendors who meet them. In July 2006, CCHIT released its first list of 22 certified ambulatory EHR products, in two different announcements.[58] Harvard Medical School added a department of biomedical informatics in 2015.[59] The University of Cincinnati in partnership with Cincinnati Children's Hospital Medical Center created a biomedical informatics (BMI) Graduate certificate program and in 2015 began a BMI PhD program.[60][61][62] The joint program allows for researchers and students to observe the impact their work has on patient care directly as discoveries are translated from bench to bedside.