Medical Informatics inContext
Graduate School of Library, Information andMedia Studies
University of Tsukuba
19 October 2007

Abstract• Medical informatics can be defined as "theapplication of information science and information
technology to the theoretical and practical problemsof biomedical research, clinical practice, and medicaleducation."• An increasing numbers of knowledge workers areinvolved in medical informatics-related programs andactivities.
• This talk will provide an overview of the field of
medical informatics and show how it "fits in" withother information fields.

Many different terms are now in use!
• Medical Informatics• Biomedical Informatics– These two are synonymous• Bioinformatics– This one is different• Health Informatics– This is the newest termMedical Informatics Definition #1
The field concerned with the cognitive,
information processing, and communication
tasks of medical practice, education, andresearch, including the information science andtechnology to support these tasks….it is both ascience and a technology.
from Shortliffe’s textbook

Medical Informatics Definition #2
An interdisciplinary field that combines medicalscience with several technologies anddisciplines in the information and computersciences [and one which] provides
methodologies by which these fields cancontribute to better use of the medical
knowledge base and ultimately to bettermedical care…
American Association of Medical Colleges

Medical Informatics Definition #3
Medical informatics has to do with all aspects ofunderstanding and promoting the effective
organization, analysis, management, and use of
information in health care. While the field of medical
informatics shares the general scope of these interests
with some other health care specialties and disciplines,
medical informatics has developed its own areas ofemphasis and approaches that have set it apart fromother disciplines and specialties.
American Medical Informatics Association

Medical Informatics Definition # 4
Applications of advanced computer andcommunications technologies to health care,and specifically to information in health care…

Ellen Detlefsen’s working definition

MeSH® defines medical informatics as• “The field of information science
concerned with the analysis anddissemination of medical data through theapplication of computers to various
aspects of health care and medicine.”• Year introduced: 1987

MI developed as an academic field in
the late 1960s and early 1970s….
• Work on the practical issues of clinical documentation,
information systems, and technology in which computers had
been introduced to increase productivity of medical processes• Work on medical knowledge representation and language
understanding, including artificial intelligence consultationand decision support systems• Work on terminologies, coding, medical records, and indexing
for Medline, exemplified in the Unified Medical Language
System and related research.
•Maojo V, Kulikowski CA. Bioinformatics and medical informatics:
collaborations on the road to genomic medicine? J Am Med Inform Assoc. 2003 Nov-Dec;10(6):515-22.

The first generation…
• many MI pioneers arrived to the field bychance, because they were interested in
informational needs in clinical settings,
complemented by colleagues from linguistics,
mathematics, computer science, L/IS,engineering, and other disciplines.

MeSH® recognizes four sub-specialty
areas• Information Science Category– Information Science• Informatics–Dental Informatics–Medical Informatics–Nursing Informatics–Public Health Informatics

Other sub-specialties are emerging• Pathology informatics• Radiology informatics• Psychiatry informatics• Primary care informatics• Surgical informatics• Veterinary informatics• Consumer informatics• Telemedicine• Can be documented with journal
articles and professional SIGs

What is Bioinformatics?
• Bioinformatics is concerned with the creationand development of advanced information andcomputational technologies to solve problems
in biology.
– Bioinformatics uses techniques from informatics,
statistics, molecular biology and high-performancecomputing to obtain information about genomic orprotein sequence data.

BI emerged in the 1990s…20-30 years
after medical informatics• The terms bioinformatics and computational biology are often
used interchangeably, although the latter typically focuses on
algorithm development and specific computational methods.
• A common thread in projects in bioinformatics andcomputational biology is the use of mathematical tools toextract useful information from noisy data produced by highthroughput biological techniques.
• The field of data mining overlaps with computational biology
in this regard…
• en.wikipedia.org/wiki/Bioinformatics

If you query the MeSH® database for“bioinformatics,” you are directed to• Computational Biology– A field of biology concerned with the development oftechniques for the collection and manipulation of biological
data, and the use of such data to make biologicaldiscoveries or predictions. This field encompasses allcomputational methods and theories applicable tomolecular biology and areas of computer-based techniques
for solving biological problems including manipulation ofmodels and datasets.

• Year introduced: 1997

Bayat A. Science, medicine, and the future:
Bioinformatics. BMJ. 2002 Apr 27;324(7344):1018-22

Real-world definition…..
• Roughly, bioinformatics is any use ofcomputers to handle biological information.
• In practice, bioinformatics is often a synonym
for "computational molecular biology"---theuse of computers to characterize the molecularcomponents of living things.

So what’s the difference?
• “Traditionally, Medical Informatics has been focused on theintersection between computer science and clinical medicine,• whereas Bioinformatics have been predominantly centered on
the intersection between computer science and biologicalresearch.
• Although researchers from both areas have occasionallycollaborated, their training, objectives and interests have beenquite different.”•Martin-Sanchez F et al. Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care.
J Biomed Inform. 2004 Feb;37(1):30-42.

Shortliffe’s 4-part model• Bioinformatics• Molecular and cellular processes• Imaging Informatics• Tissues and organs• Clinical Informatics• Individuals and patients• Public Health Informatics• Populations and society• http://sci.asu.edu/news/bmi_symposium/downloads/EdwardShortliffe_presentation.pdf

Health Informatics• The Canadian (and European) preferred term
for medical and biomedical informatics• http://www.coachorg.com/default.asp?ID=390

Key Topics in the 1980s…
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Introduction to Medical Informatics
Databases
Networking and Distributed Computing
Ambulatory Care Records
Hospital Information Systems
Integrated Clinical Information Systems
Medical Imaging Systems
Patient Monitoring
Computers in Education
Medical Decision Making
Bibliographic Retrieval
Controlled Medical Terminologies
Stanford University, Medical Informatics Short Course,1980s

“Grand Challenges” in the 1990s…
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Medical Information Standards
Medical Informatics Training
Integrated Health Information Management Systems
Computerized Medical Records
Clinical Information Systems, including radiology, laboratory, pharmacyPhysician Order Entry Systems
Computer-Aided Instruction
Medical Expert Systems
Nursing Informatics
Health Information Networks
Medical Software
Research Funding Opportunities
Cultural and Sociological Changes
Medical Software Security
Duke University, 1990s

Some of the 21st century topics?
Competing for Capital - Creative IT Investment Strategies
Overcoming Barriers to Electronic Medical Records to Support
HIV/AIDS Care in sub-Saharan Africa
Development & Evaluation of a Standards-based PDA
Documentation & Decision Support System for Advanced
Practice Nurses
Disseminating Innovations in Critical Care
Looking into & out of CPOE's (Physician Order Entry) BlackBox: Monitoring its Uses, Benefits and Consequences
eCME: Is it ready for prime time?
Progress and Prospects for the National Health Information
Infrastructure
Why is so much clinical IT so bad?
From a medical informatics conference brochure, Johns Hopkins, 2005

More 21st century topics?
Accessing Information at the Point of Care: Impact and Challenges
Three usability studies of informatics tools at patient-provider interface: a HRT
decision tool, tobacco use risk tool, & medical resident usage of PDA tools
Managing a Drug Withdrawal Crisis via Health IT PDAs for Decision Support at thePoint of Care: Lessons Learned
Effective Clinical Decision Support: Assessing Factors Critical for SuccessBringing technology to people & people to technology: Uganda as a case in point
eLearning and eEducators at the Point-of-Care
Redesigning Hospital Processes with EHRs-A Socio-Technical (ST) Approach
A Web-based Point of Care Knowledge Resource and Workflow Support forAmbulatory Care
PDAs: Improving Medication Safety through Access and Use of Drug Information
Sources
From a medical informatics conference brochure, Johns Hopkins, 2005

Who Are Medical Informaticists?
Practitioners in an interdisciplinary academic field, chiefly based in medicalschools, with a broad range of professional training• physicians/health•professions schools faculties• computer•scientists/engineers•• nurses•• pharmacists•• dentists• veterinarians•• government officials•

medical records
administrators
medical librarians
lawyers
cognitive psychologists
software/hardware
producers/publishers
healthcare
consumers/advocatesinsurance providers/ third
party payers

Where Do Medical Informaticists Work?
• health professions school faculty• academic research & development• educational support positions• clinical administrative/educational managers• healthcare facility Chief Information Officers• corporate research and development• health information professional/biomedical librarians• entrepreneurs

Medical Informatics Journals
Artificial Intelligence in Medicine
BMC Medical Informatics and Decision Making
Computers in Biology and Medicine
Computers, Informatics, Nursing: CIN
Health Informatics Journal
Healthcare Informatics
IEEE Transactions on Information
Technology in Biomedicine
International Journal of Medical Informatics
J Healthcare Information Management
J Telemedicine and Telecare
Medical Informatics and the Internet
Online Journal of Nursing Informatics
Telemedicine Journal and eHealthAcademic Medicine
Bioinformatics
BMC Bioinformatics
Health Informatics JHealthcare Informatics
JAMIA
JASIST
J Biomedical Informatics
J of Medical InternetResearchMedical Decision Making

Organizations concerned with medicalinformatics…
• American Medical Informatics Association - www.amia.org• International Medical Informatics Association - www.imia.org• Health Information Management Systems Society www.himss.org• American Health Information Management Association www.ahima.org• Association for Information Science & Technology; SIG-MED
http://www.asis.org/AboutASIS/asis-sigs.html#SIGMED• Medical Library Association - www.mlanet.org

Where can someone go to earn adegree in medical informatics?
• Universities• Medical libraries• Medical centers• Professional meetings• On the Web

A degree program in universities withan ALA–accredited LIS programInstitutions with NLM training programs in medical
informatics, and a strong L/IS program• Training Program for Imaging-Based Medical Informatics –UCLA• Biomedical and Health Informatics Research Training University of Missouri Columbia• Pittsburgh Biomedical Informatics Training Program
University of Pittsburgh• Regenstrief Informatics Research Fellowships
Indiana University - Purdue University at Indianapolis• Biomedical and Health Informatics Training Program University of Washington• Computation and Informatics in Biology and Medicine University of Wisconsin Madison

Institutions with NLM training programs in medicalinformatics, and a strong health sciences library-basedtraining program• Johns Hopkins Health Sciences Informatics Training Program- Johns Hopkins University• Vanderbilt Biomedical Informatics Training Program Vanderbilt University• Training Program in Health Informatics- Oregon Health & Science University

Institutions with NLM training programs inmedical informatics, but no L/IS program…
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Biomedical Informatics Training Program - University of California
IrvineMedical Informatics Research Training Program - Columbia UniversityProgram in Biomedical Informatics - Harvard-MIT Division of Health
Sciences & Technology
Health Informatics - University of Minnesota Twin Cities
Training Program in Computational Biology and Medicine - Rice
University
Training of Toolmakers for Bio-Medical Informatics - Medical Universityof South Carolina- MUSC
Graduate Training in Biomedical Informatics - Stanford University
University of Utah Medical Informatics Training - University of Utah
Biomedical Informatics Research Training at Yale - Yale University

http://www.ncbi.nlm.nih.gov/Class/MLACourse/

Continuing education courses•

primarily at national and regional
professional meetings– MLA– AMIA– ASIS&T

Distance education from the medical
informatics or L/IS communities• AMIA’s 10 x 10 program• OHSU’s online master’s program• Pitt’s Fast/Track medical specialization

Short courses….
• Woods Hole MBL• Stanford University– designed for health professionals seeking
additional training or updating, who will serve“change agents” in their institutions– a tradition of welcoming medical librarians as partof the multidisciplinary training classAre there any role models?
• Yes, there are L/IS faculty who teach and do researchin medical informatics• Yes, there are medical librarians and information
specialists who work in academic and library settings,
with a job description that encompasses
bioinformatics….

• Typically, these people have a PhD degree and adegree in either the health sciences and/or the L/ISfieldMedical Informatics in Japan• Associations• Departments• Individual scholars and researchers• ArticlesAnyone at Tsukuba?

Need more information?
• For a hot-linked table of URLs for all the sites
and materials in this presentation, please emailme:• Ellen Detlefsen– detlefseneg@upmc.edu– ellen@detlefsen.com