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Health Informatics: Tapping the Potential of Information Technology to improve and

transform health care.nd Transform Health Care Sripriya Rajamani

Health informatics is a scientific discipline which focuses on the acquisition, storage

and utilization of health-related data and information. The aim is to translate the
data and information into knowledge and apply this for problem solving and decision
making [1]. Health care

is a data intense field and the effective management of medical data and information
will increase efficiency of process, influence better outcomes and enhance the quality
of health care. These health data also form a vital element of health care planning,
policy and research.

The field of health informatics is multi-disciplinary comprising of computational,

cognitive, management and other sciences. Various methods and tools of information

and computer science are being used to support various tasks and to automate
certain processes. A new generation of information systems and applications are
currently being developed aimed at health care networks, physicians, health care
managers and public health. The power of health care informatics is being realized
and health institutions are beginning to make large-scale commitments to
information systems. This field has developed into a distinct entity and academic
departments are being established to train medical informatics professionals.

Health informatics has the power to revolutionize health care. Advances in computing
hardware and software translate into better multimedia applications, wireless
communications and ability to store and retrieve enormous amounts of data. The role
of health informatics is broad and ranges from application of advanced data
analytical methods, artificial intelligence techniques, medical language processing,
assessment of health outcomes to electronic surveillance for selected risk factors and
diseases. The application of informatics techniques to understand health, disease and
biological mechanisms which focus on specific areas of biomedical science or health
care has led to the development of many sub-domains (figure 1).

Advancements in the field translate into innovative methods and solutions in health
care. Some advantages are:

Physician1. Electronic medical records that facilitate the access to the medical
record of a patient at anytime and place.

2. Clinical decision support systems / intelligent systems that assist in prescribing of

medications, interpretations of lab results, disease surveillance and suggest plans of
action in data-intense areas like the intensive care units.

3. Portable and miniature hand held devices that enable to access patient data
anytime and also provide medical news and information.

4. Telemedicine that provides the ability to attend to patients who are separated by
distance and those who are unable to visit the physician.

• Electronic personal health records that enable to store essential medical


• Telemedicine which connects patient with medical experts far away.

• Web sites that provide information on health, diseases and self-help.

• Online support groups specific for various health conditions.

• Internet-based tools for disease management.

About Health Informatics

2009 Guidelines for the Protection of Health Information

The 2009 Guidelines for the Protection of Health Information, available as both user-
friendly PDF and a new reference book, is an important resource for protecting privacy
and security of health information, particularly when designing or maintaining
information systems.

COACH Definition of Health Informatics

Health informatics (HI) is the intersection of clinical, IM/IT and
management practices to achieve better health.
HI involves the application of information technology to facilitate the creation and use of
health related data, information and knowledge. Health informatics enables and supports
all aspects of safe, efficient and effective health services for all Canadians (e.g., planning,
research, development, organization, provision, evolution of services, etc.). Health
Informatics Professionals develop and deploy information and systems solutions, drawing
on expert knowledge from fields such as computer science, information management,
cognitive science, communications, epidemiology, management sciences and health
sciences. Examples of health informatics applications include the design, development,
implementation, maintenance and evaluation of:

• communication protocols for the secure transmission of healthcare data

• electronic patient record systems (regionally, provincially, territorially or
• evidence-based clinical decision support systems
• classification systems using standardized terminology and coding
• case management systems (e.g., for community, home and long-term care)
• access and referrals systems for healthcare services
• patient monitoring systems (e.g., computer controlled bedside monitors and
patient home monitoring devices)
• digital imaging and image processing systems
• telehealth technologies to facilitate and support remote diagnosis and treatment
• internet technology for engaging patients in their own care
• public health surveillance and protection systems
• methodologies and applications for data analysis, management and mining
• clinical information data warehouses and reporting systems
• business, financial, support and logistics systems
The scope and vision of epidemiology

The world that epidemiologists study is rapidly changing. As noted above, many of the
major hazards discovered by epidemiologists, such as tobacco and asbestos, have not
been eliminated and, for the most part, have merely moved to the developing world.
We are seeing the effects of economic globalization,6 structural adjustment,5 and
climate change,7 and the last few decades have seen the occurrence of the
‘informational revolution’ which is having effects as great as the previous agricultural and
industrial revolutions. The benefits have been mixed, particularly in developing
countries,6 while the countries of Eastern Europe have experienced the largest sudden
drop in life expectancy that has been observed in peacetime in recorded history.8

These trends are disturbing, but they should at least keep epidemiologists employed for
many decades to come. So why do some modern epidemiologists apparently think that
there is nothing interesting or important left to study in population terms and that
epidemiologists should essentially become data collectors for molecular biologists? (I
should stress that I am not ascribing these views directly to Ken Rothman, but rather I am
suggesting that they are typical of ‘modern epidemiologists’ in general). The main reason
is that the scope, and vision, of the field have markedly narrowed in recent decades. This
is not entirely the fault of epidemiologists, and factors such as the human genome project
and the recent strong emphasis on genetic research have also played a (both positive and
negative) role.9 However, the damage has also in part been self-inflicted. As noted by
Rothman,1 the period 1950–80 saw a remarkable growth in epidemiology as a discipline,
with a ‘rapid succession of theoretical advances in study design and analysis to overcome
the inherent handicaps of non-experimental research.’ Rothman himself played a leading
role in these developments, including the publication of an elegant and brilliant textbook,
which has been strongly influential.10 The problem is that these theoretical developments,
positive as they were, also carried a great deal of theoretical and ideological baggage.11
Traditional approaches to epidemiology started from the standpoint of populations, which
involved messy considerations such as context, culture, history and socioeconomic status,
all of which strongly influenced health.12 ‘Modern epidemiology’ strips away all of that
‘noise’ and follows a randomized clinical trial paradigm in which risk factors and disease
outcomes are considered in isolation, and the aim of an epidemiologic study is to obtain
the same findings that would have been obtained with a randomized controlled trial.

As a result, epidemiologists have been taught that some study designs, particularly cohort
and case-control studies, are better than others. No respectable epidemiologist would do
an ecologic study, even though, despite their obvious shortcomings, they continue to play
a major role in new epidemiologic discoveries,13 e.g. in the ‘fetal programming’ field14
and in asthma epidemiology.15 Epidemiology has become a set of methods, and
epidemiologists attempt to answer the types of questions that can be answered with these
methods. This works fine for issues like smoking and lung cancer, but not so well for
other risk factors such as beta carotene and cardiovascular disease, hormone replacement
therapy, vitamin E and vitamin C intake in relation to cardiovascular disease, or fibre
intake in relation to colon cancer.9 Other issues, like climate change or poverty, do not fit
the paradigm at all (you need at least two planets!), and are therefore ‘someone else's

It is as if the house is burning down, but we are focussing on developing better theories
on how to change the light bulb—while complaining that the ethics committee is putting
obstacles in our way and the government is trying to impose guidelines as to how we
should do it. Perhaps the nadir of this purist approach came when those who were trying
to restore the population perspective to epidemiology, and to broaden its vision, were
condemned as social activists by Rothman and colleagues in an influential paper in the
Lancet.16 In fact, the issue is not whether epidemiologists should be activists about the
population determinants of disease, such as poverty, but whether they should study
them.12 To let the methods determine the questions that are asked, and to ignore other
important public health problems because they do not fit the paradigm, is not only bad
public health practice but is also bad science.

Scope of Nursing Practice

ICN Position:

Nursing is responsible for articulating and disseminating clear definitions of the

roles nurses engage in, and the profession’s scope of practice. National
professional organisations bear the responsibility for defining nursing and nurses’
roles that are consistent with accepted international definitions articulated by the
International Council of Nurses, and relevant to their nation’s health care needs.
While nurses, through professional, labour relations and regulatory bodies, bear
primary responsibility for defining, monitoring and periodically evaluating roles
and scope of practice, the views of others in society should be sought and
considered in defining scope of practice.
The scope of practice is not limited to specific tasks, functions or responsibilities
but includes direct care giving and evaluation of its impact, advocating for
patients and for health, supervising and delegating to others, leading, managing,
teaching, undertaking research and developing health policy for health care
systems. Furthermore, as the scope of practice is dynamic and responsive to
health needs, development of knowledge, and technological advances, periodic
review is required to ensure that it continues to be consistent with current health
needs and supports improved health outcomes.
National nurses associations (NNAs) have a responsibility to seek support for
legislation which recognises the distinctive and autonomous nature of nursing
practice, including a defined scope of practice.

The scope of practice is defined within a legislative regulatory framework, and

communicates to others the roles, competencies (knowledge, skills and attitudes)
and the professional accountability of the nurse. Nursing’s authority comes from
evidence-based knowledge related to its sphere of practice.
However, nursing is also allied to other health professions through its
collaborating, referring, and co-ordinating activities, and thus has developed a
distinct as well as a shared body of knowledge and practice. The practice and
competence of an individual nurse within the legal scope of practice is influenced
by a variety of factors including education, experience, expertise and interests as
well as the context of practice. Therefore, definitions of roles and scope of
practice need to reflect what is distinctly nursing, while communicating the
multidisciplinary and interdisciplinary nature of health care.
Nurses require appropriate initial and ongoing education and training as well as
lifelong learning to practice competently within their scope of practice.
Therefore, nursing must ensure that nurse educators and nurses managing
nursing services are experienced nurses with suitable qualifications and
understanding of the competencies and conditions required to deliver quality
nursing care in the current health care environment. To enable the profession to
provide competent leadership, NNAs should be vigilant in assuring that nurses
are prepared with the necessary competencies to function in leadership roles at
all levels of the health system. NNAs are also responsible for ensuring that
nurses are major participants in the planning and direction of nursing education,
nursing services, regulatory bodies and other health related activities.

Scope of practice is defined as the activities that an individual health care provider
performs in the delivery of patient care. Scope of practice reflects the types of patients for
whom the advanced practice nurse can care; what procedures/activities the advanced
practice nurse can perform; and influences the ability of the advanced practice nurse to
seek reimbursement for services provided.

Determining scope of practice includes:

• Advanced practice education in a role and specialty

• Legal implications (e.g. compliance with the Nursing Practice Act and Board
• Scope of practice statements as published by national professional specialty and
advanced practice nursing organizations

Both professional and individual scopes of practice exist. Professional scopes of practice
are derived from professional specialty and advanced practice nursing organizations. An
individual advanced practice nurse may or may not practice the full scope of the
professional role and specialty. Decisions regarding individual scope of practice are
complex and related to an advanced practice nurse's knowledge, skills and competencies.
Each advanced practice nurse must practice within his/her individual scope.

Professional Scope

National professional specialty and advanced practice nursing organizations broadly

define scope of practice for each role. These documents address role, function, population
served, and practice setting. They offer advanced practice nurses the broadest parameters
for scope of practice. Therefore, professional scopes of practice are recommended as the
initial resource in defining an individual's scope of practice.

Individual Scope

Formal advanced practice nursing education is the foundation for the individual's scope
of practice and evolves over the professional lifetime of the individual. Clinical
experience in various settings, continuing education, formal course work and
developments in healthcare all impact individual scope of practice. However, there are
finite limits to expansion of scope of practice without completing additional formal
education. Advanced practice nurses cannot change their legally recognized titles or
designations through experience or continuing education; these changes may only be
achieved through additional formal educational preparation and meeting all legal
requirements to use that title and practice in that specialty set forth by the BON.