Medical Informatics: Meeting the Information Challenges of a Changing Health Care System

The major dilemma facing medical science at the beginning of the 20th Century was the lack of biomedical knowledge.  The major dilemma facing us at the dawn of the 21st Century is the application of biomedical knowledge.  Health care is a prototypical knowledge business, but it is also perhaps the most complex of all knowledge industries.  The growing complexity of the information base and the explosion of biomedical information contribute to the decay rate of scientific knowledge acquired during a typical health sciences education.  The National Library of Medicine’s Medline archives 31,000 new citations per month and it is now estimated that a clinician needs to read 17 articles a day every day of the year simply to remain current in their field of practice. Whether it is practiced at the bedside or managed in the boardroom, health care is an information intensive industry.

Clinicians create, use and promulgate information.  To be effective caregivers, researchers, and health educators therefore depends increasingly on our abilities to manage information. However, simply adopting information technologies (IT) is not enough.  Just as the ability to use a stethoscope does not make one a physician, the ability to use IT or “surf” the Internet does not imply that one understands the principles and nuances of information or information management.

Information and technology are quintessential human creations and thus require humans as managers. Because of this, information can be analyzed from ecological perspectives. Approaching information and information management in this fashion emphasizes an organization’s entire information environment.  This approach avoids the pitfalls of over-focusing on technology.

The ecological perspective of information allows an organization to think holistically about information management and to focus on the four key attributes of the ecology:

1) information is diverse; deriving from disparate sources and thus must be integrated;

2) information evolves with each new discovery or inquiry; information management must evolve with the information itself;

3) information and the use of information can be observed and described;

4) there are behavioral aspects attributed to information.

Simply put, this refers to how individuals or organizations approach and handle information.  Effective clinical information management requires every clinician to understand these principles.  It also requires an understanding of data interpretation, the logical foundations of clinical reasoning, the recognition of uncertainty in clinical knowledge, and the local politics and strategic vision or lack of surrounding information.

The task for informaticists is to design the information resources and systems that enable health care providers and organizations to recognize and create information ecologies in their practice settings. Broadly defined, informatics is concerned with the incorporation of IT into the day-to-day workflow and delivery of health care.  To accomplish this, informaticists must deal with the uncertainty of the clinical encounter, the expansion of clinical information, the complexity of the health care delivery setting (clinical and financial), the limited ability of the human mind to simultaneously utilize four to seven data constructs, and the explosion of technology itself. In effect, medical informaticists spend their careers studying the mechanics of medical information and medical reasoning, the abstraction and elaboration of knowledge, and the processes of memorization and learning.  To that end, medical informatics is a scientific discipline with its roots in information theory.  Medical information is characterized by it’s subject matter (i.e. medicine) and it’s methodology (i.e. information management).  The discipline draws on other sciences such as mathematics, cognitive psychology, statistics, linguistics, philosophy, and computer science.  Applications derived from medical informatics research allow us to provide knowledge about knowledge and therefore, it embodies all areas of the health sciences, from the microscopic to the macroscopic, and from the individual patient to society.  Clinical informatics is a subset of medical informatics and is mainly concerned with clinical practice and the information management issues contained therein. Clinical informatics is to medical informatics as clinical epidemiology is to epidemiology in general.

Social, financial, and technical forces originating within and outside the health care field are exerting tectonic changes.  Medical informatics is a field of growing importance as the health care industry struggles to adapt to these changes.  Informaticists are best suited to understand the nature of biomedical information, the working conditions of health care providers, and the information systems themselves. Medical informatics is being recognized as central to the mission of surviving in these turbulent times and will be the springboard from which practitioners of medicine, pharmacy, nursing, and dentistry will derive clinical applications to better serve their patients and society.

Given these realizations, should pharmacists be retrained as medical informaticists?  Certainly, the technologies that medical informaticists develop such as clinical decision support systems will change the way the profession delivers care and the role of the pharmacist in that delivery.  Pharmacists are particularly vulnerable to the impacts of clinical decision support systems.  These tools will replace many of the current cognitive contributions of pharmacist clinicians, however they will also spurn unimaginable opportunity.  Domain specialists are key to the content development required for clinical decision support systems. Pharmacists are natural domain specialists given their fundamental body of pharmacotherapeutic knowledge and are well positioned to play key roles in the development of clinical decision support systems.  It would be wise for pharmacists to become familiar with techniques, such as knowledge engineering and to develop relationships with medical informaticists.  These relationships will establish a vital role for pharmacists in the design and implementation of clinical decision support systems.  A proactive role of pharmacists in these developments will allow the profession to define its roles and direct its destiny.

In this issue of the Journal, Balen et al. provide us with an interesting Canadian perspective on the issue of pharmacists’ clinical informatics needs and their applications in practice. These practitioners review essential clinical informatics skills, provide some good examples of effective informatics use in everyday practice and describe their recent efforts towards enhancing pharmacy student knowledge on this topic.  I’m sure the authors would agree with me that we live in marvelous times; we just need to be organized to take full advantage of what is now available to us.

Stanley L. Pestotnik, B.Sc. (Pharm), M.Sc. (Medical Informatics)
Clinical Assistant Professor
University of Utah College of Pharmacy
President and CEO, TheraDoc.com, Inc.

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