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Computers have significantly changed the way that human beings do things, including the processing, storage, and retrieval of data in healthcare. Health informatics or medical informatics is the application of information technology to the healthcare profession with the aim of creating tools and procedures that can help doctors, nurses, and other healthcare personnel diagnose and treat patients more accurately and efficiently.
Founding Fathers of Informatics
Health informatics as a discipline has a long and interesting history that would be impossible without Charles Babbage’s ideas about the first analytical computer system way back in the nineteenth century. Even though there was talk about using computers in medicine as technology advanced in the early twentieth century, it was not until the 1950s that informatics really took off in the United States. Robert Ledley, who would later invent the first full body CT scanner, is often credited as one of the founding fathers of U.S. informatics. His use of computers in dental projects with the National Bureau of Standards set the stage for later advancements in applying information technology to medicine.
Massachusetts General Hospital Utility Multi-Programming System
Following the invention of the LISP programming language in the late 1950s and the advance in computing technology and data storage in the 1960s, doctors, graduate students, and computer specialists began working at several different locations to create diagnostic systems and other medical computer programs. The MUMPS programming language created at Massachusetts General Hospital by Pappalardo, Greenes, and Marble from 1966–1967 was also an important step in the growing field of health informatics. MUMPS allowed for the creation and integration of medical databases. It continues to form the basis for many healthcare records programs. The most famous uses of the LISP language would not occur until the 1970s with the development of the computer systems MYCIN and INTERNIST-1.
MYCIN was created at Stanford University in order to help doctors identify the bacteria behind several infections and to recommend antibiotics and dosage amounts for treatment. It was also designed to help with the treatment of blood clotting abnormalities. Edward Shortliffe invented this system, which performed better than many Stanford medical school faculty in tests of ability, though it never was used in actual medical practice. INTERNIST-1, developed at the University of Pittsburgh as a system that would provide medical information to persons who were not medical experts, likewise never achieved commercial use. However, the benefit of both of these systems was that they established the possibility of creating and using more advanced health informatics technology. Starting in the 1980s, the U.S. Veterans Administration began using the MUMPS language to develop individual health records for its patients. Today it uses an award-winning program called CPRS (Computerized Patient Record System), a graphic interface that creates a long-term view of a patient’s health record. Its features include a notification system to make users aware of significant clinical events for the patient and a reminder system that works to make sure the right treatments are given at the right time.
The Electronic Health Record
Practically speaking, the widespread adoption of electronic medical records will probably be the most significant application of health informatics in the foreseeable future. The electronic storage of patient data has created many privacy concerns, and in 1996, President Bill Clinton signed the Health Insurance Portability and Accountability Act (HIPAA). This law prevents healthcare providers, insurers, and clearinghouses from sharing medical information about a patient without the patient’s consent. These privacy safeguards have made providers and patients alike more willing to adopt cost-effective electronic billing software because they know that personal health information is not being shared with others in the process of billing and payment. Providers who use this billing software can only do so if they adhere to HIPAA regulations. The U.S. Department of Health and Human Services oversees the enforcement of HIPAA, and is overseeing a plan to ensure widespread adoption of electronic medical records by 2014. Grants and other assistance are being given to communities to achieve this goal in the hope that the adoption of electronic medical records will lower healthcare costs and improve patient care across the board.
For more information on the history of health informatics, please consult the following sites:
A Brief History of Biomedical Informatics as a Discipline — As the title would suggest, this page gives a brief history of biomedical informatics.
Health Information Technology — This page from the Department of Health and Human Services provides information on a variety of informatics-related subjects.
Health Insurance Portability and Accountability Act — This is a page on the important U.S. Health Insurance Portability and Accountability Act.
History of Biomedical and Health Informatics — The role of the University of Washington in the history of health informatics is detailed on this page.
JAMIA: Computerized Tomography — This interview with Dentist Robert S. Ledley, who helped start medical informatics in the 1950s, discusses his invention of the full-body scanner.
MEDLINE — This is the official United States government page on the MEDLINE article and information database.
MYCIN Clinical Decision Support System — Stanford University developed the MYCIN System to help diagnose infections disease, and this page gives some history and facts on the program.
National Health Information Infrastructure — The U.S. Department of Health and Human Services working group devoted to standardizing a national health informatics infrastructure can be found here.
VA on the Cutting Edge — The U.S. Department of Veteran Affairs has developed several innovative health informatics programs, and this site highlights many of them.
What is Biomedical Informatics — Vanderbilt University offers this page that defines biomedical informatics and also provides some milestones in the discipline’s history.