GOOD MORNING

HEALTH INFORMATICS

CONTENTS Introduction Definition of health informatics Development Infrastructure Objective Information skills Requisites to be satisfied Components

Uses Sources Aspects Standards Subdomains Dental informatics Introduction Goals Dentiline Opportunities and challenges

Oral health information systems-WHO Conclusion References

Introduction

If physiology literally means the logic of life, and pathology is the logic of disease, then health informatics is the logic of healthcare. It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how clinical knowledge is created, shaped, shared and applied.

Ultimately, it is the study of how we organise ourselves to create and run healthcare organisations. With such a pivotal role, the study of informatics will become as fundamental to the practice of medicine.

Health informatics is thus as much about computers as cardiology is about stethoscopes. Rather than drugs, X-ray machines or surgical instruments, the tools of informatics are more likely to be clinical guidelines, formal health languages, information systems, or communication systems like the Internet. These tools, however, are only a means to an end, which is the delivery of the best possible healthcare

Although the name health informatics only came into use around 1973 (Protti, 1995), it is a study that is as old as healthcare itself. It was born the day that a clinician first wrote down some impressions about a patients illness, and used these to learn how to treat their next patient.

Informatics has grown considerably as a clinical discipline in recent years fuelled, in part no doubt, by the advances in computer technology. What has fundamentally changed is our ability to describe and manipulate health knowledge at a highly abstract level, as has our ability to build up rich communication systems to support the process of healthcare.

A health information is defined as : "a mechanism for the collection, processing, analysis and transmission of information required for organizing and operating health services, and also for research and training" .

( WHO 1974)

Medical informatics began to take off in the US in the 1950s with the rise of the microchip and computers. The earliest use of computation for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley The next step in the mid 1950s were the development of expert systems such as MYCIN and INTERNIST-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. At 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 at Massachusetts General Hospital in Boston. In the 1970s and 1980s it was the most commonly used programming language for clinical applications.

Homer R. Warner, one of the fathers of medical informatics, founded the Department of Medical Informatics at the University of Utah in 1968. In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exists only a small number of health practitioners use fully featured electronic health care records systems.

1996-s regulating privacy and medical record transmission, created the impetus for large numbers of physicians to move towards using EMR software, primarily for the purpose of secure medical billing.

Health informatics or medical informatics is the intersection of information science, computer science, and health care.
.

It deals with the resources, devices, and formal health languages, information systems, or communication systems like the Internet methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine

Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems

The Infrastructure for Informatics Electronic medical records. data capture. Computable representations of the medical literature diagnosis. decision support for health care professionals. Systems for improved patient education and compliance. Continuing medical education Demonstration of effectiveness. Mining data for new medical knowledge. Universal access to these technologies.

The primary objective of a health information system is to provide reliable, relevant, up-to-date, adequate, timely and reasonably complete information for health managers at all levels (i.e., central, intermediate and local), and at the sharing of technical and scientific (including bibliographical) information by all health personnel participating in the health services of a country; and also to provide at periodic intervals, data that will show the general performance of the health services and to assist planners in studying their current functioning and trends in demand and work load.

Informatics Skills Communicating effectively

Structuring information, with a particular focus on the patient record, is shown to be dependent upon the task at hand, the channel used to communicate the message, and the agent who will receive the message

Questioning others to find information is essential in clinical practice to fill the ever present gaps in every individuals knowledge;
Searching for knowledge describes the broader strategic process of knowing where to ask questions, evaluating answers, and refining questions in the light of previous actions, and occurs in many different settings, from when patients are interviewed and examined, through to when treatment options are canvassed;

Making Decisions occurs when all the available information needed has been assembled using the other informatics skills, and attempts to come up with the best alternative to solve a problem like selecting a treatment, based both upon the evidence from science, as well as the wishes and needs of individuals

Requirements to be satisfied by health information systems

A WHO Expert Committee identified the following requirements:

system should be population based avoid the unnecessary agglomeration of data Employ functional and operational terms Should be problem oriented Should express information briefly and imaginatively Should make provision for the feedback of data.

Components of a health information The health information system is composed of several related subsystems. A comprehensive health information system requires information and Indicators on the following subjects

demography and vital events environmental health statistics health status: mortality, morbidity, quality of life health resources: facilities, beds, manpower Utilization and non-utilization of health services: attendance, admissions, indices of outcome of medical care financial statistics (cost, expenditure) related to the particular objective

Uses of health information

To measure the health status of the people and to quantify their health problems and medical and health care needs.

For local, national and international comparisons of health status. For such comparisons the data need to be subjected to rigorous standardization and quality control. For planning, administration and effective management of health services and programs.

For assessing whether health services are accomplishing their objectives in term of their effectiveness and efficiency For assessing the attitudes and degree of satisfaction of the beneficiaries with the health system For research into particular problems of health and disease.

Sources of health information

Census Registration of vital events Sample registration systems Notification of diseases Disease registrations Record linkage Epidemiological surveillance Health service records Environmental health data Health manpower statistics Population surveys

Non quantifiable information The health information system concentrated mainly on quantifiable (statistical) data. Health planners and decision makers require a lot of non- quantifiable information, for instance, information on health policies, health legislation, public attitudes, program costs, procedures and technology.

In other word, health information system has multi disciplinary inputs.

There should be proper storage, processing and dissemination of information.

We can formally say that health informatics is the study of information and communication systems in healthcare. Health informatics is particularly focused on:

1. Understanding the fundamental nature of these information and communication systems, and describing the principles which shape them,

2. Developing interventions which can improve upon existing information and communication systems,

3. Developing methods and principles which allow such interventions to be designed,

4. Evaluating the impact of these interventions on the way individuals or organizations work, or on the outcome of the work.

Aspects of the field architectures for electronic medical records and other health information systems used for billing, scheduling, and research

decision support systems in healthcare, including clinical decision support systems

standards and integration profiles (e.g. Integrating the Healthcare Enterprise) to facilitate the exchange of information between healthcare information systems

controlled medical vocabularies (CMVs) such as the Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT), MEDCIN, Logical Observation Identifiers Names and Codes (LOINC), OpenGALEN Common Reference Model or the highly complex UMLS - used to allow a standard, accurate exchange of data content between systems and providers use of hand-held or portable devices to assist providers with data entry/ or medical decision-making, sometimes called mHealth.

Other information projects are

eHealth (also written e-health) is a relatively recent term for healthcare practice which is supported by electronic processes and communication. The term is inconsistently used: some would argue it is interchangeable with health care informatics and a sub set of health informatics, while others use it in the narrower sense of healthcare practice using the Internet. The term can encompass a range of services that are at the edge of medicine/healthcare and information technology:

mHealth (also written as m-health or sometimes mobile health) is a recent term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine).

Subdomains of health care informatics include: clinical informatics, nursing informatics, imaging informatics, consumer health informatics, public health informatics, dental informatics, clinical research informatics, translational research informatics. bioinformatics, veterinary informatics, pharmacy informatics

Dental informatics

WHAT IS DENTAL INFORMATICS?

According to Merriam-Websters Collegiate Dictionary, informatics is derived from the term "information science," which is the collection, classification, storage, retrieval and dissemination of recorded knowledge treated both as a pure and applied science. When applied to a specific domain, such as medicine, nursing or dentistry, information science becomes "informatics."

A simple, but cogent, definition of dental informatics is "the application of computer and information science to improve dental practice, research, education and management.

Informatics is focused primarily on research, development and evaluation of information models and computing applications. IT, on the other hand, is concerned with the implementation and application of computer technology and telecommunications.

Despite the larger conceptual division, limited areas of overlap between informatics and IT exist, such as custom development of software and evaluation of implemented systems.

Dental informatics can be considered a specialty of medical informatics. A number of models, methods and applications can be shared, transferred or both between the two disciplines. For instance, the National Library of Medicines, or NLMs,

MEDLINE is the worlds largest biomedical literature database and is equally applicable to all health care disciplines. The same applies to GenBank, a database of gene and protein sequence information to which researchers from several domains contribute.

Despite much common ground, there also are many aspects that set those informatics domains apart. For instance, most design work that informs the development of computer-based medical records simply is not applicable for computer-based dental records. Dentists collect, display and analyze data differently than do their medical counterparts.

While the general medical and medication histories collected by both physicians and dentists share many common elements, the dental history and the oral health status have no equivalent in medicine.

As a consequence, developing, implementing and evaluating complete computer-based dental records is both a challenge and an opportunity for dental informatics, as are many other domain-specific aspects.

History

Dental informatics has developed significantly since the 1960s,when the first uses of informatics approaches to address dental issues were documented .

Similar to informatics researchers in medicine , researchers in the nascent field of dental informatics were individuals who had been trained in dentistry and other disciplines, such as engineering, or dentists who had partnered with other professionals, such as computer scientists.

Interest in dental informatics rose gradually, and the first conferences and workshops on the subject took place (such as the Symposium on Second Generation Clinical Databases and the Electronic Dental Record [1990], the International Conference on Computers in Clinical Dentistry [1991, 1992,1993], and the International Conference on Computer Applications in Dental Education and Practice [1994, 1999]).

In the early 1990s, some professional organizationssuch as the International Medical Informatics Association, the American Medical Informatics Association, and the American Dental Education Associationbegan to organize interest groups in dental informatics.

A key development was the initiation of funding for dental informatics training by the National Institute of Dental and Craniofacial Research (NIDCR) in 1996, which for the first time recognized the need for a formal education of dental informaticians (Schleyer and Spallek, 2001).

The National Library of Medicine [NLM] had been funding similar training in medical informatics since 1972.

Currently, two dental informatics training programs are in operation (Columbia University, 2000;University of Pittsburgh, 2003), and they collectively graduate approximately one or two trainees per year

WHAT ARE DENTAL INFORMATICS PRACTICAL GOALS?

The main goal of dental informatics is to improve patient outcomes. Thus, the discipline must support and improve diagnosis, treatment and prevention of disease and traumatic injury; relieve pain; and preserve and improve oral health.

A secondary goal is to make the delivery of dental care more efficient; for example, by maintaining or improving costbenefit ratios.

Dental informatics also must support research and education, and improvements in these areas should, and often do, translate into improved patient care

Developing, implementing and evaluating complete computer-based dental records is both a challenge and an opportunity for dental informatics.

Informatics is key in helping practitioners solve clinical problems and keep current.
Most educational programs still subscribe to the philosophy that everything dentists need to know can be learned in dental school. The trend toward problem-based learning and the development of critical-thinking skills tells a different story. Dentists must be as familiar with the problem-solving process as they are with the problem domain itself.

Computers can help practitioners maintain their continuing competency, and many dentists already are using computers to keep abreast of new developments

IS DENTAL INFORMATICS A DISCIPLINE?

Before we can answer the question of whether dental informatics is a discipline, we should discuss what features characterize a discipline. Requisite features are

a core of people who conduct research and publish in the discipline; an identifiable body of literature: books, journals and other publications;

professional societies and related activities, such as meetings and conferences;

educational programs leading to a certificate or advanced degree; funded research programs.

A core of people who conduct and publish research in dental informatics exists.

An informal review of the literature showed that since 1965 approximately 3,500 authors have published about 2,200 articles related to dental informatics and computer applications in dentistry in about 420 journals and conference proceedings.
Journals with significant numbers of informatics-related articles include Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics; JADA; Dentomaxillofacial Radiology; the Journal of Dental Education; and the British Dental Journal.

Currently, dental informatics has no mainstream journal of its own, the emergence of special-purpose journals (such as the Journal of Computerized Dentistry) notwithstanding.

This is appropriate considering that dental informatics is in the early stages of development and that, at this time, it is more important to educate a broad audience about the possibilities of dental informatics than to provide a specialized forum for dental informatics researchers.

Over the long term, however, the development of a dedicated, international and multidisciplinary dental informatics journal should be considered.

Currently, dental informatics has no dedicated professional society. Rather, its activities are integrated with those of several existing associations, such as the American Dental Education Association, or ADEA; the ADA; and the American Medical Informatics Association, or AMIA. In most cases, a section or special interest group of an association provides a forum for exchange between members.

Specialized conferences, such as the Conference on Computers in Clinical Dentistry, those sponsored by ADEA, the Consortium for Clinical Information Systems, and the Conference on Computers in Dental Education and Practice have been held in the past. Up until now, these conferences have been arranged on an ad hoc basis, and none has developed into a stable, widely accepted scientific forum

The first educational programs leading to advanced degrees in dental informatics were created in 1996 in response to a request for applications issued by the National Institute of Dental and Craniofacial Research, or NIDCR, in cooperation with NLM.

Anecdotal evidence suggests that dental informatics research receives only limited third-party funding, such as from the government, the military, foundations and companies. NIDCR and NLM have funded very few grant applications in dental informatics, and some universities have been and are receiving limited corporate support. In contrast, programs sponsored by the European Union have resulted in significant funding in dental informatics research in Europe. Much of the research in dental informatics at this time is conducted as "unfunded" research by faculty at dental schools and universities around the world.

It is instructive to compare dental informatics to its parent, medical informatics. The medical informatics research community is extremely active. Medical informatics has its own literature that is segmented into topics such as biomedical engineering, biomedical computing, decision support and education.

Dental informatics is a nascent discipline. To what degree it can mature successfully depends on its ability to take advantage of opportunities and overcome some significant challenges.

DENTILINE ?

Lipton (1992) suggested DENTLINE, a literature database similar to MEDLINE, focused exclusively on dental issues, as one measure to make information delivery more targeted and relevant for dental professionals. While a system such as DENTLINE has not come into being, it is possible to search only the dental journals in MEDLINE with search interfaces such as PubMed, the Web interface to MEDLINE provided by the NLM. Generally, however, MEDLINE, the Unified Medical Language System, GenBank, and many other major databases continue to serve all biomedical professionals rather than a defined subset.

Special information-filtering mechanisms could achieve the intent of DENTLINE while preserving the advantages of large, homogeneous collections of information in biomedicine.

A major portion of Lipton's proposed goals deal with effective knowledge management, despite the fact that they are not labeled as such. Knowledge management systems maintain data, information, and problem-solving methodologies in an organized, comprehensive, flexible, and accessible fashion.

Yet, dentistry has not succeeded in building such systems. We continually create and maintain many separate and independent stores of individual and aggregate data and information.

The overwhelming majority of problem-solving methods exist in formats that are inaccessible to computers (such as in research papers, systematic reviews, textbooks, and the heads of scientists, educators, and practitioners).

Thus, the absence of effective knowledge management hampers progress in all fields of dentistry and retards the transition of useful innovations to direct patient care.

OPPORTUNITIES AND CHALLENGES

Dentistry is an information-intensive activity, and informatics by its very nature supports such activities well. IT already has significantly improved our ability to store, access, manage, filter and apply information. When one considers what progress has been made in a myriad of aspects of human life, it is not difficult to envision how dentistry may be transformed by becoming informatics-based. Ultimately, informatics done well simply will let us concentrate on our jobs as dental professionals by improving and maintaining the oral health, and consequently the general health, of our patients. These new and powerful technologies will bring cultural changes to the dental profession itself. The following are some opportunities and challenges that informatics places before us.

Longitudinal, lifetime, comprehensive and patient-centered dental records.

Dentistry is still largely a cottage industry. This situation expresses itself in the minimal degree to which patient information is shared. Patient-centered, rather than practicecentered, dental records can eliminate duplicate information gathering, provide a rich context through access to prior diagnostic and treatment records, and allow the practitioner to concentrate on the problem at hand.

Universally accessible patient records that ensure privacy and confidentiality. As an increasing portion of patient-related information is stored and transmitted digitally, dental informatics has the responsibility to develop, implement and monitor measures to keep it private. While no system is perfectly secure, a balance between privacy and access must be found

Significant reduction of administrative overhead.

practice

management

and

A significant portion of health care expenditures go toward administration. One of the greatest sources of inefficiency has been the lack of shared information by health care buyers, sellers and consumers. Well-integrated information systems can reduce this overhead significantly, through measures from autonomous supply ordering to automated scheduling, billing and recall.

Clinical care based on empirically determined best practices. Most patients in industrialized countries already enjoy very high standards of care. However, large variations in diagnosis and treatment decisions still exist. As more patients become aware of the standard of care, dentists will be forced to prove the quality of their care. While few dental treatments are based on definitive clinical evidence obtained through randomized clinical trials, outcomes data aggregated over large numbers of practices and patients can help identify best practices. Since many patients use the Internet to access health-related information, valid and reliable information needs to be available and recognizable as such.

How can the dental profession take advantage of these opportunities?

A positive circumstance is that dentistry as a profession is relatively unified Realizing the present opportunities rests on significant innovation, research and development in informatics

One attempt is crafting a long-term strategy by the development of standards related to dental informatics

Another challenge is to increase the quality and quantity of dental informatics research. The standards for investigation and scientific inquiry in new disciplines develop over time, and dental informatics is no exception. The scarcity of people formally trained in research methods and approaches and the dearth of interdisciplinary teams that can solve complex research questions constrains the volume and quality of research output.

Support for dental informatics research from grants, contracts and funding agencies such as NIDCR or NLM is minute. The problem, however, is two-sided. The lack of investigators in dental informatics results in a scarcity of fundable research proposals. Funding agencies, on the other hand, may not view dental informatics as a programmatic priority if demand for research funding is not apparent.

HOW CAN WE GET INVOLVED IN DENTAL INFORMATICS?

Articles on dental informatics in major dental journals. Meetings and conferences Standards activities, society activities, university committees and focus groups Computer courses Dental informatics degree programs

Oral health informations systems

WHO has a long tradition of epidemiological survey methods WHO global data bank was established-1967 Emerged from gathering of information from surveys and growing burden of dental caries, particularly notable in the industrialized countries. Surveys were motivated for the need for planning of oral health services and organization of public health intervention programs. WHO has encouraged the member states to report information on the disease level for international comparisons by use of standardized methodology.

To ensure high validity and reliability- basic instruments and record forms in the collection of data. High quality data through specification of clearly defined examination procedures, training, calibration trials, for assessment of intra and inter examiner variability

Tools of oral epidemiology have been instrumental in the establishment of oral health information systems world wide.

In addition to the epidemiological information, decision makers and planners need information about risk factors to oral health, OHRQOL, intervention and care, administrative procedures, quality of care and services.

An important public health rationale of WHO global oral health data bank has been to provide for epidemiological analysis of changing oral health status, to highlight how such changes might be related to new risk profiles in countries or regions, and to access the impact of development or adjustmnet of oral health systems. Similar databanks have been developed for the WHO regional offices.

In 1996 , WHO established an internet online oral health database, supported by WHO coloborating center in oral health at malmo university, Sweden, and the university of Nigita, Japan.

CONCLUSION

Dentistry is a relatively small segment of the health care system. Thus, many companies are hesitant to invest in research and development because the potential payoff is constrained by the small size of the market. Network externalities also are a significant deterrent to investment. Products or services, such as the telephone, that become more valuable as more people use them are said to benefit from network externalities. For instance, when only a few practices can exchange patient information using computer-based patient records, or CPRs, the collective benefit is small. When most practices use such interoperable CPRs, however, the collective benefit is large. Globalization may improve this situation because it increases potential markets.

The growth of dental informatics also is hampered because many of its benefits are hard to measure, and achieving them requires significant upfront and ongoing investments. For instance, the quantifiable benefits of a computer system for billing and electronic claims submission include time and money saved in preparing claims, reduced claim and payment turnaround, and improved management of accounts receivable. The advantages of installing a CPR, on the other hand, are much harder to define and measure. Evaluating the return on investment, however, is fraught with difficulties not only in dental informatics.

The current situation simply may be symptomatic of a profession finding its way in informatics. An encouraging sign is the significant and increasing interest of many influential stakeholders in dentistry. Hopefully, this interest can be channeled into concerted action that benefits all of dentistry. Success, however, also is predicated on the level of involvement of each practitioner.

"There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Niccol Machiavellis.

Computer technology has reshaped our lives already. The question is to what degree it will reshape dentistry. The ubiquitous reach of todays computer networks presages significant change: dentistry is not an isolated province of health care anymore. We are now, more than ever, connected to a larger system of stakeholders, regulations, expectations, accountability and risk.

References

RUSS B. ALTMAN ,Medical Informatics,Informatics in the Care of Patients:Ten Notable Challenges, West j Med 1997 Feb; 166:118-122 TITUS SCHLEYER, D.M.D., Ph.D. and HEIKO SPALLEK, D.M.D., Ph.D. Dental informatics ,A cornerstone of dental practice , J Am Dent Assoc, Vol 132, No 5, 605-613 T.K. Schleyer, Dental Informatics: A Work in Progress, Adv. Dent. Res. 2003; 17; 9

D.F. Sittig, M. Kirshner and G. Maupom,Grand Challenges in Dental Informatics, Adv. Dent. Res. 2003; 17; 16 T.K. Schleyer, P. Corby and A.L. Gregg, A Preliminary Analysis of the Dental Informatics Literature, Adv. Dent. Res. 2003; 17; 20 Paul erik peterson, douglas brathal, oral health information systemstowards measuring progress in oral health promotion and disease preventiuon, bullet of world health organization,2005,83:686-693.

Titus K.L. Schleyer, Dental Informatics: An Emerging Biomedical Informatics Discipline, Journal of Dental Education, November 2003

S.Ramakrishna, Health informatics in India,CDAC, september 2008 William Harsh, Information Retreival, 2009,3rd edition,

Thank you