Discuss how the United States healthcare system has advanced in technology and how health
informatics evolved from being a concept to becoming a discipline or specialty. Emphasize the
importance of the formation of professional organizations and educational programs in
advancing health informatics as a field. As you begin to conduct research, explore (and cite in
your discussion) an early journal article or excerpt from a seminal book on the topic of health
informatics. If applicable, how has informatics evolved since then?
For your replies, respond to 2 classmates, identifying at least 1 strength and 1 weakness in each
classmate's reasoning.
Your thread is due by 11:59 p.m. (ET) on Thursday. Your replies are due by 11:59 p.m. (ET) on
Sunday.
US Health Information Technology & Health Informatics
The US healthcare system has made advancements in the areas of HIT (health
information technology) by implementing EHRs (electronic health records), thus enabling the
ability to compile a more accurate dataset on patients, quick sharing of necessary information,
and enhancing patient care (Shanholtzer & Ozanich, 2016). Per Braunstein (2014), use of EHRs
can help patients get the right medication, as in the absence of such systems pharmacists could
have difficulty reading handwritten prescriptions, for example, or a patient with chronic
conditions requiring multiple medications may be prescribed conflicting medication without
adequate EHRs which assist with coordination of care. Healthcare organizations are also able to
make use of CDS (clinical decision support) systems which utilize computing systems to link
relevant data such as patient lab results with online medical databases thus enabling care
providers to make more informed decisions on both patient diagnosis and patient treatment
pathways (Shanholtzer & Ozanich, 2016). The implementation of these measures is largely
thanks to former President Obama, who passed the HITECH Act to help reform US healthcare;
this act allotted funding and incentives to encourage healthcare organizations to engage in more
computerized data-driven practices in order to create more efficient operations that support the
goals of the Affordable Care Act (Shanholtzer & Ozanich, 2016). This revolutionary act
emphasizes a more universal healthcare approach for Americans who otherwise may not have
access to needed health and medical care (Shanholtzer & Ozanich, 2016).
Population health management (PHM) makes use of EHRs and data analytics to improve
cost efficiency in US healthcare; benefits include eliminating duplicate tests and reducing the
length of patient stays, among others (Shanholtzer & Ozanich, 2016). Per Braunstein (2014), the
US healthcare system has been historically better designed to treat acute rather than chronic
conditions despite the fact that chronic conditions are a dramatically large part of the reasons
Americans seek medical care. The transition to using HIT has created more opportunities to
engage in coordination of care activities (Shanholtzer & Ozanich, 2016), which is of course
beneficial to the patient. For example, patient centered medical home (PCMH) programs would
be a struggle without HIT because it enables the patient to have access to a portal containing
certain EHRs (ex. blood pressure patterns) and also facilitates access to CDS systems for their
doctor (Shanholtzer & Ozanich, 2016). Patients can also make use of mobile health using their
cell phone, tablet, or other electronic device in order to connect remotely with their provider on
health matters they otherwise would have to go to the clinic or hospital for, such as providing a
blood pressure check to their doctor (Shanholtzer & Ozanich, 2016). Thus, patients not only
readily have access to their own records, they also have a means to communicate electronically
with their providers. This reduces the need for the patient to take time off work or even leave
their home, and also reduces the time a doctor would spend in an appointment with them, freeing
up resources for other matters.
Early Informatics
Per Shanholtzer and Ozanich (2016), in order to support healthcare reform beginning
around 2009, spending on HIT has been in the range of hundreds of billions of dollars. A look at
some perspectives preceding today’s advancements in HIT and health informatics shows just
how far the practices have come. At the time of writing, Higgs (1997) noted that there existed
“no adequate role model of an electronic hospital anywhere in the world” (p. 62). Higgs (1997)
noted that clinical uses of computerized health records would need to be fully operational in
order to create a prototype for success. Higgs (1997) discussed issues such as funding (who
would pay for the necessary advancements in IT to support this growth?), inefficiency of
available products at that time (ex. current systems lacking flexibility), lack of required hardware
(ex. not enough readily accessible computer stations in a hospital to log into to patient check
health records), and IT infrastructure security (ex. corruption of data, archiving, maintaining
confidentiality of records), to name a few. Higgs (1997) was clearly a proponent of instituting
such change, stating that significant savings could arise from proper use of HIT, noting the
importance of efficient information flow, and how the clinical audit process could be simplified.
However, he also noted that there would be challenges in adopting HIT as at the time of writing,
he felt that few in the healthcare field had an adequate understanding of how to strategically use
this developing technology (Higgs 1997). This is a legitimate concern, and as explained by
Shanholtzer and Ozanich (2016), new jobs have been created in order to support HIT and health
informatics objectives, both technical (ex. programming) and analytical (ex. biostatisticians).
Development of Informatics
According to Masic (2014), health informatics originally began developing in the 1950s
in the US, later being adopted in other countries. Per Braunstein (2014), in the 25-year period
beginning in 1975, US healthcare underwent a transformation going from much lower uses of
technology and developing into high-tech territory. This included advancements including the
adoption of MRI scanning, sophisticated equipment for ICUs, and most recently personalized
medicine characterized by digital data (Braunstein, 2014). Masic (2014) describes 5 stages of
health informatics development:
1. Experimentation & study of new possibilities (1955-1965)
a. Examples: Biomedical computer programs, computerized medical applications
2. Invention of new technologies & advancements in automated data processing (1965-
1975)
a. Examples: Hospital information systems, computer-assisted medical decision-
making
3. Intensive development of health information systems (1975-1985)
a. Examples: Marketing of software packages, installation of computing hardware
such as bedside computer terminals
4. Standardization & quality improvements (1985-1995)
a. Examples: Development of artificial intelligence, implementation of expert
systems
5. Current age/ongoing age of development (1995-present)
a. Examples: Significant advancements in computing systems, ability to widely
integrate informatics health system-wide, improvements in diagnostic
technologies
Braunstein (2014) explains the newer models of US healthcare, such as a move towards
accountable care and pay-for-performance reimbursement models, encourages the use of EHRs
and HITs. By utilizing well-developed EHRs, physicians in accountable care organizations are
able to provide better patient care, eliminate unnecessary redundancies, and cut costs thereby
increasing their revenues (Braunstein, 2014).
Biblical Integration & Conclusion
Per Proverbs 21:13, “Whoever closes his ear to the cry of the poor will himself call out
and not be answered” (English Standard Version Bible, n.d.). It is in everyone’s best interest to
improve patient care: the patient themselves, the nurse, the physician, the laboratory technician,
medical reception, and so on. In utilizing HIT and health informatics we can create efficiencies
in healthcare that we certainly could not without it. If we have these tools available to us but
choose not to use them, it is as good as closing our ears to the needs of our patients. The Lord
would have us treat our patients as our family, and we also must remember that there is a golden
rule which states we must do unto others as we would have them do unto us. If our family were
in need of our care, we would select the finest tools in order to best help them, thus we must do
the same for our patients. Without reforming patient care, when it comes our turn to be in need
of assistance, we too can expect our cries to fall upon closed ears.
References
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
Higgs E. (1997). Health informatics blueprint: Business needs. Information Management &
Computer Security, 5(2), 58-62. https://doi.org/10.1108/09685229710182839
Masic, I. (2014). Five periods in development of medical informatics. Acta Informatica Medica,
22(1), 44-48. https://doi.org/10.5455/aim.2014.22.44-48
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
Response #1:
Interesting post! Thank you for including the portion on smart homes – I was not
previously aware of them, which I thought was an advancement in health technology that sounds
very beneficial to seniors who may have less significant health concerns but still need some
assistance.
Strengths
I took a look at the article by Majumder et al. (2017) which explained the concept of
smart homes in depth. As described in the article, life expectancy continues to increase due to
advancements in healthcare technologies and better self-care practices demonstrated by patients
(Majumder et al., 2017). The article also explains how seniors often require closer monitoring
and quick access to medical attention, often resulting in a reliance on in-patient care which
causes high expenses to the patient (Majumder et al., 2017). Per Shanholtzer and Ozanich
(2016), many elderly patients may opt for assisted living, a type of long-term care that enables a
patient to live in a home-like unit with access to medical assistance, but allows more freedoms
than a nursing home can afford, such as come-and-go access based on individual ability. What
Majumder et al. (2017) point out in their explanation of smart home platforms is an in-between
option between assisted living and living on one’s own at home. I thought a great strength of
your discussion post was how you tied in this concept. Per Majumder et al. (2017), in smart
homes there exist a central computing system which collects relevant data including
environmental, physiological and patient activity and can then transmit this data to the patient’s
healthcare provider via the internet or cellular data. This is clearly a clever use of m-health
(mobile health), described by Shanholtzer and Ozanich (2016) as a newer medical concept which
allows patients to collect and submit medical data to their doctor via smartphone, tablet or
another electronic device without even having to leave the house. Clearly having this technology
built into your home is a more fool-proof way to ensure the data integrity remains intact; it
removes any guesswork from the patient’s task list and simply transmits health data on their
behalf.
Weaknesses
Your article was concise and well-written, however one small thing that was missing was
the integration of an early article on the topic of informatics. Per Shanholtzer and Ozanich
(2016), health informatics became widespread in the US in the 1980s, originally referred to as
“medical informatics”. In her review of Rufferin (1999)’s collection of essays on digitization of
healthcare, Davis (2000) explained how informatics could be leveraged to enhance healthcare
delivery. Per Rufferin (1999), the expected future of health informatics included standardization
of data, computerization of health records, a “transition from managed care to organized care,
which will change the emphasis from finances to quality” (p. 191), and telemedicine (as cited in
Davis, 2000). Davis (2000) noted the need for industry standards to be developed in order to
make the developing practice of medical informatics usable by all in the field. Per Rufferin
(1999), managed care was an issue that was due to an inability of doctors to organize
appropriately, resulting in the general public appealing to the government to create managed care
(as cited in Davis, 2000). Davis (2000) explained that utilizing electronic medical records and
clinical information systems was expected to result in a culture of organized care. As described
in Braunstein (2014), the difference between EMRs (electronic medical records) and EHRs
(electronic health records) is that an EMR would be considered a computerized version of a
physician’s paper patient chart whereas an EHR “represents the total health of the patient across
all providers” (p. 39). Per Atherton (2011), early EHRs were referred to as clinical information
systems, therefore, although the terminology differs slightly from our textbook, both Rufferin
and Davis predicted well what advancements were to come with respect to the field of health
informatics. The later passing of the 2009 HITECH Act sought to revolutionize healthcare and
created incentives for a transition towards meaningful use of technologies such as HIT and EHRs
(Shanholtzer & Ozanich, 2016).
Biblical Integration
Per Matthew 10:8, “Heal the sick, raise the dead, cleanse lepers, cast out demons. You
received without paying; give without pay” (English Standard Version Bible, n.d.). This speaks
on how it is our responsibility to improve our systems without looking simply at what it might
cost us. Although the Affordable Care Act of 2010 provides both incentives for meaningful use
of technology and penalties for choosing not to participate (Shanholtzer & Ozanich, 2016), we
must do what is right in the eyes of the Lord and be prepared to make the necessary
technological changes that better support our patients.
References
Atherton, J. (2011). Development of the electronic health record. AMA Journal of Ethics, 13(3),
186-189. https://doi.org/10.1001/virtualmentor.2011.13.3.mhst1-1103
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
Davis, N. (2000). Using medical informatics to improve health care delivery and education.
Journal of Continuing Education in the Health Professions, 20(3), 191-192.
http://ezproxy.liberty.edu/login?qurl=https%3A%2F%2Fwww.proquest.com
%2Fscholarly-journals%2Fusing-medical-informatics-improve-health-care%2Fdocview
%2F206750568%2Fse-2%3Faccountid%3D12085
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
Majumder, S., Aghayi, E., Noferesti, M., Memarzadeh-Tehran, H., Mondal, T., Pang, Z., &
Deen, M. J. (2017). Smart homes for elderly healthcare – Recent advances and research
challenges. Sensors, 17(11). https://doi.org/10.3390/s17112496
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
Response #2:
Great job on your research and your post this week!
Strengths
A great strength of your post was how well you tied in the evolution of health informatics
from being a concept to becoming a discipline. I had a harder time finding relevant articles to
answer this part of the question (perhaps using the wrong keywords), so I appreciate that you
were able to delve deeper into the evolutionary history of health informatics. According to
Hersh (2009), the topic of informatics is centered more around information than technology;
although he notes that technology is definitely a necessary and powerful tool used to obtain said
information. Generally speaking, then, the speciality of health informatics is more concerned
with health-related information and what you can do with that information to advance the field of
healthcare.
Per Hersh (2009), there exist many sub-disciplines within health informatics. These may
include medical/clinical informatics (informatics in healthcare settings), bioinformatics
(informatics at a cellular or molecular level), consumer health informatics (informatics from a
consumer perspective), public health informatics (such as surveillance and reporting), and many
others (Hersh, 2009). Hersh (2009) also notes that the education path of an informatics
professional is generally at the doctoral level and/or individuals from a clinical background. The
necessary competencies for health informatics are a combination of the disciplines of 1) health &
biological sciences (ex. nursing, medicine), 2) management & social sciences (ex. human
resources, business administration), and 3) math & computer sciences (ex. statistics, IT) (Hersh,
2009). Overall, Hersh (2009) explains that the field of health informatics is essentially an
intersection of healthcare and information technology to ensure best use of HIT and available
health-related data; this discipline is very concerned with the structure and flow of data for use
by all members of the healthcare profession.
Weaknesses
A weakness in your post is your reference to EMRs (electronic medical records) as being
able to “see the patient as a whole and have different systems communicate with each other”.
According to Braunstein (2014), “[t]he distinction that is made between EMRs and EHRs
[electronic health records] is important. The EMR is essentially the digital version of the
traditional paper chart…[t]he EHR ideally represents the total health of the patient across all
providers (p. 39).” Essentially, an EMR is held only within one clinic, office or hospital, while
an EHR is used across many different offices such as labs, PCPs, specialists, etc (Shanholtzer &
Ozanich, 2016, p. 36). However, I realize this is nitpicking (you did a great job on your post), as
Shanholtzer & Ozanich (2016) do mention that it is common for the terms to be used
interchangeably in practice (p. 36). According to Atherton (2011), the EHR emerged around the
1960s in academic medical centers and the federal government adopted the use of EHRs in the
1970s, starting in the Department of Veteran Affairs’. In the 1980s, the use of EHRs became
more widespread, and in the 2000s both former President Bush and former President Obama
began encouraging the use (Atherton, 2011). As we know, the introduction of the HITECH Act
(2009) and the Affordable Care Act (2010) led to financial incentives and penalties to further
encourage the adoption of the EHR (Shanholtzer & Ozanich, 2016).
Biblical Integration
Per Isaiah 58:11, “And the Lord will guide you continually and satisfy your desire in
scorched places and make your bones strong; and you shall be like a watered garden, like a
spring of water, whose waters do not fail” (English Standard Version Bible, n.d.). This reminds
me of the progression of health informatics, HIT and EHRs, as seeking to develop these
disciplines will make the bones (foundation) of healthcare organizations stronger; it will be like
watering a garden – the garden being a metaphor for patients who can benefit so greatly from the
evolution of these disciplines and practices. Good Christians do what they can to achieve
improvements in all areas affecting the vitality of human life.
References
Atherton, J. (2011). Development of the electronic health record. AMA Journal of Ethics, 13(3),
186-189. https://doi.org/10.1001/virtualmentor.2011.13.3.mhst1-1103
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
Hersh, W. (2009). A stimulus to define informatics and health information technology. BMC
Medical Informatics and Decision Making, 9. https://doi.org/10.1186/1472-6947-9-24
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
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