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Edward H. Shortliffe - Biomedical Informatics

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Edward H. Shortliffe Biomedical Informatics

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Part 1
Recurrent Themes in Biomedical Informatics
Edward H. Shortliffe and James J. Cimino (eds.) Biomedical Informatics 4th ed. 2014 Computer Applications in Health Care and Biomedicine 10.1007/978-1-4471-4474-8_1
Springer-Verlag London 2014
1. Biomedical Informatics: The Science and the Pragmatics
Edward H. Shortliffe 1
(1)
Departments of Biomedical Informatics at Columbia University and Arizona State University, Weill Cornell Medical College, and The New York Academy of Medicine, 272 W 107th St #5B, New York, 10025, NY, USA
Edward H. Shortliffe
Email:
Abstract
After reading this chapter, you should know the answers to these questions:
Dr. Blois coauthored the 1990 (1st edition) version of this chapter shortly before his death in 1988, a year prior to the completion of the full manuscript. Although the chapter has evolved in subsequent editions, we continue to name Dr. Blois as a coauthor because of his seminal contributions to the field as well as to this chapter. Section (Accessed 3/3/2013).
Author was deceased at the time of publication.
After reading this chapter, you should know the answers to these questions:
  • Why is information and knowledge management a central issue in biomedical research and clinical practice?
  • What are integrated information management environments, and how might we expect them to affect the practice of medicine, the promotion of health, and biomedical research in coming years?
  • What do we mean by the terms biomedical informatics , medical computer science , medical computing , clinical informatics , nursing informatics , bioinformatics , public health informatics , and health informatics ?
  • Why should health professionals, life scientists, and students of the health professions learn about biomedical informatics concepts and informatics applications?
  • How has the development of modern computing technologies and the Internet changed the nature of biomedical computing?
  • How is biomedical informatics related to clinical practice, public health, biomedical engineering, molecular biology, decision science, information science, and computer science?
  • How does information in clinical medicine and health differ from information in the basic sciences?
  • How can changes in computer technology and the way patient care is financed influence the integration of biomedical computing into clinical practice?
1.1 The Information Revolution Comes to Medicine
After scientists had developed the first digital computers in the 1940s, society was told that these new machines would soon be serving routinely as memory devices, assisting with calculations and with information retrieval. Within the next decade, physicians and other health professionals had begun to hear about the dramatic effects that such technology would have on clinical practice. More than six decades of remarkable progress in computing have followed those early predictions, and many of the original prophesies have come to pass. Stories regarding the information revolution and big data fill our newspapers and popular magazines, and todays children show an uncanny ability to make use of computers (including their increasingly mobile versions) as routine tools for study and entertainment. Similarly, clinical workstations have been available on hospital wards and in outpatient offices for years, and are being gradually supplanted by mobile devices with wireless connectivity. Yet many observers cite the health care system as being slow to understand information technology, slow to exploit it for its unique practical and strategic functionalities, slow to incorporate it effectively into the work environment, and slow to understand its strategic importance and its resulting need for investment and commitment. Nonetheless, the enormous technological advances of the last three decadespersonal computers and graphical interfaces, new methods for human-computer interaction, innovations in mass storage of data (both locally and in the cloud), mobile devices, personal health monitoring devices and tools, the Internet, wireless communications, social media, and morehave all combined to make the routine use of computers by all health workers and biomedical scientists inevitable. A new world is already with us, but its greatest influence is yet to come. This book will teach you both about our present resources and accomplishments and about what you can expect in the years ahead.
When one considers the penetration of computers and communication into our daily lives today, it is remarkable that the first personal computers were introduced as recently as the late 1970s; local area networking has been available only since ~1980; the World Wide Web dates only to the early 1990s; and smart phones, social networking, and wireless communication are even more recent. This dizzying rate of change, combined with equally pervasive and revolutionary changes in almost all international health care systems, makes it difficult for public-health planners and health-institutional managers to try to deal with both issues at once. Yet many observers now believe that the two topics are inextricably related and that planning for the new health care environments of the coming decades requires a deep understanding of the role that information technology is likely to play in those environments.
What might that future hold for the typical practicing clinician? As we shall discuss in detail in ), especially when inadequate access to clinical information is one of the principal barriers that clinicians encounter when trying to increase their efficiency in order to meet productivity goals for their practices.
1.1.1 Integrated Access to Clinical Information: The Future Is Now
Encouraged by health information technology ( HIT ) vendors (and by the US government, as is discussed later), most health care institutions are seeking to develop integrated computer-based information-management environments. These are single-entry points into a clinical world in which computational tools assist not only with patient-care matters (reporting results of tests, allowing direct entry of orders or patient information by clinicians, facilitating access to transcribed reports, and in some cases supporting telemedicine applications or decision-support functions) but also administrative and financial topics (e.g., tracking of patients within the hospital, managing materials and inventory, supporting personnel functions, and managing the payroll), research (e.g., analyzing the outcomes associated with treatments and procedures, performing quality assurance, supporting clinical trials, and implementing various treatment protocols), scholarly information (e.g., accessing digital libraries, supporting bibliographic search, and providing access to drug information databases), and even office automation (e.g., providing access to spreadsheets and document-management software). The key idea, however, is that at the heart of the evolving integrated environments lies an electronic health record that is intended to be accessible, confidential, secure, acceptable to clinicians and patients, and integrated with other types of useful information to assist in planning and problem solving.
1.1.2 Moving Beyond the Paper Record
The traditional paper-based medical record is now recognized as woefully inadequate for meeting the needs of modern medicine. It arose in the nineteenth century as a highly personalized lab notebook that clinicians could use to record their observations and plans so that they could be reminded of pertinent details when they next saw the same patient. There were no regulatory requirements, no assumptions that the record would be used to support communication among varied providers of care, and few data or test results to fill up the records pages. The record that met the needs of clinicians a century ago struggled mightily to adjust over the decades and to accommodate to new requirements as health care and medicine changed. Today the inability of paper charts to serve the best interests of the patient, the clinician, and the health system has become clear (see ).
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