Medical informaticsBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7173.2 (Published 12 December 1998) Cite this as: BMJ 1998;317:S2-7173
The new cutting edge has but a tangential relationship with the surgical scalpel. Jeremy Sims joins the doctors from all specialties who share an interest in information
If you have not yet heard of medical informatics then expect to do so repeatedly in the future. As medical knowledge continues to expand rapidly, as the demands for more efficient coordination of patient data become paramount, and as the pressures for improved practice and application of evidence based medicine increase, medical informatics will have increasing influence in our working lives as clinicians.
Recent white papers have highlighted the need for improved organisation and communication of health information and have offered solutions.(1)(2) Medical informatics is at the centre of the overall objectives, linking such areas as knowledge management, guidance on best practice, education of professionals and the public, and the use of new communication and computer technologies. The growing emphasis on the development, collation, and delivery of information in health care means increasing opportunities for clinicians from all specialties to become involved.
Role models for the budding informatician
Doctor A studied computer science before medicine, and designed and wrote software and systems for colleagues as a medical student. After junior jobs in general medicine took a research post (with honorary clinical contract) that developed into an award winning health information project. Now a specialist registrar in public health medicine and a research associate. Current interests include medical knowledge systems and clinician-computer interfaces.
Doctor B worked towards a PhD in medical informatics research in addition to training in general practice. Contact with the Primary Healthcare Specialist Group of the British Computer Society led to interest in electronic health records and coding. Combines general practice with a post investigating information technology in general practice and clinical consultancy with a health software company.
Doctor Z is a consultant in trauma and orthopaedics, senior lecturer, and director of medical informatics in a UK royal college. Major research interest is developing the internet as a tool for conveying surgical knowledge and information. Editor and author of articles, websites, a major mailing list, and a founder member of an internet-gateway to the specialty.
Enrico Coiera defines medical informatics as the “study of how medical knowledge is created, shaped, shared and applied.”(3) Medical informatics concerns the collection, storage, communication, retrieval, analysis, and interpretation of information. Ultimately, it offers the means by which we improve understanding, management, and communication of medical information so that we can apply it to provide the best possible health care.
In the same way that surgeons use scalpel and needle, those involved in informatics use tools such as clinical guidelines, medical languages, and information and communication systems to assist the study and dissemination of medical knowledge. Medical informatics attempts to answer such questions as:
How to communicate new medical knowledge
How to devise rational structures for pooling clinical evidence, communicating it effectively, and applying it to routine care
How to organise processes that minimise the resources used in medical practice while at the same time maximising the benefits to patients and staff.
The role of informatics is to develop logical bases to respond to these questions and to create the tools, not necessarily technology based, to overcome the problems to which the questions refer.
It is the potential to improve medical practice that excites many clinicians and drives them to pursue an interest in medical informatics. Most combine this interest with their work in their chosen specialty. Their backgrounds are diverse - from general practice to psychiatry, orthopaedics to public health medicine. What they share is a realisation of the potential of informatics to revolutionise and fundamentally improve the way we use medical knowledge in patient care.
Clinicians in medical informatics find the pursuit of answers to the problems of knowledge management and delivery intellectually challenging and have committed themselves to learning more about the subject. They have achieved this either through self learning or through the acquisition of further relevant qualifications.
Why should doctors become involved in medical informatics at all when there are plenty of academic and technology experts to construct information systems for us? Would we ask a doctor to take the place of an airline pilot without a comprehensive understanding of how to fly a plane? Medical informatics is about how best to develop, use, and convey the knowledge and information used by doctors in their work. The tools created to aid us should be constructed on the basis of an understanding of the ways we actually work, and only doctors have a true understanding of their own practices.
The involvement of doctors in medical informatics projects is therefore essential in order to provide the clinical experience to ensure that knowledge and information tools are compatible with doctors' working practices, enhancing, rather than disrupting them.(4)
Examples of informatics projects
Design of electronic patient records both locally and nationally
Development and delivery of public health information
Construction of clinical information support systems
Design and maintenance of protocols based on evidence
Development of terminology, coding, and classification systems
Evaluation of the impact of information technology on the clinical process, clinical outcome, organisations, and resources
Design of clinical workstations
Use of internet technology in medicine
Training and education
Several medical bodies have made recommendations for training doctors in medical informatics. For example, the Standing Committee on Postgraduate Medical and Dental Education recently highlighted the importance of enabling consultants to acquire higher qualifications in informatics, research, education, management, and ethics.(5) With the introduction of such schemes as the Enabling People Programme,(6) which incorporates the NHS education and training programme in information management and technology for clinicians, and the NHS professional award, which includes a postgraduate certificate or diploma in healthcare information management, steps are being made to equip health workers with essential skills. With a basic skill in informatics, there is no reason why doctors at all stages in their clinical career should not be of value to an informatics team.
For those who wish to acquire deeper knowledge of medical informatics, there is the possibility of studying for an MSc (usually run full time over one year or part time over two years) or an MPhil/PhD in medical informatics, a related subject, or computing science. Such qualifications are of equal benefit to those clinicians wishing to remain in their specialty and to pursue a parallel career in medical informatics as to those wishing to develop full time careers in medical informatics in academic departments, health organisations, or companies.
There are only a handful of MSc courses in health informatics in Britain at present, though several universities and colleges are developing courses for next year. The course at City University, London, in conjunction with the United Medical and Dental Schools of Guy's and St Thomas's Hospitals is well established, and other current courses include those at the universities of Manchester, Glasgow, and Aberystwyth. It is crucial to explore the current situation regarding courses very carefully. Decide what your needs are and thoroughly scrutinise the prospectuses.
There are two possible routes to studying for an MPhil or PhD. Firstly, you can apply for a research fellowship within your specialty already organised by a university medical department with provision for research training, project development, and salary.
The second possibility is to develop a PhD project yourself and to apply independently for funding. The best bet is to apply for an NHS research and development studentship grant. Discuss your project proposal with your head of department, your local research and development unit, and your local university academic department. To be successful in your application for funding, you must prove that your project design is well thought out, has good methodology, and that the project has the potential to provide results that are relevant to NHS healthcare policies. You will also need to organise suitable research training.
Medical informatics is a young subject so there is much to be researched. Electronic patient records, terminology, access to information on the internet, decision support, quality assurance, medical communication systems, and electronic publishing are just some of the areas that still require much investigation. Choose carefully the area you wish to research, consider your research project and what questions you wish to answer, and discuss your plans with the experts. Research centres at universities that are active or developing activity in medical informatics research include the Medical Information Group, Manchester; Oxford Medical Informatics; Medical Informatics Unit, Cambridge; the Sowerby Centre for Health Informatics at Newcastle; and the Centre for Health Informatics, Aberystwyth.
Clinicians have already participated in major national projects such as the WAX clinical knowledge project at Cambridge and the award winning PathFinder, and there will be increasing need for doctors to become involved in medical informatics at local, regional, and national levels. Doctors can work full time or part time in university medical informatics or medical computing departments; in international and national government and research offices, health organisations, and commercial companies; as participants in the drawing up of national informatics strategies; and as practitioners of both a medical specialty and informatics research.