Help us write the 3rd Edition of the Guide to Health Informatics
May 28, 2013 § 23 Comments
The Guide to Health Informatics 2nd Edition was published in 2003, and has endured surprisingly well over the following decade. One of the guiding principles for selecting material in that text was to focus on core ideas that had a long half-life. In other words, the was focus less on the ever changing “bleeding edge” of technology and its application, and more on foundational principles and topics.
Well, we are now beavering away at the third edition, and hope for the totally revised text to be completed by the end of 2013.
We would very much welcome feedback from the community about what you would like to see in the third edition. What new topics would you like to see covered (remembering that we are going to focus on long-half life ideas and topics). What new features would you like to see in the chapters? We currently have questions at the end of each chapter and further reading. We will use this web site as a place for online teaching materials (such as a PowerPoint deck with the figures used in the text for teachers to download).
The table of contents for the 2nd edition is here if you want to look at it again. Some of the old topics will be substantially revised (for example all the material on the internet in health). All existing chapters are being updated with the latest material.
New chapters or topic sections are being prepared for:
- The safety of e-health (what can go wrong, how do you minimize risks)
- Nation-scale health IT systems – their designs, functions, risks and benefits (including HIEs).
- Consumer Informatics
- Social networks and media
- Modeling and analyzing large scale data sets (big data).
- Computational discovery systems
What else do you want? Now is your chance to help shape the text!
We will use this blog keep you up to date with progress on the new edition, and continue ask for feedback on the edition as it progresses.
The Guide to Health Informatics 3rd Edition 
I’d like to see a section that discusses the Enterprise Architecture and other techincal architectures such as Data, Application, Infrastructure.
Thanks,
An interesting suggestion. System architectures can be a fairly technical topics for an introductory textbook, especially with a focus on healthcare professionals as readers. What are the core concepts that you see that need to be communicated at the introductory level?
Enrico,
some ideas
practical approaches to ethical and privacy concerns…
making it all happen – project management, collaborating, overcoming inertia / organisational challenges
making sense of it all – data visualisation / communication of results
Peter
All great suggestions. Thanks. How much interest is there is a whole chapter devoted to managing clinical IT projects eg from specification through to implementation?
Enrico, I am writing as someone who moved from IT through clinical practice and health informatics to evidence-based practice. I have not read your book, so please forgive me if my suggestions are for stuff that is already there.
The grand challenge in HI is to close the loop: clinical practice -> evidence -> decision support -> clinical practice. What is the role of HI in evidence production? In other words, how can HI support clinical trials and data mining to get practice into evidence, and evidence into practice?
Quality improvement and EBP depend on information and data. How can HI support QI and EBP projects? What can HI learn from QI and EBP?
Clinical decision support and protocol-based care are as good (or as bad) as the evidence and its interpretation. My experience of HI professionals is that they do not understand that
(1) “evidence” should mean “the whole body of relevant evidence critically appraised for the facts, uncertainties, and risks of bias”
(2) evidence evolves, sometimes quite rapidly
(3) computers make decisions based on facts (which can be wrong)and logic (which can be wrong); humans make decisions based on facts (which can be wrong), logic (which can be wrong), and values (which can be inappropriate) – and values trump both facts and logic
Finally, bunch of related questions that could be addressed by appropriate chapter on professionalsim:
What is the point of a HI professional?
What should motivate them?
I would suggest (i) to improve health and healthcare AND (ii) to ensure that resources (including treatments) are used effectively and efficiently (good stewardship)
Why do HI departments so often have the reputaion of being staffed by petty bureaucrats who seem to think that their job is more about saying “No”, than looking for ways to support frontline clinicians and “back office” staff to do their jobs?
Why are IT and health professionals so often mutually suspicious of each other’s ability to contribute to what should be a joint project?
What is the role of a HI professional in managing existing systems and developing new applications?
Michael
Thanks Michael
I think the suggestions about Evidence based practice are foundational to the current edition, and will of course be reinforced. Peek at a copy if you can to see if you think there are missing elements.
I’m thinking from all the comments so far that an ‘implementation’ chapter may not be a bad idea as that is where we can raise the issues of culture you describe.
Talk about automation rather than about (making) electronic medical records.
When doctors find themselves being presented with 3 numbers and asked to decide if the first lies between the other 2 as Emis does with a myriad results of routine tests there is something wrong and the computer is actually better at that.
This suggests two things:-
A usefulness of a mini-language to express decisions and actions always to be taken on circumstances;
A way of tagging blood tests etc to indicate that a normal result would be significant, ice unexpected and to lead to action which is not the usual one. This is rare although many colleagues and others assert it is common and the reason the doctor not the computer must do the comparisons.
Vernor Vinge used the word automation in a context which caused me to realise that shift of thought is desirable.
Adrian
You raise a problem I see endlessly – the yawning gap between what is possible with IT and that which is often dished out to clinicians in the front line. All the things you discuss exist, but how often are they available?
If this keeps up the book will never finish! Thank you.
If “missed” normal results being signifiicant is common, I would contend that colleagues need to think about how they frame follow up advice to patients. They need to assume that with current IT systems, they will mark a normal result as normal & move on.
I can think of one occassion where a missed normal result was actually significant (an elderly patient whose DMARD was supposed to be stopped until bloods normalised, then restarted. The restart never happened, and the patient’s arthritis worsened). We tried a few systems to avoid this, but came to the conclusion that the only solution was social, not technical – advising the patient’s daughter to trigger a restart as a failsafe.
All other solutions fell over on the time factor that our terrible IT systems introduced to dealing with results – it takes 5-10 sec for the patient record to load (in a seperate application), and the reason for the test being done then needs to be found in free text notes. Most doctors are not likely to endure that for normal results.
My point, if I have one, is that good medical informatic solutions have to consider the whole organisational workflow, not just the need to present a doctor with a result for them to comment on. Sometimes social solutions are more full-proof than technical ones.
FLOSS. Of course.
By which I think you mean ‘Free/Libre and Open Source Software’ via http://www.flossproject.org ?
And if so, if we think of an idea with a long half-life, then open source (everything) must be one.
Definitely interested in the section relating to benefits – specifically understanding, realising, measuring and communicating benefits. So important and so poorly understood.
Enrico,
I think my team would be keen to have involvement.
Maureen
Wonderful. Being able to leverage the NHS experience in IT safety would be Tremendous.
Something on data access and records linkage, and the ethical and practical issues arising from this – happy to write a few lines
Good suggestion. Many thanks. This might be one one the subtopics in a ‘big data’ chapter. Dot points, references, sample questions – all much appreciated.
You could do a whole book on clinician and clinical engagement!
It is very hard to engage and “sell” the product to clinicians whose understanding and use of IT and systems is very wide ranging. Then, with variation in practice trying to bend a system to meet individuals and departmental needs is another whole challenge.
Hello Dr.Enrico
I am really interested in reading chapters on artificial intelligence in medicine, particularly least covered in previous issue such as virtual reality in medicine, Robotic surgery, surgical workflow analysis and some of the data mining technique for knowledge representation. There should be a brief introduction to all these topics. So, student of Health Informatics can get motivation to doing research in these areas and possibly integration with current clinical workflow and HIS.
Regards,
Dr.Hiren Nakawala.
Yes some of these are already in the planning or preparation so you will be happy . Some of the surgical stuff however might be too specialised for an introductory text. Do others think we cover surgery/robotics?
Thanks to everyone for your suggestions so far. They have helped us crystallise some of our plans, and have been *extremely useful* in pushing our thinking along.
Please do not hesitate to pop any other ideas that occur to you here. They will be seen.
We will post an update on progress with the third edition in about a 1-2 month’s time (depending on wind speed and direction).
Hi Enrico,
I was wondering if it would be useful to have a section on human/computer interaction. I believe it is important for those working in ehealth (even tangentially) to understand the implications and ramifications of interface design, and to have a vision of how even very simple functions can be dramatically improved.
There are a few related and semi-related topics within this:
– human factors engineering
– the ubiquity of workarounds (computers don’t adapt, humans do – just not necessarily along a desirable path).
– the increasing success of participatory design.
* How important it is for end users to be involved in design.
* What ethnographic methods can be used to improve design.
– what to look out for when assessing systems during procurement. (Speaking of which, procurement is a critical area, and one where improvements can be made. I have developed a technology procurement framework intended for small to medium health services (e.g. general practices)).
– design principles for safe and usable systems (e.g. “Eight Golden Rules for Interface Design” Health IT and Patient Safety, 2012. pg 85)
Sophisticated informatics is good, but so is the simple concept of a more usable interface. As you know, a poor interface can often be a problem for safety.
Another idea might be to cover the change management and the patterns of technology adoption. This would be useful in pointing out that use of technology is not deterministic (despite the best efforts of some!), and that the messy social dimensions need to be included for consideration.
One more thought. I love Berg’s work on trying to lift the level of intra and inter-system coordination of data/information (Berg “The Search for Synergy: Interrelating Medical Work and Patient Care Information Systems.” Methods of Information in Medicine 42, no. 4 (2003): 337–344.) Would this also be something you could refer to?
Cheers,
Brendon
Thanks Brendon. All terrific ideas and I will do my best to get them into the mix. System safety is an important part of the new third edition, and so interface design will feature for sure. Some of the earlier comments to the blog reinforce yours on the need for a focus on implementation and adoption – and we have heard and will do our best on that front. Much appreciated. Now back to the informatics coal mine for me and the team ….
Hi Enrico,
I might be too late with this…
I have been talking with a number of parties lately about activity based funding and the need for “better data”. I am not sure if this is another example of scope creep (probably). It would seem to me that activity based funding has potential implications for both revenue and cost management. Given this, it will obviously be an area of keen interest for managers and yet another opportunity for health informatics?
As an example, I was talking with a hospital about trying to get a better understanding of drug pricing at a patient level. The data was seemingly available but just in different systems….
Peter