Health informatics or medical informatics is the conjunction of information science, medicine and health care. It handles the resources, methods, and devices which are required to optimize the storage 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. An electronic record is very important in the study of health informatics. An electronic health record (EHR) is a distributed personal health record in digital format. The EHR provides secure, real-time, patient-centric information to aid clinical decision-making by providing access to a patient’s health information at the point of care.

An EHR is typically accessed on a computer or over a network. It was developed by ISO. New systems approached with the advancement of the science and technology. The most important ones are as follows: ISO, ISO EHR Standard, Clinical information systems (CIS),CEN ENV,HISA ,HL7 and IEEE P2407.

ISO is a worldwide federation of national standards bodies (ISO member bodies) ISO usually prepares International standards through technical committees. International organizations, governmental and non-governmental, in liaison with ISO, also take part in the work. ISO collaborates closely with the International Electro technical Commission (IEC) on all matters of electro technical standardization.

ISO EHR Standard

EHR deals with a classification of electronic health records; provides simple definitions for the main categories of EHR; and provides supporting descriptions of the characteristics of electronic health records and EHR systems.ISO EHR is different from other standards because this system is more comprehensive and widely used. Some systems use EHR for the final processing of their records.

Electronic Health Record (EHR)

An electronic health record (EHR) is a distributed personal health record in digital format.The EHR provides secure, real-time, patient-centric information to aid clinical decision-making by providing access to a patient’s health information at the point of care. An EHR is typically accessed on a computer or over a network. It may be made up of health information from many locations and/or sources, including electronic medical records (EMRs).
An EHR almost always includes information relating to the current and historical health, medical conditions and medical tests of its subject. In addition, EHRs may contain data about medical referrals, medical treatments, medications and their application, demographic information and other non-clinical administrative information. EHR contains persistent documents, multimedia data (images, signals, movies), references to multimedia data, structured content suitable for processing, supports archetypes/templates specifies library of archetypes templates, distribution rules, covers visualization, digital signatures. EHR provides services for querying, retrieving and submitting EHR content Document-centric storage/retrieval Content format agnostic EHR has security features like transport level encryption, protocol allows transmitting user credentials, and Protocol enforces access rules.

The main purpose of ISO’s family of EHR standards is to maximize interoperability between electronic records and systems that are specifically intended to be shareable, irrespective of the technologies they employ and the platforms they reside on. However, a variety of health information systems may include features and functionality that could be characterized as belonging to an EHR system. Similarly, many health information systems may produce output in the form of EHR extracts or entries, as described in ISO/TS 18308, Health informatics -Requirements for electronic health record reference architecture, irrespective of whether their primary purpose or application is as a shareable EHR. EHR is further categorized into following terms. These are:

– EHRA: It is the generic structural components from which all EHRs are built, come under the category of EHRA that is electronic health record architecture.
– EHR node: EHR node is a physical location where EHRs are stored and maintained.
– EHR system: In this system electronic health records are created and stored.
– Encounter: Health activities are delivered and health record is accessed or managed.
– Functional interoperability: The ability of two or more systems to exchange information. The information consists of the data regarding health of patients, health conditions, health organization activities, different health problems, authorized health professionals, health providers, health record, health status, specific information service.

Clinical information systems (CIS)

CIS could drive progress in health care. It helps to examine the delivery of the health care systems.

The Continuity of Care Record (CCR)

CCR is a health record standard specification developed jointly by ASTM International, the Massachusetts Medical Society (MMS), the HIMSS (HIMSS), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and other health informatics vendors.The CCR standard is a patient health summary standard. It is a way to create flexible documents that contain the most relevant and timely core health information about a patient, and to send these electronically from one care giver to another. It contains various sections such as patient demographics, insurance information, diagnosis and problem list, medications, allergies and care plan. These represent a “snapshot” of a patient’s health data that can be useful or possibly lifesaving, if available at the time of clinical encounter. The ASTM CCR standard is designed to permit easy creation by a physician using an electronic health record (EHR) system at the end of an encounter System: The CCR is being developed and enhanced in response to the need to organize and make transportable a set of basic patient information consisting of the most relevant and timely facts about a patient’s condition. Briefly, these include patient and provider information, insurance information, patient’s health status (e.g., allergies, medications, vital signs, diagnoses, and recent procedures), recent care provided, as well as recommendations for future care (care plan) and the reason for referral or transfer.

CEN ENV

European Standardisation Committee, Technical Committee on Health Care Informatics. This is including in the EHR Architecture Standards. Since 1990 CEN has regarded the Electronic Healthcare Record as one of the most important areas for the establishment of European standards. It has so far published two generations of EHR standard, in 1995 and 1999. It was a foundation standard defining the basic principles upon which the electronic health cares records should be based. [12] The task forces: WG I – Information models, WG II – Terminology and knowledge representation, WG III – Security, safety and quality, WG IV – Technology for interoperability [Internasjonal helseinformatikkstandardisering Vigdis Heimly, pdf file, KITH, 23.02.07]

HISA

The 1999 CEN ‘Standard Architecture for Healthcare Information Systems’ (ENV 12967, commonly known as “HISA”) seeks to enable the development of modular open systems to support healthcare. The HISA standard builds on the extensive work of RICHE, NUCLEUS, EDITH and HANSA in this field. The architecture of any generic healthcare information system is described as a federation of heterogeneous applications, interacting and co-operating through a middleware layer of common services. It specifies the structure of the data maintained and retrieved by each service, without prescribing its internal structure. Both applications and the middleware rely on a set of technological facilities (a bitways layer) to enable the physical connection and interaction of various modules.Two main classes of common services are identified: • Healthcare-related Common Services (HCS) meeting the particular requirements and activities of users in the healthcare business domain. These relate to the subject of care, activities, resources, authorisation, health characteristics, and concepts. • Generic Common Services (GCS) which may be common to any information system in any business domain. This standard is presently being revised by CEN. The organizations which are represented in this work include Not-for-profit organizations such as the American Society for Testing and Materials (ASTM), Health Level 7 (HL7) and Healthcare Information and Management Systems Society (HIMSS). These are involved in the standardization process for EHR.

HL7

Health Level Seven: Established in 1987 and made by an American program ware vendor association for healthcare system in the USA. It is a protocol that helps messaging standards in healthcare industry and has affiliates in 26 countries around the world. The language is standardized and makes it easier to transfer data between doctors and those who work at healthcare departments. The Certification Commission for Healthcare Information Technology (CCHIT) is a private not-for- profit organization founded to develop and evaluate the certification for EHRs and interoperable health informatics networks. At the International level in Europe, CEN’s TC/251 is responsible for EHR standards, while at a global level, ISO TC215 produces standards for EHR requirements as well as accepting certain standards from other standards organizations. CEN/TC 251 works on compatibility and interoperability between independent systems and to enable modularity in Electronic Health Record systems. The open EHR Foundation develops and publishes EHR specifications and open source EHR implementations, which are currently being used in Australia and parts of Europe. These standards are important to restore the information and maintain records.

Contsys

System of concepts to support continuity of care deals with program of care, care plan, healthcare provider etc.It describes the standardization of care plan.

IEEE P2407

Standard for Personalized Health Informatics. According to Bernd Blobel ( 2007) Personal Care and “e-Health” require the integration of personal, body worn or implanted mobile systems as part of the health telemetric infrastructure. For providing Personal Health in the sense of personalized care, we have to individualize diagnosis and therapy based on bioinformatics/genomics. Open and sustainable architectural paradigms have to be applied to all different domains integrated in Personal Health using unified processes and formal languages.

Stakeholders

A small advisory group who support and assist the Clinical Health Systems. They coordinate the required requestes and demands. Membership is drawn from key stakeholders and clinical experts. There are a number of reference groups within the networks that report to the advisory group. Membership of the network is multi sectoral, multi-disciplinary, time limited and include representation from consumer organizations. These are a large number of individuals. Not all are active members in the sense of attending meetings on a regular basis. However, it is critical that all members are supportive of each network’s principles and expected outcomes. Stakeholders of each network are vary according to the network’s needs but the core Stakeholders usually include representatives of: Consumers and Carers; Clinicians; Specialists; Area Health Services; Primary Care Team; Allied Health; GP Divisions; Population Health / Prevention Professionals; Researchers and Academics; Aboriginal Health Organizations; and Relevant Non Government Organizations. Within the Health Policy and Clinical Reform Division, the Clinical Network Development Team is supporting the initial development of the networks. Once the Network Support Teams are established, the Development Team will be responsible for across-network issues and will provide ongoing support to the individual Network Support Teams. Guiding Principles of Clinical Health System are as the following:

* Engaging clinical leaders and key stakeholders in state-wide planning, policy and clinical reforms;
* Focusing on the patient and the community by increasing participation, partnerships, communication and responsibility;
* Improving patient care in terms of quality, access, appropriateness and integration;
* Providing a focus on improving and promoting links between country and metropolitan health services;
* Driving an increased focus on the provision of co-ordinated population health strategies;
* Facilitating the alignment of strategic and operational functions of the health system;
* Promoting continuous improvement in all services and clinical practices by developing and advising on the implementation of: Evidence based practice standards and protocols, referral and support structures between and within health services with an emphasis on clinical management and partnerships. * Ensuring accountability and reporting arrangements for the network are clearly defined and the networks’ operation and dealings with all stakeholders are transparent.

The standards that were meant to interface systems in the early times were basically PAS (Patient Administrative Systems), PACS. In theory section we went through the instances who initiated the process towards a standard and their affiliates. A health information system’s automatic immunization data entry in the patient’s admission module, architectures for electronic medical records and other health information systems used for billing, scheduling or research. Decision support systems in healthcare, including clinical decision support systems Standards ( HL7) and integration profiles (e.g. integrating the Healthcare Enterprise) are there to facilitate the exchange of information between healthcare information systems. These specifically define the means to exchange data, not the content. It also useful due to use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-making It can be concluded that Health Informatics is an integrated research and learning program with health as its focus and information technology as the enabler. It is a program that promotes and supports the use of health informatics in health services delivery, health management systems, research, learning and health policy development; for the purpose of improving health outcomes and processes for people. It is based on necessary collaborations among a variety of interested groups and sectors including consumers, providers, educators, researchers, government, clinicians, industry and anyone else with a key interest in the process and outcomes. The field of Health Informatics deals with understanding the meaning and use of health information support clinical care, health services administration, research and teaching. The program deals with the management and use of health information. It includes the understanding and use of computing skills and information management techniques derived from several disciplines including mathematics, statistics, and philosophy (epistemology). Pertinent information is necessary for informed decisions by patients, clinicians and health policy makers. This interdisciplinary program will prepare individuals with knowledge and skills to contribute to further work in this field.

Summary

In all over the world the health problems and needs are increasing and becoming more complex. The demands and pressures on the hospitals and health care institutions are also increasing. At the same time the resources are becoming increasingly limited. Achievement of goals, efficiently, effectively, and economically is the primary responsibility of all the administrators. This can be achieved through business, medical and technical management systems in hospitals. The purpose of using standards in health information systems is to facilitate the intergradations of component parts and support interoperability, for example, by making data generated in one part of a system accessible, meaningful and (re-)usable in another where different technology may be in use. Standard setting is typically a voluntary activity initiated by special interest groups of experts. External organisations such as CEN, ISO or ANSI give the final seal of approval and credibility to an emerging standard. In health informatics, standards development is concentrated in such areas as data exchange, medical terminologies, documents, architectures.

References

Heffler S, Smith S, Won G, et al. Trends: Health Spending Projections For 2001-2011: The Latest Outlook. Health Affairs, March/April 2002.
Woolhandler S, Himmelstein DU. National Health Insurance: Liberal Benefits, Conservative Spending. Arch Intern Med. 2002;162:973-975.
Iglehart JK. Expenditures. The New England Journal of Medicine. 1999;340:70-76.
Iglehart JK. Changing Health Insurance Trends. The New England Journal of Medicine.2002;347:956-962.
ISO http://www.iso.org/iso/en/aboutiso/strategies/isostrategies_2004-en.pdf Retrieved, February 26 th 2007
Iglehart JK. Medicare’s Declining Payments To Physicians. The New England Journal of Medicine.2002;346:1924-1930.
Iglehart JK. The Centers for Medicare and Medicaid Services. The New England Journal of Medicine.2001;345:1920-1924.
ISO http://www.iso.org/iso/en/ISOOnline.frontpage 
EHR http://www.himss.org/ASP/topics_ehr.asp
Iglehart JK. Medicare. The New England Journal of Medicine. 1999;340:327-332.
CCR http://www.centerforhit.org/x201.xml 
CEN http://www.cen.eu/cenorm/index.htm 
HISA online source : http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9848401&dopt=Citation Retrived February 27 th 2007
Shortliffe EH, Perreault LE. Medical Informatics; Computer Applications In Health Care. Addison- WesleyPublishing Company; 1990.
CEN TC 251 activities http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10163800&dopt=Citation
IEEE P2407 http://66.102.9.104/search?q=cache:t81qg54SSJ0J:www.ieee2407.org/files//ws01_bernd.pdf+what+is+I EEE+P2407&hl=no&ct=clnk&cd=2&gl=no  February 27 th 2007

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