The History of Health Informatics
"A doctor check his patients' paperwork" by World Bank Photo Collection is licensed under CC BY-NC-ND 2.0
The history of health informatics begins almost 70 years ago. In the wake of World War II, several doctors and researchers were examining the role that computers could play in helping to diagnose medical disease. They used logic and probabilistic reasoning to tackle specific healthcare problems in biology and medicine.1
The idea of using data analysis in medical research and diagnosis was already appearing in publications such as Science. A 1959 article by Drs. Lee Lusted and Robert Ledley promoted formalizing statistical approaches for modeling medical decision-making as a way of reducing errors, among other benefits.2 However, computers were not yet advanced enough to provide individual care providers and hospital systems with the tools to conduct these analyses.
This post will track the progress of this dynamic, rapidly changing field since then.
The Early Days: Cybernetics and Information Processing
Early work in healthcare informatics, in the 1950s, involved professionals in a myriad of fields, including bio-engineering, biophysics, epidemiology, clinical documentation, and biometry. It led to the founding of the International Society of Cybernetic Medicine in 1958, a meeting of the Cybernetic Medicine Congress in 1960 in Naples, and the launch of a new journal that highlighted work in medical documentation and statistics: In 1962, Germany’s Dr. Gustav Wagner first published Methods of Information in Medicine (MIM).1
The Evolution of Computing and Data Analysis: 1960 to 2000
Initially, the discipline went by many different names3, including:
- Medical computing
- Medical computer science
- Computer medicine
- Medical electronic data processing
- Medical automatic data processing
- Medical information processing
- Medical information science
- Medical software engineering
- Medical computer technology
They all meant essentially the same thing, and often the terms were used interchangeably. Professionals in the field soon realized the importance of finding a universal term that would be broadly adopted to encompass the combination of science, engineering and technology and eventually settled on health informatics.2
The 1960s brought significant advances in the use of computers for a wide variety of medical tasks. Researchers at the University of Utah built the first operational electronic medical records system, called Health Evaluation through Logical Programming (HELP), which was launched at the Latter-Day Saints Hospital in 1967. It supported a catheterization laboratory and post-open-heart intensive care unit before eventually expanding to include laboratory, nurse charting, radiology and pharmacy.4
In the 1970s and 1980s, computers became smaller and more portable, with desktop and laptop models becoming realistic, effective tools for hospitals and clinics of all sizes. Building on the history of health informatics for data analysis, new programs such as digital patient scheduling5 and computerized order entry systems6 were introduced, and the federal government awarded over $1 billion to Science Applications International Corp (SAIC) to create the first computerized healthcare system for the Department of Defense.7 But the vast majority of healthcare providers were still using paper charts, which limited the opportunity for physicians and facilities to share information or coordinate patient care.
The Move to Digitize Healthcare: 2000 to Today
By the 2000s, many healthcare leaders recognized the potential for technology in medical care, diagnosis, record-keeping, information-sharing, and care coordination. In his 2004 State of the Union address, President George W. Bush included a goal for broad adoption of computerized health records to “avoid dangerous medical mistakes, reduce costs, and improve care.”8
The American Recovery and Reinvestment Act (ARRA), signed into law by President Barack Obama in 2009, included the Health Information and Technology for Economic Clinical Health Act (often abbreviated as “HITECH”).9 This law was the first national effort to incentivize physicians and care providers to adopt electronic health records (EHRs) as the primary means of storing and sharing patient treatment data. It provided benefits for those willing to be ‘early adopters,’ with a future provision to punish clinics that did not adopt an EHR within a specified timeframe.
While politicians were imagining what the future of medicine would look like, companies were hard at work advancing programs that would support medical practices. One of the earliest systems designed for the Windows operating system was EpicCare.5 As the interest in electronic health records and other digital health technologies grew, innovative software developers began creating technology to do more than just provide an electronic version of a patient chart.
The Tipping Point
When the HITECH Act was first passed in 2009, 12 percent of non-federal acute care hospitals had a basic EHR in place.10 These systems usually included:
- Patient demographics
- Problem lists
- Medication lists
- Discharge summaries
- Medication-ordering capabilities
- Viewing capabilities for lab reports, radiology reports, and diagnostics test results
- Clinician notes (available in some, but not all, basic EHRs)
By 2015, that number had skyrocketed to 85 percent of hospitals with at least a basic EHR, and many had certified EHRs that met “the technological capability, functionality, and security requirements adopted by the Department of Health and Human Services.”11 These more comprehensive EHRs provide additional tools to aid in diagnosis—patient health reminders, full clinician notes after each visit, and other features to enhance the quality of care.
Building the Future of Health Informatics
Today, medical practices use a combination of health informatics systems, including:
- Patient scheduling
- Practice management software
- Electronic health records
- Medical billing software
- Patient portals
- Telemedicine and telehealth
- Quality reporting and analytics
These systems streamline workflows for medical clinics and hospitals, and also provide added convenience for patients receiving care.
One of the biggest challenges in the industry, despite all the innovations in software capabilities, remains interoperability. Even within a single hospital system, clinic, or healthcare organization, you might find software programs from multiple vendors that are not standardized and don't communicate well or share data efficiently.
Another challenge that many organizations face is the rate of adoption. Simply having access to an EHR, defined by the Office of the National Coordinator for Health Information Technology as having “a legal agreement with the EHR vendor,”11 does not mean that clinicians and staff members adopt and use the technology in their daily workflows.
That’s where health informatics comes in as a profession. As the discipline of health informatics continues to grow, information systems professionals are taking the lead in developing new and innovative programming solutions for integrating disparate systems and providing the necessary training to help physicians, providers, clinical and non-clinical staff learn how to use EHRs and other technologies effectively, to improve care and reduce costs.
The field is changing quickly, and a Master’s in Health Informatics can provide you with the skills to be at the forefront of innovation. While today’s EHRs are vastly better than the ones available just 10 or 20 years ago, there is still a long way to go. Advancements in artificial intelligence, better interoperability and data sharing, speech recognition, predictive analytics, and other improvements are just a small part of the health informatics future. Skilled professionals are essential to make sure technology truly advances and enhances care.
Make a difference in the future of health informatics.
Start using data-driven methods to save lives today. Explore Kent State’s online Master of Science in Health Informatics or our shorter-term postbaccalaureate certificate option. Learn more about our classes and take the first step toward a rewarding career in this rapidly expanding field.
1. Retrieved August 10, 2020 from ncbi.nlm.nih.gov/pmc/articles/PMC6239242/
2. Retrieved August 10, 2020 from study.com/academy/lesson/history-of-health-care-informatics-from-1949-to-the-present.html
3. Retrieved August 10, 2020 from ncbi.nlm.nih.gov/pmc/articles/PMC1307150/pdf/westjmed00160-0042.pdf
4. Retrieved August 10, 2020 from researchgate.net/publication/12893281_The_HELP_hospital_information_system_Update_1998
5. Retrieved August 10, 2020 from isthmus.com/news/cover-story/epic-systems-an-epic-timeline/
6. Retrieved August 10, 2020 from onlinelibrary.wiley.com/doi/abs/10.1002/asi.21324
7. Retrieved August 10, 2020 from emrindustry.com/may-03-11-month-defense-health-record-contract-awarded-to-leidos/
8. Retrieved August 10, 2020 from washingtonpost.com/wp-srv/politics/transcripts/bushtext_012004.html
9. Retrieved August 10, 2020 from hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html
10. Retrieved August 10, 2020 from dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php#appendix
11. Retrieved August 10, 2020 from dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php