Also known as medical informatics, the US National Library of Medicine defines health informatics as the interdisciplinary study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management, and planning.
Mainframe at Texas Medical Center
Informatics is a new science. In 1943, Thomas Watson, president of IBM, famously opined, “…there is a world market for maybe five computers”. In fairness, the computer of the era was a vacuum tube-powered adding machine the size of a house. In 1977, Ken Olsen, founder of Digital Equipment Corporation, asserted “There is no reason anyone would want a computer in their home.” Between 1943, when Watson saw no market at all for computers, and 1977, when Olsen saw no need for computers in the home, computers were shrinking in size and growing in power at the enterprise level. Early progress in health informatics was stymied by price and a lack of everything that we now take for granted: power, speed and storage capacity.
The earliest application of informatics in medicine and biology was in the analysis of normal human movement to assess deviations of the norm and to help design prostheses, which led to the development of free-standing departments of biomedical engineering in various centers in the US. Health informatics soon began to develop along multiple lines: expert systems–e.g., Internist-1*, which was meant to support diagnostic and therapeutic decision-making; bibliographic databases for the storage and retrieval of journal articles–e.g., MEDLINE; and hospital information systems with key value database engines optimized for high-throughput processing of transactions–e.g., MUMPS. Obviously, the hardware has morphed in lockstep with the needs of users, with mainframes–e.g., that of the Texas Medical Center (top image, circa 1969) doing the heavy lifting.
*Internist 1 failed due to the over-long training period, unwieldy interface and excess time required for each clinical session.
The software of the 60s was followed in the 70s and 80s by development of practice management software and nascent iterations of electronic medical records (EMRs). Whilst implementation of EMRs has proven easier said than done, the end of the proverbial tunnel is getting brighter, facilitated by the latest generation of handheld computers far more powerful than their digital forefathers.
Missteps along the road to mature, stable health information platforms have included lost hard drives and laptops, unencrypted release of patient data, compromises of varying size and scope of patient privacy, massive overspending on ultimately failed informatics initiatives–e.g., the UK’s National Programme for IT, which cost British taxpayers £12 billion (dismantled in 2012) and cyberattacks–e.g., of the NHS by the WannaCry ransomware (May, 2017).
Tablet computer (iPad) on the ward
The most recent wave of health informatics innovations have been in the sphere of mobile computing, which began in 2007, spearheaded by Apple’s release of the smartphone followed shortly thereafter by the software development kit, which led to an amazing array of Apps. Noteworthy healthcare App companies include Airstrip, CardioNet, and Epocrates. Mobile Apps free physicians from the physical confines of location, allowing them to manage patients from around the corner to around the world. Release of the iPad cemented Apple’s central role as a provider of healthcare management tools. These devices have had an unanticipated benefit, that of bringing patients on board with the healthy lifestyle dialogue, through the availability of fitness, wellness and nutrition Apps.
Informatics is a central pillar on which medicine is practiced in the 21st century. Computers and smart devices are so ubiquitous and integral to medical care that not googling a question or tapping into a relevant database is inconceivable. The argot of informatics is too integral to modern medicine for it to be ignored by medical dictionaries. On this website, I’ve included biomedical publications, journals, articles, books, communication, computers, and internet-related terminology under the informatics umbrella.