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May 29, 2007

Q&A: Health Informatics

Scott Zeger, PhD

For the past few years, the term “health informatics” has been popularized by health professionals across the globe to describe an area of research that has the potential to revolutionize health care. A Google search comes up with over 1 million listings for webpages related to health informatics. Stanford, Columbia University and the University of Washington have departments focused on health informatics. And, in January 2007 the Centers for Disease Control and Prevention awarded $3.7 million to fund three Centers of Excellence in Public Health Informatics. But what exactly is health informatics?

To learn more about this emerging topic, the Office of Communications and Public Affairs spoke to Scott Zeger, PhD, chair of the Johns Hopkins Medical Institutions Committee on Health Informatics. Zeger is also chair of the Bloomberg School of Public Health’s Department of Biostatistics.

Question: How do you define health informatics?

Answer: In simplest terms, health informatics is the science that deals with health information, its structure, acquisition and use.

Health informatics is obviously not an entirely new field. At the Bloomberg School and Johns Hopkins Medical Institutions, we acquire and use health information every day in our research and in teaching and in professional practice. For example, epidemiology, health services research and genetics are research fields about the use of particular kinds of information. Biostatistics is a discipline about the design and analysis of health data.

Health informatics is a coalescence of a broad set of knowledge and methods from many different fields, including computer science, library science, statistics and others. The emergence of heath informatics at this time is largely driven by the revolution in information technology.

Laptops now are much more powerful than the computers scientists once used to do their research. And the Web has connected us in ways that have allowed us to understand each other’s work and interact more than we ever have. That’s changing how we do research, how we teach and even how we perform surgery.

The key components of new technology are the speed of processing, the amount of storage and the interconnectedness among us through the Web. Those three things are reducing the time in which we can process information–acquire it, manage it and use it. So now the question is how to best take advantage of these new technologies. That is a health informatics question.

Question: How is Johns Hopkins addressing the new emphasis on health informatics?

Answer: Late in 2006, deans [Michael J.] Klag, [Edward] Miller and [Martha] Hill launched the Committee on Health Informatics, which is made up of faculty and students from the Johns Hopkins schools of Public Health, Medicine, Nursing, the Applied Physics Lab, administrative personnel and a few key alumni and friends. Three working groups—infrastructure, curriculum and research—were created within the committee to make recommendations to the deans.

The infrastructure for faculty research increasingly depends on health informatics. This sub-committee has been asked how to improve the quality of health informatics services to faculty researchers so that they can remain leaders in health research and education in the next decade. They are asking: What the analogues today of email 15 years ago? What will we depend upon every day that is not yet standard at Johns Hopkins?

We’ve also been asked to determine what the students from the schools of Medicine, Nursing and Public Health should know about health informatics and should therefore be included in the Hopkins curricula.

We are also discussing which health informatics research areas Johns Hopkins can be a leader in. We are looking to build new strength in areas that are proximate to existing strengths.

Question: What are some specific applications of health informatics?

Answer: Health informatics can be thought of as having three major branches.

The first, bioinformatics, focuses on the molecular level. It is the use of information technologies to understand molecular and cellular processes. We have amazing new ways to measure molecules. We can sequence people’s genes; we can measure the expression of those genes; we can even measure the expression of the proteins they encode. We have huge amounts of publicly available data. And people are trying to use these new measurements to figure out what the mechanisms are that underlie health and disease.

Medical informatics, the second branch, is largely about how to use patient information. Every day we treat thousands of patients across the street [at Johns Hopkins Hospital] and there is a medical record about each encounter. In the past those were written down on paper. Now they are digitized and stored on computer. So now we have all this phenotypic information—everything from lab results, X-rays, MRI images and genetic information to basic symptoms—that represents the health status of patients. The question is how to use the information to first figure out the mechanisms of the disease and then work out better ways to treat each patient.

Finally, public health informatics deals with monitoring and measuring the health of a population. For example, one of the United Nations’ Millennium Development Goals is to substantially reduce infant mortality worldwide. To know whether we are attaining the goal, we must measure this outcome. Public health informatics can provide better tools for acquiring, managing and using the requisite data for tracking this important goal.

In all three types of informatics, the question is how best to utilize modern technology to measure more effectively and then to manage and analyze the data to understand what is going on.

Question: How does health informatics impact individuals?

Answer: One way is that the medical office of the future is probably going to be very different than it has been in the past. When a patient enters the office, he will swipe his medical card or use his thumb print, which will pull up a complete medical history. And then, rather than going in and seeing a doctor, the patient will be handed a PDA and asked to answer a series of health questionnaires that have been chosen for them based on the information in their medical records. The computer program will already know that the patient is being monitored for various chronic diseases and, if necessary, will request lab tests be done. The information provided from the survey and the lab tests results will be automatically fed into an expert system which will then provide a report to the doctor to use in a meeting with the patient. So, before the patient even sees a doctor, they will have already collected and used data to figure out what to do next. The doctor’s decisions will be entered into the system and it will all be swept back onto the patient’s medical card for reference during a future visit.

But the exciting thing about health informatics isn’t the collection of the information. It’s using the information in a sensible way. The doctor’s decisions about a particular patient will be guided by that patient’s data but also by what has worked or not for thousands and thousands of people like the patient. The doctor can make a decision for the patient that is based on experience in the general population of people because all of their data will also be in the system.

Question: How far away are we from the type of situation you just described?

Answer: Well, we are already doing some of this now. The United States has a disaggregated medical system, so we lag behind Europe, for example, in the effective use of health information. But there are examples in the United States of health organizations such as the Veterans Affairs and Geisinger that are using electronic patient records to the benefit of their patients. Americans will receive better quality health care for less money as we acquire, manage and use health information more effectively.

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Kenna Lowe or Tim Parsons at 410-955-6878 or paffairs@jhsph.edu.