James Madison University

NEW COLLEGES FORMED A plan to reorganize the College of Integrated Science and Technology into two colleges took effect July 1, 2012. The new colleges are the College of Health and Behavioral Studies and the College of Integrated Science and Engineering.

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Health Care Informatics: A unique opportunity for interdisciplinary collaboration in CISAT

By Jennifer McCabe, Health & Human Services Librarian, CISAT Library at James Madison University

"Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education and research including the information science and technology to support these tasks." 1 Originally called "computers in medicine", that definition quickly became outdated when it was understood that what was really being studied was information and that health care is more than simply the practice of medicine. The simplest and broadest definition may be "the application of information technology to enhance patient care."

The College of Integrated Science and Technology (CISAT) is composed of programs whose common denominator is "the use of science and technology to enhance the quality of life in the modern world." It is only logical then that a course covering the enhancement of patient care by technology would be developed and offered in CISAT. The Center for Innovation in Health and Human Services was established in CISAT in October 2001, with the goal of fostering collaborative, cross-disciplinary studies. It was in this climate that the Introduction to Informatics for Health Care Professionals course was born. Team-taught by Dr. David Cockley (Health Administration), Dr. Linda Hulton (Nursing), Dr. Carolyn Ericson (formerly Social Work), Dr. Jeff Kushner (Integrated Science and Technology), Dr. Tom Dillon (College of Business) and Jennifer McCabe (Health & Human Services Librarian), the course will be offered for a third time in the Spring of 2003.

JMU's Introduction to Informatics for Health Care Professionals course was designed with the recognition that while we don't educate doctors we do have a number of programs that prepare students for work in medical settings, either as clinicians, administrators, or in the information technology arena. Nurses, occupational therapists, physician assistants, social workers, and frequently billing personnel and other administrators all make up the team that delivers health care services. Behind the scenes are the network administrators and information systems staff that manage the flow of data and information. As future professionals, JMU students will need to work together to handle the vast amounts of information involved in the delivery of health care services, information needed for diagnosis and monitoring, decision support, patient education, billing and reimbursement. Students in the Introduction to Informatics for Health Care Professionals course work in cross-disciplinary teams to examine and meet some of the challenges faced by health care professionals today.

The conceptual components of Health Care Informatics include database design; human-computer interaction; controlled vocabularies; coding systems; clinical information systems; decision support and analysis (evidence based medicine); use of biomedical and genomic sequencing databases; government regulation of medical information; health literacy and evaluation studies. The following is a description of some of these components in the context of the class that is currently being offered:

Controlled Vocabularies & Coding: Currently there are multiple controlled vocabularies and coding schema being used in health care. The literature of medicine is accessed and described through the medical subject headings (MeSH), procedures get CPT codes, diagnoses get ICD-9 codes, nursing interventions have various codes, and mental health diagnoses get DSM-IV codes. Because health information is collected in and retrieved from different kinds of systems there is a need for a thesaurus so that the codes can be understood by disparate systems. The National Library of Medicine has developed the Unified Medical Language System to do just this.

  • Evidence Based Practice: One of the advantages of our technology capabilities is that clinical evidence can be quickly gathered and applied to individual situations. For example, the data regarding the use of a drug in a particular population can be used to support the decision to prescribe or not prescribe that drug to an individual. Decision support involves the judicious use of data to assist in diagnostic and treatment decisions. Informatics studies both the capture and application of data.
  • Human Computer Interaction: Computer hardware and software in health care must be carefully designed as lives can depend on their functioning. Database design, interface design, and ergonomics are all things to consider when implementing new systems or devices in any facility. What works for administrators for example, may be ineffective or even dangerous to nurses. HCI must be approached from a team perspective in order to design, select, and implement the best systems.
  • Government Regulation: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a piece of legislation that regulates medical records privacy and the electronic transmission of health care information. Although the law is several years old, the regulations are just beginning to take effect, and they will touch almost every kind of health care facility in which our students will work.
  • Health Literacy: Studies of literacy in America have revealed that nearly 90 million Americans are functionally or marginally illiterate. Low health literacy has been attributed to increased health care costs, increased hospitalization, and poor management of chronic conditions. The Internet offers great potential to provide access to health information, but information literacy skills must be taught in order for consumers to choose quality resources on which to base health care decisions.

Libraries and librarians are involved in the study and teaching of health and medical informatics for a number of reasons. Librarians have expertise in classifying information, retrieving information, using databases, teaching information literacy and retrieval, and using controlled vocabularies. The National Library of Medicine has been a leader in educational efforts and financial support for research and teaching in Informatics. Librarians in health sciences and medical libraries and hospitals around the country are creating innovative ways of integrating the vast amount of health related information on the Internet into patient care. At Vanderbilt University there is a service called Patient Informatics Consult Service (PICS) wherein patients are given information prescriptions by their doctors. These prescriptions are taken to the library where they are "filled" by librarians who are uniquely qualified to assist the patient in finding appropriate information for them and their health condition. This is just one of many ways librarians are involved in the study and application of informatics in the health care arena.

Because Informatics is intrinsically interdisciplinary and extensively intertwined with technology, it is a perfect fit for CISAT. The faculty in CISAT bring a wealth of skills and contacts to Informatics curriculum development efforts. As health care evolves so will the study of informatics, offering many rich opportunities for collaboration and partnerships among students, faculty, the community and the private sector.

1.Greenes, R.A. and Shortliffe, E.H. Medical Informatics: An emerging academic discipline and institutional priority, JAMA. 263(8), 1114-1120.