04 July 2017

What is clinical informatics?


Chris Austin


What is clinical informatics?

When I ask other health and care professionals what 'clinical informatics' means to them, they usually say it's all about IT and digital care records. But that's really a description of the much broader field of health informatics.

Clinical informatics is specifically focussed on the use of information and communication technologies (ICT) and information management, to support the commissioning, planning, delivery, evaluation, and improvement of care services- which benefit patients and clinicians. For years we have faced challenges in the health and social care system, with the gaps in information meaning that professionals often don't have access to the right data-such as patient medications or diagnosis.

Now digital care records are at the heart of clinical informatics, as the health and social care system aims to move towards integrated person-centred records, where the patient and the professionals involved in their care can access all the relevant information in real-time. However, the lack of relevant national information standards has prevented the development of digital care record systems. But once developed, they could easily transfer data between different systems, or provide a single point of access to an integrated care record for each patient.

Two of the key concerns surrounding the development of standards have been the specification for care record headings and the choice of clinical terminology for coding key patient data, namely SNOMED Clinical Terminology (SNOMED CT). The use of SNOMED CT will mean that practitioners are recording data that is comparable across England, and easily understood by all care record systems.

The use of a standard set of care record headings will ensure that data is recorded with the correct context. For example 'able to dress self independently' could be recorded in an assessment, as an agreed goal, or recorded as an outcome following interventions. Context is critical to understanding the meaning of clinical data items. The Professional Record Standards Body (PRSB) is undertaking a range of projects to develop national information standards that are essential to the delivery of integrated, person-centred digital care records.

Some of the key developments rely on action by health and care professional associations and professional bodies. For example, the development of professional subsets for inclusion in SNOMED CT requires that each profession or specialty agree a list of terms that are routinely used by their practitioners. This task is complicated when a profession is involved in many different areas of practice, and needs customised lists for each specialty - like the nursing profession.

Other developments are difficult because there is no consensus on the information requirements. For example, the recording and display of alerts and warnings, and the processes for ensuring these are updated for all care services currently involved with a patient. Finally, data recorded for direct patient care is anonymised and also used for a variety of secondary purposes. For example: service commissioning, service evaluation, clinical audit, clinical research, and national statistics. Whilst the digital care record is central to clinical informatics, there are many other ways that ICT and data analytics are used in health and care services. From telecare and telehealth to mobile health, apps, imaging, and gene technologies, the scope for digital health is growing by the day. Clinical informatics is relevant to all practitioners and managers, whether that's limited to keeping up to date with the latest developments, or being more actively involved in local pilot projects or implementation of national information standards.

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