Operational definition of Informatics (and Health Informatics) in relation to my future career.
The term ‘Informatics’ is somewhat of a broad term. To define it, informatics is the science that is made up of both information and computer science and is used to research the development, management, use and dissemination of data, information, and knowledge.
As it pertains to Health Informatics, the definition only slightly differs. Health Informatics is a unique field in Informatics, in which health related data, information and knowledge is developed, managed, analyzed, and used in numerous health-related settings, through the application of information and communication technology in various health settings. Additionally, because of the wide breath of disciplines in healthcare, Health Informatics as a whole, can be sub-divided into said discipline-specific classifications (Giddens, 2012, p.444).
Personal focus area(s) for this blog. A short description and currently identified informatics challenges and application opportunities.
Based on previous professional experience and a personal passion for IT Security, the focus area(s) of this blog (apart from Health Informatics) will be IT Security and general IT Operations issues that are commonplace in business and customer-facing settings. The main goal will be to relate these issues and the unique challenges that they bring to Health Informatics.
When relating to IT Security, this encompasses all the facets of cybersecurity, specifically the strategies, tools and technologies used to prevent the unauthorized use or access of safeguarded assets ranging from PCs to data. The goal of IT Security is to maintain high and appropriate levels of Confidentiality, Integrity and Availability.
The reason this applies to Health Informatics is that the field, per our definition, heavily relies on information and communication technologies. From access to the internet, to the use of software applications that manipulate, transmit or store important health data, these technologies and many more are commonplace in healthcare settings. So, to ensure that proper levels of Confidentiality, Integrity, and Availability are met for said technologies and data, established best practice standards and policies in the field of IT Security should be leveraged in healthcare settings that heavily rely on technology. After all, some of the most coveted and safeguarded information in any organization is data. Thus, I believe that IT Security must be at the forefront of any implementation or management discussions on new or existing technologies for use in healthcare settings since these settings tend to house sensitive and highly regulated patient or consumer data. Data that must remain confidential, have high levels of data integrity and availability (along with proper access to said data). So, a particular informatics challenge thus far identified is the proper base-level safeguards needed to house and protect health data.
An additional focus area that is of personal interest involves overall organizational or system IT issues, or what I refer to as IT Operations issues. These are issues with current systems in use that have inefficiencies, be it technological or procedural. Having had embarked on Six Sigma training and having experience in IT Operations with the technologies used in this area, I can attest to that the world of IT is always on the lookout for ways to improve processes and increase efficiency for internal or external (customer) use. Automation almost always tends to be the first answer, and to its credit, is more commonly becoming the most efficient answer. However, before getting to such a solution, a bare-bones procedural look at processes and tasks must be conducted to fully grasp the system and inefficiencies at play. Otherwise, issues could be overlooked, or solutions could not be adequately implemented to resolve the problems that were initially set-forth to be resolved.
Currently, baring my lack of clinical or healthcare experience, I do not know of many current healthcare system inefficiencies. From HIT 421 – Week 1 readings, it seems that issues of multidisciplinary triage and cooperation, and patient data errors tend to be major pain-points in existing systems. It is my belief that breaking down these processes and closely observing them for inefficiencies could prove to be extremely beneficial in properly engineering a solution. Similarly, to the Model Case presented in Giddens (2012, p.449) on informatics nurse specialist Ellipse Wrigglesworth, MSN, RN, and their efforts of following a very methodical and process-oriented approach to resolving issues with an existing fall risk management protocol for electronic health record (EHR) use, I envision that similar organizational or system IT issues can also be addressed and even yield beneficial contributions to the advancement of Health Informatics by design. Like how the protocol developed by Wrigglesworth produces meaningful data for Nursing Quality Indicators (NDNQI) use.
Why is this challenge an “informatics” challenge?
Both IT Security and Operations issues as they relate to health informatics, pose “informatics” challenges due to the close-knit relationship these areas (and their accompanying issues) have with the technology leveraged for informatics efforts. To illustrate this, if threat actors were to launch a sophisticated campaign at a health clinic through the use of malware or a DDoS attack, the data in the form of records, repositories or even communications could be compromised or severely halted. Not only would this pose a serious short-term risk, but also a long-term risk for many parties including the organization and its patients. Without properly ensuring that all collected data for health informatics use is properly safeguarded, this opens the doors for disastrous and continuous threats. Threats that include the corruption or even theft of said data, rendering it useless or inaccessible.
Additional outside research in support of Informatics definitions and its application towards IT Security and Operations focus areas.
Per Ronquillo’s article (2018) “Despite making up less than 25% of all breaches, hacking was responsible for nearly 85% of all affected patient records over the last 5 years, highlighting the broad potential reach of this kind of breach. The 2017 WannaCry ransomware attack on Britain’s National Health Service, which forced numerous clinics to close their doors and refuse patient care…” As security threats become more common and technology is further adopted by healthcare organizations, there will clearly be a needed for heavy investment and scrutiny placed on this section of informatics. Although most hackers are incentivized by monetary bounties, their actions can have secondary and sometimes dire consequences when health is involved. If one sophisticated attack such as WannaCry can have such an impact as to halt health clinics for some time, then this just further supports the ideology that Security should be at the forefront of any Health IT or informatics discussions.
(Table 2 was imported from Ronquillo’s JAMIA Open article, which was tabulated from the referenced 5-year study).
Finally, from Ronquillo’s same article (2018), it is mentioned that over the 5-year period in which the article’s study is conducted, “there were 1,512 reported data breaches of protected health information affecting 154,415,257 patient records…” with “1,073 (71.0%) breaches of a hospital or health care provider”. These figures alone paint a relatively stark picture of the landscape of the health industry’s security posture and the potential threats looming over health data. However, there are effective solutions that can be implemented early on and maintained throughout the life cycle of technologies and data. From individual level solutions, such as engaging physicians, researchers, or nurses in cybersecurity best-practices to strong data encryption policies for data at REST or being transferred. As Ronquillo suggests, “as big data, machine learning, and artificial intelligence are integrated into the practice of medicine, policies must be revised to help build the informatics infrastructure necessary to safely and effectively monitor, detect, and eliminate cyber threats” (2018).
Works Cited
Jay G Ronquillo, J Erik Winterholler, Kamil Cwikla, Raphael Szymanski, Christopher Levy, Health IT, hacking, and cybersecurity: national trends in data breaches of protected health information, JAMIA Open, Volume 1, Issue 1, July 2018, Pages 15–19, https://doi.org/10.1093/jamiaopen/ooy019
Connors H, Warren J, Popkess–Vawter Technology and informatics. In: Giddens JF, ed. Concepts for Nursing Practice. St. Louis, MO: Elsevier; 2012:443-452.