By the beginning of the third millennium, health informatics has made a path from an obscure concept to a significant discipline within the U.S. healthcare system. However, the origins of modern health informatics can be traced to ancient Egypt, up to the 17th century BC. Edwin Smith, an American antiquities collector from Connecticut, purchased Egyptian papyrus that contained the earliest form of medical records (Beth Shanholtzer & Ozanich, 2015). The purchase of Edwin Smith Papyrus can be considered the first occasion when an American citizen met practical application of health informatics.
The advancements in health data collection in the USA had occurred since the middle of the 19th century when Lemuel Shattuck published a Report on the Sanitary Commission of Massachusetts (Lumpkin, 2003). As time went by, the U.S. states established and standardized system for collecting birth and death records. However, increasing volumes of data on chronic illnesses have created a need for technological advancement, which would have been able to analyze it (Lumpkin, 2003). As a result, the need to measure a population’s health condition in order to formulate disease prevention and treatment strategies served as the essential prerequisite for health informatics development.
The State of Illinois has become a pioneer of U.S. health informatics. In 1962, the Illinois Department of Public Health (IDPH) installed a system based on IBM 1401 computer to manage data from various divisions within the department (Lumpkin, 2003). As electronic public health information systems proved their usefulness, local and state-level healthcare institutions started implementing their own health informatics solutions. However, an initially successful undertaking turned into an issue when numerous systems began to duplicate themselves since the medical staff had to enter the data into each system separately (Lumpkin, 2003). The government corrected this adverse effect with various funding programs on the federal level, which allowed the creation of state-based information systems (Lumpkin, 2003). By the end of the 20th century, the development of prototype health information systems based on software reuse was seen as the next step to modern, efficient healthcare (Lumpkin, 2003). Health informatics has firmly become a matter of federal concern rather than an ambitious project of enthusiasts in local healthcare organizations.
The evolution of health informatics has brought to life various professional organizations within that sphere. Such organizations as the National Academies of Sciences, Engineering, and Medicine (NASEM) and the U.S. Office of the National Coordinator for Health Information Technology (ONC) have championed the use of health informatics (Pantell et al., 2020). However, technological advancement in U.S. healthcare can be used not only for public health needs. For example, the data from electronic health records (EHR) can be used for integrating medical and social care in multiple ways (Pantell et al., 2020). In theory, clinical decision support (CDS) tools of modern EHRs can be supplemented with social care CDS tools. For instance, the data stored in the EHRs can potentially assist healthcare providers in mitigating the impacts of social risk factors, such as homelessness, on health outcomes (Pantell et al., 2020). However, this effort would require the extensive cooperation of multiple professional organizations due to possible complications in technological and ethical aspects.
Advancements in health informatics also put new demands in front of healthcare personnel. Hübner et al. (2018) conducted a survey of 43 experts from 21 countries who defined the top 10 core competency areas in the five nursing roles. According to the results, a modern nursing professional should understand various informatics-related disciplines, such as ethics and IT, information management, and data protection (Hübner et al., 2018). Therefore, modern education programs in nursing must include training in health informatics, as informatics has become an inseparable part of healthcare.
Some scholars are expressing concerns about the possible adverse effects of health informatics. For example, Veinot et al. (2018) argued that health informatics interventions could produce intervention-generated inequalities (IGI) by benefiting socioeconomically privileged groups. In particular, information technology-based interventions against obesity were less effective for people with lower socioeconomic status (Veinot et al.,2018). Other problems may include but are not limited to disproportional access to health informatics and difficulties in technology adoption (Veinot et al.,2018). As a result, while health informatics is not a problem per se, it can potentially lead to social discrimination if used without an inclusive approach.
These concerns may be valid; however, one might look at them from the biblical perspective and find strong support for health informatics. Apostle Paul said: “There is neither Jew nor Gentile, neither slave nor free, nor is there male and female, for you are all one in Christ Jesus” (New International Version Bible, 2011, Galatians 3:28). As such, all modern technologies in healthcare, including health informatics, can be perceived as God’s gift for humanity. Health informatics can be used to promote equality in healthcare and help people who would still be struggling otherwise. An example of this biblical approach can be found in the Fostering African-American Improvement in Total Health (FAITH!) mobile health informatics intervention (Brewer et al., 2020). Community effort translated a face-to-face church-based education program on cardiovascular health into a mHealth application (Brewer et al., 2020). As a result, the app developers managed to raise awareness about chronic cardiovascular diseases among the marginalized local African-American community (Brewer et al., 2020). Overall, in this case, one can see how health informatics integrates medical, social, and spiritual elements into a truly beneficial combination.
References
Beth Shanholtzer, M., & Ozanich, G. W. (2015). Health information management and technology. McGraw-Hill Education.
Brewer, L. C., Fortuna, K. L., Jones, C., Walker, R., Hayes, S. N., Patten, C. A., & Cooper, L. A. (2020). Back to the future: Achieving health equity through health informatics and digital health. JMIR mHealth and uHealth, 8(1), e14512.
Hübner, U., Shaw, T., Thye, J., Egbert, N., de Fatima Marin, H., Chang, P., O’Connor, S., Day, K., Honey, M., Blake, R., Hovenga, E., Skiba, D., & Ball, M. J. (2018). Technology informatics guiding education reform –TIGER. Methods of Information in Medicine, 57(S 01), e30-e42.
Lumpkin, J. R. (2003). History and significance of information systems and public health. In P. W. O’Carrol, L. Ripp, W. A. Yasnoff, M. Elizabeth Ward & E. L. Martin (Eds.) Public Health Informatics and Information Systems (pp. 16-38). Springer, New York, NY.
New International Version Bible. (2011). Bible.com.
Pantell, M. S., Adler-Milstein, J., Wang, M. D., Prather, A. A., Adler, N. E., & Gottlieb, L. M. (2020). A call for social informatics. Journal of the American Medical Informatics Association, 27(11), 1798-1801.
Veinot, T. C., Mitchell, H., & Ancker, J. S. (2018). Good intentions are not enough: How informatics interventions can worsen inequality. Journal of the American Medical Informatics Association, 25(8), 1080-1088.