It is very appropriate that John Bryant, marking the end of his term as Editor of this Journal, provides the introduction to this special issue. Not least because in doing so, it provides me with an opportunity, on behalf of Taylor & Francis and Informa, to publicly thank him most sincerely for his work on the Journal. John has been the editor in chief for over eight years, and as I just begin the task of succeeding him, I am acutely aware of the hard work and effort he has consistently put in to make the Journal successful. Personally, I am extremely grateful to him for his help in this interim, transitional period.
John provides a thoughtful, reflective editorial. He reviews selected outputs of a longstanding conference and considers them in the context of wider changes that have taken place in the field of Health Informatics. One important change in the perspective given by him is the move from what was initially considered to be health computing to the more pervasive perspective of Health Informatics that includes the nature of the information itself, its use and usefulness in care contexts as well as the diversity of systems that are designed to process it.
In truth, a selection of papers, from a single conference, and a national one at that, can only provide an incomplete snapshot of the whole field, but John has used them to reflect upon what was current in 1984, as opposed to what is current now. In doing so, John acknowledges the successes that have been achieved but recognizes, too, the lack of progress made. Explicitly, John issues the challenge to us all active within Health Informatics to improve upon what we have, and not to be satisfied with the current state.
John concludes his editorial on an optimistic note and ends by looking forward to the future in anticipation. I concur, and in so doing, I hope, with your help as both readers and contributors, to accept his challenge by improving this Journal. The goal will be to use the Journal to showcase the very best in research and practice so as to promote evidence-based informatics and thereby show its relevance and importance for improving health and social care, wherever and however it is delivered.
Professor Stephen Kay
January 2007
Guest editorial
Reflections on health informatics
The publication of this special issue, containing a selection of the best papers from the HC2006 conference, marks the end of my term as Editor of this Journal. In introducing these papers, it seems appropriate to reflect on the changes that have, or have not, occurred in the field which we now generally refer to as health informatics.
The HC2006 conference was the twenty-third in a series of events organized by the Health Specialist Groups of the British Computer Society. The series commenced with Current Perspectives in Health Computing, held in Birmingham, UK in March 1984. The conferences reflect a particularly British view of health informatics but, over the years, have frequently looked out over the rest of the world.
In 1984, the topics that concerned health informaticians tended to be concerned with the use of computer technology and information systems to support the management and delivery of care in a variety of sectors—for example, the acute hospitals, general practice, the community, the back office, and regional areas. Even in these early days, there were three papers looking at clinical records systems, three papers on decision support, and three more looking at the future. Topics of concern to the 1984 delegates included data modelling, approaches to application development, the electronic exchange of clinical information, and the harnessing of operational data to provide regional and national health planning information.
In this special issue, we have eight papers falling into three main topic areas, namely evidence-based informatics, specific applications, and requirements and modelling—ranging from high-level conceptual modelling to fine-grained syntax.
The first paper of the two papers on evidence-based informatics—‘Electronic health records: is the evidence base any use?’—reviews the impact of electronic health records (EHRs) on clinical work and administration. It suggests that that the literature has, to date, largely failed to deliver usable findings. This, despite the fact that information technology policies in many countries are full of aspirational statements concerning the implementation of EHRs. We seem to have been striving to achieve this for many years and are still not sure why!
The second paper—‘Using Artificial Intelligence to bring Evidence Based Medicine a step closer to making the individual difference’—suggests that the vision of evidence-based medicine, with experienced clinicians systematically using the best research evidence to meet the individual patient's needs, remains distant from clinical reality. The authors describe an approach, based on techniques from machine learning, to bridge this gap between evidence and individual patients in oncology. Slowly, it seems, the field of artificial intelligence is beginning to deliver on its early promise.
The following two papers—‘Progress Towards Automated Detection and Characterization of the Optic Disk in Glaucoma and Diabetic Retinopathy’ and ‘Integrating Health Information: a case Study of a Health Information Service for Thalidomide Survivors’—are excellent examples, one quite technical and one rather more general, of the application of information technology in specific clinical areas. We need more such applications.
One of the greatest challenges to the application of information technology is that life continually changes. The requirements of the users change, the processes used to deliver health care change, new health care interventions are developed, and the technology itself develops and changes. While it is not particularly difficult to develop software, it remains far more challenging to do so in a way that permits rapid and reliable maintenance to reflect this changing use. The final four papers look at ways of addressing this problem. The paper entitled ‘Addressing the Need for Adaptable Decision Processes within Healthcare Software’ suggests that by improving the adaptability of software, and in particular its decision processes, the maintenance requirements of software will be decreased. The paper looks at a set of tools to model decision processes such that they can be inspected, analysed, and adapted while the software is operational. The second paper—‘Use of OWL-based tools to aid message development and maintenance’—discusses the issues surrounding the development and maintenance of the complex and diverse set of electronic messages required if applications in the health domain are to interwork reliably. The authors report on a commissioned proof of concept study to investigate whether the Object Web Language (OWL) and its associated tools could provide a basis for the message development and implementation environments. The third paper in this section—‘Using Unified Modelling Language (UML) as a process modelling technique for clinical research process improvement’—looks at the use of UML in a quality-improvement programme which processes routinely collected general-practice computer data. UML was used to appraise the data-quality processes to see if their efficiency and predictability could be improved. The final paper, entitled ‘Using XML and XSLT for flexible elicitation of mental-health risk knowledge’, looks at how the eXtensible Mark-up Language, XML, was used as the formal representation of expertise in the mental-health field to facilitate collaborative use of different software and programming languages. Extensible Stylesheet Language Transformations (XSLT) provided the flexibility for responding to inevitable changes in knowledge-elicitation requirements.
Looking back to the 1984 conference, it is apparent that many of the challenges then are still extant. We cannot deny that considerable progress has been made and that health informatics flourishes. But, when we look at the developments in hardware technologies over the past 20 or so years, perhaps we should question whether our ability to harness and benefit from these developments has progressed correspondingly. I am somewhat disappointed with this aspect, but I look forward in anticipation to the future.
John Bryant
December 2006