1 Why change the title of this successful journal?
‘Medical Informatics and the Internet in Medicine’ may not have been the easiest title to say, but certainly its acronym, MIIM, was both comfortable and memorable as a place-holder. However, the use of the acronym disguised the fact that the old title is no longer relevant to a world that has long since moved on.
The main purpose of this editorial then is to show the relevance of the new title, i.e. Informatics for Health & Social Care. It is the goal of Editorial Board that the Journal's title is consistent with the content of the Journal and the aim that both title and content meet today's needs and those of the future. The new title is intended to be inclusive yet more comprehensive and focused than before. Informatics for Health & Social Care shows how it builds upon the past yet expresses the direction and content for future articles. This editorial therefore examines the old title, showing how the previous scope was paradoxically both too limited and at the same time too general to be helpful.
2 What's in a Name?
‘Medical Informatics’, i.e. the first part of the old title, is still held by many to be the preferred term for our discipline. To some cultures, the ‘Medical’ prefix subsumes ‘Health & Social Care’ and is therefore considered to be entirely adequate for the purpose of representing everything. To others, however, that attribute seems to exclude ‘Health & Social Care’ and, by association, the practitioners who would describe neither their profession as being medical nor themselves as being ‘medics’.
Compound terms do usefully give the sense of an interface, ‘an intersection’ or a meeting between worlds, of an essentially ‘hybrid’ discipline. For those in the know, such terms also provide a technical shorthand, a convenient jargon to delimit a discipline. It is much more difficult, however, for those from outside to distinguish subtle differences. For example, it is difficult for many to differentiate between ‘Medical Informatics’ and ‘Health Informatics’, which are often treated synonymously and which have considerable overlap in practice.
To choose one of these terms would suggest that one is more important than the other, now and also in the future. Others would regard the choice as irrelevant, considering both terms to be outdated. (Note, for example, the changes made to the names of many existing research centres and professorial titles by prefixing ‘Bio’ to ‘Medical Informatics’ and ‘Health Informatics’.) Perhaps, the worst decision would be to create a completely new, all-encompassing compound term (perhaps Human Informatics?). This novelty would add to the existing confusion, fragment further an already too-fragmented domain, and limit any potential for sharing and learning.
It was decided then to lead with the term ‘Informatics’. It meets the requirement for simplicity and has the merit of being a term already recognized and agreed as an integral part of all our disciplines, and not for something tagged on at the end, nor for something divisive. ‘Informatics’ then is to be the defining concept at the core of what is presented in this Journal and to encourage shared experience across the spectrum of care. After all, the ‘informatics’ term is now a relatively mature one (circa 1957), and unlike ‘e-health’, ‘informatics’ is not self-limiting. On the contrary, informatics by its very definition becomes of greater importance, not less, as all aspects of our lives become affected.
Informatics is the study of information and the systems that are associated with it: the concepts, structure, and terms on the one hand and its communication and use on the other. The entry in Wikipedia (accessed January 2008) describes it this way:
Informatics studies the structure, behavior, and interactions of natural and artificial systems that store, process and communicate information. It also develops its own conceptual and theoretical foundations. Since computers, individuals and organizations all process information, informatics has computational, cognitive and social aspects, including study of the social impact of information technologies.
3 What's in the Journal?
All communication and use of information require a context to make it meaningful. The widespread use of compound terms, like those mentioned previously, emphasizes the importance of the application domain. Indeed, there exists a symbiotic relationship between the two whereby the application domain specializes the informatics used, and the informatics, i.e. the concepts, theories and practice, enrich the domain to which it is being applied. It is this relationship between the two that makes for the distinctive character of the discipline and qualifies the nature of its implementation.
‘Health & Social Care’ is the target domain of this journal. No particular decomposition of this domain is assumed or intended, by setting (e.g. clinical, social, cultural, organizational), by organization (e.g. primary, secondary, tertiary), by location (e.g. institution, consulting room, ward, gymnasium, home), by subject of care (e.g. individual, family, population, species), by agent (e.g. healthcare professionals (including all types of clinicians), those in social services, family, carers, third parties, types of technology), or by any other criterion that would seek to exclude application of informatics to it. It is a broad domain, but nevertheless it is a distinctive one.
The new title uses the preposition ‘for’ to emphasize the nature of the role that the informatics research and practice play with respect to the domain of Health & Social Care. Just as the ‘information focus’ of informatics differentiates it from subjects like computer science, so the Health & Social Care domain requires the informatics to have a ‘person focus’; one that examines the impacts related to a person or persons and holds these to be of paramount importance. Consequently, topics such as ethics, safety, governance, education, work flow, usability, standards, and service are key areas for research and practice in this domain. Theoretical articles that address these areas will be particularly welcome.
Furthermore, this domain should insist upon an evidence-base for informatics solutions, which will comprise quantitative and qualitative results from evaluative studies, standards-based solutions, and trials. ‘First, do no harm’ is as relevant to the informatics aspects as it is to the clinical ones. We need to go further, however, and showcase the contribution informatics makes to improving care. We therefore welcome case studies of implementations that critique and document success, and failure, so as to enable a robust assessment to be made and to stimulate innovation, quality and progress. Furthermore, evaluation of theories and concepts related to architectures, models, terminologies, guide-lines, decision support systems, record systems, etc. is encouraged. In fact, any article that can contribute to our understanding of how best to provide effective and efficient solutions to improve care will be considered.
Finally, the Health & Social Care domain encompasses care for the acutely and chronically ill person. In addition, it also includes care for those people who are at risk, those who are vulnerable, and even those who are well. It truly has a health agenda which incorporates ill-health but is not exhausted by it. Home care and exercise, as well as hospital and rehabilitation, are in the Journal's scope, and therefore so are articles which research lifestyle and use technologies as part of the informatics solution.
Informatics for Health & Social Care is more than just a title; it is also an imperative.
Stephen Kay