Informatics: Balancing Application and Theory

As countries push for IT solutions to make patients safer and care cheaper, the prominence of health informatics is growing, as are arguments about what exactly it is.

How does a field define its essence, when being interdisciplinary is essential? Could doing so make it less powerful?

Those are central questions for informatics, the art of using information and information technology to uncover relationships and to optimize decisions. "Its not really just about technology; its about how people use information and how they use technology," said William Hersh, department chair of medical informatics and clinical epidemiology at Oregon Health and Science University.

Business and legal informatics exist, but as countries push for IT solutions to make patients safer and care cheaper, the prominence of health informatics is growing, as are arguments about what exactly it is.

"Were still trying to hash out what those [core] competencies are. Most cardiologists could tell you what you have to know to be a cardiologist. In informatics, there are always quibbles," said John Holmes, chairman of the education committee at the American Medical Informatics Association and professor of medical informatics at Pennsylvania Universitys School of Medicine.

That doesnt keep Holmes from listing several things every informatician should know: Besides domain knowledge, "people need to know about information systems theory [and] programming skills. You should be able to write a small program in a reasonably modern language, know the key areas of research, clinical vocabularies, decision-support systems, have grounding in evaluative sciences."

Another problem is that advances in computer and medical science can quickly drive technologies and skills into obscurity. (Alan Turing didnt use C++ for his breakthroughs.)

Perhaps most controversially, the optimal blend of informatics and "domain knowlege" is ambiguous; among different universities, there is a continuum of views about the degree to which general principles of informatics can be abstracted and the degree to which such principles are inherently linked with specific disciplines and applications.

Holmes said the university issuing the degree would influence students future career options. "Barring some sort of standardization process, where you went to is pretty important, because we know whos gone there." Of course, students tend to select schools based on the training they want, but at least three of the people interviewed thought students are not particularly savvy about these distinctions.

However, in masters and doctoral programs that require independent research, students can make a theoretical program more applied and vice versa, according to Russ Cucina. After completing his medical residency, Cucina entered Stanford Universitys Biomedical Informatics Program. That has a reputation for more theoretical training, but he sought out more-applied projects.

Cucina is now a professor at the University of California, San Francisco, but just over half of his responsibilities include clinical work and helping the university hospital transfer from one vendor of clinical software to another. These will keep him from becoming "too distant" to be able to bridge clinical and IT work.

Cucina said part of the appeal of Stanfords program was that he had already established useful relationships during his medical residency there.

For many students, logistics weighs as heavily as a particular programs theoretical or applied bent.

Michael Mundorff, a clinical programs analyst at Intermountain Health Care, said he has been considering medical informatics programs since working on a biosurveillance project where he saw such expertise prove particularly useful. "Having been employed in various capacities in the health care field for more than 20 years, I would prefer an applied-focus program to a theoretical one," he said. He referred fondly to the very well-regarded program at the Department of Medical Informatics at the University of Utah. But hes also looking at the distance-learning options at other schools with the NLMs (National Library of Medicines) blessing. "Im not sure that attending campus-based classes would be compatible with my work schedule."

Next page: Degree "just one piece of the puzzle."