Medical informatics is located at the intersection of information technology and the different disciplines of medicine and health care. In this Handbook, we shall also use the term health informatics without entering into a fundamental discussion of the possible differences between medical informatics and health informatics.
Medical informatics has both distinctly applied features and more fundamental characteristics. Just as medicine itself is multidisciplinary, so is medical informatics. The main reason for this convergence of disciplines is that, in principle, medical informatics deals with the whole field of medicine and health care. Blois(1) summarized the heterogeneity of medical science quite eloquently and related the multidisciplinary nature of medicine directly to the basis of medical informatics:
It is sometimes asserted that medical science is no different than any other science. I would strongly disagree with this view; medical science (human biology) in its describing, reasoning, explaining, and predicting, necessarily draws upon a number of lower-level sciences, while physics, for example, does not. This obvious state of affairs (that medicine rests upon a hierarchy of natural sciences) has profound consequences. Because medicine derives its experimental content from a set of sciences (including both "hard" and "soft" sciences), the processing of the observational data of medicine faces a number of problems. This is one of the reasons why there is a "medical' information science, and why there is not a "physics" information science.
The health care process is very different from medical science. The former is more related to the art of medicine, whereas the latter is closely connected to the academic aspects and the basic disciplines of medicine. A synonym for art is, for instance, skill. Science is related to knowledge, as expressed by Webster's Dictionary:
Science is accumulated and accepted knowledge that has been systematized and formulated with reference to the discovery of general truths or the operation of general laws.
Specialization can be accomplished in both art and science. The more specialized one's health care (the art of practicing health care), the more detailed must be one's medical knowledge (the science of medicine). What is the origin and the nature of the scientific knowledge that lies at the root of health care? How and where is that knowledge acquired? The latter appears to happen in two different locations:
in the medical research laboratory and
in clinical practice.
From the foregoing we may conclude the following: Scientific research in medical informatics is multidisciplinary because
we deal with medicine and health care as a whole, and
it is done by investigators who come from different scientific isciplines.
Research in medical informatics aims not only at the incorporation of
knowledge from the natural sciences, but also of
special knowledge or clinical experience.
Finally, research in medical informatics must deal with the normative aspects of our knowledge.
It is appropriate to ask whether medical informatics has a research domain of its own and a specific methodology or whether it borrows its methods from other disciplines and just applies these methods to medicine and health care. Is medical informatics, for instance, different from statistics or epidemiology? Are the methods of medical informatics different from those of computer science or physics? Furthermore, if in medical informatics we deal with the whole of medicine and health care, in what respect are its methods different from those that are used in medicine and health care? In addition, how should we reckon with ethical aspects in applying the results from medical informatics research?
We may state that if medical informatics is a science, then some of the following properties should be applicable:
It contains a domain where a theory is developed.
It is not merely applied science.
It is not solely determined by technology.
Models are developed to illustrate and prove theories.
Problems are solved in a methodical way, following scientific principles of abstraction and generalization.
The domain of medical informatics is determined by the intersection of the terms "medicine" and "informatics" (or "health" and "information") (see also Panel 2 for two definitions). The first term indicates the area of research, the second one its methodology. Medical informatics has both applied and theoretical aspects; models are developed both in applications and in theoretical activities. As in all science, in medical informatics research we strive for the collection of generally applicable knowledge, so that we may use it within a particular domain: health care.
In medical informatics we develop and assess methods and systems for the acquisition, processing, and interpretation of patient data with the help of knowledge that is obtained in scientific research.
Computers are the vehicles used to realize these goals. In medical informatics, we deal with the entire domain of medicine and health care, from computer-based patient records to image processing and from primary care practices to hospitals and regions of health care. Some areas of the field are relatively fundamental; others have an applied character. The challenge in developing methods and systems in medical informatics is that once the systems have been made operational for one medical specialty, they can also be transferred to some other specialty.
As much as possible, this Handbook attempts to stress the general methodology behind all methods and applications. Examples of this cross-fertilization are methods for image processing in cardiology, pathology, and radiology; the common structure of computer-based records in internal medicine, primary care, and pediatrics; or the way that medical knowledge can be structured and documented in surgery, obstetrics or oncology.
In Chapter 1 we cluster the field of medical informatics into six levels of complexity. This clustering shows a strong resemblance to the diagnostic-therapeutic cycle, which we also discuss in Chapter 1.
Related to the two types of knowledge, medical treatment consists of indisputable conclusions on the one hand and responsible decisions on the other. The conclusions are, within the domain and the limitations of scientific a prioris, absolute and objective in nature. At the same time, they are of limited scope, since they are based on the application of scientific research. Although the final diagnostic decision is based on such conclusions, it is still oriented toward the individual patient and his or her personal circumstances and expectations. The final decision is, for all that, not absolute, but is made in freedom and under the responsibility of the treating clinician (and, it is hoped, in agreement with the patient). The decision also takes into account those aspects of patient care that cannot be formalized. Therefore, the final decision regarding the therapy to be selected requires experience and insight, but it also has ethical and legal aspects and foremost should be a wise decision. These last qualities are unsuitable for formalization, let alone fit for delegation to a computer.
Medical informatics is both an Art and a Science.
Science: where methods are conceived and experimentally validated by means of computer models and formalisms.
Art: where computer processing systems are built and assessed.
Research in medical informatics is multidisciplinary and follows scientific methods; applications have a technological foundation.
Research and applications in medical informatics should take into account the responsibilities of investigators and users.
1 Blois MS. Information and Medicine: The Nature of Medical Descriptions. Berkeley, CA: Univ of California Press, 1984.