Informatics

What Is Informatics? P.S. - It's not just for nerds

Informatics remains an up-and-coming field, and its applications in medicine are far-reaching. Just don't be intimidated by the name.

Informatics has been a burgeoning field for decades, and it's time for even more people to join!

I know what you're thinking. "Informatics... Isn't it boring? Isn't it for nerds and programmers?"

The answer is no to both — hear me out.

Many people avoid informatics thinking it requires programming or technical experience, but like any worthwhile effort, the most important aspect is a passion for the cause. In nutshell, informatics is using data to gain insight, and hopefully improve things. This can be applied to anything, including advocacy, resident education, wellness, health policy, simulation, administration.

I want to illustrate this with my own personal cause: patient safety (really, equality). While in graduate school, I was working on research at a tertiary pediatric ICU, specifically optimizing the care of pediatric traumatic brain injury (TBI). I was particularly struck by the significant proportion of TBIs caused by non-accidental trauma. Data varies, but approximately 21-33% of patients admitted for TBI were injured by nonaccidental causes. Children from age 0-3 are more likely to die from TBI.1 The quality of care we deliver has lifelong consequences that affect cognitive ability, and therefore happiness, socioeconomic status, and potentially these patients' ability to stay alive at all.

My project essentially took patient data from charts and bedside monitors, and presented it in a consolidated interface. One of the cruxes of this was to graph and trend intracranial pressure data, so that clinicians could be notified of increasing rates of change or when pressure rose to a dangerous threshold. A second aspect was to provide clinical decision support (CDS) based on practice guidelines published by the critical care society. This required reading a 40-page practice guideline, translating it into a flowchart, and linking it to the patient data to help apply the guidelines to the patient's current clinical picture.

To me, this was valuable for two reasons.

  1. These patients could achieve the timeliest attention and intervention possible, particularly important in this patient population.
  2. By using established expert guidelines across the country, and standardizing care, patients were provided the best opportunity to receive excellent care, regardless of their geographic location or facility.

Of course these are lofty goals, and we are not there yet. However, the point is that informatics is a tool that can help you achieve your passion in medicine, whatever that may be.

Informatics is still in early stages, thus, the benefit is that there is a lot to do within our profession, and much low-hanging fruit. Having completed graduate school with a degree in computer science, people excitedly ask me if I will be integrating Artificial Intelligence or Natural Language Processing (nerd speak for teaching computers to understand human language). I hope medicine gets there someday, but definitely not now. Right now, so many things can be done simply by extracting the data, displaying it in a graph, even by getting notifications to work. In the ED, this is particularly important because we make a lot of highstake decisions for a large volume of patients, often with split attention.

Overall, informatics is about obtaining data, using it to measure something of interest to you, and acting on that data. If you are working with EMRs, they can be difficult to get data from. However, there are reporting features in major EMRs that can help with this. If not, there is always a team of people who support the EMR at your hospital or by the EMR vendor.

My last parting thought is the list below. These are the informatics-related projects I heard about or discussed with people recently after attending EMRA at CORD. In the next few months, the EMRA Informatics Committee will plan to put forth a repository of projects, both new ideas and existing ideas with contacts of people already working on them. We look forward to having more of you join us to change EM with Informatics!

How Can Informatics Be Applied in Medicine?

  • Wellness: Tracking resident sleep and exercise habits throughout residency. One collaboration between EMRA informatics and EMRA wellness will be to extra insight from the questions asked of residents during the 2019 In-Service Exam.
  • Workplace Safety: Investigating discrepancy between security logs vs EMRs in terms of violent patients, and potentially being able to notify future providers at the next visit.
  • Public Health: Measuring epidemiological data to determine outbreaks. Finding correlations between diagnosis and neighborhoods to better understand determinants of health.
  • Consumer: Detection of arrhythmias (Apple and a few other companies are working on this). Imagine having this data extracted at triage and included as part of your chart.
  • Clinical: Giving people a device where they can enter their own history while waiting to see a doctor, including graphical ways to enter pain scale, patterns, etc.!

Reference
Paul AR, Adamo MA. Non-accidental trauma in pediatric patients: a review of epidemiology, pathophysiology, diagnosis and treatment. Transl Pediatr. 2014;3(3):195–207.

Related Articles

Mad as a Hatter: Physostigmine for Delirium Control in Anticholinergic Toxicity

Mad as a Hatter: Physostigmine for Delirium Control in Anticholinergic Toxicity A 34-year-old female with a history of bipolar disorder, depression, and multiple previous suicide attempts is brought

Hospitals and Hackers: Keeping Patients Safe From Cyber Attacks

Hospitals and Hackers: Keeping Patients Safe From Cyber Attacks An 83-year-old female with a history of sick sinus syndrome status post pacemaker implantation presents to the emergency department (ED