CommentaryMedical informatics: Past, present, future☆,☆☆
Introduction
The aim of this essay is to reflect about medical informatics as a discipline.
Its main goal is to emphasize some promising future research directions which may become important parts of medical informatics (Section 4) while at the same time stimulating further discussion within our scientific community on these topics. In order to do this, it is helpful to be aware of important current aspects of the discipline (Section 3), and learn from past experience (Section 2). In all of these sections, emphasis will be placed on the role of IMIA, the International Medical Informatics Association [1], in influencing the direction of our discipline.
This is most certainly not the first, and is unlikely to be the last of this kind of reflection. Other debates about our discipline as a whole (or at least its major parts) can be found in [2], [3], [4], [5], [6], [7] (in chronological order). These papers focus on questions on research aims and their corresponding challenges. Other papers focus more on research aims in the context of describing the discipline of medical informatics ([8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], in chronological order).
Last, but not least, there exist some historical ‘milestones’, where sets of papers have been gathered into special issues of journals in order to critically discuss the aims, scope and challenges of our discipline. Three of them, again with a focus on questions of research aims, will be mentioned here. In 1983 a SCAMCI-sponsored workshop on ‘medical information sciences’ took place in Washington (DC), USA, discussing among other questions about “principal research issues” [19, p. 167]. Although its scope was broader, this issue contained a couple of papers dealing with research (e.g. [20], [21], [22]). In 2001 in Madrid, Spain, a conference on challenges for medical informatics as an academic discipline took place. Major results have been published in [23] (see e.g. [24], [25], [26], [27], [28], [29]). In 2008 on the occasion of the 35th anniversary of the Heidelberg/Heilbronn curriculum of medical informatics a symposium on perspectives of medical informatics took place in Heidelberg, Germany. Results have been published in [30] (see e.g. [31], [32], [33], [34], [35], [36], [37], [38]).
In this context it should be added that from time to time documents from committees, established by government or government-related institutions and professional societies, also discuss such challenges, mainly in order to define funding strategies or professional directions. Examples are published in [39], [40].
I still appreciate the generous offer of the now Editor Emeritus of the International Journal of Medical Informatics (IJMI), Arie Hasman, for not only giving me the opportunity of publishing a paper in 1997 on the aims and tasks of medical informatics [4], but also for his editing of a complete issue in IJMI debating and significantly adding to my suggestions on aims and tasks of medical informatics (e.g. [41]).
Many definitions of medical informatics as discipline can be found in the literature aiming at broad coverage and completeness. Here I simply want to refer to medical informatics as the discipline, dedicated to the systematic processing of data, information and knowledge in medicine and health care [42].
First, reflections such as those in the present paper, are necessarily subjective and biased by the author's background, i.e. his education, his professional career, his cultural and society roots.
Second, this essay does not intend to discuss the name of our discipline and its various subfields, although our discipline has had more than its share of such discussions, and even though such debates have been contributing to our discipline's development and its role in the practice of health care, education and research. Let me just mention that the meaning of the terms health informatics and medical informatics, and now also biomedical informatics, varies within and between different groups and geographical regions. The term medical informatics is used here in the broad and comprehensive meaning as defined in Section 1.3. For a more detailed discussion see e.g. [43]. Others may have preferred to use one of the other two names, mentioned above.
Section snippets
On the history of medical informatics
Medical informatics as a discipline is still young, in particular when you compare it with other medical disciplines. Yet, we can look back to a past of about 50 years, not to mention earlier roots on approaches for systematically processing of data, information and knowledge in medicine and health care in earlier history.
Our discipline's development correlates clearly with the invention and, within few decades, rapid dissemination of digital (‘von Neumann’) computers and the development of
The role of medical informatics today
In its early days medical informatics might have been considered as a ‘nice-to-have’ (but not ‘need-to-have’) discipline, both in biomedicine and health sciences as well as in computer science. In German this might be termed an ‘orchid discipline’ as being just a nice orchid in the garden of the sciences.
When looking back at the development of medical informatics, we can recognize that it has been growing steadily (see e.g. [64] in terms of published research), and that today, as a
Recapitulating the aims of medical informatics
Systematic processing of data, information and knowledge in medicine and health care does not exist for its own sake. Medical informatics is neither sufficiently defined by its methodology and technology on the one hand, nor by its application domain (such as the three application areas mentioned before) on the other hand. As usual for most disciplines, it also has practical aims, which for medical informatics are twofold:
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to contribute to progress in the sciences and
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to contribute to
Acknowledgments
These reflections are strongly influenced by the many discussions with colleagues, mainly, but by no means exclusively, from our scientific community. And, of course, also by many other persons, starting from students and ranging to, e.g., practitioners and policy makers. My acknowledgements go to all of them.
The author cordially thanks Jan Talmon, editor of IJMI, for his valuable comments on this text and for the opportunity to submit this paper to this prestigious journal. As an official
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Dedicated to IMIA, the International Medical Informatics Association. Besides the honour to serve in IMIA during the last 15 years as Working Group Chair, as Board Member, as co-editor of the IMIA Yearbook and, now, as its President, I am grateful for the opportunity of meeting so many exceptional people at events of IMIA and of IMIA's member societies. The author has benefited much from their knowledge and insights during the course of countless discussions.
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Written, extended version of a sequence of lectures, given on November 11, 2009, at CoMHI2009 in Hiroshima, Japan, on September 6, 2010, at gmds2010 in Mannheim, Germany, and on September 13, 2010, at Medinfo2010 in Cape Town, South Africa.
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President of IMIA (2007–2010).