The advent of digital technologies has had a profound impact on the medical field. Since the 1950s, health informatics has transitioned from a concept to an independent discipline. The first generation of medical informatics (1955-1965) was largely experimental, as the potential of new technologies had yet to be gauged. Collen and Ball (2015) name the introduction of biomedical software allowing the use of computers in biostatistics as one of the most important milestones of the era. The new developments in the field of symbolic logic build a foundation for automatic medical decision making, a field that has not lost its popularity until today. The second generation (1965-1975) concerned itself with automatized data processing to build hospital health information systems. It was during that time that Hounsfield and Cormack were awarded a Nobel prize for computer tomography.
By 1975, developing and manufacturing computers became cheaper, and their greater availability attracted more people and made health informatics an important part of medical education. Collen and Ball (2015) report that the 1975-1985 decade was marked by the foundation of important bodies such as the International Medical Informatics Association (IMIA) and the European Federation of Medical Informatics (EFMI). Between 1985 and 1995, health information systems had become more advanced than ever, encompassing more functions and processing diverse kinds of data. Concurrently, the health informatics scientific community deepened their interest in artificial intelligence and its application to building expert systems. It was hypothesized that medical data could help care providers with diagnosis and anomaly detection and reduce human error in medical decisions. Today, medical informatics has become even more sophisticated. Its methods allow for creating local, regional, and national networks and using microprocessors to achieve a variety of goals. The history of health informatics demonstrates how a concept matured into a discipline comprising multiple subfields.
An example of early work in health informatics is “An Artificial Intelligence program to advise physicians regarding antimicrobial therapy” by Shortliffe et al. (1973). In it, the scholars propose an AI-powered program that could help providers with decision-making with regard to treating infectious diseases. Shortliffe et al. (1973) hope that the new product could serve both educational and consultative goals and empower physicians through the use of data. An important point of the paper is the prerequisites for the successful implementation of an expert program. According to Shortliffe et al. (1973), there needs to be more rules to make decisions and more physicians should provide their human knowledge to teach the machine. Since then, building expert systems in medicine have not ceased to be one of the most relevant problems of health informatics. For instance, a paper by Cánovas-Segura et al. (2019) describes the role of expert knowledge in improving the performance of clinical decision support systems. The study demonstrated that the introduction of expert knowledge allows to identify patients at risk of a failure of antimicrobial therapy and take timely action.
As seen from the brief historical review, the health informatics field is rapidly developing. The formation of professional health information organizations is important for harnessing its potential and making sure that the knowledge is dissipated and experience is exchanged. In addition, professional bodies can handle ethical dilemmas and controversies in health informatics and ensure that new methods are non-maleficent. For instance, Phillips (2015) wonders whether a care provider who relied on a decision support system and made an incorrect decision should be held liable. Realizing the full potential of health informatics is impossible without making it part of medical education. Digital literacy is the new literacy, and given the spread of health technologies in hospitals, medical students cannot fulfill their future job roles without having a proper understanding of informatics.
References
Cánovas-Segura, B., Morales, A., Juarez, J. M., Campos, M., & Palacios, F. (2019). Impact of expert knowledge on the detection of patients at risk of antimicrobial therapy failure by clinical decision support systems. Journal of biomedical informatics, 94, 103200.
Collen, M. F., & Ball, M. J. (Eds.). (2015). The history of medical informatics in the United States. Springer.
Phillips W. (2015). Ethical controversies about proper health informatics practices. Missouri medicine, 112(1), 53–57.
Shortliffe, E. H., Axline, S. G., Buchanan, B. G., Merigan, T. C., & Cohen, S. N. (1973). An artificial intelligence program to advise physicians regarding antimicrobial therapy. Computers and Biomedical Research, 6(6), 544-560.