People and Ideas in Medical Informatics - A Half Century Review

Summary

Objective

Reviewing the onset and the rapid changes to make realistic predictions on the future of medical informatics.

Methods

Pointing to the contributions of the early pioneers, who had their roots in other disciplines and by illustrating that from the onset an interdisciplinary approach was characteristic for our field.

Results

Some of the reasons for the changes in medical informatics are that nobody was able to predict the advent of the personal computer in the 1970s, the world-wide web in 1991, and the public start of the Internet in 1992, but foremost that nobody expected that it was not primarily the hardware or the software, but human factors that would be crucial for successful applications of computers in health care. In the past sometimes unrealistic expectations were held, such as on the impact of medical decision-support systems, or on the overly optimistic contributions of electronic health records. Although the technology is widely available, some applications appear to be far more complex than expected. Health care processes can seldom be fully standardized. Humans enter at least in two very different roles in the loop of information processing: as subjects conducting care - the clinicians - and as subjects that are the objects of care - the patients.

Conclusions

Medical informatics lacks a specific methodology; methods are borrowed from adjacent disciplines such as physics, mathematics and, of course, computer science. Human factors play a major role in applying computers in health care. Everyone pursuing a career in biomedical informatics needs to be very aware of this. It is to be expected that the quality of health care will increasingly be assessed by computer systems to fulfill the requirements of medical evidence.

Keywords

Interdisciplinarity - pioneers in medical informatics - computer simulation - biosignal processing - electronic health records

• References

• 1 Ledley RS, Lusted LB. Reasoning foundations of medical diagnosis. Science 1959; 130: 9-21.
• Reprinted in MD Comput 1991; 08 (05) 300-14.
• 2 Ledley RS. Use of Computers in Biology and Medicine. New York: McGraw-Hill; 1965
• 3 Collen MF, Linden C. Screening in a group practice prepaid medical care plan as applied to periodic health examinations. J Chron Dis 1955; 02: 400-8.
• 4 Pipberger HV, Stallman FW, Berson A. Automatic analysis of the P-QRS-T complex of the electrocardiogram by digital computer. Ann Intern Med 1962; 57: 776-87.
• 5 Caceres CA. Electrocardiographic analysis by a computer system. Arch Intern Med 1963; 111: 196-202.
• 6 Kurzweil R. The Age of Spiritual Machines, When Computers Exceed Human Intelligence. East Rutherford NJ: Penguin Group; 2000
• 7 Van Bemmel JH, Strackee J, Gelsema ES, Hasman A, Smith J. Education of professionals in medical informatics. In: Van Bemmel JH, Ball MJ, Wigertz O. editors. MEDINFO 83. Amsterdam: North-Holland Publ Comp; 1983: 1043 6.
• 8 Van Bemmel JH. Detection of weak foetal electro-cardiograms by autocorrelation and cross-correlation of envelopes. IEEE Trans Biomed Engng 1968; BME 15: 17-23.
• 9 Van Bemmel JH, De Haan J, Veth AFL. Instrumentation for Obstetrics and Gynecology. In: Ray Ch. editor. Medical Engineering. Chicago: Yearbook Med Publishers; 1974: 548-88.
• 10 Van Bemmel JH, Duisterhout JS, van Herpen G, Bierwolf LG, Hengeveld SJ, Versteeg B. Statistical processing methods for recognition, classification of vectorcardiograms. In: Hoffman I. editor. Vectorcardiography 2. Amsterdam: North Holland Publ Comp; 1970: 207-15.
• 11 Van Bemmel JH, Pronk RAF. Computers in anaesthesiology. Acta Anaesthesiologica Belgica 1984; 293-311.
• 12 Swenne CA, van Bemmel JH, Relik Th, Versteeg B. A computerized interactive coronary care monitoring system. IEEE Trans Biomed Eng 1977; BME 24: 63-7.
• 13 Van Bemmel JH, van der Weide H. Detection procedure to represent the foetal heart rate from the electrocardiogram. IEEE Trans Biomed Eng 1966; BME 13: 175-82.
• 14 Veth AFL, van Bemmel JH. The role of the placental vascular bed in the foetal response to cord occlusion. In: Longo LD, Reneau DD. editors. Fetal, Newborn Cardiovascular Physiology. Vol I: Developmental Aspects. New York: Garland Stpm Press; 1978: 579-614.
• 15 Van Bemmel JH. Detection of weak foetal electro-cardiograms by autocorrelation and cross-correlation of envelopes. IEEE Trans Biomed Eng 1968; BME15: 17-23.
• 16 Van Bemmel JH. Computers in European Hospitals. Utrecht: Institute of Medical Physics; 1967. Rpt 1967/2..
• 17 McDonald CJ, Blevins L, Glazener T, Haas J, Lemmon L, Meeks-Johnson J. Data base management, feedback control and the Regenstrief medical record. J Med Sys 1983; 07: 111-26.
• 18 Van Bemmel JH, Rosenfalck A, Saranummi N. editors Biosignal Interpretation. Methods Inf Med 1994; 33: 1-160.
• 19 Van Bemmel JH. The structure of medical informatics. Med Inform 1984; 09: 175-80.
• 20 Van Bemmel JH. Knowledge for medicine and health care. Laudation at the occasion of the honorary doctorate bestowed to Donald A. B. Lindberg. Methods Inf Med 2005; 44: 596-600.
• 21 Van Bemmel JH. Medical information systems in the age of Jean-Raoul Scherrer. In: Haux R, Kulikowski C. 2003 IMIA Yearbook of Medical Informatics. Stuttgart: Schattauer Verlag; 2003: 111-7.
• 22 Reichertz PL. Curricula in medical informatics: experiences in the Federal Republic of Germany. In: Meeting the Challenge. Pages JC, Levy AH, Grémy F. editors. Amsterdam: Elsevier; 1983: 79-95.
• 23 Van der Lei J, Musen MA, van der Does E, Man in ’t Veld A, van Bemmel JH. Review of physician decision making using data from computer-stored medical records. Lancet 1991; 338: 1504-8.
• 24 Van Wijk MA, van der Lei J, Mosseveld M, Bohnen AM, van Bemmel JH. Assessment of decision support for blood test ordering in primary care. Arandomized trial. Ann Intern Med 2001; 134: 274-81.
• 25 Van Ginneken AM. Considerations for the representation of meta-data for the support of structured data entry. Methods Inf Med 2003; 42: 226-35.
• 26 Van der Lei J, Duisterhout JS, Westerhof H, Van der Does E, Cromme PVM, Boon WM. et al. The introduction of computer-based patient records in the Netherlands. Ann Int Med 1993; 119: 1036-41.