Evolution of Medical Informatics
Etienne Saliez, version 2022-06-03 /
- A review of main problems of healthcare and the
contributions of informatics over the years in Europe.
- ( 1 ) Statistics:
- WHO ICD statistics were difficult to collect and to
analyze by hand.
- +- 1975: The first medical records focusing on
classification of discharge diagnosis. Ministries of health
find budgets for these services of public interest. However
individual patients do not get any direct improvement.
- ( 2 ) Administration:
- The collection of rendered services and the preparation of
invoices is very time consuming. Moreover many
billable items were lost.
- +- 1980: Computer were introduced in most hospitals in
order to make invoices. As well in insurance organizations.
- ( 3 ) Laboratory data:
- Laboratory results are useful within hour rather than days
by traditional postal services.
- Labs are work intensive and more and more tests were
- +- 1980: lab results available on-line inside
- +- 1985: begin of automation of laboratories.
- ( 4 ) Sharing documents:
- Patient need often more than one care provider and
communications by means of carbon copies and later photo
copies is inefficient, incomplete and time consuming.
- +- 2005: hospital networks did become common.
- +- 2010: regional networks sharing at least some
- ( 5 ) Full paperless patient record:
- Handwritten papers could be scanned but remain difficult
- Less secretary personnel available due to economic
- +- 2012: most doctors type their reports directly on the
keyboard. Any still incoming papers are immediately
scanned. No more any archives of paper folders.
- ( 6 ) Document organization:
- For a long time electronic medical record did remain
limited to a kind of simulation of the paper folder but
registered in the computer, i.e. visit oriented and sorted
on sources of information. Indeed traditionally the only way
to manage paper charts.
- +- 2018: Informatics did begin to make possible the
navigation in the record from multiple points of views. The
possibility to focus on a problem with related information.
- ( 7 ) Access to medical knowledge:
- A synthesis of current knowledge can be found in textbooks
and in university courses. This knowledge is available as
- The conclusion of research projects are converted to
guidelines also in free text.
- Most current standards focus on classifications intended
for for public health statistics and retrieval of document
from the literature.
- 2022: Graph technologies can provide a way to handle
complex information. The relations between concepts can be
qualified and quantified in a more formal way.
- Definition of concepts and relationships can be extended
taking account of "clinical modifiers", among others the
- ( 8 ) Decision support:
- Up to now medical records are still essentially
"descriptive" of what did happen. Healthcare professionals
are today better informed about the patient data and better
access to medical knowledge., However there is still very
limited decision support.
- The societal problem is that there are not enough
qualified doctors particularly in developing regions and in
developed regions sub-optimal decisions and even sometimes
errors continue to occur every day.
- 2022: experimental solution begin to emerge.
- AI as "Artificial intelligence" can provide results as far
as very large reference material are available with all the
relevant parameters, which is difficult to apply for an
individual case. This approach provide results in a blind
way based on statistical models.
- AI as "Assisted Intelligence" provide by means of
graphs a way to represent the decision process step by step.
This can lead to discussion and improvement of
medicalethodology. This approach provide a way to
extend the decision process achieved by neurons and
synapses in human mind. This in a way transparent and easy
to understand by means of visual presentation of graphs.
- Of course all previous enhancements remain valuable and must