Ask someone what clinical informatics means and you are likely to get a blank stare. The reaction is understandable – even as clinical informatics is gaining in importance, it is still not widely known in the healthcare industry. So what is informatics actually?
Simply put, informatics is a translation discipline – it helps to transform different "languages" into one that can be used for effective communication.
In that respect, clinical informatics staff, who are usually both medically and IT trained, serve as the bridge between healthcare and HealthTech staff to help all parties speak and understand the same language.
Informatics does more than just transformation though. A more holistic definition refers clinical informatics as the interdisciplinary study of data, information technology, and communication with respect to the human health conditions.
In this article, we speak with Adele Lee, Senior Lead Informatics Specialist, Clinical Informatics Group, IHiS, to learn more about how clinical informatics helps public healthcare to be more efficient and deliver better care to patients.
Q: How would you describe your job to relatives?
Clinical Informatics is the bridge between healthcare and technology. We speak with medical professionals and understand what their HealthTech needs are. After that, we talk to the HealthTech engineers to see if they can make it happen. Now let's say the medical team wants to build an application to track high blood pressure (HBP). HealthTech staff may not fully know which data fields are essential and may end up including unnecessary fields, making the application less user-friendly.
Clinical informatics staff can prevent this as we understand the requirements and can promptly advise what essential data fields to include. If there are any IT limitations, we also relay that information back to the medical team, and discuss the workarounds with them.
Q: What is your background and how did you get into a clinical informatics role?
Prior to 2016, I was a nurse at Tan Tock Seng Hospital. As I worked, I began to appreciate how HealthTech made everyone's jobs easier and allowed healthcare staff to take better care of our patients. My interest was gradually piqued – I saw the huge potential of HealthTech. Even though clinical informatics had yet to trend in a big way then, I decided to do a post graduate degree in clinical informatics and see where that might lead to. I strongly believe that technology is the way forward, and healthcare and technology must work hand-in-hand to ensure that the latter has clinical relevance. As technology advances, I have no doubt HealthTech will continue to make an even bigger impact.
Q: Do clinical informatics staff have a medical background?
Yes, mostly. We have a diverse range of medical staff in our team, from doctors to nurses, pharmacists to allied health professionals. It helps to have that clinical experience – you would be able to better think from the staff or patient's perspective, not just the IT one. This also helps us to provide valuable inputs to our non-medically trained colleagues.
Q: How do the medical staff who are now in the Clinical Informatics Group keep up with medical aspect of things?
Continuous learning is key and to maintain clinical relevance, we are encouraged to do some locum work if we can spare the time. This also helps us in our work as clinical informatics specialists – the more up-to-date we are on medical knowledge, the better we can value-add. There is also a lot of self-directed learning – we attend conferences, read journals and clinical practice guidelines, etc.
Q: Share some of the projects the IHiS Clinical Informatics Group has been involved in the past few years.
The breadth of work is pretty wide. For example, we are involved in the areas of medical terminology, data contribution requirements, data mapping and reconciliation, workflow design, process review, user interface and experience, and systems testing. I'll share a few examples.
When the COVID-19 Test Repository (CTR)* was being built, it needed to be connected via data pipes to other national registries, such as the National Electronic Health Record (NEHR), National Immunisation Registry, National Appointment System and HealthHub. The question was – what data needed to be contributed to or pulled from each system? Healthcare staff with no IT background or HealthTech staff with no medical training would find it hard to comprehensively answer that question. That was where clinical informatics came in to serve as the bridge to connect policy, clinical workflow, medical terminology, and standards for health information exchange and HealthTech capabilities.
Later on, we got feedback that interpreting the diverse free text COVID-19 test result values and text patterns from over 20 labs could be confusing. So we wrote an algorithm to standardise the interpretation into easily readable COVID-19 indicators.
This allows non-clinically trained staff to be able to quickly and accurately interpret them and perform the required public health actions, especially when manpower is lean and the number of COVID-19 cases are high. The poster won an award at the Singapore Healthcare Management 2022's Poster Competition.
Another example is GPConnect. It was a system originally used at GP clinics, and was selected to be adapted for use at COVID-19 Community Care Facilities (CCFs) and COVID-19 Vaccine Centres. Together with the GPC Team, clinical informatics developed the new adaptation "GPCLite" quickly; it fulfilled the medical team's needs and also enabled patients to visit each workstation seamlessly. Through creative solutioning, we managed to create EMR templates that clinical users were familiar with, rather than saddle them with entirely new user interfaces (UIs).
Additionally, the improved UIs and user experience (UX) allowed fast and comprehensive clinical notes entries within one page, followed by one click to submit critical information at each stage of the patient's treatment journey.
By cutting down the number of mouse clicks per patient and per page, imagine the total time saved when multiplied by hundreds of thousands!
Q: What about non COVID-19 related projects?
Some of the bigger projects in recent years have been the NEHR, the Next Generation Electronic Medical Record (NGEMR) and the HealthHub. There are also less well-known but important projects. For example, when MOH came up with new directives which impacted health claim schemes, we worked with our HealthTech colleagues on how the eligibility criteria can be reflected and incorporated in the various HealthTech system applications, such that claims could continue to be as seamless as possible.
Another aspect of clinical informatics work is the reviewing of codes and keeping data clean. For example, healthcare staff have several ways of terming diabetes, such as "diabetes", "high blood sugar" or "insulin-deficient". While all three are correct, it makes the data messy. This may have implications downstream – when data scientists perform analytics, the messy data may make it harder to interpret, leading to inaccurate analysis.
The use of standardised medical terminologies, such as SNOMED CT, is therefore important, where we work with healthcare users so that the terminologies can be correctly and safely adopted into their EMR systems. We also work with our non-medically trained colleagues to identify different terms that actually mean the same thing, and these terms can be linked together through a unique identity or concept code. This helps to make the data cleaner, more consistent, and any subsequent data analysis more accurate.
I believe it is crucial to lay the foundation correctly from the start, so that data is easier to interpret and analyse in future or in times of need. If you left it to a pure IT person, it would not be obvious to him which terms to funnel to where, or which are the preferred terms.
Clinical informatics help them to understand the different variations of terminology too. Here's another example. As part of improving population health in Singapore, IHiS data scientists had to look into blood pressure data of the national population.
We worked with them to help them make better sense of the numbers. What is considered a normal reading of blood pressure numbers? What do the top and bottom numbers mean in the reading? Which are the important fields? Sharing of knowledge and information allow users and teams perform better at what they are doing.
Clinical Informatics Group is also involved in predictive medicine. An example was to use data analytics to identify or even predict patients who are at higher risk of falling. But first, they had to know which fields or indicators to look out for. So we consulted with them, and they went on to write an algorithm to identify this group of people. Now, the healthcare staff can focus on this group of patients more, helping them to reduce the chances of falling through early interventions and prevention measures.
Q: What are some of the most satisfying aspects of your work in Clinical Informatics Group?
Many! An example is HealthHub. A family member of mine was admitted to the ICU last year. Her condition necessitated tests to be done every few hours, and I was anxious to know the results as soon as possible. Instead of having to spend long hours at the hospital, I could remotely track her test results almost real-time via HealthHub, something I knew was possible as our clinical informatics team was involved in the discussion on the display of selected lab results. I think enabling patients the ability to have direct access their own health data is very powerful. This also provides me great comfort to know that the things we do can bring so much value into the lives of people, myself inclusive.
Q: What are some of the hardest aspects of your work in Clinical Informatics Group?
It probably is the aspect of managing. Clinical informatics is the bridge between healthcare and technology, we have to manage and negotiate both parties' expectations on what can be done and what cannot. After all, even technology has its limitations, especially in a sector as complex as healthcare. The key is to have lots of communication – effective communication – and really listening to and understanding what each party needs, then helping them come to a common agreement. At the end of the day, we are here to give our best support to the meaningful work that the sector does.
If you have a passion to shape the future of HealthTech in Singapore, find out more at https://www.synapxe.sg/careers.
IHiS has rebranded as Synapxe, the national HealthTech agency. Read more about our new identity here.
