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Wednesday, January 29, 2014

Public Health Informatics or Consumer Health informatics

What is the difference between public health informatics and consumer health informatics? First a basic knowledge of the different kinds of healthcare governance systems used in the country where you are situated is needed for the right context. Being from Canada, I understand we essentially have a public supported healthcare system. Our next door neighbour has Obamacare. The land of our Mother Queen has the NHS, which is apparently one of the world's largest employers, right up there with the Chinese military.

I have seen textbooks on public health informatics, and I imagine there are some for consumer health, but most of the evidence points to consumer health information being everywhere. The informatics side of it is more difficult to contend with. And when you consider that most of the known world doesn't have public or government supported healthcare, you are really looking at private, for profit, or consumer health.

The evidence for "for profit" healthcare is that it is bad for your health and might kill you. This is to disregard for a second dangers to health in the ordinary run of the mill statistics on patient safety, medical errors, hospital viruses, etc. The hippocratic or medicine buddha vow universalistic compassionate purpose for free medical treatment also comes with a price tag in limited resources, skills, and knowledge. Humans helping humans out of love is after all the only principle worth trying to apply to improving quality of life as a return on investment.

With the push of IT into healthcare comes the warning that applying IT into standards of care and therapeutic interventions requires evidence that it works, is cost effective, and is generally worth the change management stress of the push factor. Would public health support more IT for patients as part of the general healthcare standard of care if it is proven to reduce hospital costs, improves quality of life, reduces errors, etc? You betcha. Probably though a lot of IT projects for healthcare start out experimental and are only available through private networks and citizens with deeper pockets. That is a consumer health choice.

Here is a Gunther Esyenbach definition of "Consumer Health Informatics" from a BMJ article:

Consumer health informatics is the branch of medical informatics that analyses consumers' needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers' preferences into medical information systems. Consumer informatics stands at the crossroads of other disciplines, such as nursing informatics, public health, health promotion, health education, library science, and communication science, and is perhaps the most challenging and rapidly expanding field in medical informatics; it is paving the way for health care in the information age.

That is all well and good of course, but it means almost anything. When you talk about Public Health Informatics, you have a more dedicated field of investigation into such things as infectious disease, pandemics, syndromic surveillance. It always makes me think of Google Flu, which is an insane way search queries on Google can predict disease outbreaks better than the CDC or other public health surveillance systems. And then there is the phenomenon like HealthMap, which really illustrates this well.

Speaking of maps, lets take a look at what a consumer health information map of medicine would look like. It just so happens that the NHS has exactly that, a Map of Medicine, or "See what your doctor can see with Map of Medicine Healthguides". When you first go to this website you need to accept a disclaimer. I didn't read it but I think it has to do with something like "you are about to read health information that only an expert like your family doctor knows anything about so for the love of Christ be careful from here on in". What the heck, I will try to copy and paste that disclaimer in here because it is so interesting (after the diabetes flowchart).

In reality, I was actually kind of shocked when I clicked on one of these healthguides and found it was a information flowchart right out of 1960s programming land. I will link to the one for Diabetes here. The sheer brilliance of the healthguide that makes it different from just your average consumer health information page (which it strongly asserts it is not meant to be for), is that when you click or mouse over the little "i" for "Information", you get a flash or javascript window with detailed information about that condition on the path for the flowchart stage. A PDF printable view will give you all the information bubbles from the flow chart. Here is only the flowchart:

Welcome to Map of Medicine Healthguides

Patients and carers


The Map of Medicine is intended for use by healthcare professionals in a clinical setting. The Map of Medicine should not be used as a substitute for a healthcare professional's diagnosis or clinical decisions, by healthcare professionals or other users.
The treatment responsibility of a patient lies solely with the healthcare professional responsible for that treatment. The Map of Medicine is not exhaustive and may not reflect the most recent medical research. By continuing to access the Map of Medicine, you agree to accept our Terms and Conditions.

Healthcare professionals

If you are an NHS user in England, excluding London, please access the Map of Medicine using either your Athens login or your Smartcard. This will also provide access to care maps developed for use in your local area.
If you are a healthcare professional working in an area without a licence for the Map of Medicine, please register to access national care maps.
For more information about Map of Medicine licensing and access, please visit our website. Map of Medicine licensing