About Clinical Informatics

Landmark reports from USA suggested that a health informatics infrastructure was needed to cross the quality chasm in clinical practice. Without an effective information system it is hard and expensive to audit quality and conduct research based on routine clinical data. The Clinical Informatics & Health Outcomes Research group at the University of Oxford currently, and University of Surreey in the past, has been involved in a wide range of projects over the last 15 years around how technology can enable quality and support the implementation of clinical governance.

Computerised clinical systems can potentially provide a large amount of clinical data which can be used for research and to measure quality improvement. However, this is not straight forward for several reasons:

The medical record is an abstraction of the clinical interaction. A lot is said during a clinical consultation, only an abstract of this is recorded in the medical record (whether paper or computerised), and in computer systems only a small amount of this is “coded” – recorded using coding or classification systems such as ICD-10 (WHO tenth International Classification of Disease).
There is variation in the way that the same condition is represented in the clinical record. Different computerised medical record (CMR) systems hold information about the same person in different formats. Additionally clinicians may represent the same clinical condition in different ways (e.g. Asthma might be represented in a clinical record as: Exercise cough, wheezing, bronchitis and as asthma itself.)
Care-pathways often involve different providers of healthcare. Patients with many conditions receive their treatment from a number of different providers of care: their family physician, the emergency room or hospital. This means that their record or health outcome information may be fragmented across a number of different records.

The Clinical Informatics & Health Outcomes Research Group works within this space. Our main areas of research are understanding how clinical conditions are represented in computerised records (case finding); extracting and aggregating data from primary care computer systems though increasingly from other parts of the health system – hospitals and clinics; so that we can conduct cross-sectional though increasingly cohort and case-control studies. We have also used these technologies to recruit patients meeting inclusion criteria for surveys or clinical trials.