Health informatics is a relatively new discipline. When new movements seek to establish themselves they need to develop- group norms so that they can collaborate on the work they are engaged in. The root of health informatics is in the 1960s , certainly electronic health informatics. There are two roots from which the discipline emerged. These were the pathology department and medical research. The important issue is that these activities of necessity focus on classification and counting. They are by their nature reductionist for very good reasons. Fields , classifications, data models etc spring from this stable. They have spawned HL7 snomed DM&D etc . The advent of the relational database supported this approach to health informatics. The focus since that time has been on the record as conceived as a collection of well defined data fields derived from this approach to the world. The fields are to defined filled in by clinical staff and analysed. This approach present from the beginning has silently underpinned the development of the discipline.
Are you still a believer ? I think most health informaticians are because of our training and the hard graft we have had to put in to make the systems we work on in pathology , demographics, bookings pharmacy etc just work properly in the first place. Add the requirement to prioritise performance data and overcome technical lock in on a cyclical basis, and almost all our energy has been directed at structured data. Classification and counting.
This in retrospect was a strategic wrong turn. The problem we have, is that we have now built an edifice to this approach. The one true path.
Take a step back . Firstly look at clinical conversations and communications. They carry context and communicate meaning in a social environment. This is well documented in the health informatics literature but we do not seem to have understood this message. Next look at the current sets of case notes when taken as a whole. Structured data is less that 10% of the record. The important stuff we all read is in the letters and documents at the back. Lastly free text and documents have been around for thousands of years for communicating meaning between humans and across time and space.
So why do we elevate the structured data to the status it seems to have in our endeavors.
In retrospect is wasn’t a strategic wrong turn as I have thought for the past 10 years. It is the natural consequence of the evolution of several trends . Firstly the scientific tradition that values classification and measurement. Secondly the misunderstanding that the provision of care was about treating disease not people , so the socio cultural aspects of meaning and communication were downplayed. Thirdly relational databases dealt with data efficiently at a time when storage was expensive. Lastly the lack of the technical tools prior to the development of the internet and the web to deal with asynchronous human communications effectively.
This also led to the conception of a one to one relationship between the provision of health care and a single computer system. And that led to NPfIT and a spine architecture that could never have worked. There are hard limits to this approach and we hit it constantly when we have to organise the metadata and messaging to transmit discrete items of data and provide the context for their safe use. When the metadata dwarfs the payload you usually have the wrong design and it wont work.
This approach however has provided significant advances . It is absolutely necessary but insufficient. The provision of care is about people and how they interact. It is about the transmission of meaning in a socio cultural context. We communicate meaning in dialog, stories and write it down as an understandable narrative in documents
Our primary tool for asynchronous communication is the creation and transmission of documents.
So the lesson from history when setting up the Welsh program is have equal or even more respect for documents than data. They are both essential to support the provision of care.
Documents are social.
A conservative estimate is that we create in Wales within the health service 100 million documents per year !
Sowhatfollows's Blog 
Just a minor point about your introduction (not about your overall theme)….
The roots of health informatics were far more varied than pathology and medical research. There were those from medical physics etc, but one of the major sources was public health and concerns about chronic diseaase. and the work by people such as Tony Hedley and others on shared-care in the 70s, and embryo clinical information systems and GP systems in the 80s (eg Tim Benson, Abies etc, CCL renal system etc). Also in 70-80s, there was the work of Tim de Dombal etc in decision making and in USA lots of work on ‘expert systems’. These are just some of the varied roots that come to mind on a Sunday morning. I am sure there are more.
I was appointed as Lecturer in Health Informatics at Glasgow Uni in 1984, in a dept of public health having been working on clinical information systems for shared care (diabetes) from 78-84.
bw Ray Jones
Hi, I agree the roots are more varied . Never the less the factors that have led to emphasis on structure and the neglect of documents free text and meaning are rooted a long way back. There is no need to neglect them any more – an and not an or !