Employing Health Informatics to Treat Substance Abuse (Part 2 of 2)

摘要

The Veterans Administration's leadership role in using health informatics to treat medical veterans' medical conditions, including substance use disorders, has evolved since its introduction to the VA's health care systems in the 1960s. We will define health informatics through semantic and operational definitions, and follow the historical progression of informatics in the treatment of substance abuse. Use of videoconferencing, home telehealth treating patients in their homes, and store and forward telehealth will be described. Strengths of using informatics in treating substance use disorders include cost effectiveness, increased access to patients, high quality of services, and patient demand. Limitations or challenges include meeting needs of severely ill patients, privacy issues, acceptance by different age groups, lack of empirical outcome studies, reimbursement mechanisms, and the need to integrate cultural and behavioral changes in the VA system. When attempting to assess the use of health informatics in the treatment of substance use disorders, the first obstacle to overcome is to define the term, with many synonyms used in the literature. Some of these terms are: health informatics, medical informatics and clinical informatics among others. This array of terms results in difficulties in communication for health providers and for patients. To enhance communication, we are departing from a semantic definition. The definition of the U.S. National library of Medicine is that health informatics is the interdisciplinary study of the design, development, adoption and application of information technology (IT)-based innovations in health care services, deliveries, management and planning. While this definition allows us to examine informatics use in mental health and in substance use disorders, it is still broad in its scope; a more refined definition is needed to explore and illustrate the way health informatics impacts the treatment of substance use disorders. An operational definition is needed to better link techniques of health informatics to the research and clinical aspects of substance use disorders. Operationally, health informatics is easier to explain than to define. The American Heritage Dictionary's definition seems to be operational enough: Health informatics is an evolving specialization that links information technology (IT) communications and health care to improve the efficiency, quality and safety of patients care. Technologies used by the VA Health Informatics1 (Laura M. Bonner et al.) reduced the definition of clinical informatics to the integration of Electronic Health Records (HER) with computer and Computerized Patient Records Service (CPRS) to provide care to patients. Other authors refer to telemedicine as informatics, and still other authors use the terms telepsychiatry, telemedicine, telemental health, e-psychiatry or online psychiatry and telehealth interchangeably. We will describe the development of these components of informatics.