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 Review chapter 2 of your text book and describe when healthcare informatics was created and the historical evolution of its application in current healthcare? 

OBJECTIVES
1. Reflect on the progression from data to information to knowledge.
2. Describe the term information .
3. Assess how information is acquired.
4. Explore the characteristics of quality information.
5. Describe an information system.
6. Explore data acquisition or input and processing or retrieval, analysis, and synthesis

of data.
7. Assess output or reports, documents, summaries, alerts, and outcomes.
8. Describe information dissemination and feedback.
9. Define information science.

10. Assess how information is processed.
11. Explore how knowledge is generated in information science.

Introduction
This chapter explores information, information systems (IS), and information
science. The key word here, of course, is information . Health care profession-
als are knowledge workers , and they deal with information on a daily basis.
Many concerns and issues arise with health care information, such as ownership,
access, disclosure, exchange, security, privacy, disposal, and dissemination. With

Key Terms

Acquisition
Alert
Analysis
Chief information officer
Chief technical officer
Chief technology officer
Cloud computing
Cognitive science
Communication science
Computer-based

information system
Computer science
Consolidated Health

Informatics
Data
Dissemination
Document
Electronic health record

(continues)

Introduction to
Information, Information
Science, and Information
Systems
Dee McGonigle, Kathleen Mastrian , and Craig McGonigle

21

2
c h a p t e r

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the gauntlet of developing electronic health records (EHR) having been laid
down, public and private sector stakeholders have been collaborating on a wide-
ranging variety of health care information solutions. These initiatives include
Health Level 7 (HL7), the eGov initiative of Consolidated Health Informatics’
(CHI’s), the National Health Information Infrastructure (NHII), the Nation-
wide Health Information Network (NHIN), Next-Generation Internet (NGI),
Internet2, and iHealth record. There are also health information exchange
(HIE) systems, such as Connecting for Health, the eHealth initiative, the Fed-
eral Health Information Exchange (FHIE), the Indiana Health Information
Exchange (IHIE), the Massachusetts Health Data Consortium (MHDC),
the New England Health EDI Network (NEHEN), the State of New Mexico
Rapid Syndromic Validation Project (RSVP), the Southeast Michigan e-Pre-
scribing Initiative, and the Tennessee Volunteer eHealth Initiative (Goldstein,
Groen, Ponkshe, & Wine, 2007). The most recent federal government initiative,
the HITECH Act, set 2014 as the deadline for implementing electronic health
records, yet clinics, private practices, and hospitals continue to struggle with the
implementation and/or use of their electronic health records (for an overview of
HIPAA and HITECH legislation, see Chapter 5).

It is evident from the previous brief listing that there is a need to remedy
health care information technology concerns, challenges, and issues faced
today. One of the main issues deals with how health care information is man-
aged to make it meaningful. It is important to understand how people obtain,
manipulate, use, share, and dispose of this information. This chapter deals with
the information piece of this complex puzzle.

Information
Suppose someone states the number 99.5. What does that mean? It could be a
radio station or a score on a test. Now suppose someone says that Ms. Howsunny’s
temperature is 99.5°F—what does that convey? It is then known that 99.5 is a
person’s temperature. The data (99.5) were processed to the information that
99.5° is a specific person’s temperature. Data are raw facts. Information is pro-
cessed data that have meaning. Health care professionals constantly process data
and information to provide the best possible care for their patients.

Many types of data exist, such as alphabetic, numeric, audio, image, and video
data. Alphabetic data refer to letters, numeric data refer to numbers, and alpha-
numeric data combine both letters and numbers. This includes all text and the
numeric outputs of digital monitors. Some of the alphanumeric data encoun-
tered by health care professionals are in the form of patients’ names, identifica-
tion numbers, or medical record numbers. Audio data refer to sounds, noises, or
tones, such as monitor alerts or alarms, taped or recorded messages, and other
sounds. Image data include graphics and pictures, such as graphic monitor dis-
plays or recorded electrocardiograms, radiographs, magnetic resonance imaging

Federal Health
Information
Exchange

Feedback
Health information

exchange
Health Level 7
Indiana Health

Information
Exchange

Information
Information science
Information system
Information technology
Input
Interface
Internet2
Knowledge
Knowledge worker
Library science
Massachusetts Health

Data Consortium
National Health

Information
Infrastructure

Nationwide Health
Information Network

New England Health EDI
Network

Next-Generation Internet
Outcome
Output
Processing
Rapid Syndromic

Validation Project
Report
Social sciences
Stakeholder
Summaries
Synthesis
Telecommunications

Key Terms (continued)

22 CHAPTER 2: Introduction to Information, Information Science, and Information Systems

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outputs, and computed tomography (CT) scans. Video data refer to animations, mov-
ing pictures, or moving graphics, such as a physical therapist’s video of a patient. Using
these data, one may review the ultrasound of a pregnant patient, examine a patient’s
echocardiogram, watch an animated video for professional development, or learn how
to operate a new technology tool, such as a pump or a monitoring system. The data
we gather, such as heart and lung sounds or X-rays, help us produce information. For
example, if a patient’s X-rays show a fracture, it is interpreted into information, such as
spiral, compound, or hairline. This information is then processed into knowledge, and
a treatment plan is formulated based on the health care professional’s wisdom.

The integrity and quality of the data rather than the form are what matter. Integrity
refers to whole, complete, correct, and consistent data. Data integrity can be compro-
mised through human error; viruses, worms, or other computer bugs; hardware failures
or crashes; transmission errors; or hackers entering the system. Information technolo-
gies help to decrease these errors by putting into place safeguards, such as backing up
files on a routine basis, error detection for transmissions, and user interfaces that help
people enter the data correctly. High-quality data are relevant and accurately represent
their corresponding concepts. Data are dirty when a database contains errors, such
as duplicate, incomplete, or outdated records. One author (D.M.) found 50 cases of
tongue cancer in a database she examined for data quality. When the records were
tracked down and analyzed and the dirty data removed, only one case of tongue cancer
remained. In this situation, the data for the same person had been entered erroneously
49 times. The major problem was with the patient’s identification number and name:
The number was changed, or his name was misspelled repeatedly. If researchers had
just taken the number of cases in that defined population as 50, they would have con-
cluded that tongue cancer was an epidemic, resulting in flawed information that is not
meaningful. As this example demonstrates, it is imperative that data be clean if the goal
is quality information. The data that are processed into information must be of high
quality and integrity to create meaning to inform our practice.

To be valuable and meaningful, information must be of good quality. Its value relates
directly to how the information informs decision making. Characteristics of valuable, qual-
ity information include accessibility, security, timeliness, accuracy, relevancy, complete-
ness, flexibility, reliability, objectivity, utility, transparency, verifiability, and reproducibility.

Accessibility is a must; the right user must be able to obtain the right information
at the right time and in the right format to meet his or her needs. Getting meaningful
information to the right user at the right time is as vital as generating the information
in the first place. The right user refers to an authorized user who has the right to obtain
the data and information he or she is seeking. Security is a major challenge because
unauthorized users must be blocked while the authorized user is provided with open,
easy access (see Chapter 9).

Timely information means that the information is available when it is needed for the
right purpose and at the right time. Knowing who won the lottery last week does not
help one to know if the person won it today. Accurate information means that there are
no errors in the data and information. Relevant information is a subjective descriptor

Information 23

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in that the user must have information that is relevant or applicable to his or her needs.
If a health care provider is trying to decide whether a patient needs insulin and only the
patient’s CT scan information is available, this information is not relevant for that current
need. However, if one needs information about the CT scan, the information is relevant.

Complete information contains all of the necessary essential data. If the health care
provider needs to contact the only relative listed for the patient and his or her contact
information is listed but the approval for that person to be a contact is missing, this
information is considered incomplete. Flexible information means that the information
can be used for a variety of purposes. Information concerning the inventory of supplies
in a clinic, for example, can be used by health care personnel who need to know if an
item is available for use. The manager of the clinic accesses this information to help
decide which supplies need to be ordered, to determine which items are used most
frequently, and to do an economic assessment of any waste.

Reliable information comes from reliable or clean data gathered by authoritative and
credible sources. Objective information is as close to the truth as one can get; it is not
subjective or biased but rather is factual and impartial. If someone states something, it
must be determined whether that person is reliable and whether what he or she is stat-
ing is objective or tainted by his or her own perspective.

Utility refers to the ability to provide the right information at the right time to the
right person for the right purpose. Transparency allows users to apply their intellect to
accomplish their tasks while the tools housing the information disappear. Verifiable
information means that one can check to verify or prove that the information is correct.
Reproducibility refers to the ability to produce the same information again.

Information is acquired either by actively looking for it or by having it conveyed by
the environment. All of the senses (vision, hearing, touch, smell, and taste) are used
to gather input from the surrounding world, and as technologies mature, more and
more input will be obtained through the senses. Currently, people receive information
from computers (output) through vision, hearing, or touch (input), and the response
(output) to the computer (input) is the interface with technology. Gesture recognition
is increasing, and interfaces that incorporate it will change the way people become
informed. Many people access the Internet on a daily basis seeking information or
imparting information. Individuals are constantly becoming informed, discovering,
or learning; becoming re-informed, rediscovering, or relearning; and purging what
has been acquired. The information acquired through these processes is added to the
knowledge base. Knowledge is the awareness and understanding of a set of information
and ways that information can be made useful to support a specific task or arrive at a
decision. This knowledge building is an ongoing process engaged in while a person is
conscious and going about his or her normal daily activities.

Information Science
Information science has evolved over the last 50 some years as a field of scientific
inquiry and professional practice. It can be thought of as the science of information,
studying the application and usage of information and knowledge in organizations

24 CHAPTER 2: Introduction to Information, Information Science, and Information Systems

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and the interface or interaction between people, organizations, and IS. This extensive,
interdisciplinary science integrates features from cognitive science, communication
science, computer science, library science, and the social sciences. Information sci-
ence is concerned primarily with the input, processing, output, and feedback of data
and information through technology integration with a focus on comprehending the
perspective of the stakeholders involved and then applying information technology
as needed. It is systemically based, dealing with the big picture rather than individual
pieces of technology.

Information science can also be related to determinism. Specifically, it is a response
to technologic determinism—the belief that technology develops by its own laws, that
it realizes its own potential, limited only by the material resources available, and must
therefore be regarded as an autonomous system controlling and ultimately permeating
all other subsystems of society (Web Dictionary of Cybernetics and Systems, 2007,
para. 1).

This approach sets the tone for the study of information as it applies to itself, the
people, the technology, and the varied sciences that are contextually related depending
on the needs of the setting or organization; what is important is the interface between
the stakeholders and their systems and the ways they generate, use, and locate informa-
tion. According to Cornell University (2010), “Information Science brings together
faculty, students and researchers who share an interest in combining computer science
with the social sciences of how people and society interact with information” (para.
1). Information science is an interdisciplinary, people-oriented field that explores and
enhances the interchange of information to transform society, communication science,
computer science, cognitive science, library science, and the social sciences. Society
is dominated by the need for information, and knowledge and information science
focuses on systems and individual users by fostering user-centered approaches that
enhance society’s information capabilities, effectively and efficiently linking people,
information, and technology. This impacts the configuration and mix of organizations
and influences the nature of work—namely, how knowledge workers interact with and
produce meaningful information and knowledge.

Information Processing
Information science enables the processing of information. This processing links peo-
ple and technology. Humans are organic information systems, constantly acquiring,
processing, and generating information or knowledge in their professional and personal
lives. This high degree of knowledge, in fact, characterizes humans as extremely intel-
ligent organic machines. The premise of this text revolves around this concept, and the
text is organized on the basis of the Foundation of Knowledge model: knowledge acqui-
sition, knowledge processing, knowledge generation, and knowledge dissemination.

Information is data that are processed using knowledge. For information to be valu-
able or meaningful, it must be accessible, accurate, timely, complete, cost effective, flex-
ible, reliable, relevant, simple, verifiable, and secure. Knowledge is the awareness and
understanding of an information set and ways that information can be made useful to

Information Processing 25

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support a specific task or arrive at a decision. As an example, if an architect were going
to design a building, part of the knowledge necessary for developing a new building
would be understanding how the building will be used, what size of building is needed
compared to the available building space, and how many people will have or need access
to this building. Therefore, the work of choosing or rejecting facts based on their sig-
nificance or relevance to a particular task, such as designing a building, is also based on
a type of knowledge used in the process of converting data into information.

Information can then be considered data made functional through the application
of knowledge. The knowledge used to develop and glean knowledge from valuable
information is generative (having the ability to originate and produce or generate)
in nature. Knowledge must also be viable. Knowledge viability refers to applications
that offer easily accessible, accurate, and timely information obtained from a variety
of resources and methods and presented in a manner so as to provide the necessary
elements to generate knowledge.

Information science and computational tools are extremely important in enabling the
processing of data, information, and knowledge in health care. In this environment, the
hardware, software, networking, algorithms, and human organic ISs work together to
create meaningful information and generate knowledge. The links between informa-
tion processing and scientific discovery are paramount. However, without the ability to
generate practical results that can be disseminated, the processing of data, information,
and knowledge is for naught. It is the ability of machines (inorganic ISs) to support and
facilitate the functioning of people (human organic ISs) that refines, enhances, and
evolves practice by generating knowledge. This knowledge represents five rights: the
right information, accessible by the right people in the right settings, applied the right
way at the right time.

An important and ongoing process is the struggle to integrate new knowledge and
old knowledge so as to enhance wisdom. Wisdom is the ability to act appropriately; it
assumes actions directed by one’s own wisdom. Wisdom uses knowledge and experi-
ence to heighten common sense and insight to exercise sound judgment in practical
matters. It is developed through knowledge, experience, insight, and reflection. Wisdom
is sometimes thought of as the highest form of common sense, resulting from accumu-
lated knowledge or erudition (deep, thorough learning) or enlightenment (education
that results in understanding and the dissemination of knowledge). It is the ability to
apply valuable and viable knowledge, experience, understanding, and insight while being
prudent and sensible. Knowledge and wisdom are not synonymous because knowledge
abounds with others’ thoughts and information, whereas wisdom is focused on one’s own
mind and the synthesis of one’s own experience, insight, understanding, and knowledge.

If clinicians are inundated with data without the ability to process it, the situation
results in too much data and too little wisdom. Consequently, it is crucial that clini-
cians have viable ISs at their fingertips to facilitate the acquisition, sharing, and use of
knowledge while maturing wisdom; this process leads to empowerment.

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Information Science and the Foundation
of Knowledge
Information science is a multidisciplinary science that encompasses aspects of com-
puter science, cognitive science, social science, communication science, and library
science to deal with obtaining, gathering, organizing, manipulating, managing, stor-
ing, retrieving, recapturing, disposing of, distributing, and broadcasting information.
Information science studies everything that deals with information and can be defined
as the study of ISs. This science originated as a subdiscipline of computer science as
practitioners sought to understand and rationalize the management of technology
within organizations. It has since matured into a major field of management and is
now an important …

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