About a year ago, August last year, I started thinking about an area of research that I like to call wellness informatics. It took me a while to understand how to situate it with respect to the very large and always growing space of health informatics. But, here’s what I think:
Wellness Informatics is a human-centered computing science focused on the design, development, deployment and evaluation of human facing technological solutions to promote and manage wellness acts such as the prevention of disease and the management of health. Wellness Informatics is a Computing Science because it requires hardware and software innovations in order to make devices that people can use anywhere and everywhere wellness occurs. Wellness Informatics is Human-Centered because it requires that those innovations are married with innovations in how the ICT communicates with the user, in ways that are psychologically, sociologically, culturally, and societally relevant—without which wellness will not be promoted and sustained.
Research in Wellness Informatics has already begun, but has not been systematically unified. This is a serious omission, and one that should be addressed. Wellness informatics complements but stands apart from Biomedical Informatics. Biomedical Informatics (including Health Informatics and Medical Informatics) has enjoyed an explosion of growth in activity as the possibilities of technologies for health have increased and as a growing recognition of the problems in health-care has been realised. According to recent definitions Biomedical Informatics is
“The meaning of the terms health informatics and medical informatics, and how also biomedical informatics, varies within and between different nations. Both terms — health informatics and medical informatics — will be used here interchangably in a broad and comprehensive manner, in terms of the discipline dealing with the systematic processing of data, information and knowledge in medicine and health care.” (Haux, 2006) p796.
Within Biomedical Informatics some common themes frequently emerge in the nature of the problems solved.
- Patient as source of information: Biomedical Informatics have tended to view patients as input data into the systems. Whether it’s tracking patients within the hospital, or integrating their health with financial data to learn more about healthcare costs, or in public health care informatics, using patient’s data in aggregate to track trends in disease, patients are inputs.
- Emphasis on population as appropriate level of granularity of data: Populations of various forms are often the appropriate level of granularity for data. Public Health Informatics exhibits this particularly well, with disease trend analysis being emblematic of the power of large-scale synthesis of patient data. Other populations also feature strongly in research directions. Biomedical Engineering focusing on developing classes of machines to support healthcare management of various diseases, classes of diagnosis and so forth. Populations associated with particular organizations, such as hospitals, also feature strongly in solutions in Biomedical Informatics.
- Healthcare establishment as the user of information: Biomedical Informatics has tended to prioritized the improvement of the healthcare profession. Systems are targetted at helping practitioners (i.e., hospitals, nurses, dentists, vetenarians, clinicians, public health professionals) improve the quality of care delivery and management through the timely provision of information. Other research has focused on improving the science behind practice, supporting the development of novel technologies (i.e., the discipline of biomedical engineering), improving the state of the science in medice (i.e., efforts to use ICTs to process and sequence large data sets and so forth—genomics).
An exception to this exists, within the space of Consumer Health Informatics which has advocated for a patient centered approach, viewing patients as consumers of various applications and the information contained therein. This patient oriented approach, however, still focuses on healthcare. Additionally, if Biomedical Informatics is seen as patient information flowing into the systems used by the healthcare establishment, than consumer health informatics is about the flow of information from the healthcare establishment to patients. Topics include the use of online medical resources, or the development of systems that patients and doctors can use together.
Consumer Health Informatics provides an important foundation for Wellness Informatics. The centrality of the patient as actively involved rather than data is shared among the disciplines. But Wellness Informatics focuses on promoting the use of ICTs to prevent illness and prolong life. Further, there is an additional focus on communities. It is not just a relationship between an individual and the healthcare establishment, although that is part of the process, but that the patient interacts with other people, in their physical world, to make sense of and consume information about how to be well. For example, it is often said that weight loss proceeds more effectively when a person joins a group who are collectively focused on that goal.
Wellness also requires a focus on culture and socio-economic status. Individuals’ cultural background plays a significant role in their orientation to a variety of matters. Food consumption is grounded in rituals. Beliefs about body shape and size have cultural originals. Wellness is also based on what individuals can afford, where they live, and what is available.
I also chose wellness because it suggests a different type of interactional arrangement particularly with the healthcare establishment. A focus on health, and on the treatment of diseases, places a centrality on the interactions between a person (a patient) and the health care establishment. Wellness may be triggered by the healthcare establishment (e.g., someone being advised to get more exercise) and it is scaffolded by the values and advice of the healthcare establishment (e.g., guides about what constitutes appropriate weight) but it may begin with an individual feeling that they need to make life adjustments borne out of their own personal sense or in conversation with friends and family. The healthcare establishment may only be involved as a resource to gain information (e.g., using the Internet to compute Body Mass Index as part of goal setting).