"You have a big heart and want to help people, but you’re also somewhat nerdy.” -Dr. Javed Mostafa. Photo by Elizabeth Mendoza

According to a U.S. Department of Labor report, the average American will change jobs 11 times between the ages of 18 and 44.

More than three-fifths of these jobs are held from ages 18 to 27, and most are within a similar career field.

Emily Pfaff can relate to the former—after a few years of post-college work in the publishing business in the Northeast, Pfaff needed a change of scenery.

But as for staying within the same field? Not so much.

Pfaff moved down south to explore a career in the UNC-Chapel Hill psychology department where she discovered a new field unrelated to her undergraduate degree in Russian and eastern European studies: health informatics.

Emily’s journey

Before leaving for Chapel Hill, Pfaff considered the idea of entering the medical field, but quickly realized she wasn’t cut out for healing the sick.

“I got a job with the psychiatric department doing database design with them and I realized that I never wanted to be a doctor because I’m squeamish,” she says.

It was then, in 2009, that Pfaff chose to enroll in the master’s program in information science at UNC-CH.

Halfway through her master’s program, Pfaff again decided to change directions, though not as drastically as she had before. Pfaff turned to health informatics after finding out about the Carolina Health Informatics Program, or CHIP, which was just getting started.

Simply put, health informatics is the applied use of information technology for serving and improving health care, says Dr. Javed Mostafa, a professor in the School of Information and Library Science and director of CHIP. Students in health informatics study a mixture of information science, computer science and health science to optimize the acquisition, storage, retrieval and use of information in health and biomedicine.

Health informatics has emerged out of the need to become more efficient in collecting data in hospitals.

CHIP was born as a reaction to the growing use of health informatics in hospitals, a technology that UNC Hospitals now uses throughout the system. The program is part of a joint effort between UNC-CH and Duke University.

With it, Mostafa says, medical researchers can track groups and populations of people, which is becoming especially valuable with the ever-changing demographics in America. The increasing number of aging baby boomers is a specific cause for concern, as doctors expect substantial increases in the number of cases using outdated, paper-based systems of filing data.

Professionals have noticed this problem and are looking to develop programs and systems of filing and retrieving data to handle the upcoming influx of cases.

Government officials have also recognized the need for an expansion of this field, and have put their checkbooks behind improving the nation’s health care system.

“Going back to the Bush era, there was a real recognition that this area requires federal support,” Mostafa says. “In the early Obama era, there was a very significant investment.”

That was an investment worth $44 billion, set aside specifically for health information technology, says Rich Medlin, a graduate of the certificate program and employee in the Department of Emergency Medicine at UNC Hospitals.

Along with Duke, UNC-CH applied for a federal grant and received $3 million to start the graduate certificate program in August 2010, Medlin says.

After becoming the first CHIP graduate in August, Pfaff is now a product of this influx of funding, working for North Carolina Translational and Clinical Sciences Institute (NC TraCS) with the Carolina Data Warehouse for Health (CDW-H) as a research analyst. And she doesn’t regret changing to such a growing and in-demand field.

“I probably would be unemployed right now if I hadn’t done the program,” she says.

Dr. Javed Mostafa, director of the Carolina Health Informatics Program, demonstrates the extensive searching and tracking capabilities of a new database program developed for UNC Hospitals. Photo by Elizabeth Mendoza

CHIP Technology

UNC Hospitals has found use for health informatics by completely removing paper from their records system, and instead plugging records into computers.

“Hospital information systems were initially designed for logistics, billing, appointments. Records were still on paper long after, so hospitals sort of realized it would be great to look at these records in more than one place,” Mostafa says.

Bringing all of the patient records out of UNC Hospitals and into one place is what CDW-H strives to do.

CDW-H has over two million hospital records in its system so far, dating from 2004 to the present, with new updates occurring every 24 to 48 hours.

“The ability now for different medical institutions to share their data is going to allow large scale studies of conditions and treatments to really make huge changes at a much greater pace,” Pfaff says.

The warehouse was created in early 2009, in collaboration with International Business Machines (IBM).

CDW-H serves as a research portal to allow UNC-CH researchers to search and identify cohorts with relevant criteria, so that they may study groups of people with the same diseases and understand them more comprehensively.

When a researcher has a data request for the warehouse, it’s Pfaff’s job to query the data warehouse and come up with a list of results.

“They come to me with requests for data like, ‘I need a list of all patients who have this disease and they need to be this race,’” she says.

Over 100 data requests have been processed in the warehouse’s two-and-a-half years in operation, Pfaff says.

This resource is crucial for researchers looking for answers on how to improve patient care—the main goal of health informatics as a comprehensive operating system.

“Clinics can share records to learn more about common diseases,” Mostafa says. “New data about some diseases can come through the system and provide new insight for the patient.”

Problems with Technology

As with any form of technology, health informatics is not without its share of problems.
Medlin, who was the first physician to enroll in the certificate program, says some aspects of new data storage technology are impractical.

He says he enrolled in the program because he wanted to be able to better understand the health information systems he was using at work, but the new technology has turned out to be a source of frustration at times.

“A lot of places just bolted on these electronic doctor systems and the last thing that they considered was their usability by clinicians,” Medlin says.

The technology is in its infancy, and thus Medlin says there are a lot of roadblocks in the system that have yet to be fixed and expedited. In his hospital work, spanning more than a decade, Medlin says he’s often found himself inputting irrelevant information into the system.

“It’s just so incredibly complicated,” he says. “So basically my frustration with that and the products on the market was why I applied to the program—so I could work on the user interfaces.”

There is also a lot of red tape around the process of accessing information in the data warehouses. The process for getting patient information follows rigid guidelines.

Researchers have to go through the Internal Review Board before they contact patients and can’t start their projects without IRB approval.

Sometimes approval only takes weeks. Other times, Pfaff says, the convoluted, bureaucratic approval system can stall research projects for years.

But what’s more of an issue is that some researchers don’t even get to file a request for data. The technology is new and expensive, making it difficult for small practitioners to afford the software that comprises a health informatics system.

What’s Next

With UNC Hospitals’ millions of dollars in grant money, access to data warehouses is a nonissue. And with billions of dollars being invested in health informatics, expansion is Mostafa’s first priority.

Next up for CHIP is expanding to include a public health informatics graduate certificate. Mostafa says it will focus on how one may detect bioterrorism in a community using information technology, such as preventing major disasters before they happen, like food poisoning. 
Mostafa says he hopes CHIP can be a part of solving these real-world problems—and live up to UNC-CH’s renown as a leader in the health field.

“Essentially, we want to create an effort which is worthy of UNC-CH’s status and reputation,” he says. “It’s the best of both worlds—you have a big heart and want to help people, but you’re also somewhat nerdy.”