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Major milestones in the history of public health informatics, organized by the three stages in development of public health information management systems.

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The Age of Observation: Hippocrates, 400BC

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The Age of Observation: Hippocrates, 400BC

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Hippocrates, often called the "Father of Modern Medicine," made several contributions to the development of public health informatics. His teachings reflect the way early health practitioners use observations based upon individual experience to understand the relationship between health and living conditions. The observation of practitioners led to the development and implementation of public health interventions. This marked the first phase of data-based public health practice.

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The Age of Analysis: The Bubonic Plague, 1347

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The Age of Analysis: The Bubonic Plague, 1347

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The breakout of the bubonic plague occurred in Messina, Sicily. This was one of the most devastating pandemics in human history. It resulted in the spread of the lethal disease to other parts of Europe, killing millions of people along the way. This plague evoked social upheaval and a readiness to begin studying disease and disease transmission.

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The Age of Analysis: The Renaissance, 14th to 17th Century

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The Age of Analysis: The Renaissance, 14th to 17th Century

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The Renaissance prompted an intense period of European cultural, artistic, political, and economic "rebirth." This period of time is considered the bridge between the Middle Ages and Modern history. There was an increase in knowledge and learning that occurred during this era. There was also the adoption of the scientific method, a systematic approach that paved the foundation for collection and analysis of health-related data. Finally, population health is  a concept that became apparent during this time. A general recognition of the significance of a healthy population to the national wealth and power was established.

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John Graunt is known for developing the basic principles for analysis of data and determination of data reliability. During this time, he analyzed over 30 years of vital statistics and social data. His work proposed a method of creating useful information through the careful and logical interpretation of imperfect data. Based on his findings, Christiaan Huygens was able to combine this with his own previous work on probability to establish a precursor to mortality tables.

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Edmond Haley combined the concepts of data analysis and Christiaan Huygens work to develop the the first mortality tables to predict life expectancy. This work laid the way for public health data analysis to begin.

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The Age of Analysis: Roots of Epidemiology, 17th to 19th Century

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The Age of Analysis: Roots of Epidemiology, 17th to 19th Century

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Scientists applied mathematical principles to public health issues, work that set the stage for the major advances in data and information management that led to the development of the modern epidemiological approach.

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The Origin of Modern Health Public Informatics: Public Health Data Collection in the United States, 1798 - 1833

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The Origin of Modern Health Public Informatics: Public Health Data Collection in the United States, 1798 - 1833

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- 1798: First local health department formed in Baltimore, MD
- Early 1800s: Local health departments collected health data every now and then
- 1833: Formation of the Chicago Department of Health

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The Origin of Modern Public Health Informatics: The Cholera Outbreaks in England, 19th Century

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The Origin of Modern Public Health Informatics: The Cholera Outbreaks in England, 19th Century

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In England, the 19th century Cholera epidemics led to major changes in the practice of public health.
- 1834: Poor Law was passed and the Poor Law Commission was formed in response
- 1836: Births and Deaths act data became available. Edwin Chadwick proposed that this act would lead to registration of the cause of disease, with a view to devising remedies or means of prevention.
A large amount of information was collected under these two acts. Analysis of this data led to better understanding of the role of sanitation and health.
- 1854: Cholera hit London and Dr. John Snow conducted an investigation of this outbreak in the Soho section of London. He mapped the location of each of the victims, which displayed a pattern centered on the Broad Street pump. The methodology he used has become the foundation of all modern epidemiological investigations of disease outbreaks.

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The Origin of Modern Public Health Informatics: Infectious Disease Reporting, 1874

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The Origin of Modern Public Health Informatics: Infectious Disease Reporting, 1874

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Massachusetts developed a postcard-based reporting system. This marked the beginning of US infectious disease reporting.

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The Origin of Modern Public Health Informatics: Public Health Data Collection in the United States con't, 1900 - 1940

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The Origin of Modern Public Health Informatics: Public Health Data Collection in the United States con't, 1900 - 1940

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- 1900: Many state and local health departments had formed in the US
- Early 1900s: the vital records system was still struggling
- 1933: Texas became the last state to begin reporting vital statistics to the federal government
- 1940: It was estimated that 55 million native-born persons did not have birth records

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Electronic Numerical Integrator and Computer (ENIAC) was the first electronic general-purpose computer. It was able to solve large sets of numerical data through reprogramming.

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The Communicable Disease Center was established in 1946. This was an extension of the wartime agency MCWA (Malaria Control in War Areas) developed to combat malaria through mosquito control.
Creation of CDC with its emphases on working with states and other partners to monitor and prevent outbreaks; maintain national health statistics; and to prevent and control infectious and chronic diseases, injuries, and environmental health hazards.

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1960s: Vital statistics function became part of the new National Center for Health Statistics, and the current cooperative system with states was put into place.

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Homepage of the National Center for Health Statistics

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Public Health Informatics Terminology, 1962

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Public Health Informatics Terminology, 1962

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- 1957: Karl Steinbuch created the term informatik (automatic information processing) came to denote computer science in German
- 1962: Philippe Dreyfus devised the French term informatique
- 1966: Alexander Mikhailov et al. promoted the Russian term informatika (theory of scientific information)

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Public Health Informatics: "translating" knowledge for health

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- 1977: Dedicated public health initiatives brought about worldwide eradication of smallpox
- 1979: Standards for a Uniform Hospital Discharge Data set was proposed
- 1986: Standards for a Uniform Hospital Discharge Data set became effective
- 1989: American Medical Informatics Association (AMIA) was founded by the merger of three organizations: American Association for Medical Systems and Informatics, American College of Medical Informatics, and Symposium on Computer Applications in Medical Care
- 1994: Public health reduced the number of US children who had elevated levels of blood lead to 4.4% (from 88% in the 1970s)

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Health Insurance Portability and Accountability Act (HIPAA), 1996

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Health Insurance Portability and Accountability Act (HIPAA), 1996

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HIPAA is a legislation that provides data privacy and security provisions for safeguarding medical information. HIPAA was passed in order to grant patients a significant degree of confidentiality regarding their medical records. HIPAA increasingly governs decisions made in information technology. Informatics professionals need to be aware of how to implement high-grade security and encryption in their systems in order to protect records from hackers or theft.

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Health Information Technology for Economic and Clinical Health (HITECH) Act, 2009

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Health Information Technology for Economic and Clinical Health (HITECH) Act, 2009

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The HITECH Act was created to promote and expand the adoption of health information technology, specifically, the use of electronic health records by healthcare providers. Incentives were introduced to encourage hospitals and other healthcare providers to make this change. This act also pushed for improved privacy and security protections for healthcare data. Additionally, this act tightened up the language in the HIPAA Act, helping to ensure that business associates of HIPAA and covered entities were complying with HIPAA rules. Tougher financial penalties for HIPAA compliance failures were enforced to provide an extra incentive for healthcare organizations to comply with HIPAA.

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The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.

Section 13410(d) of the HITECH Act, which became effective on February 18, 2009, revised section 1176(a) of the Social Security Act (the Act) by establishing:

Four categories of violations that reflect increasing levels of culpability;

Four corresponding tiers of penalty amounts that significantly increase the minimum penalty amount for each violation; and

A maximum penalty amount of $1.5 million for all violations of an identical provision.

It also amended section 1176(b) of the Act by:

Striking the previous bar on the imposition of penalties if the covered entity did not know and with the exercise of reasonable diligence would not have known of the violation (such violations are now punishable under the lowest tier of penalties); and

Providing a prohibition on the imposition of penalties for any violation that is corrected within a 30-day time period, as long as the violation was not due to willful neglect.

This interim final rule conforms HIPAA's enforcement regulations to these statutory revisions that are currently effective under section 13410(d) of the HITECH Act. This interim final rule does not make amendments with respect to those enforcement provisions of the HITECH Act that are not yet effective under the applicable statutory provisions.

This interim final rule will become effective on November 30, 2009. HHS has invited public comments on the interim final rule, which will be considered if received by December 29, 2009.

View the Enforcement Interim Final Rule.

View the Press Release.

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HITECH Act Enforcement Interim Final Rule

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HITECH Act Enforcement Interim Final Regulation

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New Clinical Informatics Subspecialty and First Class of Diplomates, 2013

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New Clinical Informatics Subspecialty and First Class of Diplomates, 2013

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The American Medical Informatics Association (AMIA) developed the new clinical informatics subspecialty, working for more than five years to define and help create the discipline with the goal of advancing the field and the role of informaticians in improving healthcare. This creation of the new subspecialty will help standardize clinical informatics training programs, increase the number of training opportunities available, and provide an immediately recognized credential for organizations hiring informaticians.

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First diplomates board certified in the subspecialty of clinical informatics

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The newly certified diplomates in the subspecialty of clinical informatics received notice of their board certification in December 2013, a development that will contribute to the major systemic overhaul that is underway in healthcare delivery. As leaders in the field, these subspecialists are expected to apply innovative informatics solutions within health systems and encourage interdisciplinary collaboration to improve the value of care delivered.