Neglect of low and middle-income countries in the study of health informatics evolution
The history of health informatics as an academic discipline is a product of the Western world, in which LMICs find little to no mention. The exceptions in this regard are China and Brazil, which have also focused primarily on hospital-based information systems with a focus on EHRs. However, and in contrast, the practice of applying IT to primary healthcare systems has evolved significantly in LMICs over the last two decades. Now as countries are reaching higher levels of data collection coverage and quality, there is an increasing focus being placed on how this data can be used to improve the health of populations. There are initial forays being made into the development of name- based systems for programme tracking and events recording, but they are still in a nascent stage, especially in their ability to be aggregated to population- based systems, and integration with other routine reporting systems. There has been a conscious neglect of hospital information systems and EHRs in these public information systems, but they are expected to receive increased focus in the future.
Given these trends in the evolution of health informatics, we conclude in the final section with a case for a more ‘expanded public health informatics’ (we refer to this later as ‘Expanded PHI’) focus in LMICs.