1. Douthit, Brian J. MSN, RN-BC
  2. Richesson, Rachel PhD, MPH, FACMI

Article Content

Theory and science are inseparable; every scientific discipline relies on theory to build a foundation for good practice and meaningful research. The discipline of informatics is in a unique position as it is relatively new and is well poised to develop, adopt, and adapt theories that support the numerous activities of informatics stakeholders within many different contexts. While we have borrowed theory from other disciplines, informatics is becoming an area of unique scientific research and discovery, creating a need for its own discipline-specific theories. Despite the growing necessity for unique informatics theory and a subsequent response of new works showcasing new applications of theory, a significant portion of informatics-based work continues to lack reference to (and therefore appears not to be informed or driven by) existing theory as a part of their process.1,2 A desperate need exists to disseminate theory to informatics stakeholders in a way that promotes its adoption and use in both research and practice.


Applied Interdisciplinary Theory in Health Informatics3 is edited by Philip Scott, Nicolette de Keizer, and Andrew Georgiou; published in 2019, it showcases a number of theories in health informatics in a way that has not yet been collected in one volume. This book offers three major benefits that should appeal to those interested in health informatics: a concise background on theory, applied use cases for a range of relevant theories and frameworks, and an example of theory synthesis and suggestions for future theory development and related activities. With this layout, this text can be useful to a wide audience from novice to expert. This review will cover several dimensions of the book, including a critique of layout and organization, content, and editors and authorship.



Overall, this book is divided into three major sections (excluding introductory material): information science and technology theories (Part 1), social and psychological theories (Part 2), and synthesis (Part 3). Parts 1 and 2 are titled after two of the American Medical Informatics Association (AMIA) foundational domains of health informatics. Despite some overlap in concepts explored between these two sections (eg, decision-making and implementation considerations), this textbook remains simple to navigate. The text was designed to be used for different needs; those reading it cover to cover will leave with an appreciation of the role of theory, a clear understanding of several theories used in informatics research, and an understanding of the field. However, readers may also easily navigate to one of these sections and pick theories relevant to their interest.



In our opinion, one of the most impressive features of this book is its excellent coverage of the importance of theory to informatics, which is provided through the foreword, preface, and first chapter. The book opens with the perspectives of Charles Friedman, PhD, of the University of Michigan Health Sciences Center, who is known for his extensive contributions to health informatics and for promoting the "learning health system." This foreword gives a very brief but rich perspective of the relationship between informatics and theory, followed by the preface, which outlines the purpose of the book, provides definitions, and describes how the book should be used. The editors discuss varied definitions of theory and clarify their perspective as it relates to the book. Most important, health informatics is explored and defined to structure the subject areas of the text, as well as the term "interdisciplinary" in this context. The end of the preface also includes an overview of book structure and suggestions for its use in educational applications.


The first chapter explores the concept of health informatics theory in more depth, distinguishing between definitions and uses of theories, frameworks, and models. This information provides a basis to understand concepts and theory and clarifies the foundational role of theory in health informatics.


The majority of the book is divided among information science and technology theories, and social and psychological theories. Regardless of section, the format of each chapter is similar: an introduction and background, an exploration of applications, and a concise discussion. The selection of theories in this text is adequately representative without being exhaustive and overwhelming. The selection of theories is supported by information provided in the final chapter, where the editors followed two of the AMIA foundational domains of health informatics. Theories specific to health sciences, the third and final domain, were not addressed, as these topics would be less applied and not as useful to this audience.


Overall, we found the chapters to be well organized, not overly long, and clear. As there are many topics covered ranging from computational theory to behavioral change, there does seem to be a degree of tailoring toward the intended reader. For example, the chapter on information theory and medical decision making is largely explained by mathematical formulas and may not be easily understood by general readers; the framing of such chapters makes it clear that they are intended for a specific audience (in this case, computer scientists). While there are benefits and drawbacks to such a breadth of topics in a single volume, the authors succeed in making the information clear so that readers can understand key points from each chapter regardless of background. What is most important is that each chapter highlights specific use cases and utilizations for theory, which helps the reader to understand how theory affects real-world applications and practice. Limitations and challenges are also often highlighted in the discussion, further informing the reader of the current gaps in health informatics theory and the importance of future theory development in our dynamic and multidisciplinary field.


The third and final section (Synthesis) opens with an example of developing a health informatics-specific framework to address challenges in technology implementation, giving the reader an example of how to develop new frameworks with an informatics lens. The final chapter addresses gaps in current theory coverage and provides suggestions for future development, inspiring readers to both use and develop theory for their work.


We found the book well-written, clear, and concise. The layout, coverage, and depth of content of this book is useful for, and appealing to, a wide variety of health informaticists.



The editors of this text represent a wide range of expertise in health informatics, and contributed both the preface and the final chapter, which reflects on the future of health informatics theory. The remaining 16 chapters were written by authors who hold deep theoretic knowledge in different informatics domains, have made significant contributions to the field, and hold positions at well-known universities. Of note, the authors are primarily from Europe, Australia, and New Zealand. This might suggest that the informatics community in other parts of the world may be less familiar with, or lack training in or appreciation of theory, or it may simply be a coincidence. We see value in this book and are delighted to help disseminate this knowledge to others. To be a rigorous scientific discipline, informatics needs theory that is shaped not only by those with different expertise but also by those with an understanding of healthcare in different contexts.



This book appeals to an audience versed in health informatics but is written in a way that is especially appealing to educators. For those who wish to use this book in the classroom, objectives and discussion questions are provided for each chapter. For those who are interested in this text to further inform their line of work or understanding of theory, it is perfectly acceptable to read chapters of interest in any order. The chapters do not need to be read sequentially. However, we do recommend the following: if you wish to skim this book and are not an expert in theory, if nothing else, read the foreword, preface, first chapter, and final chapter. These few sections provide an excellent background and give insight into the future development of health informatics theory. From there, you may decide to read further on specific topics of interest.



In summary, we find this to be a much-needed text that samples the theories that define health informatics. Researchers, students, nurse informaticists, and clinicians alike can benefit from the information in this book, available as a free open-access eBook, but print books may be ordered as well. We highly recommend the book, as all of us who are interested in health informatics should have an appreciation for the wide variety of theories that inform our work. Only then may we guide the future of health informatics and help to distinguish it as a unique scientific discipline.




1. Lehmann CU, Gundlapalli AV. Improving bridging from informatics practice to theory. Methods of Information in Medicine. 2015;54(6): 540-545. [Context Link]


2. Nilsen P. Making sense of implementation theories, models and frameworks. Implementation Science. 2015;10: 53. [Context Link]


3. Scott P, de Keizer N, Georgiou A. Applied Interdisciplinary Theory in Health Informatics. Amsterdam, the Netherlands: IOS Press. [Context Link]