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WhatisBiomedicalInformatics?
WilliamHersh,MD,FACP,FACMIProfessorandChair
DepartmentofMedicalInformatics&ClinicalEpidemiologyOregonHealth&ScienceUniversity
Portland,OR,USAEmail:[email protected] :www.billhersh.info
Blog:http://informaticsprofessor.blogspot.comTwitter:@williamhersh
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Butler,M(2014).Adaptordisappear:AHIMA’sreality2016hasanewmissiontotransformtheHIMworkforcethrougheducation—orelse.JournalofAHIMA.85(5):24-29.Calhoun,M,Rudman,B,etal.(2012).Vision2016toReality2016:buildingaprofession.JournalofAHIMA.83(8):18-23.Carayon,PandKarsh,BT(2010).IncorporatingHealthInformationTechnologyIntoWorkflowRedesign.Rockville,MD,AgencyforHealthcareResearchandQuality.http://www.innovations.ahrq.gov/content.aspx?id=3048Chen,MA,Hollenberg,JP,etal.(2010).Patientcareoutsideofofficevisits:aprimarycarephysiciantimestudy.JournalofGeneralInternalMedicine.26:58-63.Chisholm,CD,Weaver,CS,etal.(2011).Ataskanalysisofemergencyphysicianactivitiesinacademicandcommunitysettings.AnnalsofEmergencyMedicine.18:117-122.Coiera,E(2007).Puttingthetechnicalbackintosocio-technicalsystemsresearch.InternationalJournalofMedicalInformatics.76(Supp1):98-103.Collen,MF(1994).Theoriginsofinformatics.JournaloftheAmericanMedicalInformaticsAssociation.1:91-107.Collen,MF(1995).AHistoryofMedicalInformaticsintheUnitedStates1950-1990.Bethesda,MD,AmericanMedicalInformaticsAssociation.Collen,MFandBall,MJ,Eds.(2015).TheHistoryofMedicalInformaticsintheUnitedStates.NewYork,NY,Springer.Collins,FS(2010).OpportunitiesforresearchandNIH.Science.327:36-37.Collins,FSandVarmus,H(2015).Anewinitiativeonprecisionmedicine.NewEnglandJournalofMedicine.372:793-795.Davenport,THandPatil,DJ(2012).DataScientist:TheSexiestJobofthe21stCentury.HarvardBusinessReview,October,2012.http://hbr.org/2012/10/data-scientist-the-sexiest-job-of-the-21st-century/delaCalle,G,García-Remesal,M,etal.(2012).e-MIR2:apubliconlineinventoryofmedicalinformaticsresources.BMCMedicalInformatics&DecisionMaking.12:82.http://www.biomedcentral.com/1472-6947/12/82Detmer,DEandShortliffe,EH(2014).Clinicalinformatics:prospectsforanewmedicalsubspecialty.JournaloftheAmericanMedicalAssociation.311:2067-2068.Dixon,B(2016).HealthInformationExchange-NavigatingandManagingaNetworkofHealthInformationSystems.Amsterdam,Netherlands,Elsevier.Donoho,D(2015).50yearsofDataScience.PrincetonNJ,TukeyCentennialWorkshop.https://dl.dropboxusercontent.com/u/23421017/50YearsDataScience.pdfFarber,J,Siu,A,etal.(2007).Howmuchtimedophysiciansspendprovidingcareoutsideofofficevisits?AnnalsofInternalMedicine.147:693-698.Fenton,SH,Joost,E,etal.(2012).HealthinformationtechnologyknowledgeandskillsneededbyHITemployers.AppliedClinicalInformatics.3:448-461.Ferguson,T(2007).e-Patients:HowTheyCanHelpUsHealHealthCare.Boston,MA,e-PatientScholarsWorkingGroup.http://e-patients.net/e-Patients_White_Paper.pdfFourman,M(2002).Informatics.InternationalEncyclopediaofInformationandLibraryScience,2ndEdition.J.FeatherandP.Sturges.London,England,Routledge:237-244.Friedman,CP(2009).A'fundamentaltheorem'ofbiomedicalinformatics.JournaloftheAmericanMedicalInformaticsAssociation.16:169-170.Friedman,CP(2012).Whatinformaticsisandisn't.JournaloftheAmericanMedicalInformaticsAssociation.20:224-226.Friedman,CP,Wong,AK,etal.(2010).Achievinganationwidelearninghealthsystem.ScienceTranslationalMedicine.2(57):57cm29.http://stm.sciencemag.org/content/2/57/57cm29.fullGadd,CS,Williamson,JJ,etal.(2016).Eligibilityrequirementsforadvancedhealthinformaticscertification.JournaloftheAmericanMedicalInformaticsAssociation.23:851-854.
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Gadd,CS,Williamson,JJ,etal.(2016).Creatingadvancedhealthinformaticscertification.JournaloftheAmericanMedicalInformaticsAssociation.23:848-850.Gardner,RM,Overhage,JM,etal.(2009).Corecontentforthesubspecialtyofclinicalinformatics.JournaloftheAmericanMedicalInformaticsAssociation.16:153-157.Geissbuhler,A,Kimura,M,etal.(2011).Confluenceofdisciplinesinhealthinformatics:aninternationalperspective.MethodsofInformationinMedicine.50:545-555.Giannangelo,K,Ed.(2015).HealthcareCodeSets,ClinicalTerminologies,andClassificationSystems,ThirdEdition.Chicago,IL,AHIMAPress.Gilchrist,V,McCord,G,etal.(2005).Physicianactivitiesduringtimeoutoftheexaminationroom.AnnalsofFamilyMedicine.3:494-499.Glaser,J(2012).FromtheTransaction-BasedEHRtotheIntelligence-BasedEHR.Hospital&HealthNetworks,August14,2012.http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=6510004866Gottschalk,AandFlocke,SA(2005).Timespentinface-to-facepatientcareandworkoutsidetheexaminationroom.AnnalsofFamilyMedicine.3:488-493.Greenes,RAandShortliffe,EH(1990).Medicalinformatics-anemergingacademicdisciplineandinstitutionalpriority.JournaloftheAmericanMedicalAssociation.263:1114-1120.Greiner,ACandKnebel,E,Eds.(2003).HealthProfessionsEducation:ABridgetoQuality.Washington,DC,NationalAcademiesPress.Hasman,A,Ammenwerth,E,etal.(2011).Biomedicalinformatics--aconfluenceofdisciplines?MethodsofInformationinMedicine.50:508-524.Haux,R(2010).Medicalinformatics:past,present,future.InternationalJournalofMedicalInformatics.79:599-610.Hayes,GandBarnett,D(2008).UKHealthComputing:RecollectionsandReflections.Swindon,UK,BritishComputerSociety.Henry,J,Pylypchuk,Y,etal.(2016).AdoptionofElectronicHealthRecordSystemsamongU.S.Non-FederalAcuteCareHospitals:2008-2015.Washington,DC,DepartmentofHealthandHumanServices.http://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.phpHersh,W(2004).Healthcareinformationtechnology:progressandbarriers.JournaloftheAmericanMedicalAssociation.292:2273-2274.Hersh,W(2008).HealthandBiomedicalInformatics:OpportunitiesandChallengesforaTwenty-FirstCenturyProfessionanditsEducation.IMIAYearbookofMedicalInformatics2008.A.GeissbuhlerandC.Kulikowski.Stuttgart,Germany,Schattauer:138-145.Hersh,W(2009).Astimulustodefineinformaticsandhealthinformationtechnology.BMCMedicalInformatics&DecisionMaking.9:24.http://www.biomedcentral.com/1472-6947/9/24/Hersh,W(2010).Thehealthinformationtechnologyworkforce:estimationsofdemandsandaframeworkforrequirements.AppliedClinicalInformatics.1:197-212.Hersh,W(2012).FromImplementationtoAnalytics:TheFutureWorkofInformatics.InformaticsProfessor,April1,2012.http://informaticsprofessor.blogspot.com/2012/04/from-implementation-to-analytics-future.htmlHersh,W(2013).DoPhysiciansSpendTooMuchTimeWithComputers?InformaticsProfessor,August30,2013.http://informaticsprofessor.blogspot.com/2013/08/do-physicians-spend-too-much-time-with.htmlHersh,WandEhrenfeld,J(2017).ClinicalInformatics.HealthSystemsScience.S.Skochelak,R.Hawkins,L.Lawsonetal.NewYork,NY,Elsevier:105-116.Hersh,WR(2002).Medicalinformatics-improvinghealthcarethroughinformation.JournaloftheAmericanMedicalAssociation.288:1955-1958.Hersh,WR(2006).Whoaretheinformaticians?Whatweknowandshouldknow.JournaloftheAmericanMedicalInformaticsAssociation.13:166-170.
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Hersh,WR(2009).InformationRetrieval:AHealthandBiomedicalPerspective(3rdEdition).NewYork,NY,Springer.Hersh,WR(2014).HealthcareDataAnalytics.HealthInformatics:PracticalGuideforHealthcareandInformationTechnologyProfessionals,SixthEdition.R.HoytandA.Yoshihashi.Pensacola,FL,Lulu.com:62-75.Hersh,WR,Gorman,PN,etal.(2014).BeyondinformationretrievalandEHRuse:competenciesinclinicalinformaticsformedicaleducation.AdvancesinMedicalEducationandPractice.5:205-212.http://www.dovepress.com/beyond-information-retrieval-and-electronic-health-record-use-competen-peer-reviewed-article-AMEPHersh,WR,Weiner,MG,etal.(2013).Caveatsfortheuseofoperationalelectronichealthrecorddataincomparativeeffectivenessresearch.MedicalCare.51(Suppl3):S30-S37.Hey,T,Tansley,S,etal.,Eds.(2009).TheFourthParadigm:Data-IntensiveScientificDiscovery.Redmond,WA,MicrosoftResearch.Hoyt,REandYoshihashi,A,Eds.(2014).HealthInformatics:PracticalGuideforHealthcareandInformationTechnologyProfessionals,SixthEdition.Pensacola,FL,Lulu.com.Kann,MandLewitter,F,Eds.(2013).TranslationalBioinformatics.SanFrancisco,CA,PublicLibraryofScience.Kim,CS,Lovejoy,W,etal.(2010).Hospitalisttimeusageandcyclicality:opportunitiestoimproveefficiency.JournalofHospitalMedicine.5:329-334.Kleinke,JD(2005).Dot-gov:marketfailureandthecreationofanationalhealthinformationtechnologysystem.HealthAffairs.24:1246-1262.Kloss,LL(2012).HealthInformationManagementin2016.Wayne,PA,Precyse.http://www.precyse.com/resources/HIMin2016WhitePaper_042412.pdfKrist,AHandWoolf,SH(2011).Avisionforpatient-centeredhealthinformationsystems.JournaloftheAmericanMedicalAssociation.305:300-301.Kulikowski,CA,Shortliffe,EH,etal.(2012).AMIABoardwhitepaper:definitionofbiomedicalinformaticsandspecificationofcorecompetenciesforgraduateeducationinthediscipline.JournaloftheAmericanMedicalInformaticsAssociation.19:931-938.LaTour,KMandEichenwald-Maki,S,Eds.(2013).HealthInformationManagement:Concepts,Principles,andPractice(4thEdition).Chicago,IL,AmericanHealthInformationManagementAssociation.Leshner,AI,Terry,SF,etal.,Eds.(2013).TheCTSAProgramatNIH:OpportunitiesforAdvancingClinicalandTranslationalResearch.Washington,DC,InstituteofMedicine.Lesk,A(2014).IntroductiontoBioinformatics,4thEdition.Oxford,England,OxfordUniversityPress.Lowry,SZ,Quinn,MT,etal.(2012).TechnicalEvaluation,Testing,andValidationoftheUsabilityofElectronicHealthRecords.Gaithersburg,MD,NationalInstituteforStandardsandTechnology.http://www.nist.gov/healthcare/usability/upload/EUP_WERB_Version_2_23_12-Final-2.pdfMagnuson,JAandFu,PC,Eds.(2014).PublicHealthInformaticsandInformationSystems.NewYork,NY,Springer.Mamykina,L,Vawdrey,DK,etal.(2016).Howdoresidentsspendtheirshifttime?Atimeandmotionstudywithaparticularfocusontheuseofcomputers.AcademicMedicine.91:827-832.Mandl,KDandKohane,IS(2012).EscapingtheEHRtrap--thefutureofhealthIT.NewEnglandJournalofMedicine.366:2240-2242.Manos,D(2012).CNIOroleontherise.HealthcareITNews,March12,2012.http://www.healthcareitnews.com/news/cnio-role-riseMartin,SAandSinsky,CA(2016).Themapisnottheterritory:medicalrecordsand21stcenturypractice.Lancet.388(2053-2056)Maxson,E,Jain,S,etal.(2010).Theregionalextensioncenterprogram:helpingphysiciansmeaningfullyusehealthinformationtechnology.AnnalsofInternalMedicine.153:666-670.
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Maxson,ER,Jain,SH,etal.(2010).Beaconcommunitiesaimtousehealthinformationtechnologytotransformthedeliveryofcare.HealthAffairs.29:1671-1677.McDonald,CJ,Callaghan,RM,etal.(2014).Useofinternist'sfreetimebyambulatorycareelectronicmedicalrecordsystems.JAMAInternalMedicine:Epubaheadofprint.McKethan,A,Brammer,C,etal.(2011).AnearlystatusreportontheBeaconCommunities'plansfortransformationviahealthinformationtechnology.HealthAffairs.30:782-788.Moehr,J(2004).TheQuestforIdentityofMedicalInformatics,andforGuidancetoEducationinit:theGermanConferenceattheReisensburgof1973revisited.YearbookofMedicalInformatics2004.R.Haux,A.McCrayandC.Kullikowski.Stuttgart,Germany,Schattauer:200-209.O'Reilly,T,Loukides,M,etal.(2012).HowDataScienceIsTransformingHealthCare-SolvingtheWanamakerDilemma.Sebastopol,CA,O'ReillyMedia.Osborn,R,Moulds,D,etal.(2015).Primarycarephysiciansintencountriesreportchallengescaringforpatientswithcomplexhealthneeds.HealthAffairs.34:2104-2112.Payne,TH,Detmer,DE,etal.(2011).National-scaleclinicalinformationexchangeintheUnitedKingdom:lessonsfortheUnitedStates.JournaloftheAmericanMedicalInformaticsAssociation.18:91-98.Protti,DandJohansen,I(2010).WidespreadAdoptionofInformationTechnologyinPrimaryCarePhysicianOfficesinDenmark:ACaseStudy.NewYork,NY,CommonwealthFund.http://www.commonwealthfund.org/~/media/Files/Publications/IssueBrief/2010/Mar/1379_Protti_widespread_adoption_IT_primary_care_Denmark_intl_ib.pdfQuiros,FGB,Luna,D,etal.(2009).ExperienceintheDevelopmentofanIn-houseHealthInformationSystemandtheTrainingNeedsoftheHumanResourcesattheHospitalItalianodeBuenosAires.IMIAYearbookofMedicalInformatics2009.A.GeissbuhlerandC.Kulikowski.Stuttgart,Germany,Schattauer:147-152.Reddy,CKandAgarwal,CC,Eds.(2015).HealthcareDataAnalytics.BocaRaton,FL,Chapman&Hall.Richesson,RLandAndrews,JE,Eds.(2012).ClinicalResearchInformatics.NewYork,NY,Springer.Rosenbaum,L(2015).Transitionalchaosorenduringharm?TheEHRandthedisruptionofmedicine.NewEnglandJournalofMedicine.373:1585-1588.Rowley,J(2007).Thewisdomhierarchy:representationsoftheDIKWhierarchy.JournalofInformationScience.33:163-180.Safran,CandDetmer,DE(2005).Computerizedphysicianorderentrysystemsandmedicationerrors.JournaloftheAmericanMedicalAssociation.294:179.Safran,C,Shabot,MM,etal.(2009).ACGMEprogramrequirementsforfellowshipeducationinthesubspecialtyofclinicalinformatics.JournaloftheAmericanMedicalInformaticsAssociation.16:158-166.Sarkar,IN,Ed.(2014).MethodsinBiomedicalInformatics:APragmaticApproach.London,England,AcademicPress.Sayles,NBandTrawick,KC(2014).IntroductiontoComputerSystemsforHealthInformationTechnology,2ndEdition.Chicago,IL,AmericanHealthInformationManagementAssociation.Schleidgen,S,Klingler,C,etal.(2013).Whatispersonalizedmedicine:sharpeningavaguetermbasedonasystematicliteraturereview.BMCMedicalEthics.14:55.http://www.biomedcentral.com/1472-6939/14/55Sengstack,PandBoicey,C(2015).MasteringInformatics:AHealthcareHandbookforSuccess.Indianapolis,IN,SigmaThertaTauInternational.Shaffer,VandGibson,R(2016).12thAnnualAMDIS-GartnerSurveyofCMIOsPreliminaryFindings.Stamford,CT,Gartner.http://amdis.org/wp-content/uploads/2014/01/amdisGartnerCMIOSurvey.pdfShortliffe,EHandCimino,JJ,Eds.(2006).BiomedicalInformatics:ComputerApplicationsinHealthCareandBiomedicine.NewYork,NY,Springer.
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WhatisBiomedicalInformatics?
WilliamHersh,MD,FACP,FACMIProfessorandChair
DepartmentofMedicalInformatics&ClinicalEpidemiologyOregonHealth&ScienceUniversity
Portland,OR,USAEmail:[email protected] :www.billhersh.info
Blog:http://informaticsprofessor.blogspot.comTwitter:@williamhersh
1
Outline
• Termsanddefinitions• Recentgrowthandchange– HITECHandmeaningfuluse
• People• Resources• Educationandtraining
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Whatisbiomedicalandhealthinformatics?
• IgetaskedthissooftenthatIkeepaWebsite– http://www.billhersh.info/whatis/
• Andablog– http://informaticsprofessor.blogspot.com
• Ihavealsowrittenarticlesaboutit– Medicalinformatics:improvinghealthcarethroughinformation
(Hersh,2002)– Buttherearebarriers(Hersh,2004)– Characterizationofandchangesintheprofession(Hersh,2006)– Manycareeropportunitiesaswell(Hersh,2008)– Reconcilingdefinitionsofterms(Hersh,2009)– Theinformaticsprofessionalworkforce(Hersh,2010)– Clinicalinformaticsinthecontextofhealthsystemsscience(Hersh,
2017)
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Otherviews• Earlydefinition:“storage,acquisition,anduseofinformation”(Greenes,1990)
• Other(US)perspectives– “Thescienceofinformationappliedtobiomedicine…dataplusmeaning.” (Bernstam,2010)
– Paradigmshiftinbiomedicinefrom“individualbrainstosystemsofbrains” (Stead,2011)
– AMIA:“Theinterdisciplinaryfieldthatstudiesandpursuestheeffectiveusesofbiomedicaldata,information,andknowledgeforscientificinquiry,problemsolving,decisionmaking,motivatedbyeffortstoimprovehumanhealth”(Kulikowski,2012)
• Europeanandglobalperspectives(Haux,2010;Hasman,2011;Geissbuhler,2011)
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Letusstartbydefining“informatics”
• Thedisciplinefocusedontheacquisition,storage,anduseofinformationinaspecificsettingordomain(Hersh,2009)– Ismoreaboutinformationthan
technology• Sometimesdefinedasactivity
attheintersectionofpeople,information,andtechnology
• Thescienceof“sociotechnicalsystems” (Coiera,2007)
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(SUNYBuffalo)
Whatinformatics“isandisn’t”(Friedman,2012)
• Is– Cross-trainingwherebasic
informationalsciencesmeetabiomedicalapplicationdomain
– Relentlesspursuitofassistingpeople
– Towerofachievement• Modelformulation• Systemdevelopment• Systemimplementation• Studyofeffects
• Isn’t– Scientistsorclinicians
tinkeringwithcomputers– Analysisoflargedatasets
perse– Circumscribedrolesrelated
todeploymentofelectronichealthrecords(*pointofdisagreement)
– Professionofhealthinformationmanagement
– Anythingdoneusingacomputer
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Ithasa“fundamentaltheorem” anda“goldenrule”
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FundamentalTheorem(Friedman,2009)– basedon“relentlesspursuitofassistingpeople”
Goalofinformaticsis
Goalisnot
GoldenRule(Kuperman,personalcommunication,2013):
“Neverimplementuntoothersthatwhichyouwouldnotimplementuntoyourself”
Mycurrentpreferredterminology• Biomedicalandhealthinformatics(BMHI)isthefieldconcernedwiththeoptimaluseofinformation,oftenaidedbytechnology,toimproveindividualhealth,healthcare,publichealth,andbiomedicalresearch– Informaticsappliedinamorefocuseddomainis{X}informatics,e.g.,nursing,dental,pathology,primarycare,etc.
– Canbeclassifiedby“level” ofdomainbutalsohassomeoverarchingareas,e.g.,imagingandresearch
• PractitionersofBMHIareusuallycalledinformaticians (sometimesinformaticists)
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Informaticsalsohasan“adjectiveproblem”
(Hersh,2009;adaptedfromShortliffe,2006)
Informatics=People+Information+Technology
BiomedicalandHealthInformaticsLegalInformatics Chemoinformatics
Bioinformatics(cellularandmolecular)
Clinical(orMedical)Informatics
(person)
{Clinicalfield}Informatics
PublicHealthInformatics(population)
ConsumerHealthInformatics
ImagingInformatics ResearchInformatics
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Informaticsnowviewedasacorecompetencyforhealthprofessionals
• AccordingtoInstituteofMedicinereport,themodernhealthcareprofessionalmusthavecompetencyininformaticsaspartoflargergoaltoprovidepatient-centeredcare(Greiner,2003)
• Informaticscompetencyisnotjustcomputerliteracy!– The“Googlegeneration” does
notnecessarilyhavegoodinformationskills(CIBER,2008)
• Informaticsisacorecomponentofthe“learninghealthsystem”(Friedman,2010;Smith,2012)
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Somehistoricalperspectiveoninformatics
• OriginoftermattributedtoDreyfusin1962(Fourman,2002)
• AchievedwidespreaduseinFrance(informatique),Russia,andlaterrestofEuropein1960stodenotecomputingissuesrelatedtoinformationuse
• “Medicalinformatics” firstusedin1974(Collen,1994)– MoreEuropeanhistoryfromMoehr (2004)– HistoryoffielddocumentedbyCollen(1995,2015)
• Atpresent,mostsignificantuseisinbiomedicalarena,butitisusedbyotherdomains,suchaslaw,chemistry,socialsciences,etc.
11
Howisinformaticsdistinguishedfromrelatedterms?
• Informationtechnology(IT)– computerandrelatedtechnology
• ComputerscienceisacademicdisciplinethatunderliesIT(andothertechnologies)
• ManagementinformationsystemsisanotherfieldunderlyingIT(usuallyinbusinessschools)
• Healthinformationtechnology(HITorhealthIT)– health-relatedapplicationofIT
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Otherrelatedterms
• Healthinformationmanagement(HIM)–disciplinehistoricallyfocusedonmanagementof(paper)medicalrecords(changingincurrentenvironment),withthreemainlevelsofpractice– RegisteredHealthInformationAdministrator(RHIA)–highestlevel,baccalaureatedegree
– RegisteredHealthInformationTechnologist(RHIT)–associatedegree
– CertifiedCodingSpecialist(CCS)– usuallylessthenassociatedegree
13
Otherrelatedterms
• Informationandcommunicationstechnology(ICT)– sameasITwithaddedemphasisontelecommunications
• eHealth – useofICTforhealth• Telemedicine – provisionofhealthcarewhenparticipantsseparatedbytimeand/ordistance
• Telehealth – pursuitofhealthwhenseparatedbytimeand/ordistance
• mHealth – useofmobiledevicesforhealth
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Otherrelatedterms• Evidence-basedmedicine(EBM)– theapplicationofthe
bestscientificevidenceinthemedicaldecision-makingprocess
• Evidence-basedpractice(EBP)– theapplicationofEBMinclinicalpractice
• Comparativeeffectivenessresearch(CER)– researchthatcomparesoneormorediagnosticortreatmentoptionstoevaluateeffectiveness,safetyoroutcomes(alsocalledpatient-centeredoutcomesresearch)
• Informationretrieval(alsoknownassearch,partoflargerknowledgemanagement)– thefielddevotedtosearching(mostlytext,mostlyknowledge-basedinformation)
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Termsrelatedtomedical/clinicalrecords
• Electronichealthrecord(EHR)– patient’shealthrecordindigitalform– Hasmostlysupplantedelectronicmedicalrecord(EMR)
• Meaningfuluse– programofincentivesforEHRadoptioninUSrequiringthattheybeusedinwaysthatachievehealthcaregoals
• Personalhealthrecord(PHR)– personallycontrolledhealthrecord
• Healthinformationexchange(HIE)– exchangeofhealthinformationacrosstraditionalbusinessandotherboundaries(averb)– OrganizationmanagingHIEusedtobecalledaRegionalHealth
InformationOrganization (RHIO),nowcalledanHIE(anoun)
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KeyaspectsoftheEHR
• Therecordanditsdata• Standards andinteroperability• Meaningfulusethroughclinicaldecisionsupport(CDS)andcomputerizedphysician/providerorderentry(CPOE)
• Implementationandevaluation• Privacy,security,andconfidentiality• Re-use(orsecondaryuse),includinganalytics,ofdata
17
ManyareextollingthevirtuesofBMHIinhealthcareandrelatedareas
• Mostprominentdiscussionhasfocusedonimprovinghealthcarethroughimprovedquality,safety,andefficiency
• However,therearemanychallenges– MixingITwithclinicalworkflowhasbeendifficult– SomeHIThasbeendeleterious– FinancialbenefitsofITdonotalwaysaccruetothosewhopay
– Largerproblemsinhealthcareorganizationandfinancingmakeanytypeofchangedifficult
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Informaticsisalsoessentialformodernbiomedicalresearch
• EmbodiedintheNationalInstitutesofHealth(NIH)Roadmaptoacceleratebiomedicalresearchdiscovery(http://commonfund.nih.gov)– Today’sbiomedicalresearcherroutinelygenerates…billionsofbytesof
data.…Whatresearchersneedarecomputerprogramsandothertoolstoevaluate,combine,andvisualizethesedata.Insomecases,thesetoolswillgreatlybenefitfromtheawesomestrengthofsupercomputersorthecombinedpowerofmanysmallermachinesinacoordinatedwaybut,inothercases,thesetoolswillbeusedonmodernpersonalcomputersandworkstations.
• AlsopermeatesprioritiesofNIHDirector(Collins,2010)– High-throughputtechnologies– Translationalresearch– Supportinghealthcarereform– Globalhealth– Empoweringtheresearchcommunity
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Informaticstermsforbiomedicalresearch
• Translationalresearch– classically,thetranslationofbasicresearchintoclinicalapplicability(“benchtobedside”),butalsofromcontrolledsettingstocommunityandpopulation(Woolf,2008)– Increasingrecognitionthatresearchfindingsmust“translate” intoclinicalcare
morequicklyandefficiently,leadingtoUSgovernmentinvestmentinclinicalandtranslationalresearchthroughtheNIHClinical&TranslationalScienceAward(CTSA)program(Leshner,2013)
– Translationalbioinformatics– bioinformaticsappliedtohealth-relatedproblems(Kann,2013)
• Precisionmedicine (IOM,2011;Collins,2015)– clinicalcaretailoredtoanindividual’scharacteristics,includingtheirgenome– Sometimescalledpersonalizedmedicine(Schleidgen,2013)
• Clinicalresearchinformatics(CRI)isareaofinformaticsappliedtoclinicalresearch(Richesson,2012)– Differencebetweeninformationtechnology(IT)andinformaticsvery
evidentinthisdomain(Bernstam,2009)
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Wecannotignoretheessentialroleoftheconsumer/patient/citizen
• OriginalStrategicFrameworkoftheOfficeoftheNationalCoordinatorforHealthIT(ONC)calledforITtofacilitate“consumer-centric,information-rich” healthcare(Brailer,2004)
• SomeadvocatethatthePHRbeatthecenterofthediscussionconcerninghealthrecords(Krist,2011)– Manyissuesrelatedtoflowofinformationandresponsibilityfor
it• e-Patients – Internet-enabledpatients
– Originatedwithself-helpleader,Dr.TomFerguson(2007)– Bestknownise-PatientDave,whofoundagreatdealof
incorrectinformationinhismedicalrecordinBostonteachinghospitalandpublicizeditwidely(Wangsness,2009)
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Afinalperspectiveofinformatics• Dataè Informationè Knowledge
– UsedinmanyfieldsbutintroducedininformaticsbyBlum(1984)
• Dataaretherawmaterialcollectedandstored• Informationgivesmeaningandorganizationtothedata
• Knowledgeprovidesunderstandingandapplicabilitytonewsituations
• Someaddwisdom,asknowinghowtoapplyknowledge(Rowley,2007)
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Informaticsisincreasinglybecominga“datascience”
• EHR(andprobablyallinformatics)workchangingfrom“implementation”to“analytics”(Hersh,2012)
• Datascienceisthe“sexiestjobofthe21stcentury?”(Davenport,2012)
• Growingimportanceofroleforanalytics inhealthcare(Adams,2011;O’Reilly,2012;Hersh,2014)– Butwemustusecautiontomakesurethatclinicaldataiscomplete,correct,andotherwisesound(theroleofinformatics?)(Hersh,2013)
23
Wehaveenteredtheeraof“BigData”
• Four“V’s”ofBigData:volume,velocity,variety,andveracity(Zikopoulos,2011)
• Leadingtoanewparadigmofscience(Hey,2009)?– Makingthescientificmethodobsolete,i.e.,noneedfor
experimentationanymore?(Anderson,2007)– Notreally;manycaveatsforresearchuseofclinicaldata(Hersh,
2013)• OtherconcernsaboutdatascienceandBigData
– “Provocations”tostudyingdata(Boyd,2011)• Biggerisnotnecessarilybetter• Westudywhatwecananswer• Notalldataisavailableoraccessible
– Haven’tmanyfieldsbeendoingthisalready,e.g.,statistics(Donoho,2015)?
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Ismedicine/healthreallyaninformationscience?
• Timestudiesofhospital(Ammenwerth,2009;Tipping,2010;Kim,2010;Tipping,2010;Yousefi,2011;Victores,2014)andemergency(Chisholm,2011)physiciansshowphysiciansspendabout– 15-38%oftheirtimeindirectpatientcare– 50-67%oftheirtimeinindirectpatientcare,dividedbetween
reviewingresults,performingdocumentation,andengagingincommunication
• Studiesofoutpatientphysiciansfind– 14-39%ofworktakesplaceoutsidetheexamroom(Gilchrist,
2005;Gottschalk,2005)– Workrelatedtopatientwhenhe/shenotpresentconsumes15-
23%ofphysicianworkday(Gottschalk,2005;Farber,2007;Chen,2010)
25
Evenmoreworkwithdataandinformationmorerecently
• StudiesineraofwidespreadEHRadoption– Internsinlightofdutyhoursrestrictionsfoundtospendlesstimein
directpatientcareandmoreintalkingwithotherphysiciansanddocumenting,withabout40%oftimespentinteractingwithcomputers(Block,2013)
– About60%ofinternistsreported“loss”ofaround48minutesperdayduetoEHRusage(McDonald,2014)
– Residentsinanacademicteachinghospitalfoundtospend50%oftimewithcomputersvs.10%timedirectlywithpatients(Mamykina,2016)
– PhysiciansfoundtospendtwohoursoftimedoingEHRanddesktimeforeveryhourofdirectpatienttime,plusanadditional1-2hourspernight(Sinsky,2016)
• Thesestudiesdon’tanswerwhatistherightamountoftime(Hersh,2013)
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Pause
• Turntoyourneighboranddiscussoneofthefollowing– Describeactivityinyourworkthat
• Isinformatics• Isnotinformatics
– Doeshealthcaresystemnowspendtoomuchtimewithcomputers?
• Iwillaskforafewtovolunteeranswerstooneofthetwoquestions
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Informaticshasgonefrom“dot-com”to“dot-gov”(Kleinke,2007)
• BushAdministration– Recognizedvalueofhealthinformationtechnology(HIT)– Actions:OfficeoftheNationalCoordinatorforHealthIT(ONC),AmericanHealthInformationCommunity(AHIC),etc.
• ObamaAdministration– TheAmericanRecovery&ReinvestmentAct(ARRA)of2009providedincentivesfor“meaningfuluse”ofelectronichealthrecords(EHRs)andtheinfrastructuretoachieveitthroughprovisionsoftheHealthInformationTechnologyforEconomicandClinicalHealth(HITECH)Act(Blumenthal,2011;Blumenthal,2011)
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TheBushAdministrationstartedpromotionofthefield
• PresidentBushStateoftheUnion– mentionedeveryyearfrom2004to2008– January,2004– “Computerizinghealthrecords[can]reducecosts,improvecare,andlowertheriskofmedicalmistakes.”
– January,2007– “Weneedtoreducecostsandmedicalerrorswithbetterinformationtechnology.”
• Bushalsosetgoalofelectronichealthrecords(EHRs)forhalfofallAmericansby2014(WhiteHouse,2005)
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TheObamaAdministrationuppedtheante
“Toimprovethequalityofourhealthcarewhileloweringitscost,wewillmaketheimmediateinvestmentsnecessarytoensurethatwithinfiveyears,allofAmerica’smedicalrecordsarecomputerized…Itjustwon’tsavebillionsofdollarsandthousandsofjobs– itwillsavelives.”
January,2009
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OtherUSgovernmentagenciesandentitiesinvolvedinhealthIT
• NationalLibraryofMedicine(NLM,www.nlm.nih.gov)andotherinstitutesoftheNationalInstitutesofHealth(NIH)– NLMleaderinfundingresearchandtrainingininformatics– ReaffirmedwithappointmentofnewleaderandincorporationofNIHdata
scienceactivities(Brennan,2016;Brennan,2016)• AgencyforHealthcareResearch&Quality(AHRQ,www.ahrq.gov)
– Fundsresearchandpolicydevelopment,produceshealthITinformationresources
• CentersforMedicareandMedicaidServices(CMS,www.cms.hhs.gov)– Payor forMedicareandMedicaid,includingHITECHincentives
• NationalCommitteeforVital&HealthStatistics(NCVHS,www.ncvhs.hhs.gov)– Governmentadvisoryboard,includingissuesrelatedtohealthIT
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TheObamaAdministrationledusintoanew“ARRA”ofhealthIT
• Viewedbysomeasa“downpayment”onhealthcarereform
– ARRAincludedtheHITECHAct– Incentivesfor“meaningfuluse”ofEHRsbyphysiciansandhospitalsstartingin2011(upto$27B)
– Directgrantsadministeredbyfederalagencies($2B)– AlsoHIT-relatedprovisionsinotherareasofARRA,e.g.,
• Comparativeeffectivenessresearch• NIHandotherresearchfunding• Broadbandandotherinfrastructurefunding
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ONCenhancementsduringObamaAdministration
• AppointedDr.DavidBlumenthalasthirdNationalCoordinatorforHIT– Awell-knownHarvardhealth
policyleaderwithinformaticsresearchcredentials
– LedinitialimplementationofHITECHAct(Blumenthal,2011;Blumenthal,2011)
– Followedbysubsequentothers– Currentstrategicplan(2015)
• “PuttingtheI inHealthIT”–www.healthit.gov http://www.healthit.gov/policy-researchers-
implementers/health-it-strategic-planning
Whatis“meaningfuluse?”
• Conceptintroducedinthe2007-2008Congress,HR6898:Health-eInformationTechnologyActof2008butnotpassedatthattimebyStark(2011)
• ItisnotenoughtouseEHRsbutmustusetheminmeaningfulwaystoachievegoalsofhealthcaresystem• Achievingcriteriatiedtofivegoalsforhealthcare• EHRsmustbecertified,abletoexchangeinformation,andabletoreportonclinicalqualitymeasures
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HITECHinfrastructure
• http://www.healthit.gov/policy-researchers-implementers/health-it-adoption-programs
• HITRegionalExtensionCenters(RECs)– $677milliontofund62RECsthatprovideguidance,mainlytosmallprimarycarepracticesandcriticalaccesshospitals,inachievingmeaningfuluse(Maxson,2010)
• State-basedhealthinformationexchange(HIE)– $547millioningrantstostatestodevelopHIEprograms
• Workforcedevelopment– $118millionfor– Communitycollegeconsortia($70M)– CurriculumDevelopmentCenters($10M)– Competencytesting($6M)– University-basedtraininggrants($32M)
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HITECHinfrastructure(cont.)• StrategicHealthITAdvancedResearchProjects(SHARP)Program– stillaneedforresearch;$60Mforfourcollaborativeresearchcenters– SecurityandHealthInformationTechnology– Patient-CenteredCognitiveSupport– SecondaryUseofEHRInformation– HealthCareApplicationandNetworkDesign
• Mostperseveringofthese,hasledtotheSMARTframework(Mandl,2012)
• BeaconProgram– shiningthelightforwardwith$250Mfunding17advanceddemonstrationprojects(Maxson,2010;McKethan,2011)
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Thereisstillplentyofroomforfree-marketeers
• HITindustryestimatedtoreach– $228Boverallgloballyby2020,with13.4%annualgrowthrate
(Markets&Markets,2015)– $84Bformobilesolutionsgloballyby2020,with28.4%annual
growthrate(Markets&Markets,2015)– $18.7Bfordataanalyticsgloballyby2020(Markets&Markets,
2015)• Manyinvestmentactivities,e.g.,
– RockHealth– http://rockhealth.com– NewYorkDigitalHealthAccelerator–
http://digitalhealthaccelerator.com– MassachusettsDigitalHealthInitiative–
http://massdigitalhealth.org– CambiaGrove– www.cambiagrove.com
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HITisnotlimitedtotheUnitedStates
• England– NHSConnectingforHealth– Mostambitiousinworldbutultimatelyfailedafterspending$18billionfor
developingnationwideEHRsandHIE(Brennan,2007;Hayes,2008;Payne,2011;NHS,2011)
– Morerecentapproachesbasedonscaled-backgoals(Wachter,2016)• Denmark
– Near-universaladoptionofEHRsandothertechnologies(Protti,2010)• CanadaHealthInfoway
– http://www.infoway-inforoute.ca/• SingaporeNationalEHR(Accenture,2012)
– https://www.moh.gov.sg/content/moh_web/home/Publications/educational_resources/2015/national-electronic-health-record--nehr-.html
• Argentina(Quiros,2009)• AustraliaMyHealthRecord
– https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/content/home
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UShasbeenalaggardbutisnowcatchingup
39
(Osborn,2015)
(Henry,2016)
Informaticsalsorequiresustoaddressharmsandlimitations
• IOMHITsafetyreportdocumentedconcernsaboutdangers(2012)
• Keyissuestoaddressareworkflow(Carayon,2010)andusability(Lowry,2012)
• EHRmustmovefrombeingamonolithic,transaction-basedapplicationtoaplatform(Glaser,2012;Mandl,2012)
• HasEHRunderminedmedicineorarewein“transitionalchaos”(Rosenbaum,2015;Martin,2016)?
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Pause
• Turntoadifferentneighboranddescribeactivitiesinyourworkthat– Showedthebenefitofinformatics– Showedsomeharmfrominformatics
• Iwillaskforafewtovolunteertheiranswers
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Whodoesbiomedicalandhealthinformatics?
• Opportunitiesfortheinformaticsworkforce• Whatweknowaboutthehealthinformationtechnology(HIT)workforce
• Whatweknowaboutinformaticsleaders• Educationandcertification• HITsalaries• Informaticscompetenciesforinformaticiansandnon-informaticians
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Opportunitiesfortheinformaticsworkforce
• Mostprevalentinclinicalinformatics,butplentyofotheropportunityinotherareasofinformatics– Bioinformatics– leadingandassisting
computationalanalysisofgenomicsandrelatedtechnologies
– Clinicalandtranslationalresearch– usinginformaticstoaidbiomedicalresearch
– Publichealth– usinginformationtoprotectthepublicandpromotehealth
– Consumerhealth– helpingthegeneralpopulationmaintainandimprovehealth
– Imaginginformatics– usingimagesforbiomedicalresearch,clinicalcare,etc.
43
WhyisitcriticaltohaveacompetentHITworkforce(Hersh,2010)?
• SeniorHITleaderspersistentlyliststaffingconcernsamongtheirmostimportant– Chiefinformationofficers(CIOs)state“clinicalsoftwareimplementationandsupport” astheirtopneed(CHIME,2012)
– Keybarrierinmeetingpriorities;topneedsincludeclinicalapplicationsupport,network/architecturesupport,andclinicalinformaticsprofessionals(HIMSS,2014)
• HIThasa“talentshortage”(HealthITJobs.com,2015)• Growingroleofphysicians(Shaffer,2016;SSiSearch,2015),includingnewclinicalinformaticssubspecialty(Detmer,2014);nurses(Manos,2012;HIMSS,2014);andothers,includingnon-clinicians(Fenton,2012)
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Needsforworkforce(Fenton,2012)
• SurveyofTexasHITemployersfoundneedfor“diverseknowledgeandskillsrangingfrombasictoadvanced,whilecoveringinformationtechnology,privacyandsecurity,clinicalpractice,needsassessment,contractnegotiation,andmanyotherareas.”
• Consistentthemes– employeesmust– Beabletolearnonthejob– Possesstheabilitytothinkcriticallyandproblemsolve– Havetechnicalskills,yetalsoknowledgeandunderstandingofhealthcareoperations
• EmployersuncertainaboutcareerpathwaysandadvancementinHIT
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WhatweknowabouttheHITworkforce(Hersh,2010)
• Limitedbylackofpresenceinfederallaborstatistics(StandardOccupationalClassification),whichmaybechanging(AMIA,2016)
• Traditionalgroupingsofprofessionalsinhealthcare– Informationtechnology(IT)– usuallywithcomputerscienceorinformationsystemsbackground
– Healthinformationmanagement(HIM)– historicalfocusonmedicalrecords
– Clinicalinformatics(CI)– oftenfromhealthcarebackgrounds,performinganalysis,training,etc.
– Others– librarians,managers,etc.• Whatdothedatashow?
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HIMSS2014WorkforceSurvey• About79%reportedplanstohireinthefollowingyearin2013survey,
with84%reportingthattheydidactually• About82%reportedplanningtohirein2014,withabouthalfplanningto
hire1-5FTEandtheremainderplanningtohiremore(10%plantohiremorethan20FTE!)
• Tophiringneedsforproviderorganizations– ClinicalApplicationSupport- 64%– HelpDesk- 57%– ITManagement- 45%– ProjectManagement- 35%– ITSecurity- 34%
• Tophiringneedsforvendorsandconsultants– Sales/MarketingTeam- 78%– FieldSupportStaff- 75%– SupportStaff- 73%– ExecutiveTeam- 60%
47
DemandstrongforexperiencedHITstaff(CHIME,2012)
• Skillsmostoftenindemand– Clinicalsoftwareimplementationandsupportstaff(e.g.,EHR,CPOE)– 74%
– Infrastructurestaff– 47%– Businesssoftwareimplementationandsupportstaff– 45%
• 71%saidITstaffshortagescouldjeopardizeanenterpriseITproject,while58%saidtheywoulddefinitelyorpossiblyaffectmeetingmeaningfulusecriteriaforincentivefunding
• 85%alsoexpressedconcernsaboutbeingabletoretaincurrentstaff
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HIM• HIMisafieldintransition,withleadershippromotingadvancedskills,degrees,andwork(Calhoun,2012;Kloss,2012)– Careermap– http://hicareers.com– Callto“adaptordisappear”(Butler,2014)
• HIMisonlyinformatics-relatedareaseeninUSBureauofLaborStatistics(BLS)data– Occupationalemploymentprojections2014-2024(BLS,2015)
• MedicalRecordsandHealthInformationTechnicians(RHITandCCS)– about188,600employedin2014,increasingby29,000by2024(15%growth)
– RHIAs andotherrolesnotcountedinthesenumbers
49
Clinicalinformatics• Individualswhobringskillsatintersectionofhealthcare
andIT(Hersh,2010)• BecominghardertodistinguishfromIT(HealthITJobs.com,
2015)– “TheprimaryskillgapinhealthcareIT-- specificallyClinicalSystems(EMR/EHR)-- isthatmostleadersarelookingforemployeeswithbothhands-onclinicalexperienceandtechnicalexpertise.Historically,thesehavebeentwoveryseparateskillsets.”
• Estimatesofneed– OnephysicianandnurseineachUShospital(~10,000)(Safran,
2005)– Probablymuchlarger– manyUShospitalsnowhaveclinical
informaticsdepartments,oftenreportingtoChiefMedicalInformaticsOfficer(CMIO)(Shaffer,2016)
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Certificationofphysiciansandothers
• PhysiciansubspecialtycertificationapprovedbyAmericanBoardofMedicalSpecialtiesin2011(Detmer,2014),basedoncorecurriculum(Gardner,2009)andtrainingrequirements(Safran,2009)– Subspecialtyofallmedicalspecialties– “Grandfathering” oftrainingrequirementsinitially,tobefollowedby
formalfellowshipsafter2022(originally2017;extendedin2016)– CertificationfirstofferedinOctober,2013– nowover1300passed– http://www.amia.org/clinical-informatics-medical-subspecialty– http://www.theabpm.org/abpm_clinical_informatics.pdf
• Neededordesiredforothers?– AMIAHealthInformaticsCertification(AHIC)TaskForcehasdeveloped
plansforcertificationofotherhealthprofessionalsininformatics(Gadd,2016;Gadd,2016)
• https://www.amia.org/advanced-health-informatics-certification
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Pause
• Turntoaneighboranddescribeaninstanceinyourworkwhereinformaticsexpertisecontributedtoimprovingsomeaspectofyourorganization’sactivities
• Iwillaskforafewtovolunteertheanswers
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Resourcesforfield
• Organizations• Information• Education
53
Otherprofessionalorganizations• AmericanMedicalInformaticsAssociation(AMIA)– www.amia.org
• HealthcareInformationandManagementSystemsSociety(HIMSS)–www.himss.org
• AmericanHealthInformationManagementAssociation(AHIMA)–www.ahima.org
• AssociationofMedicalDirectorsofInformationSystems(AMDIS)–www.amdis.org
• AllianceforNursingInformatics(ANI)– www.allianceni.org• PublicHealthInformaticsInstitute(PHII)– www.phii.org• InternationalSocietyforComputationalBiology(ISCB)– www.iscb.org• SocietyforImagingInformaticsinMedicine(SIIM)– www.siim.org• AssociationforComputingMachinery(ACM)– www.acm.org• MedicalLibraryAssociation(MLA)– www.mlanet.org
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Importantroleforgovernmentagencies
• NationalLibraryofMedicine(NLM)hasbeenhistoricleaderinresearchandtraining– www.nlm.nih.gov– OtherinstitutesofNationalInstitutesofHealth(NIH)havesupported
informaticsinvariousways• AgencyforHealthcareResearch&Quality(AHRQ)hasfocusedonapplied
clinicalinformatics– www.ahrq.gov
• OfficeoftheNationalCoordinatorforHealthIT(ONC)hasledhealthITandstandardsadoption– www.healthit.gov
• CriticalroleofotherfederalagenciesinDept.ofHealthandHumanServices,e.g.,– CentersforDiseaseControlandPrevention(CDC)– CentersforMedicareandMedicaidServices(CMS)– FoodandDrugAdministration(FDA)
55
Medicalandnursingspecialtysocieties(non-exhaustive)
• AmericanMedicalAssociation(AMA)– www.ama-assn.org
• AmericanNursesAssociation(ANA)–www.nursingworld.org
• AssociationofAmericanMedicalColleges(AAMC)–www.aamc.org
• AmericanCollegeofPhysicians(ACP)–www.acponline.org
• AmericanAcademyofFamilyPhysicians(AAFP)–www.aafp.org
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Wheredoesonefindmoreinformation?Textbooks
• Shortliffe andCimino (eds.),BiomedicalInformatics:ComputerApplicationsinHealthCareandBiomedicine(4thEdition),Springer,2014
• HoytandYoshihashi (eds.),HealthInformatics:PracticalGuideforHealthcareandInformationTechnologyProfessionals(6th Edition),Lulu.com,2014
• Sengstack andBoicey,MasteringInformatics:AHealthcareHandbookforSuccess,SigmaThetaTauInternational,2015
• Abdelhak etal.,HealthInformation:ManagementofaStrategicResource (5th Edition),Saunders,2015
• LaTour andEichenwald,HealthInformationManagement–Concepts,Principles,andPractice(3rd Edition),AHIMA,2013
• SaylesandTrawick,IntroductiontoComputerSystemsforHealthInformationTechnology (2nd Edition),AHIMA,2014
• WilsonandMcEvoy,HealthITJumpStart- YourBestFirstStepTowardaCareerinHealthIT.Wiley,2012
57
Wheredoesonefindmoreinformation(cont.)?Textbooks
• Weaveretal.(eds.),NursingandInformaticsforthe21stCentury,HIMSS,2010• Richesson andAndrews(eds.),ClinicalResearchInformatics,Springer,2012• Kann andLewitter (eds).TranslationalBioinformatics,PLoS,2013• MagnusonandFu(eds.),PublicHealthInformaticsandInformationSystems (2nd Edition),Springer,
2014• BuiandTaira (eds.),MedicalImagingInformatics,Springer,2010• Hersh,InformationRetrieval:AHealthandBiomedicalPerspective (3rd Edition),Springer,2009• BerkowitzandMcCarthy,InnovationwithInformationTechnologiesinHealthcare,Springer,2012• Berner (ed.),InformaticsEducationinHealthcare:LessonsLearned,Springer,2014• Sarkar,(ed.),MethodsinBiomedicalInformatics:APragmaticApproach,AcademicPress,2014• Lesk,IntroductiontoBioinformatics (4th Edition),OxfordUniversityPress,2014• Giannangelo,K,(ed.),HealthcareCodeSets,ClinicalTerminologies,andClassificationSystems,Third
Edition.Chicago,IL,2015• ReddyandAgarwal(eds.),HealthcareDataAnalytics,Chapman&Hall,2015• BensonandGrieve,PrinciplesofHealthInteroperability- SNOMEDCT,HL7andFHIR,ThirdEdition.
Springer,2016• Dixon,B(ed.).HealthInformationExchange- NavigatingandManagingaNetworkofHealth
InformationSystems.Amsterdam,Netherlands,Elsevier,2016• Skochelak etal.(eds.).HealthSystemsScience.Elsevier,2017
58
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Moreinformation(cont.),Journals
• JournalofAMIA (JAMIA,http://jamia.oxfordjournals.org)• JournalofMedicalInternetResearch(JMIR)• AppliedClinicalInformatics(ACI)• InternationalJournalofMedicalInformatics (IJMI)• JournalofBiomedicalInformatics (JBI)• MethodsofInformationinMedicine (MIM)• Bioinformatics• JournalofDigitalImaging (JDI)• BiomedCentral(BMC,www.biomedcentral.com)
– BMCMedicalInformaticsandDecisionMaking– BMCBioinformatics
59
Moreinformation(cont.),Meetings
• AMIA-relatedmeetings– AMIAAnnualSymposium– AMIASummitsonTranslationalSciences– AMIAiHealth– Medinfo (biennial)
• Otherclinicalinformaticsmeetings– HIMSS,nationalmeetingandlocalchapters– AMDISPhysician-ComputerConnection
• Bioinformaticsmeetings– PacificSymposiumonBiocomputing (PSB)– InternationalSocietyforComputationalBiology(ISCB)
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Moreinformation(cont.),Websites
• USgovernment– NLM– www.nlm.nih.gov,includingwww.pubmed.gov– HHSONC– www.healthit.gov– AHRQNationalResourceCenterforHealthIT–
http://healthit.ahrq.gov– HRSAHealthITToolbox– partofAHRQNationalResource– USHealthInformationKnowledgebase– http://ushik.ahrq.gov
• Other– HITECHAnswers– www.hitechanswers.net– Clinfowiki – http://clinfowiki.org– ElectronicMedicalInformaticsRepositoryofResources(e-MIR2;
delaCalle,2012)– http://www.gib.fi.upm.es/eMIR2/
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Moreinformation(cont.),emaillistsandblogs
• Emaillists– HISTalk – http://histalk2.com– HITStrategist–
http://www.modernhealthcare.com/section/HITSarchive/– FromorganizationssuchasAMIA,HIMSS,AMDIS,etc.
• Blogs– (many!)– GeekDoctor(JohnHalamka,MD)–
http://geekdoctor.blogspot.com– HealthcareStandards(KeithBoone)–
http://motorcycleguy.blogspot.com– HealthITBuzz(ONC)– http://www.healthit.gov/buzz-blog/– TheHealthcareBlog– http://thehealthcareblog.com– InformaticsProfessor(Hersh)–
http://informaticsprofessor.blogspot.com
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Moreinformation(cont.),acronyms
• Alwaysasked,sohereisalist– HITECHAnswers–http://www.hitechanswers.net/ehr-adoption-2/key-acronyms/
– AMIA– https://www.amia.org/glossary– Shortliffe glossary,whichincludesacronyms(2014)–http://people.dbmi.columbia.edu/shortliffe/docs/Glossary%20-%204th%20ed.pdf
– Wikipedia–https://en.wikipedia.org/wiki/List_of_abbreviations_used_in_health_informatics
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Educationandtrainingininformatics
• Educationhashistoricallyfocusedonacademicsbuthasbeenexpandingtomeettheneedsandopportunitiesofpractitionersandusers
• Anever-growingnumberofprogramsatassociate,baccalaureate,andgraduatelevels– Alsoshorter,continuingeducationcourses,suchas10x10(“tenby
ten”)– https://dmice.ohsu.edu/hersh//10x10.html• Informaticsprogramscomeinmanyflavors:medical,clinical,
biomedical,health,bio-,nursing,etc.• MajorfunderofprogramsisNLM,whichfundsfellowshipstotrain
futureresearchersatdoctoralandpostdoctorallevels• NewAccreditationCouncilforGraduateMedicalEducation
(ACGME)-accreditedclinicalfellowshipprogramsemerging– ~20accreditedand~10launched
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Academicprograms• ListofUSinformatics
programsonAMIAWebsite– http://www.amia.org/educati
on/programs-and-courses• Internationalcompendiumof
programsatHealthInformaticsWorldwide(HIWW)– www.hiww.org
• NLM-fundedprograms– http://www.nlm.nih.gov/ep/G
rantTrainInstitute.html
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Inventoryofcompetenciesforvariousgroups(Hersh,2010)
• Competenciesdifferbygroup– Informaticians
• Developing,implementing,andevaluatingsystems
• Makingoptimaluseofinformation
• RecentelucidationofcorecompetenciesbyAMIA(Kulikowski,2012)
– Clinicians• Applyinginformaticsindelivery
ofcare• Competenciesformedical
education(Hersh,2014)– Patients
• Healthinformationliteracy
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…
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Clinicalinformaticseducationforclinicians
Startedwithmedicalstudents(Hersh,2014),butinrealityapplicabletoallclinicalstudentsandprofessionals
Partoflargerhealthsystemsscience(Skochelak,2017;Hersh,2017)
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Careerpathwayshavediverseinputsandoutputs(Hersh,2009)
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Healthcareprofessions,e.g.,medicine,nursing,etc.
Naturalandlifesciences,e.g.,biology,genetics,etc.
Computerscience(CS),IT,andundergradinformatics
Healthinformationmanagement(HIM)
Others,e.g.,business,libraryandinfo.science
Jobsin:• Healthcaresystems
• Clinicalleadership• ITleadership
• Biomedicalresearch• Industry• Academia
Biomedicalandhealthinformaticseducation(graduatelevel)
Thereisnosinglecareerpathway,ladder,etc.
Therearemanycareeropportunitiesinmanysettingsforalltracks
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Example:OHSUinformaticshttp://www.ohsu.edu/informatics
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International students from: Argentina, Singapore, Egypt, Israel, Saudi Arabia, Zimbabwe, Thailand, China, and other countries
Track Degree/Certificate PhD MS MBI GradCert
ClinicalInformatics On-campusOn-campus
On-line
On-campus
On-line
On-campus
On-line
Bioinformatics andComputationalBiology
On-campus On-campus
DegreesAwarded1998-2016(653people)Track CI BCB TotalCertificate 406 0 406MBI/MMI 190 8 198MS 72 16 88PhD 18 6 24Total 686 30 716
HowhaveOHSUstudentsandgraduatesdone?
• About25yearsofexperience…• Generalobservation:Whatpeopledowhentheygraduateispartiallydependentonwhattheydidwhentheyentered,e.g.,– Physicians,nurses,publichealth,etc.drawontheirclinical/professionalbackground
– Informationtechnologyprofessionalsdrawontheiruniquebackgroundandexperience
• Graduateshaveobtainedjobsinavarietyofsettings,e.g.,clinical,academic,andindustry
• Someobtainjobsbeforefinishingprogram
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Conclusions
• Theseareexcitingtimesforbiomedicalandhealthinformatics,withmanyopportunitiesinawidevarietyofsettings
• Attentionmustalsobepaidtotheprofessionalpracticeandeducationofinformaticians
• Butthemainfocusofthefieldmustbehowtooptimallyuseinformationandtechnologyproperlytoadvancehumanhealthandimprovedeliveryofhealthcare
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