Because scientific research is guided by concerns for
uncovering “fundamental truths,” its time frame differs from that
of design, development, and practice, which are driven by immediate needs for
practical solutions. In medicine, however, as in other disciplines, basic
scientists, developers, and practitioners are being called on increasingly to
forge new alliances and work toward common goals. The authors propose that
medical informatics be construed as a local science of design. A local science
seeks to explain aspects of a domain rather than derive a set of unifying
principles. Design is concerned with the creation, implementation, and
adaptation of artifacts in a range of settings. The authors explore the
implications of this point of view and endeavor to characterize the nature of
informatics research, the relationship between theory and practice, and issues
of scientific validity and generalizability. They argue for a more pluralistic
approach to medical informatics in building a cumulative body of
People and organizational issues are critical in both
implementing medical informatics systems and in dealing with the altered
organizations that new systems often create. The people and organizational
issues area—like medical informatics itself—is a blend of many
disciplines. The academic disciplines of psychology, sociology, social
psychology, social anthropology, organizational behavior and organizational
development, management, and cognitive sciences are rich with research with
significant potential to ease the introduction and on-going use of information
technology in today's complex health systems. These academic areas contribute
research data and core information for better understanding of such issues as
the importance of and processes for creating future direction; managing a
complex change process; effective strategies for involving individuals and
groups in the informatics effort; and effectively managing the altered
organization. This article reviews the behavioral and business referent
disciplines that can potentially contribute to improved implementations and
on-going management of change in the medical informatics arena.
As health care organizations dramatically increase investment in information technology (IT) and the scope of their IT projects, implementation failures become critical events. Implementation failures cause stress on clinical units, increase risk to patients, and result in massive costs that are often not recoverable. At an estimated 28% success rate, the current level of investment defies management logic. This paper asserts that there are “chasms” in IT implementations that represent risky stages in the process. Contributors to the chasms are classified into four categories: design, management, organization, and assessment. The American College of Medical Informatics symposium participants recommend bold action to better understand problems and challenges in implementation and to improve the ability of organizations to bridge these implementation chasms. The bold action includes the creation of a Team Science for Implementation strategy that allows for participation from multiple institutions to address the long standing and costly implementation issues. The outcomes of this endeavor will include a new focus on interdisciplinary research and an inter-organizational knowledge base of strategies and methods to optimize implementations and subsequent achievement of organizational objectives.
Multi-disciplinary and multi-site biomedical research programs frequently require infrastructures capable of enabling the collection, management, analysis, and dissemination of heterogeneous, multi-dimensional, and distributed data and knowledge collections spanning organizational boundaries. We report on the design and initial deployment of an extensible biomedical informatics platform that is intended to address such requirements.
A common approach to distributed data, information, and knowledge management needs in the healthcare and life science settings is the deployment and use of a service-oriented architecture (SOA). Such SOA technologies provide for strongly-typed, semantically annotated, and stateful data and analytical services that can be combined into data and knowledge integration and analysis “pipelines.” Using this overall design pattern, we have implemented and evaluated an extensible SOA platform for clinical and translational science applications known as the Translational Research Informatics and Data-management grid (TRIAD). TRIAD is a derivative and extension of the caGrid middleware and has an emphasis on supporting agile “working interoperability” between data, information, and knowledge resources.
Based upon initial verification and validation studies conducted in the context of a collection of driving clinical and translational research problems, we have been able to demonstrate that TRIAD achieves agile “working interoperability” between distributed data and knowledge sources.
Informed by our initial verification and validation studies, we believe TRIAD provides an example instance of a lightweight and readily adoptable approach to the use of SOA technologies in the clinical and translational research setting. Furthermore, our initial use cases illustrate the importance and efficacy of enabling “working interoperability” in heterogeneous biomedical environments.
Clinical research informatics; data access; data integration; data analysis; standards; workflow; socio-organizational issues
Biomedical informatics, imaging, and engineering are major forces driving the knowledge revolutions that are shaping the agendas for biomedical research and clinical medicine in the 21st century. These disciplines produce the tools and techniques to advance biomedical research, and continually feed new technologies and procedures into clinical medicine. To sustain this force, an increased investment is needed in the physics, biomedical science, engineering, mathematics, information science, and computer science undergirding biomedical informatics, engineering, and imaging. This investment should be made primarily through the National Institutes of Health (NIH). However, the NIH is not structured to support such disciplines as biomedical informatics, engineering, and imaging that cross boundaries between disease- and organ-oriented institutes. The solution to this dilemma is the creation of a new institute or center at the NIH devoted to biomedical imaging, engineering, and informatics. Bills are being introduced into the 106th Congress to authorize such an entity. The pathway is long and arduous, from the introduction of bills in the House and Senate to the realization of new opportunities for biomedical informatics, engineering, and imaging at the NIH. There are many opportunities for medical informaticians to contribute to this realization.
We present a model of applied clinical informatics in the context of medical informatics in general, across the domain of health sciences and the continuum of information technology development and its adoption into workflow. The distinct challenges of applied clinical informatics present an opportunity to improve efforts through collaboration of the growing number of physicians, health institutional leaders and other health workers in successfully implementing working systems. This journal will be a forum for discussion regarding approaches to design, implement, deploy and evaluate systems and importantly, how to present experiences in a way to maximize sharing of those experiences.
Medical Informatics Applications; Socio-technical aspect of information technology; Communications; Evaluation; Theoretical Models
As we have advanced in medical informatics and created many impressive innovations, we also have learned that technologic developments are not sufficient to bring the value of computer and information technologies to health care systems. This paper proposes a model for improving how we develop and deploy information technology. The authors focus on trends in people, organizational, and social issues (POI/OSI), which are becoming more complex as both health care institutions and information technologies are changing rapidly. They outline key issues and suggest high-priority research areas. One dimension of the model concerns different organizational levels at which informatics applications are used. The other dimension draws on social science disciplines for their approaches to studying implications of POI/OSI in informatics. By drawing on a wide variety of research approaches and asking questions based in social science disciplines, the authors propose a research agenda for high-priority issues, so that the challenges they see ahead for informatics may be met better.
As a multidisciplinary field, medical informatics draws on a range of disciplines, such as computer science, information science, and the social and cognitive sciences. The cognitive sciences can provide important insights into the nature of the processes involved in human– computer interaction and help improve the design of medical information systems by providing insight into the roles that knowledge, memory, and strategies play in a variety of cognitive activities. In this paper, the authors survey literature on aspects of medical cognition and provide a set of claims that they consider to be important in medical informatics.
The 1999 debate of the American College of Medical Informatics focused on the proposition that medical informatics and nursing informatics are distinctive disciplines that require their own core curricula, training programs, and professional identities. Proponents of this position emphasized that informatics training, technology applications, and professional identities are closely tied to the activities of the health professionals they serve and that, as nursing and medicine differ, so do the corresponding efforts in information science and technology. Opponents of the proposition asserted that informatics is built on a re-usable and widely applicable set of methods that are common to all health science disciplines, and that “medical informatics” continues to be a useful name for a composite core discipline that should be studied by all students, regardless of their health profession orientation.
Everyone attending the AMIA conference has likely either heard about or had firsthand experience of a failed health information technology implementation. The line dividing failed implementations from successful ones frequently seems perilously thin, dependent on people and organizational factors as much as on technology design. What implementation lessons have informatics researchers and practitioners learned from prior failures and successes? Can the research domain of Implementation Science assist practitioners to improve implementation planning and execution? Implementation Science draws on multiple disciplines and perspectives (e.g., clinical, organizational, engineering, behavioral, social science) to understand technology adoption, explore patterns of technology use, and define organizational strategies for sustainable deployment. Through two case study presentations and a series of questions, our presentation will actively engage the audience in a discussion of what an evidence-based approach to implementation might mean at different institutions and explore practical implications of Implementation Science for decision-makers and technology implementers. The presentation will translate research on implementation into implementation lessons and practical strategies for practitioners.
Objective: The article offers a current perspective on medical informatics and health sciences librarianship.
Narrative: The authors: (1) discuss how definitions of medical informatics have changed in relation to health sciences librarianship and the broader domain of information science; (2) compare the missions of health sciences librarianship and health sciences informatics, reviewing the characteristics of both disciplines; (3) propose a new definition of health sciences informatics; (4) consider the research agendas of both disciplines and the possibility that they have merged; and (5) conclude with some comments about actions and roles for health sciences librarians to flourish in the biomedical information environment of today and tomorrow.
Summary: Boundaries are disappearing between the sources and types of and uses for health information managed by informaticians and librarians. Definitions of the professional domains of each have been impacted by these changes in information. Evolving definitions reflect the increasingly overlapping research agendas of both disciplines. Professionals in these disciplines are increasingly functioning collaboratively as “boundary spanners,” incorporating human factors that unite technology with health care delivery.
The Cornell University Life Sciences Core Laboratories Center (CLC) provides an array of genomics, proteomics, imaging and informatics shared research resources and services to the university community and to outside investigators. The CLC includes fee-for-service research, technology testing and development, and educational components. The Center has seven core facilities, including genomics (DNA sequencing, genotyping, and microarrays), epigenomics, proteomics and mass spectrometry, microscopy and imaging, bioinformatics, bio-IT, and advanced technology assessment. The CLC is part of a New York State designated Center for Advanced Technology in Life Science Enterprise. The mission of the CLC is to promote research in the life sciences with advanced technologies in a shared resource environment. Use of the CLC resources and services is steadily increasing due to the growth in the number and types of cores in the center, to the expansion of existing services and the implementation of new core technologies, and to the coordinated integration and synergy of services between the CLC cores. Multidisciplinary support for multi-functional instrument platforms is implemented by integrated operations of the CLC core facilities. Investigators are offered coordinated project consultations with the directors and staff of all relevant cores during the design, data production and analysis phases of their projects. The CLC is involved in establishing and supporting multidisciplinary research projects that involve both intercampus initiatives and multi-institutional collaborations. With a concentration of advanced instrumentation and expertise in their applications, the CLC is a key resource for life sciences research.
An essential part of health informatics is telemedicine, the use of advanced telecommunications technologies to bridge distance and support health care delivery and education. This report discusses the integration of telemedicine into a medical informatics curriculum and, specifically, a framework for a telemedicine course. Within this framework, the objectives and exit competencies are presented and course sections are described: definitions, introduction to technical aspects of telemedicine, evolution of telemedicine and its impact on health care delivery, success and failure factors, and legal and ethical issues. The emphasis is on literature review tools, practical exposure to products and applications, and problem-based learning. Given the rapid advances in the telecommunication field, keeping the course material up to date becomes a challenge for the instructor who at the same time aims to equip students with the knowledge and tools they will need in their future role as decision makers to detect a need for, design, implement, maintain, or evaluate a telemedicine application.
While clinical medicine is often well-supported by health system information technology infrastructure, clinical research may need to create strategies to use clinical medicine informational technology tools. The authors describe a medication safety initiative that was carried out in a National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA)-sponsored clinical research environment. A Web-based, medical informatics application was designed and implemented which allowed research groups to build protocol-specific, electronic medication templates that were subsequently used to create participant-specific medication order sets for conductance of clinical research activities in the CTSA-sponsored clinical research environment. The medical informatics initiative eliminated typewritten or handwritten medication orders, created research protocol-specific templates meeting institutional order-writing requirements, and formalized a rigorous review and approval process. Enhancing safety in medication ordering and prescribing practices in a clinical research environment provided the background for multi-disciplinary cooperation in medical informatics.
Abstract Objective: Medical informatics is an emergent
interdisciplinary field described as drawing upon and contributing to both the
health sciences and information sciences. The authors elucidate the
disciplinary nature and internal structure of the field.
Design: To better understand the field's disciplinary nature, the
authors examine the intercitation relationships of its journal literature. To
determine its internal structure, they examined its journal cocitation
Measurements: The authors used data from the Science Citation Index
(SCI) and Social Science Citation Index (SSCI) to perform intercitation
studies among productive journal titles, and software routines from
SPSS to perform multivariate data analyses on cocitation data for
proposed core journals.
Results: Intercitation network analysis suggests that a core
literature exists, one mark of a separate discipline. Multivariate analyses of
cocitation data suggest that major focus areas within the field include
biomedical engineering, biomedical computing, decision support, and education.
The interpretable dimensions of multidimensional scaling maps differed for the
SCI and SSCI data sets. Strong links to information science literature were
Conclusion: The authors saw indications of a core literature and of
several major research fronts. The field appears to be viewed differently by
authors writing in journals indexed by SCI from those writing in journals
indexed by SSCI, with more emphasis placed on computers and engineering versus
decision making by the former and more emphasis on theory versus application
(clinical practice) by the latter.
The purpose of this paper is to argue for an integration of cognitive and socio-technical approaches to assessing the impact of health information systems. Historically, health informatics research has examined the cognitive and socio-technical aspects of health information systems separately. In this paper we argue that evaluations of health information systems should consider aspects related to cognition as well as socio-technical aspects including impact on workflow (i.e. an integrated view). Using examples from the study of technology-induced error in healthcare, we argue for the use of simulations to evaluate the cognitive-socio-technical impacts of health information technology . Implications of clinical simulations and analysis of cognitive-social-technical impacts are discussed within the context of the system development life cycle to improve health information system design, implementation and evaluation.
Technology induced error; cognitive; sociotechnical; cognitive-socio-technical; patient safety.
The Cornell University Life Sciences Core Laboratories Center (CLC) provides an array of genomics, proteomics, imaging and informatics shared research resources and services to the university community and to outside investigators. The CLC includes fee-for-service research, technology testing and development, and educational components. The Center has nine core facilities, including DNA sequencing and genotyping, microarrays, epigenomics, proteomics and mass spectrometry, high throughput screening, microscopy and imaging, mouse transgenics, bioinformatics, and bio-IT. The CLC is part of a New York State designated Center for Advanced Technology in Life Science Enterprise. The mission of the CLC is to promote research in the life sciences with advanced technologies in a shared resource environment. Use of the CLC resources and services is steadily increasing due to the growth in the number and types of cores in the center, to the expansion of exiting services and the implementation of new core technologies, and to the coordinated integration and synergy of services between the CLC cores. Multidisciplinary support for multi-functional instrument platforms is implemented by coordinated operations of the CLC core facilities. CLC core users are offered coordinated project consultations with the directors and staff of all relevant cores during the design, data production and analysis phases of their projects. The CLC is also involved in establishing and supporting multidisciplinary research projects that involve both intercampus initiatives and multi-institutional collaborations. With a concentration of advanced instrumentation and expertise in their applications, the CLC is a key resource for life sciences basic research and medical research for investigators at Cornell University and at other academic institutions and commercial enterprises.
Data management and integration are complicated and ongoing problems that will require commitment of resources and expertise from the various biological science communities. Primary components of successful cross-scale integration are smooth information management and migration from one context to another. We call for a broadening of the definition of bioinformatics and bioinformatics training to span biological disciplines and biological scales. Training programs are needed that educate a new kind of informatics professional, Biological Information Specialists, to work in collaboration with various discipline-specific research personnel. Biological Information Specialists are an extension of the informationist movement that began within library and information science (LIS) over 30 years ago as a professional position to fill a gap in clinical medicine. These professionals will help advance science by improving access to scientific information and by freeing scientists who are not interested in data management to concentrate on their science.
The European INFOBIOMED Network of Excellence 1 recognized that a successful education program in biomedical informatics should include not only traditional teaching activities in the basic sciences but also the development of skills for working in multidisciplinary teams.
A carefully developed 3-year training program for biomedical informatics students addressed these educational aspects through the following four activities: (1) an internet course database containing an overview of all Medical Informatics and BioInformatics courses, (2) a BioMedical Informatics Summer School, (3) a mobility program based on a ‘brokerage service’ which published demands and offers, including funding for research exchange projects, and (4) training challenges aimed at the development of multi-disciplinary skills.
This paper focuses on experiences gained in the development of novel educational activities addressing work in multidisciplinary teams. The training challenges described here were evaluated by asking participants to fill out forms with Likert scale based questions. For the mobility program a needs assessment was carried out.
The mobility program supported 20 exchanges which fostered new BMI research, resulted in a number of peer-reviewed publications and demonstrated the feasibility of this multidisciplinary BMI approach within the European Union. Students unanimously indicated that the training challenge experience had contributed to their understanding and appreciation of multidisciplinary teamwork.
The training activities undertaken in INFOBIOMED have contributed to a multi-disciplinary BMI approach. It is our hope that this work might provide an impetus for training efforts in Europe, and yield a new generation of biomedical informaticians.
Human factors engineering is a discipline that deals with computer and human systems and processes and provides a methodology for designing and evaluating systems as they interact with human beings. This review article reviews important current and past efforts in human factors engineering in health informatics in the context of the current trends in health informatics.
The methodology of human factors engineering and usability testing in particular were reviewed in this article.
This methodology arises from the field of human factors engineering, which uses principles from cognitive science and applies them to implementations such as a computer-human interface and user-centered design.
Patient safety and best practice of medicine requires a partnership between patients, clinicians and computer systems that serve to improve the quality and safety of patient care. People approach work and problems with their own knowledge base and set of past experiences and their ability to use systems properly and with low error rates are directly related to the usability as well as the utility of computer systems. Unusable systems have been responsible for medical error and patient harm and have even led to the death of patients and increased mortality rates. Electronic Health Record and Computerized Physician Order Entry systems like any medical device should come with a known safety profile that minimizes medical error and harm. This review article reviews important current and past efforts in human factors engineering in health informatics in the context of the current trends in health informatics.
Health Informatics; Human Factors Engineering; Usability Testing; User-Centered Design; Patient Safety
New technologies that emerge at the interface of computational and biomedical science could drive new advances in global health, therefore more training in technology is needed among health care workers. To assess the potential for informatics training using an approach designed to foster interaction at this interface, the University of Washington and the Universidad Peruana Cayetano Heredia developed and assessed a one-week course that included a new Bioinformatics (BIO) track along with an established Medical/Public Health Informatics track (MI) for participants in Peru.
We assessed the background of the participants, and measured the knowledge gained by track-specific (MI or BIO) 30-minute pre- and post-tests. Participants' attitudes were evaluated both by daily evaluations and by an end-course evaluation.
Forty-three participants enrolled in the course – 20 in the MI track and 23 in the BIO track. Of 20 questions, the mean % score for the MI track increased from 49.7 pre-test (standard deviation or SD = 17.0) to 59.7 (SD = 15.2) for the post-test (P = 0.002, n = 18). The BIO track mean score increased from 33.6 pre-test to 51.2 post-test (P < 0.001, n = 21). Most comments (76%) about any aspect of the course were positive. The main perceived strength of the course was the quality of the speakers, and the main perceived weakness was the short duration of the course. Overall, the course acceptability was very good to excellent with a rating of 4.1 (scale 1–5), and the usefulness of the course was rated as very good. Most participants (62.9%) expressed a positive opinion about having had the BIO and MI tracks come together for some of the lectures.
Pre- and post-test results and the positive evaluations by the participants indicate that this first joint Bioinformatics and Medical/Public Health Informatics (MI and BIO) course was a success.
Within health and health care, medical informatics and its subspecialties of biomedical, clinical, and public health informatics have emerged as a new discipline with increasing demands for its own work force. Knowledge and skills in medical informatics are widely acknowledged as crucial to future success in patient care, research relating to biomedicine, clinical care, and public health, as well as health policy design. The maturity of the domain and the demand on expertise necessitate standardized training and certification of professionals. The American Medical Informatics Association (AMIA) embarked on a major effort to create professional level education and certification for physicians of various professions and specialties in informatics. This article focuses on the AMIA effort in the professional structure of medical specialization, e.g., the American Board of Medical Specialties (ABMS) and the related Accreditation Council for Graduate Medical Education (ACGME). This report summarizes the current progress to create a recognized sub-certificate of competence in Clinical Informatics and discusses likely near term (three to five year) implications on training, certification, and work force with an emphasis on clinical applied informatics.
Education; Professional training; Clinical informatics; Training and education requirements; General healthcare providers; Informatics specialists; Strategies for health IT training; Continuing professional development and continuing education
The promise of health information technology (HIT) has led to calls for a larger and better trained work-force in medical informatics. University programs in applied health and biomedical informatics have been evolving in an effort to address the need for health-care professionals to be trained in informatics. One such evolution is the American Medical Informatics Association’s (AMIA) 10x10 program. To assess current delivery and content models, participant satisfaction, and how graduates have benefited from the program in career or education advancement, all students who completed the Oregon Health & Science University (OHSU) offering of the AMIA 10x10 course through the end of 2006 were surveyed. We found that the 10x10 program is approaching AMIA’s goals, and that there are potential areas for content and delivery modifications. Further research in defining the optimal competencies of the medical informatics workforce and its optimal education is needed.
Neuropsychology is poised for transformations of its concepts and methods, leveraging advances in neuroimaging, the human genome project, psychometric theory, and information technologies. It is argued that a paradigm shift towards evidence-based science and practice can be enabled by innovations, including: (1) formal definition of neuropsychological concepts and tasks in cognitive ontologies; (2) creation of collaborative neuropsychological knowledgebases; and (3) design of web-based assessment methods that permit free development, large-sample implementation, and dynamic refinement of neuropsychological tests and the constructs these aim to assess. This article considers these opportunities, highlights selected obstacles, and offers suggestions for stepwise progress towards these goals.
Neuropsychology; Genomics; Psychological Theory; Psychological Tests; Information Science; Brain
Medical informatics, as a descriptive, scientific study, must be mathematically or theoretically described. Is it important to define a model for medical informatics? The answer is worth pursuing. The medical informatics profession stands to benefit three-fold: first, by clarifying the vagueness of the definition of medical informatics, secondly, by identifying the scope and content for educational programs, and, thirdly, by defining career opportunities for its graduates. Existing medical informatics curricula are not comparable. Consequently, the knowledge and skills of graduates from these programs are difficult to assess. The challenge is to promote academics that develops graduates for prospective employers to fulfill the criteria of the health care industry and, simultaneously, compete with computer science programs that produce information technology graduates. In order to meet this challenge, medical informatics programs must have unique curricula that distinguishes its graduates. The solution is to educate students in a comparable manner across the domain of medical informatics. This paper discusses a theoretical model for medical informatics.