Annual Reflections at the End of 2014

It has become a tradition for me in this blog to post some reflections in the last posting of each year. This year is no different, and this posting is the end of 2014 installment.

Each year there has been a theme to my annual reflections. As the start of this blog was very much tied to the Health Information Technology for Clinical and Economic Health (HITECH) Act, the theme of 2009 concerned the deteriorating economy and its impact on the Oregon Health & Science University (OHSU) informatics program, the American Recovery and Reinvestment Act (ARRA), and the HITECH Act within ARRA. In 2010, I focused on the rolling out of the HITECH Act, especially the workforce development grants that were to become a major part of my work life in the following years. In 2011, I described the implementation of our HITECH workforce grants. By 2012, the beginning of the end for the HITECH funding was at hand, while in 2013, I described the transition from HITECH funding and a number of new developments, including the Informatics Discovery Lab (IDL) at OHSU and the rollout of the clinical informatics subspecialty.

What is the theme for 2014? One thing for certain is that work and life have gone on without HITECH. There were many great new accomplishments for the myself and the OHSU informatics program this past year, such as achieving Accreditation Council for Graduate Medical Education (ACGME) accreditation for our new clinical informatics fellowship that will be launched in 2015, new grants from the National Institutes of Health (NIH) Big Data to Knowledge (BD2K) program, and a new focus on competencies for medical (and other health professional) students in clinical informatics.

Despite the grants of HITECH becoming a distant memory, the impact of the HITECH Act on the informatics field cannot be understated. Of course the meaningful use program is still moving along, even if Stage 2 has been daunting and the prospect of penalties for not meeting meaningful use become a possible reality. But the informatics world is truly a different place now than before the HITECH Act. The road has been rocky, but EHR adoption has become near-universal in US hospitals and very substantial in physician offices. The fact that we are now lamenting about the problems of data and its lack of interoperability demonstrates progress in our lamenting less than a decade ago about healthcare being too paper-based. Much has been written about HITECH, often with a tinge (sometimes more) of politics thrown in. My thoughts resonate most with those who view HITECH in the context of its origins and acknowledge its success and limitations, such as Robert Wachter and John Halamka.

What lies ahead for 2015? Certainly the work described above that we have undertaken in 2014 will continue to play an important role. And like in all years, indeed in my whole career, there will be opportunities that emerge out of nowhere and turn out to be major activities.