Annual Reflections at the End of 2015

As regular readers of this blog know, I traditionally end each year with a posting reflecting back on the past year. While this year has been another great success for myself and our informatics program at Oregon Health & Science University (OHSU), it has been somewhat of a transitional year for the informatics field. Many of the new and exciting initiatives in the informatics field from recent years are no longer novel, with some now settling into “midlife” and others being called out for retirement.

One program settling into midlife, although being called out for retirement by many, has been the Health Information Technology for Economic and Clinical Health (HITECH) Act. The launching of this blog, and indeed the catapult to much larger visibility of the informatics field, owes a great deal to HITECH. There is no question that HITECH has succeeded on some levels, at least in terms of increasing electronic health record (EHR) adoption, as I have noted before. A recent report from the Commonwealth Fund confirms what statistics from the Office of the National Coordinator for Health IT (ONC) show: the US is no longer a world laggard in health IT and is in some ways a global leader [1].

But there is no question that not all with HITECH has gone well. Despite the widespread adoption of EHRs, they are still very imperfect [2]. At best, they impede clinician workflow and at worst, they cause some of the safety problems they have been touted to rectify. And one vision has clearly not been achieved, which is interoperable data across systems, even those from the same vendor [3]. Going forward, the informatics field must provide leadership to guide the best use of EHRs and related systems, which is spelled out excellently in the AMIA EHR-2020 Task Force white paper [4].

Another interesting happening, perhaps related to health IT achieving midlife, is that the quantity of health IT blogging seems to be tapering off. In this blog for example, I had fewer posts this year than any since the first year I started the blog. The same is true for a number of other well-known health IT bloggers, such as Keith Boone and John Halamka. I do not view this as necessarily a bad thing, but perhaps just an indicator that some of the formerly novel aspects of informatics are reaching maturity, and there is less to say on a day-to-day basis.

Also a continuing happening this year was the continued growth of data science, and confusion as to its relationship to informatics. Informaticians are not the only ones expressing confusion where they belong in this new field; statisticians are feeling the same [5]. Nonetheless, there is no question that data and learning from it will drive many scientific fields going forward.

I would also like to call out some other year-end posts from some other bloggers, namely John Halamka, for recapping 2015 overall plus adding some focus on security and looking ahead to 2016, and the folks at HISTalk, who have a comprehensive list of 2015 top stories and 2016 predictions.

On a personal and program level, this year had a number of achievements. I was honored to be bestowed the HIMSS Physician IT Leadership Award. I was also awarded a new grant to update the ONC Health IT Curriculum. On a program level, the OHSU Department of Medical Informatics & Clinical Epidemiology (DMICE) launched its new clinical informatics fellowship and continued its mutli-faceted success in its major missions of research and education.

Looking ahead to 2016, there are plenty of new projects and other activities to keep myself and our department busy. It will be interesting to see how HITECH fares and how the critical need for data interoperability evolves. And of course, new opportunities will emerge for myself and DMICE, many of which cannot even be foreseen now.

References

1. Osborn, R, Moulds, D, et al. (2015). Primary care physicians in ten countries report challenges caring for patients with complex health needs. Health Affairs. 34: 2104-2112.

2. Rosenbaum, L (2015). Transitional chaos or enduring harm? The EHR and the disruption of medicine. New England Journal of Medicine. 373: 1585-1588.

3. Anonymous (2015). Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap version 1.0 (Roadmap). Washington, DC, Department of Health and Human Services. https://www.healthit.gov/sites/default/files/hie-interoperability/nationwide-interoperability-roadmap-final-version-1.0.pdf.

4. Payne, TH, Corley, S, et al. (2015). Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs. Journal of the American Medical Informatics Association. 22: 1102-1110.

5. Donoho, D (2015). 50 years of Data Science. Princeton NJ, Tukey Centennial Workshop. https://dl.dropboxusercontent.com/u/23421017/50YearsDataScience.pdf.