Thursday, September 30, 2010

New Talk and Department Web Site

This week I had the opportunity to kick off our OHSU Biomedical Informatics Conference Series that takes place on Thursdays at 11:30 am. I presented an overview of the HITECH program, OHSU's role in it, and how it impacts not only clinical informatics, but other areas of informatics as well, such as bioinformatics, clinical research informatics, public health informatics, and consumer health informatics. A video of the talk and PDF of my slides (with references) are available.

We also launched our new department web site this week. All of our old URLs still work, including those to the site and to information about our ONC scholarship funding.

Monday, September 27, 2010

Two New Articles Add Perspective For Informatics in 21st Century Healthcare

A couple new articles in medical journals give some added perspective for the direction of biomedical informatics and its role in healthcare. The articles are physician-oriented but could easily be applied to other healthcare professionals or for that matter patients, consumers, and researchers.

The first was published on-line ahead of print in Academic Medicine and authored by Bill Stead of Vanderbilt University and four colleagues. The main thesis of this paper is that the quantity and complexity of information in medicine requires a fundamental paradigm shift from the "power of the individual brain" to the "collective power of systems of brains." The authors note that the numbers of facts per clinical decision will increase exponentially, especially as our knowledge moves beyond the phenotype to include the genotype (e.g., genomic variation, proteomics, etc.). While I would argue whether genomics has yet had much impact in clinical medicine, I do acknowledge that just the complexity of our clinical knowledge of diseases, tests, and treatments is already overwhelming what Stead and colleagues call the "human cognitive capacity." When you factor in the social and economic complexity of our healthcare system, you do not even need genomics to make it exceedingly complicated, even though genomics is likely to make it more so.

These authors also note the consensus developing around the core competencies for the biomedical informatics field being developed by the AMIA Academic Forum. One particularly valuable exercise of this paper is to map the key competencies to the six core competencies for future health professionals first enumerated by the Accreditation Council for Graduate Medical Education (ACGME).

The authors envision a central role for academic health centers (AHCs), recommending advancement in four areas (to quote):
  • Create academic units in biomedical informatics
  • Adapt the IT infrastructure of AHCs into testing laboratories
  • Introduce medical educators to biomedical informatics sufficiently for them to model its use
  • Retrain faculty in AHCs to lead the transformation to health care based on a new systems approach enabled by biomedical informatics
Indeed, these activities could be an instance of the Health Innovation Zones that the Association of American Medical Colleges calls for AHCs to become.

The authors state that "embracing this collective and informatics-enhanced future of medicine will provide opportunities to advance education, patient care, and biomedical science."

The second paper is a commentary by Ted Shortliffe of AMIA in JAMA. This piece appears in the annual special issue of JAMA to devoted to medical education. As such, it focuses on medical education and has a central thesis that the focus of medical practice is as much information as it is patients. Yet while medical education goes to great lengths at teaching students how to assess, interact with, and treat patients, it devotes very little effort at obtaining, using, and analyzing information.

Shortliffe notes that biomedical informatics should be a discipline fundamental to medical education, focusing on both its practical application and core fundamental concepts. He points to a number of examples of where medical practice could benefit from informatics. Few students, he note, are skilled at searching. While anyone in the world can do a Google search, most medical students are not able to skillfully use the myriad of search systems available, from PubMed to the clinically oriented genomics databases. Likewise, few students have mastery of using an electronic health record, let alone make critical secondary use of its data for quality improvement, patient empowerment, or clinical research. I suspect that a paucity of medical students understand the full ramifications of privacy and security, health information exchange, or other informatics topics that will impact their practices in a large way in the coming decades.

One detractor of teaching more informatics to medical students at OHSU used to argue that today's students have no need for such instruction, since they are digital natives, proficient in email, social networking applications, and smart phone usage. Yet these technologies are not informatics, which Shortliffe pulls from the AMIA core competencies definition as "the interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making motivated by efforts to improve human health."

I hope these articles are widely read and acted upon by healthcare leaders, educators, and forward-looking practitioners.

Friday, September 24, 2010

Welcoming Unprecedented Numbers to the OHSU Informatics Educational Program

The beginning of the academic year is always an exciting time, and this year is exceptionally exciting, due to the unprecedented enrollment in our program. While numbers do not tell the entire story, they clearly show a field in ascension. While much of the growth is fueled by our University-Based Training (UBT) Grant from the Office of the National Coordinator for Health IT (ONC), there is growth in all areas of our program.

This week we welcomed an total of 95 new students to the OHSU biomedical informatics graduate program. This matriculating class includes 4 PhD, 25 Master's, and 66 Graduate Certificate students. Of the 25 Master's students, 19 are in the clinical informatics track and 6 are in the bioinformatics and computational biology track. Of the 19 in the clinical informatics track, 10 are on-campus and 9 are distance-learning students. Of the 10 on-campus master's students, 8 are funded by our new ONC UBT grant. All of the Graduate Certificate students are distance-learning students, with 36 funded by the UBT grant.

These new students bring our total student body to approximately 350 students who are actively enrolled in the program. This includes 15 PhD, 83 Master's, and approximately 250 Graduate Certificate students. The 8 Master's and 36 Graduate Certificate students starting the UBT program join 12 other Graduate Certificate students who started in the summer quarter. This brings our total UBT enrollment to 56 students. Applications are now being accepted for those who wish to apply for Graduate Certificate UBT funding starting in the winter quarter. We are well on our way to educating 148 students over three years in the UBT grant.

All of these students will aspire to join our alumni, which consists of 272 people who have received 281 degrees, certificates, and fellowships (as of June, 2010). Our program has awarded 5 PhD, 63 Master of Science, and 74 Master of Biomedical Informatics degrees. We have also awarded 120 Graduate Certificates. Many of these alumni work in a variety of health care, industry, academic, and other settings.

I suppose I am biased, but I am incredibly optimistic for the future of biomedical informatics education. This field is truly establishing an identity as leading the charge to improve health, healthcare, biomedical research, and public health through better use of information. This involves not only electronic health records, but also other information systems in areas such as genomics, telemedicine, knowledge management, and clinical and translational research. Because of this, I am confident that our current students will find many rewarding career opportunities in all of these areas. I am also certain that informatics education will continue to be appealing long after the ONC funding ends, as students will be attracted to careers in this growing field in the long run.


For those who better visualize numbers in a more tabular form, here is a summary (sorry Blogspot does not allow multiple levels of indenting):

Matriculating class, Fall, 2010 - 95
-PhD -4
-Master's - 25
--6 Bioinformatics Track
--19 Clinical Informatics Track
---10 on-campus (8 UBT)
---9 distance learning
-Graduate Certificate - 66
--(36 UBT)

Total enrollment - about 350
-PhD - 15
-Master's - 83
--60 distance learning
--23 on-campus
-Graduate Certificate - about 250

Alumni (as of June, 2010)
-People - 272
-Fellowships only - 19
-Degrees - 262
--PhD - 5 (2-3 more just about done)
--Master's - 137
---Master of Science - 63
---Master of Biomedical Informatics - 74
--Graduate Certificate - 120

Sunday, September 12, 2010

Will There Be a Need for Informaticians After EHR Implementation? Yes!

A question I am asked from time to time is whether there will be a need for informaticians once we are "done" implementing electronic health records (EHRs). My reply is that implementing EHRs is only a beginning, and actually not the most interesting part. Much more important is what we do with those EHRs and other information systems after they are implemented.

Once EHRs are implemented, there will still be all sorts of "meaningful" things that need to be done with them, and I am not just talking about the meaningful use guidelines, though those will keep us busy well past the middle of this decade. (Even the Office of the National Coordinator for Health IT [ONC] believes it unlikely that most eligible professionals and hospitals will achieve Stage 3 meaningful use before 2018-2019.)

But I only see healthcare becoming more data-driven in the future, with increasing emphasis on managing information to provide safe and less costly care. Activities such as quality measurement and improvement, improving efficiency, dealing with new types of information, and continued advances in information technology (IT) are likely to keep us busy for a long time to come.

One insight to these future needs comes from a new article by Bill Stead and colleagues (Academic Medicine, 2010, Epub ahead of print). It is unfortunate that this article is published in a journal that requires an individual or institutional subscription to access it, because it presents a clear picture that the complexity of information required to practice medicine is increasing and that clinicians - and the educators who train them - must learn how to function in the increasingly "information-rich" healthcare environment.

This article also lists a number of key competencies in informatics for physicians, organizing them within the framework Accreditation Council for Graduate Medical Education (ACGME) core competencies for physicians. The article also recommends that informatics become a foundational science for healthcare, advocating development of academic units involved in academic and operational activities, using the IT infrastructure of academic health centers as testing laboratories, and retraining faculty to lead the transformation of healthcare through the use of informatics.

There are many other reasons why informatics will not cease to be important once there are EHRs on every desk in healthcare. As us baby boomers age and develop more health problems, we will likely want to manage our healthcare the way we manage many other things in life (e.g., banking, air travel, buying certain things such as books, etc.), which is on-line. We also know that there is still plenty of room for improvement with existing EHRs. Data entry is too time-consuming, poor interfaces can hide critical data, and we still need much smoother interoperability, especially of data. The ONC SHARP program acknowledges the need for continued research in the four areas it is funding: architecture, privacy and security, secondary use of data, and cognitive-centered computing.

In essence, the implementation of EHRs enables a whole host of other activities that will allow improvement of health, healthcare, public health, and biomedical research. As such, there will only be increased demand for informaticians to perform and lead these activities.