Since the inception of this blog in 2009, I have ended each year with a post reflecting back on the year. In the early years, a good deal of the focus of this blog was on the HITECH Act, especially its workforce development provisions. Later on, there were other topics such as the clinical informatics subspecialty and emergence of data science. And many more.
Thursday, December 31, 2020
Since the inception of this blog in 2009, I have ended each year with a post reflecting back on the year. In the early years, a good deal of the focus of this blog was on the HITECH Act, especially its workforce development provisions. Later on, there were other topics such as the clinical informatics subspecialty and emergence of data science. And many more.
Monday, December 28, 2020
You might not know it from the presence of the COVID-19 pandemic, but I was quite busy and productive since being relegated to virtual work since mid-March of 2020. In the last of my periodic kudos postings, I described all of what I accomplished in the first half of 2020, some of which took place during the early dark days of the pandemic. In the rest of 2020, I have published a number of scientific papers and book chapters as well as given a number of talks, some in distant places, albeit virtually.
- Chamberlin SR, Bedrick SD, Cohen AM, Wang Y, Wen A, Liu S, Liu H, Hersh WR, A query taxonomy describes performance of patient-level retrieval from electronic health record data, Health Search and Data Mining Workshop, Web Search and Data Mining (WSDM) Conference, 2020.
- Roberts K, Alam T, Bedrick S, Demner-Fushman D, Lo K, Soboroff I, Voorhees E, Wang LL, Hersh WR, TREC-COVID: rationale and structure of an information retrieval shared task for COVID-19, Journal of the American Medical Informatics Association, 27: 1431-1436.
- Cohen A, Chamberlin S, Deloughery T, Nguyen M, Bedrick S, Ko JJ, Amin J, Wei A, Hersh W, Detecting rare diseases in electronic health records using machine learning and knowledge engineering: case study of acute hepatic porphyria, PLoS ONE, 15: e0235574.
- Fultz Hollis K, Roberts K, Bedrick S, Hersh WR, Addressing the search challenges of precision medicine with information retrieval systems and physician readers, Studies in Health Technology and Informatics, 2020, 270: 813-817.
- Chamberlin SR, Bedrick SD, Cohen AM, Wang Y, Wen A, Liu S, Liu H, Hersh WR, Evaluation of patient-level retrieval from electronic health record data for a cohort discovery task, JAMIA Open, 3: 395-404.
- Liu S, Wang Y, Wen A, Wang L, Hong N, Shen F, Bedrick S, Hersh W, Liu H, Implementation of a cohort retrieval system for clinical data repositories using the Observational Medical Outcomes Partnership Common Data Model: proof-of-concept system validation, JMIR Medical Informatics, 8(10): e17376.
- Gray TR, McFarlane C, Finch M, Fuchs JM, Hersh W, Clouse J, Incentivizing change within social determinants of health using blockchain technology, Frontiers in Blockchain, 3: 10.3389/fbloc.2020.00040.
- Hersh W, Public Health in the Larger Context of Biomedical and Health Informatics, in Magnuson JA, Dixon B (eds.) Public Health Informatics and Information Systems, 3rd Edition, New York: Springer, 2020, 31-41.
- Hersh W, Online Continuing Education in Informatics - the AMIA 10x10 Experience, in Berner ES (ed.), Informatics Education in Healthcare: Lessons Learned, 2nd Edition, New York: Springer, 2020, 251-262.
- Hersh W, Open Educational Resources in Informatics, in Berner ES (ed.), Informatics Education in Healthcare: Lessons Learned, 2nd Edition, New York: Springer, 2020, 277-285.
- The Informatics Workforce and its Certification in the United States - XV Jornadas de Informática en Salud - Hospital Italiano Annual Conference, Buenos Aires, Argentina (virtual), November 3, 2020
- Impact of COVID-19 on Digital Health and Health Informatics - CBIS '20 - XVII Congresso Brasileiro de Informatica em Saude, Sao Paulo, Brazil (virtual), December 8, 2020
- The Informatics Response to COVID-19 - OHSU Department of Medicine Grand Rounds, Portland, OR, December 8, 2020
- Our Master of Science (MS) program that offers thesis and non-thesis options for two majors: Health & Clinical Informatics and Bioinformatics & Computational Biomedicine. This program trains individuals to pursue a wide variety of professional careers in healthcare, industry, research, public health, and other settings.
- The OHSU Biomedical Informatics PhD program that prepares individuals for careers in research also in two areas: Health & Clinical Informatics and Bioinformatics & Computational Biomedicine. Most students in the program are supported through our NIH National Library of Medicine T15 Training Grant. (This training grant also offers funded postdoc positions for those seeking research careers who already have a doctoral degree in other field.)
- Our Clinical Informatics Subspecialty Fellowship that trains physicians aiming to become board-certified in the new subspecialty of clinical informatics. The ACGME-accredited fellowship requires certification in a primary specialty and offers the option of pursuing the MS degree.
I am pleased that 2020 turned out to be an academically productive year for me, but I am more than eager to return to normal living as vaccination and herd immunity are achieved for COVID-19 in 2021.
Tuesday, December 22, 2020
There is a famous line at the end of the Jewish Passover Seder, Next year in Jerusalem. While some interpret the phrase literally, to most it means that next year the community will be together and stronger, no matter where in the world everyone is.
As the current COVID-19 pandemic rages out of control, there are some signs of hope. Two vaccines have been approved and are being rolled out across the country and the world. While I am envious of friends who are posting pictures of themselves getting their first injection on social media, I am content to wait my turn in line, as I am not a frontline clinician or other frontline worker, nor do I have co-existing medical conditions that would put me at higher risk for complications if I were to get infected with SARS-CoV-2. I will wait my turn, although I will show up in a heartbeat when my number is called, which I anticipate will be in the spring or summer of 2021.
In the meantime, while we are all waiting to get our vaccine shots, there are other things we can and should be doing, such as wearing masks and social distancing. I have lent my endorsement to another effort, signing my name on to a letter calling for the development of cheap, rapid, and frequently administered antigen tests. The idea of these tests is that if we all test frequently, we can learn if we are infectious and self-quarantine. These tests do not have same sensitivity and specificity as PCR tests, but they are much faster and cheaper, and tend to be positive when one is actively infectious. If we all used these simple paper-strip tests a couple times a week, and just as importantly, self-quarantined when positive, we could keep the virus at bay until we all have herd immunity from the vaccine.
Despite this being one of most challenging years in the history of many of our lives, I look to the future with an optimistic eye. The toll of COVID-19 has been devastating, not only to those who have perished but also the devastated economy and disruption of education, especially for children. But in the end, science will prevail and, over time, the worst of the pandemic will be behind us.
I feel fortunately in having always lived a relatively virtual work life, as noted in this blog last year, and I have had little trouble staying productive in the pandemic. But that does not mean that I miss going into the office, or attending conferences and other events. I am fortunate enough to have a lifetime of friends and colleagues, and keeping in touch with them by social media, videoconferencing, and the like has been easy. I am sure it is different for those without such a long time to build interpersonal bonds, such as those earlier in their careers.
Thus I do look forward to having immunity to SARS-CoV-2, or at least the COVID-19 disease that it causes. I look forward to seeing my family, friends, and colleagues again, and getting to once again visit the world. Travel will likely be different on the other side, not only due to the pandemic but also due to climate change, but I am confident I will again visit so many wonderful people and places around the world.
Friday, November 20, 2020
2. Haux, R., Ball, M.J., Kimura, M., Martin-Sanchez, F., Otero, P., Huesing, E., Koch, S., Lehmann, C.U., 2020. The International Academy of Health Sciences Informatics (IAHSI): IMIAs Academy is Now Established and on Track. Yearb Med Inform 29, 11–14. https://doi.org/10.1055/s-0040-1701971.
3. Martin-Sanchez, F., Ball, M.J., Kimura, M., Otero, P., Huesing, E., Lehmann, C.U., Haux, R., 2020. International Academy of Health Sciences Informatics (IAHSI): Strategy and Focus Areas, 1st Version. Yearb Med Inform 29, 15–25. https://doi.org/10.1055/s-0040-1701992.
Friday, November 13, 2020
A staple in my life each fall, dating back to 1986, is my annual attendance of what is now called the AMIA Annual Symposium. This year marks my 35th consecutive year of participation. I first attended this meeting when it was still called the Symposium on Computer Applications in Medicine Care (SCAMC). I was a third-year internal medicine resident at the time, seeking to learn more about the field and how to pursue training in it. Since 1986, I have never missed this meeting each fall.
Of course, the 2020 version of the AMIA Annual Symposium will be like no other. We are in the midst of the COVID-19 pandemic, so like most scientific meetings in 2020, this year's meeting will be virtual. That won't keep me from attending all the meeting's usual events, including the opening session, the induction of fellows (of both ACMI and AMIA), the leadership gala dinner, the association business meeting, numerous scientific sessions, and the closing session. I will also conduct another staple AMIA activity of mine I have been doing since 2005, which is the in-person session that culminates the 10x10 course and will take place virtually this year. Finally, I will be making an appearance at the Oregon Health & Science University (OHSU) virtual booth in the Career Expo portion of the Exhibit Hall (see image below)
Another meeting I have attended almost every fall that typically occurs in proximity to AMIA is the Text Retrieval Conference (TREC). I attended the first TREC meeting in 1992 and have missed a few over the years, but otherwise have attended almost all of them. It has been gratifying to contribute to the leadership of the series of biomedically-oriented information retrieval challenge evaluations. At the 25th anniversary of TREC in 2016, I enjoyed giving an overview talk on all of the biomedical tracks up to that time (starting at just past 50 minutes into the Part 3 of the recorded Webcast). As with AMIA, the social aspects and hallway conversations are also what makes attending the meeting so enjoyable.
Some years I have had to made compromises with AMIA or TREC when they have been the same week but in different cities. Like AMIA, the TREC meeting will be virtual this year as well, and actually spread out over the entire week that also includes AMIA. But one upside to both conferences being virtual is that I can jump back and forth between the meetings.
These virtual conferences come on the heels of some of the early results of COVID-19 vaccines being released in the news media. I do hope that next year at this time, I will have immunity to SARS-CoV-2 as I attend in person both the AMIA and TREC meetings. We will see in retrospect that turns out to be wishful thinking.
Wednesday, November 11, 2020
Wednesday, October 28, 2020
In 2006, I published a paper entitled, Who are the Informaticians? - What We Know and Should Know . As my interest in developing educational programs was growing at the time, I was also thinking about the nascent growth of biomedical and health informatics as a profession. Since I had entered the field in the late 1980s, informatics was mostly a research discipline. But with the growth of information technology (IT) adoption in healthcare and other aspects of biomedicine, informatics was becoming a profession that included operational, research, and academic roles and activities.
The last decade (2010-2020) has seen progress in answering my questions from 2006 paper. There has been progress in defining the field on several fronts, although not all efforts have been fruitful. Beginning with the rollout of the HITECH Act, the health IT workforce was viewed as an essential component for success . Professional certification in informatics emerged, first for physicians  and soon for others working in the field . The work in preparing for the physician subspecialty led to the development of a core content outline for the field, which would be used among other things for the content of the physician board certification exam . Other efforts led to definitions of competencies for graduate study in biomedical informatics broadly  and more focused in master’s-level applied health informatics . One unsuccessful effort was the attempt to become defined in US federal labor statistics through the designation of a Standard Occupational Classification (SOC) code . Health informatics was included in the initial 2018 update of the SOC, but was ultimately left on the proverbial BLS cutting-room floor .
A more recent effort has been led by AMIA in conducting two parallel analyses focused on defining the knowledge, skills, and tasks of people who work in informatics [10, 11]. The results have been published in two papers that focus on one narrow and one broader group. The narrow group consisted of physicians in the clinical informatics subspecialty (CIS) . One goal of this effort was to update the core content that was now nearly a decade old and still being the “study guide” for the board certification exam. The larger group consisted of all who work in health informatics (HI), which was defined broadly to include those who work in informatics focused on individual health, healthcare, public health, and research .
Interestingly, the workforce analyses conducted by AMIA for the CIS and HI groups led to very similar results. Each found five domains of practice that define the required knowledge, skills, and tasks of informatics practice and research. One interesting yet unsurprising result of the analysis was that four of the domains were relatively similar to those of the original CIS core content , while the fifth domain showed the growing importance of issues related to data, including its capture, governance in organizations, and analytics. New uses of the data existed during the time of the original CIS core content but played a small role in the field, such as machine learning and predictive analytics.
I recently took a deep dive into both analyses, with a major aim of identifying the similarities. I describe my findings here (and take any blame for any misrepresentation of this impressive body of work). Both analyses describe the first domain of fundamental knowledge and skills, which include a common vocabulary, basic knowledge across all informatics domains, and understanding of the environment(s) in which the workforce functions. Depending on where an individual works, this may include consumer health, health care, public health, or research settings.
The second domain differs somewhat between the HI and CIS analyses but can be integrated into an overall focus on enhancing health decision-making and improving health care delivery and outcomes. Informatics practice should support and enhance decision-making by clinicians, patients, policy makers, researchers, and public health professionals. It must also analyze existing health processes and identify ways that health data and health information systems (HIS) can enable improved outcomes. Informatics work should also evaluate the impact of HIS on professional practice as well as pursue discovery and innovation. More clinically, informatics practice should be able to develop, implement, evaluate, monitor, and maintain clinical decision support while also supporting innovation in the health system through informatics tools and processes.
The third domain of each analysis can be combined into an overall category of health and enterprise information systems. Informatics practice should include planning, developing or acquiring, implementing, maintaining, and evaluating HIS that are integrated with existing information technology systems across the continuum of care. This should include the clinical, consumer, and public health domains and address security, privacy, and safety considerations. This domain should also include the development, curation, and maintenance of institutional knowledge repositories, also while addressing security, privacy, and safety considerations.
A critical domain is the new addition to the previous four domains of the CIS core content, which can be integrated as data governance, management, and analytics. Practice should include establishing and maintaining data governance structures, policies, and processes. The workforce should be able to acquire and manage health-related data to ensure their quality and meaning across settings and to utilize them for analysis that supports individual and population health while driving innovation. It is also critical to incorporate information from emerging data sources, ensure data quality and meaning across settings, and derive insights to optimize clinical and business decision-making. Although not explicitly mentioned in the overall descriptions of this domain (but covered in the details of practice) are the ability to identify and minimize biases in data and mitigate their impact as well as to implement and evaluate machine learning and artificial intelligence applications in all health-related settings.
The final domain reflects the organizational and management aspects of informatics, with required abilities in leadership, professionalism, and transformation. Informatics practice should be able to build support and create alignment for informatics best practices as well as lead informatics initiatives and innovation through collaboration and stakeholder engagement across organizations and systems.
Although it is valuable to have the requirements for the workforce well-elucidated, the results of the new analyses are hardly surprising. We have known for many years that biomedical and informatics is a sociotechnical discipline, i.e., influenced by the interaction between social aspects and use of technology. We also know from prior explorations of competencies for master’s-level education that foundational knowledge and skills are required from health sciences, social sciences, and information sciences . This new work demonstrates more clearly the work of informatics, and future work will hopefully quantify the different types of professionals and their require knowledge and skills.
1. Hersh, W., 2006. Who are the informaticians? What we know and should know. J Am Med Inform Assoc 13, 166–170. https://doi.org/10.1197/jamia.M1912.
2. Hersh, W., 2010. The health information technology workforce: estimations of demands and a framework for requirements. Appl Clin Inform 1, 197–212. https://doi.org/10.4338/ACI-2009-11-R-0011.
3. Detmer, D.E., Shortliffe, E.H., 2014. Clinical Informatics: Prospects for a New Medical Subspecialty. JAMA 311, 2067–2068. https://doi.org/10.1001/jama.2014.3514.
4. Gadd, C.S., Williamson, J.J., Steen, E.B., Fridsma, D.B., 2016. Creating advanced health informatics certification. J Am Med Inform Assoc 23, 848–850. https://doi.org/10.1093/jamia/ocw089.
5. Gardner, R.M., Overhage, J.M., Steen, E.B., Munger, B.S., Holmes, J.H., Williamson, J.J., Detmer, D.E., AMIA Board of Directors, 2009. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc 16, 153–157. https://doi.org/10.1197/jamia.M3045.
6. Kulikowski, C.A., Shortliffe, E.H., Currie, L.M., Elkin, P.L., Hunter, L.E., Johnson, T.R., Kalet, I.J., Lenert, L.A., Musen, M.A., Ozbolt, J.G., Smith, J.W., Tarczy-Hornoch, P.Z., Williamson, J.J., 2012. AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline. J Am Med Inform Assoc 19, 931–938. https://doi.org/10.1136/amiajnl-2012-001053.
7. Valenta, A.L., Berner, E.S., Boren, S.A., Deckard, G.J., Eldredge, C., Fridsma, D.B., Gadd, C., Gong, Y., Johnson, T., Jones, J., Manos, E.L., Phillips, K.T., Roderer, N.K., Rosendale, D., Turner, A.M., Tusch, G., Williamson, J.J., Johnson, S.B., 2018. AMIA Board White Paper: AMIA 2017 core competencies for applied health informatics education at the master’s degree level. J Am Med Inform Assoc 25, 1657–1668. https://doi.org/10.1093/jamia/ocy132.
8. Request/Recommendation for New Health Informatics Practitioner Standard Occupational Classification (SOC), 2016. https://www.amia.org/sites/default/files/Healthcar-Coalition-Response-2018-SOC.pdf.
9. AMIA Washington Download: 12.18.17 Government Equates Informatics with Registrars New Occupation Codes, 2017. http://echo4.bluehornet.com/hostedemail/email.htm?h=e869a86eb5a0ec8a88474b41ab00b063&CID=-1.
10. Silverman, H.D., Steen, E.B., Carpenito, J.N., Ondrula, C.J., Williamson, J.J., Fridsma, D.B., 2019. Domains, tasks, and knowledge for clinical informatics subspecialty practice: results of a practice analysis. J Am Med Inform Assoc 26, 586–593. https://doi.org/10.1093/jamia/ocz051.
11. Gadd, C.S., Steen, E.B., Caro, C.M., Greenberg, S., Williamson, J.J., Fridsma, D.B., 2020. Domains, tasks, and knowledge for health informatics practice: results of a practice analysis. J Am Med Inform Assoc 27, 845–852. https://doi.org/10.1093/jamia/ocaa018.
Thursday, October 1, 2020
I am gratified to be active in a number of areas of research in biomedical and health informatics, but my original and still most active area is information retrieval (IR), also sometimes called search. The appeal of getting information from a computer by entering a query or question held appeal to me from early times, including when I was dabbling with computers in medical school and residency in the mid-1980s. Upon entering formal training in the field in my postdoctoral fellowship in 1987, this appeal persisted, even as the thrust of research in the field was still focused on the first era of artificial intelligence.
My introduction to the field came through a monograph by Prof. Bruce Croft, which then led me to discover the work of Prof. Gerard Salton. I had the opportunity to meet Salton when he visited Harvard University during my postdoctoral informatics fellowship there. Salton literally invented the IR field and it is unfortunate that he passed away in 1995 before he could see the true impact of his work on IR systems in the world. The approach of Salton and his legions of graduate students he trained in “automated” IR was quite different than the main biomedical focus in the 1980s and 1990s, which was the set-based Boolean retrieval approaches used to search MEDLINE. My earliest work attempted to marry the automated approaches to the controlled vocabularies being developed and collated in the National Library of Medicine (NLM) Unified Medical Language System (UMLS) Metathesaurus.
Another early interest of mine in IR concerned evaluation of systems and users. A perspective of evaluation has guided a great deal of my informatics research, based on the premise that what we do, whether building systems or advocating their use by people, should be studied for its value to human health and healthcare. My foray into IR research led me to recognize the importance of the relevance-based metrics of recall, precision, and their aggregated combinations, but I also felt dissatisfied that they did not evaluate the entire IR experience, especially for users. I was fortunate to be able to attend the very first Text Retrieval Conference (TREC), and then become involved in organizing a number of its tracks in subsequent years.
I never would have imagined in my early days that we would be able to carry around the Internet - and access to the world’s knowledge - in our pockets via mobile devices. I could not fathom that essentially all scientific publishing would become electronic, and that it would include not only articles but the underlying data. I also would never have imagined that searching would be so ubiquitous by all Internet users, or that the name of a search engine would become a verb (Googling).
The world of IR has certainly changed. The basic task of “ad hoc” searching is pretty well a solved problem. There are still, however, challenging problems in IR to solve, such as some of those on which I currently work.
Both the eBook and hardcover editions of the new edition are now available through Springer and Amazon. If you or your institution have access to SpringerLink, the eBook version can be accessed there.
Friday, September 4, 2020
Although my career has mostly been focused on informatics, I have always considered evidence-based medicine (EBM) to be a part of, or at least overlapping with, informatics. Even though I gave up seeing patients almost two decades ago, I still enjoy maintaining a connection to medical practice through my interest in EBM.
It therefore makes an imperative for me to volunteer to participate in a randomized controlled trial (RCT) for a SARS-Co-V-2 vaccine. If I advocate for more use of RCTs to discern what works in medicine, thus requiring others to participate in RCTs, I should put my own proverbial money where my mouth is. As such, I have entered my name into the US government registry of people volunteering for one of the three major COVID-19 vaccine RCTs for vaccine candidates from ModernaTX, AstraZeneca, and BioNTech SE and Pfizer. Although each of the three trials will enroll about 30,000 people, apparently the number of people who have entered their names into the registry is much larger, so not everyone will get called to participate.
Not only do I feel a call to duty to take part, but I am probably a good candidate for one of the trials. Although I am in relatively good health without any of the underlying conditions that increase risk of death and complications from COVID-19, I am in the age group where the risk starts to climb. I am also one who is eager to move on from this pandemic and return to normal life.
If I am called to participate in a trial, it will not be completely risk-free. The main risk, of course, is that I could be among the half of participants who end up in the placebo group. But even if I am given an actual vaccine, there are some other risks. One might be that the vaccine leads to adverse effects, such as Guillian-Barre Syndrome. Another is that vaccines can sometimes cause paradoxical effects, such as antibody-dependent enhancement, where viruses leverage antibodies to aid infection, or cell-based enhancement, which leads to allergic inflammation. And finally, I could end up in an RCT of a vaccine that turns out to be less efficacious than the others being tested.
There are other risks of participation related to the politics of COVID-19, which are being driven by a desire to have a vaccine approved by Election Day. This could be dangerous not only for those who participate in the trials, with both benefits and harms may not become fully apparent with a shortened trial, but also to society at large, in not knowing the true efficacy of the vaccines, and not being able to best compare the different candidates.
Although I am most disturbed by the politics, I am still willing to take the risks of participating if I am called. Bring on the informed consent form! I do hope this pandemic will end and the world can return to some semblance of normal soon.
Thursday, August 20, 2020
In a few weeks, the COVID-19 pandemic lockdown will have been going on for a half-year for most people in the United States. I still remember its beginning in early March. Nothing in my entire life has impacted my personal and professional activities as much as this.
Thursday, July 16, 2020
- What is Biomedical and Health Informatics? (1) (24:32)
- What is Biomedical and Health Informatics? (2) (18:49)
- A Short History of Biomedical and Health Informatics (22:30)
- Resources for Field: Organizations, Information, Education (25:29)
- Clinical Data (15:08)
- Examples of the Electronic Health Record (EHR) (24:56)
- Data Science and Artificial Intelligence (1) (14:15)
- Data Science and Artificial Intelligence (2) (22:07)
- Information Retrieval (Search) (23:18)
- Information Retrieval Content (29:09)
The materials on the site are freely available and have been used by many educators and others. An article from the American Medical Association (AMA) described their use by medical educators during the COVID-19 pandemic.
Sunday, July 5, 2020
Thursday, July 2, 2020
- On Thursday, January 23, I participated in an invited meeting at the National Academy of Medicine in Washington, DC focused on the "evolution of data privacy and the implications for secondary use of health data in support of a learning health system.” My invitation likely stemmed from my informatics research focused on methods to use electronic health record (EHR) data for cohort identification for clinical studies and surveillance for undiagnosed rare diseases.
- On Monday, February 3, I gave a keynote talk at a workshop that was part of the conference, Web Search and Data Mining, in Houston, TX. The workshop was entitled, Health Search and Data Mining, and the title of my talk was, Applying Information Retrieval to the Electronic Health Record for Cohort Discovery and Rare Disease Detection.
- On Thursday, February 13, I gave an invited talk in the UCLA Distinguished Lecture Series for Biomedical Data Science, also on my research area of using EHR data for cohort identification and surveillance for undiagnosed rare diseases.
- On Thursday, March 5, I spoke at Grand Rounds for the Department of Biomedical Informatics at the University of Utah on the topic of competencies in clinical informatics for medical students. They were interested in hearing about the work that we pioneered at OHSU in clinical informatics for the MD curriculum.
Friday, June 5, 2020
It gives me great pleasure to welcome the 2020 graduates of the OHSU Biomedical Informatics Graduate Program to this year’s virtual Commencement ceremony. The annual Commencement ceremony is an important event for me, as I enjoy every year celebrating the success of our graduates and their moving on to new paths in their lives. We have been awarding degrees and certificates from our program since 1998, and only once have I had to miss Commencement.
This year was already going to be a different Commencement ceremony. I would have attended the main event for all graduates with you all, but then would have not attended the OHSU School of Medicine Graduate Programs portion. That is because I would instead be attending another Commencement event, namely the medical student commencement because this year, as many of you know, my daughter is graduating OHSU with MD and MPH degrees. I am very proud of her and excited that she will be starting her residency in Obstetrics & Gynecology at OHSU later this month.
Of course, now the entire Commencement is a different event for all of us, because of the Covid-19 pandemic and the need for the entire ceremony to be virtual. I was hoping with all the rearranging that I still might get to share this time with you all, but alas, all of the follow-on ceremonies, including graduate programs and medicine, are scheduled immediately after the main session.
So this year you will get this brief message from me. I will miss the pomp and circumstance of graduation, and getting to wear regalia and march in the procession. Hopefully things will be back to normal next year, and perhaps some of you can return to take part then.
In any case, many of you are now stepping from your informatics studies into jobs where the contributions of our field are more critical than ever. Just as the pandemic has exposed problems in our healthcare system, it has also exposed limitations in our information and data systems. It is the mandate for all informatics graduates, and everyone else in the informatics field, to keep improving how we use information and data, not only to overcome Covid-19 but also to improve biomedicine and health generally. From bio- to imaging to clinical and public health informatics, the challenges have never been greater. I am confident that you have the talent, and skills you have acquired in your studies, to meet those challenges.
I am pleased to report that our alumni now number 782 individuals with 872 degrees and certificates dating back to 1998. These include 374 master’s degrees and 31 PhD degrees. Our graduates have achieved success in academia, industry, government, and just about every other place where informaticians work. Your success in your work and life generally is one of the main aspects of our work that gives faculty and staff great satisfaction.
Let me close as always to remind you that even though you are moving on from OHSU, we are still here for you and hope you will keep in touch with us as your careers develop and prosper.
Tuesday, May 12, 2020
Sunday, April 26, 2020
I ultimately finished my fellowship and moved on to Oregon in 1990, and the development of UpToDate was taken over by a fellowship colleague, Dr. Joseph Rush, who stayed on the project for years as it matured into a commercial product that expanded to all of medicine. In 2008, UpToDate was acquired by the large publisher, Kluwer. I had not seen Dr. Rose in many years, but he continued to be a vibrant clinician and educator until his recent retirement.
UpToDate is still widely used and revered in medical settings around the world. I believe its real value is in its content. While its modern search functionality is excellent, what really draws clinicians to it is the quality of its content that can be used to make clinical decisions based on rapid access to high-quality information.
Wednesday, April 22, 2020
Thursday, April 16, 2020
Saturday, April 11, 2020
For me personally, the Covid-19 crisis so far has been relatively easy. Because of this, I have gratitude and also note my fortunes could change at any time. So far, none of my immediate family, friends, or colleagues has become infected or fallen ill. We are comfortably ensconced in our house, have access to just about all of life's essentials, and can enjoy the outdoors, including my own running, with careful physical distancing. Spring is arriving, and the weather over the last few days has been wonderful.
Thursday, April 2, 2020
Our contribution is a virtual course in biomedical and health informatics. Readers familiar with my work will recognize the content of this course as emanating from the introductory course in the Oregon Health & Science University (OHSU) Biomedical Informatics Graduate Program. This course is also used in OHSU's offering as part of the American Medical Informatics Association 10x10 ("ten by ten") program. The syllabus for the course details on how medical schools can enroll their students.
We are implementing the course as a 4-week medical student elective, which is awarded 2 credits at OHSU. The course has about 40 hours of lecture, and we anticipate another 40 hours spent on discussion forums, multiple-choice self-assessments for each unit, and optional readings. The course is graded as pass-fail, and passing requires completion of all of 10 units and their self-assessments over the 4 weeks of the course. Due to high demand, we are limiting enrollment to students in US-based allopathic and osteopathic medical schools.
One new offering of the course will begin each week starting Monday, April 6. We will enroll as many students as we have in a single section, and make all of the content available to them for the duration of the 4 weeks. We will make use of the discussion forums built into our LMS to answer questions they have, and raise a few questions for them to answer. At the end of 4 weeks, the course will end, and those who have completed all of the work will receive a passing grade, which we will report back to the contact from each school.
We are asking each medical school handle student enrollment and credit themselves. In other words, we will make the course available through our learning management system (LMS) at OHSU, but we will ask each school to provide us a list of students to enroll and each will get a login to the course. After the course is done, we will report back to the schools on whether each student completed the course or not. We would like for medical schools that participate to handle giving students credit (probably through some sort of self-study elective).
We also prefer that there be a single point of contact for each school with which we communicate. To capture this information, we have created an online survey that asks for the point of contact (please use a university email address), estimated number of students (initially up to 20 per school - we may be able to accommodate more later), and preferred dates (which we may need to change to balance load). After the survey is completed, someone from our staff will contact the schools to work out the details.
In addition, for those interested in less than a full course on informatics, we have an open Web site that provides some of the materials and is being used by some medical schools.
Monday, March 30, 2020
- How well do tests diagnose active infection with the disease?
- How well do tests diagnose serum antibodies indicating immunity?
- What treatments are available for the disease?
- Are there any preventive treatments for the disease, from drugs to immunizations?
- What is the best way to prevent spread in the general population?
- What is the best way to protect healthcare workers treatment patients with the disease?
Wednesday, March 25, 2020
- A benchmark set of important COVID-related queries (e.g., coronavirus risk factors, COVID-19 ibuprofen)
- A set of manual judgments for CORD-19 articles on these queries
- An ongoing leaderboard for comparison of IR systems
Saturday, March 21, 2020
Sunday, February 23, 2020
a. Information retrieval/search - choose correct sources for specific task, search using advanced features, apply results
b. Evaluate information resources (literature, databases, etc.) for their quality, funding sources, biases
c. Identify tools to assess patient safety (e.g., medication interactions)
d. Utilize knowledge-based tools to answer clinical questions at the point of care (e.g., text resources, calculators)
e. Formulate an answerable clinical question
f. Determine the costs/charges of medications and tests
g. Identify deviations from normal (labs/x-rays/results) and develop a list of causes of the deviation
2. Effectively read from, and write to, the electronic health record for patient care and other clinical activities
a. Graph, display, and trend vital signs and lab values over time
b. Adopt a uniform method of reviewing a patient record
c. Create and maintain an accurate problem list
d. Recognize medical safety issues related to poor chart maintenance
e. Identify a normal range of results for a specific patient
f. Access and compare radiographs over time
g. Identify inaccuracies in the problem list/history/med list/allergies
h. Create useable notes
i. Write orders and prescriptions
j. List common errors with data entry (drop down lists, copy and paste, etc.)
3. Use and guide implementation of clinical decision support (CDS)
a. Recognize different types of CDS
b. Be able to use different types of CDS
c. Work with clinical and informatics colleagues to guide clinical decision support use in clinical settings
4. Provide care using population health management approaches
a. Utilize patient record (data collection and data entry) to assist with disease management
b. Create reports for populations in different healthcare delivery systems
c. Use and apply data in accountable care, care coordination, and the primary care medical home settings
5. Protect patient privacy and security
a. Use security features of information systems
b. Adhere to HIPAA privacy and security regulation
c. Describe and manage ethical issues in privacy and security
6. Use information technology to improve patient safety
a. Perform a root-cause analysis to uncover patient safety problems
b. Familiarity with safety issues
c. Use resources to solve safety issues
7. Engage in quality measurement selection and improvement
a. Recognize the types and limitations of different types of quality measures
b. Determine the pros and cons of a quality measure, how to measure it, and how to use it to change care
8. Use health information exchange (HIE) to identify and access patient information across clinical settings
a. Recognize issues of dispersed patient information across clinical locations
b. Participate in the use of HIE to improve clinical care
9. Engage patients to improve their health and care delivery though personal health records and patient portals
a. Instruct patients in proper use of a personal health record (PHR)
b. Write an e-message to a patient using a patient portal
c. Demonstrate appropriate written communication with all members of the healthcare team
d. Integrate technology into patient education (e.g., decision making tools, diagrams, patient education)
e. Educate patients to discern quality of online medical resources (Web sites, apps, patient support groups, social media, etc.)
f. Maintain patient engagement while using an EHR (eye contact, body language, etc.)
10. Maintain professionalism through use of information technology tools
a. Describe and manage ethics of media use (cloud storage issues, texting, cell phones, social media professionalism)
11. Provide clinical care via telemedicine and refer patients as indicated
a. Be able to function clinically in telemedicine/telehealth environments
12. Apply personalized/precision medicine
a. Recognize growing role of genomics and personalized medicine in care
b. Identify resources enabling access to actionable information related to precision medicine
13. Participate in practice-based clinical and translational research
a. Use EHR alerts and other tools to identify patients and populations eligible for participation in clinical trials
b. Participate in practice-based research to advance medical knowledge
14. Apply machine learning applications in clinical care
a. Discuss the applications of artificial/augmented intelligence in clinical settings
b. Describe the limitations and potential biases of data and algorithms