Friday, December 31, 2021

Annual Reflections at the End of 2021

As is the tradition with this blog, I end each year with a reflective look at the year past and what the future may hold. The year 2021 is not ending quite like I anticipated. At the beginning of the year, there were stirrings of optimism. The new COVID-19 vaccines had been released, and a new approach to political leadership had just been elected in Washington, DC. On January 2nd, I received my first dose of the Pfizer vaccine, followed by a second one three weeks later.

By the spring, the pandemic was seeming to wane. In late June, Oregon lifted all pandemic restrictions, and life seemed to be returning to relative normal. At work, my department began making plans for returning to the office, aiming to slowly transition over the summer and then return to a new state of normal when the regular academic year started in the fall.
Alas, it was not to be. By August, the Delta wave was surging and plans for returning to the office were postponed. Things became more optimistic into the fall, with my getting my booster vaccine in early October, but then, just when it seemed that the Delta wave was on the decline, the new Omicron variant emerged.

Nonetheless, there is some reason for optimism in the long run for the pandemic. The vaccines are having an impact, even if mostly among the vaccinated. Clearly the vaccines are not completely protective against infections, but they do appear to blunt the worst complications of the disease. In addition, there are new COVID-19 treatments becoming available in pill form, such as Paxlovid, which may provide a means to further prevent the worst impacts of infection. With my three doses of Pfizer vaccine on board, I feel relatively well protected, and feel confident that if I were to have a breakthrough infection, the course would be mild. (Though I am not taking any excessive chances.)

Although I look forward to getting back to working in person, I have managed to maintain my own productivity by working mostly from my home office. One thing that the pandemic has taught the informatics field, and certainly the work of my own department, is that we can pretty much function virtually. I still enjoy interacting in person with colleagues, but clearly most of the research and educational work we do can be carried out in a virtual manner.
I am sad that this pandemic has been so politicized. Every happening, often having nothing to do with the action of politicians, seems to require being viewed through a political lens. While there is, as with all science, some room for debate on translating scientific findings into public policy, it is unfortunate that many, especially those on the right, have chosen to frame everything in that context and make decisions that defy sound public health practice. I don't enjoy wearing masks or avoiding large gatherings more than anyone, but I recognize these as a small price to pay to protect public health. And it is sad to me that new vaccine technology, one of the greatest public health advances in human history, has also become a political Rorschach test.

The ability to function virtually would not be possible without the maturing of computing and network technology. It is still far from perfect, but we almost take for granted now that we can have a synchronous video call with almost any location on the planet. Social media has played a valuable role too, especially in my case, Facebook. While I am no big fan of Facebook's business model, and I would happily pay a modest subscription fee to get the benefits of it that I like, it has been invaluable in keeping up personally and professionally with friends and colleagues around the world.

In terms of the informatics field, I am optimistic that we will continue the contributions we make to health and larger society. While the pandemic has caused a detour in our priorities, we are still moving forward in core advances, particularly turning the potential of machine learning and artificial intelligence into reality and advancing standards to make data more interoperable. The pandemic has exposed the limits of our current health information systems and processes, and even if too late to provide optimal value for this pandemic, will hopefully put us in a position to benefit the next public health crises.

This blog itself continues to be successful. This is the 361st post, and it is closing in on 768,000 page views over its nearly 13 years. This blog has provided me an opportunity to provide commentary on many topics, mainly professionally but also personally, and is easily accessible from the Internet. My frequency of posting has decreased some over the years, but I still appreciate the opportunity to weigh in on important topics and not feel the need to post at any specific level of frequency.

I head into 2022 with the optimism that things will get better, yet also with the realism that unforeseen events will happen and set us back. The key, as always, is to live life in a way that one has no major regrets for paths not taken, and living in a way that is just and equitable for the rest of society.

Tuesday, December 21, 2021

From Reading to Writing: Next Steps for Patient Data Exchange and Interoperability

The rationale and implementation for reading data from the electronic health record (EHR) and other clinical sources is relatively simple and straightforward. Especially now enshrined into law in the US by the 21st Century Cures Rule, and standardized by the FHIR application programming interface (API), accessing data for reading by clinicians, patients, and others is here to stay.

Writing data to the EHR or other clinical information systems is a little more complicated. As in all aspects of informatics, the technology part is relatively simple, as activating the API in the reverse direction is not difficult technologically. But writing data into the EHR and other systems raises a number of issues. Earlier this year, the Office of the National Coordinator for Health IT (ONC) convened a workshop to address this topic. The workshop discussed stakeholder knowledge, current usage, potential use cases, and lessons learned on “write-back” API functionality. A report from the workshop was released in November, 2021 and provides excellent insights into the usage and challenges for such technology. Five categories of stakeholders were represented: researcher, technologist, healthcare provider, patient, and financial technologist. (The provider perspective was provided by OHSU faculty Dr. Ben Orwoll.)

The report summarized a number of possible use cases and their data sources for API write-back:
  • Data from devices, such as wearables and remote monitors
  • Questionnaires from patients or care activities
  • Results of risk scores and calculators
  • Patient input of symptoms or reported outcomes
  • Recommendations of clinician decision support
  • Annotation or amending of patient notes
  • Results or recommendations of machine learning/artificial intelligence algorithms
  • Data from transitions of care across orgniazations
  • Community sources of data, including social determinants of health

Also identified were a number of technology barriers to writing data back into the EHR:

  • Limitations of FHIR standard
  • Accuracy and completeness of the data
  • Security of data from third-party apps
  • Mapping and coding issues for data entering EHR and other systems
  • Patient-matching accuracy
  • Requirements for manual workflow and/or reconciliation
  • Obligations of organization and clinicians for data written back

In addition, the report raised a number of policy, preference, and data use concerns:

  • Data ownership and expectations for patients and clinicians
  • Compliance with HIPAA and other current laws
  • Relationship to designated record set and legal medical record
  • Regulation needed to support open APIs and their adoption
  • Requirements for future policy
The entry of data into the EHR beyond the usual documentation by clinicians and others changes the nature of the EHR, marking the true transition from electronic medical record to electronic health record.

Monday, December 20, 2021

Kudos for the Informatics Professor - 2021 Update

Although virtually all work remains remote through the end of 2021, the Informatics Professor has still been productive in his work and actively collaborating with others around the world. I am proud of my accomplishments in 2021, and this post lists some of the highlights.

Probably my biggest highlight for this year is the awarding of two new National Institutes of Health (NIH) grants. One is an exciting new project funded by the NIH Harnessing Data Science for Health Discovery and Innovation in Africa Initiative (DS-I), where the Oregon Health & Science University (OHSU) Biomedical Informatics Graduate Program will be teaming up with the University of Cape Town (UCT) to develop new Research Training opportunities. A nice overview in Nature describes the larger initiative.

In this project, OHSU will partner with UCT to develop a new graduate program in Computational Omics and Biomedical Informatics (COBIP) that will start at UCT and aim to expand to other institutions from other countries across southern Africa. I will be on the leadership team and provide my expertise in developing and leading graduate programs in biomedical informatics and data science. The program will draw on the clinical informatics courses that OHSU offers, and other OHSU informatics faculty also be involved in teaching and mentoring of research projects of students in the program. We will aim to build what the overall NIH program seeks to accomplish, namely adding capacity in biomedical informatics and data science across the African continent. With the development of computer networks and sources of health data across Africa, the time is ripe to leverage it for the health of people in Africa. As with other programs we have helped developed over the years (in places like Argentina and Thailand), our goal is to develop sustainable programs in these places so they can eventually function without the need for us. Despite some setbacks from Covid, Africa is really poised to see development of using informatics to improve the healthcare and public health systems, ultimately benefiting health of the people. And hopefully in the long run the program will attract local talent and expertise and become an independent part of the global informatics community.

The second new grant is a five-year renewal of a project, Semi-structured Information Retrieval in Clinical Text for Cohort Identification. This funding continues my work in collaborating with colleagues from the Mayo Clinic and University of Texas Houston at the intersection of information retrieval and re-use of electronic health record data.

In addition to grants funded, I also served as a senior author on  a couple of journal articles published in 2021:
In 2021, I also assumed the Presidency of the International Academy of Health Sciences Informatics and was a co-author on two papers describing some activities of the Academy:
I also published three book chapters in 2021:
  • Hersh W, Biomedical Informatics, in Kutz M (ed.), Biomedical Engineering Fundamentals, Third Edition, McGraw-Hill, 2021, 31-48.
  • Hersh W, Information Retrieval, in Shortliffe EH, Cimino J, Chiang MF (eds.), Biomedical Informatics: Computer Applications in Health Care and Biomedicine, 5th Edition, New York, Springer, 2021, 761-800.
  • Hersh W, A Passion and a Calling, in: Kulikowski, C., Mihalas, G., Yacubsohn, Y., Greenes, R., Park, H.-A. (eds.), IMIA History Book. Healthcare Computing & Communications Canada, 2021, 383–386 (described further in an earlier post to this blog).
During the year, I also participated, mostly remotely, in a number of academic conferences, some of which were international. I gave an international keynote talk, although unfortunately from the confines of my home office at not with my long-time friends in Argentina, at the Jornadas de Informática en Salud del Hospital Italiano de Buenos Aires on November 16th entitled, Artificial Intelligence in Medicine: The Need to Translate From Basic Science to Clinical Value. Both the video part of my talk and my slides and references can be viewed online.

In another international conference in Portugal, I spoke virtually on a panel at the conference, Healthcare in Post-Pandemic – Will Value for Health be the Way?, hosted by the Value for Health Collaborative in Lisbon, Portugal (virtual), June 18th. Domestically, I provided an update virtually, AMIA Update on Academic, Education and Certification Initiatives, at the CAHIIM Fall Festival: Navigating Higher Education 2021 (virtual), October 7th.

Fortunately, I was able to participate in one conference in person. After a year and a half of not attending any conference in person, I was able to make it to the AMIA Annual Symposium in San Diego, CA from October 29-November 3. This meeting marked my 36th consecutive year attending the AMIA Annual Symposium, which was known as the Symposium on Computer Applications in Medical Care (SCAMC) when I first attended it in 1986. Last year, of course, the meeting was completely virtual, but fortunately the meeting took place in San Diego, where the mild climate of southern California allowed all social events to be outdoors. At the conference I participated in a panel entitled, Career Development Issues for Women in Biomedical Informatics Within Professional Organizations, on November 1st.

I was also interviewed for a couple of podcasts. One was, Conversations from the AMIA 2021 Symposium, from The Public Health Networker podcast of the Public Health Podcast Network, in which I gave some history and perspective of AMIA and its Annual Symposium over the years.

Another podcast in which I took part was from the series called Sound Practice, hosted by the American Association for Physician Leadership. My session was At the Intersection of Technology and Healing: Trends in Medical Informatics.

Finally, I also had a chance to do some writing focused on local issues in Portland, OR and the cities challenges in grappling with economic and social issues exacerbated the pandemic. I authored a perspective for a series in the Portland Business Journal entitled, Don't Count Portland Out (apologies for it being behind a paywall).