2 – What is Biomedical and Health InformaKcs? Terms related to

2 – What is Biomedical and Health Informa6cs? Copyright, 2015 William Hersh, MD Professor and Chair Department of Medical Informa6cs & Clinical Epidemiology Oregon Health & Science University Portland, OR, USA Email: [email protected] Web: www.billhersh.info Blog: hQp://informa6csprofessor.blogspot.com WhatIs2 1 Terms related to medical/clinical records •  Electronic health record (EHR) – pa6ent’s health record in digital form –  Has mostly supplanted electronic medical record (EMR) •  Meaningful use – program of incen6ves for EHR adop6on in US requiring that they be used in ways that achieve healthcare goals •  Personal health record (PHR) – personally controlled health record •  Health informa6on exchange (HIE) – exchange of health informa6on across tradi6onal business and other boundaries (a verb) –  Organiza6on managing HIE used to be called a Regional Health Informa6on Organiza6on (RHIO), now called an HIE (a noun) WhatIs2 2
Many are extolling the virtues of BMHI in healthcare and related areas •  Most prominent discussion has focused on improving healthcare through improved quality, safety, and efficiency •  However, there are many challenges –  Mixing IT with clinical workflow has been difficult –  Some HIT has been deleterious –  Financial benefits of IT do not always accrue to those who pay –  Larger problems in healthcare organiza6on and financing make any type of change difficult WhatIs2 3 Informa6cs is also essen6al for modern biomedical research •  Embodied in the Na6onal Ins6tutes of Health (NIH) Roadmap to accelerate biomedical research discovery (
hQp://commonfund.nih.gov) –  Today’s biomedical researcher rou6nely generates … billions of bytes of data. … What researchers need are computer programs and other tools to evaluate, combine, and visualize these data. In some cases, these tools will greatly benefit from the awesome strength of supercomputers or the combined power of many smaller machines in a coordinated way but, in other cases, these tools will be used on modern personal computers and worksta6ons. •  Also permeates priori6es of NIH Director (Collins, 2010) – 
High-­‐throughput technologies Transla6onal research Suppor6ng healthcare reform Global health Empowering the research community WhatIs2 4
Informa6cs terms for biomedical research •  Transla6onal research – classically, the transla6on of basic research into clinical applicability (“bench to bedside”), but also from controlled sefngs to community and popula6on (Woolf, 2008) –  Increasing recogni6on that research findings must “translate” into clinical care more quickly and efficiently, leading to US government investment in clinical and transla6onal research through the NIH Clinical & Transla6onal Science Award (CTSA) program (Leshner, 2013) –  Transla6onal bioinforma6cs – bioinforma6cs applied to health-­‐related problems (Kann, 2013) •  Personalized medicine (Schleidgen, 2013)/precision medicine (IOM, 2011) – clinical care more tailored to an individual’s characteris6cs, including their genome •  Clinical research informa6cs (CRI) is area of informa6cs applied to clinical research (Richesson, 2012) –  Difference between informa6on technology (IT) and informa6cs very evident in this domain (Bernstam, 2009) WhatIs2 5 We cannot ignore the essen6al role of the consumer/pa6ent/ci6zen •  Original Strategic Framework of the Office of the Na6onal Coordinator for Health IT (ONC) called for IT to facilitate “consumer-­‐centric, informa6on-­‐rich” healthcare (Brailer, 2004) •  Some advocate that the PHR be at the center of the discussion concerning health records (Krist, 2011) –  Many issues related to flow of informa6on and responsibility for it •  e-­‐Pa6ents – Internet-­‐enabled pa6ents –  Originated with self-­‐help leader, Dr. Tom Ferguson (2007) –  Best known is e-­‐Pa6ent Dave, who found a great deal of incorrect informa6on in his medical record in Boston teaching hospital and publicized it widely (Wangsness, 2009) –  Further elucidated in book from Stanford Medicine X (Chu, 2012) WhatIs2 6
A final perspec6ve of informa6cs •  Data è Informa6on è Knowledge –  Used in many fields but introduced in informa6cs by Blum (1984) •  Data are the raw material collected and stored •  Informa6on gives meaning and organiza6on to the data •  Knowledge provides understanding and applicability to new situa6ons •  Some add wisdom, as knowing how to apply knowledge (Rowley, 2007) WhatIs2 7 Informa6cs is increasingly becoming a “data science” •  EHR (and probably all informa6cs) work changing from “implementa6on” to “analy6cs” (Hersh, 2012) •  Data science is the “sexiest job of the 21st century?” (Davenport, 2012) •  Growing importance of role for analy6cs in healthcare (Adams, 2011; O’Reilly, 2012; Hersh, 2014) –  But we must use cau6on to make sure that clinical data is complete, correct, and otherwise sound (the role of informa6cs?) (Hersh, 2013) WhatIs2 8 4
We have entered the era of “Big Data” •  Four “V’s” of Big Data: volume, velocity, variety, and veracity (Zikopoulos, 2011) –  Leading to a new paradigm of science (Hey, 2009)? •  Making the scien6fic method obsolete, i.e., no need for experimenta6on any more? (Anderson, 2007) –  Not really; many caveats for research use of clinical data (Hersh, 2013) •  Though others rebut with “provoca6ons” to the limits of just studying data (Boyd, 2011) –  Bigger is not beQer –  We study what we can answer –  Not all data is available or accessible WhatIs2 9 Is medicine/health really an informa6on science? •  Time studies of hospital (Ammenwerth, 2009; Tipping, 2010; Kim, 2010; Tipping, 2010; Yousefi, 2011; Victores, 2014) and emergency (Chisholm, 2011) physicians show physicians spend about –  15-­‐38% of their 6me in direct pa6ent care –  50-­‐67% of their 6me in indirect pa6ent care, divided between reviewing results, performing documenta6on, and engaging in communica6on •  Studies of outpa6ent physicians find –  14-­‐39% of work takes place outside the exam room (Gilchrist, 2005; GoQschalk, 2005) –  Work related to pa6ent when he/she not present consumes 15-­‐23% of physician work day (GoQschalk, 2005; Farber, 2007; Chen, 2010) •  Studies of interns in light of duty hours restric6ons (Block, 2013) –  Less 6me in direct pa6ent care, more in talking with other physicians and documen6ng –  40% of 6me spent interac6ng with computers; too much (Hersh, 2013)? WhatIs2 10
Informa6on chaos and complexity •  Physician performance and safety impacted by “informa6on chaos” (Beasley, 2011) •  Epidemiology and all of healthcare system are “complex adap6ve systems” where small changes can be unpredictable and lead to new states of equilibrium (Pearce, 2006) WhatIs2 11 6