Special Section on Inclusive Digital Health: Notable Papers on Addressing Bias, Equity, and Literacy to Strengthen Health Systems.

OBJECTIVE: To summarize significant research contributions on addressing bias, equity, and literacy in health delivery systems published in 2021. METHODS: An extensive search using PubMed and Scopus was conducted to identify peer-reviewed articles published in 2021 that examined ways that informatics methods, approaches, and tools could address bias, equity, and literacy in health systems and care delivery processes. The selection process comprised three steps: (1) 15 candidate best papers were first selected by the two section editors; (2) external reviewers from internationally renowned research teams reviewed each candidate best paper; and (3) the final selection of three best papers was conducted by the editorial committee of the Yearbook. RESULTS: Selected best papers represent studies that characterized significant challenges facing biomedical informatics with respect to equity and practices that support equity and literacy in the design of health information systems. Selected papers represent the full spectrum of this year's yearbook theme. In general, papers identified in the search fell into one of the following categories: (1) descriptive accounts of algorithmic bias in medical software or machine learning approaches; (2) enabling health information systems to appropriately encode for gender identity and sex; (3) approaches to support health literacy among individuals who interact with information systems and mobile applications; and (4) approaches to engage diverse populations in the use of health information systems and the biomedical informatics workforce CONCLUSIONS: : Although the selected papers are notable, our collective efforts as a biomedical informatics community to address equity, literacy, and bias remain nascent. More work is needed to ensure health information systems are just in their use of advanced computing approaches and all persons have equal access to health care and informatics tools.

Development and Usability of a Smartphone Application for Tracking Antiretroviral Medication Refill Data for Human Immunodeficiency Virus.

BACKGROUND: Adherence to antiretroviral medication leads to HIV suppression and decreased morbidity and mortality. In resource- limited settings, the dependence on paper medical charts and unstable electronic health records creates a challenge to monitoring medication adherence. A pharmacy-based strategy that utilizes existing cellular phone infrastructure may lead to a more stable system to monitor adherence. OBJECTIVES: To develop and evaluate the usability of a smartphone-based software application (app) for tracking antiretroviral medication refill data in a resource-limited setting. METHODS: A pharmacy-based smartphone app for tracking HIV medication adherence was developed through a multi-step rapid prototyping process. The usability of the app was assessed during the daily activities of pharmacy dispensers at HIV clinics in and around Gaborone, Botswana using a validated computer usability survey. RESULTS: The study demonstrated the effective development of and favorable end-user responses to a pharmacy-based HIV medication adherence app. End users had suggestions for minor changes to improve the app's functionality. CONCLUSIONS: In resource-limited settings where electronic health record support is limited, such a system was feasible and appealing. In the future, this system may allow for improved HIV medication adherence tracking and be applied to medications beyond antiretrovirals.

Experts speak: advice from key informants to small, rural hospitals on implementing the electronic health record system.

The US government has allocated $30 billion dollars to implement Electronic Health Records (EHRs) in hospitals and provider practices through a policy called Meaningful Use. Small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known on implementation in this setting. We interviewed a spectrum of 31 experts in the domain. The interviews were then analyzed qualitatively to ascertain the expert recommendations. Nineteen themes emerged. The pool of experts included staff from CAHs that had recently implemented EHRs. We were able to compare their answers with those of other experts and make recommendations for stakeholders. CAH peer experts focused less on issues such as physician buy-in, communication, and the EHR team. None of them indicated concern or focus on clinical decision support systems, leadership, or governance. They were especially concerned with system selection, technology, preparatory work and a need to know more about workflow and optimization. These differences were explained by the size and nature of these small hospitals.

Design of a national distributed health data network.

A distributed health data network is a system that allows secure remote analysis of separate data sets, each comprising a different medical organization's or health plan's records. Distributed health data networks are currently being planned that could cover millions of people, permitting studies of comparative clinical effectiveness, best practices, diffusion of medical technologies, and quality of care. These networks could also support assessment of medical product safety and other public health needs. Distributed network technologies allow data holders to control all uses of their data, which overcomes many practical obstacles related to confidentiality, regulation, and proprietary interests. Some of the challenges and potential methods of operation of a multipurpose, multi-institutional distributed health data network are described.

Program requirements for fellowship education in the subspecialty of clinical informatics.

The Program Requirements for Fellowship Education identify the knowledge and skills that physicians must master through the course of a training program to be certified in the subspecialty of clinical informatics. They also specify accreditation requirements for clinical informatics training programs. The AMIA Board of Directors approved this document in November 2008.

Challenges for multilevel health disparities research in a transdisciplinary environment.

Numerous factors play a part in health disparities. Although health disparities are manifested at the level of the individual, other contexts should be considered when investigating the associations of disparities with clinical outcomes. These contexts include families, neighborhoods, social organizations, and healthcare facilities. This paper reports on health disparities research as a multilevel research domain from the perspective of a large national initiative. The Centers for Population Health and Health Disparities (CPHHD) program was established by the NIH to examine the highly dimensional, complex nature of disparities and their effects on health. Because of its inherently transdisciplinary nature, the CPHHD program provides a unique environment in which to perform multilevel health disparities research. During the course of the program, the CPHHD centers have experienced challenges specific to this type of research. The challenges were categorized along three axes: sources of subjects and data, data characteristics, and multilevel analysis and interpretation. The CPHHDs collectively offer a unique example of how these challenges are met; just as importantly, they reveal a broad range of issues that health disparities researchers should consider as they pursue transdisciplinary investigations in this domain, particularly in the context of a large team science initiative.