Preface - Access to Knowledge Revisited.

OBJECTIVE: To review and update the Preface to the 1998 Yearbook of Medical Informatics, which had as its Special Topic "Health Informatics and the Internet". METHOD: Assessment of the accuracy of predictions made in 1998 and consideration of key developments in informatics since that time. RESULTS: Predictions made in 1998 were generally accurate regarding reduced dependence on keyboards, expansion of multimedia, medical data privacy policy development, impact of molecular biology on knowledge and treatment of neoplasms, and use of imaging and informatics to advance understanding of brain structure and function. Key developments since 1998 include the huge increase in publicly available electronic information; acknowledgement by leaders in government and science of the importance of biomedical informatics to societal goals for health, health care, and scientific discovery; the influence of the public in promoting clinical research transparency and free access to government-funded research results; the long-awaited arrival of electronic health records; and the "Cloud" as a 21st century reformulation of contracting out the computer center. CONCLUSIONS: There are many challenging and important problems that deserve the attention of the informatics community. Informatics researchers will be best served by embracing a very broad definition of medical informatics and by promoting public understanding of the field.

The birth and evolution of a discipline devoted to information in biomedicine and health care. As reflected in its longest running journal.

BACKGROUND: The journal Methods of Information in Medicine, founded in 1962, has now completed its 50th volume. Its publications during the last five decades reflect the formation of a discipline that deals with information in biomedicine and health care. OBJECTIVES: To report about 1) the journal's origin, 2) the individuals who have significantly contributed to it, 3) trends in the journal's aims and scope, 4) influential papers and 5) major topics published in Methods over the years. METHODS: Methods included analysing the correspondence and journal issues in the archives of the editorial office and of the publisher, citation analysis using the ISI and Scopus databases, and analysing the articles' Medical Subject Headings (MeSH) in MEDLINE. RESULTS: In the journal's first 50 years 208 editorial board members and/or editors contributed to the journal's development, with most individuals coming from Europe and North America. The median time of service was 11 years. At the time of analysis 2,456 articles had been indexed with MeSH. Topics included computerized systems of various types, informatics methodologies, and topics related to a specific medical domain. Some MeSH topic entries were heavily and regularly represented in each of the journal's five decades (e.g. information systems and medical records), while others were important in a particular decade, but not in other decades (e.g. punched-card systems and systems integration). Seven papers were cited more than 100 times and these also covered a broad range of themes such as knowledge representation, analysis of biomedical data and knowledge, clinical decision support and electronic patient records. CONCLUSIONS: Methods of Information in Medicine is the oldest international journal in biomedical informatics. The journal's development over the last 50 years correlates with the formation of this new discipline. It has and continues to stress the basic methodology and scientific fundamentals of organizing, representing and analysing data, information and knowledge in biomedicine and health care. It has and continues to stimulate multidisciplinary communication on research that is devoted to high-quality, efficient health care, to quality of life and to the progress of biomedicine and the health sciences.

50 years of informatics research on decision support: what's next.

OBJECTIVES: To reflect on the history, status, and future trends of decision support in health and biomedical informatics. To highlight the new challenges posed by the complexity and diversity of genomic and clinical domains. To examine the emerging paradigms for supporting cost-effective, personalized decision making. METHODS: A group of international experts in health and biomedical informatics presented their views and discussed the challenges and issues on decision support at the Methods of Information in Medicine 50th anniversary symposium. The experts were invited to write short articles summarizing their thoughts and positions after the symposium. RESULTS AND CONCLUSIONS: The challenges posed by the complexity and diversity of the domain knowledge, system infrastructure, and usage pattern are highlighted. New requirements and computational paradigms for representing, using, and acquiring biomedical knowledge and healthcare protocols are proposed. The underlying common themes identified for developing next-generation decision support include incorporating lessons from history, uniform vocabularies, integrative interfaces, contextualized decisions, personalized recommendations, and adaptive solutions.

Rising expectations: access to biomedical information.

OBJECTIVE: To provide an overview of the expansion in public access to electronic biomedical information over the past two decades, with an emphasis on developments to which the U.S. National Library of Medicine contributed. METHODS: Review of the increasingly broad spectrum of web-accessible genomic data, biomedical literature, consumer health information, clinical trials data, and images. RESULTS: The amount of publicly available electronic biomedical information has increased dramatically over the past twenty years. Rising expectations regarding access to biomedical information were stimulated by the spread of the Internet, the World Wide Web, advanced searching and linking techniques. These informatics advances simplified and improved access to electronic information and reduced costs, which enabled inter-organizational collaborations to build and maintain large international information resources and also aided outreach and education efforts The demonstrated benefits of free access to electronic biomedical information encouraged the development of public policies that further increase the amount of information available. CONCLUSIONS: Continuing rapid growth of publicly accessible electronic biomedical information presents tremendous opportunities and challenges, including the need to ensure uninterrupted access during disasters or emergencies and to manage digital resources so they remain available for future generations.

Research opportunities and challenges in 2005.

OBJECTIVES: Biomedical informatics practice and research have become so broad that I will comment on only three areas. These are the electronic health record; prospective population studies; and interactive publications. METHODS: Review of the literature, Internet resources and material and reports generated by internal and external research projects. RESULTS: Development of an electronic health record continues to be problematic in the U.S. A number of large-scale prospective cohort studies of normal populations are now actively occurring or in planning stage in a number of countries; these present special research opportunities in biomedical informatics. Although there are engineering challenges to the implementation of interactive publications, they have the potential to enhance understanding, learning, and memory of scientific and health concepts. CONCLUSIONS: Three areas of bio-medical informatics challenge us and offer interesting and worthy research opportunities. These include the electronic health record, prospective cohort studies, and interactive publications.

Medicine in the 21st century: global problems, global solutions.

OBJECTIVES: To discuss application areas of information technology in medicine and health care on the occasion of the opening of the Private Universität für Medizinische Informatik und Technik Tirol/University for Health Informatics and Technology Tyrol (UMIT) at Innsbruck, Tyrol, Austria. RESULTS AND CONCLUSIONS: Important application areas of information technology in medicine and health are appropriate individual access to medical knowledge, new engineering developments such as new radiant imaging methods and the implantable pacemaker/defibrillator devices, mathematical modeling for understanding the workings of the human body, the computer-based patient record, as well as new knowledge in molecular biology, human genetics, and biotechnology. Challenges and responsibilities for medical informatics research include medical data privacy and intellectual property rights inherent in the content of the information systems.

The Unified Medical Language System.

In 1986, the National Library of Medicine began a long-term research and development project to build the Unified Medical Language System® (UMLS®). The purpose of the UMLS is to improve the ability of computer programs to "understand" the biomedical meaning in user inquiries and to use this understanding to retrieve and integrate relevant machine-readable information for users. Underlying the UMLS effort is the assumption that timely access to accurate and up-to-date information will improve decision making and ultimately the quality of patient care and research. The development of the UMLS is a distributed national experiment with a strong element of international collaboration. The general strategy is to develop UMLS components through a series of successive approximations of the capabilities ultimately desired. Three experimental Knowledge Sources, the Metathesaurus®, the Semantic Network, and the Information Sources Map have been developed and are distributed annually to interested researchers, many of whom have tested and evaluated them in a range of applications. The UMLS project and current developments in high-speed, high-capacity international networks are converging in ways that have great potential for enhancing access to biomedical information.