Reflections Towards the Future of Medical Informatics.

OBJECTIVE: To provide guidance on the future development and role of medical informatics, or biomedical and health informatics, in form of reflections. METHOD: To report on the author's previous activities as a medical informatician, which spans almost half a century. It began in 1973 when he started to study medical informatics. In 1978, more than four decades ago, his professional work started. He retired at the end of summer semester 2021. This was the occasion to prepare this farewell lecture. RESULTS: In twenty reflections, thoughts are presented on professional careers (R1 - 'places'), on medical informatics as discipline (R2 - 'interdisciplinarity', R3 - 'focuses', R4 - 'affiliations'), on research (R5 - 'duality', R6 - 'confluences', R7 - 'correlations', R8 - 'collaboration'), on education (R9 - 'community', R10 - 'competencies', R11 - 'approaches'), on academic self-governance (R12 - 'autonomy'), on engagement (R13 - 'Sisyphos', R14 - 'professional societies', R15 - 'respect', R16 - 'tightrope walk'), and on good scientific practice (R17 - 'time invariants', R18 - 'Zeitgeist', R19 - 'knowledge gain', R20 - 'exercising'). CONCLUSIONS: It has been a pleasure for me to participate in medical informatics activities for almost fifty years. During that time, there have been significant advances, including in medicine and in informatics, and also in medical informatics itself. And now it is the turn of others. While keeping in mind that tradition is not preserving the ashes, but passing on the fire, this report with its reflections may be of some help.

Digital Health Education: Determining Competences and Piloting Innovative Study Course.

Digital technology for health services plays a critical role in the delivery of health services. In order to move towards universal healthcare, improvement of patient outcomes and better health, one must make use of the advantages of Digital Health tools and recognition of the role of the health ICT worker. Therefore, it is necessary to have a workforce that is competent to use these tools. Uniquely positioned at the intersection of healthcare and information technology, the domain of Digital Health builds on a variety of disciplines termed biomedical and health informatics, and other allied fields. With the increasing need to have a knowledgeable, skilled and competent workforce, it is necessary to concentrate efforts towards the provision of education modules in Digital Health. While continuing medical education, certificate courses and other similar courses attempt to bridge the gap in the delivery of Digital Health education, it is also paramount to establish dedicated and standalone courses. Streamlining approaches to Digital Health Education across disciplinary, cultural and national boundaries, is key to address the challenges of firmly embedding Digital Health courses in the fabric of university education. In the effort to provide the necessary knowledge, skills and competencies (KSCs) to the current health ICT worker, the Deggendorf Institute of Technology, European Campus Rottal-Inn (DIT-ECRI) is in the process of piloting a virtual course in Global Digital Health. With the ability to provide core competencies in Digital heath, this virtual course is a step towards advancing Global Digital Health Education.

Public Health and Epidemiology Informatics: Recent Research Trends.

OBJECTIVES: To introduce and analyse current trends in Public Health and Epidemiology Informatics. METHODS: PubMed search of 2020 literature on public health and epidemiology informatics was conducted and all retrieved references were reviewed by the two section editors. Then, 15 candidate best papers were selected among the 920 references. These papers were then peer-reviewed by the two section editors, two chief editors, and external reviewers, including at least two senior faculty, to allow the Editorial Committee of the 2021 International Medical Informatics Association (IMIA) Yearbook to make an informed decision regarding the selection of the best papers. RESULTS: Among the 920 references retrieved from PubMed, four were suggested as best papers and the first three were finally selected. The fourth paper was excluded because of reproducibility issues. The first best paper is a very public health focused paper with health informatics and biostatistics methods applied to stratify patients within a cohort in order to identify those at risk of suicide; the second paper describes the use of a randomized design to test the likely impact of fear-based messages, with and without empowering self-management elements, on patient consultations or antibiotic requests for influenza-like illnesses. The third selected paper evaluates the perception among communities of routine use of Whole Genome Sequencing and Big Data technologies to capture more detailed and specific personal information. CONCLUSIONS: The findings from the three studies suggest that using Public Health and Epidemiology Informatics methods could leverage, when combined with Deep Learning, early interventions and appropriate treatments to mitigate suicide risk. Further, they also demonstrate that well informing and empowering patients could help them to be involved more in their care process.

Development of a core competency framework for clinical informatics.

OBJECTIVES: Until this point there was no national core competency framework for clinical informatics in the UK. We report on the final two iterations of work carried out in the formation of a national core competency framework. This follows an initial systematic literature review of existing skills and competencies and a job listing analysis.MethodsAn iterative approach was applied to framework development. Using a mixed-methods design we carried out semi-structured interviews with participants involved in informatics (n=15). The framework was updated based on the interview findings and was subsequently distributed as part of a bespoke online digital survey for wider participation (n=87). The final version of the framework is based on the findings of the survey. RESULTS: Over 102 people reviewed the framework as part of the interview or survey process. This led to a final core competency framework containing 6 primary domains with 36 subdomains containing 111 individual competencies. CONCLUSIONS: An iterative mixed-methods approach for competency development involving the target community was appropriate for development of the competency framework. There is some contention around the depth of technical competencies required. Care is also needed to avoid professional burnout, as clinicians and healthcare practitioners already have clinical competencies to maintain. Therefore, how the framework is applied in practice and how practitioners meet the competencies requires careful consideration.

Integrated digital pathology at scale: A solution for clinical diagnostics and cancer research at a large academic medical center.

OBJECTIVE: Broad adoption of digital pathology (DP) is still lacking, and examples for DP connecting diagnostic, research, and educational use cases are missing. We blueprint a holistic DP solution at a large academic medical center ubiquitously integrated into clinical workflows; researchapplications including molecular, genetic, and tissue databases; and educational processes. MATERIALS AND METHODS: We built a vendor-agnostic, integrated viewer for reviewing, annotating, sharing, and quality assurance of digital slides in a clinical or research context. It is the first homegrown viewer cleared by New York State provisional approval in 2020 for primary diagnosis and remote sign-out during the COVID-19 (coronavirus disease 2019) pandemic. We further introduce an interconnected Honest Broker for BioInformatics Technology (HoBBIT) to systematically compile and share large-scale DP research datasets including anonymized images, redacted pathology reports, and clinical data of patients with consent. RESULTS: The solution has been operationally used over 3 years by 926 pathologists and researchers evaluating 288 903 digital slides. A total of 51% of these were reviewed within 1 month after scanning. Seamless integration of the viewer into 4 hospital systems clearly increases the adoption of DP. HoBBIT directly impacts the translation of knowledge in pathology into effective new health measures, including artificial intelligence-driven detection models for prostate cancer, basal cell carcinoma, and breast cancer metastases, developed and validated on thousands of cases. CONCLUSIONS: We highlight major challenges and lessons learned when going digital to provide orientation for other pathologists. Building interconnected solutions will not only increase adoption of DP, but also facilitate next-generation computational pathology at scale for enhanced cancer research.

El genoma humano y el desarrollo de la genética forense / The human genome and the development of forensic genetics

El objetivo de este artículo es introducir al médico generalista en los adelantos científicos y técnicos de la genética forense. A partir de los trabajos de Mendel en 1865 sobre hibridación en las plantas se sucedieron avances en el conocimiento del ADN y se incorporaron nuevas técnicas de laboratorio, que permitieron detectar en el ADN un sector no codificante. El conocimiento de este sector junto con los adelantos de informática (software) han permitido progresos innovadores en el desarrollo de las técnicas de identificación forense, logrando que la Genética Forense se convierta en un auxiliar de la justicia para la resolución de casos de filiación, el reconocimiento de restos humanos y el descubrimiento de responsables de crímenes a través de la identificación de ADN encontrado en la escena. (AU)

The objective of this article is to introduce the general practitioner to the scientific and technical advances of forensic genetics. From the work of Mendel in 1865 on hybridization in plants, advances were made in the knowledge of DNA and new laboratory techniques were incorporated, which made it possible to detect a non-coding sector in DNA. Knowledge of this sector together with the advances in computer science (software) have allowed innovative progress in the development of forensic identification techniques, making Forensic Genetics an auxiliary of justice, for the resolution of filiation cases, the recognition of human remains and the discover of the person responsible for the crimes through the identification of their DNA found at the scene of a crime. (AU)

De la presencialidad a la virtualidad en tiempos de pandemia: la experiencia del Hospital Italiano de Buenos Aires / From face-to-face to virtuality in pandemic times: the experience of the Hospital Italiano de Buenos Aires

El 11 de marzo de 2020, la Organización Mundial de la Salud (OMS) declaró el COVID-19 como pandemia, afectando drásticamente la atención de la salud. A nivel global se adoptaron medidas como el distanciamiento social y la cuarentena. Ello representó un enorme desafío para los Sistemas de Información en Salud (SIS), que rápidamente debieron adaptarse, frente a una razón ineludible para abrazar por completo la transformación digital. Surge la necesidad de explorar las tecnologías digitales utilizadas durante la pandemia y considerarlas para su uso continuado en el tiempo o cíclicamente en caso de brotes recurrentes. Las herramientas informáticas se han utilizado para la prestación de servicios de telemedicina, monitorización remota de pacientes, comunicación digital entre líderes políticos y autoridades científicas, monitorización de datos para analizar la propagación y evolución del COVID-19, etc. Los países y organizaciones han impulsado el uso de soluciones tecnológicas con distintas limitaciones. El Hospital Italiano de Buenos Aires posee una trayectoria de más de 20 años en implementaciones e innovaciones tecnológicas; sin embargo, la pandemia impulsó una serie de adaptaciones en su SIS. El objetivo de este trabajo fue describir dicho proceso de adaptación digital desde marzo a diciembre de 2020, e identificar los principales resultados utilizando un modelo sociotécnico. Se empleó el modelo de Sittig que incluye 8 dimensiones: Infraestructura, Contenido clínico, Interfaz Humano-computadora, Personas, Comunicación y procesos, Regulaciones, Características organizacionales y Políticas internas y Medición y monitorización. (AU)

On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic, dramatically affecting health care. Measures such as social distancing and quarantine were adopted globally. This new context represented a huge challenge for Health Information Systems (HIS) that had to adapt quickly, facing an inescapable reason to fully embrace the digital transformation. There is a need to explore the digital technologies used during the pandemic and consider them for continued use over time or cyclically in the event of recurring outbreaks. Digital tools have been used for the provision of telemedicine services, remote patient monitoring, digital communication between political leaders and scientific authorities, data monitoring to analyze the spread and evolution of COVID-19, etc. Countries and organizations have promoted the use of technological solutions with different limitations. The Hospital Italiano de Buenos Aires has a history of more than 20 years in technological implementations and innovations, however, the pandemic prompted a series of adaptations in its SIS. The objective of this work was to describe said digital adaptation process from March to December 2020, and to identify the main results using a sociotechnical model. Sittig´model was used, which includes 8 dimensions: Infrastructure, Clinical Content, Human-Computer Interface, People, Communication and Processes, Regulations, Organizational Characteristics and Internal Policies, and Measurement and Monitoring. (AU)

Ensuring that biomedical AI benefits diverse populations.

Artificial Intelligence (AI) can potentially impact many aspects of human health, from basic research discovery to individual health assessment. It is critical that these advances in technology broadly benefit diverse populations from around the world. This can be challenging because AI algorithms are often developed on non-representative samples and evaluated based on narrow metrics. Here we outline key challenges to biomedical AI in outcome design, data collection and technology evaluation, and use examples from precision health to illustrate how bias and health disparity may arise in each stage. We then suggest both short term approaches-more diverse data collection and AI monitoring-and longer term structural changes in funding, publications, and education to address these challenges.

Development and feasibility of a Configurable Assessment Messaging Platform for Interventions (CAMPI).

INTRODUCTION: Short message service (SMS) is a widely accepted telecommunications approach used to support health informatics, including behavioral interventions, data collection, and patient-provider communication. However, SMS delivery platforms are not standardized and platforms are typically commercial "off-the-shelf" or developed "in-house." As a consequence of platform variability, implementing SMS-based interventions may be challenging for both providers and patients. Off-the-shelf SMS delivery platforms may require minimal development or technical resources from providers, but users are often limited in their functionality. Conversely, platforms that are developed in-house are often specified for individual projects, requiring specialized development and technical expertise. Patients are on the receiving end of programming and technical specification challenges; message delays or lagged data affect quality of SMS communications. To date, little work has been done to develop a generalizable SMS platform that can be scaled across health initiatives. OBJECTIVE: We propose the Configurable Assessment Messaging Platform for Interventions (CAMPI) to mitigate challenges associated with SMS intervention implementation (e.g., programming, data collection, message delivery). METHOD: CAMPI aims to optimize health data captured from a multitude of sources and enhance patient-provider communication through a technology that is simple and familiar to patients. Using representative examples from three behavioral intervention case studies implemented among diverse populations (pregnant women, young sexual minority men, and parents with young children), we describe CAMPI capabilities and feasibility. CONCLUSION: As a generalizable SMS platform, CAMPI can be scaled to meet the priorities of various health initiatives, while reducing unnecessary resource utilization and burden on providers and patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Transforming the provision of healthcare through emerging technology: A strategic transformation.

Why has the health care delivery paradigm and its integral transactions and interactions been left to muddle through, using archaic, 20th century modes and processes of delivery that are overlaid with byz antine medical record databases that pass for "cut ting-edge" technology? What is stalling the digital revolution in the provision of health care services to consumers? Understanding how and why this has happened requires that we briefly explore the evo lution of health care in the United States. Topics discussed include (1): morbidity and mortality: the public health era: (2) Medicare era: the advance of diagnostic and therapeutic technology; (3) the power of the consumer: patient-centered informatics; and (4) planning and execution of strategic transformation of provision of care informatics. Without an informatics focus, our health care system will continue limping along, costing more money and delivering many years of disability. Our most viable solutions revolve around using informatics to measure, guide and become the transformation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Age Differences in the Use of Health Information Technology Among Adults in the United States: An Analysis of the Health Information National Trends Survey.

Background: Despite significant advancements in the use of health information technologies (HITs) in health care, older adults' adoption of new technologies has consistently lagged behind that of younger adults. Objective: To compare ownership rates and preferences for utilizing technology for health information exchange among older and younger adults. Methods: Utilizing data from the 2017 and 2018 iterations of the Health Information National Trends Survey (n = 6789), we performed multivariable logistic regression while controlling for sociodemographic characteristics. Results: Older adults were less likely than younger adults to own technological devices such as smartphones, less likely to report finding these tools beneficial in monitoring their health, and less likely to use these tools in communicating with their health providers. However, these differences were substantially attenuated after adjustment for technology ownership. Discussion: Future research should aim to identify factors associated with access, usability, and adoption of HIT for managing care among older adults.

A scoping review of qualitative research in JAMIA: past contributions and opportunities for future work.

OBJECTIVE: Qualitative methods are particularly well-suited to studying the complexities and contingencies that emerge in the development, preparation, and implementation of technological interventions in real-world clinical practice, and much remains to be done to use these methods to their full advantage. We aimed to analyze how qualitative methods have been used in health informatics research, focusing on objectives, populations studied, data collection, analysis methods, and fields of analytical origin. METHODS: We conducted a scoping review of original, qualitative empirical research in JAMIA from its inception in 1994 to 2019. We queried PubMed to identify relevant articles, ultimately including and extracting data from 158 articles. RESULTS: The proportion of qualitative studies increased over time, constituting 4.2% of articles published in JAMIA overall. Studies overwhelmingly used interviews, observations, grounded theory, and thematic analysis. These articles used qualitative methods to analyze health informatics systems before, after, and separate from deployment. Providers have typically been the main focus of studies, but there has been an upward trend of articles focusing on healthcare consumers. DISCUSSION: While there has been a rich tradition of qualitative inquiry in JAMIA, its scope has been limited when compared with the range of qualitative methods used in other technology-oriented fields, such as human-computer interaction, computer-supported cooperative work, and science and technology studies. CONCLUSION: We recommend increased public funding for and adoption of a broader variety of qualitative methods by scholars, practitioners, and policy makers and an expansion of the variety of participants studied. This should lead to systems that are more responsive to practical needs, improving usability, safety, and outcomes.

Trends Associated with Hemorrhoids in Japan: Data Mining of Medical Information Datasets and the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan.

Hemorrhoids are a common anorectal disease. Epidemiological studies on medication trends and risk factors using information from real-world databases are rare. Our objective was to analyze the relationship between hemorrhoid treatment prescription trends and several risk factors using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan and related medical information datasets. We calculated the standardized prescription ratio (SPR) based on the 2nd NDB Open Data Japan from 2015. The correlation coefficients between the SPR of antihemorrhoidals and those of "antispasmodics," "antiarrhythmic agents," "antidiarrheals, intestinal regulators," "purgatives and clysters," "hypnotics and sedatives, antianxietics," "psychotropic agents," and "opium alkaloids preparations" were 0.7474, 0.7366, 0.7184, 0.6501, 0.6320, 0.4571, and 0.4542, respectively. The correlation coefficient between the SPR of antihemorrhoidals and those of "average annual temperature," "percentage of people who were smokers," and "percentage of people who drank regularly" were -0.7204, 0.6002, and 0.3537, respectively. The results of cluster analysis revealed that Hokkaido and Tohoku regions tended to have low average annual temperature values and high percentage of people who were smokers and had comparatively high SPRs of "antispasmodics," "antiarrhythmic agents," "antidiarrheals, intestinal regulators," "purgatives and clysters," "hypnotics and sedatives, antianxietics," "psychotropic agents," and "opium alkaloids preparations." Antihemorrhoidals are frequently used in Hokkaido and Tohoku, Japan; thus, it is important for these prefectural governments to focus on these factors when taking measures regarding health promotion.

Optimizing health IT to improve health system performance: A work in progress.

BACKGROUND: Despite significant investments in health information technology (IT), the technology has not yielded the intended performance effects or transformational change. We describe activities that health systems are pursuing to better leverage health IT to improve performance. METHODS: We conducted semi-structured telephone interviews with C-suite executives from 24 U.S. health systems in four states during 2017-2019 and analyzed the data using a qualitative thematic approach. RESULTS: Health systems reported two broad categories of activities: laying the foundation to improve performance with IT and using IT to improve performance. Within these categories, health systems were engaged in similar activities but varied greatly in their progress. The most substantial effort was devoted to the first category, which enabled rather than directly improved performance, and included consolidating to a single electronic health record (EHR) platform and common data across the health system, standardizing data elements, and standardizing care processes before using the EHR to implement them. Only after accomplishing such foundational activities were health systems able to focus on using the technology to improve performance through activities such as using data and analytics to monitor and provide feedback, improving uptake of evidence-based medicine, addressing variation and overuse, improving system-wide prevention and population health management, and making care more convenient. CONCLUSIONS AND IMPLICATIONS: Leveraging IT to improve performance requires significant and sustained effort by health systems, in addition to significant investments in hardware and software. To accelerate change, better mechanisms for creating and disseminating best practices and providing advanced technical assistance are needed.

Consolidation in the Electronic Health Record Market, 2009-2017.

BACKGROUND: To quantify changes to the electronic health record (EHR) market in Rhode Island and to assess the degree of EHR market consolidation between 2009 and 2017. METHODS: The EHR market in Rhode Island is represented by three measures: the proportion of physicians who have adopted an EHR, the number of EHR vendors in use, and EHR market competitiveness, captured by the Herfindahl-Hirschman Index (HHI). RESULTS: The EHR market became more consolidated overall between 2009 and 2017. Among outpatient physicians, the market has remained competitive, despite ongoing consolidation. In contrast, the EHR market among inpatient physicians crossed into the "highly concentrated" zone in 2015. DISCUSSION: While consolidation in the EHR market may facilitate the exchange of data across health systems, potentially reducing duplicative testing and facilitating timely diagnosis, limiting competition may affect vendors' responsiveness to calls for improved usability and innovation.

Trends in Clinical Information Systems Research in 2019.

OBJECTIVE: To give an overview of recent research and to propose a selection of best papers published in 2019 in the field of Clinical Information Systems (CIS). METHOD: Each year, we apply a systematic process to retrieve articles for the CIS section of the IMIA Yearbook of Medical Informatics. For six years now, we use the same query to find relevant publications in the CIS field. Each year we retrieve more than 2,000 papers. As CIS section editors, we categorize the retrieved articles in a multi-pass review to distill a pre-selection of 15 candidate best papers. Then, Yearbook editors and external reviewers assess the selected candidate best papers. Based on the review results, the IMIA Yearbook Editorial Committee chooses the best papers during the selection meeting. We used text mining, and term co-occurrence mapping techniques to get an overview of the content of the retrieved articles. RESULTS: We carried out the query in mid-January 2020 and retrieved a de-duplicated result set of 2,407 articles from 1,023 different journals. This year, we nominated 14 papers as candidate best papers, and three of them were finally selected as best papers in the CIS section. As in previous years, the content analysis of the articles revealed the broad spectrum of topics covered by CIS research. CONCLUSIONS: We could observe ongoing trends, as seen in the last years. Patient benefit research is in the focus of many research activities, and trans-institutional aggregation of data remains a relevant field of work. Powerful machine-learning-based approaches, that use readily available data now often outperform human-based procedures. However, the ethical perspective of this development often comes too short in the considerations. We thus assume that ethical aspects will and should deliver much food for thought for future CIS research.