Donald A.B. Lindberg and the U.S. National Library of Medicine transformed biomedical and health informatics.

This overview summary of the Informatics Section of the book Transforming biomedical informatics and health information access: Don Lindberg and the U.S. National Library of Medicine illustrates how the NLM revolutionized the field of biomedical and health informatics during Lindberg's term as NLM Director. Authors present a before-and-after perspective of what changed, how it changed, and the impact of those changes.

Donald A.B. Lindberg, pioneer in biomedical and health informatics: His involvement in creating professional organizations.

Among the many contributions of Donald A.B. Lindberg was his work on behalf of a variety or professional organizations in the field of biomedical and health informatics. These began during his early days at the University of Missouri and continued throughout his 30 years at the National Library of Medicine. This chapter summarizes that work, which occurred both through his personal efforts and through the impact of the NLM under his leadership. Examples include his role in the development of organizations themselves (e.g., the International Medical Informatics Association, the American College of Medical Informatics, and the American Medical Informatics Association) and also his contributions to the professional scientific meetings that have advanced the field (e.g., the Symposium on Computer Applications in Medical Care, MEDINFO, and the AMIA Annual Symposium).

Overlaying multiple sources of data to identify bottlenecks in clinical workflow.

The pursuit of increased efficiency and quality of clinical care based on the analysis of workflow has seen the introduction of several modern technologies into medical environments. Electronic health records (EHRs) remain central to analysis of workflow, owing to their wide-ranging impact on clinical processes. The two most common interventions to facilitate EHR-related workflow analysis are automated location tracking using sensor-based technologies and EHR usage data logs. However, to maximize the potential of these technologies, and especially to facilitate workflow redesign, it is necessary to overlay these quantitative findings on the contextual data from qualitative methods such as ethnography. Such a complementary approach promises to yield more precise measures of clinical workflow that provide insights into how redesign could address inefficiencies. In this paper, we categorize clinical workflow in the Emergency Department (ED) into three types (perceived, real and ideal) to create a structured approach to workflow redesign using the available data. We use diverse data sources: sensor-based location tracking through Radio-Frequency Identification (RFID), summary EHR usage data logs, and data from physician interviews augmented by direct observations (through clinician shadowing). Our goal is to discover inefficiencies and bottlenecks that can be addressed to achieve a more ideal workflow state relative to its real and perceived state. We thereby seek to demonstrate a novel data-driven approach toward iterative workflow redesign that generalizes for use in a variety of settings. We also propose types of targeted support or adjustments to offset some of the inefficiencies we noted.

The future of biomedical informatics: a perspective from academia.

Academic biomedical informatics has achieved great successes through research contributions over several decades, now reflected in a thriving commercial marketplace for electronic health records and other informatics tools. That very success, coupled with changes in the ability of governments to support research at past levels, is forcing a reconsideration of the directions and emphases for faculty members in informatics academic units. This paper discusses those forces and proposes areas of emphasis that will strengthen the academic discipline as it evolves in the years ahead. The focus is on the role of academic informaticians as practitioners of informatics, as researchers, and as educators.

Informatics as Science.

The evolution of the informatics field, now with a well-accepted and crucial role in modern biomedicine and health care delivery, is the result of creative research over seven decades. The success is due in part to recognition that, throughout the process, investigators have documented not only what they have done but what they have learned, stimulating and guiding the next generation of projects. Such iterative experimentation, learning, sharing, and progressing is typical of all scientific disciplines. Yet progress depends on identifying key lessons, insights, and methods so that others can use them. This paper addresses the nature of scientific progress in informatics, recognizing that while the field is motivated by applications that can improve biomedicine and health, the scientific underpinnings must be identified and shared with others if the field is to progress optimally.

Donald A.B. Lindberg and the U.S. National Library of Medicine Transformed Biomedical and Health Informatics.

This overview summary of the Informatics Section of the book Transforming biomedical informatics and health information access: Don Lindberg and the U.S. National Library of Medicine illustrates how the NLM revolutionized the field of biomedical and health informatics during Lindberg's term as NLM Director. Authors present a before-and-after perspective of what changed, how it changed, and the impact of those changes.

Donald A.B. Lindberg, Pioneer in Biomedical and Health Informatics: His Involvement in Creating Professional Organizations.

Among the many contributions of Donald A.B. Lindberg was his work on behalf of a variety or professional organizations in the field of biomedical and health informatics. These began during his early days at the University of Missouri and continued throughout his 30 years at the National Library of Medicine. This chapter summarizes that work, which occurred both through his personal efforts and through the impact of the NLM under his leadership. Examples include his role in the development of organizations themselves (e.g., the International Medical Informatics Association, the American College of Medical Informatics, and the American Medical Informatics Association) and also his contributions to the professional scientific meetings that have advanced the field (e.g., the Symposium on Computer Applications in Medical Care, MEDINFO, and the AMIA Annual Symposium).

A tribute to Karen Greenwood and her contributions to the American Medical Informatics Association.

After 25 years of service to the American Medical Informatics Association (AMIA), Ms Karen Greenwood, the Executive Vice President and Chief Operating Officer, is leaving the organization. In this perspective, we reflect on her accomplishments and her effect on the organization and the field of informatics nationally and globally. We also express our appreciation and gratitude for Ms Greenwood's role at AMIA.

The roles of the US National Library of Medicine and Donald A.B. Lindberg in revolutionizing biomedical and health informatics.

Over a 31-year span as Director of the US National Library of Medicine (NLM), Donald A.B. Lindberg, MD, and his extraordinary NLM colleagues fundamentally changed the field of biomedical and health informatics-with a resulting impact on biomedicine that is much broader than its influence on any single subfield. This article provides substance to bolster that claim. The review is based in part on the informatics section of a new book, "Transforming biomedical informatics and health information access: Don Lindberg and the US National Library of Medicine" (IOS Press, forthcoming 2021). After providing insights into selected aspects of the book's informatics-related contents, the authors discuss the broader context in which Dr. Lindberg and the NLM accomplished their transformative work.

DISCARDED MEDICATIONS IN VIALS ARE A SYMPTOM OF OUR HEALTH CARE SYSTEM: A CALL TO ACTION.

DISCLOSURES: No funding was received for the writing of this letter. All authors were members of the National Academies study committee to which this letter refers, with Shortliffe as the chair. All committee members who contributed to the report were themselves vetted for potential conflicts of interest, as is described in the recently published version of the report. Lieu is an employee of Kaiser Permanente and the content does not represent the official views of Kaiser Permanente. The other authors have nothing to disclose.

Effect of an Artificial Intelligence Clinical Decision Support System on Treatment Decisions for Complex Breast Cancer.

PURPOSE: To examine the impact of a clinical decision support system (CDSS) on breast cancer treatment decisions and adherence to National Comprehensive Cancer Center (NCCN) guidelines. PATIENTS AND METHODS: A cross-sectional observational study was conducted involving 1,977 patients at high risk for recurrent or metastatic breast cancer from the Chinese Society of Clinical Oncology. Ten oncologists provided blinded treatment recommendations for an average of 198 patients before and after viewing therapeutic options offered by the CDSS. Univariable and bivariable analyses of treatment changes were performed, and multivariable logistic regressions were estimated to examine the effects of physician experience (years), patient age, and receptor subtype/TNM stage. RESULTS: Treatment decisions changed in 105 (5%) of 1,977 patients and were concentrated in those with hormone receptor (HR)-positive disease or stage IV disease in the first-line therapy setting (73% and 58%, respectively). Logistic regressions showed that decision changes were more likely in those with HR-positive cancer (odds ratio [OR], 1.58; P < .05) and less likely in those with stage IIA (OR, 0.29; P < .05) or IIIA cancer (OR, 0.08; P < .01). Reasons cited for changes included consideration of the CDSS therapeutic options (63% of patients), patient factors highlighted by the tool (23%), and the decision logic of the tool (13%). Patient age and oncologist experience were not associated with decision changes. Adherence to NCCN treatment guidelines increased slightly after using the CDSS (0.5%; P = .003). CONCLUSION: Use of an artificial intelligence-based CDSS had a significant impact on treatment decisions and NCCN guideline adherence in HR-positive breast cancers. Although cases of stage IV disease in the first-line therapy setting were also more likely to be changed, the effect was not statistically significant (P = .22). Additional research on decision impact, patient-physician communication, learning, and clinical outcomes is needed to establish the overall value of the technology.