Informatics in 21st Century Healthcare

Two new articles provide some added perspective for the direction of biomedical informatics and its role in healthcare. Although these articles are physician-oriented, they could easily be applied to other healthcare professionals or for that matter patients, consumers, and researchers.

The first article was published on-line ahead of print in the journal Academic Medicine. The paper was authored by William Stead of Vanderbilt University and four colleagues. The main thrust of the paper was that the quantity and complexity of information in medicine requires a fundamental paradigm shift from the “power of the individual brain” to the “collective power of systems of brains.” The authors noted that the numbers of facts per clinical decision will increase exponentially, especially as our knowledge moves beyond the phenotype to include the genotype (e.g., genomic variation, proteomics, etc.). While it can be argued whether genomics has yet had much impact in clinical medicine, just the complexity of our clinical knowledge of diseases, tests, and treatments is already overwhelming what these authors call the “human cognitive capacity.” When you factor in the social and economic complexity of our healthcare system, you do not even need genomics to make it exceedingly complicated, even though genomics is likely to make it more so.

These authors also note the consensus developing around the core competencies for the biomedical informatics field being developed by the AMIA Academic Forum. One particularly valuable exercise of this paper is to map the key competencies to the six core competencies for future health professionals first enumerated by the Accreditation Council for Graduate Medical Education (ACGME).

The authors envision a central role for academic health centers (AHCs), recommending advancement in four areas (to quote):

• Create academic units in biomedical informatics
• Adapt the IT infrastructure of AHCs into testing laboratories
• Introduce medical educators to biomedical informatics sufficiently for them to model its use
• Retrain faculty in AHCs to lead the transformation to health care based on a new systems approach enabled by biomedical informatics…

Indeed, these activities could be an instance of the Health Innovation Zone concept that the Association of American Medical Colleges calls for AHCs to embrace. The authors state that “embracing this collective and informatics-enhanced future of medicine will provide opportunities to advance education, patient care, and biomedical science.”

The second paper is a commentary by Ted Shortliffe of AMIA in JAMA. This piece appears in the annual special issue of JAMA to devoted to medical education. As such, it focuses on medical education and has a central thesis that the focus of medical practice is as much information as it is patients. Yet while medical education goes to great lengths at teaching students how to assess, interact with, and treat patients, it devotes very little effort at obtaining, using, and analyzing information.

Shortliffe notes that biomedical informatics should be a discipline fundamental to medical education, focusing on both its practical application and core fundamental concepts. He points to a number of examples of where medical practice could benefit from informatics. Few students, he note, are skilled at searching. While anyone in the world can do a Google search, most medical students are not able to skillfully use the myriad of search systems available, from PubMed to the clinically oriented genomics databases. Likewise, few students have mastery of using an electronic health record, let alone make critical secondary use of its data for quality improvement, patient empowerment, or clinical research. I suspect that a paucity of medical students understand the full ramifications of privacy and security, health information exchange, or other informatics topics that will impact their practices in a large way in the coming decades.

One detractor of teaching more informatics to medical students at OHSU used to argue that today’s students have no need for such instruction, since they are digital natives, proficient in email, social networking applications, and smart phone usage. Yet these technologies are not informatics, which Shortliffe pulls from the AMIA core competencies definition as “the interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making motivated by efforts to improve human health.”

Let us hope these articles are widely read and acted upon by healthcare leaders, educators, and forward-looking practitioners.