Defining Core Competencies in Informatics

If you ask two well-regarded experts in informatics as to the definition of their discipline, you are highly likely to get two different answers. It is for this reason that it is remarkable that there are now several maturing efforts to define a set of core competences. These include those that are primarily around the implementation and use of clinical information/decision support systems. Others emphasize probabilistic reasoning, formalized decision science, statistically informed knowledge-mining and expertise in different communications modalities. Whatever the truly most central core competencies, it is very clear that we don't have enough experts in any of them.

Just as the lack of sufficiently well-trained bioinformaticians is delaying our harvest of the fruit of the human genome project, the lack of well-trained clinical informaticians is likely to be a rate-limiting step in the Recovery Act's plan to broadly implement electronic health record systems.

Stimulomics—An informatics initiative

This comes in somewhere between useful and cheeky.

Medical Museum on the Web

(Originally uploaded by otisarchives1 )An interesting example of how historical medical data can be shared more widely for scholars worldwide. If all medical libraries followed this lightweight formula for dissemination, we could avoid repeating many mistakes of the past and learn how better to deal with old challenges revisited (e.g. epidemics). Kudos to the Medical Museum.

Search + Internet = Better Public Health?

Our very own John Brownstein, has just published an article in the Canadian Medical Association Journal which demonstrates the consequences of removing information bottlenecks between the public and population-level analytics. Some have expressed skepticism regarding the value of mining web-activity for "objective" reporting but, in this instance at least, it seems that a distributed network of non-experts can be effective in detecting outbreaks earlier than through standard surveillance methods.

Disclosing to and educating patients about genetic risk

We've read a lot about direct to consumer disclosure of genetic risk. Here is an opportunity to learn from Prof Robert Green about what he has learned from the methodological study of the disclosure process of the genetic risk for a serious disease.

Translational Genomics Seminar Series
"Genetic Risk Assessment for Alzheimer's Disease: The REVEAL Study."
Robert C. Green, MD, MPH
Duncan Reid Conference Room Brigham and Women's Hospital on Thursday, March 19th at 5pm.

Pushing open access at Harvard Medical School

A very nice account here regarding the work of our very own Alexa McCray and Scott Lapinski in leading the medical school to implementation of an open access policy and compliance with the NIH's mandate for open access in for the publications funded by the NIH.

A cautionary note about electronic health records

Those of us who are pediatricians cannot help but take this personal story (Hat tip Ted Shortliffe) about the effect of electronic health records very seriously. It does point out that we are still a long way from the day when the computer is not a distracting magic box but rather serves as an active vigilant partner in the healthcare of our patients.

Open access week

The politics of openness are heating up. As per SPARC (Scholarly Publishing and Academic Resources Coalition):

"To accommodate widespread global interest in the movement toward Open Access to scholarly research results, October 19 – 23, 2009 will mark the first international Open Access Week. The now-annual event, expanded from one day to a full week, presents an opportunity to broaden awareness and understanding of Open Access to research, including access policies from all types of research funders, within the international higher education community and the general public.

Open Access Week builds on the momentum generated by the 120 campuses in 27 countries that celebrated Open Access Day in 2008. Event organizers SPARC (the Scholarly Publishing & Academic Resources Coalition), the Public Library of Science (PLoS), and Students for FreeCulture welcome key new contributors, who will help to enhance and expand the global reach of this popular event in 2009: eIFL.net (Electronic Information for Libraries), OASIS (the Open Access Scholarly Information Sourcebook); and the Open Access Directory (OAD).

For more information about Open Access Week and to register, visit http://www.openaccessweek.org."

Politics as Statistics

Our very own Ben Reis appears to have touched the same nerve that turns baseball fans into obsessed statisticians. Speechwars is now generating secondary analyses about the meaning of presidential utterances from a purely lexical perspective. Who is to say this is any less insightful that allegedly semantically rich punditry? Some have argued that Google's success points to the strengths of this "low-level" data driven perspective, Can we be equally effective in mining our clinical health records?

Extreme Social Networking

We already know that television viewing is associated with inactivity, obesity and a variety of other problems. Now, apparently Internet-borne social networking is being billed as a risk to cognitive development and a stable affect (or not). Yet, here is a stunning example of an extremely tight and productive social network. Most of us probably would not want to be this networked but some apparently do.

How do we know what works in medical informatics?

In the context of all the hubbub around the monies for health care information technology in the stimulus package, how are we going to know whether we will be have any lasting value from this investment?

This reminded me to peruse again the best resource on how to think about evaluation: Friedman and Wyatt's book on the topic "Evaluation Methods in Biomedical Informatics". Particularly useful is the chapter that describes approaches to evaluating systems when the conventional outcome metrics are either unavailable, premature, or inappropriate. Given that Chuck is in the Office of the National Coordinator for Health Information Technology, it's not unreasonable to suppose that some thought will be given to selecting those proposals for the stimulus that include worthy evaluations.

American College of Physicians gets excited about Electronic Health Records

The American College of Physicians is promoting the virtues of electronic health records. Contrast this offering with this.

Hat tip Ted Shortliffe.

Our Data Ourselves

The American Recovery and Reinvestment Act has important medical privacy mandates which in theory should allow for increased "liquidity" of our own healthcare data. That is, it should allow patients to request an electronic copy of their record where there is one to be had. Specifically (thanks to AMIA for a very useful summary):

Privacy –Title XIII Subtitle D

•Sec. 13405

Provides individuals the right to obtain from a covered entity using an EHR a copy of their information in electronic format, allowing the individual to designate a 3rdparty, such as a PHR, to receive a copy

This has been a long time coming and it is a welcome development. It should further stimulate an industry working on the personal use of such data.

Boston University sets an important example

Boston University in its entirety has adopted an open access policy that includes both the undergraduate and graduate schools. This move signals the continued tectonic shift in the awareness of faculty of the importance of providing more efficient access to their scholarly output, for themselves, for their colleagues and for their students. Details of the policy can be found here.

Your face or your health?

The recent brouhaha regarding the Facebook change of terms or service illustrates just how much many care about their personally placed public information. Do we, as patients, care any less about who gets to have our personal data in perpetuity? Should we advocate for tighter personal control of our health information?

How long do you have to wait in the Emergency Room?

If you ever have had a visit to the emergency room that was not a life-threatening emergency you might have made an unfavorable comparison of queue management there to that in a supermarket. It is therefore all the more stark how innovative this site from Australia is in this regard. What will it take to make this functionality available routinely? It certainly would allow consumers to effectively spread the load across the local emergency rooms.

Hat tip to HISTalk via Dan Nigrin.

Enabling the new peer review

From the capacious open source code vaults at Google, here is an interesting application called gpeerreview. It allows irrepudiably sourced reviews of any publication. In their own words:

How does it work?

1. First, you read someone's paper.
2. Next, write a review. (The review is just a simple text file that contains a few scores and your opinions about the paper.)
3. Use GPeerReview to sign the review. (It will add a hash of the paper to your review, then it will use GPG to digitally sign the review.)
4. Send the signed review to the author. If the author likes the review, he/she will include it with his/her list of published works.
5. Prospective employers or other persons can easily verify that the reviews are valid.

Why?

• Peer reviews give credibility to an author's work.
• Journals and conferences can use this tool to indicate acceptance of a paper.
• Researchers can also give credibility to each other by reviewing each others' works.
• This enables researchers to publish first, and review later.
• It meshes seamlessly with existing publication venues. Even the credibility of works that have already been published can be enhanced by obtaining additional peer reviews.
• A decentralized social-network of reviewers and papers is naturally formed by this process. The structure of this network reflects that of the research community.

This is a nice idea and if paired with the right social networking web infrastructure, could make for a nice peer view community. More evidence of the growing search for alternative modes of publication and peer review.

Can the healthcare system keep up with Grandpa?

A sensible senior citizen has come up with an efficient and cost-effective portable medical record. It's his key medical facts stored on a commodity USB drive and hung on his person by lanyard or bracelet. Alas, the real question is, how many clinical practices have a care provider who has the wherewithal and willingness to plug this drive into their office (or emergency room) computer to check the contents of the record? Perhaps the stimulus package can help increase this likely small number?

Peter Suber Speaks

What is the Future of Open Access?

A talk by Peter Suber

Thursday, February 26, 12:30 pm
Pound Hall 100, Harvard Law School
RSVP requested (rsvp@cyber.law.harvard.edu)
This talk is co-sponsored by the Harvard Office for Scholarly Communication and the Harvard Law School Library

Eloquent cri de coeur

This piece by Patrick Swayze speaks for itself. I would add that the investment in additional NIH funding is lessened if the results of the funded research are not delivered efficiently to our taxpayers.