Messages from AMIA
Chairman’s column: health informatics
and healthcare transformation—entering
the post-EMR era
One of my favorite cartoons by John Chase shows a drunk
holding a bottle while sitting in an alley looking at a normal
distribution curve on the wall with an ‘x’ marking a very early
point on the curve; the caption says ‘You are here.’ It still feels
that way at times in biomedical informatics. With respect to
healthcare transformation and the contribution we all hope
biomedical informatics will play, it nevertheless feels as though
we are still early on—there have been many significant contributions from our field, but there are many more to go.
Certainly the healthcare environment is changing dramatically under our feet. The evolution from healthcare reimbursement based upon fee-for-service and maximizing volume of
care delivered toward reimbursement based upon bundled (or
at risk in any form) payments and maximizing the value of
care delivered will take at least a decade, or more.1 2 The
aging population is increasing the burden of chronic disease,
and the shift from commercial to public insurance is reducing
once generous healthcare margins to the minimum. Times are
tough all over. If the fundamental theorem of informatics is to
improve care with the application of information and communication technologies,3 then informatics prime objective is to
increase the value of services rendered—simply considered:
value=quality/cost.
A PATH FORWARD
We are entering a post-electronic medical records (EMR) era—
one where the goals and objectives of health information technology adoption are largely met4 but the transformation we
need is not yet achieved.5 We have a distance to go still on
enhancing the exchange of health information,6 and equally
importantly, the exchange of knowledge in computable and
actionable form for clinical care.7 We have further to go on
sharing clinical data for basic research and operations improvement purposes,8 and we have a long way to go on generalizing
and delivering on the promise of ‘personalized, predictive, preventive, and participatory’ medicine.9 It is absolutely necessary
that we deliver on the value proposition for this country’s
extraordinary investment in health information technologies.
Recent reports (PCAST,10 11 JASON,8 ONC Connecting
Health and Care12) point toward an approach. In the
post-EMR era, next-generation health information technologies will be in the hands of both patients (and their proxies) as
well as providers and care teams, and connected to data
sources in diverse care settings, and at home. Seamless information exchange will need to occur across a heterogeneous
array of technologies to allow a coordinated regional (or even
The purpose of the Messages from AMIA section is to provide
a forum for AMIA to inform and involve its current and
potential members about the goals and the directions of the
association. These messages, which reflect the directions and
opinions of AMIA leaders only, are intended to inspire
members and readers to connect with the association on
strategic objectives and activities. See also http://www.amia.
org/presidents-page.
J Am Med Inform Assoc November 2014 Vol 21 No 6
global) view of care management, and facilitate collaboration
around a shared care plan. As my bank balance and credit risk
score are known throughout the financial ecosystem, so my
health status and disease risk should be known securely and
confidentially, and only as I permit, across my health and wellness ecosystem.
Given that no single application or system will ever have
complete reach across the health and wellness ecosystem, this
implies that next-generation health information technologies
will need to provide means to interact appropriately with
remote, disparate systems to exchange information about
shared patients, and to access an array of tools and services via
APIs (application programming interfaces) to support care (eg,
clinical decision support, phenotype extraction from clinical
data, population health). This also implies that we need to
envelop data with sufficient metadata so that it is essentially
self-describing and can be interpreted and used appropriately
across time and space in the healthcare ecosystem. This also
implies that patients have an ability to control access and use
of their data in ways they deem appropriate, in a secure and
confidential manner, and perhaps earn a reward for data
sharing for the purposes of research. And, this implies that
potentially competing healthcare delivery organizations appropriately share patient information, and developers of health
information technologies for patients and providers alike
design their products with sharing data in a patient-centered
manner. Only rapid alignment around these broad principles
can possibly prepare our patients and providers, and secondarily our technologies, for the era of Big Data as we see patients
adopt quantified self-applications and genomic, geospatial,
social, and environmental data come online, and we see the
‘internet of things’ wire the healthcare ecosystem.
INFORMATICS IS KEY
Biomedical informatics methods and technologies, and biomedical informaticians, therefore, play a key role in enabling
the transformation of US healthcare. We need to continue to
pursue fundamental AMIA strategic goals and objectives: to
increase research and understanding in informatics, to enhance
the applied practice of informatics, and to expand the workforce of professionally qualified informaticians from all communities engaged in this endeavor. The AMIA Board of
Directors has sponsored creation of an ‘EHR 2020’ task force
to create a vision for and a path toward next-generation health
information technologies. Another task force is charting the
informatics competencies needed among clinical informatics
practitioners in healthcare delivery organizations. And, AMIA
is committed to the professional certification of clinicians and
other health professionals, and others working at the interface
of clinical practice, research, and technology (clinical informatics board certification for physicians, and advanced interprofessional clinical informatics certification for health
professionals).
These are truly exciting times! I look forward to seeing you
at our AMIA 2014 Annual Symposium, November 15–19,
Washington, DC.
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Messages from AMIA
Blackford Middleton
Correspondence to Dr Blackford Middleton, Department of Biomedical
Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Nashville,
TN 37205, USA; [email protected]
Competing interests None.
4
5
6
Provenance and peer review Not commissioned; not internally peer reviewed.
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8
To cite Middleton B. J Am Med Inform Assoc 2014;21:1141–1142.
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J Am Med Inform Assoc 2014;21:1141–1142. doi:10.1136/amiajnl-2014-003337
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