NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

National Research Council (US) Committee on Engaging the Computer Science Research Community in Health Care Informatics; Stead WW, Lin HS, editors. Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. Washington (DC): National Academies Press (US); 2009.

Cover of Computational Technology for Effective Health Care

Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions.

Show details

Preface

It is essentially axiomatic that modern health care is an information-and knowledge-intensive enterprise. 1The information collected in health care includes—among other things—medical records of individual patients (both paper and electronic, spread across many different health care organizations), laboratory test results, information about treatment protocols and drug interactions, and a variety of financial and administrative information. Knowledge resides in the published medical literature, in the higher-order cognitive processes of individual clinicians and care providers, and in the processes of health care organizations that facilitate the provision of care.

Whereas the practices of 20th century health care were based largely on paper, there is now a broad consensus that realizing an improved 21st century vision of health care will require intensive use of information technology to acquire, manage, analyze, and disseminate health care information and knowledge. Accordingly, the Administration and Congress have been moving to encourage the adoption, connectivity, and interoperability of health care information technology. President George W. Bush called for nationwide use of electronic medical records by 2014,2 and the Department of Health and Human Services (HHS) is involved in various aspects of achieving this goal.3

The National Library of Medicine launched this study to support the engagement of individuals from the computer science research community in meeting two challenges posed by health care information technology: identifying how today’s computer science-based methodologies and approaches might be applied more effectively to health care, and explicating how the limitations in these methodologies and approaches might be overcome through additional research and development.

The study described in this report was conducted by an interdisciplinary committee of experts in biomedical informatics, computer science and information technology (including databases, security, networking, human-computer interaction, and large-scale system deployments), and health care providers (e.g., physicians who have worked with information technologies). Appendix A provides brief biographical information on the members and the staff of the Committee on Engaging the Computer Science Research Community in Health Care Informatics.

The committee’s work focused primarily on understanding the nature and impact of the information technology investments made by major health care organizations. By design, the committee’s effort was both time- and resource-limited, and thus the primary function of this report is to lay the groundwork for future efforts that can explore in a second phase some of the identified questions and issues in greater detail. Perhaps most importantly, this study does not touch, except in the most peripheral way, on a myriad of complex social, political, and economic issues that complicate the task of health care reform.

For example, although this report emphasizes the role of the clinician, there are other important decision makers in the health care system, including patients, family caregivers, and other health care professionals, whose health care information technology needs the report addresses only peripherally. Similarly, although the data-gathering efforts of the committee were focused primarily on major health care organizations, the majority of health care is delivered in small-practice settings (of two to five physicians) that lack significant organizational support. These omissions do not diminish the significance of the committee’s efforts and recommendations, although they do point to the need for more work to understand health care information technology (IT) needs more thoroughly in the areas that the committee did not examine carefully.

Other important issues omitted in this report that are worthy of serious attention in follow-on reports include the explicit inclusion of instruction in health/biomedical informatics and health care IT in various forms of health care education (e.g., medical and nursing school curricula); legal and cultural barriers to sharing information among various care providers; the development of a strategic plan or roadmap that articulates the strengths, weaknesses, opportunities, and threats to the development of health care IT; standards-development processes in the health care IT industry that might facilitate interoperability; and issues related to personal health records for use by patients, the relationship of education in computer science to health care and biomedical informatics (and vice versa), and organizational support for health care providers that operate on a small scale.

The evidentiary basis for this study involved several threads. The primary observational evidence was derived from committee site visits to eight medical centers around the country (Appendix B provides the agendas for the site visits that the committee conducted). Obviously, a comprehensive view of the current state of the art in the nation’s health care information technology cannot be derived from eight site visits—thus, the organizations visited must be regarded as a sampling of the state of practice throughout the country. Care was taken to ensure that the site visits were to medical centers that varied along important dimensions: governance and ownership (government-operated, non-profit, for-profit), academic and community, and in-house technology development and vendor-supplied technology. The centers visited shared one characteristic—for the most part, they were widely acknowledged to be leaders in the use of IT for health care. This choice was made because the committee felt that many of the important innovations and achievements for health care IT would be found in organizations thought to be leaders in the field.

The findings from the site visits are presented in Appendix C as a table of observations, consequences, and opportunities for action. The observations are de-identified generalizations of detail from multiple sites. The consequences and opportunities for action reflect the committee’s judgment. In the main text of the committee’s report, observations from site visits are cross-referenced where appropriate with the notation CxOy. Cx refers to Category x of the committee’s observations as grouped in Table C.1 (which lists six categories of observations), and Oy refers to a particular observation as numbered in Table C.1 (which includes a total of 25 observations).

The findings from the site visits were combined with other evidentiary threads:

  • Previous work of the Institute of Medicine (IOM) and the National Academy of Engineering. Rather than starting from scratch, the committee adopted as a point of departure for its work the IOM series “Crossing the Quality Chasm”—a vision of 21st century health care that is safe, effective, patient-centered, timely, efficient, and equitable.
  • Selective literature review. In many instances in this report, a claim is made that is based not on direct observation but rather on one or more papers in the scientific literature.
  • Committee expertise. The committee included a number of individuals with substantial clinical and business expertise in medical centers similar to those visited by the committee and other similar settings. Experiences from these individuals were added to this report as needed.

Eight site visits cannot support development of a statistically significant set of examples and illustrations—nevertheless, the committee believes that its observations and conclusions meet the more important test of substantive significance, especially since they arose as a result of visits to organizations regarded as among the best in the country in applying IT to solve health care problems.

Finally, although the committee’s charge (Box P.1) calls attention to the computer science research community, the health/biomedical informatics research community is also a key player for doing the necessary research. The field of health/biomedical informatics emerged from medical informatics, which was described in 1990 by Greenes and Shortliffe as “the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks.”4 “Health informatics” and “biomedical informatics” are more recent terms that acknowledge the increasing importance of informatics for aspects of health beyond medicine and for the basic biological sciences in medicine.

Box Icon

Box P.1

Study Statement of Task. The Computer Science and Telecommunications Board will conduct a 2-phase study to examine information technology (IT) problems faced by the health care system in realizing the emerging vision of (more...)

Computer science as a discipline does not subsume health/biomedical informatics, although computer scientists can and do make major contributions to that field. Health/biomedical informatics is more than medical computer science, drawing also on the decision, cognitive, and information sciences as well as engineering, organizational theory, and sociology with a health and biomedical emphasis that is largely lacking in the world of computer science research. In the context of this report, specialists in health/biomedical informatics can serve a bridging function between the computer science community and the world of biomedicine with which computer science researchers are largely unfamiliar.

The committee thanks the National Library of Medicine, the National Institute of Biomedical Imaging and Bioengineering, the National Science Foundation, the Vanderbilt University Medical Center, Partners HealthCare System, the Robert Wood Johnson Foundation, and the Commonwealth Fund for the financial support needed to conduct this study.

For providing information and hosting site visits for the committee, the committee expresses its appreciation to a number of organizations: Partners HealthCare (David Bates, Henry Chueh, Anuj Dalal, John Glaser, and Jeff Schnipper), the University of Pittsburgh Medical Center (Jocelyn Benes, Jody Cervenak, Jacque Dailey, Steven Docimo, Tom Dongilli, William Fera, Kim Gracey, Robert Kormos, James Levin, Daniel Martich, Ed McCallister, Tami Merryman, Sean O’Rourke, Vivek Reddy, Paul Sikora, Michele Steimer, and Jeff Szymanski), HCA Tristar (David Archer, Darryl Campbell, Kimberly Lewis, Annette Matlock, Jon Perlin, Melody Rose, Ruth Westcott, and Kelly Wood), Intermountain Healthcare (Lynn Elstein, Stan Huff, Marc Probst, and Brent Wallace), the Palo Alto Medical Foundation (Albert Chan, Steve Hansen, Neil Knutsen, Charlotte Mitchell, Tomas Moran, Gil Radtke, and Paul Tang), the University of California, San Francisco (Sharon Friend, Gail Harden, Michael Kamerick, Jon Showstack, and Deborah Yano-Fong), Vanderbilt University Medical Center (Rashid M. Ahmad, John Doulis, Mark Frisse, David Gregory, Ken Holroyd, Sara Hutchison, Marsha Kedigh, Randy Miller, Neal Patel, Corey Slovis, and Jack Starmer), San Francisco General Hospital (Geoff Manley), and the Department of Veterans Affairs (Stanlie Daniels, Neil Eldridge, Neil Evans, Ross Fletcher, Raya Kheirbek, Tracie Loving, Joaquin Martinez, Linwood Moore, Fernando O. Rivera, and Kenneth Steadman).

A number of individuals also briefed the committee during open sessions: B. Alton Brantley (principal, the CCI Group), Kenneth D. Mandl (Harvard Medical School and Harvard-MIT Division of Health Sciences and Technology), Greg Walton (HIMSS Analytics), Denis Cortese (Mayo Clinic), Peter Neupert (Microsoft), Scott Wallace (National Coalition for Health Care IT), Janet Corrigan (National Quality Forum), Alicia A. Bradford (Office of the National Coordinator for Health Information Technology), Peter J. Fabri (University of South Florida and Northwestern University), and Gina Grumke and Monique Lambert (Intel). Betsy Humphreys and Donald A.B. Lindberg from the National Library of Medicine provided the charge to the committee at its first meeting.

The committee also appreciates the efforts of David Padgham, associate program officer, who left the National Research Council in May 2008, in organizing these site visits and other information-gathering sessions of the committee. Finally, the committee thanks Herbert Lin, study director and chief scientist of the Computer Science and Telecommunications Board, for his counsel throughout the project and his effort in developing the report.

Institute of Medicine and National Academy of Engineering, Building a Better Delivery System: A New Engineering/Health Care Partnership, The National Academies Press, Washington, D.C., 2005, available at http://www​.nap.edu/catalog​.php?record_id=11378.

Commission on Systemic Interoperability, Ending the Document Game, U.S. Government Printing Office, Washington, D.C., 2005, available at http:​//endingthedocumentgame.gov/.

Institute of Medicine, Opportunities for Coordination and Clarity to Advance the National Health Information Agenda, The National Academies Press, Washington, D.C., 2007, available at http://www​.nap.edu/catalog​.php?record_id=12048.

Robert Greenes and Edward H. Shortliffe, “Medical Informatics: An Emerging Academic Discipline and Institutional Priority,” Journal of the American Medical Association 263(8):1114-1120, 1990.

Footnotes

1

Institute of Medicine and National Academy of Engineering, Building a Better Delivery System: A New Engineering/Health Care Partnership, The National Academies Press, Washington, D.C., 2005, available at http://www​.nap.edu/catalog​.php?record_id=11378.

2

Commission on Systemic Interoperability, Ending the Document Game, U.S. Government Printing Office, Washington, D.C., 2005, available at http:​//endingthedocumentgame.gov/.

3

Institute of Medicine, Opportunities for Coordination and Clarity to Advance the National Health Information Agenda, The National Academies Press, Washington, D.C., 2007, available at http://www​.nap.edu/catalog​.php?record_id=12048.

4

Robert Greenes and Edward H. Shortliffe, “Medical Informatics: An Emerging Academic Discipline and Institutional Priority,” Journal of the American Medical Association 263(8):1114-1120, 1990.

Copyright © 2009, National Academy of Sciences.
Bookshelf ID: NBK20633
PubReader format: click here to try

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (626K)

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...