BiomedicalandHealthInformatics:CareersandOpportunitiesattheIntersectionofComputer

ScienceandBiomedicine

WilliamHersh,MD,FACP,FACMIProfessorandChair

DepartmentofMedicalInformatics&ClinicalEpidemiologyOregonHealth&ScienceUniversity

Portland,OR,USAEmail:hersh@ohsu.eduWeb:www.billhersh.info

Blog:http://informaticsprofessor.blogspot.comTwitter:@williamhersh

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Greenes,RAandShortliffe,EH(1990).Medicalinformatics-anemergingacademicdisciplineandinstitutionalpriority.JournaloftheAmericanMedicalAssociation.263:1114-1120.Greiner,ACandKnebel,E,Eds.(2003).HealthProfessionsEducation:ABridgetoQuality.Washington,DC,NationalAcademiesPress.Halamka,JDandTripathi,M(2017).TheHITECHErainRetrospect.NewEnglandJournalofMedicine.377:907-909.Hasman,A,Ammenwerth,E,etal.(2011).Biomedicalinformatics--aconfluenceofdisciplines?MethodsofInformationinMedicine.50:508-524.Haux,R(2010).Medicalinformatics:past,present,future.InternationalJournalofMedicalInformatics.79:599-610.Hersh,W(2009).Astimulustodefineinformaticsandhealthinformationtechnology.BMCMedicalInformatics&DecisionMaking.9:24.http://www.biomedcentral.com/1472-6947/9/24/Hersh,W(2012).FromImplementationtoAnalytics:TheFutureWorkofInformatics.InformaticsProfessor,April1,2012.http://informaticsprofessor.blogspot.com/2012/04/from-implementation-to-analytics-future.htmlHersh,WR(2014).HealthcareDataAnalytics.HealthInformatics:PracticalGuideforHealthcareandInformationTechnologyProfessionals,SixthEdition.R.HoytandA.Yoshihashi.Pensacola,FL,Lulu.com:62-75.Hersh,WR,Weiner,MG,etal.(2013).Caveatsfortheuseofoperationalelectronichealthrecorddataincomparativeeffectivenessresearch.MedicalCare.51(Suppl3):S30-S37.Kleinke,JD(2005).Dot-gov:marketfailureandthecreationofanationalhealthinformationtechnologysystem.HealthAffairs.24:1246-1262.Kulikowski,CA,Shortliffe,EH,etal.(2012).AMIABoardwhitepaper:definitionofbiomedicalinformaticsandspecificationofcorecompetenciesforgraduateeducationinthediscipline.JournaloftheAmericanMedicalInformaticsAssociation.19:931-938.Lowry,SZ,Quinn,MT,etal.(2012).TechnicalEvaluation,Testing,andValidationoftheUsabilityofElectronicHealthRecords.Gaithersburg,MD,NationalInstituteforStandardsandTechnology.http://www.nist.gov/healthcare/usability/upload/EUP_WERB_Version_2_23_12-Final-2.pdfMandel,JC,Kreda,DA,etal.(2016).SMARTonFHIR:astandards-based,interoperableappsplatformforelectronichealthrecords.JournaloftheAmericanMedicalInformaticsAssociation:Epubaheadofprint.Mandl,KDandKohane,IS(2012).EscapingtheEHRtrap--thefutureofhealthIT.NewEnglandJournalofMedicine.366:2240-2242.Martin,SAandSinsky,CA(2016).Themapisnottheterritory:medicalrecordsand21stcenturypractice.Lancet.388(2053-2056)O'Reilly,T,Loukides,M,etal.(2012).HowDataScienceIsTransformingHealthCare-SolvingtheWanamakerDilemma.Sebastopol,CA,O'ReillyMedia.Osborn,R,Moulds,D,etal.(2015).Primarycarephysiciansintencountriesreportchallengescaringforpatientswithcomplexhealthneeds.HealthAffairs.34:2104-2112.Rosenbaum,L(2015).Transitionalchaosorenduringharm?TheEHRandthedisruptionofmedicine.NewEnglandJournalofMedicine.373:1585-1588.Shortliffe,EHandCimino,JJ,Eds.(2006).BiomedicalInformatics:ComputerApplicationsinHealthCareandBiomedicine.NewYork,NY,Springer.Smith,M,Saunders,R,etal.(2012).BestCareatLowerCost:ThePathtoContinuouslyLearningHealthCareinAmerica.Washington,DC,NationalAcademiesPress.Stead,WW,Searle,JR,etal.(2011).Biomedicalinformatics:changingwhatphysiciansneedtoknowandhowtheylearn.AcademicMedicine.86:429-434.Washington,V,DeSalvo,K,etal.(2017).TheHITECHeraandthepathforward.NewEnglandJournalofMedicine.377:904-906.

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BiomedicalandHealthInformatics:CareersandOpportunitiesattheIntersectionofComputerScience

andBiomedicineWilliamHersh,MD,FACP,FACMI

ProfessorandChairDepartmentofMedicalInformatics&ClinicalEpidemiology

SchoolofMedicineOregonHealth&ScienceUniversity

Portland,OR,USAEmail:hersh@ohsu.eduWeb:www.billhersh.info

Blog:http://informaticsprofessor.blogspot.comTwitter:@williamhersh

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Outline

• Termsanddefinitions• Recentgrowthandchange• Careerandeducationalopportunities

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Whatisbiomedicalandhealthinformatics(Hersh,2009)?

• IgetaskedthissooftenthatIkeepaWebsite– http://www.billhersh.info/whatis/

• Andablog– http://informaticsprofessor.blogspot.com

• Biomedicalandhealthinformatics(BMHI) isthefieldconcernedwiththeoptimaluseofinformation,oftenaidedbytechnology,toimproveindividualhealth,healthcare,publichealth,andbiomedicalresearch

• PractitionersofBMHIareusuallycalledinformaticians (sometimesinformaticists)

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Otherviews• Earlydefinition:“storage,acquisition,anduseofinformation”(Greenes,1990)

• Other(US)perspectives– Paradigmshiftinbiomedicinefrom“individualbrainstosystemsofbrains” (Stead,2011)

– AMIA:“Theinterdisciplinaryfieldthatstudiesandpursuestheeffectiveusesofbiomedicaldata,information,andknowledgeforscientificinquiry,problemsolving,decisionmaking,motivatedbyeffortstoimprovehumanhealth”(Kulikowski,2012)

• Europeanandglobalperspectives(Haux,2010;Hasman,2011;Geissbuhler,2011)

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Letusstartbydefining“informatics”

• Thedisciplinefocusedontheacquisition,storage,anduseofinformationinaspecificsettingordomain(Hersh,2009)– Ismoreaboutinformationthan

technology• Sometimesdefinedasactivity

attheintersectionofpeople,information,andtechnology

• Thescienceof“sociotechnicalsystems” (Coiera,2007)

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Informaticshasa“fundamentaltheorem”anda“goldenrule”

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FundamentalTheorem(Friedman,2009)– basedon“relentlesspursuitofassistingpeople”

Goalofinformaticsis

Goalisnot

GoldenRule(Kuperman,personalcommunication,2013):

“Neverimplementuntoothersthatwhichyouwouldnotimplementuntoyourself”

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Informaticsterminology(andour“adjectiveproblem”)

(Hersh,2009;adaptedfromShortliffe,2006)

Informatics=People+Information+Technology

BiomedicalandHealthInformaticsLegalInformatics Chemoinformatics

Bioinformatics(cellularandmolecular)

Clinical(orMedical)Informatics

(person)

{Clinicalfield}Informatics

PublicHealthInformatics(population)

ConsumerHealthInformatics

ImagingInformatics ResearchInformatics

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Informaticsnowviewedasacorecompetencyforhealthprofessionals

• AccordingtoInstituteofMedicinereport,themodernhealthcareprofessionalmusthavecompetencyininformaticsaspartoflargergoaltoprovidepatient-centeredcare(Greiner,2003)

• Informaticscompetencyisnotjustcomputerliteracy!– The“Googlegeneration” does

notnecessarilyhavegoodinformationskills(CIBER,2008)

• Informaticsisacorecomponentofthe“learninghealthsystem”(Friedman,2010;Smith,2012)

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Somerelatedterms• Healthinformationtechnology(HITorhealthIT)–health-relatedapplicationofIT

• Informationandcommunicationstechnology(ICT)– sameasITwithaddedemphasisontelecommunications

• eHealth – useofICTforhealth• Telemedicine – provisionofhealthcarewhenparticipantsseparatedbytimeand/ordistance– Telehealth – pursuitofhealthwhenseparatedbytimeand/ordistance

• mHealth – useofmobiledevicesforhealth

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Termsrelatedtomedical/clinicalrecords

• Electronichealthrecord(EHR)– patient’shealthrecordindigitalform– Hasmostlysupplantedelectronicmedicalrecord(EMR)

• Meaningfuluse– programofincentivesforEHRadoptioninUSrequiringthattheybeusedinwaysthatachievehealthcaregoals

• Personalhealthrecord(PHR)– personallycontrolledhealthrecord

• Healthinformationexchange(HIE)– exchangeofhealthinformationacrosstraditionalbusinessandotherboundaries

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ProgramminganEHRissimple,right?

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Butprogrammingisactuallytheeasypart

• MixingITwithclinicalworkflowhasbeendifficult

• SomeHIThashadsafetyissues• FinancialbenefitsofHITdonotalwaysaccruetothosewhopay

• Manyissueswithprivacyandsecurity,whogobeyondhealthcare

• Largerproblemsinhealthcareorganizationandfinancingmakechangedifficult

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Informaticsisalsoessentialformodernbiomedicalresearch

• EmbodiedintheNationalInstitutesofHealth(NIH)Roadmaptoacceleratebiomedicalresearchdiscovery(http://commonfund.nih.gov)– Today’sbiomedicalresearcherroutinelygenerates…billionsofbytesofdata.…Whatresearchersneedarecomputerprogramsandothertoolstoevaluate,combine,andvisualizethesedata.Insomecases,thesetoolswillgreatlybenefitfromtheawesomestrengthofsupercomputersorthecombinedpowerofmanysmallermachinesinacoordinatedwaybut,inothercases,thesetoolswillbeusedonmodernpersonalcomputersandworkstations.

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Informaticsisincreasinglybecominga“datascience”

• EHR(andprobablyallinformatics)workchangingfrom“implementation”to“analytics”(Hersh,2012)

• Datascienceisthe“sexiestjobofthe21stcentury?”(Davenport,2012)

• Growingimportanceofroleforanalytics inhealthcare(Adams,2011;O’Reilly,2012;Hersh,2014)– Butwemustusecautiontomakesurethatclinicaldataiscomplete,correct,andotherwisesound(theroleofinformatics?)(Hersh,2013)

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Informaticshasgonefrom“dot-com”to“dot-gov”(Kleinke,2007)

• BushAdministration– Recognizedvalueofhealthinformationtechnology(HIT)– Actions:OfficeoftheNationalCoordinatorforHealthIT(ONC),AmericanHealthInformationCommunity(AHIC),etc.

• ObamaAdministration– TheAmericanRecovery&ReinvestmentAct(ARRA)of2009providedincentivesfor“meaningfuluse”ofelectronichealthrecords(EHRs)andtheinfrastructuretoachieveitthroughprovisionsoftheHealthInformationTechnologyforEconomicandClinicalHealth(HITECH)Act(Washington,2017;Halamka,2017)

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BushAdministrationstartedpromotionoffield

• PresidentBushStateoftheUnion– mentionedeveryyearfrom2004to2008– January,2004– “Computerizinghealthrecords[can]reducecosts,improvecare,andlowertheriskofmedicalmistakes.”

– January,2007– “Weneedtoreducecostsandmedicalerrorswithbetterinformationtechnology.”

• Setgoalofelectronichealthrecords(EHRs)forhalfofallAmericansby2014(WhiteHouse,2005)

• EstablishedtheOfficeoftheNationalCoordinatorforHealthIT(ONC)– www.healthit.gov

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ObamaAdministrationuppedtheante“Toimprovethequalityofourhealthcarewhileloweringitscost,wewillmaketheimmediateinvestmentsnecessarytoensurethatwithinfiveyears,allofAmerica’smedicalrecordsarecomputerized…Itjustwon’tsavebillionsofdollarsandthousandsofjobs– itwillsavelives.”

January,2009

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UShasbeenalaggardinEHRadoptionbutnowcatchingup

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(Osborn,2015)

(Washington,2017)

OtherUSgovernmentagenciesandentitiesinvolvedinhealthIT

• NationalLibraryofMedicine(NLM,www.nlm.nih.gov)andotherinstitutesoftheNationalInstitutesofHealth(NIH)– NLMleaderinfundingresearchandtrainingininformatics– ReaffirmedwithappointmentofnewleaderandincorporationofNIHdata

scienceactivities(Brennan,2016;Brennan,2016)• AgencyforHealthcareResearch&Quality(AHRQ,www.ahrq.gov)

– Fundsresearchandpolicydevelopment,produceshealthITinformationresources

• CentersforMedicareandMedicaidServices(CMS,www.cms.hhs.gov)– Payor forMedicareandMedicaid,includingHITECHincentives

• NationalCommitteeforVital&HealthStatistics(NCVHS,www.ncvhs.hhs.gov)– Governmentadvisoryboard,includingissuesrelatedtohealthIT

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Informaticsalsorequiresustoaddressharmsandlimitations

• IOMHITsafetyreportdocumentedconcernsaboutdangers(2012)

• Keyissuestoaddressareworkflow(Carayon,2010)andusability(Lowry,2012)

• EHRmustmovefrombeingamonolithic,transaction-basedapplicationtoaplatform(Glaser,2012;Mandl,2012)– EmergingSMARTonFHIRstandardtheanswer(Mandel,2016)?

• HasEHRunderminedmedicineorarewein“transitionalchaos”(Rosenbaum,2015;Martin,2016)?

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Opportunitiesforinformaticscareers

• Mostprevalentinclinicalinformatics(inhealthcaresettings),butplentyofotheropportunityinotherareasofinformatics– Bioinformatics– leadingandassisting

computationalanalysisofgenomicsandrelatedtechnologies

– Clinicalandtranslationalresearch– usinginformaticstoaidbiomedicalresearch

– Publichealth– usinginformationtoprotectthepublicandpromotehealth

– Consumerhealth– helpingthegeneralpopulationmaintainandimprovehealth

– Imaginginformatics– usingimagesforbiomedicalresearch,clinicalcare,etc.

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Careerpathwayshavediverseinputsandoutputs(Hersh,2009)

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Healthcareprofessions,e.g.,medicine,nursing,etc.

Naturalandlifesciences,e.g.,biology,genetics,etc.

Computerscience(CS),IT,andundergradinformatics

Healthinformationmanagement(HIM)

Others,e.g.,business,libraryandinfo.science

Jobsin:• Healthcaresystems

• Clinicalleadership• ITleadership

• Biomedicalresearch• Industry• Academia

Biomedicalandhealthinformaticseducation(graduatelevel)

Thereisnosinglecareerpathway,ladder,etc.

Therearemanycareeropportunitiesinmanysettingsforalltracks

Showmethemoney:howmuchdoHITprofessionalsmake?

• HIMSScompensationsurvey(2015)andHealthITJobs.com (2016)• Salariesvarybylevel,region,experience,organizationalsize,andorganizational

type• Evenhigherforsome:physicians,advanceddatascience/analytics

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Example:OHSUinformaticshttp://www.ohsu.edu/informatics

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International students from: Argentina, Singapore, Egypt, Israel, Saudi Arabia, Zimbabwe, Thailand, China, and other countries

Track Degree/Certificate PhD MS MBI GradCert

ClinicalInformatics On-campusOn-campus

On-line

On-campus

On-line

On-campus

On-line

Bioinformatics andComputationalBiology

On-campus On-campus

DegreesAwarded1998-2016(653people)Track CI BCB TotalCertificate 406 0 406MBI/MMI 190 8 198MS 72 16 88PhD 18 6 24Total 686 30 716

HowhaveOHSUstudentsandgraduatesdone?

• About25yearsofexperience…• Generalobservation:Whatpeopledowhentheygraduateispartiallydependentonwhattheydidwhentheyentered,e.g.,– Physicians,nurses,publichealth,etc.drawontheirclinical/professionalbackground

– Informationtechnologyprofessionalsdrawontheiruniquebackgroundandexperience

• Graduateshaveobtainedjobsinavarietyofsettings,e.g.,clinical,academic,andindustry

• Growingnumberofopportunitiesindatascience/analytics

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Conclusions

• Theseareexcitingtimesforbiomedicalandhealthinformatics,withmanyopportunitiesinawidevarietyofsettings

• Attentionmustalsobepaidtotheprofessionalpracticeandeducationofinformaticians

• Butthemainfocusofthefieldmustbehowtooptimallyuseinformationandtechnologyproperlytoadvancehumanhealthandimprovedeliveryofhealthcare

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