Translational Research in Medical Informatics
or from Theory to Practice
A Call for an Applied Informatics Journal
C. U. Lehmann1, M. M. Altuwaijri2, Y. C. Li3, M. J. Ball4, R. Haux5
1Pediatrics and Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
2College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3Institute of Biomedical Informatics, National Yang-Ming University,Taipei, Taiwan 4IBM Research Center for Healthcare Management and Johns HopkinSchool of Nursing, Baltimore, MD, USA
5Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig – Institute of Technology and Hannover Medical School, Braunschweig, Germany
Summary
Objective: To bridge the divide between health informatics ‘bench research’ and the application of informatics in clinical and health care settings. Method: Identifying weak points in translational activities, i.e. in the process from health informatics research outcomes to IT system design and information management in clinical practice.
Results and Conclusions: The creation of a new peer-reviewed journal, designed to cultivate broad reader-ship across health care, is suggested in order to com-municate on informatics topics of translational interest and on the application of informatics principals. Such an applied informatics journal may appeal to practicing physicians, healthcare administrators and CIOs as well as medical informaticians. In a globalizing world with eHealth initiatives spanning across borders, such a journal should be an international effort. Close ties to the International Medical Informatics Association (IMIA) and to the journal Methods of Information in Medicine are suggested.
Keywords
Translational research, health informatics, medical informatics, IMIA
Methods Inf Med 2008; 47; 1–3
The National Institute of Health (NIH) is in the process of re-engineering its funding policy focusing on translational research. Translational research describes the two-way communication between basic science researchers and clinicians. Basic science provides clinicians with new understanding and new tools for treatment and diagnosis that were developed ‘at the bench’. Clini-cians in return offer new insights gained at the bedside in order to birth new ideas for laboratory research.
Why, we may ask, is the NIH so deter-mined to encourage translational research? The NIH (driven by US tax payer and con-gressional pressures) wants to see a better return on their investment. To date, the NIH’s investments have generated many scientific discoveries and publications, but significantly less in new treatments and diagnostic tools. For example, between 2003 and 2006 the NIH spent over 1.5 bil-lion US dollars on gene therapy research [1]. Despite this enormous investment and over 25,000 citations in Pubmed for the MeSH term “Gene Therapy”, we still have yet to see gene therapy applied at the bedside, and at last look (based on the funding for gene therapy trials [1]), we are probably still very far away from practical application.
Unfortunately, our field of medical in-formatics also suffers from a lack of trans-lational research. Progress in the implemen-tation of novel concepts and ideas devel-oped by medical informatics researchers
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into bedside clinical information systems has been excruciatingly slow. Reviewing the proceedings from two international working conferences sponsored by the International Medical Informatics Association (IMIA), we discovered truly remarkable ideas, con-cepts, and visions. The first meeting, on health care information systems, stressed human factors, patient-centeredness, and integration of education and practice – in sum, “not so much the technological capability, but techno-social performance” needed to make health care more effective. The second meeting envisioned “intelli-gent” professional workstations that would anticipate information needs and put con-text-relevant information at the clinician’s fingertips.The recommendations from both meetings – one in 1979 and the other in 1993 – remain remarkably valid and regret-tably unrealized today.
Although one in four doctors in the U.S. use electronic health records (EHRs), less than one in ten uses “a ‘fully operational’ system that collects patient information, displays texts results, allows providers to enter medical orders and prescriptions, and helps doctors make treatment decisions” [2]. Lack of quality data makes it impossible to quantify hospital adoption of EHRs, but reliable estimates are that 5% of America’s 6000 hospitals have computerized physician order entry (CPOE) systems, a component of EHRs.
These findings are alarming. In Goethe’s words, so aptly cited by the Institute of Medicine in its series on quality health care, “Knowing is not enough; we must apply. Willing is not enough; we must do”.
One has to ask, why has the progress in bringing the great ‘bench’discoveries in in-formatics to the ‘bedside’ been so slow? Why has there been so little progress, de-spite NLM funding and the efforts of so many dedicated health informaticians? It is not for lack of trying. Researchers rigor-ously test their theories and report their findings in the informatics literature, in-cluding Computer Methods and Programs
in Biomedicine, International Journal of Medical Informatics, Journal of Biomedical Informatics, Journal of the American Medi-cal InformaticsAssociation, and Methods of Information in Medicine.
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However, implementation of health in-formation technologies is not a ‘Big Bang’ event. One brilliant idea does not generate a giant leap in IT implementation. Progress consists of countless individual applications and implementations, interfaces and clini-cal tools. Each of these steps is linked to a myriad of technical, organizational, edu-cational, social, and financial issues that must be solved by each organization over and over again even if solved by others be-fore.These challenges result in an estimated 75% failure rate in health information technology-related projects [3].
The lessons learned in the implemen-tation of health informatics must be shared across all of health care, nationally and in-ternationally, so that successes can be rep-licated and failures avoided. We cannot be allowed to repeat implementation errors that others had made and had to correct at great cost and pain. In order to leap ahead, we must avoid the old mistakes in our imple-mentations to save time, costs, and human resources. In a globalizing world with eHealth initiatives beyond nations [4, 5] sharing of experiences and learning from those must be done on an international stage.
How do we bridge the divide between ‘bench research’ and applying what we know in our hospitals and clinic? The cre-ation of a new peer-reviewed journal, de-signed to cultivate readership across health care, is a critical step. MD Computing, which ceased publication in 2001 amid a flurry of efforts to save it, provides a model. Glossy, slim, attention seizing and profes-sionally edited for easy readability, it of-fered peer-reviewed feature articles and standing columns on informatics topics of TRANSLATIONAL interest to a broad readership. In what would be its last issue, for example, MD Computing featured ar-ticles examining the role of federal inno-vations in healthcare transformation, com-puter telephony integration, and implemen-tation of an integrated ambulatory care sys-tem in a family practice, as well as a week-long medical informatics course at Woods Hole and highlights of eHealthcareWorld 2000. Columns covered standards, perspec-tives on data warehousing, practice manage-ment, insights on physician-patient
relation-ship, and more. As this brief content analy-sis makes clear, MD Computing appealed to practicing physicians and healthcare ad-ministrators and CIOs as well as medical informaticians.
There is no such international journal now, when health care sorely needs one. One option would be to create an international version of the Journal of Healthcare
Infor-mation Management, the peer-reviewed
journal published by the Health Information and Management Systems Society (HIMSS). Such a move could build on the growing global activities HIMSS is sponsoring, such as its AsiaPac and Vienna conferences.
A second option would be to launch such an effort now, placing it close to Methods of
Information in Medicine. This would allow
for the quick inception that is so urgently needed. To build on this advantage over time, there must be plans for dissemination beyond the audience reached by Methods or for that matter by any of the other inter-national informatics journals mentioned above. In 2005, their editors co-authored and co-published a statement on exemplary scientific conduct in the submission of manuscripts [6]. To achieve sustained mo-mentum, a close link to or endorsement by IMIA would be critical to support these translational efforts.
Today, in 2008, we need yet another un-precedented effort, this one to determine how best to design, edit, and publish an ap-plied international informatics journal that will become a must-read for healthcare executives and clinicians worldwide. They will need all the help the informatics com-munity can provide as they work to integrate HIT into their tasks as the managers and providers of care. It is our challenge to pro-vide that help, and the first step we can take is to enter into a dialogue with them through the pages of a peer-reviewed journal that translates our best work into their environ-ments.
We invite you to send us comments, sug-gestions, and thoughts on how to best achieve the strengthening of translational research in health informatics. As Marion Ball and others point out so poignantly in this issue, we have failed long enough to provide useful IT systems to our users – it is time for a new approach [7].
References
1. National Institutes of Health. Estimates of Fund-ing for Various Diseases, Conditions, Research Areas (monograph on the Internet). Bethesda: National Institutes of Health (NIH); 2007 (cited 2007 Nov 29). Available from: http://www.nih. gov/news/fundingresearchareas.htm.
2. Robert Wood Johnson Foundation. Electronic Health Records Still Not Routine Part of Medical Practice, Says New Study (monograph on the In-ternet). Washington: Robert Wood Johnson Foun-dation; 2006 (cited 2007 Nov 29).Available from: http://www.rwjf.org/pr/product.jsp?id=21882& gsa=1
3. Wears RL, Berg M. Computer technology and clinical work: still waiting for Godot. JAMA 2005; 293 (10): 1261-1263.
Correspondence to: Christoph U. Lehmann, MD
Director, Clinical Information Technology Johns Hopkins Hospital Children’s Center 600 N Wolfe Street, Nelson 2-133 Baltimore, MD 21287 USA
E-mail: clehmann@jhmi.edu 4. Healy JC. The WHO eHealth Resolution. eHealth
forAll by 2015? Methods Inf Med 2007; 46: 2-3. 5. Geissbuhler A, Haux R, Kwankam SY. Towards
Health for All: WHO and IMIA Intensify Collab-oration. Joint Communiqué during Medinfo 2007 in Brisbane. Methods Inf Med 2007; 47: 503-505. 6. Miller RA, Groth T, Hasman A, Safran C,
Short-liffe EH, Haux R, McCray AT. On exemplary scientific conduct regarding submission of manuscripts to biomedical informatics journals. Methods Inf Med 2006; 45: 1-3.
7. Ball MJ, Silva JS, Bierstock S, Douglas JV, Norcio AF, Chakraborty J, Srini J. Failure to Provide Clinicians Useful IT Systems: Opportunities to Leapfrog Current Technologies. Methods Inf Medicine 2008; 47: 4-7.
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