AMIA Board: specification of core competencies in Biomedical Informatics

In 1998 I launched a website called "<b>Medical Informatics and Leadership of Clinical Computing</b>" (now entitled "<b>Contemporary Issues in Medical Informatics- Common Examples of Healthcare Information Technology Difficulties</b>" at <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" target="_blank">this link</a>).<br /><br />Its theme was that leadership of IT in healthcare was severely lacking in the formal competencies needed to reach any measure of success, and in fact the lack of informatics competencies in the usual IT actors was causing wasted resources and patient harm.<br /><br />I had also commented that the term "Medical Informatics" itself was being misappropriated by anyone claiming to do anything with computers in medicine, even the creation of trivial and/or low-value programs.<br /><br />Sadly, little has changed in that regard since 1998; in fact things are much worse.  The meaning of the term "Medical Informatics" itself has become severely blurred, and job listings that use the term are largely misguided.  They often seek a nurse (most common) or doctor (less common) without formal education in the domain, who's dabbled with hospital IT systems, to lead clinical IT projects.  This is a totally inappropriate and even dangerous approach (example <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=leadership" target="_blank">here</a>).<br /><br />The American Medical Informatics Association has released a paper "<b>AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline</b>" that is long, long overdue.  As of this writing, full text is available a this link:  <a href="http://jamia.bmj.com/content/early/2012/06/07/amiajnl-2012-001053.full">http://jamia.bmj.com/content/early/2012/06/07/amiajnl-2012-001053.full</a>.<br /><br />This paper certainly provides a robust affirmation of ONC's recommendations on healthcare IT leadership roles that I wrote of in my Oct. 2009 post "<a href="http://hcrenewal.blogspot.com/2009/12/onc-defines-taxonomy-of-health-it.html" target="_blank">ONC Defines a Taxonomy of Robust Healthcare IT Leadership</a>."<br /><br />Some highlights of the new AMIA paper:<br /><br /><blockquote class="tr_bq"><b>Abstract</b><br /><br /><div id="p-2">The AMIA <b>biomedical informatics (BMI)</b> core competencies have been designed to support and guide graduate education in BMI, <b>the core scientific discipline underlying the breadth of the field's research, practice, and education.</b> The core definition of BMI adopted by AMIA specifies that BMI is ‘the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health.’ Application areas range from bioinformatics to clinical and public health informatics and span the spectrum from the molecular to population levels of health and biomedicine. <b>The shared core informatics competencies of BMI draw on the practical experience of many specific informatics sub-disciplines. </b>The AMIA BMI analysis highlights the central shared set of competencies that should guide curriculum design and that graduate students should be expected to master. </div></blockquote><br />Note that Biomedical Informatics, which the Board feels is a broader term encompassing all of the information-science disciplines in healthcare and biomedical research, is defined as "a core scientific discipline underlying the breadth of the field's research, practice, and education."  <b>One does not acquire expertise in a scientific discipline without first rigorously studying that discipline, e.g., as is done in medical school</b> to gain optimal understanding of clinical medicine.<br /><br /><blockquote class="tr_bq">... The present articulation of BMI core competencies is intended to support AMIA and its members in promoting the discipline as a career choice, and to provide guidance to students and curriculum developers when choosing, designing (and implementing), or re-designing graduate-level academic BMI programs.</blockquote><br />(Who needs graduate education in Biomedical Informatics when all that seems to be needed is a little on-the-job dabbling?)<br /><br /><blockquote class="tr_bq">... Defining BMI as the scientific core of a discipline that has broad applications across health and biomedicine <b>highlights its foundational role and refutes the kind of reductionism that superficially explains BMI simply as the application of information technology (IT) to biomedical and health problems.</b></blockquote><br />I termed that phenomenon "Medical Instamatics" on that late 1990's site.  Unfortunately, the "reductionism" is all too prevalent today.  People whose BMI education and skill levels (which I define as the ability to apply deep knowledge and experience to successfully manage the unexpected, not just manage traditional activities via a book of "process"), are often at the amateur level -- in the same sense that I am a <a href="http://www.arrl.org/" target="_blank">radio amateur</a>, not a telecommunications/engineering professional -- or worse.  This wreaks havoc (as <a href="http://hcrenewal.blogspot.com/2011/02/updated-reading-list-on-health-it.html" target="_blank">here</a>) in health IT, especially when led by senior management also incognizant of the issues. <br /><br /><blockquote class="tr_bq"><div id="p-11"><b>Definition</b>: Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, driven by efforts to improve human health. </div></blockquote><blockquote><blockquote class="tr_bq"><div id="p-12"><b>Scope and breadth of discipline:</b> BMI investigates and supports <b>reasoning, modeling, simulation, experimentation, and translation </b>across the spectrum from molecules to individuals and to populations, from biological to social systems, bridging basic and clinical research and practice and the healthcare enterprise. </div></blockquote></blockquote><blockquote><blockquote><div id="p-13"><b>Theory and methodology:</b> BMI <b>develops, studies, and applies theories</b>, methods, and processes for the generation, storage, retrieval, use, management, and sharing of biomedical data, information, and knowledge. </div></blockquote></blockquote><blockquote><blockquote><div id="p-14"><b>Technological approach:</b> BMI <b>builds on and contributes to computer, telecommunication, and information sciences and technologies</b>, emphasizing their application in biomedicine. </div></blockquote></blockquote><blockquote><blockquote><div id="p-15"><b>Human and social context:</b> BMI, recognizing that people are the ultimate users of biomedical information, <b>draws upon the social and behavioral sciences</b> to inform the design and evaluation of technical solutions, policies, and the evolution of economic, ethical, social, educational, and organizational systems. </div></blockquote></blockquote><br />There is also a call for experts to:<br /><br /><ul class="list-unord" id="list-3"><li id="list-item-6"> <div id="p-24"><b><i>Acquire professional perspective:</i></b> <i>Understand and analyze the history and values of the discipline and its relationship to other fields while demonstrating an ability to read, interpret, and critique the core literature.</i></div></li></ul><br />In effect, health IT amateurs, including those in traditional business computing, have little to no formal education or experience in reasoning, modeling, simulation, experimentation, and translation; developing, studying, and applying theories; building on and contributing to computer, telecommunication, and information sciences and technologies; and drawing upon the social and behavioral sciences to inform design of these complex systems.<br /><b><br /></b><br /><blockquote class="tr_bq">BMI is the core scientific discipline that supports applied research and practice in several biomedical disciplines, including <i>health informatics</i>, which is composed of <i>clinical informatics</i> (including subfields such as medical, nursing, and dental informatics) and <i>public health informatics</i> (sometimes referred to more broadly as <i>population informatics</i> to capture its inclusion of <i>global health informatics</i>). There are related notions, such as <i>consumer health informatics</i>, which involves elements of both clinical and public health informatics. BMI in turn draws on the practical experience of the applied subspecialties, and works in the context of clinical and public health systems and organizations to develop experiments, interventions, and approaches that will have scalable impact in solving health informatics problems. However, it is the <i>depth of informatics methods, shared across the spectrum from the molecular to the population levels</i><a class="xref-bibr" href="http://jamia.bmj.com/content/early/2012/06/07/amiajnl-2012-001053.full#ref-3" id="xref-ref-3-2"></a> that defines the core discipline of BMI and provides its coherence and its professional foundation for defining a common set of core competencies.</blockquote><br />Here is the diagrammatic represention of the above in the full article:<br /><br /><br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX0WhgzQnpXO8Sql66EOfWJVSqULu2qvMhhkceeEnMfmVzwyYi4C_q3RTsX3ET_IucsBpfwlghcZdLrPFR8fAGmIzTHdsIut9g_tdM8_0ngC16xdZAyUqsYWzdqPb-qx2WJ0FRSGXGOIC8/s1600/F1.large.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX0WhgzQnpXO8Sql66EOfWJVSqULu2qvMhhkceeEnMfmVzwyYi4C_q3RTsX3ET_IucsBpfwlghcZdLrPFR8fAGmIzTHdsIut9g_tdM8_0ngC16xdZAyUqsYWzdqPb-qx2WJ0FRSGXGOIC8/s320/F1.large.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Biomedical informatics and its areas of application and practice, spanning the range from molecules to populations and society</td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"></td></tr></tbody></table><br />Finally, excerpts from the meat of the article on <b><i>Prerequisite knowledge and skills.  </i></b>This depth and breadth of knowledge does not come from studying business computing, dabbling with systems by nurses or physicians lacking formal domain education at the graduate level or beyond, or by guessing by the seat of one's pants:<br /><ul class="list-unord" id="list-2"><li id="list-item-14"><ul class="list-unord" id="list-4"><li id="list-item-16"> <div id="p-34"><b><i>Fundamental knowledge:</i></b> <i>Understand the fundamentals of the field in the context of the effective use of biomedical data, information, and knowledge. For example:</i></div><ul class="list-unord" id="list-5"><li id="list-item-19"> <div id="p-37"><i>... Healthcare: screening, diagnosis (diagnoses, test results), prognosis, treatment (medications, procedures), prevention, billing, healthcare teams, quality assurance, safety, error reduction, comparative effectiveness, medical records, personalized medicine, health economics, information security and privacy.</i></div></li></ul></li><li id="list-item-22"> <div id="p-40"><b><i>Procedural knowledge and skills:</i></b> <i>For substantive problems related to scientific inquiry, problem solving, and decision making, apply, analyze, evaluate, and create solutions based on biomedical informatics approaches.</i></div><ul class="list-unord" id="list-6"><li id="list-item-23"> <div id="p-41"><i>Understand and analyze complex biomedical informatics problems in terms of data, information, and knowledge.</i></div></li><li id="list-item-24"> <div id="p-42"><i>Apply, analyze, evaluate, and create biomedical informatics methods that solve substantive problems within and across biomedical domains.</i></div></li><li id="list-item-25"> <div id="p-43"><i>Relate such knowledge and methods to other problems within and across levels of the biomedical spectrum.</i></div></li></ul></li></ul></li><li id="list-item-26"> <div id="p-44"><b>Theory and methodology</b>: BMI develops, studies, and applies theories, methods, and processes for the generation, storage, retrieval, use, management, and sharing of biomedical data, information, and knowledge. All involve the ability to reason and relate to biomedical information, concepts, and models spanning molecules to individuals to populations: </div><ul class="list-unord" id="list-7"><li id="list-item-27"> <div id="p-45"><b><i>Theories:</i></b> <i>Understand and apply syntactic, semantic, cognitive, social, and pragmatic theories as they are used in biomedical informatics</i>. </div></li><li id="list-item-28"> <div id="p-46"><b><i>Typology:</i></b> <i>Understand, and analyze the types and nature of biomedical data, information, and knowledge.</i></div></li><li id="list-item-29"> <div id="p-47"><b><i>Frameworks:</i></b> <i>Understand, and apply the common conceptual frameworks that are used in biomedical informatics.</i></div><ul class="list-unord" id="list-8"><li id="list-item-30"> <div id="p-48"><i>A framework is a modeling approach (eg, belief networks), programming approach (eg, object-oriented programming), representational scheme (eg, problem space models), or an architectural design (eg, web services).</i></div></li></ul></li><li id="list-item-31"> <div id="p-49"><b><i>Knowledge representation:</i></b> <i>Understand and apply representations and models that are applicable to biomedical data, information, and knowledge.</i></div><ul class="list-unord" id="list-9"><li id="list-item-32"> <div id="p-50"><i>A knowledge representation is a method of encoding concepts and relationships in a domain using definitions that are computable (eg, first order logics).</i></div></li></ul></li><li id="list-item-33"> <div id="p-51"><b><i>Methods and processes:</i></b> <i>Understand and apply existing methods (eg, simulated annealing) and processes (eg, goal-oriented reasoning) used in different contexts of biomedical informatics.</i></div></li></ul></li><li id="list-item-34"> <div id="p-52"><b>Technological approach</b>: BMI builds on and contributes to computer, telecommunication, and information sciences and technologies, emphasizing their application in biomedicine. </div><ul class="list-unord" id="list-10"><li id="list-item-35"> <div id="p-53"><b><i>Prerequisite knowledge and skills:</i></b> <i>Assumes familiarity with data structures, algorithms, programming, mathematics, statistics.</i></div></li><li id="list-item-36"> <div id="p-54"><b><i>Fundamental knowledge:</i></b> <i>Understand and apply technological approaches in the context of biomedical problems. For example:</i></div><ul class="list-unord" id="list-11"><li id="list-item-37"> <div id="p-55"><i>Imaging and signal analysis.</i></div></li><li id="list-item-38"> <div id="p-56"><i>Information documentation, storage, and retrieval.</i></div></li><li id="list-item-39"> <div id="p-57"><i>Machine learning, including data mining.</i></div></li><li id="list-item-40"> <div id="p-58"><i>Networking, security, databases.</i></div></li><li id="list-item-41"> <div id="p-59"><i>Natural language processing, semantic technologies.</i></div></li><li id="list-item-42"> <div id="p-60"><i>Representation of logical and probabilistic knowledge and reasoning.</i></div></li><li id="list-item-43"> <div id="p-61"><i>Simulation and modeling.</i></div></li><li id="list-item-44"> <div id="p-62"><i>Software engineering.</i></div></li></ul></li><li id="list-item-45"> <div id="p-63"><b><i>Procedural knowledge and skills:</i></b> <i>For substantive problems, understand and apply methods of inquiry and criteria for selecting and utilizing algorithms, techniques, and methods.</i></div></li></ul></li><li id="list-item-49"> <div id="p-67"><b>Human and social context</b>: BMI, recognizing that people are the ultimate users of biomedical information, draws upon the social and behavioral sciences to inform the design and evaluation of technical solutions, policies, and the evolution of economic, ethical, social, educational, and organizational systems. </div><ul class="list-unord" id="list-13"><li id="list-item-50"> <div id="p-68"><b><i>Prerequisite knowledge and skills:</i></b> <i>Familiarity with fundamentals of social, organizational, cognitive, and decision sciences.</i></div></li><li id="list-item-51"> <div id="p-69"><b><i>Fundamental knowledge:</i></b> <i>Understand and apply knowledge in the following areas:</i></div><ul class="list-unord" id="list-14"><li id="list-item-52"> <div id="p-70"><i>Design: for example, human-centered design, usability, human factors, cognitive and ergonomic sciences and engineering.</i></div></li><li id="list-item-53"> <div id="p-71"><i>Evaluation:</i> <i>for example, study design, controlled trials, observational studies, hypothesis testing, ethnographic methods, field observational methods, qualitative methods, mixed methods.</i></div></li><li id="list-item-54"> <div id="p-72"><i>Social, behavioral, communication, and organizational sciences: for example, computer supported cooperative work, social networks, change management, human factors engineering, cognitive task analysis, project management.</i></div></li><li id="list-item-55"> <div id="p-73"><i>Ethical, legal, social issues: for example, human subjects, HIPAA, informed consent, secondary use of data, confidentiality, privacy.</i></div></li><li id="list-item-56"> <div id="p-74"><i>Economic, social and organizational context of biomedical research, pharmaceutical and biotechnology industries, medical instrumentation, healthcare, and public health.</i></div><div id="p-74"><br /></div><div id="p-74"><br /></div></li></ul></li></ul></li></ul>While nobody is an expert in all of these areas, skills in many of them are essential for successful and <b>safety-promoting </b>leadership in the health IT domain.<br /><br />I repeat, this depth and breadth of knowledge does not come from studying business computing, dabbling with health IT, or by guessing by the seat of one's pants.  It comes about from rigorous education and experience in the appropriate domains at the graduate and (especially) post-doctoral levels.<br /><br />Amateurs mistakenly put in leadership positions, and their organizations, are going to increasingly find themselves in legal hot water over mistakes in design and implementation that result in patient harm, security breaches, overbilling and other issues.<br /><br />That is probably what it will take to have hospitals manage health IT talent more appropriately.<br /><br />Finally, I plead guilty to tooting my own profession's horn.<br /><br />Somebody needs to when the stakes are so high for patients.<br /><br />-- SS

AMIA Board: specification of core competencies in Biomedical Informatics

In 1998 I launched a website called " Medical Informatics and Leadership of Clinical Computing " (now entitled " Contemporary...

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On AMIA's Jan. 2009 Letter to The Office of President Elect Barack Obama: Something is Missing

<div style="text-align: center;">------------------------------------------<br /><span style="font-size:85%;"><span style="font-weight: bold;">Nov. 11, 2010 note:</span> see the new post </span><span style="font-size:85%;">on an AMIA Board Position Paper released this day (Nov. 11) </span><span style="font-size:85%;">entitled "<span style="font-style: italic;">Report of an AMIA special task force on challenges in ethics, safety, best practices, and oversight regarding HIT</span>" at <a href="http://hcrenewal.blogspot.com/2010/11/report-of-amia-special-task-force-on.html">this link</a>.</span><br />------------------------------------------<br /></div><br />I was somewhat taken aback by the appearance of the article by Karsh et al. entitled "<span style="font-weight: bold;">Health information technology: fallacies and sober realities</span>" (covered at Healthcare Renewal <a href="http://hcrenewal.blogspot.com/2010/10/jamia-health-information-technology.html">here</a>) in the Oct. 2010 <span style="font-style: italic;">Journal of the American Medical Informatics Association</span> (<a href="http://jamia.bmj.com/">JAMIA</a>).<br /><br />I was taken aback since the article rains heavily on the academic memes of healthcare IT as a benign and deterministic solution to healthcare's ills, and of health IT-related adverse outcomes being mere "anecdotes."<br /><br />(It is ironic that my own relative recently fell victim to healthcare IT's supposed beneficence. They were harmed via health IT-related disruptions in care continuity.)<br /><br />My blog posting on that Karsh article brought a letter to my attention, authored by AMIA's leadership and sent on Jan. 7, 2009 to the Office of President Elect Barack Obama. The full PDF of the letter is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/ObamaLetter_January2009.pdf">here</a>.<br /><br />Here are relevant excerpts about which I will make only a single comment:<br /><br /><blockquote>January 7, 2009<br /><br />Dear Mr. President-Elect,<br /><br />On behalf of the more than 4,000 physicians, nurses and other members of the American Medical Informatics Association (AMIA) who use health information and communications technology (HIT) to improve the quality, efficiency and safety of healthcare, I am writing to applaud and encourage your commitment to investing in a genuine transformation of our nation’s healthcare system. Properly deployed and supported, HIT can be part of broad health care reform and, importantly in this time of economic challenge, a significant economic multiplier that will encourage the creation of new jobs and real improvements in patient care, public health and life sciences research.<br /><br />... If we are to develop a national infrastructure for the use of health information to benefit individuals and our entire population, the United States must –<br /><br /><ul><li>Develop mechanisms, including grants, loans and financial incentives for physicians, nurses, and healthcare organizations to deploy, implement successfully, and widely disseminate electronic health records (EHRs);</li><li>Develop and support local, regional and national health information exchange to ensure that accurate, secure health information is available whenever and wherever needed by those authorized to access such information;</li><li>Develop and support programs to address the need for a prepared health information technology workforce, with training and continuing education of physicians, nurses, health information managers and others;</li><li>Develop more effective ways to address the health needs of underserved populations, including providing equitable access to health information and communications technology;</li><li>Develop and assure compliance with standards, policies and practices that support effective sharing of health information, while fostering security, confidentiality and transparency, and building trust with the public;</li><li>Develop and maintain health terminologies and classifications that will allow health data to be not only useful, but uniform and consistent, and enable interoperability across myriad information systems;</li><li>Develop proper means to link information related to individuals in order to ensure the validity and integrity of health data used to inform care and research;</li><li>Develop proper means for authentication of the identity of individuals and caregivers and any others authorized to access identifiable health information;</li><li>Support the development of decision-making and other knowledge-management tools in order to permit the delivery of individualized, evidence-based care;</li><li>Develop and support secure web-portals to link individuals to their caregivers and ensure genuinely patient-centered care;</li><li>Develop appropriate and secure linkages between EHRs and the public health system to ensure safety from bioterrorism, rapidly spreading infectious diseases, and other threats;</li><li>And provide appropriate funding for the development of a robust national health information strategy, with support for continued HIT and informatics research and innovation.</li></ul>During the Presidential campaign, you demonstrated your boldness and vision by pledging to allocate $10 billion annually for five years to promote the adoption and use of health IT. Such an investment will pay dividends not only in improving health care, but in creating jobs...</blockquote><br />These are all laudable and interesting goals for an experimental technology, as tacitly admitted in the above goals (although it would have been more ethical, I believe, to have waited for the technology to have "needed" fewer of these goals as a result of research in constrained settings<span style="font-style: italic;"><span style="font-weight: bold;"> </span></span><span style="font-weight: bold; font-style: italic;">before</span> boldly promoting expensive national rollouts on live patients).<br /><br />In any case, however, something very, very important is missing...<br /><span style="font-weight: bold;"><br /></span><span>There is no mention of </span><span style="font-weight: bold;">healthcare IT safety.</span><br /><br />At $10 billion annually, surely the AMIA leadership could have specifically and explicitly recommended that some fraction, even a token % (<span style="font-weight: bold;">even a small percentage of $10,000,000,000</span> <span style="font-weight: bold;"> is not chicken feed</span>), should have been dedicated to help ensure the disruptions and unintended consequences caused by any new/developing/expanding information and communications technology (ICT) didn't kill or maim patients.<br /><br />Perhaps through the publication of the aforementioned Karsh study on HIT fallacies and sober realities, the AMIA leadership is subconsciously seeking absolution.<br /><br />-- SS<br /><br />Addendum: my own Dec. 7, 2008 "<a href="http://hcrenewal.blogspot.com/2008/12/open-letter-to-president-barack-obama.html">Open letter to President Obama</a>" on healthcare IT took a decidedly different approach, namely, I attempted to make the President-elect aware of numerous HIT "fallacies and sober realities":<br /><br /><blockquote>... our government has been <span style="font-style: italic;">seduced</span> by the promise, the potential, the Siren Song if you will of HIT, and shielded from information on its true challenges, difficulties, downsides and failures. An "irrational exuberance", a <span style="font-style: italic;">Syndrome of Inappropriate and Uninformed Overconfidence in Computers</span> prevails in healthcare.<br /><br />... [If HIT itself is not reformed,] billions of precious healthcare dollars that might be spent on “IT misadventure” in a time of unprecedented national financial challenges and hardships might simply be better spent on delivery of needed medical services, health insurance and other "safety net" interventions.<br /><br />... <span style="font-weight: bold;">healthcare’s defects cannot be effectively changed or reformed via healthcare IT, if that healthcare IT itself is defective.</span></blockquote><br />AMIA leadership and I also differed on the issue of health IT regulation, as I posted in July 2009 at "<a href="http://hcrenewal.blogspot.com/2009/07/health-care-information-technology.html">JAMA letter: Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards</a>." On that issue, JAMA published my commentary, not theirs.<br /><br />-- SS

On AMIA's Jan. 2009 Letter to The Office of President Elect Barack Obama: Something is Missing

------------------------------------------ Nov. 11, 2010 note: see the new post on an AMIA Board Position Paper released this day (Nov. 11)...

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