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Breadth and Depth of Health Informatics: Notes from the American Medical Informatics Association

by on November 30, 2015

Guest post by Sam Wambugu, Senior Health Informatics Specialist with MEASURE Evaluation

Last week was a great one for health informatics practitioners and enthusiasts in America and around the world with the convening of the annual American Medical Informatics Association’s (AMIA) annual conference in San Francisco. This was my first time to be in a conference with more than 2,000 experts talking clinical and public health practice, information technology, and health information management, or, in short, the practice of health informatics. This looked in many ways like the home of informaticians. Clinicians, scientists, vendors, innovation and information scientists, change agents, and people who cross all these areas converged. This is traditionally a US domestic conference, but it offers many lessons and case studies for the global informatics arena.

Information came in the form of posters, flyers, books, journals, and websites. Interactive sessions, including technical working groups and didactic sessions, however, occupied most of the five-day conference. The topic of Electronic Medical Records (EMR) received quite some attention—about 25 percent of the conference. The discussions resonated well with our experiences with MEASURE Evaluation, mainly in Africa. Of particular interest is the utility of decision support systems (DSS) in helping health care workers to make the right decisions. It is expected that DSS should present the right information, in the right format, at the right time, without requiring special effort.

I went to the conference as part of my work for MEASURE Evaluation, which is USAID’s primary mechanism for strengthening health information systems and is contributing thought leadership and support for the implementation of health informatics. We focus on overcoming challenges to developing strong national health information systems and help to create the enabling environment so such systems can develop. I signed up for the nascent Global Health Informatics working group to ensure that Measure Evaluation is now an active participant in the forum.

One of the main issues discussed at the conference is how to handle the growing volume of data (so-called “big data”), especially data from patients suffering from chronic illnesses such as people on anti-retroviral therapy. It’s becoming challenging to collect, distill, and analyze so much information for facilitating clinical tasks. MEASURE Evaluation is helping countries to establish program-specific systems, such as for malaria, especially where a full HI system is not yet possible but where the need for quality data is critical.

System-generated alerts from the system, alone, are not enough. They must provide the clinician with options on what to do next. But DSS, as we learnt from a number of case studies presented at the conference, have their own bottlenecks. When designed without input from health care workers, these systems can be counterproductive. Clinicians often regard the triggers and alerts as unnecessary interruptions and many ignore them.

Keynote speakers cautioned we need to be concerned about data security, as security risks grow with the expansion of technology.  And, interoperability is becoming a buzzword and was a popular theme at AIMA. Although the United States does not have universal and effective interoperability of its health information systems, there are important lessons here that the global public health informatics field can borrow. Of particular interest should be the Electronic Health Records (EHR) report, popularly known as The EHR 2020 Task Force report, includes recommendations on how to address EHR issues in the US by 2020.

Global Health informatics sessions presented lessons on using technology in public health emergencies, drawing from experiences associated with recent Ebola work in West Africa. This session also reviewed ongoing efforts to integrate health information systems through interoperability and the need for open source systems. Speakers also underscored the need for increasing the informatics workforce and strengthening the academic network to support current and future eHealth implementation.

I gathered some interesting materials, including bibliographies of published articles that resonate with our work. These include articles and abstracts on the meaningful use of electronic medical records, interoperability of health systems, health information exchange, use of social media, “big data,” standard-based rules for DSS, evaluation of effectiveness of EMRs, open source data management systems and most interesting, the so-called “pilotitis” or the “science” of always piloting and never moving to scale. Informatics is an emerging discipline and is changing and evolving quickly. How well it develops into a sharable, scalable platform will depend, in part, on rules being set down now. MEASURE Evaluation is helping to set standards and guidance for HI applications and to develop policy and practice on privacy protections.

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