Informatics is about algorithms, systems, people, and social networks
- Lucila Ohno-Machado, Editor-in-Chief
This issue of JAMIA contains articles that explore several aspects of informatics. Related to public health and algorithms, El Emam (see page 212) proposes a simple protocol to protect the privacy of providers that disclose data for public health purposes. While we often think of technology that emphasizes patient privacy, an important motivation for institutions to share data relates to the ability to maintain the privacy of their providers. The authors describe the protocol in a way that is accessible to everyone, and a related online appendix describes the technical details. Also related to public health and disease surveillance, Que (see page 218) describes a new algorithm for rapid outbreak detection that first ranks regions according to risk, then uses these ranks to define clusters, in contrast with other techniques that search for predetermined cluster shapes around a high risk area. By publishing highly technical articles written in a manner that can be understood by all, we restate JAMIA's intention to bring important findings to our diverse readership.
Since Clinical Decision Support Systems (CDSS) are becoming increasingly available, it is important to develop a systematic approach for their categorization. Wright (see page 232) provides a taxonomy for these systems. Three CDSSs are reported in this issue: Horwitz (see page 243) studies the effects of management protocols for asthma, Campion (see page 251) studies the impact of insulin therapy protocols for diabetes, and Curry (see page 267) describes the advantages of using CDSS in diagnostic imaging. Naun (see page 225) reports on the pros and cons of using poison control data for decision support related to pharmaceutical surveillance. This issue also features two reviews: Georgiou (see page 335) reports on a systematic review of computerized provider order entry (CPOE) systems for clinical imaging. Jaspers (see page 327) utilizes a “meta” systematic review approach to review the literature on the effects of CDSS on provider performance and patient outcomes.
Clinical research informatics is an area of increasing activity in our field, and readers should expect to see an increasing number of articles addressing the main challenges and solutions in upcoming issues of JAMIA. In this issue, Segagni (see page 314) describes a statistical tool for research based on R that can be plugged into existing systems. Richesson (see page 341) discusses challenges related to use or appropriate standards in data collection forms.
We must not forget, however, that informatics is as much concerned about algorithms and systems, as it is concerned about people, their information needs, and their social networks. Understanding barriers for EHR and CDSS adoption is important to devise strategies for their increased utilization. Rao (see page 271) provides evidence of specific barriers for EHR adoption in small physician practices, and Schnipper (see page 309) describes the difficulties in adopting a medication reconciliation tool. Chan (see page 276) demonstrates the importance of user-centered design for CPOE systems to be effective, and Munasinghe (see page 322) confirms this finding by showing increased CPOE usage after order sets were organized in a nested fashion that was modeled after physicians' practice patterns. Sub-optimal processes can also lead to errors in patient identification and increased nosocomial infections, and Dunn (see page 259) describes an analytical model for studying risks associated with in-patient transfers that suggests where improvements can be made.
Related to networks of people, the web has created new paradigms for biomedical information search and communication. Zheng shows that social networking techniques can be used to improve the quality and efficiency of information retrieval from EHRs (see page 282). Nambisan and Weitzman approach the problem from the patient perspective. They report on information seeking patterns (see page 298) and safety of patient support websites (see page 292), respectively. On a related topic, Sarkar (see page 318) describes concerning disparities in patient usage of a diabetes online resource, indicating that the gap cannot be solely justified on the basis of differences in access to technology. More research in this area is clearly needed for informatics to achieve its fullest societal impact. Also related to this topic, Schnall (see page 305) describes the information needs, not of physicians or patients, but other agents who are critically important in healthcare—case managers.
This issue of JAMIA thus provides a sample of the diversity of approaches and disciplines that make our field so fascinating. I hope our readers will enjoy reading these articles as much as I did.