Unmet  Challenges  in Clinical  in Clinical Research  Informatics

Facilitated Discussion of Hands‐On Practitioners f
Bob DiLaura Cleveland Clinical and Translational  Science Collaborative
AMIA Now! Spring Conference May 25‐27, 2010 Phoenix, AZ

Will We Ever Keep Up?

Leot Leydesdorff showed that knowledge  increased from 1933 to 2001 by a factor of  approximately 27 million times. A little  pp y mathematical analysis shows that this  represents a doubling of knowledge itself  about every 2.75 years.
Source: http://www.xenodochy.org/gs/hmod.html Source: Hunter L, Cohen KB. Biomedical Language  Processing: What's Beyond PubMed? Molecular Cell,21(5);  3 March 2006, 589‐594.

Who Learns from Publications?
Over 10 years of experience in several  European countries showed that there were  European countries showed that there were superior ways to teach biomedical  informatics, genomics and bioinformatics to  informatics genomics and bioinformatics to health care professionals. Specific  recommendations were given to help others  recommendations were given to help others and shorten the learning curve for such work.

Source: Training health professionals in bioinformatics. Experiences and lessons learned. Lopez‐Campos G, Lopez‐ g p p p p , p Alonso V, Martin‐Sanchez F. Methods of Information in Medicine. 2010;49(3):299‐304.

Two‐Year Ideas for the CTSAs
• Strategic 2‐yr IT plan (draft 3/30/2009) • CTSA wide survey & recommendations CTSA‐wide survey & recommendations • Basic suggestions ‐
– Si lif Simplify – Be transparent – Enable user control Enable user control – Adapt and evolve

Source: Draft Two Year Strategic Information Technology Plan. Dr. Dixie Baker, CTO, Health Solutions, SAIC, March 2009.

Format for This Discussion

“Informatics” Field – Far and Wide
• • • • • • • • • • • Biomedical Informatics Biostatistics Medical Informatics Mathematics Clinical Informatics Computer Clinical Science Health Informatics Research Medicine Nursing Informatics Nursing Informatics Physics Imaging Informatics Technology Health Informatics Pathology gy Laboratories Public Informatics Biochemistry Radiology Systems Neuroinformatics Molecular Biology Library Biology Cardiac Informatics di f i Science Translational  Bioinformatics

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Terms & Definitions ‐ BMI

Source: http://ncicb.nci.nih.gov/NCICB/

Terms & Definitions ‐ CRI
Clinical Research Informatics (CRI) is the subdomain of Clinical Research Informatics (CRI) is the subdomain of biomedical informatics concerned with the development, application, and evaluation of theories, methods, and  systems to optimize the design and conduct of clinical  research and the analysis, interpretation, and  dissemination of the information generated. f f g

Source: Clinical Research Informatics: Challenges, Opportunities and Definition for an Emerging Domain, by Embi P and  Payne P. J Am Med Inform Assoc. 2009;16:316 –327. DOI 10.1197/jamia.M3005.

Informatics Spectrum

Source: Clinical Research Informatics: Challenges, Opportunities and Definition for an Emerging Domain, by Embi P and  Payne P. J Am Med Inform Assoc. 2009;16:316 –327. DOI 10.1197/jamia.M3005.

How We Doin’ So Far?

Biomedical Informatics Competencies
• Acquire professional perspective: Summarize and explain the history and values of the 
discipline and its relationship to related fields while demonstrating an ability to read, interpret,  and critique the core literature • Analyze problems: Analyze understand abstract and model a specific biomedical Analyze problems: Analyze, understand, abstract, and model a specific biomedical  problem in terms of data, information and knowledge components • Produce solutions: Use the problem analysis to identify and understand the space of  possible solutions and generate designs that capture essential aspects of solutions and their  components t • Articulate the rationale: Defend the specific solution and its advantage over competing  options • Implement, evaluate, and refine: Demonstrate an ability to carry out the solution, to  p , , y y assess its validity, and iteratively improve its design • Innovate: Create new theories, typologies, frameworks, representations, methods, and  processes to address biomedical and informatics problems • Work collaboratively: Demonstrate the ability to team effectively with partners from Work collaboratively: Demonstrate the ability to team effectively with partners from  diverse disciplines • Disseminate and discuss: Communicate effectively to audiences in multiple disciplines in  persuasive written and oral form
Source: AMIA Academic Forum sub‐committee on BMI Competencies, 2010.

BMI Competencies DRAFT
To view the document: To view the document:
https://www.amia.org/files/shared/e_Competencies_‐ _Definition_and_Competencies.pdf

To comment on the document:
http://www.surveymonkey.com/s/2JHGQWF

AMIA Now! CRI 2010 Survey

Our Survey ‐ Response “Cloud”

Source: http://www.tagcrowd.com/

Survey ‐ Another “Cloud” View

Source: http://www.wordle.net/

Survey ‐ Final View

Source: http://www.wordle.net/

Survey – Top Future Challenges
1. Funding, staff and infrastructure resources for CRI 2. EMR‐research integration of workflow & data 3. Standardization of data, protocols, processes & HIE

How We Doin’ So Far?

CTSA Pgm Goals & Key Functions

Source: http://www.ctsaweb.org/index.cfm?fuseaction=quicklink.showSGC

The 800 lb Gorilla (patient HIT) (p )

Source: http://www.healthypeople.gov

Patient HIT from ONC

Source: http://healthit.hhs.gov

Themes for the Future of BMI
1. Build out the enterprise research infrastructure 2. Research process design, portals & workflow mgt p g p g 3. Data storage, access and security 4. System integration & research info/data exchange 5. EHR‐CR connections (technical, policy, legal) 6. Knowledge management 7. Ongoing training and education just to keep up 7 O i t i i d d ti j t t k 8. More/better/faster communication, collaborations 9. Relationship mgt  old, current and new 9 Relationship mgt – old current and new 10. Informatics leadership

How We Doin’ So Far?

Informatics Career Paths
• Academic • Scientist • Technologist g

Metrics & Evaluation
• • • • • How do we know what we are doing? How do we define value or goals? What does our data say? y How do we target or quantify improvement? Value of co‐opetition and comparisons Value of co opetition* and comparisons
If ignorance is bliss, why aren't more people happy? Thomas Jefferson

Source: Brandenburger A, Nalebuff B. 1996. Co-Opetition: A revolution mindset that combines competition and cooperation.

BMI Metrics Process and Plan
• • • • • • • Strategic goals Areas of importance p Key performance indicators Metrics plan Goals & evaluations Reporting and improvements Ongoing metrics adjustments

Are investigators  satisfied with  f h informatics support  they receive?

Source: Draft Two Year Strategic Information Technology Plan.  Dr. Dixie Baker, CTO, Health Solutions, SAIC, March 2009. , , , ,

How We Doin’ So Far?

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 15 16. 17. 18. 19. 20. 21. 22. 23. 24. 24 25. 26. 27. 28. 29. 30. 31. 32. 33. 33 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57.

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Accessibility and Web-enabled technologies Analytics applied to direct and remote clinical care Assistive and adaptive ubiquitous computing technologies Bio-surveillance Brain computer interface Cleaning, preprocessing, and ensuring quality and integrity of medical records Comparative effectiveness research Computational support for patient-centered and evidence-based care Consumer and clinician health information needs, seeking, sharing and use Consumer health and wellness informatics applications Continuous monitoring and streaming technologies Data management, privacy, security, and confidentiality Display and visualization of medical data E-commerce in health informatics E-communities and networks f patients and consumers E iti d t k for ti t d E-healthcare infrastructure design E-learning for spreading health informatics awareness Engineering of medical data Evaluation of health information system E-visit system Experience of building health information system Health informatics education Health information system framework and enterprise architecture in the developing world Health IT project management Health software design Health system simulation High-performance computing in healthcare Human-centered design of health informatics systems Information retrieval for health applications Information technologies for the management of patient safety and clinical outcomes Innovative applications in electronic health records (e.g., ontology or semantic technology, using continuous biomedical signals to trigger alerts) Intelligent medical devices and sensors Issues involving interoperability and data representation in healthcare delivery Keyword and multifaceted search over structured electronic health records Knowledge discovery for improving patient-provider communication Large-scale longitudinal mining of medical records Medical compliance automation for patients and institutions Medical recommender system (e.g., medical products, fitness programs) Multimodal medical signal analysis Natural language processing for biomedical literature, clinical notes, and health consumer texts Novel health information systems for chronic disease management Open source Open-source software in healthcare Optimization models for planning and recommending therapies Personalized predictive modeling for clinical management (e.g., trauma, diabetes mellitus, sleep disorders, substance abuse) Physiological modeling Public health informatics Quality assurance Semantic Web, linked data, ontology, and healthcare Sensor networks and systems for pervasive healthcare Social studies of health information technologies y g Survival analysis and related methods for estimating hazard functions System software for complex clinical studies that involve combinations of clinical, genetic, genomic, imaging, and pathology data Systems for cognitive and decision support Technologies for capturing and documenting clinical encounter information in electronic systems Telecare Telemedicine User-interface design issues applied to medical devices and systems

Association for Computing Machinery (ACM), 1st Int’l Health (ACM) Int l Informatics Symposium (IHI) CALL FOR PAPERS IHI 2010, November 11-12, 2010, Arlington, Virginia http://ihi2010.sighi.org http://ihi2010 sighi org

• E-commerce in health informatics • E-learning for informatics awareness p j g • Health IT project management • Open-source software in healthcare • User-interface design issues in y medical devices and systems

Word Tag of AMIA BMI Competencies

Thank You
Special thanks to Paul Harris for  S i l h k P lH i f conceptual development of the  Clinical Research Informatics track in  AMIA Now!, as well as this session ,

This presentation was made possible by the Case Western Reserve University/Cleveland Clinic CTSA Grant Number UL1 RR024989 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health and NIH roadmap for Medical Research.

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