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Medical Informatics

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Collaborations between medical informatics and health services research are a natural bridge to improved health care quality

Three studies by researchers at the Agency for Healthcare Research and Quality and a fourth AHRQ-supported study (National Research Service Award training grant T32 HS00028) recently examined the role of medical informatics in clinical research and practice. They addressed issues such as bridging the gap in medical informatics and health services research, the benefits of integrating training between the two disciplines, computer applications in health care, and the role of health information management in monitoring patient safety. The studies are described here.

Corn, M., Rudzinski, K.A., and Cahn, M.A. (2002, March). "Bridging the gap in medical informatics and health services research." Journal of the American Medical Informatics Association 9, pp. 140-143.

In January 2000, AHRQ and the National Library of Medicine (NLM) cosponsored an invitational workshop, "Medical Informatics and Health Services Research: Bridging the Gap." It was attended by researchers and educators from AHRQ- and NLM-sponsored training programs in medical informatics and health services research. Attendees addressed ways to increase the pool of people interested, trained, and experienced in either of the two fields. Both fields emphasize the application of decision sciences to health care delivery, but each has developed sets of different and complementary tools. For example, medical informatics expertise in computer sciences (database and health information system design, including vocabulary and terminology, data confidentiality, security, and modeling) can be used to translate clinical practice information into data systems.

Biostatistical, evaluative, quality management, economic, epidemiologic, and survey skills of health services research can all contribute to the use of data systems to assess and improve the delivery of health care. Workshop participants proposed a series of training and research options for individuals engaged in these fields, ranging from development of innovative curricula in areas that support both disciplines; internships in applied settings; and masters, doctoral, and postdoctoral positions (intersecting both disciplines) in some training programs supported by NLM or AHRQ.

Reprints (AHRQ Publication No. 02-R060) are available from the AHRQ Publications Clearinghouse.

Shortliffe, E.H., and Garber, A.M. (2002, March). "Training synergies between medical informatics and health services research: Successes and challenges." Journal of the American Medical Informatics Association 9(2), pp. 133-139.

This paper describes lessons that can be learned about training in medical informatics and health services research from Stanford University, where these two areas have been closely linked via administrative, curriculum, and clinical activities for almost two decades. Both curricula draw on diverse course offerings throughout the university, and the training and research overlap in such areas as outcomes research, large database analysis, and decision analysis/decision support.

The Stanford experience suggests that the design of integrated programs requires a mixture of casual and structured contact among students from both disciplines, including social interactions; the offering of common classes with joint projects that bring trainees together to work as colleagues; physical proximity when possible among the training sites; shared colloquia, research seminars and social events; and scientific retreats that build esprit, understanding, and a sense of shared commitment.

Fitzmaurice, J.M., Adams, K., and Eisenberg, J.M. (2002, March). "Three decades of research on computer applications in health care." Journal of the American Medical Informatics Association 9, pp. 144-160.

Many computerized interventions that are commonplace today, such as drug interaction alerts, had their genesis in early AHRQ initiatives, according to this review of AHRQ's investment in medical informatics research. Grants provided by AHRQ have produced achievements that range from advancing automation in the clinical laboratory and radiology and assisting in technology development (computer languages, software, and hardware) to facilitating the evolution of computer-aided decisionmaking and computer-initiated quality assurance programs.There are four major driving forces for more medical informatics research. First is understanding how links between clinical information and health information on the Internet can affect patient-physician relationships and patient understanding, compliance with treatment, and health status. Second is reducing the cost of computing, storage, and communication and increasing computing speed and communication bandwidth. Along with this, we need to develop research findings that show where the most productive information technology investments are to be made in health care.

Overcoming vocabulary and coding barriers and other data incompatibilities that have long hindered easy transfer and consolidation of clinical information across sites of care and health enterprises is a third driving force. Fourth is the demand for medical informatics tools to improve patient safety by preventing inappropriate actions and reducing errors of omission. In response to these priorities, AHRQ is funding two initiatives through 2002 and 2003. One supports medical informatics research on improving the delivery of evidence-based information to health decisionmakers and enhancing the collection of patient and practitioner data as an integral part of patient care. The second initiative supports clinical informatics research focusing on the role of computers and communication in improving patient safety.

Reprints (AHRQ Publication No. 02-R059) are available from the AHRQ Publications Clearinghouse.

Romano, P.S., Elixhauser, A., McDonald, K.M., and Miller, M.R. (2002, March). "HIM's role in monitoring patient safety." Journal of the American Health Information Management Association 73(3), pp. 72-74.

The administrative data that health information management professionals generate in coding medical records have long been used for reimbursement. More recently, these data have been used for research and quality assessment, and they hold promise for identifying potential patient safety problems. The AHRQ-supported Evidence-based Practice Center at the University of California, San Francisco-Stanford is developing and testing a set of patient safety indicators (PSIs) that focus on potentially preventable instances of harm to patients, such as surgical complications and other iatrogenic events.

This article describes the development and testing of the AHRQ PSIs, which are expected to be released later this year. The authors, including AHRQ researchers Anne Elixhauser, Ph.D., and Marlene Miller, M.D., also discuss the steps health information management professionals can take to make a contribution to the national effort of monitoring and preventing medical errors through the application and ongoing refinement of ICD-9-CM and, eventually, ICD-10-CM codes for diagnoses, procedures, and complications. In conclusion, they point out the need for continuing improvements in the precision and accuracy of coding so that the data can be used to better identify potential patient safety events.

Reprints (AHRQ Publication No. 02-R056) are available from the AHRQ Publications Clearinghouse.

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