Informatics,evidence-based care,and research; implications for national policy: a report of an American Medical Informatics Association health policy conference

There is an increased level of activity in the biomedical and health informatics world (e-prescribing, electronic health records, personal health records) that, in the near future, will yield a wealth of available data that we can exploit meaningfully to strengthen knowledge building and evidence creation, and ultimately improve clinical and preventive care. The American Medical Informatics Association (AMIA) 2008 Health Policy Conference was convened to focus and propel discussions about informatics-enabled evidence-based care, clinical research, and knowledge management. Conference participants explored the potential of informatics tools and technologies to improve the evidence base on which providers and patients can draw to diagnose and treat health problems. The paper presents a model of an evidence continuum that is dynamic, collaborative, and powered by health informatics technologies. The conference''s findings are described, and recommendations on terminology harmonization, facilitation of the evidence continuum in a “wired” world, development and dissemination of clinical practice guidelines and other knowledge support strategies, and the role of diverse stakeholders in the generation and adoption of evidence are presented.     

Three Decades of Research on Computer Applications in Health Care: Medical Informatics Support at the Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality and its predecessor organizations—collectively referred to here as AHRQ—have a productive history of funding research and development in the field of medical informatics, with grant investments since 1968 totaling $107 million. Many computerized interventions that are commonplace today, such as drug interaction alerts, had their genesis in early AHRQ initiatives.This review provides a historical perspective on AHRQ investment in medical informatics research. It shows that grants provided by AHRQ resulted in achievements that include advancing automation in the clinical laboratory and radiology, assisting in technology development (computer languages, software, and hardware), evaluating the effectiveness of computer-based medical information systems, facilitating the evolution of computer-aided decision making, promoting computer-initiated quality assurance programs, backing the formation and application of comprehensive data banks, enhancing the management of specific conditions such as HIV infection, and supporting health data coding and standards initiatives.Other federal agencies and private organizations have also supported research in medical informatics, some earlier and to a greater degree than AHRQ. The results and relative roles of these related efforts are beyond the scope of this review.Three decades ago, when the federal government''s National Center for Health Services Research and Development began to support research on computer applications in health care, few imagined the impact that information systems and sciences would have on medical care today. For most, the idea of a national clearinghouse of guidelines, available through a computer that sits on a home office desktop, seemed like science fiction. For a few researchers and those supporting their work, however, visions of what could become possible in the management of health care information called for development of computerized systems and the evaluation of their effects on quality, cost, and access to care.The Agency for Healthcare Research and Quality (AHRQ, from 1999) and its predecessor agencies—the National Center for Health Services Research and Development (beginning in 1968) and the Agency for Health Care Policy and Research (from 1989 to 1999)—have a rich history of funding research, development, and evaluation in medical informatics. Although the grant investments since 1968 total only $107 million ($246 million in 2000 dollars), they supported initiatives that have established a research framework for many of the computer applications now being used today.The focus of AHRQ''s early research funding in medical informatics was on acquiring patient care data and communicating patient care management information. The goal was not only to improve the quality of care, but also to achieve reductions in costs and medical personnel resource use by processing data more efficiently. Research aimed at improving communication of information was targeted at what we would call today “getting the right information to the right place at the right time.” The promise of this research was its ability to provide findings that would guide reorganization of care delivery, take advantage of the more rapid communication of necessary information, and reduce manpower needs.¹ Over time, AHRQ''s funding has emphasized the application of health services research methods to evaluations of information technology used in community health settings. This article highlights key accomplishments emerging from AHRQ''s funding that have improved the quality of patient care in studied sites and have the potential to improve health care in all settings.Other federal agencies (such as the National Library of Medicine, the Veterans Health Administration, and the Department of Defense) and private organizations (such as The John A. Hartford Foundation, The Robert Wood Johnson Foundation, and the American Hospital Association) have supported developments in medical informatics, with some having greater research expenditures and earlier histories than AHRQ. Nevertheless, it is the Agency''s contributions to medical informatics that are the focus of this study. The purpose of this article is to provide a historical perspective for understanding the benefits of past research funded by AHRQ that supports health care applications of information technology today and that foreshadows AHRQ''s medical informatics initiatives for the future.     

A Viewpoint on Evidence-based Health Informatics,Based on a Pilot Survey on Evaluation Studies in Health Care Informatics

Concerned about evidence-based health informatics, the authors conducted a limited pilot survey attempting to determine how many IT evaluation studies in health care are never published, and why. A survey distributed to 722 academics had a low response rate, with 136 respondents giving instructive comments on 217 evaluation studies. Of those studies, half were published in international journals, and more than one-third were never published. Reasons for not publishing (with multiple reasons per study possible) included: “results not of interest for others” (1/3 of all studies), “publication in preparation” (1/3), “no time for publication” (1/5), “limited scientific quality of study” (1/6), “political or legal reasons” (1/7), and “study only conducted for internal use” (1/8). Those reasons for non-publication in health informatics resembled those reported in other fields. Publication bias (preference for positive studies) did not appear to be a major issue. The authors believe that widespread application of guidelines in conducting health informatics evaluation studies and utilization of a registry for evaluation study results could improve the evidence base of the field.     

Theory and applications of telemedicine

In this study, telemedicine and the use of advanced telemedicine technologies are explained. Telemedicine is the use of modern telecommunications and information technologies for the provision of clinical care to individuals at a distance, and transmission of information to provide that care. Telemedicine can be used for decision making, remote sensing, and collaborative arrangements for the real-time management of patients at a distance. The use of telecommunications and information technologies in providing health services is determined. Telemedicine is described as combination of topics from the fields of telecommunication, medicine, and informatics. The medical systems infrastructure consisting of the equipment and processes used to acquire and present clinical information and to store and retrieve data are explained in details. The challenges existing in telemedicine development in different countries are given. Technological, political, and professional barriers in applications of telemedicine are defined. An investigation of telemedicine applications in various fields is presented, and enormous impact of telemedicine systems on the future of medicine is determined.     

大数据在生物医学信息学中的应用

大数据在生物医学信息学研究中的作用日益重要,介绍大数据在生物信息学、临床医学信息学、影像信息学和公共卫生信息学4个领域的应用,列举并总结一些最近的工作进展,对未来大数据在生物医疗领域的发展进行展望。     

A research agenda to support the development and implementation of genomics-based clinical informatics tools and resources

ObjectiveThe Genomic Medicine Working Group of the National Advisory Council for Human Genome Research virtually hosted its 13th genomic medicine meeting titled “Developing a Clinical Genomic Informatics Research Agenda”. The meeting’s goal was to articulate a research strategy to develop Genomics-based Clinical Informatics Tools and Resources (GCIT) to improve the detection, treatment, and reporting of genetic disorders in clinical settings.Materials and MethodsExperts from government agencies, the private sector, and academia in genomic medicine and clinical informatics were invited to address the meeting''s goals. Invitees were also asked to complete a survey to assess important considerations needed to develop a genomic-based clinical informatics research strategy.ResultsOutcomes from the meeting included identifying short-term research needs, such as designing and implementing standards-based interfaces between laboratory information systems and electronic health records, as well as long-term projects, such as identifying and addressing barriers related to the establishment and implementation of genomic data exchange systems that, in turn, the research community could help address.DiscussionDiscussions centered on identifying gaps and barriers that impede the use of GCIT in genomic medicine. Emergent themes from the meeting included developing an implementation science framework, defining a value proposition for all stakeholders, fostering engagement with patients and partners to develop applications under patient control, promoting the use of relevant clinical workflows in research, and lowering related barriers to regulatory processes. Another key theme was recognizing pervasive biases in data and information systems, algorithms, access, value, and knowledge repositories and identifying ways to resolve them.     

Medical Informatics: A Model Developed for Diabetes Education Via Telemedicine

Fast developments in information and communication technology (ICT) have made it possible to develop new services for people. One of the most interesting areas is health care. Medical informatics is the discipline concerned with the systematic processing of data, information and knowledge in medicine and health care. Information services, medical decision support systems and telemedicine are becoming important tools for medical professionals and also people who are interested in health related information. Medical decision support aims at providing health care professionals with therapy guidelines directly at the point of care. Telemedicine is the use of modern telecommunications and information technologies (IT) for the provision of clinical care to individuals at a distance and transmission of information to provide that care. In the present study, usage of IT in medicine, medical decision support systems, computerized medical measurements, patient education and network connectivity were described. A model for risk evaluation, data collection and education of undiagnosed diabetes using the world wide web (www) was presented.     

An architecture for research computing in health to support clinical and translational investigators with electronic patient data

ObjectiveObtaining electronic patient data, especially from electronic health record (EHR) systems, for clinical and translational research is difficult. Multiple research informatics systems exist but navigating the numerous applications can be challenging for scientists. This article describes Architecture for Research Computing in Health (ARCH), our institution’s approach for matching investigators with tools and services for obtaining electronic patient data.Materials and MethodsSupporting the spectrum of studies from populations to individuals, ARCH delivers a breadth of scientific functions—including but not limited to cohort discovery, electronic data capture, and multi-institutional data sharing—that manifest in specific systems—such as i2b2, REDCap, and PCORnet. Through a consultative process, ARCH staff align investigators with tools with respect to study design, data sources, and cost. Although most ARCH services are available free of charge, advanced engagements require fee for service.ResultsSince 2016 at Weill Cornell Medicine, ARCH has supported over 1200 unique investigators through more than 4177 consultations. Notably, ARCH infrastructure enabled critical coronavirus disease 2019 response activities for research and patient care.DiscussionARCH has provided a technical, regulatory, financial, and educational framework to support the biomedical research enterprise with electronic patient data. Collaboration among informaticians, biostatisticians, and clinicians has been critical to rapid generation and analysis of EHR data.ConclusionA suite of tools and services, ARCH helps match investigators with informatics systems to reduce time to science. ARCH has facilitated research at Weill Cornell Medicine and may provide a model for informatics and research leaders to support scientists elsewhere.     

WIRM: An Open Source Toolkit for Building Biomedical Web Applications

This article describes an innovative software toolkit that allows the creation of web applications that facilitate the acquisition, integration, and dissemination of multimedia biomedical data over the web, thereby reducing the cost of knowledge sharing. There is a lack of high-level web application development tools suitable for use by researchers, clinicians, and educators who are not skilled programmers. Our Web Interfacing Repository Manager (WIRM) is a software toolkit that reduces the complexity of building custom biomedical web applications. WIRM’s visual modeling tools enable domain experts to describe the structure of their knowledge, from which WIRM automatically generates full-featured, customizable content management systems.Biomedical research efforts are becoming increasingly reliant on the interoperability of autonomous heterogeneous software applications, involving widespread collaboration by teams of scientists and clinicians across multiple disciplines and institutions. Consequently, there is a need for a new generation of biomedical information systems that facilitate remote collaboration, data sharing, workflow management, and integration of heterogeneous knowledge sources. The diverse nature of experimental data and protocols dictates that each information system be custom-tailored through a domain-specific set of object classes, templates, interfaces, and workflow facilities. This suggests a need for template-based, adaptable frameworks that enable scientists, clinicians, and educators to create their own custom information systems. Such frameworks should provide high-level interfaces that empower domain experts to model the structure of their content and workflow requirements, according to their own domain knowledge.This article identifies the informatics requirements for such a framework and describes the architecture and implementation of a prototype open source toolkit that begins to meet those requirements: the Web Interfacing Repository Manager (WIRM). WIRM consists of a visual development environment and a high-level programming interface that allows health professionals to rapidly design and implement their own custom web-based interfaces to biomedical content.¹ WIRM enables a nonprogrammer to model domain knowledge as object-oriented schemas, using a menu-driven interface. Once schemas are defined, WIRM automatically generates a drill-down web information system for acquiring, querying, navigating, annotating, and editing instances of those schemas.WIRM has been released as an open source toolkit and has been used to build a wide range of applications for clinicians, researchers, and educators. As estimated by the developers, WIRM reduced implementation time for the applications by 50–75% over more traditional approaches. Planned improvements should increase the usability to point that a growing number of medical professionals will be able to create custom applications that improve the efficiency of their research efforts and expand their capacity to share knowledge.     

Research Integrated Network of Systems (RINS): a virtual data warehouse for the acceleration of translational research

ObjectiveIntegrated, real-time data are crucial to evaluate translational efforts to accelerate innovation into care. Too often, however, needed data are fragmented in disparate systems. The South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina (MUSC) developed and implemented a universal study identifier—the Research Master Identifier (RMID)—for tracking research studies across disparate systems and a data warehouse-inspired model—the Research Integrated Network of Systems (RINS)—for integrating data from those systems.Materials and MethodsIn 2017, MUSC began requiring the use of RMIDs in informatics systems that support human subject studies. We developed a web-based tool to create RMIDs and application programming interfaces to synchronize research records and visualize linkages to protocols across systems. Selected data from these disparate systems were extracted and merged nightly into an enterprise data mart, and performance dashboards were created to monitor key translational processes.ResultsWithin 4 years, 5513 RMIDs were created. Among these were 726 (13%) bridged systems needed to evaluate research study performance, and 982 (18%) linked to the electronic health records, enabling patient-level reporting.DiscussionBarriers posed by data fragmentation to assessment of program impact have largely been eliminated at MUSC through the requirement for an RMID, its distribution via RINS to disparate systems, and mapping of system-level data to a single integrated data mart.ConclusionBy applying data warehousing principles to federate data at the “study” level, the RINS project reduced data fragmentation and promoted research systems integration.     

Translational Bioinformatics: Coming of Age

The American Medical Informatics Association (AMIA) recently augmented the scope of its activities to encompass translational bioinformatics as a third major domain of informatics. The AMIA has defined translational bioinformatics as “… the development of storage, analytic, and interpretive methods to optimize the transformation of increasingly voluminous biomedical data into proactive, predictive, preventative, and participatory health.” In this perspective, I will list eight reasons why this is an excellent time to be studying translational bioinformatics, including the significant increase in funding opportunities available for informatics from the United States National Institutes of Health, and the explosion of publicly-available data sets of molecular measurements. I end with the significant challenges we face in building a community of future investigators in Translational Bioinformatics.     

Bridging the Gap in Medical Informatics and Health Services Research: Workshop Results and Next Steps

In January 2000, the Agency for Healthcare Research and Quality (AHRQ) and the National Library of Medicine (NLM) cosponsored an invitational workshop entitled “Medical Informatics and Health Services Research: Bridging the Gap.” Planned by a small committee of representatives from NLM and AHRQ institutional training centers, the workshop was designed to address the need for education of researchers interested in working at the intersection of the fields of medical informatics and health services research. More than 100 educators and researchers from AHRQ- and NLM-sponsored training programs in medical informatics and health services research participated in the workshop. Through a series of plenary presentations and breakout sessions, the workshop addressed ways of increasing the pool of persons interested, trained, and experienced in addressing specific areas of synergy between the two fields. This paper reports on the results of the workshop.As ever-more-massive data sets become available, health services researchers, like molecular biologists, will find that the use of computational tools, some basic understanding of informatics, and interaction with informaticians are essential components of investigation. For example, informatics techniques are helpful in converting data from past practice into information to guide decisions about future practices. Informatics is also a key to achieving change in practice by linking information from health services research directly into practice. Informaticians, who are generally skilled in applying computational tools to data and knowledge, will need more specific understanding of the approaches and problems of health services research. To continue the example, health services research provides techniques for determining which interventions should be tried. It also provides approaches to evaluating the effectiveness of interventions. These approaches need to be considered up front in the design of clinical databases. At the present time, however, many informatics training programs provide little or no exposure to the computational issues of health services research, and many training programs for health services research say relatively little about informatics.In January 2000, the Agency for Healthcare Research and Quality (AHRQ) and the National Library of Medicine (NLM) cosponsored an invitational workshop entitled “Medical Informatics and Health Services Research: Bridging the Gap.” Planned by a small committee of representatives from NLM and AHRQ institutional training centers, the workshop was designed to address the need for education of researchers interested in working at the intersection of the fields of medical informatics and health services research.^* More than 100 educators and researchers from AHRQ- and NLM-sponsored training programs^† in medical informatics and health services research participated in the workshop. Through a series of plenary presentations and breakout sessions, the workshop^‡ addressed ways of increasing the pool of individuals interested, trained, and experienced in addressing specific areas of synergy between the two fields as described in the companion papers of this issue of the Journal.     

The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution?

Web 2.0 is a term describing new collaborative Internet applications. The primary difference from the original World Wide Web is greater user participation in developing and managing content, which changes the nature and value of the information. Key elements of Web 2.0 include: Really Simple Syndication (RSS) to rapidly disseminate awareness of new information; blogs to describe new trends; wikis to share knowledge; and podcasts to make information available "on the move". The medical community needs to be aware of these technologies and their increasing role in providing health information "any time, any place".     

The technology behind TB DEPOT: a novel public analytics platform integrating tuberculosis clinical,genomic, and radiological data for visual and statistical exploration

ObjectiveClinical research informatics tools are necessary to support comprehensive studies of infectious diseases. The National Institute of Allergy and Infectious Diseases (NIAID) developed the publicly accessible Tuberculosis Data Exploration Portal (TB DEPOT) to address the complex etiology of tuberculosis (TB).Materials and MethodsTB DEPOT displays deidentified patient case data and facilitates analyses across a wide range of clinical, socioeconomic, genomic, and radiological factors. The solution is built using Amazon Web Services cloud-based infrastructure, .NET Core, Angular, Highcharts, R, PLINK, and other custom-developed services. Structured patient data, pathogen genomic variants, and medical images are integrated into the solution to allow seamless filtering across data domains.ResultsResearchers can use TB DEPOT to query TB patient cases, create and save patient cohorts, and execute comparative statistical analyses on demand. The tool supports user-driven data exploration and fulfills the National Institute of Health’s Findable, Accessible, Interoperable, and Reusable (FAIR) principles.DiscussionTB DEPOT is the first tool of its kind in the field of TB research to integrate multidimensional data from TB patient cases. Its scalable and flexible architectural design has accommodated growth in the data, organizations, types of data, feature requests, and usage. Use of client-side technologies over server-side technologies and prioritizing maintenance have been important lessons learned. Future directions are dynamically prioritized and key functionality is shared through an application programming interface.ConclusionThis paper describes the platform development methodology, resulting functionality, benefits, and technical considerations of a clinical research informatics application to support increased understanding of TB.     

中医药语义维基系统研发

语义维基是语义Web技术与维基系统相结合的产物,它既保持了维基系统在社会化知识工程方面的优势,又强化了对结构性数据的支持。中医百科是通过语义维基技术构建的中医药知识共享网站,它基于中医药领域本体来整合中医药领域的知识与作品,向网络用户提供百科全书式的知识服务。本文对语义维基技术进行了简要介绍,并阐述了中医百科的后台技术、交互方式和交互方式,以期为中医药信息化领域的研究和开发人员提供参考。     

Toward a National Framework for the Secondary Use of Health Data: An American Medical Informatics Association White Paper

Secondary use of health data applies personal health information (PHI) for uses outside of direct health care delivery. It includes such activities as analysis, research, quality and safety measurement, public health, payment, provider certification or accreditation, marketing, and other business applications, including strictly commercial activities. Secondary use of health data can enhance health care experiences for individuals, expand knowledge about disease and appropriate treatments, strengthen understanding about effectiveness and efficiency of health care systems, support public health and security goals, and aid businesses in meeting customers’ needs. Yet, complex ethical, political, technical, and social issues surround the secondary use of health data. While not new, these issues play increasingly critical and complex roles given current public and private sector activities not only expanding health data volume, but also improving access to data. Lack of coherent policies and standard “good practices” for secondary use of health data impedes efforts to strengthen the U.S. health care system. The nation requires a framework for the secondary use of health data with a robust infrastructure of policies, standards, and best practices. Such a framework can guide and facilitate widespread collection, storage, aggregation, linkage, and transmission of health data. The framework will provide appropriate protections for legitimate secondary use.     

MIRASS: Medical Informatics Research Activity Support System Using Information Mashup Network

The advancement of information technology has facilitated the automation and feasibility of online information sharing. The second generation of the World Wide Web (Web 2.0) enables the collaboration and sharing of online information through Web-serving applications. Data mashup, which is considered a Web 2.0 platform, plays an important role in information and communication technology applications. However, few ideas have been transformed into education and research domains, particularly in medical informatics. The creation of a friendly environment for medical informatics research requires the removal of certain obstacles in terms of search time, resource credibility, and search result accuracy. This paper considers three glitches that researchers encounter in medical informatics research; these glitches include the quality of papers obtained from scientific search engines (particularly, Web of Science and Science Direct), the quality of articles from the indices of these search engines, and the customizability and flexibility of these search engines. A customizable search engine for trusted resources of medical informatics was developed and implemented through data mashup. Results show that the proposed search engine improves the usability of scientific search engines for medical informatics. Pipe search engine was found to be more efficient than other engines.     

AMIA Advocates National Health Information System in Fight Against National Health Threats

To protect public health and national safety, AMIA recommends that the federal government dedicate technologic resources and medical informatics expertise to create a national health information infrastructure (NHII). An NHII provides the underlying information utility that connects local health providers and health officials through high-speed networks to national data systems necessary to detect and track global threats to public health. AMIA strongly recommends the accelerated development and wide-scale deployment of electronic public health surveillance systems, computer-based patient records, and disaster-response information technologies. Such efforts hold the greatest potential to protect our citizens from disaster and to deliver the best health care if disaster strikes.To protect public health and national safety, AMIA recommends that the federal government dedicate technologic resources and medical informatics expertise to create a national health information infrastructure (NHII). An NHII provides the underlying information utility that connects local health providers and health officials through high-speed networks to national data systems (e.g., Centers for Disease Control and Prevention) necessary to detect and track global threats to public health.In the short term, this means adapting existing information systems to facilitate public health surveillance and emergency response. To establish a permanent infrastructure, AMIA strongly recommends the accelerated development and wide-scale deployment of electronic public health surveillance systems, computer-based patient records, and disaster-response information technologies. Such efforts hold the greatest potential to protect our citizens from disaster, and to deliver the best health care if disaster strikes.While meeting the acute needs of today, this initiative will begin laying the groundwork for a NHII that will continue to serve the health needs of the nation—a lasting endowment for future generations. Establishing an NHII requires thoughtful strategic planning and strong inter-agency leadership. Work on key components of the NHII must begin immediately. These key components include:

• Strategic planning and coordination. There must be a central coordinating entity that can quickly inventory existing public- and personal-health initiatives and develop a strategy to fashion a national system to protect Americans against health threats of various types, including biological, chemical, nuclear, and physical. The short-term strategy must be part of a framework for a permanent infrastructure that serves public health, patient care, and research.
• Connectivity and communications. Local, regional, and national coordination cannot exist without efficient, instantaneous communication. Public health services must be linked using secure connections to the Internet as an immediate top priority. AMIA recommends federal government funding to guarantee high-speed, dedicated access to the Internet for all public and private health care facilities and related organizations. Minimum-level workstations should be required, and adequate tools and training should be provided.
• Standards. Effective communication among local, community, state, and federal facilities require the use of standards. Health care messaging standards should be used for data interchange. A common vocabulary standard and required data elements for public health surveillance databases are required to enable effective sharing of data. Without a common vocabulary, data from local systems cannot be analyzed to detect emerging health threats. Government coordination and support for consensus standardization and low-cost distribution of common vocabularies for health event detection, prevention, and intervention are a fundamental aspect of an NHII.
• Resource databases. An up-to-date, central, Internet-based health resources directory containing information about available resources—knowledge, physical, and human—is vital to providing the timely information needed to manage any public health crisis. The national health resource directory would include information about physical resources, such as health care organizations, safety facilities, and environmental agencies; human resources, including physicians, nurses, and public health and support personnel; organizational resources, such as emergency medical services, county and city law enforcement agencies, and other emergency-response groups; and knowledge resources ranging from clinical guidelines to extensive clinical decision support algorithms related to threat vectors. Local health authorities must be trained in use of the directory to effectively derive maximal benefit when responding to national health threats.
• Public health surveillance systems. Effective public health practice and decision making depend on timely information, much of which is not readily available. Information about patients with clinical conditions of public health importance, symptoms compatible with prodromes of serious infection or exposure, health behaviors, and environmental risk factors must be collected, transmitted, aggregated, analyzed, and utilized for prompt decision making. Whether the health threat is biological, chemical, or nuclear, early detection and rapid response are essential. Existing public health systems in place and under development should be adapted to meet the current needs. Implementation of public health system initiatives such as the National Electronic Disease Surveillance System and Health Alert Network must be accelerated to meet the acute threat posed by bioterrorism.
• National identifiers. National identifiers for providers, insurers, businesses, and individuals are required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The privacy provision of HIPAA that protects confidential health information has been finalized. In the face of the acute crisis, the work on identifiers should be accelerated so that effective epidemiologic data can be gathered and analyzed and appropriate health care services delivered where needed.

AMIA is an organization of professionals who operate at the interface between health care and computer and information science. Our leadership and members are capable and willing to contribute to solving the acute situation while laying the foundation for a lasting infrastructure to manage health information for the benefit of patients and the public.TANG, National Health Information System Proposal