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.     

美国医学信息学教育的发展及其启示

目的：梳理美国生物医学信息学教育博、硕士培养的学科体系、课程设置、培养方案和培养方向的变化,为我国医学信息学教育提供参考。方法：通过网络调查,纵向比较斯坦福大学、哥伦比亚大学的课程体系设置,同时与华盛顿大学、新泽西医科和牙科大学的培养方案进行横向比较。结果：4所高校的培养目标基本一致,培养层次以硕士研究生、博士研究生为主。本科阶段的学习使学生具有较全面的医学专业知识因而了解医学领域信息需求。课程设置方面信息学与医学结合非常紧密。结论：我国应重新设计医学信息专业基础医学课程,使学生能够深入理解医学领域的本质和特点及其信息需求,从而找到信息与医学的结合点。     

医学情报机构开展重点学科建设的探索与实践

概述河北省医学情报研究所面对医学信息学被列入新一轮省级医学重点发展学科的契机,探讨建设医学信息学重点学科的发展路径,包括确定学科定位、加强人才队伍建设、拓展研究方向与社会服务领域、加大学科文献资源的投资力度、建立管理保障体系等,并阐明未来发展对策.     

农村订单定向免费医学生的培养及其对基层公共卫生服务的影响研究

目的 探讨农村订单定向免费医学生的培养及其在基层公共卫生服务中的影响,为进一步提升农村定向全科医生培养方案的有效性提出针对性建议。方法 通过访谈四川省基层医疗机构的63名毕业后的农村订单定向免费医学本科学生,研究采用了主轴编码和内容分析的标准程序,深入分析了农村订单定向免费医学生培养效果对基层公共卫生服务作用的影响及不足。结果 研究发现,农村订单定向免费医学生培养成效主要体现在理论学习、实践工作能力、未来职业规划与毕业后教育情况几个方面,其中理论学习与实践工作能力2个维度的培养成效较好。农村订单定向免费医学生在基层公共卫生服务中发挥了积极作用,主要体现在重点人群的防护、老年人群及慢性病患者居家预防和管理、儿童和孕产妇人群居家预防和管理。结论 针对农村订单定向免费医学生对基层公共卫生服务的建议措施包括：国家和学校的配套政策能继续完善和执行、高校教师应更加注重全科医学生的人文精神的引导、课程体系建设中需突出基层及全科医学相关的课程、学生培养过程中应构建有效的实践方式、加强就业后的继续教育等方面。     

国际医学信息学领域研究现状与前沿分析

目的/意义 讨论医学信息学发展趋势,以期为医学信息学研究和发展提供参考。方法/过程 以科学引文索引扩展版收录的31种医学信息学领域期刊2002—2021年刊载论文为研究对象,应用文献计量法、共词分析法分析该领域的发文总量、期刊、国家及地区、机构、作者、资助基金情况,以及近5年研究方向、研究热点。结果/结论 医学信息学领域发文总量快速增长,近5年研究方向集中在医疗保健科学与服务、计算机科学的跨学科应用、数学与计算生物学等方面,研究热点集中在移动医疗、计算机技术、电子病历和自然语言处理技术等方面。该领域呈现多学科领域深度交叉融合、向健康信息学拓展、健康医疗数据开放共享、医疗信息化走向智慧医疗和智慧健康的趋势。     

Two combined residency programs in internal medicine and pediatrics

Combined residency training in internal medicine and pediatrics is becoming a popular postgraduate program among graduating medical students. The number of such programs has increased rapidly but with little interchange of ideas and without the benefit of a national data base. In this paper, the authors review the experience of two combined programs. Initially established because of the desire to provide broad-based training in primary care, the programs now offer a curriculum that prepares residents for primary care or education in the subspecialties. The difficulty for residents of achieving competence in two disciplines is compounded by a lack of faculty role models. The two programs offer special advantages to the residents and the departments involved. The career outcomes of program graduates have varied from primary care or subspecialty practice in one or both disciplines to faculty positions in teaching institutions. Whether the program remains successful will depend on the ability of its graduates to offer special talents to academic and clinical practice settings and on the availability of funding.     

基于能力素质冰山模型的卫生信息化应用型人才培养模式研究

卫生信息化高级应用型人才培养模式改革,是在卫生信息产业深化与细分的背景下,对高校医学信息、信息管理与信息系统（医药卫生方向）等相关专业提出的一种新要求。根据卫生信息化高级应用型人才能力素质冰山模型,从培养目标、能力培养方案、师资队伍与培养体系几个维度对卫生信息化人才培养模式进行重构。并对重庆市某校信息管理与信息系统（医药卫生）专业基于能力素质冰山模型的人才培养模式改革进行实证研究。     

国内医学院校情报学硕士培养现状

简要介绍了我国医学情报学专业发展历程,从培养医学情报学硕士的高校及其研究方向、培养方案分析了医学情报学硕士培养现状,并对3所高校的培养方案进行对比,针对存在的问题提出几点建议。     

Should Degree Programs in Biomedical and Health Informatics be Dedicated or Integrated?

Education in biomedical and health informatics (BMHI) has been established in many countries throughout the world. For degree programs in BMHI we can distinguish between those that are completely stand-alone or dedicated to the discipline vs. those that are integrated within another program. After running integrated degree medical informatics programs at TU Braunschweig for 10 years at the B.Sc. and for 15 years at the M.Sc level, we (1) report about this educational approach, (2) analyze recommendations on, implementations of, and experiences with degree educational programs in BMHI worldwide, (3) summarize our lessons learned with the integrated approach at TU Braunschweig, and (4) suggest an answer to the question, whether degree programs in biomedical and health informatics should be dedicated or integrated. According to our experience at TU Braunschweig and based on our analysis of publications, there is a clear dominance of dedicated degree programs in BMHI. The specialization in medical informatics within a computer science program, as offered at TU Braunschweig, may be a good way of implementing an integrated, informatics-based approach to medical informatics, in particular if a dual degree option can be chosen. The option of curricula leading to double degrees, i.e. in this case to two separate degrees in computer science and in medical informatics might, however, be a better solution.     

浅析国际大型医学论坛对医院学科发展的作用

目的：研究国际大型医学论坛对国内医疗机构中学科发展所起到的推动作用。方法：通过对国内医护人员出国留学深造过程进行观察和研究,发现其中产生的问题并分析问题发生的原因,探索解决问题的方法和途径,并从中发现人力资源培养过程中对医疗机构学科发展的推动力。结果：通过国际医学论坛所搭建的平台,更多的医护人员可以获得更具目的性、更为系统的培训项目和课程,对海外留学的效果更为突出。同时,通过此平台所完成的海外培训回归后对于原医疗机构的学科发展也更为有利。结论：通过国际医学论坛的平台可以有效代替医护人员自行去寻找海外医疗机构培训的过程,提高学习效率。同时,通过该平台培养机制的建立,能使更多医学人才获得更为科学、合理的海外进修课程,最终为医疗机构的未来学科发展打下优秀的人才梯队基础,推动学科发展。     

Community medicine for clinicians in Canada: a recommendation for postgraduate training.

A large gap presently exists between the predominantly biologic expertise of the medical profession and the complex mixture of biologic, behavioural and epidemiologic components of health problems today. Furthermore, the development of community medicine in Canada has been relatively separate from that of the clinical disciplines. To enable clinicians to acquire the knowledge and skills to manage these health problems, much more community-oriented research, applied behavioural science and clinical epidemiology is needed within the clinical sector of medicine. I have proposed a definition of clinical community medicine and presented a strategy for training clinicians in community medicine skills that calls for administrators of clinical postgraduate programs to develop training in clinical community medicine. Residency programs in community medicine cannot be expected to provide such training given their nonclinical priorities, which focus mainly on the training of public health physicians.     

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.     

非医学信息学专业医学信息学教育课程的设置

以国际医学信息学会 （ International Medical Informatics Association, IMIA）2010年修订的《关于开展生物医学与健康信息学教育的建议》为依据,结合我国目前医学生基本临床信息技能及医学信息学教育现状,以医学文献检索为课程基础,构建适合高等医学院校非医学信息学专业教育的医学信息学课程,使医学生毕业后能够适应信息化条件下医疗卫生实践对基本信息技能的要求。     

英国医学信息学教育现状概述

目的：全面了解英国医学信息学教育现状,提出我国医学信息学教育的发展建议。方法：访问英国高校医学信息学专业相关网站,调查其教学目的、学位授予、课程设置、就业情况等情况。结果：英国医学信息学教育以研究生教育为主,对入学研究生的本科成绩、学科背景等均有较高要求。教学目的明确,教学模式为全日制研究型硕士和非全日制硕士两种教育方式并存,学生可以灵活选择。课程设置模块化,采用核心模块加选修模块的课程体系。就业形势较好,毕业生在以信息学为主导的卫生服务中扮演重要角色。结论：我国医学信息学教育应注重学生实践能力培养和师资力量培养,全力打造复合、高端的医学信息学专业人才。     

The national landscape of culminating experiences in master’s programs in health and biomedical informatics

Health and biomedical informatics graduate-level degree programs have proliferated across the United States in the last 10 years. To help inform programs on practices in teaching and learning, a survey of master’s programs in health and biomedical informatics in the United States was conducted to determine the national landscape of culminating experiences including capstone projects, research theses, internships, and practicums. Almost all respondents reported that their programs required a culminating experience (97%). A paper (not a formal thesis), an oral presentation, a formal course, and an internship were required by ≥50% programs. The most commonly reported purposes for the culminating experience were to help students extend and apply the learning and as a bridge to the workplace. The biggest challenges were students’ maturity, difficulty in synthesizing information into a coherent paper, and ability to generate research ideas. The results provide students and program leaders with a summary of pedagogical methods across programs.     

Ten years of international collaboration in biomedical informatics and beyond: the AMAUTA program in Peru

Well-trained people are urgently needed to tackle global health challenges through information and communication technologies. In this report, AMAUTA, a joint international collaborative training program between the Universidad Peruana Cayetano Heredia and the University of Washington, which has been training Peruvian health professionals in biomedical and health informatics since 1999, is described. Four short-term courses have been organized in Lima, offering training to more than 200 graduate-level students. Long-term training to masters or doctorate level has been undertaken by eight students at the University of Washington. A combination of short-term and long-term strategies was found to be effective for enhancing institutional research and training enterprise. The AMAUTA program promoted the development and institution of informatics research and training capacity in Peru, and has resulted in a group of trained people playing important roles at universities, non-government offices, and the Ministry of Health in Peru. At present, the hub is being extended into Latin American countries, promoting South-to-South collaborations.     

Medical informatics. An emerging academic discipline and institutional priority

Information management constitutes a major activity of the health care professional. Currently, a number of forces are focusing attention on this function. After many years of development of information systems to support the infrastructure of medicine, greater focus on the needs of physicians and other health care managers and professionals is occurring--to support education, decision making, communication, and many other aspects of professional activity. Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks. An intrinsically interdisciplinary field, medical informatics has a highly applied focus, but also addresses a number of fundamental research problems as well as planning and policy issues. Medical informatics is now emerging as a distinct academic entity. Health care institutions are considering, and a few are making, large-scale commitments to information systems and services that will affect every aspect of their organizations' function. While academic units of medical informatics are presently established at only a few medical institutions in the United States, increasing numbers of schools are considering this activity and many traditional departments are seeking and attracting individuals with medical informatics skills.     

医学院校非信息类专业医学信息学选修课的教学实践研究

以移动互联网、物联网、云计算、大数据等为代表的新一代信息技术与健康医疗行业紧密融合，对医学院校面向非信息类专业的医学信息学选修课提出了更高的教学目标和内容要求。本文结合实际教学需求和临床医学生培养目标，对医学信息学选修课的教学内容进行了科学地优化和配置。选择医学信息学教育中的“小数据集，电子病历/电子健康档案的基本应用”为主要内容，模块化医学信息处理中的数值型数据、文本型数据和图像数据，以案例驱动和翻转课堂变革教学方式，将机器学习中常见的方法（如回归、分类和聚类方法）根植于案例的解决方案中，以综合的算法实例报告作为课程考核评价方式。实践表明，以上探索既激发了学生对医学信息学选修课的兴趣，又有效贯彻了医学生培养早预测、早调整、早发现、早诊断和早治疗的“五早”模式。     

Community outreach, training, and research: the Hawai'i/Pacific Basin area Health Education Center of the University of Hawai'i, John A. Burns SChool of Medicine

The Hawai'i/Pacific Basin AHEC is a federal grant program that utilizes academic/community partnerships to recruit students to health careers, train students in rural and underserved areas, and assist with workforce development across the region. Ongoing activities and programs include 1) Outreach for recruitment to health careers for students from kindergarten through adulthood; 2) Individual and interdisciplinary health professions student training in rural and underserved areas; 3) Community health education using distance learning; 4) Assessment of and efforts to improve recruitment and retention of providers in rural areas including continuing education; and 5) Health disparities research. The AHEC programs reach more than 4,000 individuals annually, helps to train more than 1,000 individuals a year and assist with placement of up to 20 providers a year in rural and underserved healthcare practices. This article describes the existing AHEC programs that are community based, community driven and inclusive of all who choose to participate. Collaboration is invited and necessary for success and future program development. Future areas for collaboration activities include increased statewide community health worker training, an expanded health careers pipeline, ongoing rural and underserved health needs assessments and an expanded training network for students in healthcare. Additional information is available at www.ahec.hawaii.edu.