Examining the role of collaboration in studies of health information technologies in biomedical informatics: A systematic review of 25 years of research

PurposeOur objective was to identify and examine studies of collaboration in relation to the use of health information technologies (HIT) in the biomedical informatics field.MethodsWe conducted a systematic literature review of articles through PubMed searches as well as reviewing a variety of individual journals and proceedings. Our search period was from 1990–2015. We identified 98 articles that met our inclusion criteria. We excluded articles that were not published in English, did not deal with technology, and did not focus primarily on individuals collaborating.ResultsWe categorized the studies by technology type, user groups, study location, methodology, processes related to collaboration, and desired outcomes. We identified three major processes: workflow, communication, and information exchange and two outcomes: maintaining awareness and establishing common ground. Researchers most frequently studied collaboration within hospitals using qualitative methods.DiscussionBased on our findings, we present the “collaboration space model”, which is a model to help researchers study collaboration and technology in healthcare. We also discuss issues related to collaboration and future research directions.ConclusionWhile collaboration is being increasingly recognized in the biomedical informatics community as essential to healthcare delivery, collaboration is often implicitly discussed or intertwined with other similar concepts. In order to evaluate how HIT affects collaboration and how we can build HIT to effectively support collaboration, we need more studies that explicitly focus on collaborative issues.     

The reorganization of basic science departments in U.S. medical schools, 1980-1999.

The evolution of biomedical science and technology over the last 50 years has made biomedical research inherently interdisciplinary. Such changes have led observers to speculate about the ways in which traditional basic science departments in U.S. medical schools are being changed or consolidated. The authors describe their findings from a study that constructed a 20-year longitudinal database (1980-1999) to examine how basic science departments have been reorganized at U.S. medical schools. The data reveal that, in fact, there were fewer basic science departments in the traditional disciplines of anatomy, biochemistry, microbiology, pharmacology, and physiology in 1999 than in 1980. But as biomedical science has developed in an interdisciplinary manner, new basic science departments have been added. The most frequent type of change, however, has been in the renaming of existing departments. Overall, there were more, not fewer, basic science departments and more, not fewer, faculty members in these departments. These changes, taken together with the growth of interdisciplinary research centers and institutes and changing patterns of biomedical PhD training, affect both teaching and research in academic medicine. First, basic scientists are becoming increasingly dissociated from the traditional disciplines around which medical students' education is often organized. Second, the organization of biomedical research is in a state of transition that is responding to advances in scientific knowledge, technology, and targets of opportunity.     

HIV medication adherence. The intersection of biomedical, behavioral, and social science research and clinical practice

The unique nature of the HIV/AIDS epidemic and the needs of people living with HIV disease have required the expertise of clinicians and biomedical, clinical, behavioral, and social scientists. The successes achieved in the past 25 years are the collective product of committed individuals from within all these disciplines. This is particularly true in HIV care and therapeutics and, specifically, in medication adherence, where biologic, clinical, behavioral, and social issues converge and each has been critically important in achieving the stunning therapeutic benefit for individuals and populations with HIV disease. There has been growing acceptance and success of interdisciplinary collaboration to address HIV medication adherence in the past 2 decades. Nevertheless, there remain real and perceived impediments obstructing collaboration among biomedical, behavioral, and social scientists and important differences between all these research domains and clinical practice. Differences in training and expertise, perceived mission, orientation, culture, and personal and professional skills can thwart meaningful collaboration or be used synergistically to move understanding and improvement of HIV medication adherence forward. This article explores these relations and differences from the perspective of an HIV clinician and clinical researcher with a background in biology and an inclination toward behavioral and social science and suggests some approaches for their resolution.     

医学信息学的研究领域及人才培养

医学信息学(MedicalInformatics,又称医药信息学)是计算机科学、信息科学与医学科学结合,新近形成的前沿多学科交叉的科学,它以信息论、系统论、计算机科学技术为理论基础,几乎全方位地涉及所有的医药卫生领域,已成为现代和未来生物医学发展的基石。目前,医学信息学应用的领域,面临人才短缺的现象,本文论述了在生物医学工程学科中,建立医学信息本科专业方向,通过相关课程体系的设置,培养符合社会需要的医学信息人才。     

Medical engineering and industry

Biomedical engineering began 25 years ago. Since its beginnings it has progressed from a construction and repair service to an applied science which has made many important contributions to medicine. However, for biomedical engineering to make greater contributions to medicine in the future, more co-operation and planning are needed.     

Facilitating biomedical researchers’ interrogation of electronic health record data: Ideas from outside of biomedical informatics

Electronic health records (EHR) are a vital data resource for research uses, including cohort identification, phenotyping, pharmacovigilance, and public health surveillance. To realize the promise of EHR data for accelerating clinical research, it is imperative to enable efficient and autonomous EHR data interrogation by end users such as biomedical researchers. This paper surveys state-of-art approaches and key methodological considerations to this purpose. We adapted a previously published conceptual framework for interactive information retrieval, which defines three entities: user, channel, and source, by elaborating on channels for query formulation in the context of facilitating end users to interrogate EHR data. We show the current progress in biomedical informatics mainly lies in support for query execution and information modeling, primarily due to emphases on infrastructure development for data integration and data access via self-service query tools, but has neglected user support needed during iteratively query formulation processes, which can be costly and error-prone. In contrast, the information science literature has offered elaborate theories and methods for user modeling and query formulation support. The two bodies of literature are complementary, implying opportunities for cross-disciplinary idea exchange. On this basis, we outline the directions for future informatics research to improve our understanding of user needs and requirements for facilitating autonomous interrogation of EHR data by biomedical researchers. We suggest that cross-disciplinary translational research between biomedical informatics and information science can benefit our research in facilitating efficient data access in life sciences.     

Approaches to verb subcategorization for biomedicine

Information about verb subcategorization frames (SCFs) is important to many tasks in natural language processing (NLP) and, in turn, text mining. Biomedicine has a need for high-quality SCF lexicons to support the extraction of information from the biomedical literature, which helps biologists to take advantage of the latest biomedical knowledge despite the overwhelming growth of that literature. Unfortunately, techniques for creating such resources for biomedical text are relatively undeveloped compared to general language. This paper serves as an introduction to subcategorization and existing approaches to acquisition, and provides motivation for developing techniques that address issues particularly important to biomedical NLP. First, we give the traditional linguistic definition of subcategorization, along with several related concepts. Second, we describe approaches to learning SCF lexicons from large data sets for general and biomedical domains. Third, we consider the crucial issue of linguistic variation between biomedical fields (subdomain variation). We demonstrate significant variation among subdomains, and find the variation does not simply follow patterns of general lexical variation. Finally, we note several requirements for future research in biomedical SCF lexicon acquisition: a high-quality gold standard, investigation of different definitions of subcategorization, and minimally-supervised methods that can learn subdomain-specific lexical usage without the need for extensive manual work.     

Primary and community health services in Newcastle upon Tyne--a joint statement of intent.

In the absence of a single primary health care authority (except in Scotland) district health authorities and family practitioner committees must cooperate in planning health services for the community. Equally, in the field, the potential for teamwork between salaried district health authority nursing staff and the independent general practitioners remains largely unrealized. Yet the government has restated its commitment to the development of primary health care teams as the best means of delivering health care in the community. In Newcastle upon Tyne the local medical committee and the community health services management team have set out their shared aspirations for future development in a joint 'Statement of intent'. This statement, since endorsed by the district health authority and family practitioner committee, includes a number of key principles as a basis for future joint working. These principles emanate from an understanding of the complementary nature of general practice and district health authority community services, and firmly support the primary health care team approach. This statement of intent could serve as a useful model for collaboration and planning of services elsewhere in the country.     

The SWAN biomedical discourse ontology

Developing cures for highly complex diseases, such as neurodegenerative disorders, requires extensive interdisciplinary collaboration and exchange of biomedical information in context. Our ability to exchange such information across sub-specialties today is limited by the current scientific knowledge ecosystem's inability to properly contextualize and integrate data and discourse in machine-interpretable form. This inherently limits the productivity of research and the progress toward cures for devastating diseases such as Alzheimer's and Parkinson's. SWAN (Semantic Web Applications in Neuromedicine) is an interdisciplinary project to develop a practical, common, semantically structured, framework for biomedical discourse initially applied, but not limited, to significant problems in Alzheimer Disease (AD) research. The SWAN ontology has been developed in the context of building a series of applications for biomedical researchers, as well as in extensive discussions and collaborations with the larger bio-ontologies community. In this paper, we present and discuss the SWAN ontology of biomedical discourse. We ground its development theoretically, present its design approach, explain its main classes and their application, and show its relationship to other ongoing activities in biomedicine and bio-ontologies.     

An interdisciplinary team communication framework and its application to healthcare 'e-teams' systems design

Background

There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS) to support those team processes. This was an exploratory study with two purposes: (1) To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2) To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication.

Methods

An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes.

Results

We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'.

Conclusion

The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.     

Consultation and interprofessional collaboration: modeling for the future

Consultation and interprofessional collaboration by psychologists occur with individuals, groups, programs, and organizations. The practice of consultation and interprofessional collaboration involves interdisciplinary relationships, preparation, and advanced skill development within specialty areas of psychology (e.g., clinical, counseling, industrial-organizational, and school). The Workgroup on Consultation and Interdisciplinary Relationships engaged in a planning process at the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology to address fundamental issues regarding consultation and interprofessional collaboration in professional psychology. The Workgroup articulated working definitions, consensus points about psychologists as consultants and interprofessional collaborators, a consulting and interprofessional competency blueprint for preparation and assessment strategies, and future directions. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

An enhancement of the Role-Based Access Control model to facilitate information access management in context of team collaboration and workflow

Although information access control models have been developed and applied to various applications, few of the previous works have addressed the issue of managing information access in the combined context of team collaboration and workflow. To facilitate this requirement, we have enhanced the Role-Based Access Control (RBAC) model through formulating universal constraints, defining bridging entities and contributing attributes, extending access permissions to include workflow contexts, synthesizing a role-based access delegation model to target on specific objects, and developing domain ontologies as instantiations of the general model to particular applications. We have successfully applied this model to the New York State HIV Clinical Education Initiative (CEI) project to address the specific needs of information management in collaborative processes. An initial evaluation has shown this model achieved a high level of agreement with an existing system when applied to 4576 cases (kappa = 0.801). Comparing to a reference standard, the sensitivity and specificity of the enhanced RBAC model were at the level of 97–100%. These results indicate that the enhanced RBAC model can be effectively used for information access management in context of team collaboration and workflow to coordinate clinical education programs. Future research is required to incrementally develop additional types of universal constraints, to further investigate how the workflow context and access delegation can be enriched to support the various needs on information access management in collaborative processes, and to examine the generalizability of the enhanced RBAC model for other applications in clinical education, biomedical research, and patient care.     

Integrating health and mental health services in schools: psychologists collaborating with primary care providers

This article reviews recent trends, developments and empirical support for the expansion of psychological practice to include school-based treatment and management of serious and chronic medical conditions, including somatization, in collaboration with primary health care providers. Trends and developments reviewed include (a) the expansion and integration of health, mental health, social and community services in schools, (b) the rapid growth of school-based health centers (SBHCs), (c) psychology's increased involvement in the collaborative treatment of chronic and serious medical disorders, (d) recent federal and state legislative initiatives, and (e) cost-driven marketplace changes. Lack of empirical data specific to collaborative psychologist-health care provider collaboration in schools and SBHCs, particularly around somatization, is discussed. Ethical and legal, professional, and reimbursement issues that must be addressed if psychologists are to practice in this emergent arena are identified. This article calls for research to document both the clinical effectiveness and cost-efficacy of collaborative psychologist-primary care provider intervention in schools and SBHCs.     

From page to stage: dramaturgy and the art of interdisciplinary translation

In recent years, interdisciplinary collaboration between artists and social scientists has received sustained interest from many members of the academic community. However, cross-disciplinary work is often more difficult than presumed. Epistemological and methodological differences between disciplines create barriers that may impede collaborative projects. This article explores some of the unique tensions and challenges that arose from the creation of ;After the Crash', a research-based theatre production about traumatic brain injury. Through the narrative lens of the project's dramaturg, we explore moments of interdisciplinary tension, and the possibility for the role of the dramaturg to build bridges between disparate methods of knowledge generation and translation.     

Knowledge construction from time series data using a collaborative exploration system

This paper deals with the exploration of biomedical multivariate time series to construct typical parameter evolution or scenarios. This task is known to be difficult: the temporal and multivariate nature of the data at hand and the context-sensitive aspect of data interpretation hamper the formulation of a priori knowledge about the kind of patterns that can be detected as well as their interrelations. This paper proposes a new way to tackle this problem based on a human–computer collaborative approach involving specific annotations. Three grounding principles, namely autonomy, adaptability and emergence, support the co-construction of successive abstraction levels for data interpretation. An agent-based design is proposed to support these principles. Preliminary results in a clinical context are presented to support our proposal. A comparison with two well-known time series exploration tools is furthermore performed.     

Tools for integrating women's health into medical education: clinical cases and concept mapping.

The authors describe two teaching tools, case-based learning and concept mapping, and how they support cross-disciplinary, multidisciplinary, and interdisciplinary learning, use a biopsychosocial model, and promote the integration of sex- and gender-based science into the medical curriculum. The process of case development at MCP Hahnemann University (MCPHU) is outlined in detail for a specific case. That case, which integrates three different components of women's health, is then presented in full. The authors then provide an example of a concept map dealing with women and alcohol use; the map defines current knowledge and serves as a blueprint for developing curricular goals and learning objectives for the topic. Properly constructed concept maps and cases help teach patient-centered approaches to problem solving, address sex- and gender-based differences in disease as well as in pathophysiology and pharmacology, integrate psychosocial issues-such as family dynamics, environmental stressors, access to health care, effective gender-based communication between patient and provider, and cultural variations-along with biomedical ones, and encourage a multidisciplinary approach to patient care. The authors maintain that these tools might be used to transform medical education by making it more integrated and interdisciplinary.     

Incorporating ideas from computer-supported cooperative work

Many information systems have failed when deployed into complex health-care settings. We believe that one cause of these failures is the difficulty in systematically accounting for the collaborative and exception-filled nature of medical work. In this methodological review paper, we highlight research from the field of computer-supported cooperative work (CSCW) that could help biomedical informaticists recognize and design around the kinds of challenges that lead to unanticipated breakdowns and eventual abandonment of their systems. The field of CSCW studies how people collaborate with each other and the role that technology plays in this collaboration for a wide variety of organizational settings. Thus, biomedical informaticists could benefit from the lessons learned by CSCW researchers. In this paper, we provide a focused review of CSCW methods and ideas-we review aspects of the field that could be applied to improve the design and deployment of medical information systems. To make our discussion concrete, we use electronic medical record systems as an example medical information system, and present three specific principles from CSCW: accounting for incentive structures, understanding workflow, and incorporating awareness.     

Collaboration in Psychopharmacotherapy

Collaboration in pharmacotherapy implies a professional willing to prescribe an effective medication and a patient willing to adhere to the therapeutic regimen in order for both to achieve their common goal. This relationship requires trust in the relationship, collaboration in goal setting, and effective means for promoting and restoring mental health. Variables like illness insight and patients’ attitudes towards medication should be dealt within a collaborative relationship. Several methods of shared decision making, culled from the research literature and clinical experience, promote such prescriber‐patient collaboration and, even more specifically, medication adherence. Detailed physician‐patient interactions in 2 cases, one of a depressed patient and one of a patient suffering from schizophrenia, serve to highlight common difficulties in the management of pharmacotherapy in the context of a collaborative relationship.