Learning health systems need to bridge the ‘two cultures’ of clinical informatics and data science

Philip Scott, Rachel Dunscombe, David Evans, Mome Mukherjee, Jeremy Wyatt

Abstract


Background

 

UK health research policy and plans for population health management are predicated upon transformative knowledge discovery from operational “Big Data”. Learning health systems require not only data, but feedback loops of knowledge into changed practice. This depends on knowledge management and application, which in turn depend upon effective system design and implementation. Biomedical informatics is the interdisciplinary field at the intersection of health science, social science and information science and technology that spans this entire scope.

 

Issues

 

In the UK, the separate worlds of health data science (bioinformatics, “Big Data”) and effective healthcare system design and implementation (clinical informatics, “Digital Health”) have operated as ‘two cultures’. Much NHS and social care data is of unusably poor quality. Substantial research funding is wasted on ‘data cleansing’ or by producing very weak evidence. There is not yet a sufficiently powerful professional community or evidence base of best practice to influence the practitioner community or the digital health industry.

 

Recommendation

 

The UK needs increased clinical informatics research and education capacity and capability at much greater scale and ambition to be able to meet policy expectations, address the fundamental gaps in the discipline’s evidence base and mitigate the absence of regulation.Independent evaluation of digital health interventions should be the norm, not the exception.

 

Conclusions

 

Policy makers and research funders need to acknowledge the existing gap between the ‘two cultures’ and recognise that the full social and economic benefits of digital health and data science can only be realised by accepting the interdisciplinary nature of biomedical informatics and supporting a significant expansion of clinical informatics capacity and capability.


Keywords


Big Data; health informatics; bioinformatics; biomedical informatics; evidence-based practice; health policy; programme evaluation; education; learning health systems

Full Text:

PDF HTML

References


Snow CP. The Two Cultures and the Scientific Revolution. The Rede Lecture, 1959. Cambridge, UK: University Press, 1959.

Scott P, Bentley S, Carpenter I, Harvey D, Hoogewerf J, Jokhani M, et al. Developing a conformance methodology for clinically-defined medical record headings: a preliminary report. European Journal for Biomedical Informatics 2015;11(2):23–30.

Burnett S, Franklin BD, Moorthy K, Cooke MW and Vincent C. How reliable are clinical systems in the UK NHS? A study of seven NHS organisations. BMJ Quality & Safety 2012;21(6):466–72. Available from: https://doi.org/10.1136/bmjqs-2011-000442. PMid:22495099; PMCid:PMC3355340.

Koppel R. The health information technology safety framework: building great structures on vast voids. BMJ Quality & Safety 2016;25(4):218–20. Available from: https://doi.org/10.1136/bmjqs-2015-004746. PMid:26584580.

NHS England. Global digital exemplars. 2018. Available from: https://www.england.nhs.uk/digitaltechnology/info-revolution/exemplars/. Accessed 26 March 2018.

Mukherjee M, Wyatt JC, Simpson CR and Sheikh A. Usage of allergy codes in primary care electronic health records: a national evaluation in Scotland. Allergy 2016;71(11):1594–602. Available from: https://doi.org/10.1111/all.12928. PMid:27146325.

Jordan K, Porcheret M and Croft P. Quality of morbidity coding in general practice computerized medical records: a systematic review. Family Practice 2004;21(4):396–412. Available from: https://doi.org/10.1093/fampra/cmh409. PMid:15249528.

Tate AR, Dungey S, Glew S, Beloff N, Williams R and Williams T. Quality of recording of diabetes in the UK: how does the GP’s method of coding clinical data affect incidence estimates? Cross-sectional study using the CPRD database. BMJ Open 2017;7(1):e012905. Available from: https://doi.org/10.1136/bmjopen-2016-012905. PMid:28122831; PMCid:PMC5278252.

Kyriacou DN and Lewis RJ. Confounding by indication in clinical research. JAMA 2016;316(17):1818–9. Available from: https://doi.org/10.1001/jama.2016.16435. PMid:27802529.

Mukherjee M, Stoddart A, Gupta RP, Nwaru BI, Farr A, Heaven M, et al. The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases. BMC Medicine 2016;14(1):113. Available from: https://doi.org/10.1186/s12916-016-0657-8. PMid:27568881; PMCid:PMC5002970.

KLAS. What is the Arch Collaborative? KLAS Research [electronic document]. 2017. Available from: https://klasresearch.com/usability-studies.

Koppel R. Illusions and delusions of cut, pasted, and cloned notes: ephemeral reality and pixel prevarications. Chest 2014;145(3):444–5. Available from: https://doi.org/10.1378/chest.13-1846.

Kulikowski CA, Shortliffe EH, Currie LM, Elkin PL, Hunter LE, Johnson TR, et al. AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline. Journal of the American Medical Informatics Association 2012;19(6):931–8. Available from: https://doi.org/10.1136/amiajnl-2012-001053. PMid:22683918; PMCid:PMC3534470.

AMIA. Health Informatics Core Competencies for CAHIIM [electronic document]. 2017. Available from: https://www.amia.org/sites/default/files/AMIA-Health-Informatics-Core-Competencies-for-CAHIIM.PDF. Accessed 26 March 2018.

Coiera E. Guide to Health Informatics, 2nd edition. Abingdon, UK: CRC press, 2003. Available from: https://doi.org/10.1201/b13618.

Heathfield HA and Wyatt J. The road to professionalism in medical informatics: a proposal for debate. Methods of Information in Medicine 1995;34(5):426–33. Available from: https://doi.org/10.1055/s-0038-1634627.

Friedman CP, Rubin JC and Sullivan KJ. Toward an Information Infrastructure for Global Health Improvement. Yearbook of Medical Informatics 2017;26(1):16–23. Available from: https://doi.org/10.15265/IY-2017-004. PMid:28480469.

Rouse WB, Johns MME and Pepe KM. Learning in the health care enterprise. Learning Health Systems 2017;1(4):e10024. Available from: https://doi.org/10.1002/lrh2.10024.

ONC. A 10-year vision to achieve an interoperable health IT infrastructure [electronic document]. 2014. Available from: https://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf. Accessed 17 April 2018.

NHS England. NHS digital academy. 2017. Available from: https://www.england.nhs.uk/digitaltechnology/info-revolution/nhs-digital-academy/. Accessed 26 March 2018.

Health Education England. Building a digital ready workforce. 2018. Available from: https://hee.nhs.uk/our-work/building-digital-ready-workforce. Accessed 26 March 2018.

Faculty of Clinical Informatics. Safe, effective and efficient healthcare achieved through the best use of information and information technology. 2018. Available from: https://www.facultyofclinicalinformatics.org.uk/. Accessed 26 March 2018.

De Lusignan S, Barlow J and Scott PJ. Genesis of a UK Faculty of Clinical Informatics at a time of anticipation for some, and ruby, golden and diamond celebrations for others. Journal of Innovation in Health Informatics 2018;24(4):344–6. Available from: https://doi.org/10.14236/jhi.v24i4.1003. PMid:29334353.

NHS England. Academic health science networks. 2018. Available from: https://www.england.nhs.uk/ourwork/part-rel/ahsn/. Accessed 26 March 2018.

The University of Edinburgh. Global digital exemplar programme evaluation. 2018. Available from: https://www.ed.ac.uk/usher/digital-exemplars. Accessed 26 March 2018.

Farenden J and Singh I. Local Health and Care Record Exemplars. Invitation to Participate. UK; NHS England, 2018.

Haux R, Kulikowski CA, Bakken S, de Lusignan S, Kimura M, Koch S, et al. Research strategies for biomedical and health informatics. Some thought-provoking and critical proposals to encourage scientific debate on the nature of good research in medical informatics. Methods of Information in Medicine 2017;56:e1–10. Available from: https://doi.org/10.3414/ME16-01-0125. PMCid:PMC5388922.

Reis ZSN, Maia TA, Marcolino MS, Becerra-Posada F, Novillo-Ortiz D and Ribeiro ALP. Is there evidence of cost benefits of electronic medical records, standards, or interoperability in hospital information systems? Overview of systematic reviews. JMIR Medical Informatics 2017;5(3):e26. Available from: https://doi.org/10.2196/medinform.7400. PMid:28851681; PMCid:PMC5596299.

Dranove D, Forman C, Goldfarb A and Greenstein S. The Trillion Dollar Conundrum: Complementarities and Health Information Technology. US National Bureau of Economic Research Working Paper Series, No. 18281, 2012.

Friedberg MW, Chen PG, Van Busum KR, Aunon F, Pham C, Caloyeras J, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Quarterly 2014;3(4):1. PMid:28083306; PMCid:PMC5051918.

Hill RG Jr, Sears LM and Melanson SW. 4000 clicks: a productivity analysis of electronic medical records in a community hospital ED. The American Journal of Emergency Medicine 2013;31(11):1591–4. Available from: https://doi.org/10.1016/j.ajem.2013.06.028. PMid:24060331.

Heponiemi T, Hypponen H, Vehko T, Kujala S, Aalto AM, Vanska J, et al. Finnish physicians’ stress related to information systems keeps increasing: a longitudinal three-wave survey study. BMC Medical Informatics and Decision Making 2017;17(1):147. Available from: https://doi.org/10.1186/s12911-017-0545-y. PMid:29041971; PMCid:PMC5646125.

Kash BA, Baek J, Davis E, Champagne-Langabeer T and Langabeer JR 2nd. Review of successful hospital readmission reduction strategies and the role of health information exchange. International Journal of Medical Informatics 2017;104:97–104. Available from: https://doi.org/10.1016/j.ijmedinf.2017.05.012. PMid:28599821.

Rigby M, Georgiou A, Hypponen H, Ammenwerth E, de Keizer N, Magrabi F, et al. Patient portals as a means of information and communication technology support to patient-centric care coordination—the missing evidence and the challenges of evaluation. A joint contribution of IMIA WG EVAL and EFMI WG EVAL. Yearbook of Medical Informatics 2015;10(1):148–59. Available from: https://doi.org/10.15265/IY-2015-007. PMid:26123909; PMCid:PMC4587055.

Ammenwerth E, Nykanen P, Rigby M and de Keizer N. Clinical decision support systems: need for evidence, need for evaluation. Artificial Intelligence in Medicine 2013;59(1):1–3. Available from: https://doi.org/10.1016/j.artmed.2013.05.001. PMid:23810731.

Marcilly R, Peute L and Beuscart-Zephir MC. From usability engineering to evidence-based usability in health IT. Studies in Health Technology and Informatics 2016;222:126–38. PMid:27198098.

Turner P, Kushniruk A and Nohr C. Are we there yet? Human factors knowledge and health information technology—the challenges of implementation and impact. Yearbook of Medical Informatics 2017;26(1):84–91. Available from: https://doi.org/10.15265/IY-2017-014. PMid:29063542.

Coiera E, Ash J and Berg M. The unintended consequences of health information technology revisited. Yearbook of Medical Informatics 2016;10(1):163–9. Available from: https://doi.org/10.15265/IY-2016-014. PMid:27830246; PMCid:PMC5171576.

Schiff GD, Amato MG, Eguale T, Boehne JJ, Wright A, Koppel R, et al. Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems. BMJ Quality & Safety 2015;24(4):264–71. Available from: https://doi.org/10.1136/bmjqs-2014-003555. PMid:25595599; PMCid:PMC4392214.

Amato MG, Salazar A, Hickman TT, Quist AJ, Volk LA, Wright A, et al. Computerized prescriber order entry-related patient safety reports: analysis of 2522 medication errors. Journal of the American Medical Informatics Association 2017;24(2):316–22. PMid:27678459.

Cresswell KM, Bates DW, Williams R, Morrison Z, Slee A, Coleman J, et al. Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two ‘early adopter’ hospitals. Journal of the American Medical Informatics Association 2014;21(e2):e194–202. Available from: https://doi.org/10.1136/amiajnl-2013-002252. PMid:24431334; PMCid:PMC4173168.

Thomas M. Making Software Correct by Construction. Oxford, UK: Gresham College, 2017.

Ammenwerth E and Rigby M (Eds). Evidence-Based Health Informatics. Amsterdam, Netherlands: IOS Press, 2016.

Wyatt JC. Evidence-based Health Informatics and the Scientific Development of the Field. Studies in Health Technology and Informatics 2016;222:14–24. PMid:27198088.

Sheikh A, Atun R and Bates DW. The need for independent evaluations of government-led health information technology initiatives. BMJ Quality & Safety 2014;23(8):611–3. Available from: https://doi.org/10.1136/bmjqs-2014-003273. PMid:24950693.

Scott P. Exploiting the information revolution: call for independent evaluation of the latest English national experiment. Journal of Innovation in Health Informatics 2015;22(1):244–9. Available from: https://doi.org/10.14236/jhi.v22i1.139. PMid:25924557.

Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005;293(10):1223–38. Available from: https://doi.org/10.1001/jama.293.10.1223. PMid:15755945.




DOI: http://dx.doi.org/10.14236/jhi.v25i2.1062

Refbacks

  • There are currently no refbacks.


This is an open access journal, which means that all content is freely available without charge to the user or their institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal starting from Volume 21 without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open accessFor permission regarding papers published in previous volumes, please contact us.

Privacy statement: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.

Online ISSN 2058-4563 - Print ISSN 2058-4555. Published by BCS, The Chartered Institute for IT