Dr. Smith is department head and clinical professor (E-Health), Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut.
Dr. Agresta is associate professor and director of medical informatics, Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.
Correspondence should be addressed to Dr. Smith, Department of Pharmacy Practice, UConn School of Pharmacy, 69 North Eagleville Rd., Unit 3092, Storrs, CT 06269-3092; telephone: (860) 486-2854; fax: (860) 486-8152; e-mail: email@example.com.
The recent national health care reform agenda and policy momentum around health information technology (HIT) adoption, implementation, and meaningful use has been loud, effusive, and somewhat unclear at times, but it continues to garner significant attention.1 As a maturing discipline, the health care and biomedical informatics communities are intensifying the debate over the defining terminologies for the field and the role delineation of personnel across academia, industry, biomedical research, and health care delivery systems.2,3
Most of the public discussions use broad-based terms such as HIT and E-Health with a focus on applied informatics and derivative tools. The academic world uses the terms health informatics or biomedical informatics to focus more on the development of knowledge and skills required to develop these tools. For the purposes of this discussion, HIT is the use of computers, technology, and the Internet for the complex information management and business aspects of health care delivery; E-Health is the application of HIT to improve access, efficiency, effectiveness, quality of clinical care, and the health status of patients; and health informatics and biomedical informatics are the disciplines that use information and technology to improve individual health, health care, public health, and biomedical research.
While HIT and E-Health are multistakeholder arenas, it is disheartening that so much of the direction and dialogue are coming from those with business, political, or advocacy interests, many of whom do not fully understand the implications associated with their advocacy. Several national HIT or E-Health strategy and advisory groups are occupied with those representing HIT vendors, transaction intermediaries, consultants, pharmaceutical companies, professional organizations, employer business groups, governmental agencies, large provider organizations, advocacy groups, and managed care/health care payers. At this time, few advocacy seats are filled with those who bring a nonbiased perspective, have led evaluations on the value of HIT for the improvement of patient care, or have overcome practice-based HIT adoption challenges.
The breadth of the E-Health landscape requires diverse and multidisciplinary expertise. So where are the perspectives of the primary care physician who is challenged with selecting an electronic health records (EHR) system that qualifies for federal or payer incentives, the pharmacist who is building comprehensive medication and adherence profiles for a health information exchange (HIE), the nurse who is using an EHR for discharge planning and coordination, the IT engineer who is configuring a statewide health exchange infrastructure, the attorney who is negotiating patient privacy policies, the hospital administrator who is designing a change management plan for an physician order entry installation, or the health services researcher who is examining legislative E-Health policy initiatives? Many of these individuals exist within academia and are actively pursuing research to demonstrate the impact and value of HIT on patient care and health care policy.
Other than a handful of academicians who are working at large, tertiary health science centers, why aren't more academic faculty members/health care professionals involved in state or national HIT/E-Health strategic policy or governance bodies? Because HIT and E-Health are still emerging domains and biomedical informatics is an evolving discipline, here are some plausible reasons:
* The earliest HIT and E-Health initiatives were led and nurtured by those with strong business interests (e.g., HIT consultants, vendors, business venture groups, pharmaceutical companies).
* Many health care academic institutions have not prioritized and allocated adequate resources for a distinct organizational unit with experts in health care or biomedical informatics.
* There is not a well-established cadre of health care professionals/faculty members with backgrounds or expertise in HIT or E-Health for appointments on national or state-level policy groups or strategic organizations.
* Academic scholarly initiatives in HIT and E-Health research have lagged behind because of limited, and often insufficient, external funding opportunities. Academicians are often not viewed as leaders and change agents by those in the HIT or E-Health business and policy communities.
Despite these plausible reasons, the academic community has a great deal of expertise to offer the diverse (and sometimes fragmented) E-Health and HIT efforts on the federal, state, and local levels. Here are some examples of ways for health care or biomedical informatics faculty members to achieve greater involvement at the local/state or regional level:
* convene a multistakeholder, invitational conference to bring together statewide leaders in HIT, E-Health, biomedical informatics, clinicians, and health care policy makers to address current professional, business, and policy opportunities and challenges with E-Health/HIT master plans, practice-level implementations, and regulatory/legislative initiatives;
* establish public–private partnerships to utilize shared human capital and funding resources to address HIT or E-Health challenges, policy relevance, or needed research topics;
* perform a needs assessment for HIT/E-Health educational programs and curricula for the current health care workforce, continuing education programs, and degree programs (undergraduate, graduate, professional);
* identify a practice-based translational research agenda for demonstration or pilot projects needed to accelerate state or regional HIT/E-Health agendas;
* leverage academic expertise in grantsmanship, research methods, and evaluation strategies that can produce highly competitive funding success for HIT/E-Health academic–community partnerships; and
* track legislative efforts and seek opportunities for involvement in local/state E-Health or HIT policy workgroups or governance organizations.
Some major academic health centers have strong health or biomedical informatics programs that incorporate community–academia partnerships. For example, Oregon Health & Science University has partnered with a local health care system to build strength in understanding clinical informatics and use of data, lead to better outcomes in health and safety, and facilitate change management in a hospital setting.4 At Indiana University School of Medicine, the Regenstrief Institute developed a citywide electronic medical records system that allows emergency department physicians, with the patient's permission, to view as a single virtual record all previous care at any of 18 participating hospitals.5 The Columbia University Department of Biomedical Informatics participates in a $30 million project with the New York City Department of Health and Mental Hygiene to improve primary care EHR adoption in primary care settings such as hospital clinics, correctional facilities, and community health centers.6 The University of Washington's Center for Public Health Informatics is evaluating the effectiveness of current and novel message delivery systems and communication methods between state public health agencies and health care providers for emergency preparedness and response.7
These prototypical partnerships in E-Health and biomedical informatics should be occurring at most public universities—driven by their academic, scientific, and community engagement missions (including state workforce development responsibilities to train future health care professional and health informatics leaders). In addition, abundant opportunities exist for academicians to become active participants in public forums on E-Health and HIT—especially those with educational, research, and policy initiatives. The American Medical Informatics Association has an Academic Forum comprising informatics professionals responsible for the leadership and excellence of informatics educational training and research programs. Some health care professional societies have formed informatics sections/interest groups.
We have seen increased funding through the American Recovery and Reinvestment Act and the Agency for Healthcare Research and Quality, as well as multiple governmental (federal and state-level) policy initiatives. Several states have developed E-Health/HIT strategic plans that list academia as a stakeholder to implement these plans. Health care academic institutions (especially public universities) should form health/biomedical informatics organizational units or revisit the mission of an existing unit to ensure that all opportunities for partnering in educational, research, and policy initiatives are being fully realized.
So, academia, what are you waiting for? Form multidisciplinary collaborations with academic colleagues, build public–private partnerships, and advance the E-Health/HIT/health informatics agenda for better patient care.