AMIA's code of professional and ethical conduct

Utilization of a Best Practice Alert (BPA) at Point-of-Care for Recruitment into a US-Based Autism Research Study

Provider referral is one of the most influential factors in research recruitment. To ease referral burden on providers, we adapted the Best Practice Alert (BPA) in the EPIC Electronic Health Record and assessed its utility in recruiting pediatric patients with autism spectrum disorder for the national SPARK study. During a year-long surveillance, 1203 (64.0%) patients were Interested in SPARK and 223 enrolled. Another 754 participants not recruited via the BPA also enrolled; 35.5% of these participants completed their participation compared to 58.3% of BPA-referred participants. Results suggest that (a) a BPA can successfully engage providers in the study-referral process and (b) families who learn about research through their providers may be more engaged and effectively retained.

Donald A. B. Lindberg: Inspiring Leader and Visionary in Biomedicine, Healthcare, and Informatics

Background: As Director of the US National Library of Medicine (NLM) for 30 years, Dr. Donald A. B. Lindberg was instrumental in bringing biomedical research and healthcare worldwide into the age of genomic and translational medicine through the informatics systems developed by the NLM. Lindberg opened free access and worldwide public dissemination of all the NLM's biomedical literature and databases, thus helping transform not only biomedical research like the Human Genome Project and its successors, but also the practices of medicine and healthcare internationally. Guiding, leading, and teaching-by-example at national, regional, and global levels of biomedical and healthcare informatics, Lindberg helped coalesce a dynamic discipline that provides a foundation for the human understanding which promotes the future health of our world.

Objectives: To provide historical insight into the scientific, technological, and practical clinical accomplishments of Donald Lindberg, and to describe how this led to contributions in the worldwide interdisciplinary evolution of informatics, and its impact on the biosciences and practices of medicine, nursing, and other healthcare-related disciplines.

Methods: Review and comment on the publications, scientific contributions, and leadership of Donald Lindberg in the evolution of biomedical and health informatics which anticipate the vision, scholarship, research in the field, and represent the deeply ethical humanism he exhibited throughout his life. These were essential in producing the informatics systems, such as the Unified Medical Language System (UMLS), MEDLINE, PubMed, PubMed Central, and ClinicalTrials.gov , which, together with NLM training programs and conferences, made possible the interactions among researchers and practitioners leading to the past quarter-century of rapid and dramatic advances in biomedical scientific inquiry and clinical discoveries, openly shared across the globe.

Conclusion: Dr. Lindberg was a uniquely talented physician and pioneering researcher in biomedical and health informatics. As the main leader in developing and funding innovative informatics research for more than 30 years as Director of the National Library of Medicine, he helped bring together the most creative interdisciplinary researchers to bridge the worlds of biomedical research, education, and clinical practice. Lindberg's emphasis on open-access to the biomedical literature through publicly shared computer-mediated methods of search and inquiry are seen as an example of ethical scientific openness.

AMIA Board White Paper: AMIA 2017 core competencies for applied health informatics education at the master's degree level

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master's level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.

Social Responsibility Practices of EHR Vendors: An Analysis of Disclosures in Annual Corporate Reports and Websites

Socially desirable outcomes within healthcare IT depend not only on the ethical behavior of individuals, but also on the actions and policies of large corporations. It is therefore important to have public accountability mechanisms that can be applied to corporations. The Sustainability Accounting Standards Board (SASB) publishes standards for assessing corporate transparency around ethical issues of broad public interest. The SASB standards and methodology were used to assess disclosures in the annual shareholder reports and websites of the top EHR vendors. The results showed a very low rate of meaningful disclosure.

Five Years of Clinical Informatics Board Certification for Physicians in the United States of America

Objectives:  To review the highlights of the new Clinical Informatics subspecialty including its history, certification requirements, development of and performance on the certification examination in the United States.

Methods:  We reviewed processes for the development of a subspecialty. Data from board certification examinations were collated and analyzed. We discussed eligibility requirements in the fellowship as well as practice pathways.

Results:  Lessons learned from the development of the Clinical Informatics subspecialty, opportunities, challenges, and future directions for the field are discussed.

Conclusions:  There remains a need for fellowship programs and creation and maintenance of a professional home for the subspecialty with the American Medical Informatics Association. Ongoing attention to the currency of the core content is required to maintain an examination designed to test the key concepts within the field of Clinical Informatics.

Evidence-based Health Informatics: How Do We Know What We Know?

Background: Health IT is expected to have a positive impact on the quality and efficiency of health care. But reports on negative impact and patient harm continue to emerge. The obligation of health informatics is to make sure that health IT solutions provide as much benefit with as few negative side effects as possible. To achieve this, health informatics as a discipline must be able to learn, both from its successes as well as from its failures.

Objectives: To present motivation, vision, and history of evidence-based health informatics, and to discuss achievements, challenges, and needs for action.

Methods: Reflections on scientific literature and on own experiences.

Results: Eight challenges on the way towards evidence-based health informatics are identified and discussed: quality of studies; publication bias; reporting quality; availability of publications; systematic reviews and meta-analysis; training of health IT evaluation experts; translation of evidence into health practice; and post-market surveil-lance. Identified needs for action comprise: establish health IT study registers; increase the quality of publications; develop a taxonomy for health IT systems; improve indexing of published health IT evaluation papers; move from meta-analysis to meta-summaries; include health IT evaluation competencies in curricula; develop evidence-based implementation frameworks; and establish post-marketing surveillance for health IT.

Conclusions: There has been some progress, but evidence-based health informatics is still in its infancy. Building evidence in health informatics is our obligation if we consider medical informatics a scientific discipline.

Orchestrating differential data access for translational research: a pilot implementation

Background

Translational researchers need robust IT solutions to access a range of data types, varying from public data sets to pseudonymised patient information with restricted access, provided on a case by case basis. The reason for this complication is that managing access policies to sensitive human data must consider issues of data confidentiality, identifiability, extent of consent, and data usage agreements. All these ethical, social and legal aspects must be incorporated into a differential management of restricted access to sensitive data.

Methods

In this paper we present a pilot system that uses several common open source software components in a novel combination to coordinate access to heterogeneous biomedical data repositories containing open data (open access) as well as sensitive data (restricted access) in the domain of biobanking and biosample research. Our approach is based on a digital identity federation and software to manage resource access entitlements.

Results

Open source software components were assembled and configured in such a way that they allow for different ways of restricted access according to the protection needs of the data. We have tested the resulting pilot infrastructure and assessed its performance, feasibility and reproducibility.

Conclusions

Common open source software components are sufficient to allow for the creation of a secure system for differential access to sensitive data. The implementation of this system is exemplary for researchers facing similar requirements for restricted access data. Here we report experience and lessons learnt of our pilot implementation, which may be useful for similar use cases. Furthermore, we discuss possible extensions for more complex scenarios.

Legal assessment tool (LAT): an interactive tool to address privacy and data protection issues for data sharing

BACKGROUND

In an unprecedented rate data in the life sciences is generated and stored in many different databases. An ever increasing part of this data is human health data and therefore falls under data protected by legal regulations. As part of the BioMedBridges project, which created infrastructures that connect more than 10 ESFRI research infrastructures (RI), the legal and ethical prerequisites of data sharing were examined employing a novel and pragmatic approach.

METHODS

We employed concepts from computer science to create legal requirement clusters that enable legal interoperability between databases for the areas of data protection, data security, Intellectual Property (IP) and security of biosample data. We analysed and extracted access rules and constraints from all data providers (databases) involved in the building of data bridges covering many of Europe's most important databases. These requirement clusters were applied to five usage scenarios representing the data flow in different data bridges: Image bridge, Phenotype data bridge, Personalised medicine data bridge, Structural data bridge, and Biosample data bridge. A matrix was built to relate the important concepts from data protection regulations (e.g. pseudonymisation, identifyability, access control, consent management) with the results of the requirement clusters. An interactive user interface for querying the matrix for requirements necessary for compliant data sharing was created.

RESULTS

To guide researchers without the need for legal expert knowledge through legal requirements, an interactive tool, the Legal Assessment Tool (LAT), was developed. LAT provides researchers interactively with a selection process to characterise the involved types of data and databases and provides suitable requirements and recommendations for concrete data access and sharing situations. The results provided by LAT are based on an analysis of the data access and sharing conditions for different kinds of data of major databases in Europe.

CONCLUSIONS

Data sharing for research purposes must be opened for human health data and LAT is one of the means to achieve this aim. In summary, LAT provides requirements in an interactive way for compliant data access and sharing with appropriate safeguards, restrictions and responsibilities by introducing a culture of responsibility and data governance when dealing with human data.