One of my favorite sessions at the AMIA conference each year is the selection of the top 10 events in health informatics for the year. For eight years, Daniel Masys, M.D., a professor at the University of Washington, presented the top 10. In 2014, William Hersh, M.D., and Joan Ash, Ph.D., of Oregon Health & Science University in Portland continued the tradition.
This year, I missed the Top 10 session because I was covering another meeting session, so last week I called Dr. Hersh, chair of OHSU’s Department of Medical Informatics and Clinical Epidemiology, and asked him to lead me through the top 10 choices and offer a few comments about why each of the 10 was chosen. In keeping with Dr. Masys’ tradition, the list of 10 is presented in David Letterman-style from least to most important.
10. Federation of State Medical Boards Telemedicine Licensing Template. “One of the issues with telemedicine is licensure across state boundaries,” Hersh said. There are various reciprocities but it is always a hassle, he added. “It is not clear in the 21st century why states need to be the boundaries of medical licensure. With telemedicine, what does it matter if you are across the street or halfway across the country? So I thought the creation of this template was significant. I am not sure if any states have adopted it yet.”
9. ICD-10 Delay. The fact that it was delayed for the third time in four years, and that some groups are asking Congress to delay it again until 2017 struck Hersh as significant. “The real issue lurking behind this is why are we coding medical records in this day and age?” he asked. “How important is that?”
8. Reproducibility of Research. Hersh noted that there was a study published in Nature by scientists about studies that could not be reproduced. “A lot of drug development happens from basic science studies. It raises the issues of clinical trials and how reproducible they are. NIH has started to think about what we need to do to ensure that research is reliable. They have funded grants around reproducibility.”
7. SAFER Guides. “In the early years we promoted EHRs as a way to improve, safety but there is a recognition now that we need to be careful about how we implement them so they don’t cause safety problems,” Hersh said. “The SAFER Guides provide a roadmap of how to do that sort of thing.”
6. Big Data/Data Analytics, and the NIH Big Data to Knowledge (BD2K) Funding. Hersh said he thought most people would agree that big data is becoming increasingly important, including NIH’s Big Data to Knowledge funding this year. “Now that we have very widespread adoption of electronic health records, we have all this data, including data coming out of gene-sequencing machines and web data.” Big data will continue to be an important “event” in years to come, he said.
5. Fast Health Interoperability Resource (FHIR) Standard. “I talk to people in the standards community who are used to having their work ignored, and now everyone realizes how critical interoperability is,” Hersh said. “We’ve achieved widespread adoption of EHRs, but now we have all these systems that cant talk to each other. FHIR isn’t going to come in and miraculously solve all these problems, but it is a step in the right direction in terms of being able to move basic types of data between systems.”
4. Delays and Difficulties with Meaningful Use Stage 2. “A lot of people say ONC should declare victory and end meaningful use,” Hersh said. The problem is a lot of the money was front-loaded. A good proportion of the HITECH dollars have been spent. Meaningful use was only taken seriously because of the money attached to it. The only thing left is penalties, which may or may not ever happen, he said. There has already been legislation introduced to get rid of the penalties. Other people have advocated that the disparate quality programs be rolled into one. “Stage 1 made a lot of sense, Stage 2 has been more difficult,” he said. “Who knows what is going to happen with Stage 3?”
3. PCORI Clinical Data Research Network Funding. The federal Patient-Centered Outcomes Research Institute funded 11 clinical data research networks that if successful will result in a lot of data that is accessible to researchers and others.
2. ONC Interoperabilty Roadmap, JASON Report, and JASON Task Force Report. "The whole ONC interoperability issue is really important and is reflected in several entries here, including the FHIR one at No. 5."