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Top Ten Informatics Events of 2008

December 29, 2008
by Joe Bormel
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Top Ten Informatics Events of 2008

Daniel Masys and AMIA publish their Year in Review

Last month, at the 2008 AMIA annual meeting in DC, Dr Dan Masys presented his annual Year-in-Review. In case you missed it, he often is invited to present it at the subsequent HIMSS. He reviews the most notable publications and events; It seemed reasonable to share it as we all contemplate what 2008 meant for us.

Here's the link and those top ten notable events:

AMIA Informatics 2008 Year in Review

Notable Events

#10 –

Personal Genome Project data available, October 2008

#9 –

ONC Strategic Plan published

#8 –

Massachusetts joins Nevada in requiring encryption of person identifiable data

#7 –

Exchange of clinical data using HITSP standards orchestrated by ONC, Sept 23.2008

#6 – AMIA organizes Rockefeller Global eHealth conference

#5 -

CMS Medicare Improvements Act of 2008 pays more for e-prescribing

#4 – Explosion of molecular data

#3 -

FDA Sentinel Initiative launched

#2 –

NIH Public Access policy becomes mandatory

#1 –

Obama wins Presidency on platform including $50B for EMR infrastructure

This is an excellent list and the links are very effective. If anyone is interested in elaboration of any of them, I did take notes at Dan's presentation which I can share here. Incidently, in the link and in the presentation, Dan is very clear in his criteria for what made it into the

Review. It includes literature as well as a well qualified social network.

It was nice to see that the list included all of the topics covered in the HCI blogs over the same time period. So, Kudos to the HCI bloggers, and to AMIA, for once again demonstrating leadership in bringing the important issues to everyone's attention.

Does anyone notice any important events that aren't included?




Thanks again for your highly thoughtful observations.  I appreciate your insights as well as your passion!

I've taken the liberty to indent and re-color your pasted sections, to make it easier for other readers (and me) to scan, parse and read.  I've also called out some other pivotal comments with some combination of Color/Bold/Italic/Underline.  Lastly, I added a link to WSJ article, Orszag's Warning, as a courtesy/convenience for our readers.

My reaction to the authors of the AMIA list, Dan and fellows who provided input was less critical, given his audience and goals.  I think that Dan was pointing out that, to quote Rodney Dangerfield, for an organization and topic that often 'gets no respect' (we're talking about Informatics here,) it was a notable event that EMR infrastructure made it to the prioritized list of topics of presidential campaign messaging.

If that's what Dan and, by extension, AMIA meant, than he's right, it could be a #1 event winner for 2008.

To your points, 'Messaging' by itself is impotent.  Further, as you clearly elaborated, strategy is important, but without a good plan, it's "the noise before defeat."

I agree with you that 'Orszag's Health Warning' is highly worthy for review.  We talk all of the time about ROI.  By my read, Peter Orszag (head of the Congressional Budget Office. CBO ) and the CBO itself evaluated 115 reform options and used real data to score them.  Actually, that's scoring the Bills containing the proposed scenarios.  He's now Barack Obama's budget director.

The article states the there are difficult trade-offs and:

"CBO also finds that programs designed to trim costs, such as health information technology or comparative effectiveness research, will produce only modest savings."

"... even Democrats concede that their new health programs will cost $150 billion or even $200 billion per year. The real numbers will be higher."

In summary, I think you made your point well, i.e. we don't seem to have elaborated a solid strategy, plan and quantified options (i.e. a model and ideally, a simulation) for how to reform the Healthcare system.  If Health Care Informatics Technology is to play a role, we all, including AMIA need to bring the sobriety you described.  To AMIA's credit, they've done a great job of providing educational leadership, through their meetings, publication, and campaigns like 10x10.  The disappointments some have with AMIA are the same that you are articulating:  We share a grand vision; the gap with execution is broad, complicated, and painful.

Thanks for providing the "Notable Events" list from AMIA. Although the majority of the top 10 offer concrete accomplishments we can all get our arms around and make perfect sense, two are glaringly inconsistent.

The first of these is listed as #9, "ONC Strategic Plan published." Here, nothing of real substance occurred in 2008, and it's simply not notable that what appears to be a seriously flawed plan was published last year.

To make my point, this so-called plan consists of 43 separate strategies! What? In ONC's own opening section,

"The goals, objectives, and strategies of the Plan portray the totality of what must be done, in a coordinated manner distributed across the federal government, to achieve an interoperable health IT infrastructure for the nation in support of patient-focused health care and population health.

There is no overall strategic goal? The word "strategy" and its derivatives is way over used, coupled with the usual government speak, throughout the plan that the verbiage brings the document's credibility into question. The following two paragraphs are also contained in the opening section of the plan.

"Consistent with ONC's mission and role, the Plan is not limited to the activities and tasks that ONC directly sponsors. This Plan is primarily federally focused with many of the strategies proposed in the Plan designed to harmonize activities in the public and private sectors. This approach is designed to ensure that federal resources allocated to health IT, while supporting the individual and distinct missions of the Departments, are also positioned to realize maximum benefit for the nation as a whole.

In developing the Plan, ONC worked with other federal agencies to solicit input and assure that the full breadth of federal activity was reflected. ONC will periodically update the Plan and actively engage other federal agencies in re-evaluating the strategic objectives and strategies, and in tracking progress toward these goals and objectives."

ONC plans to, with other federal agencies, "re-evaluate the strategic objectives and strategies?" Does anyone there understand how to structure a plan? Developing a strategy with a realistic strategic goal would be a good start. Then set tactical objectives that that serve as incremental steps to achieve the goal, and to provide lessons learned that will enable the tactics to better support the strategy over time. Does anyone in ONC know anything about tactics, that not everything is strategic, nor can it be so to succeed?

It seems to me that this plan can be best characterized as "off we go into the wild blue quagmire." But space is limited, so let's move on.

The other event I question is listed as #1, "Obama wins Presidency on platform including $50B for EMR infrastructure." In the overall scheme of newsworthy events, Senator Obama's election was arguably the year's most notable event. And I think it's safe to say we can all use some change and relief from the current administration. But in terms of healthcare, and particularly healthcare IT, the Obama platform is, at this time, nothing more than political rhetoric . . . as are all platforms. In reality, his election itself is the only thing that's notable.

Members of the president-elect's own team have already been quoted as saying that many of our new president's proposals (including funding healthcare IT initiatives) may need to be postponed so the new administration can focus on curing the nation's economic crisis. Postponed for how long? No one knows. But in terms of healthcare, many programs may never come to fruition.

I suggest reading an article in the December 29 edition of the WSJ entitled, "Orszag's Health Warning."   Peter Orszag is the former head of the Congressional Budget Office, and under his leadership CBO research a couple of important reports concerning healthcare financing that seem to put funding changes, and even some existing programs, into perspective.

Taking just potentially new programs into consideration, including programs similar to those proposed by the incoming administration, according to CBO, would result in costs so staggering they could annually match the initial bailout for the current recession. Note, these would be reoccurring, annual costs! Further, CBO found, according to the article, "that programs designed to trim costs, such as health information technology or comparative effectiveness research, will produce only modest savings."

These CBO reports are significant in-and-of themselves. But of equal importance is that Peter Orszag will soon be spending his days in the White House, serving as Mr. Obama's budget chief. This would lead one, at least this one, to think that the healthcare plank of the platform may be heading for the sawmill.

What the ONC Plan shows me is that Mr. Obama's administration needs to core the Office like an apple and start over at the top. That's a notable realistic strategic goal that makes sense. As for our new president, I for one look forward to seeing him implement change, but I don't believe his election is a notable event for a list entitled, "AMIA Informatics 2008 Year in Review."