AMIA Board: specification of core competencies in Biomedical Informatics

In 1998 I launched a website called "Medical Informatics and Leadership of Clinical Computing" (now entitled "Contemporary Issues in Medical Informatics- Common Examples of Healthcare Information Technology Difficulties" at this link).

Its theme was that leadership of IT in healthcare was severely lacking in the formal competencies needed to reach any measure of success, and in fact the lack of informatics competencies in the usual IT actors was causing wasted resources and patient harm.

I had also commented that the term "Medical Informatics" itself was being misappropriated by anyone claiming to do anything with computers in medicine, even the creation of trivial and/or low-value programs.

Sadly, little has changed in that regard since 1998; in fact things are much worse.  The meaning of the term "Medical Informatics" itself has become severely blurred, and job listings that use the term are largely misguided.  They often seek a nurse (most common) or doctor (less common) without formal education in the domain, who's dabbled with hospital IT systems, to lead clinical IT projects.  This is a totally inappropriate and even dangerous approach (example here).

The American Medical Informatics Association has released a paper "AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline" that is long, long overdue.  As of this writing, full text is available a this link:  http://jamia.bmj.com/content/early/2012/06/07/amiajnl-2012-001053.full.

This paper certainly provides a robust affirmation of ONC's recommendations on healthcare IT leadership roles that I wrote of in my Oct. 2009 post "ONC Defines a Taxonomy of Robust Healthcare IT Leadership."

Some highlights of the new AMIA paper:

Abstract

The AMIA biomedical informatics (BMI) core competencies have been designed to support and guide graduate education in BMI, the core scientific discipline underlying the breadth of the field's research, practice, and education. The core definition of BMI adopted by AMIA specifies that BMI is ‘the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health.’ Application areas range from bioinformatics to clinical and public health informatics and span the spectrum from the molecular to population levels of health and biomedicine. The shared core informatics competencies of BMI draw on the practical experience of many specific informatics sub-disciplines. The AMIA BMI analysis highlights the central shared set of competencies that should guide curriculum design and that graduate students should be expected to master.

Note that Biomedical Informatics, which the Board feels is a broader term encompassing all of the information-science disciplines in healthcare and biomedical research, is defined as "a core scientific discipline underlying the breadth of the field's research, practice, and education."  One does not acquire expertise in a scientific discipline without first rigorously studying that discipline, e.g., as is done in medical school to gain optimal understanding of clinical medicine.

... The present articulation of BMI core competencies is intended to support AMIA and its members in promoting the discipline as a career choice, and to provide guidance to students and curriculum developers when choosing, designing (and implementing), or re-designing graduate-level academic BMI programs.

(Who needs graduate education in Biomedical Informatics when all that seems to be needed is a little on-the-job dabbling?)

... Defining BMI as the scientific core of a discipline that has broad applications across health and biomedicine highlights its foundational role and refutes the kind of reductionism that superficially explains BMI simply as the application of information technology (IT) to biomedical and health problems.

I termed that phenomenon "Medical Instamatics" on that late 1990's site.  Unfortunately, the "reductionism" is all too prevalent today.  People whose BMI education and skill levels (which I define as the ability to apply deep knowledge and experience to successfully manage the unexpected, not just manage traditional activities via a book of "process"), are often at the amateur level -- in the same sense that I am a radio amateur, not a telecommunications/engineering professional -- or worse.  This wreaks havoc (as here) in health IT, especially when led by senior management also incognizant of the issues.

Definition: Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, driven by efforts to improve human health.

Scope and breadth of discipline: BMI investigates and supports reasoning, modeling, simulation, experimentation, and translation across the spectrum from molecules to individuals and to populations, from biological to social systems, bridging basic and clinical research and practice and the healthcare enterprise.

Theory and methodology: BMI develops, studies, and applies theories, methods, and processes for the generation, storage, retrieval, use, management, and sharing of biomedical data, information, and knowledge.

Technological approach: BMI builds on and contributes to computer, telecommunication, and information sciences and technologies, emphasizing their application in biomedicine.

Human and social context: BMI, recognizing that people are the ultimate users of biomedical information, draws upon the social and behavioral sciences to inform the design and evaluation of technical solutions, policies, and the evolution of economic, ethical, social, educational, and organizational systems.

There is also a call for experts to:

• Acquire professional perspective: Understand and analyze the history and values of the discipline and its relationship to other fields while demonstrating an ability to read, interpret, and critique the core literature.

In effect, health IT amateurs, including those in traditional business computing, have little to no formal education or experience in reasoning, modeling, simulation, experimentation, and translation; developing, studying, and applying theories; building on and contributing to computer, telecommunication, and information sciences and technologies; and drawing upon the social and behavioral sciences to inform design of these complex systems.

BMI is the core scientific discipline that supports applied research and practice in several biomedical disciplines, including health informatics, which is composed of clinical informatics (including subfields such as medical, nursing, and dental informatics) and public health informatics (sometimes referred to more broadly as population informatics to capture its inclusion of global health informatics). There are related notions, such as consumer health informatics, which involves elements of both clinical and public health informatics. BMI in turn draws on the practical experience of the applied subspecialties, and works in the context of clinical and public health systems and organizations to develop experiments, interventions, and approaches that will have scalable impact in solving health informatics problems. However, it is the depth of informatics methods, shared across the spectrum from the molecular to the population levels that defines the core discipline of BMI and provides its coherence and its professional foundation for defining a common set of core competencies.

Here is the diagrammatic represention of the above in the full article:

Biomedical informatics and its areas of application and practice, spanning the range from molecules to populations and society

Finally, excerpts from the meat of the article on Prerequisite knowledge and skills.  This depth and breadth of knowledge does not come from studying business computing, dabbling with systems by nurses or physicians lacking formal domain education at the graduate level or beyond, or by guessing by the seat of one's pants:

• • Fundamental knowledge: Understand the fundamentals of the field in the context of the effective use of biomedical data, information, and knowledge. For example:
    • ... Healthcare: screening, diagnosis (diagnoses, test results), prognosis, treatment (medications, procedures), prevention, billing, healthcare teams, quality assurance, safety, error reduction, comparative effectiveness, medical records, personalized medicine, health economics, information security and privacy.
  • Procedural knowledge and skills: For substantive problems related to scientific inquiry, problem solving, and decision making, apply, analyze, evaluate, and create solutions based on biomedical informatics approaches.
    • Understand and analyze complex biomedical informatics problems in terms of data, information, and knowledge.
    • Apply, analyze, evaluate, and create biomedical informatics methods that solve substantive problems within and across biomedical domains.
    • Relate such knowledge and methods to other problems within and across levels of the biomedical spectrum.
• Theory and methodology: BMI develops, studies, and applies theories, methods, and processes for the generation, storage, retrieval, use, management, and sharing of biomedical data, information, and knowledge. All involve the ability to reason and relate to biomedical information, concepts, and models spanning molecules to individuals to populations:
  • Theories: Understand and apply syntactic, semantic, cognitive, social, and pragmatic theories as they are used in biomedical informatics.
  • Typology: Understand, and analyze the types and nature of biomedical data, information, and knowledge.
  • Frameworks: Understand, and apply the common conceptual frameworks that are used in biomedical informatics.
    • A framework is a modeling approach (eg, belief networks), programming approach (eg, object-oriented programming), representational scheme (eg, problem space models), or an architectural design (eg, web services).
  • Knowledge representation: Understand and apply representations and models that are applicable to biomedical data, information, and knowledge.
    • A knowledge representation is a method of encoding concepts and relationships in a domain using definitions that are computable (eg, first order logics).
  • Methods and processes: Understand and apply existing methods (eg, simulated annealing) and processes (eg, goal-oriented reasoning) used in different contexts of biomedical informatics.
• Technological approach: BMI builds on and contributes to computer, telecommunication, and information sciences and technologies, emphasizing their application in biomedicine.
  • Prerequisite knowledge and skills: Assumes familiarity with data structures, algorithms, programming, mathematics, statistics.
  • Fundamental knowledge: Understand and apply technological approaches in the context of biomedical problems. For example:
    • Imaging and signal analysis.
    • Information documentation, storage, and retrieval.
    • Machine learning, including data mining.
    • Networking, security, databases.
    • Natural language processing, semantic technologies.
    • Representation of logical and probabilistic knowledge and reasoning.
    • Simulation and modeling.
    • Software engineering.
  • Procedural knowledge and skills: For substantive problems, understand and apply methods of inquiry and criteria for selecting and utilizing algorithms, techniques, and methods.
• Human and social context: BMI, recognizing that people are the ultimate users of biomedical information, draws upon the social and behavioral sciences to inform the design and evaluation of technical solutions, policies, and the evolution of economic, ethical, social, educational, and organizational systems.
  • Prerequisite knowledge and skills: Familiarity with fundamentals of social, organizational, cognitive, and decision sciences.
  • Fundamental knowledge: Understand and apply knowledge in the following areas:
    • Design: for example, human-centered design, usability, human factors, cognitive and ergonomic sciences and engineering.
    • Evaluation: for example, study design, controlled trials, observational studies, hypothesis testing, ethnographic methods, field observational methods, qualitative methods, mixed methods.
    • Social, behavioral, communication, and organizational sciences: for example, computer supported cooperative work, social networks, change management, human factors engineering, cognitive task analysis, project management.
    • Ethical, legal, social issues: for example, human subjects, HIPAA, informed consent, secondary use of data, confidentiality, privacy.
    • Economic, social and organizational context of biomedical research, pharmaceutical and biotechnology industries, medical instrumentation, healthcare, and public health.
      
      
      
      

While nobody is an expert in all of these areas, skills in many of them are essential for successful and safety-promoting leadership in the health IT domain.

I repeat, this depth and breadth of knowledge does not come from studying business computing, dabbling with health IT, or by guessing by the seat of one's pants.  It comes about from rigorous education and experience in the appropriate domains at the graduate and (especially) post-doctoral levels.

Amateurs mistakenly put in leadership positions, and their organizations, are going to increasingly find themselves in legal hot water over mistakes in design and implementation that result in patient harm, security breaches, overbilling and other issues.

That is probably what it will take to have hospitals manage health IT talent more appropriately.

Finally, I plead guilty to tooting my own profession's horn.

Somebody needs to when the stakes are so high for patients.

-- SS

Summer Hair Care || Battling the Humidity

Summer is officially here and so is the humidity in certain regions of the world.  What does this mean for those who are stretching, transitioning, or natural?  Well, it could mean reversion, shrinkage, and frizz.  However, you can mitigate each of these unwanted effects by following the tips below:

1. Protective Style.  In my relaxed, transitioning, and now natural days, protective styling has been the number one weapon against summer humidity.  My go-to protective styles were and still are twists or braids because reversion, shrinkage, and frizz are minimized.

2. Work with your texture. Some ladies enjoy wearing their hair out during the summer, especially if they've spent the rest of the year in protective styles.  However, wearing the hair out can be an invitation to the unwanted effects of humidity.  One way to minimize those effects is to "work with your texture" via braidouts, twistouts, straw sets, or rod sets.  These styles are less likely to be ruined by the humidity than straighter styles (e.g., a fresh press) that are further from your actual texture.
-Tutorials on the strawset and cornrow-out
-Tips for maintaining twistouts

3. Embrace your texture.  Another way to combat humidity while wearing your hair loose is to simply "embrace your texture".  What does this mean?  It means wearing your hair in its natural state (e.g., a wash-n-go).  However, those with medium to long hair, especially those with kinks or tighter coils, should proceed with caution.  Wash-n-gos can create an environment conducive to tangles.  If you do have medium to long, Type 4 hair and would like to experiment with, read my earlier post on the Curly Girl Method on Type 4s.

4. Run from humectant-containing moisturizers.  Humectants (e.g., glycerin, propylene glycol, sorbitol) draw moisture from the air.  When applied to the hair which is then exposed to humidity, humectants will facilitate the processes of reversion, shrinkage, and frizz.  However, if your hair absolutely needs these ingredients in a moisturizer, then do not change your routine.  It is better to put healthy hair care before an anti-humidity technique any day.
-List of more humectants

5. Use a shine/smoothing serum.  If your hair fairs fine with silicones, then using a serum containing dimethicone is another method for battling the summer humidity.  Apply the serum to a fresh set of twists or braids or onto your out style (e.g., twistout or braidout).  Dimethicone will not only aid in taming any frizzies, but it will create a slight barrier against humidity.  NOTE: Because this silicone does not dissolve in water, it can lead to buildup with continued use.  Be sure to wash your hair with a shampoo containing any of the following surfactants in order to prevent this buildup: SLS, SLES, cocamidopropyl betaine, cocobetaine, ALS, or ALES (Source).


6. Wear a scarf.  Hair scarves are very much the trend this summer, and they can be useful for disguising hair that has suffered the effects of humidity.  Opt for silk or polyester (i.e., satin) scarves, which are both gentler on the hair than cotton.

For previous posts on summer hair & skin care:

Black Skin and Sunscreen

Chlorine and Summer Hair

Hair and Sun Damage

Type 4 Series: Curly Girl Method & Summer Hair

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How to Barbecue Healthier

{Image Source}

Here is an excerpt from an article geared towards healthier barbecuing:

"The key is to cut down on the greasy ribs and switch to lean cuts, which have a higher protein-to-fat ratio. Try flank steak. With only 176 calories per 4-ounce serving, flank is one of the leanest cuts at the meat counter, and it offers an impressive 24 grams of protein. "

To read the FULL article: Page 1, Page 2, Page 3.


For a previous post on summer eating: Summer Time Meals

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http://www.facebook.com/healthyhairandbody.

A Pressure Cooker for the 21st Century

Pressure cookers are an extremely useful kitchen tool.  They greatly speed cooking and reduce energy usage by up to 70 percent.  This is because as pressure increases, so does the boiling point of water, which is the factor that limits cooking speed in water-containing foods (most foods).  If it weren't for my pressure cooker, I'd rarely eat beets or globe artichokes.  Instead of baking, boiling or steaming these for 60-90 minutes, I can have them soft as butter in 30.  But let's face it: most people are intimidated by pressure cookers.  They fear the sounds, the hot steam, and the perceived risk of explosion.  I escaped this because I grew up around them.

Read more »

Administrators at Pepper Spray U Found to Have Violated Medical Professor's Academic Freedom

There they, the management of University of California - Davis, go again.

The Wilkes and Hoffman Op-Ed Questioning A University Sponsored Aggressive Prostate Cancer Screening Program

According to the Los Angeles Times, and a post in Inside Higher Ed, the trouble began when Dr Michael Wilkes, a professor of medicine at University of California - Davis, and Jerome Hoffman, a professor of emergency medicine, wrote an op-ed in the San Francisco Chronicle in 2010 questioning the wisdom of a program run by UC-Davis promoting aggressive screening for prostate cancer with the PSA test.  They brought up problems with using PSA for screening that have been known for a while, including the poor ability of the test to detect cancer, the inability of the test or of prostate biopsy performed in response to the test to differentiate aggressive prostate cancer from cancer that will not progress, which is more common, the risks of such biopsies, and the poor effectiveness of available prostate cancer treatments, compared with the frequency with which they produce harms.  All these issues have again been brought to the fore by US Preventive Services Taskforce's latest recommendations not to screen for prostate cancer, based on similar concerns.

Not only did Wilkes and Hoffman question the basis for the university sponsored program's aggressiveness, they speculated that it might have to do with money.  The program was sponsored not only by UC-Davis but by the American Urological Association Foundation.  In fact, that foundation's current corporate sponsors include:  Astellas Pharma, Inc., Endo Pharmaceuticals, Ferring Pharmaceuticals, Intuitive Surgical, Inc., Pfizer, Inc., and Qualigen, Inc., although the op-ed did not specifically list its commercial support.

The University Slap(p?)s Back

Nonetheless, per the Inside Higher Ed post,

Michael Wilkes received an e-mail from an administrator at the University of California at Davis. Wilkes, a professor at the medical school, was told that he would no longer lead a program sequence that taught better patient care, and support for a Hungarian student exchange program he headed would be withdrawn.

Within weeks, Wilkes was told that he would be removed as director of global health for the UC Davis Health System. He also received letters from the university’s health system counsel suggesting that the university could potentially sue him for defamation over the op-ed.

Again, this occurred despite the facts that many distinguished people have questioned the wisdom of aggressive prostate cancer screening, and that this particular prostate cancer program was supported by an organization that in turn is supported by money from pharmaceutical devices and drug companies that may stand to gain from selling drugs and devices related to screening for prostate cancer, and the diagnosis and treatment of such cancer. Wilkes and Hoffman were raising valid clinical and policy concerns about the public actions of a government-supported university, in my humble opinion.

Thus the university lawyer's apparent threat of defamation suits thus appears to be a SLAPP, a threat of strategic litigation against public participation. In California, a 1993 law provides recourse for people who have been threatened with SLAPPs (look here).

The Faculty Committee Responds

Regardless, Prof Wilkes filed an internal complaint, and again, per Inside Higher Ed,

Now, a committee on academic freedom at the university that investigated allegations of intimidation and harassment against Wilkes has found them to be true. The faculty committee said in its report, a copy of which was obtained by Inside Higher Ed, that the actions of the university administrators cast doubt on its ability to be a 'truthful and accountable purveyor of knowledge and services.'

The group has asked the dean and other top officials at the university’s school of medicine to write letters of apology to the professor, admit to errors of judgment, stop proposed disciplinary actions against him and take steps to prevent future violations of academic freedom. This week, representatives of the university’s Academic Senate are expected to vote on similar resolutions against the administrators.

Now, according to the LA Times,

The next step is up to campus Executive Vice Chancellor Ralph Hexter, who in consultation with Chancellor Linda P.B. Katehi is expected to decide by fall whether to impose any discipline on the medical school executives, campus officials said.

Good luck with that.

The Context at UC-Davis

I would be surprised if any such punishment occurs. After all, UC-Davis has a record of not tolerating dissent, but tolerating administrators who suppress such dissent.  We have previously discussed:
- How the UC-Davis police infamously pepper sprayed peaceful student demonstrators, apparently at least partially in response to Chancellor Katehi's vague orders to clear the campus (see post here).
- A subsequent report blamed this incident on incompetent, or worse leadership by Katehi's administration, but so far it is not obvious that this has lead to any changes (see post here).
- How UC-Davis adminstrators tried to punish a medical student who got in a dispute with an overly officious student who apparently was "monitoring" his actions on an email list server, apparently on behalf of the administration, invoking "professionalism" as if that meant blind obedience to academic administrators (see post here).

Furthemore, Chancellor Katehi has a record of her own relationships to industry.  Here we noted that she sits on the board of a large publishing conglomerate that includes a medical education and communication company (a MECC) as a subsidy.  So I suspect she may not rush to punish subordinate executives because they suppressed criticism of the role of commercial money in medical academics.

Summary

So UC-Davis seems to be another academic medical institution run by people more interested in bringing in commercial support than the academic medical mission, including the support of free speech and academic freedom.  Its case is another example of how leadership that seems hostile to the mission in one instance is likely to be hostile to the mission in other instances.

Here I summarized what I believe to be the real threats against professionalism in the academic medical context.  As we have said again and again, true health care reform would encourage leadership who understand the mission and will put its support ahead of financial concerns and ahead of their own self-interest.

See also posts in the Health News Review blog, and the University Diaries blog.

Protective Style Lookbook || Two Loc-Inspired Styles for Twists & Braids

By popular demand, this is a series showcasing various protective hair styles.  Protective styling does not have to be boring. :o)

**This segment contains two styles.**

Model: Francesca

Style description: Style #1 - formal faux hawk updo.  Style #2 - french braid wrap.

Difficulty level: Style #1 - 5/5. Style #2 - 4/5.

Formal Faux Hawk Updo:

French Braid Wrap:

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The UGLY Truth Behind Health and Fitness

By Stephanie of Infinite Life Fitness

When consulting and talking with people about health and fitness, I am able to hear excuses and other reasons why people give up or do not finish their health and fitness goals.

I guess people see and hear all kinds of motivation…but for some people that is not enough! They thought if they ran and ate right for a few weeks then…*TAH DAH* that body that those Victoria secret models rock will magically appear under their clothes. Well I have news for them…and for anyone else who needs a little tough love to help you with your health and fitness goals…

Reaching your goals is going to be HARD! No your results will not show up overnight. It is going to take days…weeks…and even MONTHS for you to finally start to see the effects of your hard work!

For most people, it takes almost a year for them to reach their goal or surpass it. This is including a possible relapse in eating right…skipping workouts for a few weeks at a time (due to crazy work schedules or other crazy life situations)…or having to get re-motivated with the goals that are set. For some people it will not take that long…but just as an average I would shoot for a solid year until you can sit down and say “YES! I have for sure reached my health and fitness goals”.

Getting healthy and fit is a lifestyle change! It is not a hobby or something you can do on the weekends. You have to commit 110% to your goals. That is eating right 7 days a week and sticking to the workouts you schedule for yourself.

Yes it will take some work, dedication, and tons of sweat. But looking and feeling like you want is worth all the hours you put into eating right and working out. It is a great idea to have motivational things to keep you going, but you will also need something to keep you going on those tough days that you do feel like you want to give up.

So the ugly truth…it will be hard….the road will be long…and yes some days you will want to make up a million excuses as to why you can’t work out or why you should have that piece of cheesecake. But, if you keep making these excuses and putting off your workouts you will not get the health and fitness goals that you set for yourself! No magic powder or pill…no fancy “I saw it on TV” machine or device…no obscene “this celebrity diet” ….or any other get slim quick trick will work! You have to put in the work and you have to have confidence that you are working hard. The results will be there if you work at it!

So my tough love lesson to you….STOP making the excuses…STOP letting people influence you away from your goals….MAKE time for your workouts….MAKE time for YOURSELF! That is the most important. Your health and fitness goals are a health and fitness journey for YOU and not for anyone else!

I hope this post did not scare anyone away from wanting to get healthier and more fit…but I like to put it all out on the table and be honest and upfront! I do not want to mislead anyone to think that getting fit is going to be easy because it is not always easy! Even for someone like me! I do have my down days but I also have found ways to get back motivated and dedicated to my health and fitness goals.

If you would like more health and fitness tips please feel free to check out my health and fitness blog at infinitelifefitness.com. For daily health and fitness topic follow me on Instagram @ ms4composure.