Commentaries on “Informatics and Medicine: From Molecules to Populations”

R. B. Altman; R. Balling; J. F. Brinkley; E. Coiera; F. Consorti; M. A. Dhansay; A. Geissbuhler; W. Hersh; S. Y. Kwankam; N. M. Lorenzi; F. Martin-Sanchez; G. I. Mihalas; Y. Shahar; K. Takabayashi; G. Wiederhold

doi:10.1055/s-0038-1627413

Methods of Information in Medicine, Table of Contents

Methods Inf Med 2008; 47(04): 296-317
DOI: 10.1055/s-0038-1627413

Original Article

Schattauer GmbH

Commentaries on “Informatics and Medicine: From Molecules to Populations”

R. B. Altman

¹Stanford University, Stanford, CA, USA

,

R. Balling

²Helmholtz Centre for Infection Research, Braunschweig, Germany

,

J. F. Brinkley

³University of Washington, Seattle, WA, USA

,

E. Coiera

⁴University of New South Wales, Sydney, NSW, Australia

,

F. Consorti

⁵University of Rome “Sapienza”, Rome, Italy

,

M. A. Dhansay

⁶South African Medical Research Council, Cape Town, South Africa

,

A. Geissbuhler

⁷Geneva University and University Hospitals, Geneva, Switzerland

,

W. Hersh

⁸Oregon Health and Science University, Portland, OR, USA

,

S. Y. Kwankam

⁹World Health Organization, Geneva, Switzerland and University of Yaounde I, Cameroon

,

N. M. Lorenzi

¹⁰Vanderbilt University, Nashville, TN, USA

,

F. Martin-Sanchez

¹¹Institute of Health “Carlos III”, Madrid, Spain

,

G. I. Mihalas

¹²Victor Babes University of Medicine and Pharmacy, Timisoara, Romania

,

Y. Shahar

¹³Ben Gurion University, Beer Sheva, Israel

,

K. Takabayashi

¹⁴Chiba-University, Chiba, Japan

,

G. Wiederhold

¹Stanford University, Stanford, CA, USA

› Author Affiliations

Abstract

Summary

Objective: To discuss interdisciplinary research and education in the context of informatics and medicine by commenting on the paper of Kuhn et al. “Informatics and Medicine: From Molecules to Populations”.

Method: Inviting an international group of experts in biomedical and health informatics and related disciplines to comment on this paper.

Results and Conclusions: The commentaries include a wide range of reasoned arguments and original position statements which, while strongly endorsing the educational needs identified by Kuhn et al., also point out fundamental challenges that are very specific to the unusual combination of scientific, technological, personal and social problems characterizing biomedical informatics. They point to the ultimate objectives of managing difficult human health problems, which are unlikely to yield to technological solutions alone. The psychological, societal, and environmental components of health and disease are emphasized by several of the commentators, setting the stage for further debate and constructive suggestions.

Keywords

Medical informatics - biomedical informatics - health informatics - interdisciplinarity

Full Text

References

References
1 Kuhn KA, Knoll A, Mewes HW, Schwaiger M. et al. Informatics and medicine: from molecules to populations. Methods Inf Med 2008; 47: 283-295.
2 Kuhn TS. The Structure of Scientific Revolutions. Chicago: Univ of Chicago Press; 1962
3 Hartwell LH, Hopfield JJ, Leibler S, Murray AW. From molecular to modular cell biology. Nature 1999; 402 6761 Suppl C47-52.
4 Butte AJ, Chen R. Finding disease-related genomic experiments within an international repository: first steps in translational bioinformatics. AMIA Annu Symp Proc 2006; pp 106-110.
5 Blois MS. Medicine and the nature of vertical reasoning. N Engl J Med 1988; 318: 847-851.
6 Tsafnat G. The Field Representation Language. J Biomed Inform 2008; 40: 46-57.
7 Coiera E. Guide to Health Informatics. 2nd Edition. London: Hodder Arnold; 2003
8 Berg M, Langenberg C, v d Berg I, Kwakkernaat J. Considerations for sociotechnical design: experiences with an electronic patient record in a clinical context. Int J Med Inform 1998; 52: 243-251.
9 Coiera E. When conversation is better than computation. J Am Med Inform Assoc 2000; 7: 277-286.
10 Latour BWS, Salk J. Laboratory Life: The Construction of Scientific Facts. Princeton, NJ: Princeton University Press; 1986
11 Ash JS, Anderson NR, Tarczy-Hornoch P. People and Organizational Issues in Research Systems Implementation. J Am Med Inform Assoc. 2008; 15: 283-289.
12 Trist EL. The evolution of sociotechnical systems as a conceptual framework and as an action research program. In: Van de Ven AH, Joyce WF. editors. Perspectives on organization design and behavior. New York: John Wiley, Wiley-Interscience; 1981. pp 19-75.
13 Coiera E. Getting technical about socio-technical systems science. Int J Med Inform 2007; 76: S98-S103.
14 Stephens J. Retelling stories, framing culture: traditional story and metanarratives in children’s literature. New York: Routledge Publ.; 1998
15 Lindemann Nelson H. Damaged identities, narrative repair. Ithaca, NY: Cornell Univ. Press; 2001
16 Roesler C. The self in cyberspace. Identity formation in postmodern societies and Jung’s Self as an objective psyche. J Anal Psychol 2008; 53: 421-436.
17 Arnett JJ. The psychology of globalization. American Psychologist 2002; 57: 774-783.
18 Harter LM, Japp PM, Beck CS. Narratives, health, and healing: communication theory, research, and practice. New York: Routledge Publ.; 2005
19 Wald HS, Dube CE, Anthony DC. Untangling the Web – the impact of Internet use on health care and the physician-patient relationship. Patient Educ Couns 2007; 68: 218-224.
20 Demiris G. The diffusion of virtual communities in health care: concepts and challenges. Patient Educ Couns 2006; 62: 178-188.
21 Greenhalgh T, Hurwitz B. Narrative based medicine: why study narrative?. BMJ 1999; 318: 48-50.
22 Hunter KM. Doctors’stories. The narratrive structure of medical knowledge. Princeton, NJ: Princeton University Press; 1991
23 Sackett DL, Rosenberg WC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn’t. BMJ 1996; 312: 71-72.
24 Thomas P. General medical practitioners need to be aware of the theories on which our work depend. Ann Fam Med 2006; 4: 450-454.
25 Revere D, Turner AM, Madhavan A, Rambo N, Bugni PF, Kimball A, Fuller SS. Understanding the information needs of public health practitioners: a literature review to inform design of an interactive digital knowledge management system. J Biomed Inform 2007; 40: 410-421.
26 Le Beux P, Fieschi M. Virtual biomedical universities and e-learning. Int J Med Inform 2007; 76: 331-335.
27 Hiatt R, Samet J. Ness RB for the American College of Epidemiology Policy Committee.. The role of the epidemiologist in clinical and translational science. Ann Epidemiol 2006; 16: 409-410.
28 Zerhouni EA. Translational and clinical science – time for a new vision. N Engl J Med 2005; 353: 1621-1623.
29 van Mulligen EM, Cases M, Hettne K. et al. Training multidisciplinary biomedical informatics students: three years of experience. JAm Med Inform Assoc 2008; 15: 246-254.
30 National Academy of Sciences.. Facilitating Interdisciplinary Research. Washington, DC: The National Academic Press; 2005
31 Aboelela SW, Larson E, Bakken S. et al. Defining interdisciplinary research: conclusions from a critical review of the literature. Health Serv Res 2007; 42: 329-346.
32 Rhoten D. Interdisciplinary Research: Trend or Transition. Items and Issues 2004; 5 1-2 6-11.
33 Choi BC, Pak AW. Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clin Invest Med 2006; 29: 351-364.
34 Choi BC, Pak AW. Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education and policy: 2. Promotors, barriers, and strategies of enhancement. Clin Invest Med 2007; 30: E224-232.
35 Choi BC, Pak AW. Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education and policy: 3. Discipline inter-discipline distance, and selection of discipline. Clin Invest Med 2008; 31: E41-48.
36 Martin-Sanchez F, Iakovidis I, Nørager S. et al. Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care. J Biomed Inform 2004; 37: 30-42.
37 Maojo V, Kulikowski C. Medical informatics and bioinformatics: integration or evolution through scientific crises?. Methods Inf Med 2006; 45: 474-482.
38 Kulikowski CA. The micro-macro spectrum of medical informatics challenges: from molecular medicine to transforming health care in a globalizing society. Methods Inf Med 2002; 41: 20-24.
39 Maojo V, Martin-Sanchez F. Bioinformatics: towards new directions for public health. Methods Inf Med 2004; 43: 208-214.
40 Lynch J. It’s not easy being interdisciplinary. Int J Epidemiol 2006; 35: 1119-1122.
41 Smith JA, Carey GE. What is the role of an interdisciplinary researcher?. Int J Epidemiol 2007; 36: 690.
42 Payton A, Zoback M. Crossing boundaries, hitting barriers: interdisciplinary research may be lauded, but it’s not yet rewarded. Nature 2007; 445: 950.
43 Carey G, Smith J. Jack of all-trades, master of none: postgraduate perspectives of interdisciplinary health research in Australia. BMC Health Services Res 2007; 7: 1-15.
44 Lehmann CU, Altuwaijri MM, Li YC, Ball MJ, Haux R. Translational research in medical informatics or from theory to practice. A call for an applied informatics journal. Methods Inf Med 2008; 47: 1-3.
45 Dhansay MA. The need for context-specific nutrition and health policies and interventions: the reality of disparities in socio-economic, health and nutritional status. S Afr J Clin Nutr 2006; 19: 142-145.
46 Séguin B, Hardy B-J, Singer PA, Daar AS. Genomic medicine and developing countries: creating a room of their own. Nat Rev Genet 2008; 9: 487-493.
47 Séguin B, Hardy B, Singer PA, Daar AS. Bidil: recontextualizing the race debate. Pharmacogenomics J 2008; 8: 169-173.
48 Eriksson N, Pachter L, Mitsuya Y. et al. Viral population estimation using pyrosequencing. PLoS Comput Biol 2008; 4: e1000074.
49 Lengauer T, Sander O, Sierra S. et al. Bioinformatics prediction of HIV coreceptor usage. Nat Biotechnol 2007; 25: 1407-1410.
50 Rocco MC. Science and technology integration for increased human potential and societal outcomes. Ann N Y Acad Sci 2004; 1013: 1-16.
51 Hunter PJ, Crampin EJ, Nielsen PM. Bioinformatics, multiscale modeling and the IUPS physiome project. Brief Bioinform 2008; 9: 333-343.
52 Anderson C. The end of theory: the data deluge makes the scientific method obsolete. Wired Magazine 23.06.2008 www.wired.com/science/discoveries/magazine/16-07/pb_theory Last accessed July 10 2008
53 Mandl KD, Kohane IS. Tectonic shifts in the health information economy. New Engl J Med 2008; 358: 1732-1737.
54 Berners-Lee T, Hall W, Hendler JA, O’Hara K, Shadbolt N, Weitzner DJ. A framework for web science. Foundations and Trends in Web Science 2006; 1: 1-130.
55 Crisp N, Gawanas B, Sharp I. Task force for scaling up education and training for health workers.. Training the health workforce: scaling up, saving lives. The Lancet 2008; 371: 689-691.
56 Anderson NR, Ash JS, Tarczy-Hornoch P. A qualitative study of the implementation of a bioinformatics tool in a biological research laboratory. Int J Med Inform 2007; 76: 821-828.
57 Pearson TA, Manolio TA. How to interpret a genome-wide association study. J Am Med Assoc 2008; 299: 1335-1544.
58 Prüss-Üstün A, Bos R, Gore F, Bartram J. Safer water, better health: Costs, benefits and sustainability of interventions to protect and promote health. Geneva: WHO; 2008
59 Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford Jr JM. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and metaanalysis. Lancet Infect Dis 2005; 5: 42-52.
60 BC Workshop. March 27-28, Morris J, Wosk Center for Dialogue, Vancouver, BC.
61 Weed LL. New connections between medical knowledge and patient care. BMJ 1997; 315: 231-235.
62 Kwankam SY, Pablos-Mendez A, Kay M. eHealth. In: Unwin T. editor. ICT for Development. In press.
63 Carroll L. Alice’s adventures in wonderland. 1865
64 The IMIA Strategic Plan: Towards IMIA 2015. Available online at http://www.imia.org/strategic/index.lasso Last accessed July 10 2008
65 Murray PJ. The IMIA strategic plan – towards IMIA 2015. Geissbuhler A, Kulikowski CA. editors. IMIA Yearbook of Medical Informatics 2008. Methods Inf Med 2008; 47 (Suppl. 01) 7-15.
66 Lorenzi NM, Murray PJ, Moura L, Goh HM, Huesing S, Martin-Sanchez F, Eisenberg F, Strachan H. (The IMIA Strategic Planning Task Force). Strategy in a fishbowl: An invitation to determine the shape of IMIA in 2015. Methods Inf Med 2006; 45: 235-239.
67 Murray PJ, Haux R, Lorenzi NM. Let a thousand flowers bloom: Transition towards implementation of the IMIA strategic plan. Methods Inf Med 2007; 46: 625-628.
68 Schmidt KF. Nanofrontiers: Visions for the future of Nanotechnology. Woodrow Wilson International Center for Scholars. Project on Emerging Nanotechnologies; 2007
69 Poland CA. et al. Carbon nanotubes introduced into the abdominal cavity of mice show asbestoslike pathogenicity in a pilot study. Nature Nanotechnology 2008; 3: 423-428.
70 NNN – National Nanomanufacturing Network.. NSF. Workshop on nanoinformatics strategies. Arlington, VA, June 2007. http://128.119.56.118/~nnn01/Workshop.html. Last accessed July 10 2008
71 Martin-Sanchez F, Lopez-Alonso V, Hermosilla-Gimeno I, Lopez-Campos G. A primer in knowledge management for Nanoinformatics in Medicine. (Accepted as oral communication in the 12th International Conference on Knowledge-Based and Intelligent Information and Engineering Systems). KES 2008. Zagreb Croatia: September 2008
72 Mihalas GI, Lungeanu D, Vernic C, Kigyosi A, Focsa M. Criteria for classification of medical information. In: Baud R, Fieschi M, Le Beux P, Ruch P. editors. The new navigators: from professionals to patients (Proc MIE 2003, St. Malo). Amsterdam: IOS Press; 2003. pp 358-363.
73 Hafizovic S, Heer F, Ugniwenko T, Frey U, Blau A, Ziegler C. Hirlemann.. A CMOS-based microelectrode array for interaction with neuronal cultures. J Neurosci Methods 2007; 164: 93-106.
74 Information workshop in neuroinformatics.. http://cordis.europa.eu/search/ (Brussels, 09.06.2000). Last accessed July 10 2008
75 Picard RW. Affective computing. Cambridge Mass: MIT Press; 2000
76 http://ecell3d.iab.keio.ac.jp Last accessed July 10 2008
77 http://www.e-cell.org Last accessed July 10 2008
78 http://www.physiome.org.nz Last accessed July 10 2008
79 http://www.biomedtown.org Last accessed July 10 2008
80 Engelbrecht R, Geissbuhler A, Lovis C, Mihalas GI. editors. Connecting Medical Informatics and Bioinformatics (Proc. MIE 2005, Geneva). Amsterdam: IOS Press; 2005
81 Reichert A, Mihalas GI, Stoicu-Tivadar L, Schulz S, Engelbrecht R. editors. Integrating biomedical information: From e-Cell to e-Patient. (Proc. STC 2006, Timisoara). Amsterdam: IOS Press; 2006
82 Grimshaw JM, Russel IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993; 342: 1317-1322.
83 Quaglini S, Stefanelli M, Lanzola G, Caporusso V, Panzarasa S. Flexible guideline-based patient careflow systems. Artif Int Med 2001; 22: 65-80.
84 Shahar Y, Young O, Shalom E. et al. A framework for a distributed, hybrid, multiple-ontology clinical-guideline library and automated guidelinesupport tools. J Biomed Inform 2004; 37: 325-344.
85 Shalom E, Shahar Y, Taieb-Maimon M, Lunenfeld E, Bar G, Yarkoni A, Young O, Martins SB, Vaszar LT, Goldstein MK, Liel Y, Leibowitz A, Marom T, Lunenfeld E. A quantitative evaluation of a methodology for collaborative specification of clinical guidelines at multiple representation levels. J BioMed Inform 2008; in press.
86 Chen DP, Weber SC, Constantinu PS, Ferris TA, Lowe HJ, Butte AJ. Clinical arrays of laboratory measures, or “clinarrays”, built from an electronic health record enable disease subtyping by severity. Proceedings of the 2007 American Medical Informatics Fall meeting (AMIA 2007). pp 115-199.
87 Doyal L. Informed consent: moral necessity or illusion?. Quality in Health Care 2002; 10 (Suppl. 01) i29-i33.
88 Bowling A, Ebrahim S. Measuring patients’ preferences for treatment and perceptions of risk. Quality in Health Care 2001; 10 (Suppl. 01) i2-i8.
89 Woolf SH, Chan ECH, Harris R, Sheridan SL, Braddock BH, Kaplan RM, Krist A, O’Connor AM, Tunis S. Promoting informed choice: transforming health care to dispense knowledge for decision making. Annals of Internal Medicine 2005; 143: 293-300.
90 Kuhn KA, Giuse DA. From hospital information systems to health information systems. Problems, challenges, perspectives. Methods Inf Med 2001; 40: 275-287.
91 Bhave SV, Hornbaker C, Phang TL, Saba L, Lapadat R, Kechris K, Gaydos J, McGoldrick D, Dolbey A, Leach S, Soriano B, Ellington A, Ellington E, Jones K, Mangion J, Belknap JK, Williams RW, Hunter LE, Hoffman PL, Tabakoff B. The PhenoGen informatics website: tools for analyses of complex traits. BMC Genet 2007; 30: 8-59.
92 Vivona S, Gardy JL, Ramachandran S, Brinkman FS, Raghava GP, Flower DR, Filippini F. Computer-aided biotechnology: from immuno-informatics to reverse vaccinology. Trends Biotechnol 2008; 26: 190-200.
93 Hawkins T, Chitale M, Kihara D. New paradigm in protein function prediction for large scale omics analysis. Mol Biosyst. 2008; 4: 223-231.
94 Borisjuk L, Hajirezaei MR, Klukas C, Rolletschek H, Schreiber F. Integrating data from biological experiments into metabolic networks with the DBE information system. In Silico Biol 2005; 5: 93-102.
95 Olsson S, Hofmann I, Brambilla PM, Jacobsson U, Kennedy P, Roca J, Schmitt KJ, Wyke A. New solutions for personalised health management: citizens’ needs, healthcare changes, and market perspectives round table debate. Stud Health Technol Inform 2004; 108: 305-312.
96 Ball MJ, Costin MY, Lehmann C. The personal health record: consumers banking on their health. Stud Health Technol Inform 2008; 134: 35-46.
97 Ferreira A, Cruz-Correia R, Antunes L, Chadwick D. Access control: how can it improve patients’ healthcare?. Stud Health Technol Inform 2007; 127: 65-76.
98 Hazlehurst B, Sittig DF, Stevens VJ, Smith KS, Hollis JF, Vogt TM, Winickoff JP, Glasgow R, Palen TE, Rigotti NA. Natural language processing in the electronic medical record: assessing clinician adherence to tobacco treatment guidelines. Am J Prev Med 2005; 29: 434-439.
99 Post AR, Harrison Jr JH. Temporal data mining. Clin Lab Med 2008; 28 (Suppl. 01) 83-100.
100 Haux R. et al. Strategic information management in hospitals. New York: Springer; 2004
101 Shortliffe EH. et al. Medical informatics: Computer applications in health care and biomedicine. 1st edition. Addison; Wesley: 1990. p 164
102 Brown B. VHA eyes open-source replacement for VistA. Government HealthIT, June 2006
103 Ricadela A. Closing the door to Microsoft Vista. Business Week 2008, March 13,
104 Cusumano MA. The business of software. Free Press; 2004
105 Wiederhold G. What is Your Software Worth. Comm ACM 2006; 49 (Suppl. 09) 65-75
106 Reid PP. et al. Building a better delivery system, a new engineering/healthcare partnership. Washinton DC: National Academy Press; 2005
107 The Economist: Places in the Sun. 2007 February 2.
108 Commission on Systemic Interoperability: Ending the Document Game, Connecting and Transforming Your Healthcare Through Information Technology.. Washington, DC: U.S.: Government Printing Office; 2005
109 Institute of Medicine. Crossing the Quality Chasm, A New Health System for the 21st Century. Washington DC: National Academy Press; 2001
110 Ness RB. Influence of the HIPAA privacy rule on health research. JAMA 2007; 298: 2164-2170.
111 Wiener N. Perspectives in cybernetics, 1964; published 1965 and in Masanti: Norbert Wiener, collected works. Boston , MA: MIT Press; 1985. pp 360-369.