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National Information Center on Health Services Research and Health Care Technology (NICHSR)

MI/HSR/PH Bridging the Gap Mtg., 1/6-7/00, Workshop Summary

Medical Informatics and Health Services Research:
Bridging the Gap

January 6-7, 2000
National Library of Medicine (NLM)
Agency for Healthcare Research and Quality (AHRQ)

Overview:

The focus of the workshop was on the intersection between MI and HSR (including public health research) and what is needed to foster needed synergy (in terms of both training and the conduct of research) between the two multi-disciplines. The theme of the intersection could be characterized as translating clinical practice into information systems that provide input into decisions at the individual, policy, and systems levels. MI provides the tools for the design of computer systems and HSR the tools for the evaluation of such systems. Specific areas of synergy between the two fields include:

  • At the clinical level, quality improvement, risk adjustment, and episode grouping, reducing errors;
  • At the systems level, data classification, systems analysis, cost analysis, quality measurements, realistic evaluations of claims data;
  • At the policy level, health care financing, patient outcomes, Translating Research Into Practice (TRIP).

MI plays a role in the following areas of interest to HSR:

  • Use of large databases - design, manipulation, and analysis of the data;
  • Support the organization and delivery of medical knowledge;
  • Support health systems administration;
  • Effect change at the point of care (e.g., patent reminders, TRIP, medical error reduction);
  • Capture clinical data at the point of care (e.g., utilize Internet, telehealth).

HSR in turn provides valuable analytic skills for the evaluation of systems developed.

Tools:

MI Curricula Contribution to HSRHSR Curricula Contribution to MI
  • Vocabulary/terminology
  • Data modeling
  • Database design
  • Health information systems
  • Confidentiality/security
  • Computer science
  • Cognitive issues
  • Decision sciences
  • Biostatistics
  • Clinical epidemiology
  • Survey design
  • Evaluation
  • Quality management
  • Economics
  • Decision sciences

Recommendations:

Immediate recommendations were to promote materials from the presentations and breakout groups to the web (see http://www.nlm.nih.gov/nichsr/mihsr/agenda.html) and to publish in JAMIA and/or JAMA on:

  1. The integration of HSR and informatics, focusing on the need for dual training at the clinical, health systems, and policy levels (Ken Mandl and Tom Lee, lead authors).
  2. Summary of existing MI and HSR training programs (Chris Cimino, lead author).
  3. Lessons learned from the Stanford collaboration (Ted Shortliffe and Alan Garber, lead authors).
  4. What health services researchers need to know about MI and informaticians need to know about HSR, focusing on training needs, avenues to bridging the gap, and proposed curricula (Steve Downs, lead author).

Submission of papers is planned for late Spring 2000.

For the longer term, the workshop participants emphasized the need to support dual competency training and research in areas noted below:

Level of ExpenseTrainingResearch

Less Expensive

(least to more)

  • Share curricula and experiences on web, distance learning
  • Faculty exchanges
  • Coordinate student projects
  • Support and share seminars
  • Support internships in applied settings
  • Support slots in some programs for the intersection between the two disciplines
  • Flexible, well-constructed study sections

More Expensive

(more to most)

  • Support curriculum development, case studies
  • Support programs to train MA-level researchers (as well as fellows)
  • Support mid-career development
  • Support faculty development
  • Create and support new Centers of Excellence
  • Joint NLM-AHRQ RFPs for: a) tool development, b) training evaluation, c) data quality evaluation, d) discerning the informatics needs of public health practitioners / researchers in general and of health service researchers / practitioners in particular
  • Joint NLM-AHRQ RFAs on research needs requiring multidisciplinary collaboration between the two fields
  • Joint NLM-AHRQ RFP/As for research requiring MI-HSR collaboration

Over the coming months, participants will help to prioritize these recommendations. Subsequently, NLM's and AHRQ's future plans in response to the workshop (including a position statement from the NLM/AHRQ that explains compellingly the importance of this hybrid field of HSR informatics) may be incorporated in the first paper listed above or included in a condensed report on the workshop prepared for the web.

Return to Agenda