The Challenge of Applied Medical Informatics for the Chest Physician

Applied medical informatics (AMI) is an emerging field that is evolving at a rapid pace. While medical informatics encompasses a myriad of disciplines, the basic understanding of AMI for most chest physicians remains “the science of processing information/data for storage and retrieval.” Unfortunately, the uptake and implementation of AMI has been mediocre (Blumenthal and Tavenner. N Engl J Med. 2010;363[6]:501).Futuristic developments in AMI are exciting as we move toward virtualizing of medical practice, utilizing many diverse technologies, such as remote radiograph interpretation, electronic office visits, and the virtual ICU. The integration of electronic medical records (EMR) into a clinical practice, even the smallest of offices, is the foundation of AMI.

EMR, in practical terms, comprises three major components: (1) a results-reporting information system(RRIS); (2) a computerized physician order-entry system (CPOE); and (3) a clinical decision support system (CDS).CPOE is the most critical component of EMR and leads the way to CDS, guidelines, and care pathways. The barriers to successful implementation of EMR include, but are not limited to, the following: complexity of the EMR, cost of change, time commitment, clinician expectations, interoperability, understanding clinical workflow, and other competing agendas (Bria. Chest. 2006;129[2]:446).

Having been at the threshold of launching a new era of AMI-enabled American health care, the failure is disappointing. In order to achieve what was anticipated, we need to be more knowledgeable, demanding, and involved with the introduction of information tools and systems into health care (Shortliffe EH. Health Aff. 2005; 24[5]:1222). We need to emphasize greater incorporation of medical knowledge, evidence-based medicine, and clinical decision support. Such advancement will achieve realization of the delivery of cost-effective best care to our patients. Only close collaboration between the multidisciplinary team of clinicians and technical experts can make this happen (Bria. Chest. 2006; 129[2]:777). Finally, laying firm timelines for change, with strong directives from the federal, state, local, payer, provider, and user consortia, will help chest physicians reach the lofty goal of full integration of AMI into their profession.

Dr. Satyendra Sharma, FCCP
Steering Committee Member