Just 10 years ago ‘informatics’ was a relatively unknown concept to the healthcare and biomedical science communities. Over the past years, the field expanded significantly and informatics became not only well known, but also an integral part of daily business in these communities. Accordingly, JAMIA has been continuously expanding the informatics pyramid of published work, from the foundational work upon which important applications are built (such as new algorithms and innovative approaches), all the way to illustrative experiences of system implementations that have generalizable lessons and randomized trials of informatics interventions.
Practitioners suggest that JAMIA should publish a larger number of applied articles that describe the design, implementation, or evaluation of systems. Academics suggest that JAMIA should publish a larger quantity of foundational research reports. Defining the boundary can be challenging; what some consider applied work may be considered somewhat theoretical by others. Whether there is a dividing line between theory and practice of informatics and where this line would sit does not really matter (hence our section ‘Research and applications’). What matters is that our current and future readers get value for the time they spend reading the articles or abstracts, that informatics becomes even better known outside its own community, and that the dissemination of information afforded by this journal translates into developments that positively impact healthcare and accelerate biomedical science. In JAMIA, articles from any tier of the pyramid are judged by their quality and innovation, and not by the theoretical or applied nature of the work. This issue of the journal reinforces the point that the journal welcomes diverse kinds of work; we focus on applications of health information technology (IT) and clinical decision support (CDS), while also integrating articles that support some foundations for these areas.
This issue starts with Payne discussing health IT and economics (see page 212), Strasberg discussing some of the challenges of making targeted information available at the point of care (see page 218), and Friedman providing a perspective on what informatics is and is not (see page 224). In our section ‘Focus on health information technology’, Vest discusses changes in the electronic health record (EHR) market given health IT certification and meaningful use (see page 227), Harle describes the characteristics of hospitals that successfully responded to meaningful use requirements (see page 233), and Hernández-Ávila evaluates the process of designing and implementing an EHR system for a public health system (see page 238). Once deployed, there are marked differences in EHR use and satisfaction, as well as patient outcomes. Keenan and Hoonakker describe the challenges from the perspective of nurses and other clinicians (see pages 245, 252). Hilligoss describes the impact of EHR on admission handoffs in an emergency department (see page 260), Tundia describes effects on outpatient preventive care (see page 268), and Czaja reports on factors that determine healthcare consumers’ use of e-health information sources (see page 277). The underlying infrastructure to achieve high utilization of EHR resources is critically important: Malin describes a practical approach to link medical records scattered in different locations (see page 285). Zunner describes a semi-automated approach to map laboratory concepts into LOINC (see page 293), and Sánchez-de-Madariaga proposes a markup language to facilitate data extraction from EHRs (see page 298).
EHR systems can help clinicians do a better job. In our section ‘Focus on clinical decision support’, Adelman reports on a clinical trial evaluating computerized provider order entry (see page 305), and Carroll describes results of a clinical trial of an informatics intervention to screen for maternal depression (see page 311). Mainous reports the impact of CDS on antibiotic prescribing (see page 317), and Torsvik compares visualization techniques for laboratory results (see page 325). Modeling temporal relationships and extracting information from narrative text have always been a challenge to CDS. Hanauer proposes an approach for modeling these temporal relationships (see page 332). Natural language processing approaches are used by Carrell and Quinn to support sharing of de-identified clinical text and to determine cancer types in clinical records, respectively (see pages 342, 349). Jindal utilizes natural language processing to resolve coreferences in biomedical text (see page 356). Wliczynski evaluates the robustness of MEDLINE clinical queries, which help users retrieve answers to their clinical questions from the biomedical literature (see page 363). In ‘Brief communications’, de Bruin describes a CDS for surveillance of ICU-acquired infections (see page 369), and Ríos-Bedoya reports on the effects of using text messaging to screen for alcohol use among adolescents (see page 373). In ‘Case reports’, Martin shares generalizable lessons learned while customizing a commercial EHR CDS module (see page 377), and Sánchez-Mendiola reports on the implementation of biomedical informatics education for medical students (see page 381). Finally, Kawamoto systematically reviews the literature on CDS for genetically-guided personalized medicine (see page 388).
As this issue illustrates, the field of biomedical informatics is diverse, complex, and exciting. We strive to make JAMIA work for a diverse, highly demanding readership. Your suggestions and feedback are important so that the premier informatics journal continues to work for you.