Rethinking the role and impact of health information technology: informatics as an interventional discipline

Abstract

Recent advances in the adoption and use of health information technology (HIT) have had a dramatic impact on the practice of medicine. In many environments, this has led to the ability to achieve new efficiencies and levels of safety. In others, the impact has been less positive, and is associated with both: 1) workflow and user experience dissatisfaction; and 2) perceptions of missed opportunities relative to the use of computational tools to enable data-driven and precise clinical decision making. Simultaneously, the "pipeline" through which new diagnostic tools and therapeutic agents are being developed and brought to the point-of-care or population health is challenged in terms of both cost and timeliness. Given the confluence of these trends, it can be argued that now is the time to consider new ways in which HIT can be used to deliver health and wellness interventions comparable to traditional approaches (e.g., drugs, devices, diagnostics, and behavioral modifications). Doing so could serve to fulfill the promise of what has been recently promoted as "precision medicine" in a rapid and cost-effective manner. However, it will also require the health and life sciences community to embrace new modes of using HIT, wherein the use of technology becomes a primary intervention as opposed to enabler of more conventional approaches, a model that we refer to in this commentary as "interventional informatics". Such a paradigm requires attention to critical issues, including: 1) the nature of the relationships between HIT vendors and healthcare innovators; 2) the formation and function of multidisciplinary teams consisting of technologists, informaticians, and clinical or scientific subject matter experts; and 3) the optimal design and execution of clinical studies that focus on HIT as the intervention of interest. Ultimately, the goal of an "interventional informatics" approach can and should be to substantially improve human health and wellness through the use of data-driven interventions at the point of care of broader population levels. Achieving a vision of "interventional informatics" will requires us to re-think how we study HIT tools in order to generate the necessary evidence-base that can support and justify their use as a primary means of improving the human condition.

Keywords: Biomedical research; Informatics; Research design.

Fig. 1

Overview of the transition required from a traditional role for informatics in healthcare research and innovation to one that is interventional in nature. The core of this model is the rethinking of the type of evidence to be generated, and the corresponding focus of studies contributing to such a knowledge base. In this figure, we compare and contrast the way in which informatics theories and methods apply to the design, execution, and analysis of a given area of inquiry, shifting from a support or enabling role to one that is the direct and primary focus of ensuing research programs

Fig. 2

Overview of the “Interventional Informatics” paradigm, aligned with traditional clinical study phases and outcomes. These overall approaches are also contrasted relative to their average cost and timeliness. In this figure, we show how traditional types of research questions commonly pursued in a clinical trial or study can be modified and applied to enable the study of interventions that are primarily data-driven and technology focused