50 Years of Achievements and Persistent Challenges for Biomedical and Health Informatics and John Mantas' Educational and Nursing Informatics Contributions.

Biomedical and Health Informatics (BMHI) have been essential catalysts for achievements in medical research and healthcare applications over the past 50 years. These include increasingly sophisticated information systems and data bases for documentation and processing, standardization of biomedical data, nomenclatures, and vocabularies to assist with large scale literature indexing and text analysis for information retrieval, and methods for computationally modeling and analyzing research and clinical data. Statistical and AI techniques for decision support, instrumentation integration, and workflow aids with improved data/information management tools are critical for scientific discoveries in the - omics revolutions with their related drug and vaccine breakthroughs and their translation to clinical and preventive healthcare. Early work on biomedical image and pattern recognition, knowledge-based expert systems, innovative database, software and simulation techniques, natural language processing and computational ontologies have all been invaluable for basic research and education. However, these methods are still in their infancy and many fundamental open scientific problems abound. Scientifically this is due to persistent limitations in understanding biological processes within complex living environments and ecologies. In clinical practice the modeling of fluid practitioner roles and methods as they adjust to novel cybernetic technologies present great opportunities but also the potential of unintended e-iatrogenic harms which must be constrained in order to adhere to ethical Hippocratic norms of responsible behavior. Balancing the art, science, and technologies of BMHI has been a hallmark of debates about the field's historical evolution. The present article reviews selected milestones, achievements, and challenges in BMHI education mainly, from a historical perspective, including some commentaries from leaders and pioneers in the field, a selection of which have been published online recently by the International Medical Informatics Association (IMIA) as the first volume of an IMIA History WG eBook. The focus of this chapter is primarily on the development of BMHI in terms of those of its educational activities which have been most significant during the first half century of IMIA, and it concentrates mainly on the leadership and contributions of John Mantas who is being honored on his retirement by the Symposia in Athens for which this chapter has been written.

Ethics in the History of Medical Informatics for Decision-Making: Early Challenges to Digital Health Goals.

BACKGROUND: Inclusive digital health prioritizes public engagement through digital literacies and internet/web connectivity for advancing and scaling healthcare equitably by informatics technologies. This is badly needed, largely desirable and uncontroversial. However, historically, medical and healthcare practices and their informatics processes assume that individual clinical encounters between practitioners and patients are the indispensable foundation of clinical practice. This assumption has been dramatically challenged by expansion of digital technologies, their interconnectable mobility, virtuality, surveillance informatics, and the vastness of data repositories for individuals and populations that enable and support them. This article is a brief historical commentary emphasizing critical ethical issues about decisions in clinical interactions or encounters raised in the early days of the field. These questions, raised eloquently by François Grémy in 1985, have become urgently relevant to the equity/fairness, inclusivity and unbiasedness desired of today's pervasive digital health systems. OBJECTIVES: The main goal of this article is to highlight how the personal freedoms of choice, values, and responsibilities arising in relationships between physicians and healthcare practitioners and their patients in the clinical encounter can be distorted by digital health technologies which focus more on efficiency, productivity, and scalability of healthcare processes. Understanding the promise and limitations of early and current decision-support systems and the analytics of community or population data can help place into historical context the often exaggerated claims made today about Artificial Intelligence and Machine Learning "solving" clinical problems with algorithms and data, downplaying the role of the clinical judgments and responsibilities inherent in personal clinical encounters. METHODS: A review of selected early articles in medical informatics is related to current literature on the ethical issues and technological inadequacies involved in the design and implementation of clinical systems for decision-making. Early insights and cautions about the development of decision support technologies raised questions about the ethical responsibilities in clinical encounters where freedom of personal choice can be so easily limited through the constraints from information processing and reliance on prior expertise frequently driven more by administrative rather than clinical objectives. These anticipated many of the deeper ethical problems that have arisen since then in clinical informatics. CONCLUSIONS: Early papers on ethics in clinical decision-making provide prescient commentary on the dangers of not taking into account the complexities of individual human decision making in clinical encounters. These include the excessive reliance on data and experts, and oversimplified models of human reasoning, all of which persist and have become amplified today as urgent questions about how inclusivity, equity, and bias are handled in practical systems where ethical responsibilities of individuals patients and practitioners intertwine with those of groups within professional or other communities, and are central to how clinical encounters evolve in our digital health future.

A scientific mind embraces medicine: Donald Lindberg's education and early career.

As a young pathologist, Donald A.B. Lindberg, M.D., tirelessly sought scientific solutions to clinical and research problems. Directing several clinical laboratories at the University of Missouri in Columbia, Dr. Lindberg developed the world's first computerized laboratory information system, speeding analysis and reporting. He directed his team in building computer systems to help clinicians retrieve medical knowledge, enable patients to find information about personal or family health issues, and provide expert automated assistance to physicians in reaching differential diagnoses outside their specialties. Developing superior functionalities with the limited information technologies of the time, Dr. Lindberg's pioneering work in Columbia foreshadowed his subsequent inspired leadership as Director of the United States National Library of Medicine.

A Scientific Mind Embraces Medicine: Donald Lindberg's Education and Early Career.

As a young pathologist, Donald A.B. Lindberg, M.D., tirelessly sought scientific solutions to clinical and research problems. Directing several clinical laboratories at the University of Missouri in Columbia, Dr. Lindberg developed the world's first computerized laboratory information system, speeding analysis and reporting. He directed his team in building computer systems to help clinicians retrieve medical knowledge, enable patients to find information about personal or family health issues, and provide expert automated assistance to physicians in reaching differential diagnoses outside their specialties. Developing superior functionalities with the limited information technologies of the time, Dr. Lindberg's pioneering work in Columbia foreshadowed his subsequent inspired leadership as Director of the United States National Library of Medicine.

Pandemics: Historically Slow "Learning Curve" Leading to Biomedical Informatics and Vaccine Breakthroughs.

BACKGROUND: The worldwide tragedy of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic vividly demonstrates just how inadequate mitigation and control of the spread of infectious diseases can be when faced with a new microorganism with unknown pathogenic effects. Responses by governments in charge of public health, and all other involved organizations, have proved largely wanting. Data infrastructure and the information and communication systems needed to deal with the pandemic have likewise not been up to the task. Nevertheless, after a year of the worldwide outbreak, hope arises from this being the first major pandemic event in history where genomic and related biosciences - relying on biomedical informatics - have been essential in decoding the viral sequence data and producing the mRNA and other biotechnologies that unexpectedly rapidly have led to investigation, design, development, and testing of useful vaccines. Medical informatics may also help support public health actions and clinical interventions - but scalability and impact will depend on overcoming ingrained human shortcomings to deal with complex socio-economic, political, and technological disruptions together with the many ethical challenges presented by pandemics. OBJECTIVES: The principal goal is to review the history of biomedical information and healthcare practices related to past pandemics in order to illustrate just how exceptional and dependent on biomedical informatics are the recent scientific insights into human immune responses to viral infection, which are enabling rapid antiviral vaccine development and clinical management of severe cases - despite the many societal challenges ahead. METHODS: This paper briefly reviews some of the key historical antecedents leading up to modern insights into epidemic and pandemic processes with their biomedical and healthcare information intended to guide practitioners, agencies, and the lay public in today's ongoing pandemic events. CONCLUSIONS: Poor scientific understanding and excessively slow learning about infectious disease processes and mitigating behaviors have stymied effective treatment until the present time. Advances in insights about immune systems, genomes, proteomes, and all the other -omes, became a reality thanks to the key sequencing technologies and biomedical informatics that enabled the Human Genome Project, and only now, 20 years later, are having an impact in ameliorating devastating zoonotic infectious pandemics, including the present SARS-CoV-2 event through unprecedently rapid vaccine development. In the future these advances will hopefully also enable more targeted prevention and treatment of disease. However, past and present shortcomings of most of the COVID-19 pandemic responses illustrate just how difficult it is to persuade enough people - and especially political leaders - to adopt societally beneficial risk-avoidance behaviors and policies, even as these become better understood.

Evolution of Interdisciplinarity in Medical Informatics in Europe: Patterns from Intertwining Histories.

The IMIA History project book we are co-editing with colleagues from the IMIA History Working Group includes histories of early contributions to medical and healthcare informatics, as described by a sample of pioneers and experts, detailing how their own ideas developed from their work on various topics in the field at the beginnings of their contributions to the field. Its contents serve as a preliminary guide for meta-analyses of how the different contributors state their personal interdisciplinary origins from today's perspectives. In this short article we provide a brief preview of how an analysis of disciplinary characteristics from individual histories can begin to shed light on processes of interdisciplinary evolution of medical informatics in Europe.

Donald A. B. Lindberg: Inspiring Leader and Visionary in Biomedicine, Healthcare, and Informatics.

BACKGROUND: As Director of the US National Library of Medicine (NLM) for 30 years, Dr. Donald A. B. Lindberg was instrumental in bringing biomedical research and healthcare worldwide into the age of genomic and translational medicine through the informatics systems developed by the NLM. Lindberg opened free access and worldwide public dissemination of all the NLM's biomedical literature and databases, thus helping transform not only biomedical research like the Human Genome Project and its successors, but also the practices of medicine and healthcare internationally. Guiding, leading, and teaching-by-example at national, regional, and global levels of biomedical and healthcare informatics, Lindberg helped coalesce a dynamic discipline that provides a foundation for the human understanding which promotes the future health of our world. OBJECTIVES: To provide historical insight into the scientific, technological, and practical clinical accomplishments of Donald Lindberg, and to describe how this led to contributions in the worldwide interdisciplinary evolution of informatics, and its impact on the biosciences and practices of medicine, nursing, and other healthcare-related disciplines. METHODS: Review and comment on the publications, scientific contributions, and leadership of Donald Lindberg in the evolution of biomedical and health informatics which anticipate the vision, scholarship, research in the field, and represent the deeply ethical humanism he exhibited throughout his life. These were essential in producing the informatics systems, such as the Unified Medical Language System (UMLS), MEDLINE, PubMed, PubMed Central, and ClinicalTrials.gov, which, together with NLM training programs and conferences, made possible the interactions among researchers and practitioners leading to the past quarter-century of rapid and dramatic advances in biomedical scientific inquiry and clinical discoveries, openly shared across the globe. CONCLUSION: Dr. Lindberg was a uniquely talented physician and pioneering researcher in biomedical and health informatics. As the main leader in developing and funding innovative informatics research for more than 30 years as Director of the National Library of Medicine, he helped bring together the most creative interdisciplinary researchers to bridge the worlds of biomedical research, education, and clinical practice. Lindberg's emphasis on open-access to the biomedical literature through publicly shared computer-mediated methods of search and inquiry are seen as an example of ethical scientific openness.

Roots of Interdisciplinarity in European Medical Informatics.

The roots of interdisciplinary of medical informatics are sought through the analysis of the themes approached by the pioneers of this field. The data included in the study comes mostly from "personal stories" of European these scientists collected by IMIA WG History as well as from some biographical notes. Most researchers came from the technical-scientific field, but the double specialization was very common. The proportions of the main topic approaches are discussed. The roots of medical informatics interdisciplinary were formed during the pioneering period, when most major concepts and chapters of medical informatics took contour.

Beginnings of Artificial Intelligence in Medicine (AIM): Computational Artifice Assisting Scientific Inquiry and Clinical Art - with Reflections on Present AIM Challenges.

BACKGROUND: The rise of biomedical expert heuristic knowledge-based approaches for computational modeling and problem solving, for scientific inquiry and medical decision-making, and for consultation in the 1970's led to a major change in the paradigm that affected all of artificial intelligence (AI) research. Since then, AI has evolved, surviving several "winters", as it has oscillated between relying on expensive and hard-to-validate knowledge-based approaches, and the alternative of using machine learning methods for inferring classification rules from labelled datasets. In the past couple of decades, we are seeing a gradual but progressive intertwining of the two. OBJECTIVES: To give an overview of early directions in AI in medicine and threads of some subsequent developments motivated by the very different goals of scientific inquiry for biomedical research, and for computational modeling of clinical reasoning and more general healthcare problem solving from the perspective of today's "AI-Deep Learning Boom". To show how, from the beginning, AI was central to Biomedical and Health Informatics (BMHI), as a field investigating how to understand intelligent thinking in dealing professionally with the practice for healthcare, developing mathematical models, technology, and software tools to aid human experts in biomedicine, despite many previous bouts of "exuberant optimism" about the methodologies deployed. METHODS: An overview and commentary on some of the early research and publications in AI in biomedicine, emphasizing the different approaches to the modeling of problems involved in clinical practice in contrast to those of biomedical science. A concluding reflection of a few current challenges and pitfalls of AI in some biomedical applications. CONCLUSION: While biomedical knowledge-based systems played a critical role in influencing AI in its early days, 50 years later they have taken a back seat behind "Deep Learning" which promises to discover knowledge structures for inference and prediction, both in science and for clinical decision-support. Early work on AI for medical consultation turned out to be more useful for explanation and teaching than for clinical practice, as had been originally intended. Today, despite the many reported successes of deep learning, fundamental scientific challenges arise in drawing on models of brain science, cognition, and language, if AI is to augment and complement rather than replace human judgment and expertise in biomedicine while also incorporating these advances for translational medicine. Understanding clinical phenotypes and how they relate to precision and personalization of care requires not only scientific inquiry, but also humanistic models of treatment that respond to patient and practitioner narrative exchanges, since it is the stories and insights of human experts which encourage what Norbert Weiner termed the ethical "human use of human beings", so central to adherence to the Hippocratic Oath.

Research Strategies for Biomedical and Health Informatics. Some Thought-provoking and Critical Proposals to Encourage Scientific Debate on the Nature of Good Research in Medical Informatics.

BACKGROUND: Medical informatics, or biomedical and health informatics (BMHI), has become an established scientific discipline. In all such disciplines there is a certain inertia to persist in focusing on well-established research areas and to hold on to well-known research methodologies rather than adopting new ones, which may be more appropriate. OBJECTIVES: To search for answers to the following questions: What are research fields in informatics, which are not being currently adequately addressed, and which methodological approaches might be insufficiently used? Do we know about reasons? What could be consequences of change for research and for education? METHODS: Outstanding informatics scientists were invited to three panel sessions on this topic in leading international conferences (MIE 2015, Medinfo 2015, HEC 2016) in order to get their answers to these questions. RESULTS: A variety of themes emerged in the set of answers provided by the panellists. Some panellists took the theoretical foundations of the field for granted, while several questioned whether the field was actually grounded in a strong theoretical foundation. Panellists proposed a range of suggestions for new or improved approaches, methodologies, and techniques to enhance the BMHI research agenda. CONCLUSIONS: The field of BMHI is on the one hand maturing as an academic community and intellectual endeavour. On the other hand vendor-supplied solutions may be too readily and uncritically accepted in health care practice. There is a high chance that BMHI will continue to flourish as an important discipline; its innovative interventions might then reach the original objectives of advancing science and improving health care outcomes.

Decision-Tree Model for Support of Health Policy Choices Based on Pneumococcal Conjugate Vaccine (PCV) Program Outcomes.

Pneumococcal Conjugate Vaccine (PCV) has the potential to save lives in low-income countries. We have developed a computational model and web-based decision support software for comparing cost-benefit tradeoffs from alternative PCV program designs, considering their direct and indirect effects on early childhood populations in resource-poor settings. This supports policy-makers in estimating potential health outcomes and cost-effectiveness of different vaccination program strategies for a wide range of population coverage and vaccine effectiveness assumptions.

50th Anniversary International Medical Informatics Association (IMIA) History Working Group and Its Projects.

The IMIA History Working Group has as its first goal the editing of a volume of contributions from pioneers and leaders in the field of biomedical and health informatics (BMHI) to commemorate the 50th anniversary of IMIA's predecessor IFIP-TC4. This paper describes how the IMIA History WG evolved from an earlier Taskforce, and has focused on producing the edited book of original contributions. We describe its proposed outline of objectives for the personal stories, and national and regional society narratives, together with some comments on the evolution of Medinfo meeting contributions over the years, to provide a reference source for the early motivations of the scientific, clinical, educational, and professional changes that have influenced the historical course of our field.

Discussion of "The New Role of Biomedical Informatics in the Age of Digital Medicine".

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "The New Role of Biomedical Informatics in the Age of Digital Medicine" written by Fernando J. Martin-Sanchez and Guillermo H. Lopez-Campos [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of Martin-Sanchez and Lopez-Campos. In subsequent issues the discussion can continue through letters to the editor.

A method for exploring implicit concept relatedness in biomedical knowledge network.

BACKGROUND: Biomedical information and knowledge, structural and non-structural, stored in different repositories can be semantically connected to form a hybrid knowledge network. How to compute relatedness between concepts and discover valuable but implicit information or knowledge from it effectively and efficiently is of paramount importance for precision medicine, and a major challenge facing the biomedical research community. RESULTS: In this study, a hybrid biomedical knowledge network is constructed by linking concepts across multiple biomedical ontologies as well as non-structural biomedical knowledge sources. To discover implicit relatedness between concepts in ontologies for which potentially valuable relationships (implicit knowledge) may exist, we developed a Multi-Ontology Relatedness Model (MORM) within the knowledge network, for which a relatedness network (RN) is defined and computed across multiple ontologies using a formal inference mechanism of set-theoretic operations. Semantic constraints are designed and implemented to prune the search space of the relatedness network. CONCLUSIONS: Experiments to test examples of several biomedical applications have been carried out, and the evaluation of the results showed an encouraging potential of the proposed approach to biomedical knowledge discovery.

Discussion of "Computational Electrocardiography: Revisiting Holter ECG Monitoring".

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Computational Electrocardiography: Revisiting Holter ECG Monitoring" written by Thomas M. Deserno and Nikolaus Marx. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of Deserno and Marx. In subsequent issues the discussion can continue through letters to the editor.

Social Media as Catalyzer for Connected Health: Hype or Hope? Perspectives from IMIA Working Groups.

The Internet and social media are becoming ubiquitous technologies that are transforming the health sector. Social media has become an avenue for accessing, creating and sharing health information among patients and healthcare professionals. Furthermore, social media has become a key feature in many eHealth solutions, including wearable technologies, Big Data solutions, eLearning systems, Serious Games, Medical imaging, etc. These hyper-connected technologies are facilitating a paradigm shift towards more connected health. In this panel, representatives of different IMIA Working Groups will explore how both hope and hype contribute to social media's catalyzing role in creating connected health solutions.

Impact of prostate biopsy tumor amount on imaging based prognostics employing transductive semi-supervised regression.

For newly diagnosed prostate cancer patients with a positive biopsy, there are a variety of treatment options to consider. To aid physicians and patients in their decision making, a variety of predictive assays have emerged within the last decade, many of them imaging based. These assays build predictive models for survival analysis to provide personalized risk assessments for the patients. However, there have rarely been any published studies on how the amount of tumor in the positive prostate biopsy affects the predictive power of these imaging based assays. Recently we have proposed a new algorithmic framework for survival analysis employing semi-supervised transductive regression. This approach has improved the predictive power of biopsy based prostate cancer prognostic models. In this paper, we explore how different amounts of tumor in the prostate biopsy affect the accuracy of imaging based prognostic models employing this framework. We show that the framework improves accuracy even with diminishing amounts of tumor, thereby enabling more accurate treatment decisions.

The 50(th) Anniversary IMIA History of Medical Informatics Project.

At the meeting of the IMIA Board in 2009 in Hiroshima, it approved an IMIA 50th Anniversary History Project to produce a historical volume and other materials to commemorate the anniversary of the foundation of the predecessor of IMIA-the IFIP-TC4 in 1967. A Taskforce was organized under the direction of Casimir Kulikowski, then the VP for Services of IMIA, and since that time it has met regularly to plan and implement the 50th Anniversary History of IMIA as an edited volume, and as material available online on a Media Presentation Database. The IMIA Taskforce is gathering IMIA-related archival materials, currently accessible through a prototype media repository at Rutgers University in order to help those contributing to the book or writing their own recollections and histories. The materials will support a chronicle of the development and evolution of IMIA, its contributors, its sponsored events and publications, educational and other professional activities. During 2013 Workshops were held at the Prague EFMI-STC meeting in April and at the MEDINFO 2013 Congress in Copenhagen in August.

An informatics approach to chronicling the history of IMIA.

With the 50th Anniversary of IMIA approaching in 2017, the IMIA Board approved the creation of a Taskforce for compiling materials and writing a history of the organization. As part of the work of the Taskforce, the authors have developed informatics tools, and begun collecting IMIA-related historical materials from its members, while soliciting participation and contributions from those involved in the early days of the organization and its predecessor IFIP-TC4. This poster describes the structure and preliminary contents of the media mining and presentation tools designed at Rutgers University for use by the IMIA History Editorial Board, being constituted to produce the 50th Anniversary publication, as well as an online archive of materials chronicling the evolution of IMIA. A major feature of the data repository is its ability to present different modalities of textual, visual and graphical (timelines, trends) summarizations for the IMIA document collection. It will be augmented with audio material, and will serve as an archival repository for historical research, including software tools for text analysis and extraction of the information entering into the 50th Anniversary volume.