A tribute to Karen Greenwood and her contributions to the American Medical Informatics Association.

After 25 years of service to the American Medical Informatics Association (AMIA), Ms Karen Greenwood, the Executive Vice President and Chief Operating Officer, is leaving the organization. In this perspective, we reflect on her accomplishments and her effect on the organization and the field of informatics nationally and globally. We also express our appreciation and gratitude for Ms Greenwood's role at AMIA.

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.

Half a century of computer methods and programs in biomedicine: A bibliometric analysis from 1970 to 2017.

BACKGROUND AND OBJECTIVE: Computer Methods and Programs in Biomedicine (CMPB) is a leading international journal that presents developments about computing methods and their application in biomedical research. The journal published its first issue in 1970. In 2020, the journal celebrates the 50th anniversary. Motivated by this event, this article presents a bibliometric analysis of the publications of the journal during this period (1970-2017). METHODS: The objective is to identify the leading trends occurring in the journal by analysing the most cited papers, keywords, authors, institutions and countries. For doing so, the study uses the Web of Science Core Collection database. Additionally, the work presents a graphical mapping of the bibliographic information by using the visualization of similarities (VOS) viewer software. This is done to analyze bibliographic coupling, co-citation and co-occurrence of keywords. RESULTS: CMPB is identified as a leading and core journal for biomedical researchers. The journal is strongly connected to IEEE Transactions on Biomedical Engineering and IEEE Transactions on Medical Imaging. Paper from Wang, Jacques, Zheng (published in 1995) is its most cited document. The top author in this journal is James Geoffrey Chase and the top contributing institution is Uppsala U (Sweden). Most of the papers in CMPB are from the USA followed by the UK and Italy. China and Taiwan are the only Asian countries to appear in the top 10 publishing in CMPB. A keyword co-occurrences analysis revealed strong co-occurrences for classification, picture archiving and communication system (PACS), heart rate variability, survival analysis and simulation. Keywords analysis for the last decade revealed that machine learning for a variety of healthcare problems (including image processing and analysis) dominated other research fields in CMPB. CONCLUSIONS: It can be concluded that CMPB is a world-renowned publication outlet for biomedical researchers which has been growing in a number of publications since 1970. The analysis also conclude that the journal is very international with publications from all over the world although today European countries are the most productive ones.

Envisioning health equity for American Indian/Alaska Natives: a unique HIT opportunity.

The Indian Health Service provides care to remote and under-resourced communities in the United States. American Indian/Alaska Native patients have some of the highest morbidity and mortality among any ethnic group in the United States. Starting in the 1980s, the IHS implemented the Resource and Patient Management System health information technology (HIT) platform to improve efficiency and quality to address these disparities. The IHS is currently assessing the Resource and Patient Management System to ensure that changing health information needs are met. HIT assessments have traditionally focused on cost, reimbursement opportunities, infrastructure, required or desired functionality, and the ability to meet provider needs. Little information exists on frameworks that assess HIT legacy systems to determine solutions for an integrated rural healthcare system whose end goal is health equity. This search for a next-generation HIT solution for a historically underserved population presents a unique opportunity to envision and redefine HIT that supports health equity as its core mission.

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.

Artificial Intelligence in Medicine: Weighing the Accomplishments, Hype, and Promise.

INTRODUCTION: Artificial Intelligence in Medicine (AIM) research is now 50 years old, having made great progress that has tracked the corresponding evolution of computer science, hardware technology, communications, and biomedicine. Characterized as being in its "adolescence" at an international meeting in 1991, and as "coming of age" at another meeting in 2007, the AIM field is now more visible and influential than ever before, paralleling the enthusiasm and accomplishments of artificial intelligence (AI) more generally. OBJECTIVES: This article summarizes some of that AIM history, providing an update on the status of the field as it enters its second half-century. It acknowledges the failure of AI, including AIM, to live up to early predictions of its likely capabilities and impact. METHODS: The paper reviews and assesses the early history of the AIM field, referring to the conclusions of papers based on the meetings in 1991 and 2007, and analyzing the subsequent evolution of AIM. CONCLUSION: We must be cautious in assessing the speed at which further progress will be made, despite today's wild predictions in the press and large investments by industry, including in health care. The inherent complexity of medicine and of clinical care necessitates that we address issues of usability, workflow, transparency, safety, and formal clinical trials. These requirements contribute to an ongoing research agenda that means academic AIM research will continue to be vibrant while having new opportunities for more interactions with industry.

Twenty-five years of national health IT: exploring strategy, structure, and systems in the English NHS.

Objective: There is global interest in implementing national information systems to support healthcare, and the National Health Service in England (NHS) has a troubled 25-year history in this sphere. Our objective was to chronicle structural reorganizations within the NHS from 1973 to 2017, alongside concurrent national information technology (IT) strategies, as the basis for developing a conceptual model to aid understanding of the organizational factors involved. Materials and Methods: We undertook an exploratory, retrospective longitudinal case study by reviewing strategic plans, legislation, and health policy documents, and constructed schemata for evolving structure and strategy. Literature on multi-organizational forms, complexity, national-level health IT implementations, and mega-projects was reviewed to identify factors that mapped to the schemata. Guided by strong structuration theory, these factors were superimposed on a simplified structural schema to create the conceptual model. Results: Against a background of frequent NHS reorganizations, there has been a logical and emergent NHS IT strategy focusing progressively on technical and data standards, connectivity, applications, and consolidation. The NHS has a complex and hierarchical multi-organization form in which restructuring may impact a range of intra- and inter-organizational factors. Discussion: NHS-wide IT programs have generally failed to meet expectations, though evaluations have usually overlooked longer-term progress. Realizing a long-term health IT strategy may be impeded by volatility of the implementation environment as organizational structures and relationships change. Key factors influencing the strategy-structure dyad can be superimposed on the tiered NHS structure to facilitate analysis of their impact. Conclusion: Alignment between incremental health IT strategy and dynamic structure is an under-researched area. Lessons from organizational studies and the management of mega-projects may help in understanding some of the ongoing challenges.

History of Romanian Medical Informatics: Learning from the Past to Reshape the Future.

OBJECTIVES: The paper presents a review of the history of medical informatics in Romania, starting from the pioneering works, relating the present, and foreseeing the future. METHODS: Major milestones of the development of this field have not been simply enumerated, but described within the specific socio-political frame, grasping the entire context over the last four decades in Romania. Two main perspectives have been traced: education and training in medical informatics and implementations in healthcare. RESULTS: Four distinctive historical periods are identified and the major events of each period are described in a critical manner. The history of the Romanian Society of Medical Informatics is presented in a separate chapter. The last section is dedicated to the present state of the field in Romania. CONCLUSION: The history of Romanian Medical Informatics spans many years and is rich in content. The Romanian Society of Medical Informatics is mainly the result of the efforts undertaken by an enthusiastic and sound professional community, trying to continue the tradition, to achieve new goals, and to work as an active member of the international biomedical/health informatics community.

Anesthesia Information Management Systems.

Anesthesia information management systems (AIMS) have evolved from simple, automated intraoperative record keepers in a select few institutions to widely adopted, sophisticated hardware and software solutions that are integrated into a hospital's electronic health record system and used to manage and document a patient's entire perioperative experience. AIMS implementations have resulted in numerous billing, research, and clinical benefits, yet there remain challenges and areas of potential improvement to AIMS utilization. This article provides an overview of the history of AIMS, the components and features of AIMS, and the benefits and challenges associated with implementing and using AIMS. As AIMS continue to proliferate and data are increasingly shared across multi-institutional collaborations, visual analytics and advanced analytics techniques such as machine learning may be applied to AIMS data to reap even more benefits.