The relationship between biomedical and health informatics and society: is it time for a social contract?

JAMIA’s founding Editor, William W. Stead, entitled his inaugural editorial “JAMIA—why?”¹ Two of the multiple reasons for establishing JAMIA informed my selection of papers to highlight in this issue. One reason was to provide a forum for identification of career paths, definition of curricula, and consideration of credentialing in medical informatics. Dr. Stead also envisioned JAMIA as a vehicle for reaching beyond the medical informatics community to educate the public about the potential of the field for improving the healthcare environment and the challenges that must be overcome to achieve that potential. Taken together, these reasons for JAMIA and the substantial progress in these areas by AMIA contribute to defining our field’s relationship with society—a concept well-known to us from clinical disciplines as a social contract.

JAMIA has published a substantial number of papers, primarily AMIA position papers, on the competencies and core educational content for our field throughout its history ranging from defining core content and competencies for educational programs^2–6 to certification as a medical subspecialty⁷ or for advanced health informatics practice.^8–10 Two of the highlighted papers in this editorial are AMIA position papers that build upon this prior work by defining the foundational domains and competencies for baccalaureate health informatics education¹¹ and mapping the delineation of practice to the AMIA foundational domains for applied health informatics at the Master’s level¹² while a third characterizes the experiences of clinical informatics fellow graduates during fellowship.¹³

Two papers describe the potential of the field for improving the healthcare environment and explicate specific challenges that must be overcome to achieve that potential: (1) applying anti-racist approaches to informatics to help realize the vision of health systems that are more fair, just, and equitable,¹⁴ and (2) scalable, flexible guidelines and tools for electronic health record (EHR) data quality assessment.¹⁵

The Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) accredits Associate, Baccalaureate, and Master’s degree educational programs in information management and Master’s degree programs in Health Informatics. Toward the goal of curriculum development and CAHIIM accreditation quality assessment for baccalaureate education in applied health informatics, AMIA’s Academic Forum Baccalaureate Education Committee adapted the 10 foundational domains for Master’s level education in applied health informatics: F1—Health, F2—Information Science and Technology, F3—Social and Behavioral Science, F4—Health Information Science and Technology, F5—Human Factors and Socio-technical Systems, F6—Social and Behavioral Aspects of Health, F7—Social, Behavioral, and Information Science and Technology Applied to Health, F8—Professionalism, F9—Interpersonal Collaborative Practice, and F10—Leadership.¹¹ The Committee also defined the baccalaureate level competencies (ie, knowledge, skills, and attitudes) for each foundational domain.

To explore the alignment between AMIA’s foundational domains for applied health informatics Master’s level education⁶ and its delineation of practice knowledge statements for health informatics,⁸ Johnson et al.¹² iteratively mapped the relationships between the 2 products developed independently for different purposes. The foundational domains guide Master’s level education development and accreditation assessment which provide an educational pathway to the minimum competencies for health informatics practice. The delineation of practice defines the domains, tasks, knowledge, and skills needed to competently perform in the discipline of health informatics. The mapping analyses reveal similarities and differences between the practice experience and the curricular needs of health informaticians. Notably, few delineation of practice knowledge statements and tasks mapped to foundational domain 6-Social and Behavioral Aspects of Health.

Previous AMIA position statements published in JAMIA defined the medical subspecialty of clinical informatics,² delineated the core content for the subspecialty of clinical informatics,³ and identified the program requirements for fellowship education in the subspecialty of clinical informatics.⁴ In this issue, Kim, Van Cain, and Hron, report findings from a survey of clinical informatics fellows completing their programs in 2016-2024.¹³ Almost half of 394 alumni and current clinical informatics fellows responded to the survey. Most were male (62%), 31–40 years old (72%), and from primary care (54%) and nonprocedural specialties (95%). In terms of race and ethnicity, 39% were White, 31% Asian, and 10% Black and only 4% identified as Hispanic/Latino. About 43% had informatics experience prior to their fellowship. Among the 106 respondents who had finalized a post-fellowship position, the great majority (87%-94%) participated significantly in operations, research, teaching, coursework, quality improvement, and clinical care activities during fellowship. The most common activities were data extraction from an EHR or building information technology systems (73%), implementing a clinical decision support tool in an EHR (64%), and EHR transition or Go Live of a digital project (62%). Most received a Master’s degree and/or certificate. The authors highlighted the need for strategies to improve the pipeline for individuals from racial and ethnic minority groups as well as for those who do not identify as male.

I believe that the fourth and fifth highlighted papers are useful to broadly educate the public about the potential of our field for improving the health care environment and 2 challenges that must be overcome to achieve that potential. Platt et al.¹⁴ argue that structural, institutional, and systemic racism—which operate independently of any individual or personal racism, prejudice, or attitude—are chronic and embedded in contemporary health-related systems including the hierarchy of data, information, knowledge, and wisdom (DIKW) and that “without anti-racist expertise, the field risks reifying and entrenching racism in information systems.” They propose the use of the Public Health Critical Race Praxis Informatics Framework and its guiding questions across the DIKW hierarchy to mitigate and dismantle racism in such systems as a strategy to help realize the vision of health systems that are more fair, just, and equitable.

Despite the benefits of using EHR data for research, EHR data quality concerns for research purposes remain a challenge and there is not a standard approach for assessing EHR data quality. Lewis et al. extended a 2013 literature review on EHR data quality assessment approaches and tools to determine improvements or changes in EHR data quality assessment methodologies over the last decade. Seventy-three of the103 papers in the review focused on data quality outcomes of interest papers, 22 reported on tools, and 8 were opinion pieces. The most common dimension of data quality assessed was completeness, followed by correctness, concordance, plausibility, and currency. Bias, an added dimension of data quality for the updated review, was defined as missingness not at random, and only assessed in 11% of the papers. The authors advocate for a standard approach and scalable, flexible guidelines for EHR data quality assessment to improve the efficiency, transparency, comparability, and interoperability of data quality assessment. They also note the important role of automation in operationalizing the standard approach and guidelines.

The 2 reasons for JAMIA that motivated my selection of highlights are components of the relationship between our field of biomedical and health informatics and society, that is, ensuring the existence of well-qualified professionals and educating the public about the potential of our field in creating safe, fair, just, and equitable health systems and challenges that we face to achieve that potential. Informaticians coming from clinical disciplines such as nursing and medicine have a long history of social contracts that define the relationship between the discipline and society.¹⁶ Should our biomedical and health informatics discipline have a social contract? If so, what role should AMIA and JAMIA play in explicating the social contract? Given that a social contract is bidirectional, what should our expectations of society be?

Conflicts of interest

None declared.

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