Better-connected health care

The field of health care continues to make remarkable strides when it comes to patient care and outcomes, but information technology and data-systems support are lagging a few decades behind. As the industry moves toward an emphasis on wellness and disease prevention, the health-care system is not well designed for it.

Arizona State University professor Robert Greenes has an ambitious goal: to make medical information accessible to all providers involved in an individual’s care by building capabilities to integrate all electronic health-care record systems, and also connect the patient more directly to the health-care system.

“Health care is changing a lot, and the IT systems to support it are at least 20 to 30 years old,” said Greenes (pictured above), who is the Ira A. Fulton Chair in Biomedical Informatics and ASU professor of biomedical informatics at the Mayo Clinic.

“It’s hard for a person to manage his or her health and wellness, or as a patient, to receive continuity of care when the relevant health data are stored in silos and locked up.”

This is becoming a national priority as well as a focus of Greenes’ work at ASU. As the newly appointed chairman of the Board of Regents of the National Library of Medicine (NLM) — located on the campus of the National Institutes of Health in Bethesda, Maryland — Greenes is hoping to help bring this about.

It’s a significant time for the NLM, which is the largest biomedical library in the world and coordinates a 6,000-member national network by providing health information in communities throughout the United States. NLM is also the largest funding agency for research and development in biomedical informatics — the field underlying the data and knowledge science, technology and applications for improving health and health care. 

Greenes will be calling attention to the need for coordination of the infrastructure, tools and research methods in which the NLM has traditionally had a leadership role.

He recently spoke to ASU Now about his new appointment and how work at ASU is in line with the directions that the NLM will be leading, and how NLM nationally and ASU locally could help shape the future of biomedical informatics.

Question: What is the role of the NLM, and why is it important to medicine and biomedical informatics?

Answer: The National Library of Medicine is much more than a library and is somewhat of a misnomer. For over 40 years, the NLM has been a primary internal innovator and funder of external grants in the area of biomedical and health informatics — methods for creating, organizing, representing and reasoning with knowledge. This has been applied to creating internally supported repositories of the world’s medical literature, GenBank, clinical-trials registries and other major knowledge resources. But it also has funded methodologies for discovering knowledge from data, formalizing it to facilitate sharing, and applying to many biomedical applications. It has been the major funder of graduate and postdoctoral training in biomedical and health informatics in the United States. 

A 2015 NIH Advisory Committee report on the future of the NLM emphasized the increasingly strategic role of these activities to all of the rest of NIH, to other federal agencies and across the entire biomedical and health enterprise. This is particularly true in light of the major transformations occurring in health care, the genomics revolution, the shift to pay-for-value and emphasis on wellness, the President’s Precision Medicine Initiative, and many other important trends and challenges.

Q: How do you feel your research and background will come to bear in this position?

A: My own research and background as an M.D. and PhD in computer science with long-term engagement in biomedical informatics has included emphasis on using the computer to help provide advice for clinical decision making, and on the standards, interoperability and knowledge resources needed for that, to enhance health-care quality and safety.

Our recently launched HII-C collaborative is an example of this. We are seeking to attract local and national stakeholders to apply principles of computer architecture, design and interoperability to create a platform for evolution of next-generation health IT capabilities. We believe this is important because of the changes that are occurring in health and health care, such as those mentioned above, that are not met by current systems.

Q: What are some initiatives you think the NLM will undertake during your tenure as chairman?

A: The timing of this appointment is significant, in that the NLM has just named its new director, Dr. Patricia Brennan, after a period of significant growth of the NLM over the past 30 years under the previous director, Dr. Donald Lindberg. Coupled with the NIH Advisory Committee report on the future of the NLM and the Precision Medicine Initiative, the NLM is poised to take on broader responsibilities. 

As one of the first tasks under its new director, the NLM will be carrying out a strategic planning process, to be led by the Board of Regents. This strategic planning process is important in terms of how NIH allocates its budget and also to what extent NLM can position itself to provide broad services through its operations, advances in the field through its grantees, and expanded workforce development to support needs of the other government agencies and the broader health community. As the NIH ramps up to implement the Precision Medicine Initiative this year, this also has strong informatics and data science implications, so the good timing for this is also relevant. 

Q: How will the recommendations the Board of Regents make directly affect/impact the general public?

A: In my view, if the NLM were to have a greater role in NIH in coordinating informatics aspects of all the NIH’s grant and intramural programs, as well as outside of NIH, this would be to everyone’s advantage. It will ensure greater levels of data and knowledge sharing and ability to capitalize on the value of research by the many institutes and centers of the NIH, as well as that of other stakeholders.

Now that data, information and knowledge are being recognized as requiring standardization and sharing, it is very important to lay the strategic groundwork for this and a roadmap of specific initiatives that can help realize it.

I’m hoping to engage local as well as national stakeholder input into the strategic planning process. Locally, we also want, ideally, to be positioned to take advantage of the emerging plan.

Q: Regarding your own work at ASU, how soon do you hope to put an integrated medical system into place?

A: I see the new vision for an integrated health-care system being realized gradually and coming together in pieces. There will be parts of it that will be integrated with the current system and add value to it within the current year. The interoperability issue is just starting to become important nationally.

Q: How do you see ASU playing a role in helping to build a platform?

A: It has to be done on a national scale, but I want ASU to be a convener, test bed and collaborative partner that will try and pull together different parts. Locally, our HII-C initiative enables faculty and students to work together on many projects involved in bringing about this vision, along with local and national health-care organization partners. We expect to create prototypes of solutions, attract industry participants, and grow this into a development and economic engine.

Top photo by Deanna Dent/ASU Now