Grand Challenges in Clinical Informatics

"Grand Challenges" are fundamental scientific or technologic problems whose solution requires significant increases in our current level of scientific knowledge and/or technical capabilities. Solutions to clinical informatics grand challenges should significantly improve both the quality and delivery of healthcare while decreasing its costs. Finally, solutions to these problems should be achievable within a decade.

1. a unified controlled medical vocabulary.
2. a complete computer-based patient record that could serve as a regional/national/multinational resource and a format to allow exchange of records between systems.
3. the automatic coding of free-text reports, patient histories, discharge abstracts, etc.
4. Automated analysis of medical records, yielding (for example)

   a) The expected (most common) clinical presentation and course, and degree of clinical variability, in patients with a given diagnosis.

   b) The resources required in the care of patients compared by diagnosis,treatment protocol, clinical outcome, location and physician.

5. a uniform, intuitive, anticipating user interface.
6. a complete 3-dimensional, digital representation of the body, including the brain, with graphic access to anatomic sections, etc.
7. techniques to ease the incorporation of new information management technologies into the infrastructure of organizations so that they can be used at the bed side or research bench.
8. a comprehensive, clinical decision-support system.

In reading this list, one is struck by the fact that it is made up of areas in which active research is already underway. In fact, they represent the grand challenges of the past two decades. Which of these projects are truly worthy of the type of concerted effort that would bring them to fruition within the next decade? Are there projects that people are not yet even thinking about that might be more beneficial and achievable within the same timeframe? Please send any comments or suggestions for inclusion in this list to: dean@informatics-review.com

Note: This is an revised and edited version of an article that originally appeared in:
Sittig DF. Grand challenges in medical informatics? J Am Med Inform Assoc 1994 Sep-Oct;1(5):412-3

Ó 1998 Dean F. Sittig

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