“You never know what's going to result from what you fund directly, but I can tell you now, the synergies have an enormous chance of paying dividends above and beyond the funding of these groups,” Friedman said. “The coalitions that are being formed through SHARP will yield these benefits beyond even the work being funded.”
The grant awards for the SHARP program were announced last week. The money will go to four lead recipients whose work will address four different research objectives described by the ONC as “key challenges.”
Researchers led by the folks at Harvard University will focus on network-platform architectures; the Mayo Clinic will focus on the use of patient data for medical research, quality improvement and other so-called “secondary uses”; the University of Illinois at Urbana-Champaign will focus on the security of health IT; and the University of Texas Health Science Center at Houston will focus on patient-centered cognitive support for clinicians.
Each of the four grant awardees will head up coalitions that will include researchers from other outside institutions, Friedman said.
Friedman knows firsthand about the potential for research and development serendipity.
According to his biography on the ONC Web site, from 1996 to 2003, Friedman served as a professor and associate vice chancellor for biomedical informatics at the University of Pittsburgh. At Pittsburgh, Friedman set up its Center for Biomedical Informatics, which conducted informatics research and hosted master's and doctoral degree programs in biomedical informatics. Friedman came to the ONC after a stint as associate director of the National Heart, Lung and Blood Institute at the National Institutes of Health.
“Even though we laid our four separate focus areas, the four areas touch each other in very interesting ways,” Friedman said. “I think that's going to be another interesting way in which SHARP plays itself out.
“We're going to operate this as a cooperative project across the four centers.” Friedman said, with a federal steering committee set up to oversee the entire SHARP program “as one project with four components.”
Friedman said prioritizing and selecting the four work areas was the result of “thinking about this in very general terms, for a long time.” It included several planning sessions on the future of health IT and what research areas were needed, he said. A list of possible target areas emerged, and then a consensus formed around the top four. ONC head David Blumenthal was a participant in the final target selection, Friedman said.
The ONC then opened up the application process to institutions of higher-education or not-for-profit organizations with a research mission.
Each of the four, four-year grants carries with it the obligation that recipients come up with what Friedman described as short- and long-term results. The short-term projects “would need to lead to innovations through research that would very quickly be realized into products,” Friedman said. Long-term results should lead to more fundamental improvements in the project areas.
“Every one of our major high-tech projects will have an external evaluation, contemporaneous with the project,” Friedman said. “Each one will be done with a separate competitive contract.”
The specific questions to be addressed by the project evaluations still have to be nailed down, Friedman said, but with the short-term projects, success will be measured if, in two years' time, they produce products that people will use.
Expect the first public report from the evaluators in about 18 months to two years, according to Friedman.
Speaking of the individual projects, Friedman said the work at Texas will do more than simply help design a more user-friendly physician/computer interface, although that could be part of the two-year deliverable.
Friedman said ONC project planners borrowed liberally from a 2008 National Research Council report, Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, co-authored by veteran physician informaticist William Stead, chief information officer of the Vanderbilt University Medical Center, Nashville.
The Texas group will address its challenge “to figure out how to provide information to clinician decisionmakers in a way that is aligned with their cognitive process, in contrast to the way machines like to do things,” Friedman said.
The vision, Friedman said, is to create an “intelligent mechanism” that goes beyond simply displaying data but instead creates a visual summary of information that the system determines to be most important for the clinician to see for each patient based on that patient's information.
The University of Illinois team will address security issues for data, not only at rest in an EHR, but also in motion through a health information exchange organization, in telehealth applications and in personal health-record systems.
“It's a truly visionary proposal that's looking at the next generation of security,” Friedman said.
The Mayo-led team will investigate new methods of natural language processing, phenotyping and other techniques with an eye to using patient data to find individuals eligible for a particular clinical trial.
The Harvard group will work on a platform with a Web-based service architecture analogous to the iPhone structure in which multiple applications can be written around a standardized core.
Friedman said the goal is to keep the resultant products and technology from the publicly funded research in the public domain.
“We certainly emphasize open source and publication in open-source journals of research results,” Friedman said. "There are complex issues of intellectual property that come into play when grant money is given to universities for research purposes. It's safe to say we did everything we could to make the products of SHARP as open as possible.”
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