Dr. Randolph (Randy) A. Miller, founding Associate Editor and second Editor-in-Chief of theJournal of the American Medical Informatics Association (JAMIA), has been selected to receive the 2021 Morris F. Collen Award from the American College of Medical Informatics for his sustained and innovative contributions to the field including his pioneering research in clinical decision support systems. We have created an online collection of selected papers from among Dr. Miller’s publications inJAMIA that is available at:https://academic.oup.com/jamia/pages/morris-collen-award. The collection includes his paper inJAMIA’s inaugural issue, Medical Diagnostic Decision Support Systems—Past, Present, And Future: A Threaded Bibliography and Brief Commentary, which has been cited 569 times to date.¹

This issue ofJAMIA includes a historical review by Miller and Shortliffe along with three papers focused on clinical decision support.^2–5 Given that Dr. Miller has played a significant role in advancing rigor in evaluation in biomedical informatics, I also highlight a Perspective on rigor in qualitative research.⁶

Miller and Shortliffe² review the role of Dr. Donald A.B. Lindberg and his colleagues at the National Library of Medicine (NLM) in fundamentally changing the field of biomedical and health informatics. They characterize the activities that occurred during Dr. Lindberg’s 31 years as Director of the NLM as a scientific revolution that broadly influenced biomedicine. They summarize key chapters from a 2021 book that provides evidence of this influence.⁷ They also place these activities in a historical perspective of biomedical and health informatics that includes the formation of the American Medical Informatics Association, with Dr. Lindberg as its first President and Chair of the Board of Directors, and the establishment ofJAMIA as the Association’s first journal.

Dixon et al. deployed event notification system (ENS) alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange networks to notify VA-based primary care teams (physicians, nurse practitioners, and registered nurses) when older patients were hospitalized or had emergency department (ED) visits outside the VA system.³ Using a concurrent cohort study design, they compared postdischarge outcomes between patients (n = 202) whose providers received ENS alerts and those (n = 191) that did not (usual care). Veterans whose primary care team received notification of non-VA acute care encounters via a Health Level 7 admission, discharge, transfer message were 4 times more likely than those receiving usual care to have phone contact within 7 days and 2 times more likely to have an in-person visit within 30 days. However, there were no significant differences between groups in hospital or ED utilization within 30 days of the index discharge. Although the health information exchange provided a straightforward approach for pushing ENS messages, the authors suggest that optimization of ENS processes may be required to scale use and impact across health systems given that less than half of the individuals in the ENS group received a phone call or in-person visit within 30 days.

Clinician burden related to the electronic health record including interruptive alerts is an important concern. Orenstein et al.⁴ analyzed interruptive alert firings logged in EHR databases at 6 pediatric health systems using 4 metrics: (1) alerts per patient encounter, (2) alerts per inpatient-day, (3) alerts per 100 orders, and (4) alerts per unique clinician day. Alert firing was defined as “the number of interruptions from custom (developed using locally managed rules), medication administration, and drug–drug interaction alerts requiring the clinician to act on the alert before being able to proceed with their workflow in the EHR.” Although alert burden varied widely across institutions, the rank order of institutions by alert burden was similar regardless of which alert burden metric was chosen. However, estimates of the clinical areas with the highest alert burden varied based on the metric suggesting that using multiple metrics may be useful in determining relevant intervention targets for addressing alert burden.

Krist et al.⁵ summarize the findings and recommendations of a National Academies of Sciences, Engineering, and Medicine committee focused on creating a plan to implement high-quality primary care. In response to the key objective of “designing information technology that serves the patient, family, and interprofessional care team,” the committee recommended 2 essential actions for the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services: (1) developing the next phase of digital health certification standards that support relationship-based, continuous, person-centered care; simplify user experience; ensure equitable access; and hold vendors accountable; and (2) adopting a comprehensive aggregate patient data system usable by any certified digital health tool. These actions require key decision support functionality including supporting the diagnostic reasoning process, automating the use of up-to-date guidelines, using artificial intelligence to identify persons who require care and support delivery of care, and clinician- and patient-facing tools to aid decision-making and health promotion.

A 2021 scoping review provided evidence that qualitative research represents a small but important portion of published articles inJAMIA.⁸ In a Perspective, Ancker et al.⁶ argue that qualitative research is integral to the field of biomedical and health informatics and offer guidance on reporting qualitative research in informatics in a manner that clearly explicates the rigor of the work. This includes providing details on the underlying theory, research question, sampling, data collection methods, data analysis, results, and discussion. The recommendations are intended to complement existing checklists for qualitative research and highlight issues which are specific to informatics.

On behalf ofJAMIA’s Editorial Team, I am delighted to offer congratulations to our former Editor-in-Chief, on his achievements, which have been recognized with the 2021 Morris F. Collen Award. I encourage readers to visitJAMIA’s special online collection to truly appreciate the breadth and impact of Dr. Randolph Miller’s work.