18 Expressions of the Fundamental Theorem of Biomedical Informatics

The fundamental theorem of biomedical informatics (BMI), proposed by Charles Friedman, PhD, states that “A person working in partnership with an information resource is ‘better’ than that same person unassisted.” Friedman’s theorem is not actually a formal mathematical theorem (which is based on deduction and is accepted as true), but rather a distillation of the essence of BMI.

The theorem implies that biomedical informaticians are concerned with how information resources can (or cannot) help people.

It is useful to consider expressions of the theorem in terms of the people or organizations who would use the information resources. Whether the theorem holds true in a given scenario can be empirically tested with randomized controlled trials and other studies.

Patient users

  • A patient using a medication reminder app will be more adherent to her medication regimen than the same patient not using the app.
  • A patient trying to lose weight who tracks diet and exercise on a smartphone app will lose more weight than the same patient without the app.
  • A patient who uses a patient portal to communicate with his physician will feel more engaged in his care than the same patient without the portal.
  • A patient who uses a patient portal to view tests results will express higher satisfaction with her care than the same patient without the portal.
  • A patient who participates in an online forum for rheumatoid arthritis will cope more effectively with her disease than the same patient without the forum.

    Clinician users

    • A pediatrician using an electronic health record (EHR) with vaccination reminders will be more likely to order timely vaccinations than the same physician without the reminders.
    • An emergency medicine provider with access to a local health information exchange (HIE) will order fewer duplicate tests than the same provider without the HIE.
    • A nurse who uses a wireless system to transmit vital signs directly into the EHR will make fewer documentation errors than the same nurse without the wireless system.
    • A case manager using a patient registry will identify more patients with uncontrolled hypertension than the same case manager without the registry.
    • A surgical team using a safety checklist will have fewer surgical site infections than the same surgical team without a checklist. ** Note that the checklist is an example of an information resource that does not need to be computerized.
    • A physician using a clinical decision support (CDS) tool for antibiotic dosing is more likely to prescribe the appropriate antibiotic dose than the same physician without the CDS tool.

    Health care organization users

    • A hospital with a computerized deep venous thrombosis (DVT) risk assessment program in the EHR will have fewer DVTs than the same hospital without the program.
    • A hospital with a mobile computerized physician order entry (CPOE) platform will have fewer telephone orders than the same hospital without mobile CPOE.
    • A hospital that uses an HIE to send discharge summaries to primary care providers will have fewer readmissions than the same hospital without the HIE.
    • A nursing home using sensor technologies will have a lower rate of patient falls than the same nursing home without the sensors.
    • A student health clinic that sends text message reminders will achieve higher vaccination rates for human papillomavirus than a clinic without the text messaging system.
    • A rural health clinic using telemedicine for virtual consultations with specialists will send fewer patients to the emergency room, compared to the same clinic without telemedicine.
    • A medical practice with a quality improvement dashboard will identify gaps in health care provision more rapidly than the same practice without the dashboard.

    Sources:

    Friedman CP. A “Fundamental Theorem” of Biomedical Informatics. J Am Med Inform Assoc. 2009;16:169–170.

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