How Should We Organize to Do Informatics?: Report of the ACMI Debate at the 1997 AMIA Fall Symposium

The continuing development of the field of medical informatics has raised new questions and placed before us new dilemmas. Spurred by the proliferation of information systems to support the broad missions of our institutions, and the evolution of these systems from luxuries to necessities, organizational issues have assumed increasing prominence. Among a dazzling array of organizational issues now before us is the tension between the long-standing academic role of informatics groups within medical centers and the ever-expanding service role. In the academic role, we seek the knowledge to create improved technology and to train the next generation of informatics researchers. In the service role, we seek to put existing technology, developed internally or purchased from vendors, to best use across the full scope of medical center activities. The dilemma before us is not whether both roles are important—the answer to that is clear—but rather how to organize ourselves within our institutions to address both of them. How much organizational distance should exist between the people who carry out these different roles, and who should direct their efforts? Most academic medical centers are actively searching for answers to these organizational questions, and many AMIA members are engaged in this pursuit. The answers obtained will be of profound consequence for our field. The salience of this issue directed its selection as the focus of the ACMI Debate at the closing session of the 1997 AMIA Fall Symposium. The purpose of the debate was not to generate a universal answer, for no such answer exists, but rather to illuminate the many factors that must be considered as our institutions search for an appropriate organizational model. To frame the debate, we intentionally polarized the issue around a specific proposition: Resolved: Academic medical centers should have a single unit responsible for information systems supporting the clinical and academic missions and also should be charged to carry out high-quality education and research in medical informatics. The polarity is such that the affirmative team would argue in favor of one group under one leader who would carry out all roles. The negative team would argue for a significant level of separation. We adapted the standard high school and college debate format to fit the available time and to use competition as a device to promote deeper understanding of key issues. There were no judges and no declared winners. Each team had two members: Warner Slack and William Stead for the affirmative, Mark Frisse and Mark Musen for the negative. The format included eight-minute constructive statements, two-minute cross-examinations, and three-minute closing (rebuttal) statements in this order: First affirmative constructive statement, by Slack Cross-examination of Slack, by Musen First negative constructive statement, by Frisse Cross-examination of Frisse, by Slack Second affirmative constructive statement, by Stead Cross-examination of Stead, by Frisse Second negative constructive statement, by Musen Cross-examination of Musen, by Stead Closing (rebuttal) statements by Frisse, Slack, Musen, and Stead, in that order In preparing this summary, we sought to convey the substance and spirit of the debate in a manner suited to printed text. This narrative follows the order of the debate as it occurred on October 29, 1997, at the AMIA Fall Symposium in Nashville, Tennessee. The constructive statements included here were edited from the notes the debaters used to prepare their statements. The cross-examinations and closing statements were edited from the debate transcripts and retain much of the colloquial language used in the event. We include bibliographic references only to direct quotations and citations used by the debaters themselves. The format of this and any debate, and most notably the polarization of a multifaceted issue, often requires participants to take extreme positions. The debaters' views, in reality, overlap more than this report would suggest. Some of the debaters believed that they could, if asked, argue with equal effectiveness in support of their opponents' position. 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