Challenges in Medical Informatics 209 Yearbook of Medical Informatics 2003 Challenges in Medical Informatics A Discipline Coming of Age M.A. Musen 1 , J.H. van Bemmel 2 1 Stanford Medical Informatics Stanford University School of Medicine Stanford, California, USA 2 Institute of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands Adolescence is a difficult time. Teenagers harbor doubts about them- selves and about their relationship with others. They enter a period of deep introspection and begin to question their roots. They also begin to envision what it is that they truly want to become. Medical informatics—after a prolonged period of development—is facing its own adolescence. During the past three to four decades, we have transitioned from a group of hospital-based technologists whose primary focus was the implementation of clinical information systems to a diverse community of scholars, clini- cians, engineers, and pragmatists who often share common long-term objec- tives but who often have different agendas for achieving them. Today, academicians in medical informatics constitute a large group of scholars with their own professional societies, conferences, and journals—venues in which they happen to express quite heterogeneous scientific philosophies and goals. Although the emergence of organized elements of scholarship shows how far we have come, the variability in our scientific approach suggests that we are facing a period of continued development. These are tough times in which to be an adolescent. Many health-care institutions are beginning to question the value of the investments that they have made in informatics. Some of our best scientists are leaving their univer- sity positions and many of our trainees seem ill prepared to take on academic jobs. Funding organizations are suddenly enraptured by the glamour of computational biology (which they confuse with bioinformatics), heighten- ing the competition for limited resources. In these demanding times, workers in medical informatics do not have the luxury to act as teenagers and to brood about why the world may be treating them unfairly; they need to define their purpose clearly and to set achievable goals for the years ahead. As we reported last year in these pages [1], a group of senior academi- cians in medical informatics convened in Madrid in March 2001 in conjunction with the meeting of the IMIA Board. The goal of the Madrid workshop was to define the challenges faced by medical informatics as an academic discipline and to suggest strategies to enhance the scholarly foundation of our field. Some of the position papers that were contributed to the Madrid workshop appeared last year in a special issue of Methods of Informa- tion in Medicine [2]. Four of those papers are now reprinted in this edition of the Yearbook. These papers were selected because they provide a cross- section of opinions and are represen- tative of all the contributions discussed at the workshop. The papers point to the need for our community to define clearly what medical informatics is and why it is important. We cannot continue to characterize medical informatics in terms of other, more established disciplines. If we claim that medical informatics is a kind of “applied computer science,” for example, then it remains unclear why medical informatics—at least academically—needs to exist apart from more traditional computer-science groups. If we claim that our field is simply an amalgam of other disciplines, such as computer science, biostatistics, health-services research, and cognitive science, then there is nothing that we can claim to be our own. Like teenagers struggling to understand what differentiates themselves from their parents, the participants at the Madrid workshop worked hard to characterize what are the unique elements of