Introduction
This manuscript was solicited in 2017 originally for the International Medical Informatics
Association's (IMIA) History project.[1] The intent was to provide details on the history of the Applied Clinical Informatics (ACI) journal—an official IMIA journal—before the individuals involved in its inception
and development retired and the details were lost.
While ACI generally does not publish historical perspectives, the article was transferred to
ACI to allow readers to place the journal in its historical context, to explore the factors
required for the birth of a new journal, to appreciate the serendipitous factors that
made the journal possible, and to pay tribute to many of the individuals whose efforts
led to this journal ACI. In this article, we seek to span the entire period from recognition of the need
for a new applied journal to the current state including data on recent journal measures
from submissions to publications.
Path Toward Creating a New Journal
Demand for a New Journal
Although the biomedical informatics field had multiple strong journals, by the early
2000s it had become obvious to several clinical informatics researchers and developers—including
the authors—that applied clinical informaticians had difficulty finding a dedicated
home for their work in established journals. Frequently, applied papers were rejected
because they were not advancing the theory of the field or were deemed to be outside
the editorial scope of the journal. As a result many clinical informaticians resorted
to publishing in clinical journals[2]
[3]
[4] or in their informatics societies' proceedings.[5]
[6]
[7] Thus, the need for a new applied clinical informatics journal had become apparent.
In addition, interest in the domain grew dramatically with the $29 billion financial
stimulus provided through the United States' 2009 Health Information Technology for
Economic and Clinical Health (HITECH) Act.[8] Health care in America today represents 19.7% of the U.S. gross domestic product,[9] and the rapid adoption of electronic records increased the need and desire to publish
more applied manuscripts about the successes and failures of health information technology
(IT).
A Serendipitous Start
In 2007 during IMIA's MedInfo conference in Brisbane, Australia, Christoph U. (Chris)
Lehmann was invited to a meeting with IMIA board members, where Marion Ball articulated
what others had already perceived: it was time for a new journal focused on the applied
aspects of clinical informatics. IMIA Past-President Marion Ball and incoming IMIA
President Reinhold Haux noted that electronic health records were increasingly being
used around the world. The availability of more systems and more data produced a new
breed of informaticians—those in charge of implementing, maintaining, and improving
clinical health information systems. These informaticians had more applied research
agendas, wanted to share lessons learned with their peers, and needed a recognized
forum to exchange successes, failures, opinions, and thoughts. The number of people
in this field continued to grow rapidly. In time, they would play an ever bigger and
more important role at the interfaces between clinicians and their colleagues and
patients. The meeting adjourned with the decision to write an editorial that articulated
the need for a journal whose primary focus was applied clinical informatics.
From Vision to Reality
The article summarizing the results of the meeting, entitled “Translational Research
in Medical Informatics or from Theory to Practice,” was published in 2008 and declared
the need that IMIA perceived for a new applied journal.[10] The selection of a publisher was serendipitous. As then-IMIA President and as Editor-in-Chief
of Methods of Information in Medicine (MIM), Reinhold Haux had close connections with Schattauer Verlag owner Dieter Bergemann.[11] Schattauer Verlag also published IMIA's flagship publication the Yearbook of Medical Informatics. Prof. Haux arranged for a meeting with Schattauer's Dieter Bergemann, Dr. Andrea
Schürg, Dr. Peter Henning, Jan Haaf, and Chris Lehmann. Although initially the idea
of a new journal was met with skepticism, the final outcome of the meeting was an
agreement—Schattauer would publish a new journal in clinical informatics.
Chris Lehmann was invited to serve as the Editor-in-Chief for the new journal. The
first order of business was a name for the journal. The journal's title—Applied Clinical Informatics (ACI)—emphasized the focus on clinical systems and their implementations. Manuscripts had
to be informative but of significant applicable value to users of health IT. ACI emphasized the use of research methods to study the impact of health IT. The journal's
goal was to serve as a manual, a guide, and a helpful reference that would make it
easier to apply new skills, tools, and techniques to health information data and technology.
Getting Off the Ground
ACI's first editorial board was composed of leaders from the IMIA organization.[12] From the start, ACI aimed to establish a platform that allowed sharing of knowledge between clinical
medicine, informaticians, and health IT specialists. ACI is known for bridging gaps between visionary design and successful and pragmatic
deployment. One mission is to report on failures of implementation and systems to
allow others to learn from and avoid the same mistakes.
Review Process
From its inception, ACI used a double-blinded review process to reduce bias against authors from regions
other than North America and Europe.[13] Authors do not know who the reviewers are, and reviewers do not know the authors
and their institution. The latter requires the blinding of submissions to authors,
their citations, and their institutions and countries. Over the years, several papers
have slipped through the process with information remaining unblinded, and sometimes
reviewers have been able to identify authors based on similar or related papers. However,
the vast majority of papers have been reviewed in a blinded fashion. Because ACI has been an official journal of IMIA since its inception, one important goal for
ACI was to become a journal that would publish manuscripts from low- and middle-income
countries as well as developed countries.
Early Years
Any new journal struggles with obtaining relevant, high-quality submissions, and initially
this was the case for ACI. We used the connection to IMIA to advertise the new journal and started a relationship
with the Association of Medical Directors of Information Systems (AMDIS) for 4 years
to help promote the journal. A critical moment in the history of ACI came when the journal was listed in Medline. The hurdle to become indexed in Medline
is high. A journal must “demonstrate quality of editorial work, including features
that contribute to the objectivity, credibility, and quality of its content.”[14] The journal has to be published for at least a year and must have published a minimum
of 40 papers. ACI received its Medline indexing approval starting in 2012, which resulted in a significant
increase in the number and quality of submissions.
Clinical Informatics Subspecialty
ACI had been an official journal of IMIA since its start and became an official journal
of the European Federation of Medical Informatics (EFMI) in 2021. Early on, the American
Medical Informatics Association (AMIA) Board of Directors declined ACI's request to be named an official AMIA journal. Subsequently, the American Board
of Medical Specialties in the United States approved Clinical Informatics as a new
subspecialty, creating with it the need for research and education in this new field.[15]
[16]
[17]
[18]
[19] Chris Lehmann became the first board-certified Clinical Informatician to chair the
new sub-board at the American Board of Preventive Medicine and ACI was added to the official list of resources to study for the board examination. The
new subspecialty and its need to provide a forum for research and education in the
field resulted in the reversal of the AMIA's Board of Directors' position, and ACI became an official AMIA journal and provided free article access as a member benefit.[20] AMIA's endorsement was a major milestone in the history of ACI and significantly increased readers and manuscript submissions, which allowed ACI to improve its standards for manuscripts. By 2020, the manuscript rejection rate
approached 70%.
Over the years, ACI has become a home for the new Clinical Informatics profession. It has provided a
platform to discuss issues related to the new Clinical Informatics Fellowships such
as Milestone Development,[17] Financing,[21]
[22] and Candidate Matching.[23] It also added to the discussion of the training and skill set for the new workforce
in clinical informatics.[24]
ACI also invited the best contributions at the AMIA Clinical Informatics Conference to
be published in a special topic section in 2019 and 2021.[25] With the Clinical Informatics subspecialty, ACI introduced the Multiple Choice feature to manuscripts to aid applicants to study
for the board examinations.
Publisher Transition
In 2018, Dieter Bergemann sold Schattauer Verlag including the ownership of the journal
ACI to Thieme Verlag—another German publisher. The transition saw many familiar friends
and collaborators including Dr. Schürg and Mr. Jan Haaf leave the ACI orbit. Thieme Verlag was able to fill these vacancies with a new team that included
Dr. Daniel Schiff, Graham Brumfield, and Dr. Elinor Switzer, who have worked diligently
to further grow ACI. [Table 1] lists ACI's outstanding Managing Editors over the years.
Table 1
ACI's managing editors since its inception
|
Managing Editor
|
Institution
|
Period
|
|
George R. Kim, MD
|
Johns Hopkins University
|
2009–2010
|
|
Jessica Holzner, PhD
|
Johns Hopkins University
|
2010–2016
|
|
Robert Cronin, MD, MS
|
Vanderbilt University
|
2016–2018
|
|
Jenna S. Lehmann, MS
|
Tennessee State University
|
2018–present
|
First Controversy—Impact Factor
Establishing a journal will create disagreements and issues. Since its inception,
ACI has seen cases of plagiarism (usually self-plagiarism), authors' upset about rejections,
and many attempts by predatory journals to acquire the journal. The politics of academic
publishing led to many disagreements and controversies. Perhaps the largest controversy
arose in 2016, when Thompson-Reuter suppressed ACI's and MIM's impact factors. The journals were accused of stacking, a phenomenon in which an abnormally
large number of citations from one journal appear in another journal. As the editors
for both journals discussed, the issue arose from the publication of papers analyzing
the interrelationship between the two journals. Each paper referenced a large number
of papers from the other journal, which affected the Impact Factor calculation. As
a result, both MIM and ACI were suspended for a year by Thompson-Reuter from the Impact Factor listing.[26]
[27]
[28] Editors still monitor the interrelationship between the journals without citing
individual articles.
Journal Measures
[Table 2] shows selected performance measures for ACI from recent years. In 2021, total submission included 316 papers. In 2021, the journal
started to thank its reviewers publically in an editorial.[29] We hope that this effort will translate into a future tradition.[30]
Table 2
Journal measures for Applied Clinical Informatics 2019 to 2021
|
Measurement description
|
2021
|
2020
|
2019
|
|
Impact factor
|
IF 2021 to be released in June 2022
|
2.342
|
2.147
|
|
Total citations
|
511
|
415
|
338
|
|
Total submissions
|
316
|
278
|
252
|
|
Days to first decision (all manuscripts)
|
25.7
|
21.2
|
23
|
|
Days to final decision (average)
|
53.0
|
41.0
|
55
|
|
Total articles published
|
126
|
89
|
104
|
|
Acceptance rate
|
39.9%
|
32.0%
|
41.2%
|
|
Full text downloads (HTML and PDF)
|
284,608
|
200,350
|
65,056
|
|
Mean Altmetric Attention score
|
5.7
|
6.43
|
4.8
|
A recent article reviewing publications on “Electronic Health Record” found that ACI was the third most influential journal in this domain with 244 total publications
on the topic, 244 total cited papers, and 2,178 total citations to these papers.[31]
The Future
The ongoing worldwide adoption of electronic health record suggests that ACI's focus on applied issues of health IT will become even more influential and important. The
growing importance of Clinical Informatics Board Certification[20] and future Advanced Health Informatics Certification[32] will require a more systematic approach toward examination preparation. ACI in 2016 required authors to add multiple-choice questions to their papers to help
readers prepare for these exams.
Conclusion
ACI started with a vision to highlight the application of clinical informatics to health
care. It developed and blossomed because of serendipity, good timing, supportive organizations,
an outstanding editorial board, and wonderful mentors. Ultimately, however, its authors
and reviewers are the ones who have contributed most to its success.
