Current Affiliation: Associate Professor of Clinical Emergency Medicine; Fellowship Director, Medical Informatics, Indiana University School of Medicine; Research Scientist, Regenstrief Institute, Inc.
Education: MD, University of Vermont School of Medicine
How do I describe my work to those outside the field …
It depends on who I’m talking with. Most commonly it is with med students taking the student elective. We have a 3rd and 4th year elective at Regenstrief where students can spend time learning about biomedical informatics. The reason I got into this field is that, as a medical student back in the 1980s, we had to write all discharge instructions by hand. When I worked in the emergency department and somebody came in with a wound, we had to physically write out on paper to watch for signs of infection, increased redness, increased pain, etc., and I was frustrated about the fact that I had to keep doing it. I thought, there’s got to be a more efficient way to do this. So, I proposed to the head of the emergency department to come up with a template. She endorsed it, and so I went home and wrote the 10 most common reasons for people to come into the emergency department, and created a handout. Then we pre-printed the discharge instructions for each indication. It was a way to make us more efficient. So the answer to the medical students is that there’s a fair amount of cognitive load or overhead that we have to do, and if you can offload that into a template or a work flow, then you can spend the rest of your time worrying about what you really need to be doing.
The other line that I’ll use is that you could write one line of code and impact hundreds of thousands of patients. The example there is we instituted a food program in the emergency department. It was a little controversial because older emergency physicians think that’s primary care and public health, but many people today recognize the value of the safety net, and if a patient is in your environment you can actually improve their health. So over the winter month we had a simple rule that said, if the patient is not known to be vaccinated and yet eligible, we should remind them to get the vaccine. So, with one line of code we impacted over 100,000 patients as they presented to the emergency department for various complaints. These are the tools we can use in health care to make us more efficient.
Years of experience:
Informatics started formally in 2002. Before that time, I didn’t know there was such a thing as informatics. I was just trying to be more efficient during residency. My first rotation was emergency medicine. I came up with template notes, and I had no idea that this was an IT thing. I wanted a way to be more efficient, so at night I would print out all my patients notes and pre-populate the data that I knew, and the next morning I would fill out the fields that I needed to enter. When I took my first job in Minnesota, one of my residents told me about informatics.
It is a way of increasing our efficiency as doctors.
What are your ambitions? At the end of your career, what do you hope to have accomplished?
My focus is on education at this point. We have a newly-developed clinical informatics fellowship program and are hoping to train the next generation of informaticians, so that is a near term goal. Long term, it’s more of developing data integration tools to allow us to be more effective clinically. I use this analogy: small children, when they are playing with toys, they really don’t want to share. That’s the way people tend to be about their own clinical data. It’s hard to get that data out from different systems and people are reluctant to share. I’m hopeful that by the end of my career, people will be more willing to share data and it won’t even be a question anymore, but a fact.
Who or what are your “key sources” in the informatics field?
Clem McDonald, an early role model, and still is. I remember meeting him the first day, I was incredibly nervous, he pulled me into the board room and asked me why I wanted to go into informatics. I wasn’t sure what he was looking for but I described one of the problems that we have in emergency medicine is that our guidelines are hard to follow, and his eyes lit up. And the other person is Bill Hersh. He influences a lot of my peers and a lot of my students. I think he’s a wonderful clinician and leader in informatics, and appreciate all he has done for us.
Hobbies/Interests outside AMIA ...
Running is a hobby of mine. I do several half-marathons. I’ll be running the Chicago marathon soon. 26.2 miles takes roughly 4 hours. I’m hoping to do that with my sister who is a runner as well.
AMIA is important to me because ...
It’s really the home of all things informatics. It’s interdisciplinary. There is nursing and public health and other disciplines. I think of it as the one-stop shop if you are going to have an informatics need or question. It’s the place to go.
I am involved with AMIA ...
My primary role is building the clinical informatics practice exam (CIBRC). Essentially because clinical informatics is now a newly sub-boarded specialty, physicians need to take an additional certification exam in order to be boarded. What AMIA has done is it has set up an equivalent practice exam to try to emulate what the real board exam is going to be like so physicians can go through the reading, the training, and the in-class experience, and then take our exam as an opportunity to see what their strengths and weaknesses are.
As the Chair of the InSpire 2016 Academic Forum Conference, what do you hope will come from the meeting this year?
It's been an honor to work with the SPC and AMIA staff. They have all been outstanding committee members and have provided valuable insight into creating this revised event. InSpire grew out of the natural need to be more inclusive and to expand the traditional Academic Forum meeting into more of a national presence. There are many faculty across the country who are involved in informatics education and this is the meeting for them to meet their educational needs. We are totally excited about the upcoming meeting this month, and look forward to seeing this meeting continue to grow and mature. In Emergency Medicine, there is a similar group called CORD. This meeting was very informal when I was a member 15 years ago. I've since learned this meeting has grown to over 1,000 participants. I think InSpire will also realize similar growth and it's exciting to be part of this process.