Current Affiliation: AVP & Chief Health Informatics Officer, Children’s Hospital of Philadelphia; Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania
BS, Biology, Emory University, Atlanta
MD, Washington University, St. Louis
MBI, Oregon Health & Science University, Portland
How I describe my work to those outside the field ...
I start by defining clinical informatics. I tell them it’s the field of medicine that applies information science and computer science to improve health. Most people have seen their health care providers use computers as part of their job, but they probably haven’t considered what those systems are meant to do other than serve as a place to document orders and notes. Usually I’ll ask them, did you know that your healthcare team use the EHR to remind themselves of standards of care, or to ensure that the doses they prescribe are safe and effective and that health systems can then use the information to monitor and improve health for entire populations? We can also use the data collected in these systems to monitor healthcare, resource utilization and to inform sophisticated analytics – using techniques like machine learning, predictive analytics, enhanced data visualization, and precision medicine. So, I usually start by describing something they are familiar with, like order entry or documentation, and then start to describe to them what else you can do with those same data.
Years of experience:
If I include my first year out of residency, this will be my 15th year in the field.
I’ve always been a techie. I’ve always enjoyed working with computers. As a kid, I taught myself a few programming languages and did some trivial website design and that kind of stuff, and I always especially liked finding the easier way to do something. Making a repetitive task easier or automating something. I really liked the idea that you could use this tool to make you more efficient. During my last year of residency at Children’s Hospital of Philadelphia, we were in the middle of transitioning from one electronic health record to another. They needed physician input in the design of that system, and as one of the rising chief residents that year, we were asked to give input on order set design, dosing recommendations, work flow redesign and training strategies. I completely fell in love with it. I had no idea that this was a discipline within medicine that you could pursue. I didn’t know it had a name. I didn’t know that there was a corpus of knowledge around it or anything like that. But just the experience of working with the technical team during that implementation made me realize that, with the right blend of clinical expertise and technology, you could really do a lot with these order entry systems.
For example, my first real informatics project was to safeguard the prescribing of high-risk medications using intentionally-designed order sets. From the years of data collected using our old CPOE system, we knew exactly which meds were the riskiest and accounted for the most prescribing errors. When the team started to look at the pattern of errors, we could see that they were very predictable. We could see that people consistently miscalculated doses or used the wrong dose for an indication or picked the wrong frequency. So, we were able to engineer these order sets to anticipate the kinds of errors the prescriber was likely to make, guide them to the correct dose, and prevent the error in the first place. That was my “aha” moment. We were going to reduce error rates and potentially reduce harm to patients just by having this tool match the thought process and information needs of the clinician. That was in 2003. After that, I started exploring what my other options were to get more training in this field and enrolled in the biomedical informatics master’s program at Oregon Health & Science University, joined AMIA straight out of residency that year, and the rest is history.
What are your ambitions? At the end of your career, what do you hope to have accomplished?
I’ve heard people describe pediatrics this way: we’re in the job of putting ourselves out of business. In other words, if our goal is to improve child health, then success means a child never (or rarely) has to see a pediatrician. My goal for health IT is the same. With all the active debate around how to design these systems, how to match the cognitive needs of physicians and other clinical staff – if we’re really successful, those of us who think about implementation should be in the business of designing systems that are so good that we make ourselves obsolete. We should design systems that are so intuitive and so intelligent that they seamlessly blend into clinical practice. It will, of course, take a lot of work to get there but I think we’re already starting to see some change. For example, the kinds of questions we get now concerning the electronic health record are very different than the kinds of questions we used to get five or 10 years ago. They are much more sophisticated. Back then we used to argue about the layout of order sets and things like that. These days people are asking questions like ‘can we predict the likelihood of patient deterioration? Or can we overlay genomic information into this patient’s medical record’? How can we more easily use technology to collaborate with and gather information from patients? How can we leverage national EHR data for large-scale research? This is an example of how the field has evolved. If we keep hammering away at this, some of the things that we think are big issues right now, like physician burnout related to the electronic health record, we will be able to solve, and we will look back on it in the future and say, can you believe we used to obsess about that?
Who or what are your “key sources” in the informatics field?
On the research informatics side, I still very closely follow the work of some of my former OHSU faculty, like Dean Sittig, an informatics researcher who was my capstone mentor, and researchers like him who study the overlay of usability, safety and design, have been very influential. These days my role is mostly administrative, so in the leadership realm I have learned a lot from the AMIA leadership, like Tom Payne, past board chair at AMIA, whose leadership style I admire. Bill Hersh has been very influential in my career as I work with informatics trainees and teach a variety of informatics topics as part of my role. I value my mentors at Children’s Hospital of Philadelphia, including our chief information officer, Kisha Hawthorne.
I also love the AMIA Annual Symposium and health IT conferences. They give me a really good view of what’s coming down the pike. People compare and contrast the trade organizations like HIMSS, the Health Information Management System Society, and professional societies like AMIA. I value both organizations and their respective conferences – HIMSS is where I go to learn about current trends and near-term innovation. AMIA is where I go to see where informatics is going to be five to 10 years from now. That’s one of the roles of a professional society like AMIA. It’s a great balance for me because I live in the operations world, but I need to keep in touch with where this field is going to go in the next few years.
Articles that spotlight my research interest ...
1: Simpao AF, Ahumada LM, Larru Martinez B, Cardenas AM, Metjian TA, Sullivan KV, Gálvez JA, Desai BR, Rehman MA, Gerber JS. Design and Implementation of a Visual Analytics Electronic Antibiogram within an Electronic Health Record System at a Tertiary Pediatric Hospital. Appl Clin Inform. 2018 Jan;9(1):37-45. doi: 10.1055/s-0037-1615787. Epub 2018 Jan 17. PubMed PMID: 29342478; PubMed Central PMCID: PMC5801883.
2: Payne TH, Desai BR. Examination of medication clinical decision support using Bayes' theorem. Am J Health Syst Pharm. 2016 Nov 15;73(22):1876-1878. PubMed PMID: 27821399.
3: Ross RK, Beus JM, Metjian TA, Localio AR, Shelov ED, Desai BR, O'Neill SP, Zaoutis TE, Gerber JS. Safety of Automatic End Dates for Antimicrobial Orders to Facilitate Stewardship. Infect Control Hosp Epidemiol. 2016 Aug;37(8):974-8. doi: 10.1017/ice.2016.103. Epub 2016 May 13. PubMed PMID: 27174362.
4: Simpao AF, Ahumada LM, Desai BR, Bonafide CP, Gálvez JA, Rehman MA, Jawad AF, Palma KL, Shelov ED. Optimization of drug-drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard. J Am Med Inform Assoc. 2015 Mar;22(2):361-9. doi: 10.1136/amiajnl-2013-002538. Epub 2014 Oct 15. PubMed PMID: 25318641.
5: Harper MB, Longhurst CA, McGuire TL, Tarrago R, Desai BR, Patterson A; Children’s Hospital Association CDS working group. Core drug-drug interaction alerts for inclusion in pediatric electronic health records with computerized prescriber order entry. J Patient Saf. 2014 Mar;10(1):59-63. doi: 10.1097/PTS.0000000000000050. PubMed PMID: 24522227.
6: Vergano SA, Crossette JM, Cusick FC, Desai BR, Deardorff MA, Sondheimer N. Improving surveillance for hyperammonemia in the newborn. Mol Genet Metab. 2013
Sep-Oct;110(1-2):102-5. doi: 10.1016/j.ymgme.2013.05.005. Epub 2013 May 18. PubMed PMID: 23746553; PubMed Central PMCID: PMC3755016.
Hobbies/Interests outside AMIA ...
In addition to studying biology, I was a music major and studied voice at Emory University. For years, I was very active in civic and semiprofessional choirs as a tenor. I love choral music. I love performing music with friends. I’m in a band with a bunch of the neighborhood fathers. We jokingly call it the “Dad Band” but can’t decide on a real name. We sing everything from blues and pop to rock. In the past couple years, I’ve gotten into cycling and am training for my first 100-mile ride.
AMIA is important to me because ...
When I learned about AMIA, as I was finishing residency, I realized that informatics was a legitimate academic pursuit, that this was a legitimate medical discipline. I really found my intellectual mentors and colleagues through this organization. I had this feeling in residency that there must be other doctors out there who were interested in these kinds of topics, like how to use the electronic health record more effectively. I went to my first AMIA conference in San Francisco in 2004, which happened to coincide with the International Medical Informatics Association’s MedInfo conference. So, my very first academic informatics conference was this international symposium in San Francisco with thousands of attendees. It was such a revelation to me that there were this many people across the world who were interested in these topics. I remember feeling like a sponge, trying to attend every session I could, learning everything I could as fast as I could. It was a great feeling of finding your community.
Seven years ago, Bill Hersh from OHSU asked me if I wanted to join the faculty of a new informatics board review course that AMIA was planning. It was the first of its kind. ABPM had just announced the board certification program in clinical informatics and AMIA wanted to create the first national board-review course. I jumped at the opportunity and I was flattered that Bill would ask me. Six seasons later, we have prepared something like 2,200 physicians to sit for the exam. It’s been amazing to meet so many physicians across the country who attend our course. It didn’t sink in just how broad the reach of this program was until I had a physician recognize me from the online course at the airport. For me, the idea that I can give back to this field is very rewarding.
I am involved with AMIA ...
My longest involvement is with the CIBRC, or Clinical Informatics Board Review Course as one of four faculty lecturers. This September will be our sixth year of giving the course. We have developed a two-and-a-half-day curriculum of lectures, exercises and discussions. It’s offered both in person and as an online course.
It may surprise people to know ...
My twitter handle is @origamidoc and that’s a reference to my longest and most enduring hobby, which is origami, making animals and other creatures out of paper. I’ve been doing that since I was like 7.