• November 16-20, Washington, DC

    AMIA 2013 Annual Symposium

AMIA 2013 Panels

Note to Authors and Attendees! Please reference the itinerary planner for the MOST CURRENT information on posters.

The specific time and date of all sessions, speaker names and abstracts are available in the Itinerary Planner. It is an excellent tool for building your AMIA 2013 Symposium experience.

Panels topics are on a specific aspect of theory, application, or experience pertaining to aspects of biomedical or health informatics. Panels may also provide interdisciplinary viewpoints that cut across traditional themes.

Findings from a Five-Year Clinical Decision Support Demonstration Project and the Road Ahead

K. Chaney, Agency for Heathcare Research and Quality; R. Shiffman, Yale University School of Medicine; B. Middleton, Vanderbilt University Medical Center; J. White, Agency for Heathcare Research and Quality; J. Reider, Office of the National Coordinator for Health IT

Prior to the HITECH Act and Meaningful Use, the Agency for Healthcare Research and Quality (AHRQ) awarded two large demonstrations (Clinical Decision Support Consortium (CDSC) and Guidelines Into DEcision Support (GLIDES)) in 2008 to apply varying approaches to develop, implement and evaluate clinical decision support (CDS) to enhance care delivery. The CDSC project centers on a services-oriented approach for managing clinical knowledge and delivering CDS across care providers and EHR systems, while the GLIDES project focuses on a broad-based model addressing knowledge synthesis, formalization, and implementation. Both approaches showcase routes to develop, deliver and evaluate CDS.

This panel will highlight key findings and lessons learned from both projects and approaches for how to generate and synthesize knowledge from practice based-guidelines, transform knowledge into an executable format, and evaluate the effectiveness of the implementation in the midst of changing technologies and standards, and Meaningful Use criteria. After looking at various approaches demonstrated by the projects, AHRQ and the Office of the National Coordinator for Health IT will review future initiatives for improving the quality and safety of patient care through the implementation of end-to-end quality improvement programs that include both CDS and quality measurement.

Multi-site Electronic Data Infectious Diseases Consortium (MEDIC): Industry-Academic Collaboration for Research Using EHR Data

M. Cantor, Pfizer, Inc.; M. Kouznetsova, A. Masica, Baylor Healthcare System; A. Thomas, Pfizer, Inc.

EHR data is increasingly seen as a valuable, efficient resource for research.. Currently, most multi-institutional consortia that utilize clinical EHR data consist primarily of academic medical centers, and industry’s access to EHR data is mainly limited to commercially-available datasets. Building on an earlier pilot’s success, MEDIC (Multi-site Electronic Data Infectious Disease Consortium), is an example of an industry-health care delivery organization collaboration leveraging EHR data for research. Sponsored by Pfizer, the consortium involves four health systems (Baylor, Henry Ford, University of Maryland, Washington University) that represent geographic, practice environment, and patient population diversity. A centralized, de-identified database will be constructed, to which all participants will contribute, that can be used to answer research questions determined by the consortium steering committee.

This panel will address issues involved in both creation and function of the consortium from industry and delivery organization viewpoints.

Informatics Careers in Industry: What Creates Business Value?

A. Kamauu, Anolinx, Inc.; M. Cantor, Pfizer, Inc.; H. Cao, Astra Zeneca, Inc.; H. Wei, Aetna, Inc.

Because of its multi-disciplinary nature, informatics is a field with applications in a variety of settings. Increasingly, industry is seeing the value of informatics training and hiring graduates and professionals in a variety of roles. Experience in informatics also provides the network and capabilities of a more entrepreneurial bent. Above all, in industry there is no one specific pathway to getting hired.

This panel will draw on the diverse backgrounds and experience of the panelists to explain 1) how they arrived at their current positions and 2) how their informatics training and experience provides value to their companies.

Query Health: Toward a Learning Health System

J. Klann, Harvard Medical School; M. Buck, New York City Department of Health and Mental Hygiene; J. Brown, Harvard Medical School; S. Murphy, Harvard Medical School; D. Fridsma, Office of the National Coordinator for Health Information Technology

Measuring population health is critical to understanding the healthcare landscape. The Query Health initiative, a public-private collaboration convened by the Office of the National Coordinator for Health Information Technology (ONC) in 2011, is developing a standards-based, secure, distributed approach for measuring population health through electronic health record data, without sharing clinical data from individual sites. To date, Query Health has: developed a standards-based methodology; developed a reference implementation; and, launched several pilots to gauge its effectiveness at providing broad, standards-based access to multiple data sources for the purpose of population health management.

This panel will present these accomplishments and future directions of the initiative.

Preparing for Informatics Careers and Trends in the Age of Meaningful Use

N. Theera-Ampornpunt, Mahidol University; K. Zheng, University of Michigan; Y. Gong, The University of Texas Health Science Center at Houston; J. Boehne, University of Louisville (KentuckyOne Health); D. Kaelber, Case Western Reserve University; R. Zhang, University of Minnesota; S. Kaushik, Case Western Reserve University; R. Shaw, Duke University; T. Kelley, Nexus Consulting Corp; S. Khairat, University of Minnesota

In the age of Meaningful Use, the career landscape for informatics students has expanded greatly. It is crucial that the next-generation informatics workforce is well-prepared for the diverse opportunities and the upcoming health information technology (HIT) trends. The AMIA Student Working Group proposes a “Career Panel” of informatics professionals that will offer perspectives and helpful advices to students on their career opportunities and professional development.

This year’s panel will feature panelists from both academia and industry, and from different professional backgrounds (e.g., technical vs. clinical or health). Panelists will also discuss upcoming trends on HIT and informatics, and the implications of these trends on students’ careers. The panel will better prepare today’s informatics students for tomorrow’s workforce expectations, which will have a positive impact for the success of the informatics field in the future.

Health eDecisions: a Public-Private Partnership to Enable Standards-Based Clinical Decision Support at Scale

K. Kawamoto, University of Utah; T. Hongsermeier, Lahey Health; A. Boxwala, Meliorix, Inc.; V. Lee, Zynx Health Incorporated; J. Reider, Office of the National Coordinator for Health IT

The ubiquitous availability of robust, standards-based clinical decision support (CDS) has been an important goal of the biomedical informatics community for many years. While many notable efforts have been undertaken in this area, attainment of this goal has remained elusive. In 2012, the Office of the National Coordinator for Health IT (ONC) launched the Health eDecisions (HeD) initiative to directly address this important challenge. The HeD initiative is a public-private partnership to develop and validate interoperability specifications that can be widely adopted to enable CDS at scale. Included in the scope of HeD is the support for two broad uses cases: the sharing of knowledge artifacts for import into CDS systems (Use Case 1) and the sharing of patient-specific inferencing capabilities through CDS Guidance Services (Use Case 2).

In this panel, HeD leaders and community members – including the CMO of ONC and a CDS vendor executive – will provide an overview of HeD, its methodology, and its deliverables. HeD deliverables include functional requirements, interoperability standards, and pilot implementations of the standards by commercial CDS and electronic health record (EHR) vendors. Standards developed and validated through HeD processes will be available to policy makers for potential inclusion in future EHR certification requirements.

Public and Global Health Informatics Year in Review

B. Dixon, Indiana University-Purdue University Indianapolis, School of Informatics and Computing; A. Turner, University of Washington School of Public Health; J. Pina, RTI International; H. Kharrazi, Johns Hopkins School of Public Health; J. Richards, Centers for Disease Control and Prevention

The disciplines of public health and global health informatics are rapidly expanding within the field of biomedical informatics. Increased attention and activity by the Centers for Disease Control and Prevention in the U.S. as well as health ministries, the World Health Organization, and non-governmental organizations are generating new knowledge and lessons regarding the development, implementation, and use of information systems in health care delivery around the globe. Thus a growing body of literature now contains important informatics science and methods from international informatics activities, stimulating the need to synthesize the knowledge for the field.

In this panel, a review of recent literature in the areas of public health and global health informatics will be presented. Key articles revealing trends, knowledge, methods, and lessons will be summarized to bring attendees up-to-date on the use of informatics in resource-constrained settings.

Informaticians, CxIOs and Industry: Strengthening the Fabric of HealthIT

T. Schleyer, Regenstrief Institute; B. Middleton, Vanderbilt University Medical Center; B. Shillingstad, Epic Systems Corporation; M. Overhage, Siemens Healthcare; C. Aliferis, New York University

Health information technology (HIT) is often touted as an important remedy for many problems in healthcare. However, the business model of biomedical informatics, the 'engine of innovation for HIT,' is broken in many respects. The culture and values of informatics and industry differ significantly, successful academic/industry collaboration is scarce, and the contributions of informatics to the operational context of healthcare delivery are increasingly marginalized. Informaticians are viewed as closeted researchers while IT staff do the 'real work.' On the other hand, industry is looking to academia for leadership in important areas of HIT and electronic health records, such as providing and maintaining evidence-based content; integrating basic science breakthroughs into EHRs; designing EHRs and clinics of the future; and aggregating and analyzing data on large cohorts (nationally and internationally).

This panel will present thought-provoking viewpoints from key industry and academic leaders, and stimulate discussion on strategies to improve informatics’ contribution to bringing about positive change in healthcare.

Clinical Decision Support(CDS): From Theory to Practice

J. Kannry, Mount Sinai Medical Center; D. Bates, Partners Healthcare; T. Hongsermeier, Lahey Clinic; M. Krall, Kaiser Permanente-Northwest

The promise of Clinical Decision Support (CDS) has always been to transform patient care and improve patient safety with delivery of timely and appropriate recommendations that are both patient-specific and more often than not appropriately actionable. However, the users of CDS, providers, are frequently bombarded with inappropriate and inapplicable CDS that is frequently neither informational, integrated into the workflow, patient-specific, and may present out of date and irrelevant recommendations. The life cycle of Clinical Decision Support begins with a request for CDS, continues with design and implementation, and concludes with ongoing knowledge maintenance.

This panel will look at how using the best science and latest knowledge regarding CDS can create request and maintenance processes that work in the real world. Dr. David Bates will present the best science and knowledge behind CDS that works. Dr.’s Joseph Kannry will present a case study of CDS requests and design processes that use this science to generate useful, useable, and timely patient-specific recommendations. Dr. Tonya Hongsermeier will present best practices in knowledge maintenance. Finally, Dr. Michael Krall will present a case study of knowledge maintenance from Kaiser Permanente that results in appropriate and up-to-date CDS.

Consumer Engagement in HIT: Building Capacity for Shared Decision-making

B. Westra, University of Minnesota; D. Skiba, University of Colorado; S. Long, K. Harder, University of Minnesota; S. Hull, Wellspring Consulting

Implementing meaningful use of electronic health records (EHRs) now requires engaging consumers in use of health information technologies (HIT). The ultimate goal is not simply getting consumers to use HIT, rather HIT needs to be tailored to the needs, preferences, and motivators for consumers to access, use, and manage their health through shared decision-making using HIT. Consumer engagement requires both consumers and providers to change behaviors. A culture shift is needed to change behaviors for both; however, consumers also need the right tools and access to information tailored to their lifestyles and circumstances.

The purpose of this panel is to describe strategies for various stakeholders to shift behavior change toward shared decision-making. The panel will present a range of strategies from educating future providers, shared a state-wide plan for consumer engagement in HIT, describe innovation and design principles to tailor HIT for consumers, and shared national initiatives and resources.

Towards Computational Reuse of Clinical Research Eligibility Criteria with Collaboration across Academia, Industry, and Standardization Organizations

C. Weng, Columbia University; M. Cantor, Pfizer, Inc; A. Taweel, King's College; T. Arvanitis, The University of Birmingham; R. Kush, CDISC

Central to clinical and translational research activities, clinical research eligibility criteria are perceived, defined, interpreted, and implemented by various stakeholders in a series of translations during protocol authoring, research subject recruitment, electronic screening for cohort selection for clinical research studies, systematic reviews, and evidence-based medicine. The efficiency and integrity of these research activities heavily rely on the quality and clarity of clinical research eligibility criteria. However, the free-text clinical research eligibility criteria are fraught with problems, including ambiguities and the lack of representativeness of the real-world patient population. In the past 25 years, the biomedical informatics community, from academia to industry, and from USA to UK, has spent significant efforts, combining knowledge representation and natural language processing, to improve the standardization and computational reuse of clinical research eligibility criteria across various stakeholders throughout the clinical and translational research pipeline.

How Fit is Electronic Health Data for its Intended Uses? Exploring Data Quality across Clinical, Public Health, and Research Use Cases

S. Grannis, Indiana University, School of Medicine; B. Dixon, Indiana University-Purdue University Indianapolis, School of Informatics and Computing; S. Liaw, University of New South Wales; M. Kahn, University of Colorado School of Medicine; H. Fraser, Brigham and Women’s Hospital

Given growing adoption of electronic systems in health care, many providers and nations are looking to apply large volumes of electronic data across a wide spectrum of uses. Leveraging large-scale clinical and administrative data sets assumes that the data are of sufficient quality to enable valid, generalizable conclusions. Yet studies outside health care show that data quality (DQ) in information systems is often poor. In this panel, we explore the definition of DQ and how to measure it across research, clinical, and population health use cases. Each speaker provides unique context and approaches for approaching what could be a showstopper for efforts that aim to address health system challenges using Big Data from electronic health records and other informatics systems.

Informatics Challenges and the Future of Electronic Clinical Documentation

D. Vawdrey, Columbia University; S. Trent Rosenbloom, Vanderbilt University; P. Stetson, Columbia University; T. Payne, University of Washington; P. Embi, The Ohio State University

As adoption of electronic clinical documentation grows, system capabilities and note-writing practices have come under increased scrutiny. Many clinicians have been reluctant to use electronic documentation systems, citing reasons such as fear of decreased efficiency, possible adverse effects on patient-physician communication, personal lack of computer skills, and poor system usability. Concern has been expressed among policymakers and administrators regarding potential billing fraud stemming from use of electronic documentation systems. At the same time, discussions are ongoing about documentation-related requirements in the “meaningful use” program, and momentum is building around criteria for “next-generation” documentation tools.

The panelists will summarize their own experiences overseeing large-scale implementations of electronic documentation using four distinct commercial EHR systems. They will discuss the current and future state of clinical documentation, debating topics such as:

  1. the advantages and limitations of structured vs. narrative text,;
  2. the use and monitoring of copy-paste and other electronic “documentation support” tools;
  3. best practices for developing and managing clinical documentation knowledge assets; and
  4. measuring the quality of clinical documents.

Additionally, panelists will discuss successful and unsuccessful implementation strategies and the impact of electronic documentation on training the next generation of healthcare providers. Ample time will be provided for audience questions.

Towards Patient Engagement: Meaningful Use of Electronic Health Record Systems and the HL7 Infobutton Standard

G. Del Fiol, University of Utah; D. Borbolla, Hospital Italiano de Buenos Aires; L. Hall, Healthwise; S. Dennis, National Library of Medicine

Active patient engagement in decisions related to their health care is one of the main components of health care reform. In the United States, the “Meaningful Use” incentive program is promoting the wide adoption and use of electronic health record (EHR) systems to improve health care quality and reduce costs. The incentive program includes criteria for the adoption of measures to enable patients to increasingly engage in their health care decisions. One of these measures is the requirement for EHR systems and health care providers to deliver consumer health information in the context of EHR use. EHR developers are required to implement this capability in a standards-based manner, compliant with the Health Level Seven (HL7) Infobutton Standard.

Speakers in this panel will provide their perspectives in health IT standards, patient engagement advocacy, consumer health information, and EHR systems. After the panel, attendees are expected to:

  1. understand the HL7 Infobutton Standard and examples of how it has been used for delivering context-specific consumer health information;
  2. describe how consumer health information resources can be leveraged for patient engagement; and
  3. describe future applications of the Infobutton Standard for patient engagement.

Insights from the Implementation Forum’s Discussions: What Thirty Percent of AMIA Members Say about HIT Implementation and Use

B. Kaplan, Yale University; R. Koppel, University of Pennsylvania; C. Kuziemsky, University of Ottawa; K. Ravvaz, University of Wisconsin; H. Sobko, University of Alabama; M. Adams, Duke University

Over 30% of AMIA’s members are part of the Implementation listserv. Since its inception in September, 2012, members have ardently discussed, debated, and shared wisdom about implementation and HIT. This unique, cross-working group listserv was formed to reduce redundant postings generated by the CIS, ELSI, Evaluation, and POI Working Groups' listservs. The mega-discussion about implementation addresses barriers, challenges, and lessons learned about implementing HIT, as well as ways to maximize adoption and to make “meaningful use” meaningfully useful. Listserv participants confront what is well understood and what is not, disseminate knowledge, and suggest research agendas to inform practice and policy. The listserv reflects AMIA members’ systematic and rigorous thinking about implementation issues.

Panelists will discuss themes and knowledge emerging from listserv content, focusing on five salient areas: education, HIT integration with workflow, pros and cons of current systems, nursing perspectives, and user experiences (including ethical concerns). They will present examples of how listserv participants are informing AMIA’s membership about their experiences with HIT; and the challenges, successes and lessons learned. Panelists are current or former working group chairs and informatics thought leaders who make up AMIA’s Implementation Forum Steering Committee (with John Holmes, Gilad Kuperman, and Donald Schnader).

Genomic Sequencing and Genetic Testing: Current Technological, Regulatory, Clinical, and Social Issues and Future Directions

C. Petersen, Mayo Clinic; L. Ozeran, Clinical Informatics, Inc.; J. Tenenbaum, Duke Translational Medicine Institute; S. Volchenboum, University of Chicago

Advances in the ability to rapidly sequence genomes at lower costs and test patients in clinical environments have expanded the potential for, and desirability of, genetic and genomic testing. At the same time, an evolving regulatory environment and untested legal requirements promote uncertainty and concern among researchers, clinicians, consumer advocates, and patients. These circumstances necessitate re-evaluation of data security and privacy considerations not only for the individual and the individual’s family, but for society as a whole. In this panel, the presenters will describe technical and methodological considerations for genomic sequencing and genetic testing. They will review issues related to patients’ understanding of genetic data privacy and security practices, secondary data use expectations and desires, and potential issues related to genomic sequencing. Through a pediatric oncology scenario, they will explore how genetic testing can be used in a clinical setting. Finally, the panel will suggest potential regulatory and enforcement changes that may enable and facilitate population-wide collection and use of genomic data.

Informatics Infrastructure for Routine Personalized Medicine

E. Bernstam, The University of Texas Health Science Center; K. Chen, The University of Texas MD Anderson Cancer Center; H. Xu, The University of Texas Health Science Center; F. Meric-Bernstam, The University of Texas MD Anderson Cancer Center

Personalized medicine is not a new concept, but it is only recently become practical. However, for personalized med-icine to become routine, rather than the exception, formidable information challenges must be addressed. The Institute for Personalized Cancer Therapy at MD Anderson Cancer Center is partnering with the UT School of Biomedical Informatics in Houston to develop tools and methods that enable routine delivery of personalized med-icine.

This panel will discuss:

  1. the clinical problem;
  2. processing the molecular data;
  3. identifying clinically relevant variants from the literature; and
  4. processing the clinical data and Decision Support.

The panel includes practicing clinicians who are practicing personalized medicine and informaticians who are developing technologies to enable personalized practice. We will use the example of personalized cancer therapy, but our work is in-tended to be generally applicable.

Training the Informatics Research Workforce, Part 1: Program Fundamentals

V. Florance, National Library of Medicine; J. Hurdle, University of Utah; R. Kukafka, Columbia University; W. Hersh, OHSU; C. Gadd, Vanderbilt University; A. McCray, Harvard Medical School

For more than 40 years, universities have offered training in biomedical informatics. From the four programs funded by the National Library of Medicine in 1972 that trained physicians to use computers to solve information management problems, informatics training has become broader and more diversified, ranging from certificate programs to post-doctoral fellowships. In an era when every health-related field depends upon computers for capture, storage, organization, management, analysis and dissemination of health data, information and knowledge, the need for more trained informaticians is indisputable. In this two-session panel, nine program directors of NLM-funded informatics training programs will cover basic concepts ,tools and techniques of graduate training in biomedical informatics, and look to future workforce needs in the field.

Part 1, Program Fundamentals, five presenters will cover core curriculum, content development; trainee recruitment to enhance diversity, career outcomes, and training for future workforce needs.

Part 2, Fostering Interdisciplinarity, five presenters will cover approaches for interdisciplinary programming: defining tracks across domain or departmental boundaries, mentoring and tracking trainee accomplishments, building a sense of community and models for online teaching.

Training the Informatics Research Workforce, Part 2: Fostering Interdisciplinarity

V. Florance, National Library of Medicine; P. Miller, Yale University; L. Ohno-Machado, University of California San Diego; G. Hripcsak, Columbia University; W. Hersh, OHSU; G. Demiris, University of Washington

In an era when every health-related field depends upon computers for capture, storage, organization, management, analysis and dissemination of health data, information and knowledge, the need for more trained informaticians is indisputable. In this two-session panel, nine program directors of NLM-funded informatics training programs will cover basic concepts ,tools and techniques of graduate training in biomedical informatics, and look to future workforce needs in the field.

Part 1, Program Fundamentals, five presenters will cover core curriculum, content development; trainee recruitment to enhance diversity, career outcomes, and training for future workforce needs.

Part 2, Fostering Interdisciplinarity, five presenters will cover approaches for interdisciplinary programming: defining tracks across domain or departmental boundaries, mentoring and tracking trainee accomplishments, building a sense of community and models for online teaching.

Health IT: Assessment of Safe and Effective Use – Measuring the HIT Hazard Function

B. Middleton, Vanderbilt University; C. Nohr, Aalborg University; J. Walker, University of New South Wales; F. Magrabi, Siemens Healthcare

Successful adoption and effective use of Health IT is a central tenet of national policy objectives around the Western world. Health IT adoption and use is viewed as a prerequisite to effect cost control and quality improvement for healthcare delivery. However, with the broad adoption of health IT certain unintended consequences of its use are being observed.

This panel will focus on the potential hazards which may arise from the untoward use of health IT, discuss the primary sociotechnical, usability and human factors related issues, and understand basic approaches to defining and measuring a Health IT hazard function. Examples and illustrations will be presented from three countries: US, Australia, and Denmark.

HIT supported health management in the home environment

U. Backonja*, P. Brennan, University of Wisconsin; G. Demiris, University of Washington; H. Jimison, Oregon Health & Science University; W. Riley, National Institutes of Health

Health care management, including capturing and utilizing personal health information, is shifting from the hospital and clinic to the home. Health information technology (HIT) can facilitate this shift and support home-based health care management. However, more HIT innovation is needed to meet the diverse, complex demands of this shift. This panel is convened to discuss HIT’s potential to support health care management in the home environment and address related challenges. It includes experts with diverse experience in research and implementation of home-based health management HIT strategies. Dr. Patricia Flatley Brennan is a pioneer in community based HIT and PHRs; Dr. George Demiris conducts innovative research on smart homes and telehealth in home and hospice care; Dr. Holly Jimison is an mhealth leader, using remote sensing and coaching of elders at home; Dr. William Riley is an expert on mobile health technology evaluation.

Panel Description: The panel includes experts who have experience in the development and implementation of HIT in the home setting for health management. Specifically, the panel will discuss their experiences in HIT in the home setting, how their research has supported health management and promotion, and how they believe their work and home-based HIT can be integrated into the current health care system in the United States. The panel will serve as a platform for discussion and interaction format where panelists can discuss topics with each other and with members of the audience. Specifically,

  • Dr. Patricia Flatley Brennan will discuss her experience using HIT, including PHRs, to manage chronic health conditions;
  • Dr. George Demiris will discuss his research on smart homes and telehealth in home and hospice care;
  • Dr. Holly Jimison will discuss her research on remote sensing and coaching of elders at home; and
  • Dr. William Riley will discuss his experience in evaluating mobile health technologies.

After the introductory presentations, the moderator will ask questions, as well as solicit questions from the audience, to prompt discussion among the panelists. Potential topics and questions include:

  • Describe two instances where home-based HIT has been used to support health management.
  • Identify challenges and successes in ways that HIT can bridge between the hospital or clinic and the home.
  • Identify challenges and successes in ways that HIT can bridge between the hospital or clinic and the home.
  • What are the challenges that need to be overcome so that home-based HIT can be successful and thrive in support of patient care and patient self-management in the future?
  • How can the AMIA community accelerate the development of tools and systems to support heath management in the home and build the evidence for the effectiveness of HIT interventions in the home?
  • How can the AMIA community facilitate integration of home-based health management into the current health care system?

*This panel proposal was prepared by Uba Backonja in her personal capacity. The opinions expressed in this article are the author's own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government.

Integration and Interoperability of Prescription Drug Monitoring Programs

J. Finnell, Regenstrief Institute; B. Yeaman, Heartland Health; M. Allain; J. Bolin, National Boards of Pharmacy; C. Line, MITRE Corporation

The Centers for Disease Control (CDC) has declared that the United States is in the midst of an epidemic of prescription drug overdose deaths (figure 1). Deaths from prescription drugs now outnumber deaths from heroin and cocaine combined. In response to this epidemic, the Office of the National Coordinator for Health IT (ONC) has sponsored pilot programs to test the effects of expanding state prescription drug monitoring programs (PDMP) utilizing health information technology (HIT). The goal of these pilot programs is to increase timely access to PDMP data by providers, emergency department physicians, and pharmacists in an effort to reduce prescription drug misuse and overdose.

The discussants will share an overview of the pilot implementations from Oklahoma and Indiana. Sharing information about the implementation models and key learning’s will provide stakeholders with the initial framework to pursue building their own connections. Panel members will share best practices to help health care professionals combat prescription drug misuse at the moment of care with real solutions, real results, and real stories.

Ethical, legal, and public policy barriers to unleashing the full power of Consumer Health Informatics for care delivery

T. Wetter, Heidelberg University; R. Hsiung, Dr. Bob LLC; B. Kaplan, Yale University; P. DeMuro, Schwabe, Williamson and Wyatt; A. Waldo, Wittie, Letsche & Waldo, LLP;

Abstract: Consumer Health Informatics (CHI) is among the fastest developing fields in advanced medical care. Various trials have shown superior effectiveness or cost efficiency of particular interventions with essentially the same scrutiny as when approving a new pharmaceutical treatment. Aging societies with an impending shortage of healthcare professionals could benefit from effective CHI services that allow human clinicians to concentrate on the truly demanding cases that require in person visits. However, those CHI services that free up human clinicians the most because they operate only virtually, without in-person contact between the provider and the patient, are generally illegal, both in the U.S. and Germany. Rebalancing principles of medical ethics (such as respect of autonomy, non-maleficence, beneficence, distributive justice) may prompt national legislatures and medical professional associations to reconsider the acceptability of putting CHI innovations into practice. CHI has great potentials but risks may not be known well enough yet.

In the panel we want to explore the opportunities and risks from the perspectives of ethics, law, and medicine. The panel will try to explore whether legislation should move towards giving approved services a legal place in regular healthcare and what methods of ethics could support respective societal processes.

Sharing of Genomic Information: Perspectives from Stakeholders

J. Warner, Vanderbilt University; G. Alterovitz, Harvard Medical School; J. Denny, Vanderbilt University; R. Fassett, Oracle Corporation; K. Hughes, Massachusetts General Hospital

With the falling price of genome-level data generation, large amounts of genotyping data are being produced at an accelerating rate. There is increasing interest in sharing genotype and phenotype data for both research and clinical purposes across geographic sites. “Clinicogenomic” data networks have enabled increased understanding of both rare diseases and common diseases that have genetic heterogeneity. Sharing of genomic information holds great promise for enabling personalized medicine and could be the basis of a “human phenome project”. Such sharing is also an important step towards achieving a “Rapid Learning System” model, which incorporates multiple sources of information from multiple stakeholders, ideally leading to rapid implementation of new knowledge and quality improvement efforts. However, the technical challenges of transferring large amounts of genomic data, presenting the data in a format accessible by clinicians and patients, and the sensitive nature of the information being shared requires the input of many different affected parties. The purpose of this panel is to provide perspectives from stakeholders representing the perspectives of clinicians, researchers, standards organizations, and industry.

Implementing and Harmonizing Nursing Terminology Standards to Support Clinical Documentation and Evidence-based Nursing Practice

P. Dykes, Brigham and Women’s Hospital; N. Hardiker, University of Salford; D. Ariosto, Vanderbilt University Medical Center; T. Kim, University of California; K. Saranto, University of Eastern Finland; J. Englebright, HCA

There are a number of standard nursing and healthcare terminologies in use across the world. There are also many im-plementations of these terminologies within EHR systems. Even within a particular implementation, several different healthcare terminologies may be required, and these may be positioned within a range of different record structures. There is a practical imperative to harmonize content from the multiple terminologies. Harmonization of content from different terminologies into common structures will ensure interoperability between systems and will facilitate data capture to support building an evidence base from and for nursing practice.

The purpose of this panel is to explore, through four case studies, the practical use of nursing terminologies in EHRs. The case studies will cover a) the value of terminologies in clinical practice; b) use of standards to support care planning and event reporting; and c) harmonization of different terminologies to promote interoperability. The aim is to stimulate thinking, to build and consolidate understanding and to provoke discussion about the use and the value of nursing terminologies in EHRs. During the panel attendees will be encouraged to share their own experiences of implementation.

The Innovation and Synergy of HIT Approaches Addressing Complex Care within the VA

D. Hynes, Edward Hines, Jr. VA Hospital; A. Young, Greater Los Angeles VA; M. Ohl, Iowa City VAMC; T. Houston, Edith Nourse Rogers Memorial Veterans Hospital; M. Goldstein, VA Palo Alto Health Care System

This panel focuses on the use and impact of health information technology (HIT) to address complex care within the Veterans Affairs (VA). We highlight specific HIT approaches, including innovative and interactive uses of the VA’s electronic health record, databases, and information systems; personal health record; and applications of automated systems for intervention, evaluation, and tracking patient care. Examples include patient-facing, health care team-facing and health system-facing technologies to support clinical care and with systematic research-based evaluations. These processes demonstrate both the innovation and synergy of a range of HIT approaches in dynamic health care settings developed for patients, health care teams, and managers.

Attendees will:

  1. Become familiar with the VA Quality Enhancement Research Initiative and the role of informatics in advancing the program’s impact;
  2. Learn about a range of innovative patient-facing, health care team-facing and health system-facing technologies to support clinical care; and
  3. Understand the value of systematic evaluation of health information technologies and how research and clinical care can be synergistic in advancing healthcare quality.

We hope that this material stimulates systematic application of innovative HIT in health care within and beyond the VA.

Closed Loop Care Coordination: The Critical Linkages and Shared Concepts

S. Collins, Partners Healthcare Systems; P. Dykes, Brigham and Women's Hospital; P. Stetson, Columbia University; L. Samal, Brigham and Women's Hospital; R. Rocha, Partners Healthcare Systems

Care coordination can improve patient outcomes by establishing common ground through interpersonal communication and prevention of information loss between members of the care team across the care spectrum. Electronic health records (EHR) can aid in establishing a closed loop of communication by clinicians across settings, domains, disciplines, and time. One particular area for improvement is around goals of care, both documenting and tracking progress toward those goals. Goals of care are common to all clinical disciplines but remain siloed in EHRs.

This interdisciplinary panel will present four specific use cases to demonstrate how linkages within computer-based documentation workflow can facilitate a closed-loop system for the delivery of coordinated care. Each use case will describe a clinical scenario that demonstrates the need for one or more critical linkages and present the current state, barriers, facilitators, and potential solutions for coordinated closed loop computer-based documentation to support that use case.

The learning objectives for this panel are:

  1. to highlight common care coordination concepts between disciplines;
  2. to promote a common understanding of linkages needed to support closed loop care coordination; and
  3. to identify incremental steps toward that vision grounded in clinical use cases.

Shared Resources, Shared Code, and Shared Activities in Clinical Natural Language Processing

G. Savova, Harvard Medical School; W. Chapman, University of California; N. Elhadad, Columbia University; M. Palmer, University of Colorado

Natural Language Processing (NLP) of the clinical narrative has been a major effort within medical informatics. In our 2011 panel we discussed one of the main barriers for advancement of the field - the lack of large shared, annotated corpora to be leveraged for methods development and system evaluations. In the general domain, the gold-standard annotated Penn Treebank fostered truly revolutionary advances. Research papers are made available open access through the ACL Anthology. There are a number of shared tasks establishing the state of the art, from lexical semantics to discourse level tasks. Pedersen (Pedersen, 2008) further challenged the NLP community to close the loop by releasing code open source to enable experiment reproducibility. On the other hand, these four pillars of our scientific clinical NLP community are only half-built. It is widely accepted that even de-identified, clinical datasets are sharable only under certain conditions. The flagship journals in our domain, Journal of the American Medical Informatics Association and Journal of Biomedical Informatics, allow open-access of publications albeit for a significant cost accrued by the authors. The open source availability of the tools described in these publications is rare. This panel discusses these topical issues – shared resources, code, and activities.

Studying Those Who Study Us: Diana Forsythe and the Importance of Interpretive Research in Informatics

L. Novak, Vanderbilt University; J. Aarts, Erasmus University; G. Fitzpatrick, Vienna University of Technology; P. Gorman, Oregon Health and Science University; M. Reddy, The Pennsylvania State University

Diana Forsythe was a pioneering anthropologist who raised innovative and unsettling questions about the role of information technology in life and work, and differences in perspective between designers and users of technology. Diana was known for her tenacious defense of the integrity of ethnographic research, and for her enthusiastic examination of the “culture of no culture” that is American science and biomedicine. We examine Diana’s ongoing influence and relevance from the varied perspectives of four distinguished informatics researchers.

International perspectives on the digital infrastructure for The Learning Healthcare System

B. Delaney, King's College; J. Ethier, University of Rennes; V. Curcin, Imperial College; D. Corrigan, Royal College of Surgeons; C. Friedman, University of Michigan

The Learning Healthcare System (LHCS) refers to the close coupling of practice of clinical medicine with both the conduct of research and the translation of research into practice. This panel presents an outline of the TRANSFoRm project (www.transformproject.eu), a large EU FP7 Integrated Project to develop a digital infrastructure for the LHCS in European Primary Care, and discussion contrasts this with similar work in the USA, considering the opportunities for international collaboration.

Four presentations will cover: The aims, requirements, and informatics approach of the TRANSFoRm project. The method adopted to access clinical data using a common clinical data information model The techniques developed to capture the provenance of the research process in conjunction with generated data. An ontology for Clinical Prediction Rules to provide integrated Decision Support for diagnosis using chest pain, abdominal pain and shortness of breath as exemplars. A discussion will provide an overview of work on the LHCS in the USA, with opportunities for collaboration and international standards development.

Biomedical and Healthcare Analytics on Big Data

N. Peek, Academic Medical Center; J. Sun, IBM TJ Watson Research Center; J. Holmes, University of Pennsylvania; F. Martin-Sanchez, The University of Melbourne; R. Bellazzi, Università degli Studi di Pavia

The life and biomedical sciences are massively contributing to the big data revolution, due to advances in genome sequencing technology and digital imaging, growth of clinical data warehouses, increased role of the patient in managing their own health information and rapid accumulation of biomedical knowledge.

The purpose of this panel discussion is to outline current trends and challenges of big data analytics in biomedicine and health. In particular, the panelists will cover examples from three phases of the big data analytics in biomedicine and healthcare:

  1. data collection: the Quantified Self (QS) movement enables collecting and sharing patient data in a near continuous basis using various devices such as smartphone through a common interface. Patients can manage and share their own data with others. These high frequency patient data provide new opportunities and challenges for analytics.
  2. data sharing: distributed research networks (DRN) provides an effective mechanism to perform large-scale studies using data from multiple clinical sites. We will discuss the history of DRN and possible pathways for DRNs of the future.
  3. data mining: Patient similarity learning aims at constructing an appropriate distance measure of patients for a given clinical context using their electronic health records. We will describe a large-scale analytic pipeline that computes the patient similarity measure and its associated applications.

Research Informatics : Re-engineering the Research Enterprise

M. Weiner, AstraZeneca; P. Payne, P. Embi, The Ohio State University; S. Murphy, Massachusetts General Hospital

Recent incentives favoring the adoption and meaningful use of information technology in clinical practice are helping to increase the comprehensiveness and quality of routinely collected electronic patient information. Research informaticists play a vital role in capturing, organizing, visualizing, analyzing, understanding and relaying to others the full breadth, depth and longitudinal scope of these data. This panel will describe how the discipline of research informatics and the products of this work add value to multidisciplinary research teams and interinstitutional partnerships that span the full spectrum of research endeavors, from basic science innovations to translational research and clinical trials to health services research and post marketing safety surveillance.

A Proposed Model for Advancing the Science of Nursing Informatics and its Value Proposition for Clinical Practice, Nursing Education and Research

E. Weiner, Vanderbilt University; C. Weaver, Gentiva Home Health and Hospice; R. Kennedy, Thomas Jefferson University; H. Marin, Universidade Federal de Sao Paulo; P. Brennan, University of Wisconsin

In October 2011, a group of 12 senior nursing informatics experts from the American Medical Informatics Association’s Nursing Informatics Working Group (AMIA NI-WG) convened to address the relevancy of nursing informatics to clinical practice, research and education. The NI-WG task force used face-to-face meetings and monthly webconferences to map out a nursing informatics approach and model that would deliver value to all nursing domains. Using the Scan Focus Act methodology [1], the group sought to advance the science of nursing informatics through use of standards for terminology, domain analysis models, and quality and data exchange standards while clarifying and strengthening the intersection of informatics, clinical practice, education and research.

This panel will present an NI model for Practice-Research-Education in detail with its underlying assumptions. The Moderator will engage the audience in dialogue to critique the work and proposed model.

Learning objectives are:

  1. Summarize current work on nursing infor-matics state of the science;
  2. Apply the use case presented to illustrate aspects of informatics as a science and a process in the development of nursing knowledge for practice; and
  3. Create strategies to promote the value-add proposition for other nursing domains using nursing informatics components as described by the model.

Social Media and Me, An EduPanel - what is social media and how can I best use social media for research and education?

D. Sands, B. Crotty, Harvard Medical School; M. Adams, Duke University Medical Center; G. Eysenbach, University of Toronto

Who doesn’t have a Twitter handle by now? Has someone asked you to join LinkedIn? There is an ongoing, undeniable explosion of social media consumption by our society including health professionals. In medicine, a separate movement is taking place towards promotion of data sharing and critics are trying to grasp a new transition to have publications available as open access. As a result, many online open access journals and journal-lets are appearing and many self-declared experts are tweeting opinions, setting up FaceBook pages, and regularly contributing to the blogosphere of information. How will we all filter this information?

This panel will explore basics about social media and will challenge the audience perception about the potential impact on our research, education and patient care, including the pros and cons of social media in medicine. Panelists specifically aim to provide education for attendees about fundamentals of participating in the social media stream as well as to provide new knowledge about the power and risks of being in the stream.

Using Behavioral Economic Principles to Improve Informatics Applications

J. Linder, Brigham and Women's Hospital; J. Doctor, University of Southern California; D. Meeker, M. Friedberg, RAND; S. Persell, Northwestern University

Informatics interventions often do not deliver expected improvements in cost, safety, and quality. Implicitly, many informatics interventions are designed and implemented using a “standard economic model,” which assumes that decision-makers are rational, seeking only to maximize benefit for themselves and their patients. The standard model assumes that exposure to clinically relevant information such as reminders and alerts will lead to high-quality, predictable, rational decisions. Behavioral economics recognizes that people, including physicians, appear to make irrational decisions when they confront uncertainty, weigh present and future tradeoffs, or face complexity. Behavioral economics recognizes limits to attention and cognition and identifies deviations from “rational” behavior that is predictable. The application of behavioral economics to informatics requires the identification of “errors” and the subsequent reframing or restructuring physicians’ choice options in a way that leads to better decision-making.

This panel consists of collaborators on a national, multi-EHR, randomized controlled trial of behavioral economic interventions to reduce inappropriate antibiotic prescribing. The panelists will review underlying behavioral economic theory, providing medical and non-medical examples. The panelists will consider how behavioral economics can inform the design of informatics applications that facilitate better decisions with an ultimate goal of providing patients with higher-value, safer, more effective care.

Community Health Workers and Information Technology: Needs Assessment for A New Opportunity

M. Gibbons, H. Lehmann, Johns Hopkins University; Y. Harris, Health Resources and Services Agency; R. Sloan, Johns Hopkins Health System; H. Young, Johns Hopkins University

Community Health Workers (CHWs) increasingly provide vital services to clinics, in general, and accountable care organizations (ACOs), in particular. CHWs are medical laity brought in to aid community members at a variety of points along the care continuum who, therefore, undertake a wide variety of tasks. Only recently have CHW groups worked at taking advantage of IT in different forms to accomplish those tasks.

In this panel, we will explore this new opportunity for a range of perspectives: That of CHW organizations, of informaticians trying to support their activities, of payers and the federal government trying to reduce the cost of care and to maintain or improve health quality.