• November 16-20, Washington, DC

    AMIA 2013 Annual Symposium

AMIA 2013 Tutorials & Working Group PreSymposia

Tutorials: Half-day and full-day tutorials are dedicated to in-depth treatment of special topics and interests of relevance to informatics. Half-day tutorials include three hours of instruction; full-day tutorials include six hours of instruction. The SPC selects the slate of presentations to offer a balance between tutorials that address essential core informatics theory and principles, with those that address practical applications, current issues, and emerging trends and developments in informatics. Tutorials range from the general introductory level through specialized advanced treatments.

Working Group Pre-symposia: Pre-symposia promote formal discussion among constituents sharing common interests and raising the profile of AMIA Working Groups at the Annual Symposium. Presentations bring together individuals with similar or different roles in developing, implementing, or using informatics in practice, management, education, research, or policy.

CME/CE eligibility

  • Half-Day sessions = 3 CME/CE
  • Full Day sessions = 6 CME/CE
Tutorials are CME/CE eligible and incur an additional fee beyond the registration fee. Tutorials and Working Group PreSymposia fees are not included in the registration fee.

Tutorial & Working Group PreSymposia Length

CME/CE eligible creditsFull &
Member Advantage
Half-Day sessions3$95$150$95
Full Day sessions6$190$300$190
CMIO Tutorial (includes dinner, lunch on your own)6$395$495$395

*Note: WISH 2013 is not a CME/CE eligible session.

Saturday, November 16, 8:30 a.m. – 12:00 p.m.

T01: Architectural Principles Applied to Integrated Clinical Systems

Content Level: 80% basic; 20% intermediate
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: Healthcare Information Technology decision-makers; Healthcare Informaticists and IT professionals; Healthcare/Informatics educators; Healthcare informatics students

K. Kuttler, Intermountain Healthcare; S. Huff, Intermountain Healthcare; J. Hales, Intermountain Healthcare; L. Heermann Langford, Intermountain Healthcare

Clinical Information Systems (CIS) frequently comprise a web of multiple specialty systems implemented to meet specific clinical needs, but do not always adhere to an overarching clinical systems architecture for an enterprise. This often results in a variety of issues manifested in the form of system incompatibilities, inefficiencies, and failures to meet fundamental operating requirements. Experience at Intermountain Healthcare has led to the articulation of a core set of architectural principles to promote CIS efficiency and effectiveness. These principles are intended to create a common understanding and communicate medical informatics best practices for clinical systems architecture in support of clinical excellence for Healthcare Information Technology (HIT) decision-makers, Healthcare Informaticists and Information Technology professionals. Adherence to architectural principles improves interoperability and integration, enables agility, reduces costs, and improves security, management1 and CIS evolution which can significantly contribute to the goal of the highest quality healthcare at the lowest appropriate cost.

The aim of this tutorial is to describe fundamental architectural principles for CIS to teach HIT decision-makers, allowing them to benefit from our experience and “lessons learned”. Topics discussed will include: storage and retrieval of data, identification of patients and clinicians, knowledge-driven decision support, application of standards, uses for transactional and analytical data, and considerations for future evolution in clinical and system needs. Real life examples will be used to demonstrate the implementation of these principles and the resulting challenges when the principles are not applied.

Attendees will be challenged to apply the principles learned in the tutorial using a hands-on simulated experience. Examples will form the basis for interactive discussion interspersed with small group breakout sessions. Instructors will coach attendees as they address their own CIS architecture problems during the breakout sessions to understand how the principles apply to their situation and how architectural tradeoffs affect their CIS challenges.

Attendees will address their real life clinical information systems’ challenges by applying the principles taught in the tutorial. Instructors will use small group breakout sessions and interactive discussions to coach attendees as they understand how the principles apply to their situation, find solutions to their own CIS architecture problems, and recognize how architectural tradeoffs affect their CIS challenges.

Tutorial outline:

Importance of system architecture in clinical information systems

  • Single source / Single Repository/ Single Identifiers
  • Single enterprise data repository
  • Single master identification of patients and providers
  • Single clinician facing order entry
  • Single clinician facing communication system

Knowledge-driven systems

  • Role of coded and structured data to support advanced decision support and quality improvement
  • Central management of content with a single central data dictionary and knowledge repository
  • Decision support using a suite of common applications and services

Adherence to standards

  • Use of standard services in comparison to messages and data duplication
  • Role of national and international standards

Support Transactional / Analytical Data needs

  • Reuse of accurate coded data
  • Extremely fast performance
  • Use of a data warehouse for population based data analysis

Support graceful evolution to newer technologies

  • Considerations for “buy” vs. “build” decisions
  • Handling additions/exceptions to the architecture principles

At the conclusion of this tutorial the learner will be able to:

  • Articulate the importance of system architecture in obtaining clinical and operational goals in healthcare.
  • Recognize the importance of a single source for data storage and retrieval for clinical information systems.
  • Describe the importance of a single master identification of patients and providers in a clinical information system.
  • Define a content driven system and its importance in successful clinical information systems.
  • Identify the multiple points in clinical information systems where standards should be applied.
  • Compare and contrast the application and uses of an enterprise data warehouse and an analytical health repository.
  • Discuss techniques supporting the graceful evolution of clinical information systems to newer technologies.
  • Apply learned architectural principles through course exercises.

T02: Clinical Decision Support: A Practical Guide to Developing Your Program to Improve Outcomes

Content Level: 60% basic; 40% intermediate
Fee: $95 member/student $150 non-member CME/CE=3
3 hours ACPE # 0204-9999-13-014-L04-P

Intended Audience: Clinicians and administrators interested in quality improvement and patient safety; physicians, nurses and other health care professionals; and computer scientists, system developers and programmers interested in understanding applications of health information technology to clinical decision support.

R. Jenders, Charles Drew University & UCLA; J. Osheroff, TMIT Consulting, LLC; J. Teich, Elsevier Health Sciences; D. Sittig, University of Texas Health Science Center at Houston; R. Murphy, Memorial Hermann Healthcare System

This tutorial will provide attendees with a practical approach to developing and deploying clinical decision support (CDS) interventions that measurably improve outcomes of interest to a health care delivery organization. The instructors initially will examine in detail the key building blocks of a CDS program, including creating and enhancing organizational structure for CDS success; identifying information systems for providing the data that drive CDS interventions; leveraging clinical workflow to optimize CDS interventions; processes and systems for measuring the outcomes of these interventions; and knowledge management to acquire and maintain the expert clinical and scientific knowledge that informs these interventions. The instructors then will show how to leverage these building blocks to address key steps in developing, implementing, managing and evaluating CDS interventions, including how to select interventions to deliver targeted improvements in health care; configuring those interventions in specific environments; putting the interventions into action; measuring the results of the CDS interventions and in turn refining the program based on the results.

Additional discussion will touch on the role of national programs relevant to CDS, including knowledge sharing; structured guidelines; meaningful use; special considerations for CDS for small clinical practices, for hospitals and health systems and for vendors; and medico-legal considerations pertinent to CDS. Further, following interactive presentations by the instructors, attendees will divide into small groups and participate in a highly interactive exercise in planning and designing a CDS project to address a specific clinical target, facilitated by the instructors.

Overall, this systematic approach to CDS implementation will be presented in an interactive, case-oriented fashion, incorporating examples provided by tutorial leaders and participants’ experiences. The course content is drawn from the tutorial leaders' popular and award-winning guidebook series on improving outcomes with clinical decision support, the last two volumes of which (in 2009 and 2012) were co-published by AMIA.

Tutorial Outline:

  • Developing effective governance structures, stakeholder engagement and other key requirements for implementing a CDS program.
  • Selecting CDS goals.
  • Implementing goal-directed CDS interventions that improve outcomes, including the “CDS Five Rights”.
  • Monitoring and measuring CDS interventions.
  • Knowledge management and the refinement of CDS interventions based on results.
  • National programs relevant to CDS, including knowledge sharing, clinical guidelines and meaningful use.
  • Medico-legal considerations in the use of CDS.

At the conclusion of this tutorial the learner will be able to:

  • Understand the critical people, process and technology building blocks needed to implement a successful CDS program.
  • Follow a systematic process for developing, implementing and evaluating clinical decision support interventions that measurably improve key health care outcomes.
  • Detail factors both external and internal to a health care organization that drive CDS initiatives, including medico-legal considerations.
  • Understand the importance and details of knowledge management for maintaining CDS interventions.

Saturday, November 16, 8:30 a.m. – 4:30 p.m.

T03: Clinical Classifications and Biomedical Ontologies: Terminology Evolution, Principles, and Practicalities

Content Level: 75% Basic; 25% Intermediate.
Fee: $190 member/student $300 non-member CME/CE=6
Intended Audience: Scientists; researchers; physicians, nurses, and other healthcare professionals; computer scientists, system developers, and programmers.

C. Chute, Mayo Clinic; J. Cimino, NIH; M. Musen, Stanford University

Standardized terminologies and classification systems are an essential component of the information infrastructure that supports healthcare delivery and evaluation. Despite significant advances and increased motivation for the use of terminology systems, widespread integration of standardized terminologies into computer-based systems has not yet occurred. In this tutorial, we provide an overview of the state of the science related to terminologies and classification systems and demonstrate application of selected terminologies to a patient case study to highlight the strengths and weaknesses of various terminologies. Standardized terminologies alone are insufficient to achieve semantic interoperability. Consequently, the tutorial will include content designed to elucidate the relationships among standards for terminologies, information models, messages, and document and record structures. In addition, we will demonstrate the use of advanced terminology tools that facilitate the use of standardized terms in computer-based systems and provide an overview of significant international and national initiatives related to terminology systems.

Tutorial Outline:

  • Historical appreciation of the evolution and development of terminology and ontologies
  • An overview of current terminologies and ontologies used in clinical practice
  • The relationship of terminologies and ontologies to Meaningful Use Standards
  • Speculations about the future trends and current developments in health related terminologies and ontologies
  • A laboratory practicum on accessing and using clinical terminologies
  • Desiderata for practical and effective terminologies and ontologies
  • Practical examples and demonstrations about current terminologies and ontologies

At the conclusion of this tutorial the learner will be able to:

  • Understand the origins and evolution of terminologies and ontologies
  • Appreciate the present state of the art in health terminology development and deployment
  • Articulate the dependencies within Meaningful Use standards on ontologies and vocabularies
  • Demonstrate practical access methods to many terminologies and ontologies 

T04: CMIO Workshop

Content Level: 20% basic, 40% intermediate, 40% advanced
Fee: $190 member/student $300 non-member CME/CE=6
Intended Audience: New CMIO seeking new skills; Established CMIO seeking to develop new skills and build knowledge; Individuals aspiring to serve in the role of CMIO seeking to understand the position and its challenges.

There will also be a dinner on Saturday evening for CMIO Tutorial registered participants only. (Lunch is on your own.)

P. Fu, Harbor-UCLA Medical Center; J. Kannry, Mount Sinai Medical Center; R. Schreiber, Holy Spirit Hospital; J. Hollberg, Emory Healthcare

With the arrival of clinical informatics board certification for physicians, AMIA support for the applied clinical informatics communities has become more important than ever. A major part of that support is outreach to Chief Medical Information Officers (CMIO), who are charged with leading informatics change within their organization. AMIA is uniquely positioned to serve as the professional “home” for the CMIO community because it can provide a combination of personal experience and anecdote with firm grounding in evidence-based biomedical informatics literature, informatics theory, foundational knowledge, and proven best practices, in a thoughtful and coherent educational setting.

The CMIO Workshop was first held at the AMIA 2011 Annual Symposium behind the leadership of Gilad Kuperman, MD. It was again held at the AMIA 2012 Annual Symposium where enrollment doubled and met our target number for enrollment. The goal of the workshop is to provide an introduction for new and provide continuing education for established CMIOs and others who have similar roles (such as Medical Directors for Information Systems) to a set of topics that will help them carry out their professional responsibilities and also provide them with a deeper understanding of the field of informatics and how it can be integrated into their daily workflow in an evidence-based way. The offering will help to assure that their organizations realize the potential benefits that health IT can bring and also to assure that the organizations will have leadership that will embrace biomedical informatics as a core discipline.

WG01: Natural Language Processing Working Group Pre-symposium

This is a Working Group Pre-Symposia presented by NLP-WG Natural Language Processing Working Group.

Content Level: 20% basic, 60% intermediate, 20% advanced
Fee: $190 member/student $300 non-member CME/CE=6
Intended Audience: Anyone interested in clinical NLP is welcome. Doctoral students working on biomedical and clinical NLP projects and researchers who want to learn and share NLP knowledge are strongly encouraged to attend. The AMIA NLP working group is a large community with over 600 members.

W. Chapman, University of California at San Diego; J. Denny, Vanderbilt University; P. Haug, University of Utah; S. Meystre, University of Utah; J. Patrick, University of Sydney; G. Savova, Harvard Medical School and Children's Hospital Boston; I. Solti, Cincinnati Children's Hospital Medical Center; O. Uzuer, University at Albany; H. Xu, University of Texas Health Science Center at Houston

Natural Language Processing (NLP) technologies have received great attention in the clinical domain and have demonstrated numerous uses in many clinical applications. The pre-symposium of the AMIA NLP working group provides a unique platform for close interactions among students, scholars, and industry professionals who are interested in clinical NLP.

The event will consist of two sections: 1) a doctoral consortium, where students can present their work and get feedback from experienced researchers in the field; and 2) a workshop with a focused theme for each year. This year, our focus is open source clinical NLP systems. Our excellent podium and poster presentations will provide participants a complete picture of current efforts in developing open source clinical NLP systems.

Topics to be covered:

  • Overview of existing open source clinical NLP systems.
  • Detailed introduction to main open source systems such as cTAKES (now an Apache Software Foundation top-level project) and MetaMap, with demonstrations.
  • Development of applications based on open source systems.

At the conclusion of this pre-symposium the learner will be able to:

  • Obtain knowledge on available open source clinical NLP systems
  • Understand essential designs for developing open source clinical NLP systems
  • Learn how to use, extend, and customize open source NLP systems for specific applications

WG02: Current and Emerging Issues for Population Health Informatics in Healthcare and Public Health

This is a Working Group Pre-Symposia presented by PHI-WG Public Health Informatics Working Group.

Content Level: 20% basic, 30% intermediate, and 50% advanced
Fee: $190 member/student $300 non-member CME/CE=6
Intended Audience: Public health practitioners from the state, local and clinical care levels; public health officials, informaticians, faculty members, and consultants; AMIA healthcare informatics professionals who are interested in population health practice, research and outcomes and its intersection with healthcare; AMIA Public Health Informatics Workgroup (PHI‐WG); PHI students, young practitioners and researchers.

H. Kharrazi, Johns Hopkins School of Public Health; A. Joshi, University of Nebraska Medical Center; J. Loonsk, CGI Federal

Webcast Option

Webcast registration is also $95. In Webcast format, this Pre-symposia is not eligible for CME/CEs.

To attend the WG-02 Pre-symposia Webcast: Register online

Advancing population health outcomes is of prime interest to many informaticians both in healthcare and public health. This strong interest was demonstrated by the great success of AMIA’s Population Health Informatics (PHI) pre‐symposium workshop in 2012, making it the second most attended workshop. This year, multiple healthcare and public health factors are driving the PHI workshop to the next level including: implementation of Meaningful Use 2 (MU2); evolving population‐health focused MU3 objectives; enactment/enforcement of new CMS population policies; and, lack of a dedicated national public health informatics conference. Hence, it is especially important to bring public health and healthcare informatics professionals together to discuss timely population health informatics issues and suggest paths forward.

In this pre‐symposium, healthcare and public health informatics participants will understand, discuss, and advance current and emerging population health informatics issues. Faculty and presenters will frame different sides of each issue to demonstrate various developments in PHI and promote understanding of a common PHI vocabulary. Pre‐symposium participants will then discuss each issue to further advance a shared understanding and common ground. Consensus statements designed to move the management of each issue forward will be developed and communicated broadly. Timely issues will be included (in session topics list) that are associated with advancing population outcomes such as: the role of Accountable Care Organizations (ACO); supporting non‐syndromic surveillance needs; federated query for public health; establishing registries at the EHR, ACO, and health department levels; using population data for the public good; public health challenges with MU; decision 2 support for population health workers; the viability of two way communication between public health and healthcare; and other emerging topics.

Topics to be covered:

The overarching topical framework for 2013 PHI pre‐symposium will be adapted from PHI agenda developed from the 2011 AMIA PHI conference (doi:10.1136/amiajnl‐2011‐000507). Potential issues for individual session framing, discussion and consensus statements will include:

Information Exchange for Detection and Monitoring ‐ Clinical Care to Health Departments

  • Public Health Surveillance needs are met by syndromic data and lab results
  • Federated query can supplant public health reporting

Information Exchange for Communication and Coordination ‐ Health Department to Clinical Care

  • Healthcare provider needs for public health information are clear and feasible

Best Practices for Health Registries

  • Registries should exist at the: 1) EHR level, 2) Accountable Care Organization level, 3) Health Department level, 4) All of the above

Balancing Personal and Population Privacy Needs

  • Public discussion of public health needs for identifiable data lead to less data sharing
  • The third data class (identified, de‐identified, and ?) needs better definition for better protection

Health Departments and HITECH / ACA

  • Meaningful use is not meaningful to public health
  • Public health infrastructure cannot support existing demands

Long Term Objectives for Working Population Issues

  • ACO’s should promote a healthcare – public health relationship more like the European model
  • Clinical decision support obviates the need for population health workers
  • Human Resource Development
  • Integrated programs combining schools of public health / information systems and computer science
  • Funding streams and Career Panel in Public Health Informatics
  • Knowledge repository of organizations in the areas of Public Health Informatics

Public Health Informatics versus Population Health Informatics

  • Differences and similarities between public health informatics and population health informatics: problems, solutions, modalities, and outcomes
  • Aligning approaches to address both population and public health informatics concerns
  • How decision support will differ in clinical, population, and public health contexts?

At the conclusion of this tutorial the learner will be able to:

  • Discuss timely population health issues and explore collaboration
  • Expose and engage AMIA healthcare informatics participants in broader public and population health practice and research needs
  • Expose more public health and CDC professionals to AMIA
  • Advance the discussion of fundamental and pressing population and public health informatics issues
  • Demonstrate hands on population and public health informatics applications (e.g., case studies)
  • Outline the gaps and challenges of the existing population and public health informatics research
  • Discuss the need of developing workforce in the areas of population and public health informatics.

CANCELED WG03: The “Learned Intermediary” Question: Who Really Holds the Medico-Legal Risks of Inadequate HIT?

This is a Working Group Pre-Symposia presented by the POI-WG People and Organizational Issues, ELSI-WG Ethical, Legal and Social Issues, EVAL-WG Evaluation, and CIS-WG Clinical Information Systems Working Groups.

Content Level: 60% basic, 20% intermediate, 20% expert
Fee: $190 member/student $300 non-member CME/CE=6
Intended Audience: Users of HIT with responsibility for clinical care, i.e., any provider who uses HIT; CMIOs, CMOs, CNIOs, CQOs, CTOs, CIOs, and those who make decisions about the purchase of HIT hospital or practice legal departments; those involved in med. mal insurance issues

R. Koppel, University of Pennsylvania; W. Drummond, University of Florida; P. DeMuro, Schwabe Williamson & Wyatt; B. Kaplan, Yale University; S. Hoffman, Case Western Reserve University School of Law; R. Trocki, Agency for Healthcare Research and Quality; H. Solomon, GE Healthcare IT; A. Hussain, UHS Hospital; L. Ozeran, Clinical Informatics, Inc.

"Learned Intermediaries" (LIs) are medical experts who, because of education and experience, are qualified to cognitively and operationally balance multiple benefits and risks of: medications, treatments, and medical device performance. The "Learned Intermediary’s" choices follow the premise that their decisions are fully informed, individualized medical judgments, founded in knowledge of both the patient, of appropriate medical practice, and the characteristics of the prescribed medications, treatments, or devices. Some assert the LI doctrine also applies to clinician use of healthcare information technology (HIT). Few clinicians, however, have any real knowledge of either proprietary HIT software systems’ complex design or the processes involved in a given clinician/computer "transaction" (or "encounter"). Most "LIs" are unqualified to judge "the accuracy” of the computer performance for doing the task assigned to it. HIT vendors often enjoy a contractual and legal structure, “hold harmless”, which renders them virtually liability free. This may apply when proprietary products are implicated in adverse events involving patients. This contractual and legal method shifts liability and remedial burdens to physicians, nurses, hospitals and clinics, even though these HIT users may be strictly following vendor instructions. Medico-legally, any plan that involves a cognitive "third axis" extension into software engineering -- making clinicians responsible for system performance and accuracy in complex clinical computer installations -- is professionally inappropriate. This workshop will explore the ramifications of "LI" responsibility shift, across legal and clinical dimensions.

Topics to be covered:

Legal Aspects of the “Learned Intermediary Doctrine”
The presentation will address the fundamentals of the Learned Intermediary Doctrine as relates to use of electronic medical record (EMR) systems. Professor Hoffman will argue that the Learned Intermediary Doctrine should not apply in the context of EMR use. Corollary Topic: Legal Components' impacts on caregivers and care environments. Together, the combined presentations will address:

  • Whose "Insurance Contracts" cover medical and financial consequences of computer system “mal-performance”?
  • What if patient injury or death is involved?
  • Key unresolved issue sets evolving in Legal/Informatics Domain(s):
  • What questions should also be asked (of whom, and at what time in the process of acquiring, installing, etc.) by any person who is called a “Learned Intermediary”?
  • What kind of testing should the "LI" ask for before, during, and after, computer installations?
  • Who are “Learned Intermediaries” in today’s complex matrix of “providers”? Physicians, Physician Assistants? Nurses: staff, advanced practitioners, administrators (high level, or care unit?); Respiratory therapists? Pharmacists? Consultants? Staff Specialists (ECMO specialists, Perfusionists, Social Workers, Physical Therapists, Psychologists, radiologists, others?
  • What if that “LI” has absolutely no computer background … and:
  • Is presented with a very poor, distracting and time-consuming user interface, and
  • Is expected, as a condition of continued employment, to use that system with only a few hours of “training” and no training with patient-specific nuances of particular sub-populations, and
  • That at “go-live” has problem, after problem … ad infinitum, and faces delayed mitigation of reported faults and failures

At the conclusion of this tutorial the learner will be able to:

  • Understand the concept of the "Learned Intermediary"
  • Appreciate how poor systems' designs, installed with insufficient (or no) clinical testing, fail to support expert clinicians' real-time, temporally overlapping, complex mental models, and clinicians' time-sensitive, multi- tasking teamwork.
  • Define the legal risks of existing software, systems design and human factors problems embedded in commercial electronic record products.
  • Discover which entities are medico-legally responsible for problems arising in the human-computer interaction in medical settings.
  • Understand the potential changes in responsibility that may arise with regulation of HIT.
  • Each participant will be expected to internalize the medical, legal, and possibly personal risks and responsibilities that each member of the medical team has in their professional role(s).

WG04: Patient Engagement in Meaningful Use: Informatics Challenges and Opportunities

This is a joint Working Group Pre-Symposia presented by the NI-WG Nursing Informatics and CIS-WG Clinical Information Systems Working Groups.

Content Level: 80% basic, 20% intermediate
Fee: $190 member/student $300 non-member CME/CE=6
Intended Audience: Informatics professionals from all areas of practice (leaders in healthcare, healthcare informaticists and IT professionals, vendors, clinicians, researchers, and educators) should find this tutorial contemporary and relevant to current issues with Meaningful Use and Patient Engagement.

L. Heermann Langford, Intermountain Healthcare; J. Kannry, Mount Siani; D. Goldsmith, Brigham and Women's Hospital; L. Ricciardi, Office of the National Coordinator for Health IT; D. Skiba, University of Colorado Health Sciences Center; U. Sarkar, University of California San Francisco; A. Kushniruk, University of Victoria; G. Dolin, Lantana Consulting Group; E. Borycki, University of Victoria

Engaging patients in their healthcare through the use of Health Information Technology is an overriding goal that will stretch across all stages of Meaningful Use (MU). At present Meaningful Use focuses on four areas of patient engagement: Personal Health Records (PHRs), secure messaging, patient education/instructions, and clinical summaries. This tutorial looks at the three stages of MU and the requirements laid out for patient engagement. We have gathered together an impressive panel of experts in the field of patient engagement policy, technology, and usability. We will have interactive breakout sessions for participants to review feasibility, usability, next steps and possible future development. Participants in the breakout sessions will develop ideal future states in which the technology fulfills the requirements of MU and ultimately facilitates patient engagement. Our expert presenters in the field of usability will review the current state of the art of such tools. This topic is significant and timely for several reasons especially as MU enters a penalty phase in 2015.

Topics to becovered:

  • Meaningful Use and Patient Engagement: Meaningful for Patients?
  • Getting patients engaged in using health information technology
  • What tools are already in place that can be used? What other tools and strategies may be needed?
  • Personal Health Records – What do we know and are we ready for MU?
  • Patient Use of Secure Messaging: We are not all walking around with smartphones!
  • Summary of Care Record, the Care Plan, Patient Instructions, and Patient Authored Note – How are we going to meet MU requirements?
  • Usability Principles for the PHR, Summary of Care Record, Care Plan and Patient Instructions
  • Putting the Principles to work: Breakout groups – Let’s design the ideal tools for PHR with secure messaging, Summary of Care Record, Care Plan, Patient Instructions and Patient Authored Note.

At the conclusion of this tutorial the learner will be able to:

  • Describe the meaningful use MU requirements for increased patient engagement in their health care.
  • Discuss current tools required by MU related to personal health records, secure messaging, and care coordination available.
  • Identify shortcomings of current state tools to facilitate patients’ engagement in their healthcare per MU.
  • Suggest solutions to improve the design of informatics tools that will encourage and enable patients to more fully engage in their own or their family’s healthcare in accordance with MU.

WG05: Medical Informatics and Decision Support Systems in Intensive Care

This is a Working Group Pre-Symposia presented by the ICI-WG Intensive Care Informatics Working Group.

Content Level: 50% basic, 50% intermediate
Fee: $190 member/student $300 non-member CME/CE=6
Intended Audience: This Pre-symposium would be of interest to a physician and non-physician audience interested in the topic of intensive care informatics.

V. Herasevich, Mayo Clinic; P. Haug, University of Utah/ Intermountain Healthcare; J. Fackler, Johns Hopkins University School of Medicine; J. Zaleski, Nuvon, Inc.; B. Pickering, Mayo Clinic; K. Kuttler, Intermountain Healthcare; S. Khairat, University of Minnesota; V. Smith, Mayo Clinic; J. Blum, University of Michigan Medical Center; N. Chbat, Philips Research North America

Topics to be covered:

  • Applied clinical informatics: Fundamentals.
  • Electronic Protocols in the ICU.
  • Decision support systems overview
  • Tools and methods for patients’ data acquisition from bedside devices
  • Clinical data viewers in the ICU
  • Real -Time Decision Support and Smart Alerts in Intensive Care
  • Human-Computer Interaction & Clinical Communication for Patient Safety
  • Data Integration across existing EMRs
  • Building and Using Datamarts for Critical Care Clinical Research
  • Acute Disease Detection and Prediction based on Modeling

At the conclusion of this tutorial the learner will:

Have a clear overview of the topic and a printed brochure with the main concepts, research topics and available resources and tools in intensive care informatics.

WG06: Workshop on Visual Analytics in Healthcare

Content Level: 50% basic, 25% intermediate, 25% advanced
Fee: $190 member/student $300 non-member CME/CE=6
Intended Audience: Individuals interested in the analysis, exploration, and understanding of large and complex clinical datasets. Also vendors, clinicians and others responsible for maintaining clinical decision support systems and developing business intelligence tools to measure outcome.

J. Caban, National Intrepid Center of Excellence; D. Gotz, IBM Research; J. Wojtusiak, George Mason University

As hospital organizations and clinics move to electronic medical records and embrace new health information technology (HIT), the amount of data available to clinicians continues to grow at a rate not seen before. The vast amount of clinical data often captured for every patient poses a challenging task for clinicians trying to make sense of the patient’s condition and understand the patient’s medical history. Visualization and visual analytics show great potential as methods to analyze, filter, and illustrate many of the diverse data used in clinical practice. Today, (a) physicians and clinical practitioners are faced with the challenging task of analyzing large amount of unstructured, multi-modal, and longitudinal data to effectively diagnose and monitor the progression of a particular disease; (b) patients are confronted with the difficult task of understanding the correlations between many clinical values relevant to their health; and (c) healthcare organizations are faced with the problem of improving the overall operational efficiency and performance of the institution while maintaining the quality of patient care and safety.

Visualization and visual analytics can potentially provide great benefits to each of these three core areas of healthcare. However, to be successful, the resulting visualization must be able to meet the challenges of the clinical workflow and be useful for both patients and clinicians. Despite the continuous use of scientific visualization and visual analytics in medical applications, the lack of communication between engineers and physicians has meant that only basic visualization and analytics techniques are currently employed in clinical practice. During the last three years the authors of this proposal have organized and chaired the Workshop on Visual Analytics in Healthcare (VAHC) at the IEEE Visualization Conference. See visualanalyticshealthcare.org for more information about previous events.

Now that many engineers and scientists have participated, presented, and are engaged in the topic of visual analytics for healthcare application, we propose to host the workshop at AMIA 2013. Given AMIA is attended by clinicians and scientists, we believe that hosting the workshop there will give scientists to opportunity to discuss their latest clinical data visualization techniques with individual interested in clinical informatics. In addition, the workshop will provide clinicians with a gathering to share their needs for specific informatics techniques to visually analyze and explore their clinical data.

Topics to be covered:

  • Visual analysis and exploration of longitudinal clinical test
  • Visual data mining of EHR
  • Visualization of prescriptions drugs and interactions
  • Improving OR workflow with visual analytics
  • Outcome forecasting or prediction
  • Visual analytics for patient safety
  • Pandemic forecasting and tracking
  • Visual analytics in surgery
  • Visual analytics in radiology
  • Visual analytics in the ER and OR
  • Improving patients understanding with visual analytics

At the conclusion of this tutorial, the learner will be able to:

  • Discuss different visualization techniques
  • Promote better collaboration between visualization experts and clinical practitioners
  • Discuss the areas of healthcare in which better tools and visualization techniques are needed
  • Support and encourage new collaborations between the visualization community and clinical practitioners
  • Help the visualization community receive feedback and suggestions from expert physicians
  • Provide an opportunity for the visualization community to showcase emerging techniques and applications to invited representatives from the open health data initiatives.
  • Build a community amongst researchers and expert clinicians focusing on healthcare application of visual analytics.
  • Discuss new visual analytics opportunities to leverage open data in the healthcare space.

WISH 2013

Fee: $190 member/student $300 non-member (No CME/CE credits available for this session)
Intended Audience: researchers and practitioners with interests in health information technology (HIT)

Addressing the complex interplay among human, organizational, and technological systems in healthcare is critically important. At the intersection of these systems lies a significant research area that has the potential to impact quality, safety, efficiency, and effectiveness of health care in America. Although new research initiatives aim at better aligning health information technology, real clinical practice, and design of technologies informed by the best practices in human factors and human-computer interaction, current efforts are spread out in several disjointed research communities, without established pathways for transfer of knowledge and expertise.

At WISH 2013, researchers and practitioners with interests in health information technology will come together to promote deeper and more profound connections among the biomedical informatics, human-computer interaction, medical sociology and anthropology communities. The gathering of these communities in a focused conference will lead to the development of new methods, approaches, and techniques to improve the design, adoption, and use of health information technology (HIT). This workshop is designed to foster conversation, bridge communities, and develop a shared body of knowledge. WISH 2013 will offer an exciting program, including keynote speeches, invited and peer-reviewed panels, and poster exhibitions.

Saturday, November 16, 1:00 p.m. – 4:30 p.m.

T05: Fundamentals of EHR Usability

Content Level: 75% basic, 20% intermediate, 5% advanced
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: Those involved in designing, developing, maintaining and implementing EHRs including:
EHR developers and programmers; EHR designers; EHR software quality assurance personnel; Information Technologists charged with assisting the EHR acquisition process; Physicians, nurses, and other healthcare professionals; Graduate students and postdoctoral fellows

Franklin, M. Walji, J. Zhang, University of Texas Health Science Center at Houston

A current and significant challenge in the design and implementation of health information technology (HIT) is to deal with the high failure rate of HIT projects. Most of these failures are not due to flawed technology, but rather due to the lack of systematic considerations of human factors and other non-technology issues in the design and implementation processes. In other words, designing and implementing HIT is not so much an IT project as a project about human-centered computing akin to human-computer interaction, workflow, organizational change, and process reengineering.

Due to the complexity and unique features of healthcare, human-centered methods and techniques specifically tailored for this domain are necessary for the successful development of health information systems such as electronic health records (EHRs). Good usable design would engender systems that increase efficiency and productivity, are easy to use and straight forward to learn, increase user adoption, retention, and satisfaction, and decrease medical errors, development time and cost. In this tutorial we will focus on teaching two methods appropriate for assessing EHR usability. After the half-day tutorial, the attendees should have a basic understanding of the usability issues in health IT and have gained skills enabling them to evaluate the usability of EHRs and related products using these methods.

Topics to be covered:

  • Role of usability in adoption and meaningful use of EHRs
  • Fundamental principles of usability and human-centered computing
  • Usability Methods
    • Overview of usability methods and appropriate uses
    • Expert Review: In depth and hands-on session
    • User Testing: In depth and hands-on session
  • Group discussion on how to integrate usability techniques into the development lifecycle

At the conclusion of this tutorial, the learner will be able to:

  • Understand the principles of usability and human-centered design
  • Understand the significance of usability and human-centered design and the consequences of technology-driven
  • development
  • Describe usability methodologies and techniques to evaluate health information systems
  • Perform user testing and expert reviews to detect usability problems in health information systems

T06: Personal Health Records, Portals And Consumer-facing Health Information Technologies

Content Level: 30 % basic, 60 % intermediate, 10 % advanced
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: (TBD)

P. Brennan, University of Wisconsin-Madison; J. Wald, RTI International; D. Sands, Harvard University

Consumer information technology solutions are assuming increasing importance in engaging people in self care and disease management. Personal health information tools provide lay people with access to subsets of their clinical records and with the health information management tools needed for self-care and effective health care utilization. Taking on many forms, including PHRs, iPhone apps, patient portals, stand-alone applications, mHealth and Web 2.0 services, these innovative IT tools may also enable better access to the health care systems resources, including health information, appointment scheduling and provider communication, and personal health tracking. Through case studies this tutorial will introduce clinicians, systems administrators, and IT developers to critical issues regarding the design and deployment of PHRs and other personal health information management tools. This tutorial addresses the AMIA 2013 theme of Consumer Informatics and Personal Health Records. The aim of this tutorial is to provide an experienced-based, practical introduction to patient-facing health IT, with particular attention to the clinical consequences of engaging patients through health IT.

This tutorial addresses the AMIA 2013 theme of Consumer Informatics and Personal Health Records. The aim of this tutorial is to provide an experienced-based, practical introduction to patient-facing health IT, with particular attention to the clinical consequences of engaging patients through health IT. Drawing from over four decades of experience in the consumer health space, Dr. Brennan with Project HealthDesign, Dr. Wald with Partners HealthCare and AHRQ-sponsored research, and Dr. Sands with Beth Israel Deaconness Medical Center and the Society for Participatory Medicine have substantial experience leading innovations in consumer health.

During the tutorial, participants will have an opportunity to examine and critically evaluate existing tools & applications, explore patient portals, and discuss technical, ethical and policy considerations related to the deployment of personal health records tools. An update of the national environment and trends enabling (or interfering with) deploying IT tools for direct-to-consumer will be provided: meaningful use, privacy policies, payment schemes, accountable care organizations and health reform. Participants are encouraged to appraise their institutions' current plans for deploying consumer facing HIT and to come prepared to engage in discussions regarding implementation challenges and anticipated benefits.

Topics to be covered:

PHRs, Patient Portals and consumer facing technologies

  • Early experiences
  • Adoption by clinicians and staff
  • Patient engagement

Design of Patient facing technologies

  • Technical Considerations and Challenges
  • Platforms and Devices
  • Human-computer interaction
  • Clinical considerations
  • Integration with clinical information systems, health information exchange, & data integrators

Policy and the View from the National Scene

  • Meaningful Use
  • Privacy
  • Ethical Issues
  • Social benefits & challenges of consumer-facing health IT

At the conclusion of this tutorial, the learner will be able to:

  • Determine how consumer-facing HIT, including PHRs and patient portals help achieve clinical goals
  • Pose solutions to the clinical and usability challenges of effective consumer-facing HIT
  • Evaluate the technical requirements, ethical considerations and social value of PHRs, portals, etc

Sunday, November 17, 8:30 a.m. – 12:00 p.m.

T07: Practical Modeling Issues: Representing Coded and Structured Patient Data in EHR Systems

Content Level: 50% intermediate, 50% advanced
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: Anyone interested in the principles and practice of clinical data models and the practical use of standard coded terminologies should attend. This would include physicians, nurses, developers of clinical software, and clinical systems architects and designers.

S. Huff, Intermountain Healthcare

This tutorial will describe the need for formal data models (detailed clinical models) for the EHR and how standard terminologies are used in the models. Starting with use cases encountered while developing EHR systems at Intermountain Healthcare, the instructor will discuss the basic name-value pair paradigm for flexible representation of patient data; the proper roles for standard terminologies like LOINC, SNOMED CT, First Data Bank, and RxNORM; approaches to handling pertinent negative findings and negation; support for precoordinated data entry while storing the data in a post coordinated database; and storage of data that belongs to another patient (baby or donor) in the patient record.

Topics to be covered:

  • What are detailed clinical models?
  • Why are detailed clinical models important?
  • What are the requirements for defining and using detailed clinical models?
  • Name-value pair (NVP) and entity-attribute-value (EAV) strategies for representing clinical data
  • What are the proper roles for use of LOINC, SNOMED CT, drug codes (First Data Bank, RxNorm) and classifications in the models
  • The necessity of supporting both pre and post coordinated models in a clinical system
  • Approaches to the representation of negation and pertinent negative findings
  • Storing data that belongs to another person (relative, family member, donor) in the patient record
  • Specific alternatives for modeling including observations, diagnoses, and problems
  • Open candid discussion of ideas that the participants have about ways that the modeling issues can be addressed
  • Importance of supporting open consensus standards for EHR systems that are purchased or developed
  • Brief discussion of various national and international activities related to formal clinical data models

At the conclusion of this tutorial, the learner will have a better understanding of:

  • The assumptions and motivation for formal definitions of detailed clinical models
  • How standard coded terminologies are referenced by detailed clinical models, and the different roles that SNOMED CT and LOINC play in the models
  • The various alternative logical models for implementing clinical models related to diagnoses, problems, measurements and observations.
  • The importance of adhering to terminology and modeling standards in developing or purchasing interoperable EHR systems
  • National and international activities for sharing models that enable interoperability of EHR systems

T08: The EHR Usability Symposium: Vendor, User, Researcher, and Policy Perspectives

Content Level: 25% basic, 50% intermediate, 25% advanced
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: Those involved in designing, developing, maintaining and implementing EHRs including: EHR designers , developers and programmers; EHR software quality assurance personnel; Information Technologists charged with assisting the EHR acquisition process; EHR purchasers; Physicians, nurses, and other healthcare professionals; Usability experts; Academic researchers and trainees (including graduate students and postdoctoral fellows); Policy makers

J. Zhang, K. Graves, A. Franklin, M. Walji, UT Health Science Center at Houston

The National Center for Cognitive Informatics and Decision Making in Healthcare (NCCD), funded by the Office of the National Coordinator for Health Information Technology, as part of the Strategic Health IT Advanced Research Program (SHARP), was formed to focus on the urgent and long-term cognitive challenges in Health Information Technology (HIT) adoption and meaningful use. Over the last three years, researchers at the NCCD have focused on addressing the urgent usability, workflow, and cognitive support issues of HIT that can fundamentally remove the key cognitive barriers to HIT adoption and meaningful use. The center generates research findings, tools and guidelines that have a real world impact in order to maximize the benefits of HIT for healthcare quality, efficiency, and safety. This symposium presents an opportunity for the user, vendor and research communities to share progress, ideas, and solutions in improving the usability of EHRs.

Topics to be covered:

  • State of EHR Usability: User community perspective: A review of the progress made over the last three years from a clinical user perspective. This presentation will be given by a representative from the EHR user (provider) community.
  • State of EHR Usability: Vendor community perspective: A review of the progress made over the last three years from a vendor perspective including the impact of the Safety Enhanced Design requirements included in the 2014 EHR Certification criteria. This presentation will be given by a representative from the vendor community.
  • State of EHR Usability: Research community perspective: A review of the progress made over the last three years from a researchers perspective. This presentation will be given by a representative from the usability research community.
  • EHR Usability in Meaningful Use 2014 Certification: Federal perspective: A review of the Safety-Enhanced Design in MU 2014 from the regulatory perspective. This presentation will be given by a representative from ONC. 5. Open Forum: An interactive discussion to better align the perspectives of the user, vendor, research, and regulatory communities. A moderator (TBD) will be tasked with facilitating the open forum with the goal of identifying 1) common needs, challenges, and barriers in designing and using EHRs, and 2) how the different stakeholders can work cooperatively to enhance the field, and 3) specific next steps. Examples of topics that the moderator. Note takers will be present to record the ideas discussed, and a final report will be developed and shared with all the attendees.
  • Discussion Summary and Next Steps: The moderator will summarize the discussion and review the strategies developed by the group.

At the conclusion of this tutorial, the learner will be able to:

  • Identify EHR usability challenges and understand how to different stakeholders can work together to jointly improve the state of EHR usability
  • Identify and share strategies to help the adoption of user-centered design strategies already underway by representatives in industry
  • Understand how the 2014 EHR certification criteria related to safety enhanced design
  • Describe specific strategies that can be used to meet the safety enhanced design requirements

CANCELED T09: Cancer Proteome Informatics

Content Level: 50% basic, 50% intermediate
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: Clinicians who are interested in the process by which protein biomarkers enter service as clinical tests will find this course particularly valuable. Computer scientists who are interested in addressing challenges from systems biology will learn about a host of potential projects. IT professionals will be introduced to first-line data analysis in a field that can benefit from their talents.

This pre-symposium will emphasize material of intermediate complexity. Participants will benefit from a basic knowledge of the Central Dogma of molecular biology, and some knowledge of biochemistry will be helpful. Prior experience of mass spectrometry will not be assumed of participants. Individuals with software development skills and those without should equally be able to understand the concepts described in this pre-symposium.

D. Tabb, Vanderbilt University; P. Rudnick, National Institute of Standards and Technology

This pre-symposium will introduce participants to the bioinformatics essential to the success of cancer proteomics. Topics will include the identification and differentiation of tumor proteomes, quantifying the changes in protein biomarkers, and establishing resources and repositories from experimental sets. The presenters will draw on their experience from the NCI Clinical Proteomic Tumor Analysis Consortium and Early Detection Research Network. Course material is designed to be accessible to participants who have no prior exposure to proteomics.

Cancer biology has gained substantial detail through the application of clinical proteomic technologies. The identification of peptides from tandem mass spectra from LC-MS/MS and the assembly of proteins from peptide identifications will be the first topic detailed. The presentation will clarify the structure and strengths of two distinct methods for peptide identification: database search algorithms and spectral library search. Participants will then learn about comparative and quantitative proteomics experiments through spectral counting and Selected Reaction Monitoring. As more data sets from these experiments are released to the public, significant public resources for proteomics have been constructed. This pre-symposium will detail the construction of the NIST spectral libraries and the establishment of public repositories for experiments. Open-source tools for pathway and biological network analysis have been tailored to summarize cancer proteomes at a higher level. Each instructor will draw upon more than a decade of experience in bioinformatics to familiarize participants with this vibrant area of biomedical research.

Topics to be covered:

  • Introduction to tandem mass spectrometry and protein identification
  • Fundamentals of LC-MS/MS and Collision-Induced Dissociation
  • Matching peptide sequences to MS/MS scans through database search algorithms
  • Matching MS/MS scans to spectral libraries
  • Filtering peptide identifications and assembling proteins

Differentiation and quantitation in proteomics

  • Comparing spectral counts for candidate biomarker detection
  • Integrating extracted ion chromatograms to estimate peptide quantities
  • Quantifying changes by Selected Reaction Monitoring
  • Establishing ELISA tests for clinical application

Building resources and repositories for clinical proteomics

  • Managing laboratory data via LIMS
  • Constructing robust spectral libraries for sensitive identification

Establishing repositories for publishing proteomic biomarkers

  • Discerning pathways and biological network enrichment from proteomes

At the conclusion of this tutorial, the learner will be able to:

  • Understand the means by which peptides can be identified from collections of tandem mass spectra.
  • Understand the need for multi-stage validation of biomarkers prior to clinical implementation of these tests.
  • Understand the public resources that have become possible through public release of proteomic data sets.

T10: Introduction to Biomedical Informatics

Content Level: 100% basic
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: First time symposium attendees, Health IT decision makers, Healthcare leaders

J. Hales, Intermountain Healthcare; C. Cimino, New York Medical College

Introduction to Biomedical Informatics provides a historical overview of the development of the field of biomedical informatics, beginning in the 1950s, together with an introduction to the fundamental organizing principles of the discipline. Intended for first time attendees of the Fall Symposium, this tutorial will provide a foundation for ideas presented in the meeting through didactic instruction, interactive discussion and linkage to program content. With the publication of a formal specification of core competencies by AMIA 1), as well as the emergence of a clinical subspecialty certification, this tutorial will provide a practical overview of essential fundamental ideas of the field of biomedical informatics for those newly introduced to the discipline, Shortliffe’s model 2) of core methods, techniques and theories applied to application domains will be used as a framework to introduce the broad application of the principles of biomedical informatics at the present time (and within the symposium program). Selected methods and theories will be defined and presented along with representative examples of domain specific applications.

Topics to be covered:

  • Defining the discipline
  • Historical development a. Key figures
    • Key milestones
    • Seminal publications
  • Key principles
    • Data and Knowledge Representation
    • Terminology
    • Decision support
    • Human-computer interaction
  • Program map – linking principles to symposium content

At the conclusion of this tutorial, the learner will be able to:

  • Appreciate historical contributions to the evolution and development of the discipline of biomedical informatics
  • Articulate some of the central principles (models, theories, processes) of biomedical informatics
  • Describe the application of fundamental principles of biomedical informatics in one or more application domain
  • Select symposium content based on an understanding of relevance, application, and fundamental principles.

T11: Developing an i2b2 Cell and Client Plugin

Content Level: 20% Basic, 50% Intermediate, 30% Advanced
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: Scientists; researchers; healthcare analysts, database programmers, and other healthcare professionals; Academic faculty or professionals setting up bioinformatics facilities and/or relating these to clinical data repositories and computer scientists, system developers, and programmers

M. Mendis, Partners Healthcare; I. Kohane, Childrens’s Hospital; S. Murphy, Massachusetts General Hospital

Informatics for Integrating Biology and the Bedside (i2b2) (http://www.i2b2.org), is an open source software suite to construct and manage the clinical research chart in the genomic age. With it, query tool become generally available to researchers to search and work with pretention populations. This workshop will focus on the mechanics of setting up and populating an i2b2 database, and the more advanced topic of extending i2b2 software for custom uses needed at a site.

The software i2b2 which is distributed by the project (Informatics for Integrating Biology and the Bedside) is used by many hospitals, universities, and healthcare businesses to aid the research of clinical data. One of the goals of i2b2 is to provide clinical investigators broadly with the software tools necessary to collect and manage project-related clinical research data in the genomics age as a cohesive entity—a software suite to construct and manage the modern clinical research chart.

The architecture consists of two pieces. The first is the back-end "i2b2 Hive" infrastructure that manages the data repository, security and authentication. The i2b2 Hive, composed of fundamental cells (or modules) allows this open-communication to occur through web services and XML messages. The second piece is the front-end that allows users to query and mine the data. i2b2 is deployed across over 100 academic health centers. We will summarize typical applications and use cases.

The beginning of the tutorial will contain an overview of the i2b2 architecture. We then describe a step-by-step approach in implementing i2b2 at your institution such as the technologies and the third party software that are required. We will continue by writing a new analytic "cell" and leveraging advanced services such as natural language processing. The new cell will be a fully working i2b2 cell that can receive and respond to i2b2 messages. Once the cell has been developed, an i2b2 webclient plugin will be developed that sends a message to the cell and displays the response. We will conclude with a roadmap for the near term and longer term i2b2 developments. Due to the complex nature of this tutorial, the participants should download and install the tutorial Virtual Machine (VM) prior to attending. The VM will run on any Windows or Macintosh machine and will contain a complete and installed i2b2 server, i2b2 webclient, application server, database server and any development tools needed. A completed cell and plugin will also be included.

Topics to be covered:

  • i2b2 Introduction
  • i2b2 Cell Architecture and overview – Shawn Murphy & Mike Mendis will begin with an introduction into the i2b2 architecture and how the i2b2 cells work together. Will go over how the i2b2 cells message each other in a loosely coupled fashion. A breakdown of the different Virtual Machines (VM) that is available from i2b2. The tutorial will use the Java language and a brief discussion on the j2EE standards and how they are used and also the main server side 3rd party components such as JBoss and Axis2.
  • Starting and Stopping the VMware framework – Mike Mendis will discuss how to start, stop and pause the tutorial VM image. He will also discuss some of the benefits of using a VM for development.
  • Technology and application within the tutorial VM – Mike Mendis will talk about the Server, Client and database, users will learn how to stop and start the i2b2 instance, query the star schema, and how to monitor the logs.
  • Develop and deploy an analytic “cell” that will leverage NLP technologies – Mike Mendis will show that by using the Eclipse framework, a new cell can be created and deployed. The cell will accept a value from a properly formed i2b2 XML message and run a regular expression on that value. The cell will return the output via a standard i2b2 response message.
  • Develop a webclient plugin to test the new cell – Mike Mendis will finish the development with creating a client that is written in HTML and JavaScript that will communicate with the new cell. This will test that the server is working correctly and also introduce users into the i2b2 webclient.
  • Roadmap for near term and future i2b2 developments – Shawn Murphy will end the presentation with talks about the future of i2b2.

At the conclusion of this tutorial, the learner will be able to:

  • Install and extend the functionality of the clinical research chart
  • Understand and extend the functionality of the i2b2 hive cell
  • Understand and extend the functionality of the i2b2 web client

T12: Writing for Publication in Biomedical Informatics

Content Level: 70% basic, 30% intermediate
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: No specific background will be necessary. Tutorial participants should be interested in understanding the process of scientific publication in biomedical informatics. We would like to encourage participants from developing countries and young PhD students to attend this tutorial as to assist them in increasing their contribution to the scientific evidence base of Biomedical Informatics.

D. Aronsky, Vanderbilt University; J. Talmon, Maastricht University; R. Haux, University of Braunschweig and Hannover Medical School; N. de Keizer, Academic Medical Center; T. Leong, National University of Singapore; C. Safran, Beth Israel Deaconess Medical Center and Harvard Medical School; C. Lehmann, Vanderbilt University

Participants will learn how to plan and prepare manuscripts, select an appropriate audience, decide on a suitable type of publication, understand the submission, peer review, and editorial decision making process, and learn how to reply to reviewers’ comments. Manuscript preparation will include a detailed explanation of the various sections of a manuscript, elements of writing style, use of abbreviations, formatting of tables, preparing of figures, creating bibliographies, and common errors to avoid. Ethical considerations, such as authorship responsibilities, conflict of interest, duplicate submissions, plagiarism, prepublication, etc., will be discussed. For authors whose primary language is not English, the tutorial will provide advice on the general aspects of writing scientific English.

Writing for publication can be a rewarding activity for researchers at all levels of experience. However, many students and researchers are less familiar with the various aspects of the publication process. The purpose of this tutorial is to provide participants with the knowledge, skills, and practical advice that can lead to successful scientific publications. Participants will learn how to plan and prepare manuscripts, select an appropriate target audience, decide on an appropriate type of publication, understand the submission, peer review, and editorial decision making process, and learn how to reply to reviewers’ comments.

Manuscript preparation will include a detailed explanation of the various sections of a manuscript, elements of writing style, use of abbreviations, formatting of tables, preparing of figures, creating bibliographies, and common errors to avoid. Ethical considerations, such as authorship responsibilities, conflict of interest, duplicate submissions, plagiarism, prepublication, etc., will be discussed. For authors whose primary language is not English, general advice on writing scientific English will be provided.

The presenters will share their knowledge and learned lessons from being authors, research advisors, reviewers, editorial board members and editors, so that participants can become more familiar with the process. During the interactive tutorial participants are expected and encouraged to share their experiences. At the end of the tutorial, participants should understand the scientific publication process and be able to overcome barriers that will lead to successful manuscript submissions. The interactive tutorial is intended to provide an informal and educational forum for tutorial participants. During the first part of the tutorial the presenters will discuss information about the various aspects of the publication process, as outlined below, and include practical examples. During the second part participants will have the opportunity to discuss specific questions and share their experience with the audience.

Topics to be covered:

Preparing a Manuscript: From Idea to Submission

  • getting your thoughts together (outlines, mind-mapping, developing a structure …)
  • targeting your audience
  • how to select a journal, instructions for authors, electronic publications, open access
  • types of papers (research, letters, review, brief communication)
  • your first draft
  • revising your manuscripts
  • writing for the various sections (IMRAD: introduction, methods, results, and discussion)
  • considerations for creating tables, designing figures, and selecting references
  • acknowledgments, keywords, appendices
  • authors and authorship responsibilities
  • aspects of writing style
  • considerations for authors whose primary language is not English

Submitting a Manuscript: From Submission to Final Decision

  • submitting your paper
  • communicating with the editorial office
  • revising your manuscript and replying to reviewers’ comments
  • final decision, copy-editing, galley proof

Receiving a Manuscript: The Editor’s Perspective:

  • handling submitted manuscripts
  • internal and external review
  • peer review process
  • selecting reviewers
  • editorial decisions
  • communicating with authors

Ethical Aspects:

  • authorship
  • conflict of interest
  • copyrights
  • plagiarism
  • duplicate publication
  • pre-publication

Helpful Hints and Common Errors to Avoid

At the conclusion of this tutorial, the learner will be able to:

  • Understand the types and structure of publications (journals, conferences)
  • Plan and get started on a scientific manuscript
  • Understand how to prepare manuscripts for publication, including tables, graphs, references, etc.
  • Realize ethical aspects, such as authorship, duplicate submission, electronic publication
  • Understand the submission, review, and editorial decision process
  • Know information technology tools that can support the manuscript preparation: mindmapping, bibliographic references, etc.

T13: An Introduction to Clinical Natural Language Processing

Content Level: 70% basic, 30% intermediate
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: Any clinician or medical informatician with an interest in learning more about clinical NLP.

L. D'Avolio, VA Boston Healthcare System; W. Chapman, University of California, San Diego; D. Demner-Fushman, National Library of Medicine

Natural language processing is the umbrella term used to describe the automated structuring and extraction of information formatted as free text. The demand for natural language processing technologies in medicine will grow significantly in the coming years. This growth will be fueled by the continuing adoption of the electronic medical record, increasing emphasis on quality measurement and improvement initiatives, and the growing need for evidence to be used as part of evidence-based medicine. This half-day tutorial is designed to introduced clinicians and informaticians to the practice, tools, techniques, and science of clinical natural language processing. Instruction will be hands on, inter-active, and case driven. The tutorial will focus primary on clinical NLP, although related uses and methods such as literature-based NLP and text mining will be discussed to lend context.

The introduction to clinical NLP tutorial has been successfully held at AMIA for the past three years, and the attendance and interest to the topic continue to grow. Topics covered in the tutorial include: an overview of clinical NLP and its uses in medicine; a brief history of clinical NLP and the evolution of NLP methods; the challenges to NLP; the number of approaches used to process natural language and the strengths and weaknesses of each; implementation considerations, creating annotated corpora as training / test sets, evaluation of NLP, and a review of open source tools for natural language processing. Demonstrations and in-class exercises will be used to help tie the theory of NLP to everyday research problems addressed by these technologies. The tutorial will be taught by three instructors experienced as researchers, developers, and users of a variety of tools and approaches to clinical NLP.

Topics to be covered:

Overview: What is NLP and how is it being used in medicine?

  • Literature
  • Clinical reports
  • Applied to bioinformatics

What makes clinical NLP so difficult?

  • Overview of policies affecting NLP
  • Characteristics of the clinical documentation environment

Different approaches to clinical NLP

  • Simple rules-based (information extraction)
  • Statistical
  • Symbolic or grammatical
  • Hybrid approaches

The clinical NLP process

  • The various components of clinical NLP
  • Annotated corpora for training \ testing
  • The pipeline or clinical NLP software
  • Evaluation (its role in the process)

Available open source tools and components

Implementation considerations

Evaluating clinical NLP (in greater detail)

At the conclusion of this tutorial, the learner will be able to:

  • Describing the current uses of clinical NLP
  • Describe the relationship between clinical NLP and related techniques such as text and data mining
  • Understand the challenges to clinical NLP
  • Describe the various approaches to clinical NLP and their strengths and weaknesses
  • Understand the process of clinical NLP and its various components
  • Find available open source clinical NLP components, frameworks, and packages
  • Identifying potential implementation concerns and challenges
  • Understand the process of creating and using annotated corpora
  • Interpret the performance of published clinical NLP research
  • Users will also be exposed to several open source technologies for clinical NLP including the Unstructured Information Management Architecture (UIMA) and Knowtator for manual annotation. They will also experience, first hand, the challenges of clinical NLP through manual annotation of de-identified patient records.

T14: Ethnographic Sociotechnical Evaluation for Health Information Technology

Content Level: 50% basic, 50% intermediate
Fee: $95 member/student $150 non-member CME/CE=3
Intended Audience: Clinicians, designers, researchers, scientists, managers, health care professionals, executives, and others involved in research, development, or deployment of information systems in health care.

Bonnie Kaplan, Yale University

Sociotechnical approaches are grounded in theory and are evidence-based. They provide a way to conduct needs analysis, to understand what people do when working with these technologies, and to identify why they view and use these technologies in those ways. They assess how an application and workflow influence each other; how clinical and patient roles relate to system use; how useful and usable health information technologies are; and what unintended consequences, patient safety issues, or user responses might occur. Ethnographic approaches explore how users experience health information technology and why they interact with it as they do. Ethnographic sociotechnical evaluation, applicable in all areas of medical informatics, can help prevent difficulties through better needs analysis, system design and implementation practices.

The tutorial explains these approaches and how to use them. It addresses how to identify challenges in designing and implementing both clinician-facing and patient facing health information technologies and to successfully implement them. Dr. Kaplan draws on her 40 years of evaluation research and teaching to engage participants in designing in situ and ethnographic sociotechnical evaluations for needs analysis, application development, implementation, and continued use. After introductory didactic presentation, participants will discuss and design sociotechnical ethnographic evaluations. Dr. Kaplan has authored chapters on qualitative evaluation in the key evaluation textbooks, published seminal methodological papers as well as evaluation studies, and presented popular tutorials and sessions on evaluation methods at previous AMIA Symposium, Medinfo, and other conferences.

Topics to be covered:

  • Sociotechnical theory
  • Why do ethnographic and in-situ evaluation through all phases of a project development and implementation
  • Sample evaluation designs and what was learned from them
  • Frameworks for evaluation
  • Sociotechnical and ethnographic approaches to HIT design and on-going evaluation

At the conclusion of this tutorial, the learner will be able to:

  • Describe key concepts in sociotechnical theory
  • Employ sociotechnical evaluation frameworks
  • Articulate the importance of on-going in situ and ethnographic evaluation
  • Design HIT projects and evaluations that include people, organizational, social, and ethical issues