AMIA 2014 Tutorials & Working Group PreSymposia

New this year! Sessions are included in the registration fees.

  • Individual session registration is required for each tutorial or working group pre-symposia you wish to attend
  • Tutorials and Working Group pre-Symposia can be added to an existing registration

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

Tutorials are CME/CE eligible where noted.

  • Half-Day sessions = 3 CME/CE
  • Full Day sessions = 6 CME/CE
  • CMIO Tutorial (lunch fee $60) = 6 CME/CE

Saturday, November 15, 8:30 a.m. – 12:00 p.m.

T01: Personal Health Records, Patient Portals, And Consumer-facing Health Information Technologies

Content Level: 25% Basic, 60% Intermediate, 15% Advanced
Intended Audience: Consumers, patients, providers, insurers, clinical leaders, policymakers, researchers, activists, and those who want to understand how patient engagement is accelerated through health IT.

Jonathan Wald, RTI International and Daniel Sands, Beth Israel Deaconess Medical Center

Consumer information technology solutions are assuming increasing importance in engaging people in self-care and disease management. Personal health information tools provide 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, provider communication, and personal health tracking. Through case studies this half-day 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.

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. Wald with RTI and formerly with Partners HealthCare and Cerner Corporation, and Dr. Sands with Beth Israel Deaconess Medical Center and the Society for Participatory Medicine, have substantial experience leading innovations in consumer health and will examine a broad set of topics including: Patient portal functions; Implementation strategies; Clinician adoption; Patient adoption; eHealth strategy; Opportunities and limitations of patient engagement; Clinician, practice, and patient workflow; Clinical care experiences with portals; and Patient-gathered and contributed health observations (patient-generated health data.)

WG01: Aligning Consumer Health Informatics Tools with Patient Work: Key Frameworks for Design

Presented by the People and Organizational Issues Working Group

Content Level: 50% basic and 50% intermediate
Intended Audience: Health care, public health and consumer health professionals, designers, or researchers involved in sponsorship, development, or selection of CHI technology; information systems project managers; systems and business analysts; members of the AMIA clinical information systems, consumer health informatics, primary care informatics, people and organizational issues working group, and student working groups as well as those that are members of the implementation listserv.

Laurie Novak, Vanderbilt University; Rupa Valdez, University of Virginia; Richard Holden, Vanderbilt University; Tiffany Veinot, University of Michigan

It has been widely accepted that clinical information systems should be designed to align with healthcare work activity. This principle can also apply to the design of consumer health informatics (CHI) applications. Though not always recognized, patients and their family members may allocate significant effort toward their treatment and care – a phenomenon we call “work.” Understanding patient work, including tasks, tools and context, can result in potentially actionable design criteria for applications. This perspective can augment existing CHI design priorities that have traditionally focused on biomedical content and intrapersonal characteristics and skills of patients, such as health literacy, self-efficacy and motivation. A patient work lens extends such foci by attending to the embeddedness of patients’ health management in larger processes and contexts and prioritizing patients’ perspectives on illness management.

This tutorial will introduce participants to two complementary frameworks:
Patient Work System, grounded in human factors engineering and macroergonomics, and Patient Work Activity, drawing on work practice research in the social sciences. Participants in the tutorial will apply the frameworks using their own cases or a case provided by the tutorial faculty. Application exercises will focus on 1) identifying methods for solving real-world challenges in understanding patient work and 2) translating the information into concrete design elements for CHI tools within an expanded User-Centered Design process.

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

  • Articulate the value of understanding patient and caregiver activities outside the institutional setting for the purpose of CHI design.
  • Describe two rich approaches to the analysis of patient work.
  • Apply two patient work analysis approaches to CHI application design.

Saturday, November 15, 8:30 a.m. – 4:30 p.m.

T02: Workshop on Visual Analytics in Healthcare

Content Level: Basic 50%, Intermediate 25%, Advanced 25%
Intended Audience: Individuals interested in the analysis, exploration, and understanding of complex clinical datasets, ranging from single patients to large multi-million patient populations. Others who would be interested in this workshop include vendors, clinicians and others responsible for maintaining clinical decision support systems and developing business intelligence tools to measure outcome.

Jesus Caban, NICoE, Walter Reed National Military Medical Center; David Gotz, University of North Carolina at Chapel Hill; Hadi Kharrazi, Johns Hopkins Bloomberg School of Public Health; Adam Perer, IBM Research

As medical organizations move to electronic medical records and increasingly embrace health information technology (HIT), the amount of data available to clinicians is growing 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. The same issues of scale and complexity make it challenging for those performing exploratory analysis with large populations of observational data when conducting comparative effectiveness or outcomes research.

Visualization and visual analytics show great potential as methods to help users overcome this challenge. These highly interactive, visual methods can help domain experts explore, filter, analyze, and communicate the large and diverse data found in the modern clinical environment. For example, (a) physicians and clinical practitioners are today faced with the challenging task of analyzing large amounts 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 a broad range clinical values and their own patient-generated health data to uncover insights relevant to managing their health and wellness; and (c) healthcare and public health organizations are faced with the problem of understanding the nature of disease in broad populations, and improving overall operational performance while still maintaining the quality of patient care and safety.

Visualization and visual analytics has the potential to provide great benefits to each of these three core constituencies: providers, patients, and those studying populations of patients. However, to be successful, visualization-based methods must be developed to align with the unique demands of the healthcare system.

Despite the continuous use of scientific visualization and visual analytics in medical applications, there remains a general lack of communication between visualization technologists and those with clinical expertise. This limited collaboration has meant that only basic visualization techniques are commonly employed in clinical practice. To bridge this gap, the authors of this proposal have organized and chaired the Workshop on Visual Analytics in Healthcare (VAHC) annually since 2000. For the first three years (2000-2012), VAHC was hosted by the IEEE Visualization Conference. In 2013, VAHC was hosted by AMIA for the first time, resulting in a successful and well-attended workshop. See for more information about previous events including online proceedings. As a direct result of last year’s large and enthusiastic workshop at AMIA, we have worked with the editors at JAMIA to develop a special issue on the topic of Visual Analytics in Healthcare, which will be published online just prior to the 2014 AMIA Symposium. In addition, we have developed a large online mailing list to foster year round communication between technologists and clinicians with respect to this important topic.

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

  • Design improved visual representations of clinical data to improve data comprehension.
  • Formulate goals for adopting visualization and visual analytics technologies to solve challenges in a variety of health-related functions
  • Evaluate visualization-based systems in a broader context of state-of-the art methods and technologies.

T03 - AMIA CMIO Workshop

Content Level: 20% basic, 40% intermediate, 40% advanced
Fee: $60 for lunch
Intended Audience: New CMIO seeking new skills; established CMIO seeking to develop new skills and build knowledge; individuals aspiring to serve as CMIOs who understand the position and its challenges; healthcare leaders looking to understand how to best position CMIOs for organizational success

Paul Fu, Jr., Harbor-UCLA Medical Center; Julie Hollberg, Emory Healthcare; Joseph Kannry, Mount Sinai Medical Center; Richard Schreiber, Holy Spirit Hospital

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 (CMIOs), who are charged with leading informatics change within their organizations. 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 goal of the 2014 workshop is to introduce CMIOs, and others who have similar roles (such as Medical Directors for Information Systems), to evidence-based informatics principles that they can integrate into their daily workflow and help their organizations realize the potential benefits of health IT. All topics are new or have been refreshed from previous years’ curricula in order to provide an opportunity for repeat attendees to benefit from this activity.

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

  • Describe specific informatics best practices, tools, and techniques that are relevant to the CMIO
  • Identify how these best practices, tools, and techniques can be applied within the participant’s organization
  • Identify which CMIO career track is most applicable to the participant
  • Describe how AMIA can support the continuing education needs of the applied clinical informatics

WG02: Medical Informatics and Decision Support Systems in Intensive Care

Presented by Intensive Care Informatics Working Group

Content Level: 50% basic, 50% intermediate
Intended Audience: clinicians, students

Vitaly Herasevich, Mayo Clinic; Peter Haug, University of Utah/Intermountain Healthcare; James Fackler, Johns Hopkins University School of Medicine; John Zaleski, Nuvon, Inc.; Brian Pickering, Mayo Clinic; Kathryn Kuttler, Intermountain Healthcare; Saif Khairat, University of Minnesota; Vernon Smith, Mayo Clinic; James Blum, University of Michigan Medical Center; Nicolas Chbat, Philips Research North America

The focus of this activity is the research and development of technology which facilitates safe and effective patient care in the emergency department (ED), intensive care unit (ICU), and the operating room (OR).

Pre-symposium Outline

  • 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 and clinical communication for patient safety
  • Date 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 be able to:

Understand concepts of clinical informatics in Emergency Room (ER), Intensive Care Unit (ICU) and Operation Room (OR)

WG03: Data Analytics in Patient-centered Care

Presented by Nursing Informatics Working Group

Content Level: 80% intermediate, 20% advanced
Intended Audience: nurses, nursing students, clinicians

Denise Goldsmith, Brigham and Women’s Hospital; Patricia Abbott, University of Michigan; Suzanne Bakken, Columbia University; Holly Jimison, Northeastern University; Sally Okun, PatientsLikeMe; Bonnie Westra, University of Minnesota School of Nursing; Sunnmoo Yoon, Columbia University

The promise of big data is its potential to move healthcare forward towards authentic data-driven, personalized care. While big data and the analytics that underpin it have transformed entire industries, healthcare has been slow to derive maximum value from the full spectrum of data generated in health and healthcare. A quickly emerging area of focus is related to the increasingly large data streams that are flowing from home monitoring interventions, sensor technologies, mobile phones, and social networking sites. This pre-symposium will engage transdisciplinary practitioners and researchers who would like to interact with, and learn from, some of the top leaders and educators who work with big data from the technologies mentioned above. Our goal in assembling this group of experts is to not only provide a deeper understanding of the need for skilled individuals, but to also share methods, techniques and experiences with our audience.

We have gathered together an impressive panel of experts who work with big data that generates from continuous monitoring of physiologic and behavioral measures outside of a formal acute care setting, social networking interactions, and in the emerging area of the “quantified self”. This topic is important and timely. As the movement towards the quantified self, aging in place & home monitoring, and ubiquitous cellular connectivity continues to increase, our current capacity to analyze, manage and interpret data will be overwhelmed. As the provision of health services moves out of the acute care facility and into home or transitional care settings, patients, their families and health care providers need to understand the complexity of information that may be produced from new forms of information streaming.

Our goal in this pre-symposium is to create a basis of understanding of the general concepts of big data from continuous monitoring, the feedback loops that include the patient (and their families) as a central player, to give participants a grasp of some of the more common techniques being used to analyze such data and give students the opportunity to interact with one another and learn from experts in this domain.

Topics to be covered:

  • Significance – why the topic is important to the future of health care, opportunities for expansion/uptake, the need for transdisciplinary teams, and the importance of leadership
  • Foundational/Introduction to the science, aspects of continuous monitoring approaches and the data that emerges, promises and pitfalls, current methods, and future needs
  • Presentation of real-world approaches, how done, results, and the data magnitude and character
  • Analytics – including visualization approaches, social network analysis, knowledge discovery, etc.
  • Focusing on the patient as a data source – research at PatientsLikeMe
  • Data mining to understand improvement in mobility for home care patients
  • Hands on interaction and group work

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

  • Describe the relevance, importance and policy implications of the “Quantified Self” movement
  • and the importance of the data streams that flow from it
  • Express a foundational understanding of the concepts of self-monitoring/self-sensing
  • Explain how data is captured and manipulated from a wide variety of patient focused devices, monitors, and networks
  • Examine how data streams from continuous monitoring can be used to improve outcomes
  • Suggest solutions to improve the use of tools that will encourage and enable patients to more fully engage in their own or their family’s health
  • Relate how patients’ contributions to large data collections can contribute to healthcare quality improvement
  • Demonstrate the Open Research Exchange PRO development platform.
  • Critique the application of current tools to facilitate mining and visualization of Big Data.
  • Relay the challenges of standards, data storage, and manipulation from these types of data streams

Participants are strongly encouraged to bring a web-enabled laptop or tablet.

WG04: Pharmacy TIGER Initiative ­ Core Competencies in Informatics for Pharmacists

Presented by Pharmacoinformatics Working Group

Content Level: TBD
Intended Audience: Pharmacists, educators and training program directors, leaders of pharmacy organizations, deans and department chairs of pharmacy schools, recruiters, clinical informaticians, nursing informatics educators.

Joan Kapusnik-Uner, PharmD, FASHP, FCSHP Director, Clinical Editorial, FDB; John Poikonen, University of Massachusetts; Terry Seaton, St. Louis College of Pharmacy; Sharon Murphy Enright, EnvisionChange LLC

Core informatics competencies are essential for all health professions. Medicine through board certification and Nursing through the T.I.G.E.R Initiative plans have clearly articulated and executed their respective informatics core competencies for their professions. Pharmacy lags behind. This active learning workshop will build on the work of medicine and nursing to build a consensus of the core informatics competencies of pharmacists. A consensus will be developed and plans for further dissemination and implementation for the pharmacy informatics core competencies will be developed.

Pre-symposium Outline:

  • Experience to date with knowledge, skillset and education of informatics with pharmacists
  • Description of other health professionals informatics competency programs
  • Similarities and difference of pharmacists informatics and other health professional competency
  • Current state of pharmacy informatics
  • Future state of pharmacy informatics
  • Gaps in the pathways to get to future state of pharmacy informatics
  • Dissemination and implementation plans for pharmacy informatics competencies

At the end of the pre-symposium, the learner will be able to:

  • Publish a report on the findings of the consensus of informatics competencies for pharmacists
  • Report findings to the Accreditation Council for Pharmacy Education (ACPE) for consideration in their 2016 Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree
  • Establish consensus guidelines for colleges of pharmacy and professional organizations to follow as they integrate informatics knowledge, skills and education into curricula, training and practice settings.
  • Set an agenda whereby the pharmacy organizations specify what they plan to do to bridge the quality chasm with informatics.
  • Establish a method to build on this session to construct a toolkit for dispersed learning, building on a learning culture and essential skills for enhanced informatics competency.

WG05: Data Mining for Medical Informatics (DMMI) – Electronic Phenotyping

Presented by Knowledge Discovery and Data Mining Working Group

Content Level: 30% basic, 40% intermediate, 30% advance
Intended Audience: TBD

Fei Wang, IBM T. J. Watson Research Center; Gregor Stiglic, University of Maribor; Niels Peeks, University of Amsterdam; Nigam Shah, Stanford University

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. Under this context, data mining techniques, with the goal of knowledge discovery and deriving data driven insights from various data sources, has played a more and more important role in medical informatics. Effective data mining approaches have been applied in many medical problems including drug development, personalized medicine, disease modeling, cohort study, comparative effectiveness research, etc. The main theme of the workshop this year is electronic phenotyping, which aims to identify the set of people for further study.

Pre-symposium Outline:

  • Discuss different data mining techniques for electronic phenotyping
  • Text mining – mining free text in electronic medical records
  • Visual analytics for high throughput phenotype discovery
  • Novel architectures for facilitating high-throughput electronic phenotyping
  • Cost-benefit analyses of electronic phenotype identification
  • Data quality assessment and improvement
  • Pattern detection and hypothesis generation from observational data
  • Privacy and security issues in healthcare
  • Information fusion and knowledge transfer in healthcare
  • Evolutionary and longitudinal patient and disease models
  • Evaluation and validation of electronic phenotypes

WG06: Current and Emerging Issues for Population Health Informatics in Healthcare and Public Health

Presented by Public Health Informatics Working Group

Content Level: 20% basic, 30% intermediate, 50% advance
Intended Audience: public health practitioners from the state, local, and clinical care levels; healthcare informatics professionals who are interested in population health practice, research and outcomes.

Hadi Kharrazi, Johns Hopkins School of Medicine; John Loonsk, CGI Federal; Barbara Massoudi, RTI International

Webcast Option

WG06 is also available via a webcast. Webcast registration is $75. In Webcast format, this Pre-symposia is not eligible for CME/CEs.
To attend the WG-06 Pre-symposia Webcast: Register online

Advancing population health outcomes is of prime interest to many informaticians both in healthcare and public health. 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 support for population health workers; the viability of two way communication between public health and healthcare; and other emerging topics.

Outline of Topics:

  • Information Exchange for Monitoring and Care Coordination ‐ Clinical Care to/from Health Departments
  • Public Health Informatics versus Population Health Informatics
  • Investigate Cross‐disciplinary Approaches
  • Public and Population Health Workforce Training Issues
  • Best Practices for Health Registries
  • Balancing Personal and Population Privacy Needs
  • Health Departments and HITECH/ACA
  • Long Term Objectives for Working Population Issues
  • Human Resource Development

WG07: Doctoral Consortium and a Workshop on Interoperability of Clinical NLP Systems

Presented by Natural Language Processing Working Group

Content Level: 20% basic, 60% intermediate, 20% advance
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.

Hua Xu, The University of Texas Health Science Center; Stephane Meystre, University of Utah; Hongfang Liu, Mayo Clinic, Rochester; Wendy Chapman, University of Utah; Joshua Denny, Vanderbilt University; Peter Haug, University of Utah/Intermountain Healthcare; Jon Patrick, Health Language Analytics; Guergana Savova, Ozlem Uzuner, University at Albany, SUNY

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 continues the tradition since its inception in 2011 to provide 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, the focus is interoperability of clinical NLP systems.

At the end of the pre-symposium, the learner will be able to:

  • Obtain knowledge on current standards on building interoperable clinical NLP systems
  • Understand essential issues for developing interoperable clinical NLP systems
  • Discuss possible standards for data formats in clinical NLP systems

Workshop on Interactive Systems in Healthcare (WISH) 2014
(not eligible for CME/CE)

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 the quality, safety, efficiency, and effectiveness of health care in America. Given the recent emphasis on health information technology (HIT) solutions as part of the ongoing efforts towards healthcare reform and in conjunction with the American Recovery and Reinvestment Act of 2009, these issues are timely and of utmost priority to be addressed. HIT and interactive health care systems have the potential for supporting a wide variety of stakeholders, from patients to providers, individuals to institutions, and policymakers at all levels — both corporate and governmental. However, biomedical informatics, human-computer interaction (HCI), and other research areas related to HIT are often confined in their disciplinary silos making significant trans-disciplinary progress challenging. Discussions at highly specialized conferences, or tracks within conferences, can become deep but disjointed: investigating particular issues in detail but sometimes missing the meta-context and issues from other relevant disciplines represented by specific presentations and conferences. For more information, please visit

Saturday, November 15, 1:00 p.m. – 4:30 p.m.

T04: Imaging Informatics: Foundations and Clinical Applications

Content Level: 60% basic, 20% intermediate, 20% advance
Intended Audience: This tutorial is directed broadly to those in the informatics community, including scientists; researchers; physicians, nurses, and other healthcare professionals; educators, computer scientists, system developers, leaders in healthcare or other organizations, researchers, policy makers, IT professionals, and programmers who work with or are interested in learning about using medical images in their work.

Daniel Rubin, Stanford University

Medical imaging is a vital component of healthcare, providing information about disease phenotype. However, only a fraction of the rich biomedical content in images is utilized in research and clinical practice, since images are complex unstructured data, and informatics methods to extract and manage their semantic and quantitative content are only recently being developed. The proliferation of imaging provides enormous opportunities in the Big Data era, which will accelerate discovery and help to improve patient care. Specifically, researchers and clinicians are trying to relate phenotype information in images to molecular and clinical characterizations of disease on large scale in order to use non-invasive imaging for diagnosis and assessment of treatment response.

The core imaging informatics topics of semantic annotation of images, integrating images with molecular and clinical data, image mining, content based image retrieval, and image-based decision support, are becoming crucial themes to advance medical practice and biomedical discovery; however, these topics are not commonly reviewed in tutorials. Reviewing and pointing out opportunities for using these imaging informatics methods and applications will ultimately improve our ability to diagnose disease, enable tailoring the optimum treatment to each patient, permit automated tracking disease response, and enable predicting clinical outcomes.

Outline of topics:

  • Introduction and motivation
  • Foundation and application
  • Applications
  • Future directions

By the end of this tutorial, the learner will be able to:

  • Obtain an overview of the key methodologies and overview of some key applications of biomedical imaging informatics
  • Recognize the generalizability of imaging informatics methods to other imaging domains such as pathology as well as to the biomedical informatics field in general
  • Develop a deeper understanding of the exciting developments driving the imaging informatics field
  • Understand the use of informatics methods to images, the new algorithms/techniques, and the forthcoming applications that will enable discovery in research and improvement in healthcare quality

T05: Fundamentals of EHR Usability

Content Level: 75% basic, 20% intermediate, 5% advance
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

Amy Franklin, University of Texas School of Biomedical Informatics at Houston; Muhammad Walji, University of Texas School of Biomedical Informatics at Houston/ University of Texas School of Dentistry at Houston; Jiaije Zhang, University of Texas School of Biomedical Informatics 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 should 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.

Outline of topics:

  • Role of usability in meaningful use and safety enhanced design in EHRs
  • Fundamental principles of usability and human-centered computing
  • Usability Methods
  • Integration of usability techniques into the development lifecycle

By the end of the 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.

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

T06: Clinical Decision Support: A Practical Guide to Developing Your Program to Improve Outcomes

Content Level: 60% basic, 40% intermediate
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.

Robert Jenders, Charles R Drew University/University of California; Jerome Osheroff, TMIT Consulting, LLC/ and University of Pennsylvania; Jonathan Teich, Elsevier Health Sciences/Harvard University; Dean Sittig, Robert Murphy, University of Texas Health Science Center at Houston

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; and special considerations for CDS for small clinical practices, for hospitals and health systems and for vendors. 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.

Outline of Topics:

  • Developing effective governance structures, stakeholder engagement and other key requirements for implementing a CDS program
  • Formulating and refining CDS goals and strategies
  • Selecting the optimal types of CDS interventions based on your issues, goals and culture
  • Configuring CDS interventions to maximize benefit, including essential elements of interventions and use of the "CDS Five Rights"
  • Best practices in implementing, measuring and monitoring 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

By the end 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.
  • Understand the importance and details of knowledge management for maintaining CDS interventions.

T07: Introduction to Biomedical Informatics

Content Level: 100% basic
Intended Audience: First time symposium attendees, Health IT decision makers, Healthcare leaders

Joseph Hales, University of Utah, and Christopher 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, release of by the Office of the National Coordinator of health IT curriculum material, 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 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.

Outline of topics:

  • Defining the discipline
  • Historical development
  • Key principles
  • Program map – linking principles to symposium content

By the end 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

T08: Developing an i2b2 Cell and Client Plugin

Content Level: 20% basic, 50% intermediate, 30% advanced
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

Michael Mendis, Partners Healthcare Inc., and Shawn N. Murphy, Massachusetts General Hospital

Prerequisites: The participant should download and install the source code of the” i2b2 Tutorial” that is available at prior to arriving at the tutorial. Please have a laptop with a fully charged battery.

Informatics for Integrating Biology and the Bedside (i2b2), 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.

Outline of topics:

  • i2b2 Introduction
  • i2b2 Cell Architecture and overview
  • Technology and application
  • Develop an webclient plugin to test the new cell
  • Roadmap for near term and future i2b2 developments

By the end of this tutorial, the learners 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

T09: Practical Modeling Issues: Representing Coded and Structured Patient Data in EHR Systems

Content Level: 50% intermediate, 50% advance
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.

Stanley Huff, Intermountain Healthcare/University of Utah

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.

Outline of topics:

  • 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

By the end of the tutorial, the learner will be able to:

  • Understand the assumptions and motivation for formal definitions of detailed clinical models
  • Understand how standard coded terminologies are referenced by detailed clinical models
  • Understand the different roles that SNOMED CT and LOINC play in the models
  • Understand the new agreement between LOINC and SNOMED CT

T10: What We See, Say, and Write: Qualitative Data Coding, Grounded Theory, and Other Analytic Approaches for Listservs, Records, and Patient Narratives

Content Level: 100% basic
Intended Audience: clinicians, IT personnel and designers, medical educators, HCI designers, researchers, scientists, and others involved in research or clinical care.

Martha B. Adams, Duke University Medical Center; Bonnie Kaplan, Yale University; Ross Koppel, University of Pennsylvania; Craig Kuziemsky, University of Ottawa, Ottawa; Kourosh Ravvaz, University of Wisconsin

We rely on text, images, and other non-numeric information for professional and personal communication to provide care, conduct handoffs, and communicate in other ways and for other purposes. This qualitative data in patient records, handoffs, listserv exchanges, etc. are valuable for research and patient care. Rigorous and time-tested qualitative methods for analyzing progress and nursing notes, interviews, narratives, observations, images, and videos are especially useful in medicine and informatics. Building on many previous successful AMIA sessions on qualitative methods, we use postings to the American Medical Informatics Association’s (AMIA) Implementation and Optimization Forum to illustrate the power of qualitative methods, and insights that can be developed by using these approaches. We demonstrate how these same techniques can be used for all kinds of non-numeric data, such as clinical narratives, images, even maps. We illustrate coding and analysis for grounded theory, a way of preserving context and flavor of the original textual material while rigorously deriving significant and relevant themes from that data. Participants who bring their laptops will engage in hands-on exercises to learn key concepts of qualitative research and data analysis.

Outline of topics:

  • Examples of prevalence and usefulness of qualitative data in clinical care and research
  • Utility of qualitative data, including advantages and challenges
  • Qualitative data analysis methods for medical informatics, especially data coding and grounded theory
  • Using ATLAS.ti or other software for qualitative data analysis including coding and an overview of other ATLAS.ti capabilities, e.g. Google maps, network analysis, content analysis, graphical displays
  • Analyzing AMIA listserv postings and other qualitative data, such as progress notes and patient narratives and images
  • Developing theory from data using grounded theory
  • Transitioning from quantitative to qualitative approaches
  • Ethical considerations, such as informed participants’ consent
  • Rigor and advice for publishing qualitative research

By the end of this tutorial, the learner will be able to:

  • Understand many uses of qualitative data
  • Describe key concepts in qualitative data analysis
  • Recognize clinically and theoretically useful materials generated from data such as natural language in EHRs, PHRs, listserv postings, maps, and images
  • Use qualitative data anlysis software to code data from, e.g., listservs, patient narratives, handoffs, etc.

WG08: Drug Terminology Standards: Meaningful Use and Better Knowledge

Presented by Knowledge Representation and Semantics and Clinical Information Systems Working Groups

Content Level: 90% intermediate, 10% advance
Intended Audience: Informatics professionals from all areas of practice (leaders in healthcare, healthcare informaticians and IT professionals, vendors, clinicians, researchers, and educators)

Tomasz Adamusiak, Medical College of Wisconsin; Kin Wah Fung, National Library of Medicine; Joseph Kannry, Mount Sinai Medical Center; John Poikonen, University of Massachusetts Lowell; George Robinson, First Databank, Inc.; Li Zhou, Brigham and Women’s Hospital/Harvard Medical School

An overriding goal of Meaningful Use is better health through better health information. There are many differences in the way medication ordering, prescribing, dispensing, and administrating are conceptualized by physicians, nurses, pharmacists, hospital administration, and insurance companies. Even when communication occurs, knowledge is not always shared because sender and receiver attach different meanings to the same message. This tutorial looks at the different stages of drug representation across a typical clinical workflow and in the context of Meaningful Use requirements. We have gathered together an impressive panel of experts in the field of knowledge representation and clinical information systems. 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 improves healthcare delivery. Our expert presenters will review the current state of the art and expected future developments. This topic is significant and timely for several reasons especially as Meaningful Use enters a penalty phase in 2015.

Outline of topics:

  • Drug information and Meaningful Use
  • Drug information and Clinical Decision Support
  • Breakout groups

By the end of this pre-symposium, the learner will be able to:

  • Describe drug terminology standards used in clinical information systems.
  • Discuss drug-related Meaningful Use requirements.
  • Identify shortcomings of current state drug representation for representing patient information and building Clinical Decision Support rules and logic.
  • Suggest solutions to improve the design of clinical information systems that will result in more efficient healthcare delivery in accordance with Meaningful Use.

WG09: Moving From Fragmentation and Duplication to Coordination, Continuity, and Sustainability

Presented by Global Health Informatics Working Group

Content Level: 50% basic, 50% intermediate
Intended Audience: TBD

Heather Cole-Lewis, ICF International/Columbia University; Onyinyechi Enyia Daniel, University of Illinois at Chicago; Patricia Mechael, mHealth Alliance/Columbia University; Janise Richards, Centers for Disease Control and Prevention; Olivia Velez, ICF International/Columbia University

Widespread adoption of technology and increased availability of high-speed networks across low- and middle-income countries (LMICs) is making it possible to provide health services and collect health data in ways that were not previously conceivable. Whether providing health behavior information to pregnant women in rural Bangladesh via text messages, integrating electronic medical records with community collected data in Kenya, or improving data collection speed and accuracy for ministry of health decision-making in Bolivia, global health informatics (GHI) plays an important role in quality improvement and health systems strengthening in LMICs. However, developing, implementing, and sustaining appropriate informatics solutions for LMICs includes many challenges: siloed funding streams; low standards adoption; lack of capacity to support long-term sustainability; limited resources and weak healthcare systems; and poor infrastructure. This pre-symposium will cover three areas: (1) the current state of GHI; (2) challenges and barriers resulting in fragmentation and duplication of GHI projects; (3) solutions and recommendations for increasing partnership, integration, sustainability, and collaboration. Through a case-study and open discussion participants will collaborate on recommendations for improving coordination, continuity, and sustainability of global health informatics projects.

Outline of topics:

  • An overview of the working group and the field of GHI
  • An overview of the current state of GHI
  • A presentation on pilotitis and challenges to scaling GHI in LMICs
  • A case-study and discussion on developing, implementing, and using informatics in LMICs

By the end of this pre-symposium, the learner will be able to:

  • Define "pilotitis"
  • Describe at least two examples of challenges in implementing information technology to support the delivery of health services in LMICs
  • Describe at least two examples of informatics driven solution deployed in health service delivery in LMICs
  • Explain the importance of coordinated implementations of health services-related information technology in LMICs