• Nov. 14-18, San Francisco

    AMIA 2015 Annual Symposium

AMIA 2015 Tutorials & Working Group PreSymposia

Individual session registration is required for each tutorial or working group pre-symposia you wish to attend. Please select only one session per time slot. Seats are limited.

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

Saturday, November 14, 8:30 a.m. – 12:00 p.m.

FULL T01: Health Information Exchange: Challenges and Methods

W. Sujansky, Sujansky & Associates, LLC

Health information exchange (HIE), the electronic sharing of patient data among disparate health care enterprises, is recognized as a critical component in realizing the full value of EHRs and the “meaningful use” of clinical information systems. The recent growth of accountable care organizations (ACOs) and value-based reimbursement programs has also created business drivers for the electronic sharing of health information. Despite such incentives, however, HIE has rarely been achieved for a host of technical, legal, business, and policy reasons. This tutorial explores the practical challenges of HIE and the specific informatics solutions that exist or are under development to address these challenges.

The tutorial provides background on the structure of the U.S. health care system, how this structure can impede the electronic sharing of health information, and what benefits would accrue for patient care, public health, and medical cost containment in overcoming these impediments. The discussion then covers several different technical architectures that have been developed for exchanging health information, including direct peer-to-peer communications (e.g., DIRECT messaging), brokered data retrieval across federated information sources (e.g., RHIOs and HIEs), and centrally managed data repositories (e.g., registries); it also addresses the different operational models for sharing information, such as sender-initiated (“push”) data transmissions and receiver-initiated (“pull”) data queries. The advantages, limitations, and challenges of these various architectures and models are explored.

The tutorial then explores a number of specific informatics techniques for addressing certain of the most important challenges to health information exchange, including the establishment of effective interoperability standards, the assurance of private and secure data transmissions, the reliable matching of patients to their data across enterprises, and the anonymization/pseudonymization of data to protect patient privacy. The tutorial concludes with a survey of contemporary initiatives at the national and local levels for applying these techniques to achieve real-world health information exchange.


FULL T02: A Problem Well Stated is Half Solved: A Case-Based Tutorial About Approaching Evaluation and Technical Assistance Projects Through Informatics Problem-Solving

H. Tolentino, L. Franzke, S. Papagari Sangareddy, Centers for Disease Control and Prevention; C. Pepper, Texas A&M University

Problem solving is considered an important cognitive activity in everyday personal and professional life. Development of problem-solving expertise is achieved by deliberate practice designed to master critical skills with repetition, feedback, and reflection. In public health informatics (PHI), a unified problem-solving framework can increase the effectiveness by which defined problems and provided solutions are shared and communicated among diverse stakeholders in a multidisciplinary and boundary-spanning informatics practice community. Workshop participants will work in teams on real, technical assistance and informatics evaluation case studies to learn how to apply concepts, tools, and methods of a PHI problem-solving framework. This workshop is open to PHI students, educators, and practitioners who want to learn more about tools and methods used for informatics problem solving.


FULL WG01: Biomedical and Health Informatics Curricula: Development of Recommendations for Evaluation Courses (Sponsored by the AMIA Evaluation, People and Organizational Issues, and Education Working Groups, and the EFMI and IMIA Working Groups on Evaluation)

C. Craven, University of Missouri; E. Eisenstein, Duke University; S. Khairat, University of North Carolina - Chapel Hill ; F. Magrabi, Macquarie University; C. Weir, University of Utah

To guarantee that health IT evaluation studies, of systems and all related socio-technical aspects, are conducted in accordance with robust standards, well-trained health informatics evaluation experts are needed. In this pre-symposium, we will work on recommendations for content of informatics evaluation courses. In particular, participants will first get an overview on first recommendations developed during earlier joint workshops in this series, at MIE 2014, MIE 2015, and MEDINFO 2015, and will then work in smaller groups to refine these recommendations.


FULL WG02: Clinical Data and Patient-Powered Research Networks (sponsored by the Clinical Research Informatics Working Group)

A. Solomonides, NorthShore University HealthSystem

In December 2013, the Patient-Centered Outcomes Research Institute (PCORI) approved $93.5 million to support 29 clinical research data networks that have been brought together to form a new national resource known as PCORnet, the National Patient-Centered Clinical Research Network. PCORnet is a large, highly representative, national network for conducting clinical outcomes research. PCORnet is integrating data from 11 Clinical Data Research Networks (CDRNs) -- networks that originate in healthcare systems such as hospitals, health plans, or practice-based networks and securely collect "real-time," "real-world" health information during the routine course of patient care – and 18 Patient-Powered Research Networks (PPRNs) -- networks operated and governed by groups of patients and their partners who are focused on a particular condition and interested in sharing health information and participating in research. The first phase of funding was completed in September 2015 and a number of CDRNs and PPRNs are now continuing the work into Phase II. CRI-WG will recognize the immense work already done in, and further potential of, PCORnet by inviting all groups to contribute to a pre-symposium to discuss their unique contributions and successes, the common problems they have encountered and their goals in Phase II.


Saturday, November 14, 8:30 a.m. – 4:30 p.m.

FULL T03: An introduction to Natural Language Processing Methods in Clinical Research

S. DuVall, P. Alba, O. Patterson, VA Salt Lake City Health Care System, University of Utah

As the use of natural language processing (NLP) methods in preparing data for research continues to increase, researchers should understand the benefits and limitations of such a tool. While NLP is not a “solved” science, there are many tasks that NLP can do reliably. Extracting concepts (symptoms, diseases, medications) and values (lab values, vital signs) that are stored in the text is one example. More complex tasks, such as determining what caused an event of interest or why a patient discontinued a medication can also be addressed using the right tools. This tutorial will provide attendees with a general overview of NLP tools and methods used in health research and patient care. Participants will be introduced to NLP, the types of problems that can be addressed with NLP, and how to effectively plan and execute an NLP task using patient medical records. Synthetic clinical notes will be provided along with open-source tools that will allow participants to implement a working NLP system. The eHOST annotation application, Unstructured Information Management Architecture Asynchronous Scaleout (UIMA AS)1, the Leo NLP libraries2,3, tools developed and used in the Department of Veterans Affairs (VA) and built on existing community standards, will be introduced and used to illustrate the complete life cycle of an NLP project, from design to human annotation / chart review to NLP system creation to evaluation. The tutorial will be presented by three instructors involved in the design and development of these NLP tools who have completed more than 100 NLP tasks in the VA and other health care institutions. Attendees will experience the process of completing an NLP task and leave the tutorial with concrete examples of how NLP can be used at their institutions to benefit research studies or patient care.


FULL T04: AMIA 2015 CMIO Workshop

Fee for Lunch - $60

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

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) and those in similar roles (such as Medical Directors for Information Systems), who are charged with leading informatics change within their organizations, both large and small. 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. More than 150 individuals have attended the CMIO Workshop since its inception in 2011, more than 50 individuals participating in 2014, ranging from seasoned CMIOs of large systems to those who are just beginning their applied clinical informatics career. The goal of the 2015 CMIO Workshop is to focus on the introduction of new topics that will attract repeat attendees, while providing up-to-date content for those who are exploring or new to the field.


FULL WG03: Tools and Resources Demonstration and ‘Connectathon’ (Sponsored by Natural Language Processing Working Group)

S. Meystre, University of Utah; H. Liu, Mayo Clinic; K. Cohen, University of Colorado School of Medicine; J. Denny, Vanderbilt University; P. Haug, Intermountain Healthcare, University of Utah; J. Patrick, Health Language Analytics; G. Savova, Harvard Medical School, Boston Children’s Hospital; O. Uzuner, University at Albany, SUNY; H. Xu, University of Texas Health Science Center at Houston

The application of Natural Language Processing (NLP) methods and resources to clinical and biomedical text has received increased attention over the past years, but progress has been limited by difficulties to access shared tools and resources, difficulties partly caused by clinical data confidentiality requirements. Efforts to increase sharing and interoperability of the few existing resources are needed to facilitate the progress observed in the general NLP domain. To answer this need, the AMIA NLP working group pre-symposium continues the tradition since its inception in 2012 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) the presentation and demonstration of existing NLP tools and resources, where their authors or experts explain and show the functioning of these NLP tools or resources; and 2) a ‘connectathon’ of NLP tools, where authors will prepare their tool as a module in a standardized NLP pipeline assembled on-site to realize pre-defined typical clinical and biomedical NLP tasks.


FULL WG04: Linking Biomedical Imaging and Clinical Data: Challenges and Opportunities (Sponsored by the Biomedical Imaging Informatics Working Group)

V. Pai, National Institute of Biomedical Imaging and Bioengineering; J. Saltz, Stony Brook University; D. Rubin, Stanford University; Y. DeBois, Northwestern University; A. Sharma, Emory University; W. Hsu, UCLA

Biomedical imaging plays a vital role in patient care, spanning the scale from microscopic and molecular to whole body visualization, and encompassing many areas of medicine, such as radiology, pathology, dermatology, and ophthalmology. Biomedical imaging informatics is a discipline that focuses on improving patient outcomes through the effective use of images and imaging-derived information in research and clinical care. The objective of this pre-symposium is to assemble an interdisciplinary group of experts to share methods and experiences in biomedical imaging informatics with the goal of generalizing this knowledge to other imaging domains and the broader informatics community. This year’s overarching theme focuses on the opportunities and challenges of bridging phenotypic information from images with clinical and molecular characterizations of a disease to improve decision support. The event will touch upon topics such as extracting and retrieving semantic content from large imaging archives, utilizing imaging features as part of electronic health record-based phenotyping, applying machine learning to discover uncover correlations between images and other biological scales, characterizing the significance of evolutionary features derived from images, and translating multi-scale disease models into practice. These topics synergize tightly with the broader informatics interests of the AMIA attendees and will raise their awareness of the opportunities and relevance of imaging informatics research to other biomedical informatics activities.


FULL WG05: Evaluation Methods and Frameworks for Measuring Effectiveness and Impact of eHealth Systems Implementations in Low Resource Environments (Sponsored by the Global Health Informatics Working Group)

J. Richards, CDC; H. Fraser, University of Leeds, Harvard Medical School; J. Talmon, Maastricht University

Evaluation of eHealth projects is necessary to understand the impact of electronic health information systems on health outcomes. Currently there is a shortage of well-designed and implemented evaluations in the published literature. The aim of this Global Health Informatics Working Group (GHIWG) Pre-symposium is to provide participants with an opportunity to participate in the development of an eHealth Evaluation Framework and to gain knowledge and skills to critique evaluation designs, recognize potential barriers, and select suitable evaluation methodologies to ensure meaningful and generalizable results that will assist in building the needed evidence-base. Building on the activities of the eHealth evaluation tutorial, this pre-symposium workshop is divided into two sections. This GHIWG Pre-symposium first concentrates on describing a draft eHealth evaluation framework and fundamental principles of eHealth evaluation. Within this section the participant will learn about the components of eHealth evaluation, evaluation methods, and evaluation environments, and will be involved in the review of the draft framework. During the second section, the GHIWG Pre-symposium focuses on the existing evidence base on eHealth in resource poor environments and how to select suitable evaluation designs, and plan and implement evaluations. Participants will work in small groups to critique and redesign evaluation studies and are encouraged to bring a current evaluation project for the discussion. The faculty has over 50 years of combined experience of informatics and evaluation. eHealth in resource poor environments and how to select suitable evaluation designs, and plan and implement evaluations. Participants will work in small groups to critique and redesign evaluation studies and are encouraged to bring a current evaluation project for the discussion. The faculty has over 50 years of combined experience of informatics and evaluation.


FULL WG06: Data Mining for Medical Informatics (DMMI) – Predictive Analytics (Sponsored by the Knowledge Discovery and Data Mining Working Group)

F. Wang, University of Connecticut; G. Stiglic, University of Maribor; N. Peek, University of Manchester; N. Shah, Stanford University ; A. Perer, IBM

Advances in digital imaging, growth of clinical data warehouses, increased role of analytics in managing patient care, and the increasing use of genome sequencing in the clinic increasingly require the use of data mining techniques in medical informatics. Data Mining for Medical Informatics (DMMI) is a series of workshops that focus on the use of data mining techniques to address current challenges in health informatics. The main theme of the workshop this year is predictive analytics. We will focus on methods for predicting clinical outcomes under uncertainty, including risk assessment, diagnosis, prognosis and treatment effects. Predictive Analytics has received a lot of interest recently and we would like to invite researchers from both academia and industry to participate in this workshop, share their experiences, as well as discuss future research directions.


FULL WG07: Transdisciplinary “Maker Health” Faire (Sponsored by the Nursing Informatics Working Group)

Only 40 seats available

P. Abbott, University of Michigan ; J. Gomez-Marques, MIT; P. Brennan, University Wisconsin-Madison; J. Goldman, Partners Health Care; M. Taylor, Intel; M. Topaz, Harvard University; A. Young, MIT; M. QUINN, Intel; T. Rausch, Docboxinc; S. Hull, Well-Spring Consulting

Making is a skill-set and a toolset. It represents the convergence of accessible fabrication technologies, a robust community of user-innovators and a very fast cycle of artifacts and products developed by non-traditional actors that operate with a few degrees of freedom of the demand opportunity. They may be accountants, musicians, patients, lawyers, students, nurses, doctors, engineers and others. In the world of making, they are defined by their tangible output not their formal training. Products and artifacts of Making in the healthcare domain hold immense promise, from creative hacks in developing nations, to empowering patients and families to engage, to contributing to the rapidly expanding Medical Internet of Things (MiOT). However, with creative expansion and empowerment come challenges of connectivity, interoperability and the threat of disconnected “one-off” solutions. Realizing progress in the MiOT will require connectivity and interoperability among a wide array of health IT applications, medical devices, consumer devices, sensors and other devices in healthcare settings and beyond. We will suggest a framework for building the MiOT using the Open ICE (Integrated Clinical Environments) standard while also addressing exchange issues for non-clinical environments such as homes and communities. This full-day tutorial will include a combination of hands-on team based "Making" and thought-provoking presentations.


Saturday, November 14, 1:00 p.m. – 4:30 p.m.

FULL T05: Practical Modeling Issues: Representing Coded and Structured Patient Data in EHR Systems

S. Huff, Intermountain Healthcare, University of Utah School of Medicine

This tutorial describes 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 Databank, 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.


FULL T06: The Art and Science of Writing Items for High Stakes Exams

B. Munger, AMIA; J. Finnell, Indiana University

The emergence of Clinical Informatics certification created a growing need for multiple-choice test items that adhere to national standards for use in high stakes exams. The American Board of Preventive Medicine convened subject matter experts to develop items for the clinical informatics subspecialty certification exam. AMIA established an item writing activity to generate items for a clinical informatics practice exam. Newly accredited clinical informatics fellowship programs will need items to help fellows assess their mastery of the core content for clinical informatics. AMIA’s work towards Advanced Inter-professional Informatics Certification (AIIC) will create additional demand for high quality clinical informatics test items. Maintenance of certification requires that well written multiple-choice questions accompany learning content for credit to be offered. The ability to write items is a skill that will be in high demand as the discipline of clinical informatics matures. It is a skill that will also strengthen informatics education more generally.

A well-established set of rules for writing sound test items exists, yet many individuals who write test questions for use in their educational programs are unfamiliar with these guidelines. The knowledge to be tested for the discipline of clinical informatics differs from that of traditional clinical domains and therefore creates additional challenges for clinical informatics item writers. This tutorial will present guidelines for writing high quality items, offer a recommended approach for writing clinical informatics items, and provide participants with an opportunity to write items that will be shared for discussion. Drawing upon three years of experience in writing clinical informatics items, tutorial faculty will share common pitfalls that have been observed and strategies for effective item writing. After participating in this activity, the individual should be able to create items that comply with guidelines on creating one-best-answer multiple choice questions for high stakes exams and self-assessments.


FULL WG08: Public Health Community Platform: A solution for a modern public health enterprise (Sponsored by the Public Health Informatics Working Group)

M. Rennick, A. Davidson, ASTHO; J. Loonsk, CGI Federal; A. Chi, AIRA; R. Gamache, 2Population Health Informatics Solutions; P. Soper, ASTHO; B. Massoudi, RTI International

This dynamic 3-hour Public Health Informatics Workgroup-sponsored pre-symposium will both educate attendees and solicit their input on a significant and emerging public health informatics initiative: the Public Health Community Platform (PHCP). The panelists will provide attendees with an overview of the PHCP activities and challenges to date, as well as the anticipated future trajectory of the PHCP’s ongoing development. The PHCP is a Centers for Disease Control and Prevention (CDC) funded, Association of State and Territorial Health Officials (ASTHO) led initiative to provide a forum for common information exchange and development of innovative and interoperable systems. This initiative is motivated by the need for state and local public health to have the tools to fully engage in the Learning Health System by efficiently and effectively transforming data into public health action. This engagement requires efforts and investments from across the public health enterprise, including health care. The PHCP recognizes these agencies’ need for user-driven, interoperable applications to access, exchange, visualize, and analyze both internal data and data from trusted partners. The PHCP will allow developers to deploy solutions in a common environment, allowing state and local public health agencies to benefit by reducing development and maintenance costs of these shared solutions. This panel will include: the chairs from three PHCP pilot groups for Analysis and Visualization, Immunizations, and Electronic Case Reporting; a representative from the PHCP Executive Committee; and ASTHO project directors.


FULL WG09: Primary Care and EMRs in the 21st Century – Why Haven’t We Got it Right Yet and How Can We Make it Better? (Sponsored by the Primary Care Informatics Working Group)

S. Morgan, Partners Healthcare Inc.; D. Newman, University of Rochester; W. Sumner, Washington University School of Medicine; M. Kordek, Giesinger Health Systems

With the progression of many intuitions into Meaningful Use, primary care providers are struggling more and more just to keep up with the documentation requirements to meet these new mandates. Often providers bemoan that they have become clerical workers and not health care providers, often spending multiple hours completing documentation requirements during an average workday. EMR vendors have made strides in providing tools for hospitalist care but the daily workflow needs of primary care providers appear to have been lost in the “sea” of complicated features and function. This is often compounded in the care of children, the elderly and patients with special healthcare needs such as technology dependence. As a result providers are frustrated and raise the question if patient care and safety is being compromised buy tools that cannot meet the users needs. This workshop will explore some of these challenges and obstacles and through the discussion compose a “wish list” for the vendor community to work on.


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

FULL T07: Innovations in Standards & Standards Development: Advances in Standards Methodologies & Implementation

C. Jaffe, Health Level 7 International; D. Fridsma, AMIA; S. Huff, Intermountain Health; C. Chute, Johns Hopkins University; J. Halamka, Beth Israel Deaconess Medical Center; W. Hammond, Duke University

The simple unambiguous sharing of healthcare data is insufficient to meet the needs of our delivery systems if we are to improve quality and reduce costs. Traditional standards development processes are too slow and inefficient. Moreover, the means for exchanging data has not facilitated data reuse for a broad range of purposes, including quality evaluation, decision support, clinical research, primary medical science application, public health, and comparative effectiveness. The standards needed to support these goals must rapidly evolve despite an environment constrained by the limited availability of resources, by government regulation and by a rapidly evolving knowledge base. The report of the JASON Task Force provides a clear and achievable path to that goal. Standards developers and the organizations that provide those standards are applying innovative approaches to realizing these goals.


FULL T08: Building Successful Natural Language Processing Applications in Clinical Research and Healthcare Operations

Y. Huang, Kaiser Permanente; H. Xu, The University of Texas Health Science Center at Houston, Houston; J. Denny, Vanderbilt University School of Medicine

Over the last few decades, growing adoption of Electronic Health Record (EHR) systems has made massive clinical data available electronically. However, over 80% of clinical data are unstructured (e.g., narrative clinical documents) and are not directly assessable for computerized clinical applications. Therefore, natural language processing (NLP) technologies, which can unlock information embedded in clinical narratives, have received great attentions in the medical domain. Many NLP methods and systems have been developed in the medical domain. However, it is still challenging for new users to decide which NLP methods or tools to pick for their specific applications. In fact, there is a lack of best practices for building successful NLP applications in the medical domain.

In this 3-hour tutorial, we would like to propose some best practices in using clinical NLP to resolve real-world problems. We will start with an introduction of basic NLP concepts and available tools, and then focus on two important applications of NLP: 1) to extract phenotypic information from EHRs to support clinical research; and 2) to facilitate real-time decision support systems in clinical operations. We plan to use lectures, demonstrations and hands-on exercises to cover the basic knowledge/tools and use case studies to illustrate important trade-offs in the design and implementation of clinical NLP applications. Each of the three instructors has over 10 years of experience in clinical NLP research and application. Case studies will borrow heavily from their experience as a clinician, a researcher and an application developer to share their recommendations in building successful NLP applications in healthcare research and operations.


FULL T09: Aligning Consumer Health Informatics Tools with Patient Work: Strategies for Fieldwork in Home and Community Settings

R. Valdez, University of Virginia; R. Holden, Indiana University; T. Veinot, University of Michigan; L. Novak, Vanderbilt University

This tutorial will introduce participants to the practical challenges of conducting consumer health informatics-related fieldwork in home and community settings and strategies for overcoming these challenges. As health care shifts to the home and community, patients are increasingly becoming active care participants. Consumer health informatics (CHI) tools such as personal health records, online health communities, and remote monitoring systems are being developed to support patients in this role. However, patient use of CHI tools is often suboptimal, and there is mixed evidence regarding intervention effectiveness, efficiency, and patient-centeredness. Thus, while the potential benefits of CHI tools have been demonstrated, it is clear that new design and implementation methods are required. Jimison and colleagues’ review showed that design and implementation approaches facilitating integration of CHI tools into users’ daily routines may lead to more extensive adoption of these technologies. Building on this insight, our tutorial at AMIA 2014 presented two complimentary theoretical frameworks that hold promise for achieving such daily routine integration through simultaneous attention to patient, family members, activity, and context. Application of these frameworks requires fieldwork in home and community settings. The present tutorial responds to participants’ request for further instruction related to the practical challenges and strategies associated with conducting this CHI-related fieldwork. While some of these challenges and strategies overlap with those associated with fieldwork in more controlled health care institutional settings, many are unique to patients’ home and community living environments. Application exercises in this tutorial will focus on 1) identifying challenges related to gaining access to home and community environments, conducting data collection activities in these environments, and translating the data generated into design guidance for CHI tools and 2) selecting strategies to address these challenges that balance the needs of community participants, the needs of the research/design team, and the integrity of the project.


FULL T10: Clinical Decision Support: A Practical Guide to Developing Your Program to Improve Outcomes

R. Jenders, Charles Drew University/UCLA; J. Osheroff, TMIT Consulting, LLC, University of Pennsylvania; J. Teich, Elsevier, Harvard University; D. Sittig, University of Texas Health Science Center at Houston; R. 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.


FULL T11: Patient Engagement and Consumer-facing Health Information Technologies

J. Wald, RTI, Harvard Medical School, Society for Participatory Medicine; D. Sands, Beth Israel Deaconess Medical Center, Harvard Medical School

Consumer-facing technologies used for self-care and condition management by patients and caregivers are promising tools for patient engagement. Innovative use of technologies such as PHRs, patient portals, smartphone applications, SMS texting, and mHealth services are enhancing communication, access to clinical records, use of medical reference information, participation in online communities, and tracking of personal health status. However, many challenges including technology silos, device incompatibility, information gaps, usability challenges, and policy conflicts limit the impact of these technologies for patient engagement.

This half-day tutorial will offer clinicians, system administrators, IT developers, policymakers, and patients (we are all patients, eventually!) insights into how enabling technologies such as patient portals, patient-generated health data, and mobile applications are used to enhance patient engagement. Instructors will present material from both research and practical perspectives, with a particular focus on identifying and addressing the challenges of patient engagement, patient portals, patient-generated health data, and the use of consumer health technologies in order to promote an active and collaborative patient role as part of the care team.

Drawing from over four decades of experience in the patient engagement 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 and researching innovations in consumer health and will examine a broad set of topics including: implementation strategies; clinician adoption; patient adoption; opportunities and limitations of patient engagement; clinician, practice, and patient workflow; and patient-gathered and contributed health observations (patient-generated health data).

In summary, this tutorial will provide an experience-based, practical introduction to consumer-facing health technologies and patient engagement, with particular attention to the clinical challenges of engaging patients through health IT.


FULL WG10: Introduction to Visual Analytics in Healthcare (sponsored by Visual Analytics Working Group)

J. Caban, Walter Reed National Military Medical Center; D. Gotz, University of North Carolina; A. Perer, IBM Research

Big data is changing our world and the way scientific breakthroughs are discovered. As healthcare organizations continue to collect most of their information in digital form, the resulting massive collections are creating many data challenges from (a) clinicians trying to analyze large amounts of unstructured, multi-modal, and longitudinal data to effectively diagnose and monitor the progression of a particular disease; to (b) patients who are confronted with the difficult task of understanding the correlations between clinical values and their own patient-generated health data; to (c) healthcare organizations who 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 techniques have the potential to assist in many of the informatics data challenges by providing intuitive and interactive interfaces to explore, analyze, and compare large collection of structured and structured clinical data. However, to be successful, visualization-based systems must be developed to align with the unique demands of the healthcare system.

This tutorial will introduce the concepts of visual analytics in healthcare by (a) teaching some of the core concepts of data visualization, (b) introducing the basic concepts of visual analytics, (c) demonstrating case studies of how visual analytics can be used to analyze healthcare data, and (d) by providing step-by-step explanations of how to start creating advanced visualization systems and dashboards with commercial and open-source applications. The tutorial will mix instructional material with hands-on exercises.


FULL T12: Using R for Healthcare Data Science

V. Huser, NIH ; L. Wiley, Vanderbilt University

The R statistical programming language provides powerful tools to manipulate data and attracts many non-programmers. R offers a unique package management system and powerful data visualization packages. This tutorial will provide an introduction to the language, R installation (free software) and use of RStudio, a free integrated development environment built for R. In the first part we will cover R solutions for basic challenges facing data scientists like wrangling, cleaning and visualizing data in reproducible ways. We will focus on the most recent R packages, such as dplyr (data manipulation), ggplot2 (publication ready plots), and shiny (interactive web-based reports). In the second part, we will use several case studies (using publically available data from International Warfarin Pharmacogenomics Consortium (IWPC), Drugs@FDA, ClinicalTrials.gov and RxNorm) to demonstrate R in action on biomedical informatics datasets. We will demonstrate how the previously introduced packages for data cleaning and visualization can be applied to a dataset that combines clinical and genomic data and a range of informatics resources. All work will be demonstrated using reproducible reporting tools (e.g., RMarkdown) that combine code and analysis output in a single file (html, docx, or pdf). We will conclude with a summary of latest trends in the R language and comparison of R to other languages commonly used for data science (such as Python, Java, Julia, C or SAS), and a general Q&A section.


FULL T13: Introduction to Biomedical Informatics

J. Hales, Intermountain Healthcare; C. Cimino, Kaplan Test Prep

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 AMIA1), release of by the Office of the National Coordinator of health IT curriculum material2), 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 model3) 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.


FULL T14: Developing Leadership within AMIA: Pathways to Success

S. Labkoff, Labkoff & Associates Healthcare Informatics; P. Payne, The Ohio State University

The field of biomedical and health informatics has experienced accelerated growth, spurred on by multiple factors including the HITECH Act of 2009, the Accountable Care Act of 2010, the growing prominence of clinical and translational research, an increased emphasis on big data and data analytics, advances in genomics, the acceleration of EHR adoption, and a recent emphasis on delivering upon the promise of personalized or precision medicine. As the preeminent professional home for biomedical and health informatics leaders, researchers, educators, and practitioners, AMIA has a central and critical role to play in this dynamic setting. Doing so will require the organization to grow in a variety of ways, relative to both its breadth and depth of programs and initiatives. This type of growth will necessitate the further development of AMIA members who can serve as organizational leaders at all levels. In response to the preceding need, this tutorial will provide participants with a comprehensive and systematic primer on the structure, function, and pathways to success for leadership that define AMIA, illustrated using a series of “real world” examples, and taught by individuals with substantial expertise in the aforementioned areas. The primary goal of doing so will be to create a “pipeline” of AMIA members who can assume important and emergent leadership roles within the organization.