AMIA 2019 Clinical Informatics Conference Panels

9:45 a.m. – 10:45 a.m.

H. Silverman, The University of Arizona College of Medicine - Phoenix; D. Fridsma, AMIA; C. Gadd, Vanderbilt University

In March 2018 the American Medical Informatics Association (AMIA) began separate but coordinated practice analyses of the Clinical Informatics Subspecialty and Health Informatics. Practice analysis involves the delineation of the major content areas/domains of practice and the specific tasks performed by individuals in a profession, as well as the knowledge and skills required to perform the tasks. The conduct of a practice analysis study results in a comprehensive and contemporary profile of practice in a profession.

The results of these practice analyses can be used to:

  • • Articulate clinical informatics tasks/competencies used in practice, as well as prerequisite knowledge and skills

  • • Develop validated examination blueprints for the domains of practice, competencies/tasks, and knowledge and skills required to practice

  • • Inform training, fellowship, and examination requirements

  • • Provide insight into maintenance of certification and requirements

The aim of this presentation is to inform CIC participants about the aims, process, results, and uses of these practice analyses.

11:00 a.m. – 12:00 p.m.

L. Samal, Harvard Medical School; A. McCoy, Vanderbilt University Medical Center; J. Teich, Harvard Medical School; D. Dorr, Oregon Health & Sciences University

Care coordination – broadly defined as the set of activities which improve safety and continuity of care for patients and populations – continues to present numerous challenges. This panel will present examples of information tools for care coordination. We will also discuss electronic health record (EHR)-based care coordination measures, which will be imperative to develop a learning health system approach to care coordination. We will describe practical systems that handle a wide range of care coordination activities at a local, regional and national scale. We will discuss the challenges of meeting clinical needs with current electronic tools as well as how to optimize them.

J. McGreevey, University of Pennsylvania Health System/Perelman School of Medicine at the University of Pennsylvania; C. Mallozzi, University of Pennsylvania Health System; E. Shelov, The Children’s Hospital of Philadelphia; R. Schreiber, Geisinger Health System; R. Perkins, H. Lee Moffitt Cancer Center & Research Institute

Electronic Health Record (EHR) alerts and alert fatigue, while widely recognized as a concern nationally, lack a corresponding action plan for management. This panel assembles health care institution leaders who represent academic, pediatrics, community, and specialized care domains who will describe their respective approaches to better management of EHR alerts. Clinical Informatics Conference attendees who are considering creating a program to manage alerts will benefit from the experiences of the panelists and transferable lessons shared during this panel.

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2:00 p.m. – 3:00 p.m.

G. Dolin, Intelligent Medical Objects; S. Matney, Intermountain Healthcare; R. McClure, Partners Inc.; N. Davis, Intermountain Healthcare

It is well known that “plug and play” health care information exchange interoperability is rarely seamless. Knowledgeable clinical informaticists are necessary to clarify requirements, build interfaces, define useable terminologies, and manipulate the plugs that allow all of us to play. Recent experiences gained through real implementations based on evolving standards have highlighted the importance of simultaneously crafting the model with the standard terminology and aligning this with real-world content. Fast Healthcare Interoperability Resources (FHIR®) provides a standard data model, but the model can be profiled with differing ways thus impeding interoperability. The Clinical Information Modeling Initiative (CIMI) models provide one solution for standardizing FHIR® profiles. The goal of this panel is to educate attendees about the CIMI modeling structure and vocabulary management and how it can be represented using FHIR® profiles. This knowledge will equip clinical informaticists with the knowledge to intelligently work in the trenches with their vendors and within their own EHR implementations to achieve ‘plug and play’ interoperability over time.

3:30 p.m. – 4:30 p.m.

V. Tiase, New York Presbyterian Hospital/University of Utah; S. Collins, Columbia University; J. Smith, AMIA; D. Liebovitz, University of Chicago

This interactive panel will engage conference participants in a range of topics in order to provide thorough information regarding the FAMIA program. Panelists will discuss the origin and intent of the program, details on its application requirements, and the submission experience of the current Fellows of AMIA. A large portion of the panel will be dedicated to answering questions from participants.

8:00 a.m. – 9:00 a.m.

T. Carton, Louisiana Public Health Institute; M. Zirkle, Patient Centered Outcomes Research Institute; J. Block, Harvard Medical School; K. Lyman, Louisiana Public Health Institute; W. Hogan, University of Florida College of Medicine; S. Barbash, Patient-Centered Outcomes Research Institute

The Patient-Centered Outcomes Research Institute (PCORI) funded the National Patient-Centered Clinical Research Network, PCORnet. PCORnet leverages the power of electronic health data in a nationally distributed research network (DRN) to conduct patient-centered research. From 2014 to   2018, PCORnet refined and expanded its infrastructure to engage a variety of stakeholders: researchers; patients and patient communities; clinicians; health systems leaders; and payors. This panel will focus on the progress and outcomes of PCORI’s initiatives to strengthen PCORnet’s capacity for public health surveillance and population research. The panel will highlight innovative pilot projects conducted in collaboration with Sentinel and the Centers for Disease Control (CDC). Panelists will cover the unique attributes of PCORnet that make it opportune for public health research, as well as the challenges to building this capacity within PCORnet given the availability of data elements within PCORnet’s Common Data Model. This panel will showcase significant accomplishments across the PCORnet community in the areas of surveillance, infrastructure for population health research, and clinical research informatics.

9:15 a.m. – 10:15 a.m.

C. Richards, A. Goodman, A. Srinivasan, J. Loonsk, U.S. Centers for Disease Control and Prevention

Public health relies upon varied data including clinical data from electronic health records and community level data for routine surveillance and outbreak investigations as well as data to better understand public health interventions. This session will describe the CDC’s Public Health Data Strategy and population health initiatives that rely upon and use clinical data to address critical public health priorities, e.g., childhood obesity and diabetes. Panelist will discuss the CDC’s strategy to improve its collection and use of data and how the CDC is working to achieve better data, more informed decisions, and healthier lives. Discussion will address key areas identified for improvement including: developing a data science savvy workforce; accessible and usable data; interoperable systems and tools; supported and coordinated partners; and coordinated investments and governance.

10:45 a.m. – 11:45 a.m.

N. Fareed, D. Walker, A. McAlearney, T. Huerta, The Ohio State University

The Ohio State University Wexner Medical Center implemented a facility-wide in-patient portal starting in 2013 and has engaged in a robust implementation evaluation to determine the barriers and facilitators to the use of the new technology (what the characteristics of users are and how the technology ultimately impacts patient satisfaction). To evaluate the implementation, we conducted qualitative interviews with patients, caregivers, and health care providers about their experience. To characterize users of the in-patient portal, we matched survey data about patient socio-demographic characteristics with audit log files. To assess the relationship between in-patient portal use and patient satisfaction, we examined the relationship between unit-level activation rates and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. In-patient portals are a relatively new technology, and there is a need for research informing implementation of these tools on a large scale. Further, there is little evidence in the literature about best strategies to overcome the specific challenges of in-patient portal implementation, use, and impact. Our intent in this panel is to offer guidance based on our research and evaluation experience including the areas of implementation; reducing disparities in use; and improving the patient experience and organizational impact of the technology.

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12:45 p.m. – 1:45 p.m.

E. Orenstein, Emory University/Children's Healthcare of Atlanta; M. Tobias, Children's Hospital of Philadelphia; A. Weitkamp, Vanderbilt University; C. Mallozzi, University of Pennsylvania Health System; P. Rosenau, University of Vermont Medical Center

Clinical Decision Support (CDS) systems delivered through the Electronic Health Record (EHR) system are an important part of quality and safety initiatives within a health care system. However, managing a large CDS knowledge base can be an overwhelming task for informatics teams. Additionally, it can be difficult for these informatics teams to communicate a larger vision as to where they are struggling and how they want to improve. A CDS maturity model can help provide guidance and a roadmap for organizations looking to augment their operational practices. In this interactive panel, we will discuss the origin and development of a proposed maturity model as a framework for CDS; describe four organizations’ approaches to CDS operations; illustrate examples of self-assessment and areas in which organizations have excelled; and facilitate a discussion with the audience about improving CDS effectiveness.

E. Lomotan, Agency for Healthcare Research and Quality; J. Meadows, The MITRE Corporation; M. Michaels, Centers for Disease Control and Prevention; J. Michel, Children's Hospital of Philadelphia/ University of Pennsylvania; K. Miller, National Center for Human Factors in Healthcare/MedStar Health

Health care systems spend millions annually developing Clinical Decision Support (CDS), yet they largely develop CDS independently from each other. The process of translating evidence-based practice into effective and useful CDS could be more efficient if health care systems shared knowledge about the translation, including workflow considerations, key assumptions made during the translation process, and technical details. Further, standards such as HL7 Clinical Quality Language (CQL) and Fast Healthcare Interoperability Resources (FHIR®) are gaining momentum and aid interoperability of these knowledge resources or “artifacts.” In 2016, the Agency for Healthcare Research and Quality launched CDS Connect as a public, web-based platform for authoring and sharing CDS knowledge artifacts. Since its launch, Federal agencies, academic institutions, and others have contributed to CDS Connect as a vehicle for sharing and dissemination. Other organizations are using content available through CDS Connect for continued research, innovation, and implementation. Panelists will share their experience using the platform and its tools, including describing ongoing research to try to quantify potential efficiencies gained by health care systems using shareable, interoperable CDS.

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2:00 p.m. – 3:00 p.m.

J. Skapik, Cognitive Medical Systems Inc.; R. McClure, Partners; C. Macumber, Apelon; A. Smith, National Committee on Quality Assurance

Duplication and misalignment are widespread in the electronic Clinical Quality Information (CQI) content space. Implementers report a high level of effort with low value or return on investment at the implementation level due to the fragmentation of measure definitions and presence of unnecessarily similar but different CQI value sets, data elements, and logical clause or library content. Measure developers, although in adamant agreement as to the need for harmonization, do not currently have a workflow or tooling that adequately supports identifying and responding to alignment opportunities. Furthermore, a governance body and/or process is needed to negotiate the retirement of duplicate content and shared maintenance of new, aligned content.

This panel will address the problem by:

  • 1. Explaining the context and impact of misalignments in the quality improvement content space

  • 2. Demonstrating the steps required to identify non-harmonized content and a plan to harmonize it

  • 3. Outlining how a harmonized resource library can be utilized by authors to proactively identify the reusable resources for new measures

W. Blumenthal, S. Wilmore, M. Michaels, Centers for Disease Control and Prevention; R. Tarar, Northrop Grumman/Centers for Disease Control and Prevention; A. Srinivasan, Centers for Disease Control and Prevention

Knowledge for action from public health to health care is largely human readable and not in machine-interpretable formats. This knowledge (e.g., clinical guidelines, case definitions) resides outside of Electronic Health Records (EHRs) in document servers or loose-leaf binders and depends on human interpretation and translation into system workflows. The result is significant variability and inefficiency of implementation. More and more Centers for Disease Control and Prevention (CDC) public health programs are now embarking on a path towards streamlining clinical guidelines implementation and its use in clinical settings. The panel consists of CDC leads that provide their perspectives from the CDC’s Adapting Guidelines for Digital Age initiative and present perspectives from two projects: Cancer Registry Reporting and Contraceptive Use in Clinical Workflow. These diverse project perspectives will provide the audience with actionable, grounded information on the Clinical Decision Support landscape available to agencies like the CDC. The panel will share the approach, architecture, and how it can be scaled and sustained nationally.