AMIA 2020 Clinical Informatics Conference Panels

9:45 a.m. – 10:45 a.m.

A. Dietz, U.S. Department of Veterans Affairs; D. Classen, University of Utah School of Medicine, Pascal Metrics; T. Kuruganti, Oak Ridge National Laboratory; M. Rosen, Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing; J. Scott, U.S. Department of Veterans Affairs

Learning health systems need evidence-based tools and methodological approaches to understand why vulnerabilities exist within their health information technology (HIT) systems to identify strategies to eliminate and manage risk. The application of such approaches is critical for ensuring the safety of HIT systems not just at deployment, but that (1) existing systems continue to function correctly and provide meaningful feedback to users, and that (2) organizational leadership and governance structures are in place to manage the safety of operations. This panel brings together leaders in the field of health care informatics to discuss the development and validation of prominent HIT evaluation tools and best practices, their application and lessons learned, and what the future may bring for evaluating HIT safety. Specific learning objectives for this panel include: (1) Identify ways to evaluate HIT system performance, (2) Understand the tradeoffs between different methods and approaches for evaluating HIT safety, (3) Determine how to translate evaluation findings to foster organizational learning and continuous improvement.

J. Windle, T. Windle, M. Clarke, University of Nebraska Medical Center; J. Tcheng, Duke University

This panel will present the results of an AHRQ funded project to define, model, and validate the characteristics of clinician-defined electronic health record (EHR) functionality. Using complex simulated inpatient and outpatient cardiovascular patient scenarios, we defined the transactions, workflows, data flows, information management streams, operational characteristics and logistical interactions required to manage these simulated cases at eight institutions (four academic and four private practice). A prototype EHR was created and iterated upon via agile and user-centered design principles to evaluate and model approaches to the optimized EHR. The prototype was then evaluated across the eight participating institutions and compared to their installed EHR. Results: Based on the System Usability Survey (SUS), the clinician-centered prototype EHR scored significantly higher than the installed EHR (77.8 versus 48.1, p<0.0001). The panel will review the qualitative results of the 60 clinician interviews, the deconstructed clinical framework that allowed us to construct the prototype EHR, and the functionality of the framework via the prototype EHR. Critically, this study elucidates the framework for the efficient, effective and satisfying EHR of the future.

11:00 a.m. – 12:00 p.m.

K. Kim, University of California Davis; P. Franklin, Northwestern University; S. Greene, Health Care Systems Research Network; M. Edmunds, AcademyHealth

The growing prevalence of chronic conditions requires longitudinal engagement in treatment decisions by individuals and their care teams underscores the need for effective shared decision making (SDM). Person-generated health data (PGHD), integrated with data from clinical encounters are necessary to provide a comprehensive understanding of health and illness, including both self-management support and SDM. While an ever-expanding number of consumer-facing tools are deployed across care settings there is a concomitant need for a unifying framework to guide the identification of evidence gaps, set priorities for future studies, and learn about consumer technology preferences to optimize the practice of SDM and the development of useful and usable tools. A collaborative consensus project engaging a variety of stakeholder perspectives resulted in the findings offered by this panel. All stakeholder insights were valued equally during the deliberations and during co-authoring of papers and other products of the work. This session will offer perspectives on the technical, regulatory, and cultural challenges of shared decision making (SDM) and suggestions for how emerging technologies and data generated by individuals can be combined with clinical data to improve SDM processes. Panelists will present existing evidence and future priorities for clinical informatics research, implementation, and development.

M. Josephson, KLAS Research; A. Chaumeton, Legacy Health; L. Milligan, Asante Health Systems; R. Tarrago, Seattle Children's; P. Scariati, Dignity Health

Clinical end-users of EHR systems are often frustrated by the lack of usability with this core technology. The Arch Collaborative is an effort to benchmark provider organizations against a standardized survey in order to unearth data-validated best practices. To date, the Arch Collaborative has surveyed over 130,000 clinicians across 210 organizations. This benchmarking effort has uncovered that there are three key areas within which organizations can make improvements to improve clinical end-user satisfaction with their core health technology systems. Those three areas are personalizations, training and ongoing education, and governance. This panel will discuss the specific best practices used to improve satisfaction among end-users.

2:00 p.m. – 3:00 p.m.

M. Baez, Parkland Health & Hospital System; L. Amos, National Library of Medicine; A. Ragsdale, Washington State Department of Health; B. Reilly, Texas Department of State Health Services; R. Goodwin, National Library of Medicine

This panel presentation and discussion will address the nationwide need for development or improvement of standardized clinical (electronic health record) EHR and (laboratory information system) LIS electronic test ordering and reporting (ETOR) solutions for newborn screening. Attendees will gain insight into the prevalence of this need in every healthcare provider system in the nation that provides birthing services, learn about the published HL7 and LOINC panel standards, and hear both the public health laboratory and healthcare provider perspectives on the successful outcomes and challenges of implementation. Panelists will outline the development of current best practice specifications for interoperability and present specific interventions applied to bridge gaps between these specifications and real-world products.

A. McCoy, Vanderbilt University Medical Center; E. Gershon, InterSystems Corporation; J. Russell, Epic Systems Corporation; E. Karp, Cerner Corporation; G. Zuccotti, Partners Healthcare, Brigham and Women's Hospital

Unintended consequences related to electronic health records (EHRs) may occur due to increased adoption and overdependence on EHRs and clinical decision support. Shared responsibility between healthcare organizations and EHR vendors is necessary to improve EHR and patient safety. This panel includes safety officers from leading EHR vendors and healthcare organizations who will provide an overview of the safety program at their organization. Panelists will define their role and governance structure; outline processes for preventing, investigating, and reporting EHR-related adverse events across all domains of the HITS framework; and describe opportunities for shared responsibility between vendors and healthcare organizations.

3:30 p.m. – 4:30 p.m.

B. Karras, Washington State Department of Health, University of Washington; S. De Leon, Washington State Department of Health; B. Lober, J. Baseman, University of Washington; C. Baumgartner, Washington State Department of Health

Washington State is impacted by the opioid crisis. State and federal resources are being marshalled towards a multi-pronged response, and in 2019, the Centers for Medicare and Medicaid Services (CMS) funded a one-year initiative to improve the access to state Prescription Monitoring Program (PMP) data to reduce the harm of opioid use. The University of Washington contributes informatics expertise in three areas: assessing and supporting provider use of the PMP, improving the access of data by providers through the use of FHIR and other standards, and contributing to improvements in the usability and infrastructure of the state’s opioid dashboard system. Washington has dramatically improved PMP access among large providers in the last five years with the use of standards-based API query of the PMP via the state-wide HIE. Small and medium sized providers still have barriers to access. This panel will discuss how Washington is addressing this gap. The panel will explore the novel technologies and application of traditional technical assistance that have the potential to be disruptive in addressing the opioid crisis. They will conclude with a discussion of government policy, political pressure, societal forces, and financial and technical drivers that contribute to fixing this health informatics challenge.

E. Begoli, Oak Ridge National Lab; Z. Cai, Merck & Co., Inc.; J. Ferraro, Intermountain Healthcare, University of Utah; J. Nebeker, University of Utah, U.S. Department of Veterans Affairs; W. Ou, U.S. Department of Veterans Affairs

Healthcare informatics is a critical part to the success in a healthcare organization. To revert today’s 80/20 data wrangling-to-analysis ratio and to ensure scientifically sound and consistent results, healthcare organizations need to invest on enterprise data and analytics platforms. This panel of four from different parts of the healthcare industry will describe their organizations’ initiatives in building the data and analytics platforms. Although the missions of the organizations vary, the platforms address common challenges faced in the data and analytics life cycle. The panelists will also share the overall strategy and the example use cases that enabled by the platforms.

8:00 a.m. – 9:00 a.m.

C. Hebert, Ohio State University; N. Shah, NorthShore University; J. Chaparro, Nationwide Children's Hospital, The Ohio State University; A. Robicsek, Providence St. Joseph Health; K. Woeltje, BJC HealthCare

Increasing antibiotic resistance and emerging infectious diseases continue to pose a major global threat. The field of clinical informatics is uniquely positioned to address some of the challenges in identification and prevention of infections, as well as to develop best practices in providing point-of-care interventions. This panel will consist of five clinical informaticians trained in infectious diseases, who will discuss novel informatics initiatives focused on healthcare acquired infections, antibiotic stewardship, and controlling the spread of global infectious diseases. The moderator will then lead an interactive panel discussion to determine gaps and future directions in the field and to get feedback from the informatics community on how best to address these serious public health issues.

F. Manion, University of Michigan School of Nursing; W. Hammond, Duke University; M. Harris, University of Michigan School of Nursing; P. Harris, Vanderbilt University Medical Center; J. Obeid, Medical University of South Carolina

The informed consent process is an essential component of clinical research and is required by ethical norms in both research and clinical practice, and by US Federal regulations codified in the Common Rule, HIPAA, and FDA regulations. During the last decade advances in technology have allowed for various mechanisms for clinicians and researchers to electronically capture and transmit informed consent choices directly into the EHR, clinical trial management, and other systems. There is emerging evidence that these advances also lower barriers to participation in clinical research. However, a lack of clear definitions about the vocabulary we use to describe informed consent, the terms we use to capture patient preferences, and standards-based technical approaches can hamper our ability to exchange consent information, and build interoperable applications. In this panel, we will describe some of the challenges and promises of capturing consent electronically. We will describe work in the field to examine remotely captured informed consent, and to represent consent formally using ontologies, to incorporate e-Consent into the REDCap clinical data capture systems, and the current work on FHIR-based representations.

9:15 a.m. – 10:15 am.

S. Hull, Gartner; M. Wang, Inspiren; D. Womack, Oregon Health & Science University; R. Kennedy, eCare Informatics

Today’s care delivery platforms are changing the nature and location of care and how health and services are coproduced, untethered by walls or geographical setting. Nurse, patients and care team members are in an early learning curve to leverage new digital health data types and sources (smart devices, sensors, wearables, and digital twins) for real time feedback into care activities, for in person and virtual care. Real time digital health data generated by the patient and about the patient including interactions with the nurse, care partners, and the environment offer feedback loops to shape the design and evaluation of care interventions and care models. The use of AI, algorithms, machine learning, advanced computer vision, and environmental sensing technologies require a next generation of decision support for shared care activities with patients. This panel will discuss three case studies of how to leverage real time digital health data to shape the design and evaluation of interventions and care models.

J. Lee, J. Hoffman, Nationwide Children's; C. Sarabu, N. Pageler, Stanford University

Regulation, technology, and culture shifts have enabled patient access to their own information through the EHR patient portals and soon increasingly through third party apps. In the world of pediatric patients, parents and guardians access their children’s data but as they grow older adolescents have the right to confidential care in many areas that are considered more sensitive such as reproductive and mental health. To protect that privacy digitally requires segmenting data such as a lab test for sexually transmitted infections or a birth control prescription. Due to various state laws there has never been a standard agreed upon list of what data is considered sensitive and furthermore, highlighting these points in unstructured free text is even more challenging. This will be a panel discussion that presents technical and governance ideas to practically think about data segmentation for privacy for both structured and unstructured data in order to protect adolescent’s confidentiality while still advancing goals of patient access to their health data.

10:45 a.m. – 11:45 a.m.

L. de Souza, Cerner Corporation; S. Locke, Adventist Health; J. Schultz, Vail Health; M. Ross, Northern Light Health

Clinician burnout is multi-factorial problem that affects us all, whether we are consumers or providers of care. With high personal impact to professional caregivers, negative effects on care quality and patient satisfaction, as well as significant economic costs to organizations, moving from burnout to wellness, requires a multiprong systems approach. As we move towards a fully integrated era of IT, EHRs and other technologies will play an even bigger role in burnout. In this panel, four health care executives will share how organizations can successfully improve clinician EHR satisfaction and efficiency by focusing on the value of investment (VOI), instead on the return on investment (ROI). By investing in people through a collegial culture and clinically integrated governance, ongoing training and support of the clinical staff, and re-designing clinical practice to support care team models, these organizations have demonstrated measurable ways to decreased EHR-related burnout.

K. Condon, U.S. Department of Veterans Affairs; A. Park, U.S. Department of the Army; T. Hancock, U.S. Department of Veterans Affairs; T. Newton, U.S. Department of the Army; J. Nebeker, U.S. Department of Veterans Affairs

The DoD's Defense Health Agency and the VHA are two large government healthcare organizations that are adopting a single commercial electronic health record. This presents many challenges but also affords the Department of Defense and the VA the opportunity to think through what a common digital experience for our beneficiaries might look like. A joint working group between the Departments has been collaborating to develop a strategy for a common and consistent digital experience for patients that has as its main goal the improvement in patient/consumer engagement in order to deliver higher quality care at lower cost with a better patient experience while improving health and military readiness. It has become clear that adopting a single EHR does not necessarily deliver a comprehensive and consistent patient digital experience. The presentation will review the core strategic principles developed by the workgroup to make decisions on future design and capabilities to facilitate patients being fully engaged in their health care. Discussions include the implications of a tethered patient portal versus an untethered Personal Health Record (PHR) where the beneficiary is in complete control of the PHR and the data in it.

12:45 p.m. – 1:45 p.m.

E. Lourie, Children's Hospital of Philadelphia, University of Pennsylvania; L. Stevens, Stanford Children's Health, Stanford University; E. Webber, Riley Children's Health, Indiana University/Regenstrief Institute, Inc.; M. Hribar, Oregon Health & Science University

Many hospital systems are developing programs to improve the user electronic health record (EHR) experience in direct response to the growing problem of provider burnout. While there has been some variability in how EHR-related burnout is addressed, most of the efforts are geared towards improving provider efficiency. Measuring efficiency gains is not straightforward especially when trying to quantify the EHR burden on providers. In this panel, attendees will first hear from presenters who use two different EHRs describing their programs addressing EHR-related burnout and their successes and struggles in measuring success. This will be followed by a researcher who is studying how we can measure EHR burden and efficiency gains using EHR access logs. In this way, we hope to leave attendees with a comprehensive picture of the current state of EHR optimization programs charged with reducing EHR-related provider burnout and different techniques to effectively measure their success.

K. Xu, University of Pennsylvania; A. Knight, Johns Hopkins University; R. Khanna, University of California San Francisco; M. Cui, University of Chicago

Medication errors in the hospital are common and can result in patient harm. This is an interactive panel discussion of physicians and informatics leaders at 4 academic institutions who will explore patient, clinician and EHR factors that contribute to unintentional medication discrepancies. The panelists will also discuss recommendations, including targeted training, clear designation of roles and responsibilities and usability improvements to EHR design that can reduce medication errors.