AMIA 2020 Clinical Informatics Conference Workshops

Tuesday, May 19

8:00 a.m. – 10:00 a.m.

J. Herigon, Boston Children's Hospital, Harvard Medical School; C. Uptegraft, Boston Children's Hospital, Harvard Medical School, U.S. Air Force

Fast Healthcare Interoperability Resources (FHIR) is a major new standard for making health data more easily accessible. The SMART specification provides mechanisms within an EHR for 3rd party app launching, authentication, and scoping of information available to the app. By combining FHIR with the SMART specification and standard web tools (such as HTML, CSS, JavaScript), developers can create medical apps that are able to run against diverse EHR implementations. This 2-hour workshop will provide an introduction to the basic steps for developing a clinician-facing SMART on FHIR app. After participating in this session, attendees will be able to create a basic functioning SMART on FHIR app and run it against a public FHIR server. Attendees will also be able to identify challenges and potential pitfalls when working with the FHIR standard, SMART, and vendor APIs.

This workshop consists of four sections. During the first two sections, we will briefly overview SMART on FHIR, how EHR vendors are implementing the FHIR standard, and cover basic application design principles and resources for development. The third section encompasses the hands-on portion of the workshop where we will guide participants as they build a functioning SMART on FHIR application tested against a publicly available FHIR server. Participants may build one of our step-by-step guided applications or may build one on their own using a provided FHIR resource ‘cheat sheet’. Lastly, we will conclude with an overview of the practicalities of implementing a SMART on FHIR application within the production environment, with experiences from past implementations across different EHR settings.

H. Dunnenberger, NorthShore University HealthSystem; J. Hoffman, St. Jude Children's Research Hospital

Precision medicine is a dynamic and growing area of health care today where applied clinical informatics support is crucial. Pharmacogenomics is a leading aspect of precision medicine that is being applied in routine care to optimize drug therapy across therapeutic areas. To realize the potential of pharmacogenomics, various clinical decision support (CDS) tools must be deployed across the care continuum. Unique considerations exist for successful use of pharmacogenomic CDS. Genomic data have fundamental differences from other laboratory data that must be considered and CDS tools are often targeting clinicians with limited training in pharmacogenomics. Health-systems with different patient populations and electronic health record vendors are gaining experience implementing pharmacogenomic CDS to illustrate strategies other organizations can follow. A growing number of resources are also available to support clinical informatics leaders who are deploying pharmacogenomic CDS. Ultimately, pharmacogenomic CDS can be designed to proactively guide clinicians toward data-driven decisions through highly integrated, seamless, and interactive interventions.

During this workshop session, presenters with experience implementing pharmacogenomic CDS in different hospitals will summarize foundational pharmacogenomics topics, highlight key publicly available resources, define strategic decision points, and identify key processes for developing pharmacogenomics CDS. Examples of CDS from different institutions will be examined to compare approaches and identify emerging best practices. Efforts to standardize pharmacogenomic terms to enable implementation and the role of pharmacogenomic knowledge sources will be discussed. Strategic and tactical decisions clinical informatics leaders must make when implementing precision medicine and supporting CDS will be highlighted. The session will be highly interactive and culminate with an activity for participants to consider the initial steps to implement pharmacogenomic CDS.

8:00 a.m. – 12:30 p.m.

J. Hollberg, Emory University; P. Fu, City of Hope; R. Schreiber, Geisinger Holy Spirit

In addition to state-of-the-art applied clinical informatics training, physicians, nurses, and pharmacists must also acquire leadership skills that are essential to be a successful CxIO or informatics leader. This leadership workshop will focus on specific techniques to improve: your relationship with your boss and employees; meeting management; and setting clear expectations for your team. During the workshop, we will also discuss methods to successfully deal with frustrated colleagues, increase your energy bandwidth, and more effectively partner with your organization's other executive leaders (ex. CNIO, CMIO, CIO, CEO). Didactic presentations will be integrated with small group breakouts and larger structured group discussions regarding real life cases. Additionally, the workshop will include a panel discussion from the perspectives of employers and employees regarding an informatics job search. Participants will leave the workshop with practical skills and knowledge designed to facilitate their growth as informatics leaders.

J. Manning; E. Olson, Atrium Health's Carolinas Medical Center; J. Nielson, Northeast Ohio Medical University; E. Puster, Regenstrief Institute, Inc., Indiana University Health; A. Marshall, Beth Israel Deaconess Medical Center

Informaticians are often frustrated by the poorly-designed user interfaces that they use every day. This workshop teaches informaticians how to harness Flutter — an open-source front-end toolkit for simultaneous iOS and Android app development — to create next generation “Best of Breed” software. During last year’s CIC workshop, attendees live-coded a mockup of the AMIA CIC app. We will build directly off this work to refresh the basics, then we will cover intermediate concepts. We will also introduce the changes that have occurred in the last year, such as Flutter’s expansion beyond mobile to also include web and desktop development. This will be an interactive, guided workshop with the opportunity for questions, suggestions, and discussion throughout. The goal is to impart our audience with the skillset to build their own workflows and user interfaces via a simple and easy-to-use tool. By live-coding with other informaticians who are subject matter experts in this field, attendees of this workshop will be empowered to turn their own designs into products. Bring your laptops and come ready to code! To make the most of this event, it is strongly recommended to watch the Flutter4CME videos.

E. Shelov, Children's Hospital of Philadelphia; M. Dewan, P. Hagedorn, Cincinnati Children's Medical Center; E. Kirkendall, Wake Forest School of Medicine; L. McNeely, Children's Hospital of Philadelphia; E. Webber, Indiana University Health

Background
As we strive to improve care and deliver higher quality patient outcomes, the EHR can be a powerful tool in implementing care standards to achieve these goals. Most clinicians are familiar with CDS tools like order sets and many have learned how to design their own. Have you designed or built what you thought was a great CDS intervention only to become frustrated that nobody is using it the way you intended? Knowing which EHR Decision Support tool is the best fit for your QI project or to address the recent safety event is vital. From pop-up alerts and reminders to the visual presentation of data and useful information, there are many forms of CDS that can support improved care, but navigating the options can be challenging.

Objective
All improvement projects must begin with a clear definition of a problem and a clear improvement goal. Often, clinicians and information system teams skip this critical step and jump to tools that are familiar, but may not be effective in driving the consistent behavior change they are seeking. Worse yet, poorly designed interventions may introduce new risks or potential harm to patients as well as contribute to physician burnout by creating yet another EHR task for the day. Even without becoming a software or usability expert, informaticians can learn to approach quality and safety problems in a way that greatly facilitates finding the right CDS tool for the intended results. This approach begins with careful attention to the problem and creating a clear intervention plan. From there, the 5 Rights of effective Decision Support (right person, information, time, format, channel) can be incorporated into a problem-oriented algorithm that will greatly improve the chances of a successful implementation.

Structure
This workshop will have 2 distinct phases: 1) Problem Definition with Aim statement development and 2) Intervention planning & design.

A. Davison, Johns Hopkins University School of Medicine; P. Gorman, Oregon Health & Science University; J. Zavodnick, Jefferson; H. Lehmann, Johns Hopkins University School of Medicine; S. Panchanathan, University of Arizona

In this workshop, attendees will engage in a robust discussion around the intersection of Entrustable Professional Activities (EPAs) and Clinical informatics. During this transformative time in U.S. healthcare, we must think broadly about how medical students are trained and assessed on inputting, interpreting, and extracting data to and from not just EHRs, but wearables, mHealth apps, telemedicine platforms, chatbots and other technologies. The Association of American Medical Colleges (AAMC) has been piloting a competency-based approach to medical student education with the development of 13 core EPAs. Yet questions remain: Within each EPA, what are the specific competencies and behaviors that have technology-based imperatives? How can we standardize the approach to training and assessment in a vendor and institution agnostic manner? Each of the core EPAs have specific behaviors and functions that require medical students to demonstrate critical thinking and clinical acumen in the context of modern health information technology. While most EPAs implicitly involve the use of technology, some explicitly reference health IT tools. For example, one of the competencies in EPA 8 (Give or receive a patient handover) involves explicit mention of updating an electronic handover tool. This workshop will be a great opportunity for clinical informatics educators to share best practices on teaching and assessing medical students on the essential competencies they need to be entrusted with prior to starting residency. The output of this workshop will be a foundational framework for viewing the EPAs through a clinical informaticians’ lens. This discussion will then serve as a springboard for future work on developing and validating assessments of EPAs.

10:30 a.m. – 12:30 p.m.

J. Finnell, Indiana University School of Informatics and School of Medicine; L. Masson, Cedars-Sinai Heath System

The ability to write multiple-choice test items is a skill that is growing in importance for informatics practitioners and educators. The emergence of Clinical Informatics (CI) certification created the need for multiple-choice test items that adhere to national standards for use in high stakes exams. AMIA established an item writing activity to generate items for a clinical informatics practice exam. CI fellowship programs collaborate to create an in-training exam to help fellows assess their mastery of the CI core content. Applied Clinical Informatics requests that authors submit multiple-choice questions with manuscripts. AMIA’s work towards Advanced Health Informatics Certification (AHIC) will create additional demand for high quality informatics test items.

Many individuals who write test questions for use in their educational programs are unfamiliar with the well-established set of rules for writing sound test items. Increased use of these test question guidelines would help students become familiar with the format of questions used on high-stakes exams as part of their educational program and could positively impact the quality of assessments used by educators.

This workshop will present guidelines for writing high quality items, offer a recommended approach for writing clinical or health informatics items, and provide participants with an opportunity to write items that will be shared for feedback. Workshop faculty will share common pitfalls 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.

1:30 p.m. – 3:30 p.m.

K. Unertl, Vanderbilt University Medical Center; S. Haque, RTI International

Successful implementation and use of health information technology requires attention to technical and organizational components. Organizational components include workflow, technology acceptance and sociotechnical factors, among others. Fields such as Organizational Theory and Change Management offer a substantial foundation of evidence-based guidance on how to navigate the human and organizational aspects of technology-based change. Support is needed to translate theory and concepts from multiple fields into clinical informatics practice in a way that’s accessible for organizations. The goal of this workshop is to draw from evidence in related fields to bridge the gap between theory and practice. This will be accomplished by providing participants with hands-on experience through exploration of real-world case studies and participatory exercises.

R. Hoyt, Virginia Commonwealth University

Machine learning and artificial intelligence have become a reality in clinical medicine. Very recently, artificial intelligence has exceeded human diagnostic accuracy in cardiology, dermatology, ophthalmology and radiology. Clinical informaticists need to have a working knowledge of these modalities because they are being used for predictive analytics, clinical decision support, image recognition, voice recognition and natural language processing.

The standard pathway to learn machine learning is through a Masters-level data science program, specifically learning one of the programming languages (R or Python). While this approach is optimal, it is not practical for those not in a degree program and there is a very steep learning curve associated with programming languages. In addition, knowledge of higher math (calculus and linear algebra) is generally required.

An alternate approach towards “democratizing machine learning” is through the use of machine learning software. This workshop will discuss seven such programs but focus only on RapidMiner which is felt to be the “best of breed.” This software package automates many of the data preparation, exploration and visualization phases (TurboPrep), as well as the modeling phase (AutoModel).

Workshop participants will learn how to perform data preparation, exploration and analysis using this platform. They will download datasets to predict heart disease (classification) and medical charges (regression). The machine learning software will automatically select multiple appropriate algorithms and then compare algorithm performance with standard measures of accuracy.

A. Solomonides, NorthShore University HealthSystem; A. Desai, VA; B. Middleton, Apervita; J. Platt, University of Michigan; J. Richardson, RTI International; P. Walker, Vanderbilt University

We have long envisioned integrated actionable knowledge in electronic health records (EHR). For those working at the cutting edge of biomedical informatics, this vision is still a major motivation. Yet there are common complaints of technology-induced provider burnout, of meaningless data, of inappropriate alarms, and of perfunctory discharge notes – all resulting in a failure to deliver upon the expected value proposition. The revitalized field of artificial intelligence (AI), especially in the form of adaptive machine learning, is promising anew to revolutionize medicine. Yet AI itself gives rise to ethical concerns: is it acceptable if the AI does not provide clear reasons for its decisions? Is it acceptable if its reasoning process is obscured by the “black box” in which it lies hidden?

The Learning Health System (LHS) movement has conceptualized the development of evidence through science and practice as an integral part of the delivery of healthcare and support for good health and wellbeing. Implicit in this concept is the idea that the knowledge developed, validated, curated and distributed throughout the LHS is not only actionable, but ideally is executable.

How do the issues of trust and policy impact the LHS movement and its diverse initiatives, including Mobilizing Computable Biomedical Knowledge (MCBK)? We wish to explore the fundamental characteristics of a knowledge commons that would warrant the trust of the many communities it would engage and serve: engineers who would develop the systems, informaticians who develop knowledge artifacts, providers and others who would use them, and patients—and their caregivers and advocates—who would be impacted. How will trust be established, how perceived, how maintained? Several frameworks for conceptualizing knowledge commons, establishing and maintaining trust, and incorporating executable knowledge will be explored and discussed.

S. Rehman; H. Abbaszadegan, Phoenix VA Healthcare Systems, University of Arizona College of Medicine Phoenix

Great leaders are great negotiators, they resolve seemingly intractable disputes and yet enhance working relationships. Their negotiation and communication skills determine their effectiveness. Physicians and non-physician members of AMIA are expected to negotiate with a vast array of third parties, including healthcare system governing boards, leaders in the C-suites, patients, end-user consumers, government, health plans, insurance companies, EMR vendors, and pharmaceutical companies. Additionally, negotiation skills are an essential competency and requirement for board certification for physicians (ABPM and ABP), yet one may not find any session on this topic in AMIA meetings. It is time for all medical professionals be trained in negotiation skills.

Law, business, and public policy schools offer classes in negotiation. The ability to negotiate requires a collection of interpersonal and communication skills used together to bring about a desired result. It is based on exploring underlying interests and positions to bring parties together in a constructive way. Effective negotiators use innovative thinking to create lasting value and forge strong professional relationships. They take a deep dive in to what is behind the opponent and their own positions that may not seem logical at first but essential to understand the issues/ideas behind the problem.

The 2-hour highly interactive and educational session provides tools for identifying individual communication preferences, delivery methods, conflict resolution styles as well identifying best practices and “best alternative to a negotiated agreement” (BATNA).

The session is interactive and involves exercises and activities that will allow the participants to discover, learn and practice the negotiation skills.

K. Couperus, Madigan Army Medical Center

We can enhance training opportunities and improve learning efficiency through new innovative teaching platforms. Traditional lecture has been augmented by simulation, flipped classrooms, and more engaging teaching styles. We propose another addition to emergency medicine education: virtual and augmented reality. These technologies have vastly increased in capability and portability while decreasing in cost. Case Western is teaching medical school anatomy classes in 50 percent less time using tailored augmented reality programs, and other industries are showing similar results. Emergency medicine and first responders are well suited to leverage these technologies given our frequent encounters with low frequency high stakes cases. To our knowledge, we developed the first autonomous trauma simulator, leveraging $7 million in DoD physiology engine software to create a dynamic decision training platform for military medical providers. Broadly, these solutions can facilitate and/or automate educational processes through immersive simulation environments and guided educational content. This offers immense potential for core and continuing educational objectives. Our aim is to present current virtual, augmented, and mixed reality platforms. We will describe cost, current programs, funding opportunities, and discuss how educators can help shape this next evolution in training. We will bring devices for demonstration and/or use to further promote individual creativity. Finally, we will present the workflow we leveraged to develop our virtual reality content: picking a case, learning objectives, gameplay design, platform, funding source, and how to work with technical experts to achieve the desired training outcome. We will augment this by presenting telementoring use cases actively being researched through DoD funding. We appreciate your consideration of this proposal.