iHealth 2017 Panels address the following topics
- Affordable Care Act
- Bridging Analytics, Bedside care, and Education
- Clinical Decision Support
- CMIO + CNIO + CIO
- Data and Network Security
- Population Health
- Healthcare Big Data Analytics
- Team-based Care
- Value-based Care
Wednesday, May 3
S01: Panel - Rethinking Documentation: Streamlining Communication and Workflow in the Inpatient Setting
Evan Orenstein, Children's Hospital of Philadelphia
Subha Airan-Javia, University of Pennsylvania Health System
Mark Mai, Children's Hospital of Philadelphia
Eric Shelov, Children's Hospital of Philadelphia
Inpatient front-line clinicians (FLCs) have a significant documentation burden that includes notes (admission notes, progress notes, and discharge summaries) as well as a problem list, a handoff, and a to-do list. Each of these documents serves an important function and contains similar information, but because they each have a different purpose and audience, the content is not the same. Because these documents generally do not communicate with each other, FLCs must update them separately, leading to inconsistencies between the documents, no clear source of truth, and missed opportunities for secondary uses of data such as clinical decision support and billing. Problem-based documentation tools from electronic health record vendors begin to address the goal of connecting these documents, but do not realize the full potential of documentation tools to improve clinical workflow. Borrowing from the model-view-controller software framework, we will demonstrate two approaches that use discrete data elements to organize clinical reasoning into user interfaces that facilitate rounding, handoffs, critical thinking, and list management.
S04: Panel – Implementing EHR Patient Management Tools in the Pediatric Medical Home: Moving Toward Value-based Care
Anthony Luberti, Children’s Hospital of Philadelphia
Elizabeth Brooks, Children’s Hospital of Philadelphia
Jonathan Crossette, Children’s Hospital of Philadelphia
Matt Dye, Children’s Hospital of Philadelphia
Children’s Hospital of Philadelphia (CHOP) recently implemented EHR-based care plans, patient outreach workflows, and registry/reporting tools for pediatric high risk care management, wellness, asthma, and other chronic disease programs such as sickle cell and inflammatory bowel disease. These tools were rolled out and tested across a 31-practice primary care network with a patient population of 260,000 children and adolescents. Practices are using these tools to successfully meet the NCQA Patient-Centered Medical Home (PCMH) requirements for care plans, patient goals, and care coordination. We will discuss the training approaches, implementation strategies, and outcomes of a pilot project to embed these tools as part of existing staffing models and demonstrate improvement for the PCMH survey. In addition, CHOP has recently undertaken its first ACO contract with a commercial payer, and will share the analytics work that was required to integrate payer data into our EHR data warehouse and identify improvement areas with the aim of achieving shared savings. This panel will share replicable approaches to implement cross-system care coordination outreach workflows, build wellness and chronic disease care management registries for pediatric populations, and undertake the early ACO data analytics work necessary to improve the delivery of value-based care.
Lyle Ungar, University of Pennsylvania
Anneke Buffone, University of Pennsylvania
J. Eichstaedt, University of Pennsylvania
Hansen Schwartz, Stony Brook University
The language the people use on social media such as Twitter, Facebook, and Yelp reveal a great deal about the thoughts, concerns, personality, and behavior of the people posting. In this panel we represent and discuss four case studies relating social media to healthcare: 1) how the Facebook language used by hospital patients varies with their disease, 2) how Twitter use in communities reveals community psychological risk factors for heart disease, 3) how social media language gives insight into different kinds of empathy, and how this relates to health care provider stress (an important predictor of burnout in medical caregivers), and 4) what patients like and dislike about hospitals as revealed in Yelp reviews. Natural language processing (NLP) has long been used for analyzing medical journal articles and analyzing physician notes; we show here how NLP can be used to analyze social media for insight into health concerns and behaviors of both individuals and communities.
Bradley Doebbeling, Arizona State University/Mayo Clinic Arizona
Tammy Toscos, Parkview Mirro Center for Research & Innovation
Kislaya Kunjan, Indiana University
Huanmei Wu, Indiana University
Improving access to healthcare care and efficiencies are critical to the US healthcare system, more so in light of recent federal legislation. Our interdisciplinary panel of healthcare professionals, informaticists, services researchers, and systems engineers will present findings from a large, multisite systems redesign and implementation research project aimed at improving access to care and efficiency in over forty community health center (CHC) sites. The project employs innovative workflow assessment strategies, simulation modeling, data analytics and implementation research to uncover effective approaches to redesign CHCs. This panel will discuss the three key intervention strategies: (i) the optimization and implementation of expanded open access appointment scheduling aided by simulation modeling, (ii) the engagement of patients, providers and staff in designing and implementing a culture of accountability and customer service; and (iii) the development an interactive dashboard for clinic operations and healthcare outcome comparison. The panel attendees will (1) learn the conceptual framework in driving study design and implementation, (2) familiarize themselves with workflow assessment, intervention prioritization strategies, data warehousing, role-specific dashboards, and implementation science in a broad range of clinical settings, and (3) learn the application of data warehousing and analytics in dissemination and follow-up studies.
Yalini Senathirajah, SUNY Downstate
Andre Kushniruk, University of Victoria
Jon Patrick, APAC: Health Language Analytics Pty Ltd (HLA), Nth America: Health Language Analytics Global LLC (HLA-G)
Ross Koppel, University of Pennsylvania
Elizabeth Borycki, University of Victoria
Conventional electronic health record (EHR) design has failed to meet minimum usability thresholds. Concurrently, the number of external and internal mandates to document more frequently and heavily in the EHR has increased. Clinicians find themselves using interfaces poorly suited to their needs, resulting in inefficient workflows with potential to increase medical errors. Complaints from clinician-users highlight that EHR software is not adaptable and that adaptations cannot be made immediately (that is, within the next few hours, days, or weeks and not months or years). This panel will address EHR usability complaints by proposing the functional behavior required of the EHR software that is needed to resolve these complaints: immediate adaptability. Panel members from academic health IT safety and usability research will discuss why optimal design of EHR software has proven difficult. This discussion will include the lack of translation of academic usability research into EHR vendor products. This panel will also include testimony from successful implementation of immediate adaptability features in technologies supporting NASA space shuttle mission control.
Scott Nelson, Vanderbilt University Medical Center
John Horn, University of Washington
Joan Kapusnik-Uner, First Databank
Bimal Desai, Children’s Hospital of Philadelphia
Richard Boyce, University of Pittsburgh
Healthcare professionals have stopped taking potential drug-drug interaction (PDDI) alerts seriously. Poor usability and the low positive predictive value of PDDI alerts have lead to high override rates. In order to focus on clinically relevant PDDIs, many clinical and prescription systems filter PDDI alerts based on seriousness or severity ratings; however, applying a single seriousness rating to an interacting drug pair may be fundamentally flawed. PDDIs are dependent on pharmacodynamics, pharmacokinetics, patient disease states, genetic information, concurrent treatments, and clinician factors; yet information regarding these is rarely considered or provided by alerts. Inaccuracy of medication lists and weaknesses in the triggering logic of computerized provider order entry (CPOE) systems also contribute to the problem. One of the questions facing a task force seeking to develop a minimum information model for representing PDDI evidence and knowledge is whether the concepts of seriousness and severity should be included the model. This interactive panel of drug-interaction experts will discuss the pros and cons of including these and other concepts in the PDDI minimum information model.
Paul DeMuro, Broad and Cassel
John Rasmussen, MedStar Health
Cathy Beech, Children’s Hospital of Philadelphia
This didactic panel on Data and Network Security—What you need to know! will address the state of cybersecurity in healthcare organizations and legal considerations concerning same, including the HIPAA privacy and security rules. It will consider institutional preparedness (or lack thereof), cite a number of examples, and address preventative measures. It also will address ransomware in the healthcare industry, including negotiating with ransomware hackers, and best practices for healthcare organizations to avoid ransomware attacks.
Thursday, May 4
S16: EHR 2020 After 2 Years: What Have We Done For You(r EHR) Lately?
Sarah Corley, Internal Medicine Associates
Theresa Cullen, Regenstrief
Gil Kuperman, New York Presbyterian Hospital
Thomas Payne, University of Washington
Charlene Weir, University of Utah
S17: Are We There Yet? Policy Outlook 2 Years After EHR 2020
Doug Fridsma, AMIA
Paul Fu, Harbor-UCLA
Jeffery Smith, AMIA
The EHR 2020 Report sought to describe the qualities and characteristics of EHRs in the year 2020, and it described public policies needed to achieve this future. This session will discuss the immediate and long-lasting impact EHR 2020 had on the policy landscape, and consider where policy may go as we pass the halfway mark on our way to 2020.
S18: Panel – Clinician Engagement in Informatics: The Experience of the Pediatric Residency NERD Squad at the Children’s Hospital of Philadelphia
Mark Mai, Children's Hospital of Philadelphia
Evan Orenstein, Children's Hospital of Philadelphia
Ivor Asztalos, Children's Hospital of Philadelphia
Anthony Luberti, Children's Hospital of Philadelphia
George Dalembert, Children's Hospital of Philadelphia
The demand for informatics interventions in the clinical setting often exceeds the capacity of informaticians to adequately address these needs fully. Front-line clinicians (FLCs) represent a natural and valuable source of wide-reaching ideas, practical feedback, and invested engagement. Many FLCs express frustrations with electronic health records (EHRs) to their peers, but do not have specific informatics interests that lead them to become clinician champions or committee members where they can effect change. Nonetheless, engagement of these stakeholders can identify problems at the sharp end of care delivery and crowdsource potential solutions. At the Children’s Hospital of Philadelphia (CHOP), a group of residents interested in clinical informatics founded a resident-run organization known as the NERD Squad (New Epic Resident Development) with mentorship provided by faculty in the Department of Biomedical and Health Informatics. The NERD Squad facilitates resident engagement in informatics projects, empowers residents to participate in building new tools, and creates a space for non-technically-oriented residents to interface with peers who can help provide solutions. In this panel, we will explore a model of clinician engagement in informatics that has produced successful projects, discuss institutional resources that support this model, and outline how this program integrates into pediatric residency.
William Hersh, Oregon Health & Science University
Michelle Troseth, Elsevier
Susan Woods, HiTecHiTouch
While the informatics community has devoted a great deal of time and effort to developing competencies for informatics professionals, the value of informatics interventions will only succeed if used successfully by clinicians and patients. In this panel, three informatics leaders will discuss the competencies and learning experiences that clinicians and patients should have to be successful users of informatics tools and techniques.
Marianne Hamilton Lopez, National Academy of Medicine
James Tcheng, Duke University
Jonathan Teich, Harvard University/Elsevier Clinical Solutions
Blackford Middleton, Harvard University/Apervita Inc
Scott Weingarten, Cedars-Sinai Health System
Kensaku Kawamoto, University of Utah
With support from the Office of the National Coordinator (ONC), the National Academy of Medicine (NAM) convened a collaborative effort with health care leaders to better understand potential opportunities and practical strategies for improving clinical decision support (CDS) practices and adoption. Expert authorities described current and emerging CDS practices and identified collaborative opportunities to accelerate national progress in the real-time application and use of CDS to inform health and health care decision making. The Planning Committee also initiated small work-groups to address: content (CDS authoring), platform integration (technical implementation), functionality and measurement (operations), and dissemination (distribution). The project was guided by an external planning committee and is not a product of the ONC. The deliverables included NAM-facilitated working meetings; an overview summary of the discussion and observations related to the key issues; and small work-group action plans that include the key priorities for action for substantially expanded CDS adoption. The learning objectives for the panel are to: Provide an overview of the collaborative process and multi-stakeholder partnership -- composed of clinicians, academics/researchers, industry, patient advocates, and government -- that facilitated the identification and development of the project deliverables. Present the cross-cutting Priorities for Action developed at the conclusion of this work.
S24: Panel - A Proposed National Research and Development Agenda for Population Health Informatics: Case Studies and Future Directions
Hadi Kharrazi, Johns Hopkins School of Public Health
Steve Fihn, Department of Veterans Affairs
William Yasnoff, National Health Information Infrastructure (NHII)
Bharat Sutariya, Cerner Corporation
Jonathan Weiner, Johns Hopkins School of Public Health
Aneel Advani, Global Virtual Group
Population Health Informatics (PopHI) is a growing field and has received major attention due its key role in value-based care and pay-for-performance policies such as ACO, PCMH, and MACRA. This panel will review the published national research and development agenda for PopHI (doi: 10.1093/jamia/ocv210), and provide case studies of recent advancements in PopHI at the Veterans Health Administration, the Johns Hopkins University, the Health Record Banking Alliance, and the Cerner initiatives. The panel will discuss the existing gaps and provide insight on future opportunities in PopHI.
- Why do you need the roles and how do they work together?
- What unique skills does each role bring to the collaboration?
- Since not all organizations have these positions (yet), how have the positions/roles evolved? What happens when there is no one with the title/job description?
- What challenges/scenarios demand this collaboration?
- What is one example where the triad collaboration/leadership anticipated or addressed system issues?
- What are the benefits of CMIO-CNIO-CIO triad – any drawbacks?
- When and how do ever they work completely apart? When and how do they work together on shared issues? And, how do they interact with members of each other’s respective teams?