Alistair Erskine, MD
AMIA is important to me because
It advances the science of informatics across healthcare in an organized way because it brings the community of brilliant people to share ideas in a non-denominational way. It doesn’t matter if I’m talking to somebody who is using EPIC or Cerner, or Athena, or Meditech. We all share with each other. Because AMIA serves as a means to match the supply of mentors to the demand of people who are entering the field, it serves as an educational resource for people at all levels, including certification for the Clinical Informatics Fellowship, and for certification programs.
I am involved with AMIA
I am involved with AMIA to the extent that next week I am going to Congress to a hearing organized by AMIA to speak with senators and representatives about the impact on the most recent FHIR APIs. Recently, Apple made an announcement about how they are putting the health record on the iPhone so now, if you happen to be in a hospital, and there are about 50 hospital systems now that have signed up, they can pull your medical records onto your iPhone, and the reason that’s helpful is because people have had a hard time getting their medical record from hospitals. It usually involves going to the basement of the hospital and getting a CD-ROM or a stack of paper. So, Apple’s approach may be a much more efficient process. FHIR is an open standard that lets systems like EPIC communicate with patients more directly in terms of pulling their information. I’m contributing to AMIA by virtue of the fact that I am able to testify to the value that FHIR has brought and has the potential to bring to the community. Obviously, we also contribute to AMIA by hosting our Clinical Informatics Fellowship program (we were amongst the list of the first 10 programs in the U.S.). We host at the AMIA meetings, get togethers of all the clinical informatics fellows so they can share information amongst each other. That’s the second way. I also have journal club discussions on the articles that come out in JAMIA.
Primarily because of a desire to help larger number of patients at once. I practiced as an internal medicine and pediatric hospitalist and found that the majority of my time was spent not taking care of the patient but doing other things, including using the electronic health record. So, I was under the impression that there was an opportunity, and actually, what I found when I started to get into it, what was missing was not people with technical knowledge that needed more technical knowledge, what was missing was very simply a concept of how you actually take care of patients. The CIO’s team needed people with a reasonable understanding of how things actually work at the point of care. I found providing feedback and prioritizing projects towards applications or functionality that were going to add value back in terms of the quality of care that could be delivered to the patient, the experience the patient would have with the clinical or the cost that would be incurred if we didn’t do things the right way. Taking those values and embedding that into the strategy and the road map so that IT, over time, would end up being helpful.
How do I describe my work to those outside the field
I describe it primarily as a translator between the clinical and research enterprise, and information technology. In other words, taken what people need, or recognizing what is needed on the business side and convert these needs into IT specifications that are compatible with the way that IT organizations function, as a bridge between the two.
I installed an EMR in a resident clinic called “Logician” in 2000, as a resident. In 2004, I took on the Virginia Commonwealth University’s first CMIO role in 2005, so I suppose I have been a formal appointed informaticians for 13 years at this point. I have installed EHRs in the U.S. and the Middle East. My most recent experience has been with Geisinger Health in Danville, Penn., a long time user of Epic (since 1995).
What are your ambitions? At the end of your career, what do you hope to have accomplished?
I really enjoying teaching and trying to turn young minds to things that they see the potential and can grow, become into their own people. I think what I’d like to accomplish at the end of my career is contributing to the science of service delivery using technology not just for technology’s sake but when appropriately applied. I also think that I want to get out of the pure transactional system and focus on the data layer and the artificial intelligence layer. The transactional systems, be they the electronic health record, or a PACS system, or a customer relations management system, those transaction, things that the users are trained up typing in to a keyboard and looking at a screen for, all that digitization of the health care transaction, which has to some extent been accomplished with the advent of American Recovery and Reinvestment Act (ARRA) and HITECH. I realized that all of this would be great for the transactions of health care. I don’t think everybody understood the value of the secondary use of the data that would be generated from these transactions. So, while it was important to go paperless and to make it so an order would enjoy clinical decision support, all the associated digital exhaust has turned out to be incredibly valuable to provide additional insight and to create models that are more prescriptive, in terms of what the next best thing is to do. So, I can use now historical information that was gathered by people who were entering dutifully into the EMR and I could use that to create models and “bots” that can inform us. For example, when a patient is likely to develop a stroke before they do so, and engineer a series of interventions to prevent them from developing a stroke, never mind treating them when they’ve had a stroke. The better thing is to prevent it before it occurs. That requires not only tailored approaches, individualized approaches that scale on disease conditions; it also requires a commitment to population health but broadly more than just in terms of the people that are seen at a particular health system, but also the people who are on the panel at that system’s provider list but don’t even come into the hospital. These people need our help but are often outside of our line of sight until they get sicker. And then I would say it also involves clearly a deep partnership with the public health initiatives, obesity, smoking, and opioids, and so on.
Who or what are your “key sources” in the informatics field?
AMIA clearly serves as a foundational core. The Journal, the leadership, the efficacy I would say is clearly one. Two would be a community of informaticians who aren’t just physicians, so we have meetings and events that serve as soundboards to ideas, but also across informatician disciplines, meaning those who are more involved on the nursing side, those who are more involved on the education side, or those who are more involved in the bioinformatics research side. I think there are different players in that community who don’t always get together but actually share similar skills and capabilities. Third, which is very helpful is the entrepreneurial venture capital community. These are the horizon scanners of new Health IT. They serve as a tremendously interesting set of imaginative, sometimes unsuccessful, sometimes creative approach to solving problems that are either being solved inside healthcare, or even sometimes more importantly that come from outside the healthcare system, so mentalities of technologies that will work in other industries that try to be applied to the healthcare space, sometimes not successfully but that ends up being a third important contributor. And I think the last one would be life sciences companies, like EHR and pharma and biotech, that have successful business entities, with working business models that have a long history. So obviously a major source of support comes from EPIC, or comes from Cerner, comes from Medtronics or comes from GSK, or Pfizer or Merck. I think they are all trying to contribute and have done so successfully into the space.
Articles that spotlight my research interest
- Erskine, Alistair. Geisinger’s Dr. Alistair Erskine shares 5 elements of Apple’s Health records app. Beckers Hospital Review; 2018 February 13.
- Erskine A, Karunakaran B, Slotkin J, Feinberg D. How Geisinger Health System Uses Big Data to Save Lives. Harvard Business Review; 2016 Dec 15.
- Andrea T. Feinberg AT, Jonathan R. Slotkin JR, Allison Hess A, Erskine A. How Geisinger Treats Diabetes by Giving Away Free, Healthy Food. Harvard Business Review; 2017 Oct 15.
- Erskine A, Wendling C, Feinberg D, Slotkin J. Why this Health System Offers Refunds to Dissatisfied Patients. Harvard Business Review; 2016 Nov 16.
- Bowman, D. Geisinger’s Alistair Erskine: How we’re using FHIR to create EHR-agnostic applications. Fierce Healthcare; 2015 Oct 23.
- Graf T, Erskine A, Steele G. Leveraging Data to Systematically Improve Care: Coronary Artery Disease Management at Geisinger. J Amb Care Mgmt 2014;37:199-205.
- Banas C, Erskine A, Retchin SM. Phased Implementation of Electronic Health Records Through an Office of Clinical Transformation. J Am Med Inform Assoc; 2011;18:721-725.
Hobbies/Interests outside AMIA
I have two main hobbies. One is very specifically gardening but as it pertains to flowering vines. In central Pennsylvania, you’re at a certain latitude that limits the number of vines that will actually survive the winter months. My hobby is on weekends when I can entirely detach from technology, my phone, and anything else and dig my hands deep into the dirt of pots, soil, and fertilizer, and basically take care of gardenias and clematis and wisterias and roses – that’s how I unwind and get back to nature within the miracle of growth, even within the plant world. The second key hobby is sailing. I lived on a sailboat when I was in residency and one could say it’s similar to gardening by virtue of the fact that it takes you back to nature in the form of water. So just the beauty of water and the humility you have to stand in front of a storm or squall or big blue ocean. The need for redundancy on a boat, in terms of being able to make sure the systems are up 100 percent and operational, comparable to informatics. And, also the fact that you have to be a carpenter, you have to be able to work on a diesel engine, you have to be a cook and be a navigator, all of which requires a lot of different skills which you get to hone. And a community of people who are around you and teaching you and helping you come up to speed on those skills, which is really nice.
It may surprise people to know
I lived in a museum as a kid; I was taken care of by a village of people in the Pyrenees when I was 14; I worked at Taco Bell when I was a sophomore in high school, and I lived on a sailboat when I was a medical resident.