Current Affiliation: Chief Medical Information Officer, Arkansas Children's Hospital; Professor of Pediatrics and Biomedical Informatics, University of Arkansas for Medical Sciences
BS, Biology, University of the Philippines
MD, University of the East RMM Medical Center College of Medicine, Philippines
MS, Health Informatics, University of Alabama at Birmingham
MS, Public Health in Outcomes Research, University of Alabama at Birmingham
How do I describe my work to those outside the field ...
The best way to describe what I do to people outside the field is to first tell them that I am a pediatrician and a clinical informaticist. More often than not, I would get like a blank stare and they typically respond with, “What is a clinical informacist?” I then say, “You know when you go to your doctor’s office or in a hospital, you will likely notice that computers are all over?” Well, Clinical Informatics is a new medical subspecialty that applies information, communications and computer science to the practice of medicine. My job is to make sure that the patients and their families, as well as the care delivery team, have access to the right information at the right time so they all can make the best decision that leads to better health. For example, I work with the clinical team to figure out that best way to improve the care of the patient and then I translate this information to the software developers, computer programmers and vice versa, ultimately making sure that the care delivery team can improve what they do with the help of information and communications technology.
Years of experience:
I have been a practicing pediatrician for 23 years and a clinical informaticist for about 19 years.
Well, my motivation and curiosity with informatics started in 1998, when I was practicing community pediatrics in a small town in South Carolina. About the third year into my clinical practice, I got involved in a hospital-led quality improvement effort. I got hooked to this very simple idea that healthcare can be improved, and that measurement is vital when one wants to improve something. I thought that this made sense and that there is a method upon which one can follow to improve what I do and become a better physician for my patients. That led me to start a few quality improvement efforts in my clinic. I realized that in order to improve quality and safety, the right structural components needed to be in place so that it could support the processes that ultimately lead to better outcomes. It did not take a while for me to learn that healthcare information technology is an important aspect of quality improvement – you know, from improving clinical workflows, to efficiency in documentation, clinical decision support, and most importantly – data and analytics! I learned to code and started augmenting my paper medical records with basic database tools. It is through this process of building software that supports quality improvement that led me to learn about medical informatics. I enrolled myself in a certificate program in Medical Informatics with Bill Hersh at Oregon Health & Science University and after that, I was so hungry to learn more about this emerging science that I started planning a career shift. Eventually, I landed in the University of Alabama at Birmingham (UAB) in 2000, because 1) there was a maturing master’s degree in health informatics program at UAB, 2) I could continue seeing patients in the Children’s Hospital of Alabama and 3) I learned that the Children’s Hospital is in the process of implementing an electronic medical record! So, I said goodbye to my clinical practice and started my career in informatics. I became the ever-present IT doc, volunteering my services to a number of IT projects that eventually led me to having an office in the IT building. I built order sets, notes, clinical decision support tools, learned about medical logic modules, among others. To give me more sheltered time in informatics, I also applied for and was awarded an NIH-National Research Service Award Fellowship fund to further my research. I wanted to know the healthcare quality outcomes of hospitals implementing health IT. My public health degree helped me make sense of the large data sets that I was able to collect during my fellowship. Around that time, I also began contributing to standards development organizations, particularly HL7 – of which I am still active at this time. After my fellowship in 2005, I was hired as an informaticist and later became Chief of Informatics at Children’s Hospital of Alabama. I moved to St. Louis Children’s Hospital in 2010, when I became its CMIO, implementing their EMR and establishing the inaugural Washington University in St. Louis Clinical Informatics Fellowship training program in 2013. Then, I moved to Arkansas Children’s Hospital in 2016 as their CMIO to work with the team to implement their EMR and to build up the clinical informatics capabilities. I also teach a graduate course on the Healthcare Informatics of Quality and Safety at the University of Arkansas for Medical Sciences School of Medicine clinical informatics master’s degree program. By July 2020, I will be directing the inaugural Clinical Informatics Fellowship training program across two campuses in Arkansas Children’s Hospital and the University of Arkansas for Medical Sciences School of Medicine.
What are your ambitions? At the end of your career, what do you hope to have accomplished?
I have always wanted to become the best physician that I can be. I want to see patients getting the best care possible, and that care is delivered in a timely manner, with the lowest cost and the most appropriate care. Given the complexities of 21st century medicine, I would like to see physicians like me inspired with our chosen vocation, caring for patients and their families in a way that brings joy to our daily work and that promotes a trusting and caring environment. I’d like to see a time when we physicians will have increasing accuracy and confidence with medical decision making, armed with the right information for the unique patient in front of us, tailoring the care based on the best available evidence and in an environment where technology tools are very intuitive and fund to interact with. I would like to see the science of clinical informatics grow and become so ingrained in the fiber of healthcare delivery that we see formally-trained informaticists as a vital member of the care delivery team. I’d like to see that that at the end of my career, and that is what I am working on every day to achieve, in this dream job that I have been so blessed to be in.
Who or what are your “key sources” in the informatics field?
I have several areas of interest in the field of informatics and for each area, I have a number of reasons to get excited about and several people to look up to!
For instance, for Research Informatics, I am interested in developing the cyberinfrastructure that is needed for organizations improve their ability to do clinical research. I look up to institutions like Boston Children’s, Children’s Hospital of Philadelphia, Cincinnati Children’s among others, organizations who have successfully made a formal investment on convening the right tools and skill sets that promote research and innovation. I am in the informatics of Quality Improvement and Patient Safety, just like research, I believe that the same cyberinfrastructure that supports research, can also support efforts relating the improving Quality of Care and Patient Safety. In both situations, one must be able to develop the framework of hypothesis-generating activities, discovery and data capture/storage/feedback loop mechanisms so that organizations can harness the power of digitized information and augment their organizational strengths with the cyber tools.
I am also interested in promoting and advancing the field of Clinical Informatics science, education and workforce development. I believe that CI is such a young science and we have a lot of room to grow as a specialty. That is why I founded the CI Fellowship training in Washington University in St. Louis in 2013, as well as initiated the ground work to establish the inaugural CI Fellowship program here at the University of Arkansas for Medical Sciences.
Lastly, I have a mission to understand the intersection of e-iatrogenesis. E-iatrogenesis was coined by Jonathan Weiner from Hopkins in 2006 to denote the “patient harm caused at least in part by the application of health information technology”. I have been involved locally and nationally to learn more about this phenomenon and working with other groups in this emerging field of EHR Safety Science.
Articles that spotlight my research interest ...
- Teufel RJ, Yu FB, Nakamura MM, Harper MB, Menachemi N, Factors Associated With Meaningful Use Incentives in Children's Hospitals, Pediatrics. 2015 Jun;135(6):e1409-16
- Nakamura MM, Harper MB, Castro AV, Yu FB, Jha AK. Impact of the meaningful use incentive program on electronic health record adoption by US children's hospitals. J Am Med Inform Assoc. 2015 Mar 9.
- Forrest CB, Margolis PA, Bailey LC, Marsolo K, Del Beccaro MA, Finkelstein JA, Milov DE, Vieland VJ, Wolf BA, Yu FB, Kahn MG., PEDSnet: a National Pediatric Learning Health System, J Am Med Inform Assoc. 2014 Jul-Aug;21(4):602-6.
- Yu FB, Menachemi N, Houston TK, Hospital Patient Safety Levels among Healthcare’s “Most Wired” Institutions, Journal for Healthcare Quality, 2010 March/April; 32(2):16-23
Hobbies/Interests outside AMIA ...
I am in two local bands in Little Rock, where I play the bass guitar and sing. We play in local bars, events and parties. I spend more than what I earn in those bands, but it’s all about having fun. I also ride my bicycle as weather permits and spend quality time with my 15-year-old son mountain biking local trails in the area.
AMIA is important to me because ...
AMIA is important to me because I think of it as my home. I have been involved in AMIA for a long time and I truly believe that it best represents that formalization of the field of Clinical Informatics. I feel like I am in kindred spirits when I attend the conferences, the webinars, and other events. In AMIA, I get to interact with the leaders and pioneers in the field, smart people who are movers in their organizations, people who are practicing in the trenches just like me. AMIA is important to me because it provides me with the opportunity to contribute to the emerging field.
I am involved with AMIA ...
I am contributing to AMIA in a number of ways, 1) through the CIBRC, or Clinical Informatics Board Review Course as one of Editors for the practice examination since 2012. I am also involved in the Academic Forum as one of the CI Fellowship program directors. And finally, and what a great honor and opportunity to co-chair this year’s CIC Conference in Atlanta with Ann O’Brien, who is one of the brightest people I know in nursing informatics.
It may surprise people to know ...
I also teach meditation at the hospital and the university. This is a mental hygiene practice that has helped me personally all these years and I want to share this with everyone.