Current Affiliation: Associate CMIO, University of Pennsylvania Health System; Associate Professor of Clinical Medicine, Perelman School of Medicine at the University of Pennsylvania
MD, Penn State College of Medicine
BA, English, Cornell University
Board Certified in Internal Medicine and Clinical Informatics
Certified Epic Physician Builder
How do I describe my work to those outside the field …?
I work as an associate Chief Medical Information Officer (CMIO) at a large health system, reporting to the CMIO. My job is to lead and manage change. Often, people are surprised when I tell them that my work is more about negotiations with people, about their needs, desires, concerns, expectations, than about technology. I help to develop strategies for how our organization should proceed with regard to using and maintaining health information technology. I am part of a team responsible for helping to shepherd the development of enhancements in the health information technology to solve problems. For example, if the state passes a law requiring that hospitals screen patients for a certain disease, I am one of the people who needs to figure out how to meet that requirement. What is our approach as an organization? Do we need to build an alert or other tool in the electronic health record? Who is going to get that alert, what should the criteria be for triggering the alert, and how do we guide clinicians to do the right thing for their patients?
Years of experience:
I have been working in clinical informatics since 2010.
At the prior hospital where I was working, that hospital had migrated from one lab system to another, and I had an experience that first introduced me to informatics. To illustrate what happened, it was a Monday and I reviewed blood culture results in the computer for one of my patients. The blood culture report said four out of four blood culture bottles were positive for Gram positive cocci in clusters. As a clinician I knew exactly what that meant. I knew that indicated a bloodstream infection, clear and simple. And then the next day, Tuesday, the lab system had changed and I looked at a new blood culture result for a patient, and the results were reported in the computer as “blood culture positive.” And I panicked because I had no idea what that meant. I didn’t have the detailed information I needed to make a decision for my patient. The blood culture was missing the nuances of the blood culture results I had had on Monday. Was one bottle positive? Four bottles? What kind of bacteria was growing from the blood culture? I could not tell if that result represented a true bloodstream infection or contamination. I felt like I was blindfolded to the actual blood culture results. So I called the microbiology lab and they said, “Well, gee, you’re the first person to report this as a problem.” Not even the infectious disease physicians had recognized it. Ultimately, the display of blood culture information was corrected. It was really an eye opener about how important it is to display clinical information to clinicians in the right way. I came to recognize that changes in systems and technology can have a profound impact on the ability of clinicians to care for patients.
What are your ambitions? At the end of your career, what do you hope to have accomplished?
Have I helped to raise all boats in terms of the quality of information that clinicians have to make decisions? I am interested in how we scale successful informatics solutions beyond the leading institutions and groups that may develop them, so that a rural hospital in Nebraska would have access to the same quality medical informatics resources, such as clinical decision support tools, as an academic center in Boston. That way we can increase the potential that all patients, no matter where they live, can receive high quality care. Have I helped to share the expertise that we have as an informatics community? Have we made it easier for clinicians to do the right thing in taking care of patients? These are some of the things I would hope to achieve at the end of my career.
Who or what are your “key sources” in the informatics field?
AMIA meetings, notably the Clinical Informatics Conference and the Annual Symposium. JAMIA and Applied Clinical Informatics. What is interesting to me is that even journals that are outside of the informatics field, such as the Annals of Internal Medicine and the Journal of the American Medical Association, are publishing more in the way of informatics articles. So, we’re seeing more articles about informatics-related topics in the journals that are not exclusively dedicated to informatics, which I think is a recognition of how critical health informatics is, not only to our own field but to the future of medicine in general. And last but not least, AMIA colleagues are certainly a great source of information and mentorship.
Articles that spotlight my research interest …
- Amato MG; Salazar A, Hickman TT, Quist AJ, Volk LA, Wright A, McEvoy D, Galanter WL, Koppel R, Loudin B, Adelman J, McGreevey JD 3rd, Smith DH, Bates DW, Schiff GD. Computerized prescriber order entry-related patient safety reports: Analysis of 2522 medication errors. Journal of the American Medical Informatics Association. 24(2):316-322, 2017 03
- Unexpected drawbacks of electronic order sets. AHRQ Web M&M. November 2016. Available at: https://psnet.ahrq.gov/webmm/case/390.
- McGreevey JD 3rd. Order sets in electronic health records: Principles of good practice. Chest. 143(1): 228-235, 2013
Hobbies/Interests outside AMIA...
When I have time, I enjoy photography and playing guitar. I’m taking lessons in both. I also love to travel.
AMIA is important to me because ...
It is my professional home in health informatics. AMIA is the gravitational center for all things related to health informatics, where all of the leading practitioners and scholars meet to envision a future greater than what they can achieve independently. I would like to think that we share a common vision for the future, one in which health informatics optimizes the experiences of patients, families, and clinicians, and improves human health.
I am involved with AMIA ...
I served two terms on the Public Policy Committee. I was also a member of the Scientific Program Committee for the Annual Symposium in 2018 and a member of the Program Committee for the Clinical Informatics Conference in 2019. This past spring, I was inducted into the inaugural class of Fellows of AMIA (FAMIA).
It may surprise people to know ...
My senior thesis in college was about the early experiences of human beings with technology in the 19th century, particularly their experience with steam engine trains, as described in two novels: La Bete Humaine, by Emile Zola, and The Octopus, by Frank Norris. It was striking to me to consider a time when train travel was foreign and anxiety provoking, frightening, even violent, and how it distorted widely held notions about time, space and travel. I didn’t know it at the time of course, but it’s interesting to me that my work now involves managing human interactions with 20th and 21st century technology, such as electronic health records. Some of these reactions to technology still apply today.
After college, I moved to Paris without a job or a place to live. Soon after I arrived, one of the longest strikes in French history occurred, and there were no subways, trains, or buses available to get around; bicycles and skateboards were all rented out. For several weeks I lived in a tiny one-star hotel room and ended up walking about two hours to a job doing medical and pharmaceutical transcription on the other side of the city. Sometimes I would take a bateau mouche, those long boats that go up and down the Seine that are usually reserved for tourists. During the strike, the city converted them into water taxis. I went through a lot of socks and shoes during that time, but I wouldn’t have traded the experience for the world.