AMIA 2021 Virtual Clinical Informatics Conference Panels

11:30 a.m. – 12:30 p.m.

A. McCoy, N. Patel, S. Nelson, A. Wright, Vanderbilt University Medical Center; A. Wright, Vanderbilt University Medical Center

The Vanderbilt Clinical Informatics Center (VCLIC) established the Clickbusters initiative to improve safety and quality and reduce burnout through optimization of Vanderbilt’s electronic health record. Through this initiative, 31 participants identified 84 alerts to review and improved 52 alerts, resulting in a total of 71,227 clicks busted. This panel includes both leaders and participants in the Clickbusters program. Panelists will introduce the Clickbusters initiative and then then describe their perspectives leading and participating in the program.

J. Hales, Intermountain Healthcare; C. Ivory, Vanderbilt University Medical Center; P. Charney, University of North Georgia; A. Valenta, University of Illinois at Chicago; C. Earhart, AMIA

During this panel session, members of the AMIA Health Informatics Certification Commission (HICC) will describe the AMIA Health Informatics Certification (AHIC) eligibility criteria, exam structure, and recertification requirements; outline how health informatics professionals can become part of the first class of AHIC diplomates; and respond to questions about the inaugural AHIC examination.

R. Uy, J. Skapik, National Association of Community Health Centers; J. Ballard, American College of Obstetricians and Gynecologists; L. Masinter, AllianceChicago; M. Whitt, A. Overholser, Oregon Community Health Information Network

No women’s health specific data elements are included in federal interoperability standards. This issue is further compounded by the fact that there are regulatory loopholes that exempt women’s health content from interoperability support, such as implantable devices like intrauterine devices for contraception. This panel aims to discuss the emerging importance of data elements, classes and terminology in the context of women’s health to support interoperability within and outside healthcare organizations that focus on obstetrics, gynecology, family planning and other related specialties. Timely discussion of the difficulty in extracting and aggregating women’s health data elements across community health centers, health center-controlled networks and primary care associations, which adversely affects the coordination and transitions of care in the prenatal, delivery, and post-partum periods is needed as the second version of the United States Core Data for Interoperability (USCDI) for the year 2021 is currently being drafted and discussed by the Office of the National Coordinator for Health Information Technology (ONC).

Motivated by the importance of having a data class or common data elements encompassing women’s health from the perspective of obstetricians, gynecologists and primary care physicians, this panel aims to spread awareness and engage the clinical informatics community to support interoperability and inclusion of women’s health data elements in policy and health IT infrastructure. This will allow women, especially those who are pregnant, have pertinent OBGYN data be interoperable in various use cases such as bridging the data gap between community health centers, ambulatory care, birthing centers and delivery rooms in hospitals, allowing access to pregnancy and women’s health data at the point-of-care.

1:00 p.m. – 2:00 p.m.

S. Rossetti, Columbia University; S. Rosenbloom, K. Johnson, Vanderbilt University Medical Center; K. Cato, Columbia University Irving Medical Center; J. Murphy, Consultant; D. Detmer, University of Virginia

The 25 by 5: Symposium to Reduce Documentation Burden on U.S. Clinicians by 75% by 2025 was held over six sessions in January and February 2021. The overall goal of the symposium goal was to establish strategies and approaches to reduce clinician documentation burden on U.S. clinicians to 25% by 2025. This panel will report-out on overall themes and specific calls for actions from the 25x5 Symposium. We will discuss the collaborative and actionable pathways identified during the Symposium to further the mission of reducing clinician documentation burden. By raising awareness of the outputs, action items, and initiatives that result from this symposium series we hope to continue and grow these efforts. After attending this panel individuals will be aware of the immediate, medium term and long-term calls to action and opportunities to become involved.

F. Reza, U.S. Centers for Disease Control and Prevention; L. Smith, Physician’s Computer Co; R. Warner, Union Pediatrics, PSC, American Academy of Pediatrics, River Valley Pediatrics Board of Trustees; J. Vallero, Sutter Health; K. Beagle, Deloitte Consulting, LLP.

From 2010 to 2017, CDC conducted demonstration projects to assess the effects of using 2D barcodes on vaccine products and 2D barcode scanning technologies in clinical settings on data quality and staff experience. Scanning 2D barcodes as a form of richer, higher fidelity data entry and validation was demonstrated to be beneficial in routine and mass vaccination scenarios. These benefits included reducing time and effort spent on data entry and validation, improving accuracy of information stored and propagated through health information systems, and ultimately increasing the efficiency of the vaccination and documentation process.

Since then, vaccine manufacturers are applying 2D barcodes to more vaccine products, with 82 having 2D barcodes on the unit-of-use (e.g., vials, syringes) as of December 2020, compared to eight in 2013. Similarly, electronic medical record (EMR) system vendors are adding further functionalities for 2D barcode scanning-based data entry and validation. Clinicians are implementing and optimizing scanning workflows in their informatics workspaces to increase efficiency and leverage verification and clinical decision support tools.

This interactive panel of CDC project personnel, clinicians, and EMR system vendors will present vaccine 2D barcode scanning innovations and experiences to enable attendees to explore opportunities, and overcome barriers, to implementation and optimization.

U. Backonja, University of Washington, Tacoma; B. Bednarski, UCLA; E. Weber, Icahn School of Medicine at Mount Sinai; S. Airan-Javia, University of Pennsylvania

Health disparities in The United States are pervasive and must be addressed. Efforts to ensure diversity, equity, and inclusion (DEI) in all clinical informatics projects are a necessary step towards addressing this problem. In a special series, AMIA VCIC presents two panels to provide insights into clinical informatics projects aimed at addressing DEI issues. Presenters will answer three main DEI questions: 1) Why did they start their DEI work? 2) What was the work they did? 3) What impact is their work having, or are they hoping it will have? Additionally, the presentations are focused on providing information for applied clinical informaticists that can be taken back and applied in attendees’ local settings.

2:30 p.m. – 3:30 p.m.

D. van Leeuwen, Health Hats; E. Lomotan, AHRQ; M. Mittelman, American Living Organ Donor Fund; L. Fabian, MITRE

Partnerships among patients, families, caregivers, and clinicians are critical to helping patients lead their best lives given their specific genetics, conditions, circumstances, and the environments in which they live and work. These partnerships extend to the development of health information technology, including clinical decision support (CDS). Patient perspective is important not only for patient-facing applications but for provider-facing applications, especially those intended to support shared decision-making. This panel features two patient activists participating in projects funded by the Agency for Healthcare Research and Quality who will describe models for including patients and caregivers in healthcare delivery, research, and business. Project leads will describe patient partnerships thus far and provide examples of impact. The panel will encourage audience participation, particularly by soliciting ideas and sharing experiences of how to scale patient-led input and co-design of CDS.

E. Orenstein, Emory University School of Medicine, Children’s Healthcare of Atlanta, Inc.; J. Chaparro, Nationwide Children’s Hospital; P. Hagedorn, Cincinnati Children’s Hospital Medical Center; N. Muthu, The Children’s Hospital of Philadelphia; E. Kirkendall, Wake Forest University School of Medicine

While many electronic health record (EHR) alerts have improved patient outcomes, a systematic review found that computerized alerts improved adherence to the intended care process by a median of only 4.2%. Providers override the recommended action in up to 95% of EHR alerts. Routinely overriding alerts habituates providers into ignoring. However, alert burden metrics have not been fully standardized, benchmarks are unknown, and as such, alert burden across institutions and care settings remains unknown. In this didactic panel, we will (1) discuss benefits and challenges in developing a pediatric learning collaborative for clinical decision support benchmarking and sharing of best practices (2) describe the strengths and weaknesses of different approaches to alert burden measurement, (3) demonstrate how alert prioritization can inform quality improvement initiatives to reduce alert burden, (4) examine unique measurement challenges for non-EHR alerts such as phone calls and text messages, and (5) discuss strategies for linking alert burden analytics to governance strategies that facilitate improvement.

A. Chung, University of North Carolina, Chapel Hill; F. Shaya, University of Maryland Schools of Pharmacy & Medicine; R. Jelinek, Hennepin County Medical Center; K. Cato, Columbia University School of Nursing

Health disparities in The United States are pervasive and must be addressed. Efforts to ensure diversity, equity, and inclusion (DEI) in all clinical informatics projects are a necessary step towards addressing this problem. In a special series, AMIA VCIC presents two panels to provide insights into clinical informatics projects aimed at addressing DEI issues. Presenters will answer three main DEI questions: 1) Why did they start their DEI work? 2) What was the work they did? 3) What impact is their work having, or are they hoping it will have? Additionally, the presentations are focused on providing information for applied clinical informaticists that can be taken back and applied in attendees’ local settings.

10:00 a.m. – 11:00 a.m.

J. Kodish-Wachs, Vizient, Inc.; R. Perkins, Moffitt Cancer Center; J. Manning, Atrium Health; C. Sarabu,, Stanford Medicine; R. Leviton, New York City Health and Hospitals Corporation

The attendee will be able to present and justify the value of their role as a physician informatician to their employer. You will be able to identify key variables of importance to employers, how to quantitatively and qualitatively describe those variables, and tell the story to support a physician informatician salary to your organization.

Physician informatician is a relatively new role that is not yet fully recognized in the workforce. Anecdotally, many physician informaticians express challenges in trying to explain and justify to their employer the need for their expertise. Many struggle to not only justify the value of their work, but also to clearly differentiate between a physician informatician and a physician subject matter expert or between a physician informatician and a nurse informatician. Thus, the burden for justifying salary and roles that support physician informaticians land on each individual. This panel will be the first of its kind to share individual experiences and formulate best practices in describing the business value of the physician informatician. Discussions will incorporate suggestions from the audience on identification of missing perspectives, and suggestions on how CICOP can utilize this information to further support physician informaticians in their role.

K. Cato, Columbia University; P. Dykes, M. Kang, Harvard University; S. Rossetti, Columbia University

Our team implemented a machine learning-based clinical decision support system during the first COVID surge in the spring of 2020. We were able to really on established implementation principles and impromptu modifications of user-design and simulation testing to overcome the myriad of pandemic induced challenges. Also, we were able to quickly pivot our modeling approach to support the operational and clinical needs of the health system. For example, we built a machine learning-based system to hourly track the changing level of care of beds. Our lessons learned can be applied to other use cases.

11:30 a.m. – 12:30 p.m.

A. Wright, Vanderbilt University Medical Center; G. Zuccotti, Brigham and Women’s Hospital, Harvard Medical School, Mass General Brigham, Inc.; N. Pageler, Stanford Children’s Health; C. Longhurst, University of California San Diego; P. Sengstack, Vanderbilt University

Clinical informaticians in academic medical centers often straddle two worlds: an academic informatics world, where grants and papers reign, and an operational world of projects, governance, budgets and metrics – on top of this, they may also have clinical and teaching responsibilities in their organizations. To add to the complexity, some informaticians may do entirely academic work, others only operations, and many will do both in various combinations.

A key challenge for these institutions is supporting both academic and operational informatics work, encouraging collaboration and avoiding siloes and conflicts, while also creating opportunities for professional growth, advancement and recognition.

In this panel, we present the experience of several academic medical centers who have had success bridging academic and operational informatics. They are geographically diverse, and their approaches and experiences differ, but all have navigated similar questions, and will share their lessons on issues like support for research, system and data access, evaluation, dissemination, training and faculty appointments and promotion.

J. Roski, Booz Allen Hamilton, Inc; M. Abramoff, The University of Iowa Hospitals and Clinics Department of Pathology; M. Matheny, Vanderbilt University Medical Center; I. Cohen, Harvard Law School

Expectations are high for AI technologies to address health challenges. However, there have been prior periods of enthusiasm about AI followed by periods of disillusionment, known as AI Winters. We are currently at risk of another AI Winter due to many AI solutions not meeting expectations and subsequent lack of trust in AI. The panelists will discuss policy options and approaches to promote and maintain trust in AI solutions. Specifically, the panelists will discuss specific AI risks and mitigation techniques and how greater industry self-governance could help avoid another AI winter, including through verified implementation of risk mitigation practices (certification/ accreditation).

P. Dykes, Brigham & Women’s Hospital; S. Rosenbloom, Vanderbilt University; W. Brown, University of California San Diego; G. Purcell Jackson, IBM Watson Health; Vanderbilt University; T. Bright, IBM Watson Health

In June 2020, the American Medical Informatics Association (AMIA) Board of Directors unanimously approved the creation of the AMIA Diversity, Equity, and Inclusion (DEI) Task Force to advise AMIA on specific, actionable steps to further address matters of racial diversity, equity and inclusion. A diverse Board of Directors is central to advancing DEI in AMIA. In this session, current Directors will discuss the importance of a diverse Board for AMIA, what Board service entails, and the Board self-nomination process. Several Board members will also share their personal paths to Board membership to encourage a broad range of AMIA members to self-nominate for the Board. This session will also include discussion with conference participants about Board diversity.

1:00 p.m. – 2:00 p.m.

J. Serrao, J. Zaleski, Capsule Technologies

Mechanically ventilated patients often require suctioning or checks to ensure occlusions or unintentional disconnects have not occurred. Indicators of potential problems are illustrated in the form of medical device alarms, but many of these alarms are non-actionable. This analysis describes an interim assessment showcasing how the use of a newly coined peak inspiratory pressure index (PIPI) compared against the Rapid Shallow Breathing Index (RSBI), an established measure of vent weaning and extubation management. Computing the ratio of peak inspiratory pressure (PIP) to expired tidal volume (VTe), PIPI can serve as a metric for emergent intervention in mechanically ventilated patients due to its strong positive correlation with RSBI. The novel index also paves the path for a new combinatory synthetic alert addressing not only PIP but VTe as well.

A. Dennis, K. Chaney, U.S. Department of Health and Human Services; R. Milius, Be the Match Foundation; M. Murugan, Baylor College of Medicine; R. Freimuth, Mayo Clinic Minnesota

Genomic data sharing is critical to the Precision Medicine Initiative (PMI) and advancement of genetic medicine and research. Launched in 2016, Sync for Genes aims to standardize the sharing of genomic information between laboratories, providers, patients, and researchers. Its first two phases advanced the Health Level Seven International (HL7®) Fast Healthcare Interoperability Resources (FHIR®) Clinical Genomics profile and involved demonstrations of foundational versions of the HL7® FHIR® Clinical Genomics Implementation Guide (IG) with goals of bringing genomics data to the point of care and research. The third phase of Sync for Genes, which concluded in 2020, expanded participation and refinement of the HL7® FHIR® Clinical Genomics IG to include demonstration projects with genetics testing laboratories, as the primary producers of genomics testing results. This panel will share results and findings from Phase 3 of the Sync for Genes project, discussing semantic representation, translation tools, and complexities within genomics reports that need to be addressed to enable use of of FHIR to exchange genomics results with electronic health records (EHRs) and other health information technology (IT) systems used by providers and researchers. The discussion will explore interoperability advancements, opportunities, and challenges as genomics data continues to become more complex and specialized.

2:30 p.m. – 3:30 p.m.

J. Lee, Nationwide Children’s Hospital, The Ohio State University; R. deMayo, Connecticut Children’s Medical Center, University of Connecticut School of Medicine; A. Chandawarkar, Nationwide Children’s Hospital, The Ohio State University; A. Heggland, Connecticut Children’s Medical Center

The COVID-19 pandemic created opportunities and imperatives to introduce and expand telehealth technologies as quickly as possible. Starting in the spring of 2020, health services across the US were swiftly transformed to virtual care delivery, often within a few days to weeks, encouraged by federal and state emergency actions. Informatics teams are now turning their attention to optimizing these rapidly implemented platforms and processes to more successfully serve providers and patients. Data-driven approaches and evidence-based best practices are needed to support telemedicine program evaluation and enhancement. A brief provider survey was developed by a collaborative group of children’s hospitals with intent to inform organizational strategic plans for improving provider and patient telemedicine experience. This panel includes a CMIO and members with clinical expertise in primary care, subspecialty consult and procedural care, and emergency medicine and discussion will consider the implementation and optimization of telemedicine at two academic centers including successes and ongoing opportunities.

A. Pullman, Brigham and Women’s Hospital; A. Syrowatka, P. Dykes, Brigham and Women’s Hospital, Harvard Medical School; M. Sainlaire, Brigham and Women’s Hospital; J. Malinowski, Cerner

The Centers for Medicare and Medicaid Services (CMS) annually report on various healthcare performance measures. There are many factors influencing performance, and it is often left to hospital administrators and providers to determine how to improve practice at the local level. The development and implementation of electronic clinical quality measures (eCQMs) offer new opportunities to address this gap. The purpose of this interactive panel is to engage participants in a range of key topics and share lessons learned from the design and development of an electronic health record (EHR)-integrated rapid report tool and discuss its potential value to improve care at the local level. This approach provides clinicians with a snapshot of their performance compared with peers and the health system overall creating an opportunity to modify their practice to improve the quality and safety of care as well as their eCQM performance prior to submitting the results to CMS. Attendees will learn about how to develop and use informatics tools to deconstruct the results of eCQMs based on information stored in their local EHR to provide tailored feedback to healthcare providers on how to improve care for their patients.

J. Boehne, Careloop; B. Rockwell,; E. Sezgin, Nationwide Children’s Hospital; A. Wallace, The University of Utah College of Nursing; M. Austin, The University of Texas Health Science Center at Houston; F. Gross, Careloop

The 2020 AHRQ Digital Solutions to Support Care Transitions Challenge invited participating teams to propose and develop demonstrations of interoperable health information technology (HIT) solutions to engage patients and caregivers for safe care transitions from hospital-to-home. Teams were asked to address the information sharing needs and burdens for patients with multiple comorbidities, low health literacy and limited English language proficiency.

We are fortunate to have all five finalists from this challenge participate in this submission and share their experiences designing innovative ways to facilitate transitions in care. Panelists will discuss their team’s solution to the challenge, including design and development challenges and key learnings. Common approaches among teams include iterative person-centered and participatory design approaches; transition from in-person to virtual design sessions; diverse stakeholder collaboration and engagement; use of open APIs and interoperable system architecture; and recognition of the importance of medication management, reconciliation, and adherence. Teams focused on patient populations ranging from neonatal to adults and their solutions offer unique insight into providing safe and effective transitions of care utilizing a wide range of technology solutions including apps, discharge communication pathways, virtual visits, personal health navigators, digital assistants, and tool kits.

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