AMIA 2021 Virtual Clinical Informatics Conference Workshops

Tuesday, May 18

10:30 a.m. – 12:30 p.m.

R. Kennedy, eCare Informatics; S. Hull, CareLoop; D. Womack, Oregon Health & Science University; M. Wang, Inspiren; S. Tinianov, Advocates for Collaborative Education

The COVID-19 outbreak has amplified the adoption of digital health technology and challenged the traditional boundaries of institution-centric care. The pandemic has created seismic shifts in telehealth, predictive analytics, smart applications, artificial intelligence, and other types of informatics interventions. In parallel, virtual care has rapidly evolved, supporting better health when clinicians, patients, communities, and health care systems have a reciprocal relationship whereby all stakeholders are involved in all stages of the production process (co-production). Successful solution development is contingent on ensuring that all stakeholder voices (patients, developers, vendors, payers, communities) are heard through the entire life cycle of informatics practice and solution design. The concept of co-production involves producers/developers of solutions and consumers/patients working together and sharing responsibility to create value. This workshop will introduce principles of co-production providing practical tools for successful co-design of digital health technologies and co-production of healthcare services. The content will include an overview of the science of co-production, including methods, tools, and principles of co-production as applied to the design of three technology-enabled healthcare solutions. This workshop aims to teach fundamental concepts of co-production from user engagement to implementation of digital health solutions and care delivery models.

A. Kimia, A. Landschaft, Boston Children’s Hospital Division of Emergency Medicine; C. Parsons, Boston Children’s Hospital

Mining data from medical narrative has been for many years a task limited to NLP informaticians or outsourced to commercial companies. The belief that mining text-based data in a productive way requires advanced technical skills in programming, and substantial hardware infrastructure hindered medical informatics officers engagement with NLP. In this workshop we present a software platform that brings narrative data mining to the fingertips of those that do not have these advanced technical skills and may have limited access to these technologies. This workshop will teach participants to build and train NLP models using a graphical user interface, and use a machine learning classifier to extracts clinical information from a large corpus of unstructured medical data. By completing the workshop, the participants will be able to deploy state-of-the-art machine learning workflows at their institutions using an innovative and intuitive natural language processing platform for clinicians that is called DrT (document review tools).

DrT has been developed in Boston Children’s Hospital by the instructors of this course and has resulted in more than 50 manuscripts based off the data mined with DrT. DrT has also been part of the methodology offered in federal and non-federal grants and has been deployed in other workflows such as surveillance of medical records to improve patient safety, and identification of patients that fulfil inclusion criteria for a clinical trial.

10:30 a.m. – 3:00 p.m.

L. Heermann, Intermountain Healthcare, Logica; R. Leftwich, InterSystems; J. McClay, University of Nebraska Medical Center

Beginning in 2010, HL7 created Fast Healthcare Interoperability Resources (FHIR) as a next generation standard to address clinical data interoperability. Clinicians on FHIR evolved in 2014 as an event held at each HL7 Working Group Meeting (3 times yearly) to educate clinicians about HL7 FHIR and provide feedback to the HL7 FHIR team regarding the clinical viability and usability of the FHIR standard. The latest regulations from the 21st Century Cures Act now specifies the use of FHIR in certified health information technology directly affecting clinicians. This AMIA CIC workshop will bring the Clinicians on FHIR activity to a broader clinical audience attending the AMIA 2021 Virtual Clinical Informatics Conference. The workshop is designed to educate attendees about HL7 FHIR and tools available to access, review, and provide feedback to the HL7 FHIR team regarding the evolving HL7 FHIR standard. It is also intended to make the audience aware of how of FHIR is used for innovation in their organizations. The faculty will provide lectures describing HL7 FHIR history, background, and fundamental principles. After this initial overview of FHIR, the attendees will be guided through using online tools to examine HL7 FHIR Resources (the basic building blocks of FHIR) and build FHIR Profiles (implementation guides for specific use cases). Demonstrations of existing FHIR based tools will highlight important principles.

J. Manning, Atrium Health; J. Faulkenberry, Children’s Hospital of Philadelphia Pediatrics Residency Program; L. Olson, Atrium Health; J. Nielson, Northeastern Ohio Medical University; A. Marshall, Brigham and Women’s Hospital Department of Emergency Medicine; Z. Liao, University of Washington

Informaticians are often frustrated by the poorly-designed user interfaces that fail to display the information they want to see. This workshop teaches informaticians how to harness Flutter – an open-source front-end toolkit for simultaneous iOS and Android app development – to work with FHIR data and create next generation “Best of Breed” software. During our first annual CIC workshop, attendees live-coded a mockup of the AMIA CIC app. In our second annual live-coding workshop at CIC 2020, we created a sleek symptom tracker app. To improve access to data and make apps interoperable, our team has developed a set of Flutter packages that support FHIR integration. This year’s workshop will first review the basics of FHIR, why it matters, and describe some use cases for implementing FHIR in mobile apps. We will then walk attendees through harnessing our novel tools to build an app that can securely store and transmit protected health information using the FHIR standard. This will be an interactive, guided workshop with the opportunity for questions, suggestions, and discussion throughout. The goal is to impart our audience with the skillset to build their own workflows and user interfaces via a simple and easy-to-use tool. By live-coding with other informaticians who are subject matter experts in this field, attendees of this workshop will be empowered to turn their own designs into products. To make the most of this event, it is strongly recommended to watch some introductory videos on Flutter beforehand. The prerequisites and references section contain curated lists of videos to consider. Install the software in advance and come ready to code!

S. Rehman, H. Abbaszadegan, Phoenix VA Healthcare Systems, University of Arizona College of Medicine Phoenix; P. Dykes, Harvard University, Brigham and Women’s Hospital

Great leaders are great negotiators, they resolve seemingly intractable disputes and yet enhance working relationships. Their negotiation and communication skills determine their effectiveness. Physicians and non-physician members of AMIA are expected to negotiate with a vast array of third parties, including healthcare system governing boards, leaders in the C-suites, patients, end-user consumers, government, health plans, insurance companies, EMR vendors, and pharmaceutical companies. Additionally, negotiation skills are an essential competency and requirement for board certification for physicians (ABPM and ABP), yet one may not find any session on this topic in AMIA Symposium. It is time for all informatics professionals to be trained in effective negotiation skills. Law, business, and public policy schools offer classes in negotiation. The ability to negotiate requires a collection of interpersonal and communication skills used together to bring about a desired result. It is based on exploring underlying interests and positions to bring parties together in a constructive way. Effective negotiators use innovative thinking to create lasting value and forge strong professional relationships. They take a deep dive in to what is behind the opponent and their own positions that may not seem logical at first but essential to understand the issues/ideas behind the problem.

The 4-hour highly interactive session provides evidence-based tools & interventions for identifying individual communication preferences, delivery methods, conflict resolution styles as well identifying best practices and “best alternative to a negotiated agreement” (BATNA). The interactive session involves exercises and activities that will allow the participants to discover, learn and practice the negotiation skills and tools. We will also be including data from the literature review, needs assessment, and Informatic tools that are useful in negotiation. We also have incorporated the outcome measures used in data science for success factors upon completion. The interventions/tools discussed/practiced in the workshop are evidence based and supporting data will be provided.

P. Hsueh, Bayesian Health; V. Tiase, New York Presbyterian Hospital; G. Jackson, IBM Watson Health, Vanderbilt University Medical Center; S. Saria, Bayesian Health, Johns Hopkins University

With the continued impetus to move from fee-for-service to value-based care, one major challenge is to enable the generation of real-time insights for effective response for individualized care delivery at the point of care when care teams are most likely to take actions and make impacts to reduce care variations. Recently, impactful use cases have emerged in a number of healthcare delivery scenarios to demonstrate the value of real-time insights. While many of the use cases are centered around the use of individualized insights learned from data, there has not been consensus on how best to embed data-driven insights in clinical workflow and how to better enable behavioral changes at the point of care.

The overarching goal of this workshop is to bring healthcare system leaders and the clinical informatics community together to pinpoint the challenges in the implementation of evidence in practice from case studies and to identify best practices leading to successful future implementation. The workshop will draw on real-world case studies to share lessons learned in the patient-centered design process of incorporating real-time insights in clinical workflows. The invited speakers are the leading experts in the highlighted areas: (1) Reducing care variations for value-driven care; (2) Delivering real-time insights to comprehensively care for the critically-ill; (3) Transforming patient safety. They will provide case studies to illustrate the potential impacts of real-time insights for healthcare delivery, as well as specify lessons learned, including the pros and cons of them. In the discussion, the invited experts will collaborate with workshop participants to further identify criteria and pathways to the successful adoption and continuous evaluation in current practice. Some special cases, such as how to handle critical responses under the constraints posed by the COVID-19 pandemic, will also be discussed.

1:00 p.m. – 3:00 p.m.

The global COVID-19 pandemic has brought new urgency to the drive toward devising a common framework for the development & deployment of high quality, patient centric, digital clinical measures. Multiple digital technologies for symptom tracking and contact tracing are currently in use and/or development, & clinical researchers are now designing new decentralized clinical trial strategies using telemedicine & remote patient monitoring to minimize pandemic-related disruption of the clinical research enterprise. Adoption of a comprehensive “how-to” roadmap to synthesize best practices in the digital health field is essential for guiding these efforts & safeguarding public health.

The Digital Measures Playbook (The Playbook) synthesizes best practices from the digital health field into one comprehensive “how-to” document. A first draft, built by collaborators from the Digital Medicine Society, Elektra Labs, Genentech, Koneksa, Myokardia, Sage Bionetworks, Scripps Research, and the U.S. Food and Drug Administation. The Playbook is now being advanced for broad adoption by these organizations and new collaborators from ActiGraph; Activinsights; American Pharmacists Association; BlackThorne Rx; Center for Digital Health at Brown University; Covance; Digital.Health; Duke University; Eli Lilly & Company; the European Medicines Agency; Evidation Health; Merck and Co., Inc.; Open mHealth; Pfizer; physIQ; Savvy Coop; Takeda; VivoSense; & Winterlight Labs.

The Playbook Masterclass will be delivered as an interactive workshop, providing participants with the foundational elements of developing & deploying high quality digital clinical measures that cut across use cases.

R. Schreiber, Penn State Health, Geisinger Commonwealth School of Medicine Department of Medical Education; J. Hollberg, Emory University; P. Fu, City of Hope National Medical Center, University of California Los Angeles David Geffen School of Medicine, University of California Los Angeles Jonathan and Karin Fielding School of Public Health; N. Safdar, Emory University

The 2021 CIC CMIO Workshop will focus on leadership development, including didactic and small group exercises. We will focus on successful negotiation strategies, change management processes, and interactions with other C-suite and key stakeholders within a single hospital as well as for large health systems. We will then apply the leadership and change management skills to case-based discussion of current contentious yet practical topics for CMIOs including management of EHR transitions, open notes, optimization projects, and best practices regarding confronting the Covid-19 crisis. Didactic presentations will be integrated with structured group discussions. Participants in the workshop will engage each other during the group discussions to practice the concepts and teachings from the didactic sessions.

3:30 p.m. – 5:30 p.m.

J. Herigon, Boston Children’s Hospital Department of Pediatrics, Harvard Medical School; C. Uptegraft, Defense Health Agency

This two-hour workshop will provide an introduction to the basic steps of developing clinician- and patient-facing SMART on FHIR applications. Attendees of all skill levels are invited to attend and participate, though this session will primarily focus on the basics of SMART on FHIR app development. After participating in this session, attendees will be able to create a basic functioning SMART on FHIR app and run it against a public FHIR server available via the SMART sandbox. Attendees will also be able to identify challenges and potential pitfalls when working with the FHIR standard, SMART, and vendor APIs.

S. Maviglia, R. Rocha, Harvard Medical School, Brigham and Women’s Hospital, Semedy, Inc.; D. Aronsky, Vanderbilt University Medical Center, Semedy, Inc.

Different types of healthcare organizations build increasingly large amounts of knowledge assets. These organizations are responsible for the accuracy and availability of the knowledge they produce. Inconsistent, incomplete, outdated, and inaccessible knowledge assets contribute to operational costs and create quality and safety risks. Such costs and risks are greater when knowledge management activities are reactive and ad-hoc, lack a formal content review and maintenance process, and are not aligned with business goals and strategies. This workshop will survey basic and advanced knowledge management topics, such as definitions of knowledge, data, and metadata; the knowledge lifecycle as the framework on which to build knowledge management governance and process; how to model knowledge consistently, regardless of domain; and best practices for managing relationships and dependencies and guaranteeing structural and semantic integrity of knowledge assets as they evolve. The workshop includes practical experiences, challenges, and lessons learned.

R. Jenders, Charles Drew University, University of California Los Angeles; G. Del Fiol, University of Utah; P. Haug, Intermountain Healthcare; K. Kawamoto, University of Utah; B. Rhodes, Dynamic Content Group, LLC; H. Strasberg, Wolters Kluwer Health

Clinical decision support (CDS) can help improve clinical practice and health behaviors. The use of health information technology (HIT) standards for encoding data, representing knowledge and delivering knowledge-based interventions in turn can help facilitate implementation of CDS. However, many standards from numerous standards development organizations (SDOs) exist. These are variously incorporated into vendor software, and consensus on the use of these standards is lacking. Moreover, new work in the past year on CDS standards and in related areas such as clinical quality measurement has increased the complexity of this domain. The emergence of the Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR) standard for patient data representation is particularly pertinent in light of its prominent inclusion in the 21st Century Cures Act Final Rule published recently by the Office of the National Coordinator for HIT (ONC) in the USA.

Accordingly, the leaders of this instructional workshop, who are co-chairs of the HL7 CDS and Arden Syntax Work Groups, will address two overarching educational objectives. First, attendees will learn key details of and latest developments in extant and proposed HIT standards that are applicable to CDS and which they may need to use in their work. Second, the attendees will recognize how these standards relate to one another and can be used to implement CDS that improves outcomes. Through interaction with workshop leaders, attendees will be able to contribute ideas regarding refinement and use of HIT standards to facilitate CDS.

K. Unertl, Vanderbilt University; S. Haque, RTI International

Successful implementation and use of health information technology requires attention to technical and organizational components. Organizational components include workflow, technology acceptance and sociotechnical factors, among others. Fields such as Organizational Theory and Change Management offer a substantial foundation of evidence-based guidance on how to navigate the human and organizational aspects of technology-based change. Support is needed to translate theory and concepts from multiple fields into clinical informatics practice in a way that’s accessible for organizations. The goal of this workshop is to draw from evidence in related fields to bridge the gap between theory and practice. This will be accomplished by providing participants with hands-on experience through exploration of real-world case studies and participatory exercises.

N. Fareed, P. Singh, I. Dunn, P. Jonnalagadda, C. Swoboda, The Ohio State University

Area-level measures of deprivation account for social determinants of health (SDoH) factors at the geographic level. These indices have been successfully used in other countries for resource allocation. The State of Ohio, through the Ohio Department of Medicaid, tasked researchers at the Ohio State University with the development of an area-level measure of SDoH relevant to children’s outcomes known as the Ohio Children’s Opportunity Index (COI). Further, a dashboard tool for the visualization of COI to end-users was needed. The workshop covers the following modules:

  1. Input data selection and extraction for the Ohio COI
  2. Construction of the COI: the compilation of 53 measures in eight domains to construct the COI
  3. Alternative approaches to weighting the COI: use of latent class analysis to combine the eight domains into the COI and equally-weighting all eight domains to construct the COI
  4. Visualization of COI using Tableau: visualizations to effectively present COI using Tableau
  5. Applications of COI: use cases of COI for end-users from public health agencies

The goal of our workshop is to present an approach for the development, visualization, and communication of an area-level deprivation measure that can be easily adopted by audience members to their own SDoH context and problems. Our approach, moreover, engenders a user-centered design philosophy that engages key stakeholders as co-creators of our measures and their associated tools. This approach ensures their sustained and meaningful use over time, which we will also highlight during our workshop.

M. Alexeev, Boston Children’s Hospital

If you have been interested in learning R, but haven’t taken the plunge, this is the workshop for you! In this workshop, attendees will learn to use R to create a project proposal and conduct analysis on a demo quality improvement project. Participants will be introduced to the powerful tools R offers for creating and sharing research and projects. Participants will also learn about ggplot2, a widely used plotting package in R to make beautiful graphs. While this workshop will use a quality improvement project as an example, the same techniques can be extended to many other uses such as journal articles, teaching material, and simple website creation.

Many clinical informaticians participate in quality improvement projects as either project leads or in supporting roles—helping other clinicians collect data from EHRs or implement projects within an EHR. There are many tools and guidelines for quality improvement projects, but the tools are not well-integrated into a single, comprehensive workflow of a quality improvement project. This workshop will give you a quality improvement template that you can take with you and modify to fit your needs.

Pre-workshop prerequisites are minimal: RStudio account set up, computer with internet connection and modern browser, and an optional tutorial on Markdown syntax.

No experience in R is required. The workshop will utilize a cloud service to share the materials, so you will not need to set up R on your personal computer to participate. If you are a more advanced R user, the workshop will have additional material available for you to take your skills to the next level.

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