Background-The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C v... more Background-The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965. Objective-To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. Design-Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. Subjects and Setting-Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. Intervention-Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. Main Outcomes-HCV testing; the incidence of HCV antibody positive tests was a secondary outcome.
Background: Individuals with type 2 diabetes manage complex multi-drug regimens, but nearly half ... more Background: Individuals with type 2 diabetes manage complex multi-drug regimens, but nearly half of all patients do not consistently take the dose prescribed for them, and therefore may not receive the full potential therapeutic benefit. Both patient and health system factors contribute to achieving and maintaining medication adherence. To determine if patients with type 2 diabetes who are concurrently managing other chronic conditions could improve their adherence, we devised and are testing a multifaceted, primary care-based strategy to provide health literacy-appropriate and language concordant regimen information, guidance and reminders. Objective: We are testing the effectiveness of an electronic health record (EHR) based strategy and short message service (SMS) text reminders to help patients with type 2 diabetes adhere to their medications. Methods: We are conducting a 3-arm, multi-site trial to test and compare the effectiveness of the EHR, and EHR + SMS text reminder strategies compared to usual care on medication adherence. Our goal is to enroll a total of 900 English or Spanish-speaking patients with type 2 diabetes and hemoglobin A1C value ≥7.5%. Enrolled participants will complete interviews at baseline and 3 and 6 months following their baseline interview. Conclusions: Our trial is evaluating practical, clinic-based, scalable, evidence-based solutions for patients with type 2 diabetes managing complex medication regimens. Our findings will evaluate strategies that can be implemented broadly in primary care practices, and programmed as defaults within EHRs to support appropriate medication adherence to allow the widespread implementation of those strategies.
Background: Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-... more Background: Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR) has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR) trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting. Methods: A multidisciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS) tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149) were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated) groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters) and chest x-rays (pneumonia iCPR only) between intervention and control providers. Discussion: Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidencebased practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to higher rates of utilization and EBM guided use of antibiotics and chest x-ray's in primary care.
Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and ... more Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and decisions need to be evidence based and standardized. Interventional informatics is ideally positioned to provide evidence based and standardized solutions in the enterprise (aka, the medical center) which includes all or some combination of hospital(s), hospital based-practices, enterprise owned offsite medical practices, faculty practice and a medical school. For purposes of this chapter, interventional informatics is defined as applied medical or clinical informatics with an emphasis on an active interventional role in the enterprise. A department of interventional informatics, which integrates the science of informatics into daily operations, should become a standard part of any 21st century medical center in the United States. The objectives of this chapter are to: review and summarize the promise and challenge of IT in healthcare; define healthcare IT; review the legacy of IT in healthcare; compare and contrast IT in healthcare with that of other industries; become familiar with evidence based IT: Medical informatics; differentiate medical informatics from IT in healthcare; distinguish medical, clinical, and interventional informatics; justify the need for operational departments of interventional informatics.
► clinical informatics ► professional training ► education ► physician ► general healthcare provi... more ► clinical informatics ► professional training ► education ► physician ► general healthcare providers ► training and education requirements ► health care ► accreditation and licensure ► clinical informatics fellowship
Board certified clinical informaticians provide expertise in leveraging health IT (HIT) and healt... more Board certified clinical informaticians provide expertise in leveraging health IT (HIT) and health data for patient care and quality improvement. Clinical Informatics experts possess the requisite skills and competencies to make systems-level improvements in care delivery using HIT, workflow and data analytics, knowledge acquisition, clinical decision support, data visualization, and related informatics tools. However, these physicians lack structured and sustained funding because they have no billing codes. The sustainability and growth of this new and promising medical subspecialty is threatened by outdated and inconsistent funding models that fail to support the education and professional growth of clinical informaticians. The Clinical Informatics Program Directors' Community is calling upon the Centers for Medicare and Medicaid Services to consider novel funding structures and programs through its Innovation Center for Clinical Informatics Fellowship training. Only through structural and sustained funding for Clinical Informatics fellows will be able to fully develop the potential of electronic health records to improve the quality, safety, and cost of clinical care.
Background: Older adults are at risk for inadequate emergency department (ED) pain care. Unreliev... more Background: Older adults are at risk for inadequate emergency department (ED) pain care. Unrelieved acute pain is associated with poor outcomes. Clinical decision support systems (CDSS) hold promise to improve patient care, but CDSS quality varies widely, particularly when usability evaluation is not employed. Objective: To conduct an iterative usability and redesign process of a novel geriatric abdominal pain care CDSS. We hypothesized this process would result in the creation of more usable and favorable pain care interventions. Methods: Thirteen emergency physicians familiar with the Electronic Health Record (EHR) in use at the study site were recruited. Over a 10-week period, 17 1-hour usability test sessions were conducted across 3 rounds of testing. Participants were given 3 patient scenarios and provided simulated clinical care using the EHR, while interacting with the CDSS interventions. Quantitative System Usability Scores (SUS), favorability scores and qualitative narrative feedback were collected for each session. Using a multi-step review process by an interdisciplinary team, positive and negative usability issues in effectiveness, efficiency, and satisfaction were considered, prioritized and incorporated in the iterative redesign process of the CDSS. Video analysis was used to determine the appropriateness of the CDS appearances during simulated clinical care. Results: Over the 3 rounds of usability evaluations and subsequent redesign processes, mean SUS progressively improved from 74.8 to 81.2 to 88.9; mean favorability scores improved from 3.23 to 4.29 (1 worst, 5 best). Video analysis revealed that, in the course of the iterative redesign processes, rates of physicians' acknowledgment of CDS interventions increased, however most rates of desired actions by physicians (such as more frequent pain score updates) decreased. Conclusion: The iterative usability redesign process was instrumental in improving the usability of the CDSS; if implemented in practice, it could improve geriatric pain care. The usability evaluation process led to improved acknowledgement and favorability. Incorporating usability testing when designing CDSS interventions for studies may be effective to enhance clinician use.
Background-The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C v... more Background-The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965. Objective-To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. Design-Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. Subjects and Setting-Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. Intervention-Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. Main Outcomes-HCV testing; the incidence of HCV antibody positive tests was a secondary outcome.
Introduction: The emerging operational role of the "Chief Clinical Informatics Officer" (CCIO) re... more Introduction: The emerging operational role of the "Chief Clinical Informatics Officer" (CCIO) remains heterogeneous with individuals deriving from a variety of clinical settings and backgrounds. The CCIO is defined in title, responsibility, and scope of practice by local organizations. The term encompasses the more commonly used Chief Medical Informatics Officer (CMIO) and Chief Nursing Informatics Officer (CNIO) as well as the rarely used Chief Pharmacy Informatics Officer (CPIO) and Chief Dental Informatics Officer (CDIO). Background: The American Medical Informatics Association (AMIA) identified a need to better delineate the knowledge, education, skillsets, and operational scope of the CCIO in an attempt to address the challenges surrounding the professional development and the hiring processes of CCIOs. Discussion: An AMIA task force developed knowledge, education, and operational skillset recommendations for CCIOs focusing on the common core aspect and describing individual differences based on Clinical Informatics focus. The task force concluded that while the role of the CCIO currently is diverse, a growing body of Clinical Informatics and increasing certification efforts are resulting in increased homogeneity. The task force advised that 1.) To achieve a predictable and desirable skillset, the CCIO must complete clearly defined and specified Clinical Informatics education and training. 2.) Future education and training must reflect the changing body of knowledge and must be guided by changing day-today informatics challenges. Conclusion: A better defined and specified education and skillset for all CCIO positions will motivate the CCIO workforce and empower them to perform the job of a 21st century CCIO. Formally educated and trained CCIOs will provide a competitive advantage to their respective enterprise by fully utilizing the power of Informatics science.
267 Background: Clinical information management is a burdensome process for oncology providers ow... more 267 Background: Clinical information management is a burdensome process for oncology providers owing to the complexity of modern cancer data. The results that a clinician needs to review are often spread across several areas within the EHR, making it cumbersome to sense a broad overview of patient status. The purpose of this study is to describe a framework for oncologist-driven development of a data visualization tool to trend cancer biomarkers and assess the feasibility of this tool to query and display EHR data relevant for the treatment of prostate cancer. Methods: A clinical sponsor is selected to identify data elements necessary to make treatment decisions for patients receiving therapy for prostate cancer and to provide rapid feedback for the clinical tool interface. The commercial EHR database is queried to determine identifying codes for relevant laboratory tests, medications, and procedures. Data elements are assembled using the EHR platform for clinical synopsis and the clinical tool is made available to five genitourinary medical oncologists for initial pilot. Results: Oral prostate cancer medications were queried based on medication therapeutic and pharmaceutical class. In addition, androgen deprivation therapy (ADT) injections were separately identified based on route of administration. Prostate specific antigen (PSA) and testosterone result values were queried using laboratory base and/or common name codes. However, many duplicate entities are found varying by hospital/laboratory site and test assay. The assembled clinical data visualization tool can overlay temporal trends in PSA and testosterone over medication start/stop dates to convey treatment response and signs of early medication resistance. The clinician also has the option to overlay vital signs or other laboratory information to visualize treatment related adverse events (ex. weight gain related to ADT, anemia related to PARP inhibitor therapy, etc.) Lastly, the tool can also highlight the dates of the patient’s last imaging tests to allow clinicians to determine if the patient is due for any follow up imaging. Conclusions: The EHR can support novel data visualization tools for cancer biomarkers that can reasonably support clinical workflows. Development requires an intimate knowledge of EHR data but may still be limited by duplicate or erroneous codes for laboratory results. This issue may be addressed by using standard nomenclature for laboratory results such as LOINC codes but is not currently supported by the commercial EHR. Future work in this area will include formal usability testing from the perspective of oncology providers and patients.
Opioid prescribing for postoperative pain management is challenging because of inter‐patient vari... more Opioid prescribing for postoperative pain management is challenging because of inter‐patient variability in opioid response and concern about opioid addiction. Tramadol, hydrocodone, and codeine depend on the cytochrome P450 2D6 (CYP2D6) enzyme for formation of highly potent metabolites. Individuals with reduced or absent CYP2D6 activity (i.e., intermediate metabolizers [IMs] or poor metabolizers [PMs], respectively) have lower concentrations of potent opioid metabolites and potentially inadequate pain control. The primary objective of this prospective, multicenter, randomized pragmatic trial is to determine the effect of postoperative CYP2D6‐guided opioid prescribing on pain control and opioid usage. Up to 2020 participants, age ≥8 years, scheduled to undergo a surgical procedure will be enrolled and randomized to immediate pharmacogenetic testing with clinical decision support (CDS) for CYP2D6 phenotype‐guided postoperative pain management (intervention arm) or delayed testing wit...
Summary Objectives: Issues related to lack of system usability and potential safety hazards conti... more Summary Objectives: Issues related to lack of system usability and potential safety hazards continue to be reported in the health information technology (HIT) literature. Usability engineering methods are increasingly used to ensure improved system usability and they are also beginning to be applied more widely for ensuring the safety of HIT applications. These methods are being used in the design and implementation of many HIT systems. In this paper we describe evidence- based approaches to applying usability engineering methods. Methods: A multi-phased approach to ensuring system usability and safety in healthcare is described. Usability inspection methods are first described including the development of evidence-based safety heuristics for HIT. Laboratory-based usability testing is then conducted under artificial conditions to test if a system has any base level usability problems that need to be corrected. Usability problems that are detected are corrected and then a new phase i...
Journal of Patient-Centered Research and Reviews, 2019
(HCSRN) is made up of nonprofit health systems with embedded research departments whose scientist... more (HCSRN) is made up of nonprofit health systems with embedded research departments whose scientists are dedicated to public domain research. The network's annual conference serves as a forum for research teams to disseminate study findings, stimulate new collaborations, and share insights about conducting research in realworld care settings. Abstracts accepted for presentation at HCSRN 2019 are published in this supplement of
The widespread adoption and use of electronic health records and their use to enable learning hea... more The widespread adoption and use of electronic health records and their use to enable learning health systems (LHS) holds great promise to accelerate both evidence-generating medicine (EGM) and evidence-based medicine (EBM), thereby enabling a LHS. In 2016, AMIA convened its 10th annual Policy Invitational to discuss issues key to facilitating the EGM-EBM paradigm at points-of-care (nodes), across organizations (networks), and to ensure viability of this model at scale (sustainability). In this article, we synthesize discussions from the conference and supplements those deliberations with relevant context to inform ongoing policy development. Specifically, we explore and suggest public policies needed to facilitate EGM-EBM activities on a national scale, particularly those policies that can enable and improve clinical and health services research at the point-of-care, accelerate biomedical discovery, and facilitate translation of findings to improve the health of individuals and popu...
Background-The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C v... more Background-The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965. Objective-To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. Design-Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. Subjects and Setting-Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. Intervention-Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. Main Outcomes-HCV testing; the incidence of HCV antibody positive tests was a secondary outcome.
Background: Individuals with type 2 diabetes manage complex multi-drug regimens, but nearly half ... more Background: Individuals with type 2 diabetes manage complex multi-drug regimens, but nearly half of all patients do not consistently take the dose prescribed for them, and therefore may not receive the full potential therapeutic benefit. Both patient and health system factors contribute to achieving and maintaining medication adherence. To determine if patients with type 2 diabetes who are concurrently managing other chronic conditions could improve their adherence, we devised and are testing a multifaceted, primary care-based strategy to provide health literacy-appropriate and language concordant regimen information, guidance and reminders. Objective: We are testing the effectiveness of an electronic health record (EHR) based strategy and short message service (SMS) text reminders to help patients with type 2 diabetes adhere to their medications. Methods: We are conducting a 3-arm, multi-site trial to test and compare the effectiveness of the EHR, and EHR + SMS text reminder strategies compared to usual care on medication adherence. Our goal is to enroll a total of 900 English or Spanish-speaking patients with type 2 diabetes and hemoglobin A1C value ≥7.5%. Enrolled participants will complete interviews at baseline and 3 and 6 months following their baseline interview. Conclusions: Our trial is evaluating practical, clinic-based, scalable, evidence-based solutions for patients with type 2 diabetes managing complex medication regimens. Our findings will evaluate strategies that can be implemented broadly in primary care practices, and programmed as defaults within EHRs to support appropriate medication adherence to allow the widespread implementation of those strategies.
Background: Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-... more Background: Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR) has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR) trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting. Methods: A multidisciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS) tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149) were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated) groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters) and chest x-rays (pneumonia iCPR only) between intervention and control providers. Discussion: Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidencebased practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to higher rates of utilization and EBM guided use of antibiotics and chest x-ray's in primary care.
Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and ... more Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and decisions need to be evidence based and standardized. Interventional informatics is ideally positioned to provide evidence based and standardized solutions in the enterprise (aka, the medical center) which includes all or some combination of hospital(s), hospital based-practices, enterprise owned offsite medical practices, faculty practice and a medical school. For purposes of this chapter, interventional informatics is defined as applied medical or clinical informatics with an emphasis on an active interventional role in the enterprise. A department of interventional informatics, which integrates the science of informatics into daily operations, should become a standard part of any 21st century medical center in the United States. The objectives of this chapter are to: review and summarize the promise and challenge of IT in healthcare; define healthcare IT; review the legacy of IT in healthcare; compare and contrast IT in healthcare with that of other industries; become familiar with evidence based IT: Medical informatics; differentiate medical informatics from IT in healthcare; distinguish medical, clinical, and interventional informatics; justify the need for operational departments of interventional informatics.
► clinical informatics ► professional training ► education ► physician ► general healthcare provi... more ► clinical informatics ► professional training ► education ► physician ► general healthcare providers ► training and education requirements ► health care ► accreditation and licensure ► clinical informatics fellowship
Board certified clinical informaticians provide expertise in leveraging health IT (HIT) and healt... more Board certified clinical informaticians provide expertise in leveraging health IT (HIT) and health data for patient care and quality improvement. Clinical Informatics experts possess the requisite skills and competencies to make systems-level improvements in care delivery using HIT, workflow and data analytics, knowledge acquisition, clinical decision support, data visualization, and related informatics tools. However, these physicians lack structured and sustained funding because they have no billing codes. The sustainability and growth of this new and promising medical subspecialty is threatened by outdated and inconsistent funding models that fail to support the education and professional growth of clinical informaticians. The Clinical Informatics Program Directors' Community is calling upon the Centers for Medicare and Medicaid Services to consider novel funding structures and programs through its Innovation Center for Clinical Informatics Fellowship training. Only through structural and sustained funding for Clinical Informatics fellows will be able to fully develop the potential of electronic health records to improve the quality, safety, and cost of clinical care.
Background: Older adults are at risk for inadequate emergency department (ED) pain care. Unreliev... more Background: Older adults are at risk for inadequate emergency department (ED) pain care. Unrelieved acute pain is associated with poor outcomes. Clinical decision support systems (CDSS) hold promise to improve patient care, but CDSS quality varies widely, particularly when usability evaluation is not employed. Objective: To conduct an iterative usability and redesign process of a novel geriatric abdominal pain care CDSS. We hypothesized this process would result in the creation of more usable and favorable pain care interventions. Methods: Thirteen emergency physicians familiar with the Electronic Health Record (EHR) in use at the study site were recruited. Over a 10-week period, 17 1-hour usability test sessions were conducted across 3 rounds of testing. Participants were given 3 patient scenarios and provided simulated clinical care using the EHR, while interacting with the CDSS interventions. Quantitative System Usability Scores (SUS), favorability scores and qualitative narrative feedback were collected for each session. Using a multi-step review process by an interdisciplinary team, positive and negative usability issues in effectiveness, efficiency, and satisfaction were considered, prioritized and incorporated in the iterative redesign process of the CDSS. Video analysis was used to determine the appropriateness of the CDS appearances during simulated clinical care. Results: Over the 3 rounds of usability evaluations and subsequent redesign processes, mean SUS progressively improved from 74.8 to 81.2 to 88.9; mean favorability scores improved from 3.23 to 4.29 (1 worst, 5 best). Video analysis revealed that, in the course of the iterative redesign processes, rates of physicians' acknowledgment of CDS interventions increased, however most rates of desired actions by physicians (such as more frequent pain score updates) decreased. Conclusion: The iterative usability redesign process was instrumental in improving the usability of the CDSS; if implemented in practice, it could improve geriatric pain care. The usability evaluation process led to improved acknowledgement and favorability. Incorporating usability testing when designing CDSS interventions for studies may be effective to enhance clinician use.
Background-The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C v... more Background-The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965. Objective-To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. Design-Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. Subjects and Setting-Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. Intervention-Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. Main Outcomes-HCV testing; the incidence of HCV antibody positive tests was a secondary outcome.
Introduction: The emerging operational role of the "Chief Clinical Informatics Officer" (CCIO) re... more Introduction: The emerging operational role of the "Chief Clinical Informatics Officer" (CCIO) remains heterogeneous with individuals deriving from a variety of clinical settings and backgrounds. The CCIO is defined in title, responsibility, and scope of practice by local organizations. The term encompasses the more commonly used Chief Medical Informatics Officer (CMIO) and Chief Nursing Informatics Officer (CNIO) as well as the rarely used Chief Pharmacy Informatics Officer (CPIO) and Chief Dental Informatics Officer (CDIO). Background: The American Medical Informatics Association (AMIA) identified a need to better delineate the knowledge, education, skillsets, and operational scope of the CCIO in an attempt to address the challenges surrounding the professional development and the hiring processes of CCIOs. Discussion: An AMIA task force developed knowledge, education, and operational skillset recommendations for CCIOs focusing on the common core aspect and describing individual differences based on Clinical Informatics focus. The task force concluded that while the role of the CCIO currently is diverse, a growing body of Clinical Informatics and increasing certification efforts are resulting in increased homogeneity. The task force advised that 1.) To achieve a predictable and desirable skillset, the CCIO must complete clearly defined and specified Clinical Informatics education and training. 2.) Future education and training must reflect the changing body of knowledge and must be guided by changing day-today informatics challenges. Conclusion: A better defined and specified education and skillset for all CCIO positions will motivate the CCIO workforce and empower them to perform the job of a 21st century CCIO. Formally educated and trained CCIOs will provide a competitive advantage to their respective enterprise by fully utilizing the power of Informatics science.
267 Background: Clinical information management is a burdensome process for oncology providers ow... more 267 Background: Clinical information management is a burdensome process for oncology providers owing to the complexity of modern cancer data. The results that a clinician needs to review are often spread across several areas within the EHR, making it cumbersome to sense a broad overview of patient status. The purpose of this study is to describe a framework for oncologist-driven development of a data visualization tool to trend cancer biomarkers and assess the feasibility of this tool to query and display EHR data relevant for the treatment of prostate cancer. Methods: A clinical sponsor is selected to identify data elements necessary to make treatment decisions for patients receiving therapy for prostate cancer and to provide rapid feedback for the clinical tool interface. The commercial EHR database is queried to determine identifying codes for relevant laboratory tests, medications, and procedures. Data elements are assembled using the EHR platform for clinical synopsis and the clinical tool is made available to five genitourinary medical oncologists for initial pilot. Results: Oral prostate cancer medications were queried based on medication therapeutic and pharmaceutical class. In addition, androgen deprivation therapy (ADT) injections were separately identified based on route of administration. Prostate specific antigen (PSA) and testosterone result values were queried using laboratory base and/or common name codes. However, many duplicate entities are found varying by hospital/laboratory site and test assay. The assembled clinical data visualization tool can overlay temporal trends in PSA and testosterone over medication start/stop dates to convey treatment response and signs of early medication resistance. The clinician also has the option to overlay vital signs or other laboratory information to visualize treatment related adverse events (ex. weight gain related to ADT, anemia related to PARP inhibitor therapy, etc.) Lastly, the tool can also highlight the dates of the patient’s last imaging tests to allow clinicians to determine if the patient is due for any follow up imaging. Conclusions: The EHR can support novel data visualization tools for cancer biomarkers that can reasonably support clinical workflows. Development requires an intimate knowledge of EHR data but may still be limited by duplicate or erroneous codes for laboratory results. This issue may be addressed by using standard nomenclature for laboratory results such as LOINC codes but is not currently supported by the commercial EHR. Future work in this area will include formal usability testing from the perspective of oncology providers and patients.
Opioid prescribing for postoperative pain management is challenging because of inter‐patient vari... more Opioid prescribing for postoperative pain management is challenging because of inter‐patient variability in opioid response and concern about opioid addiction. Tramadol, hydrocodone, and codeine depend on the cytochrome P450 2D6 (CYP2D6) enzyme for formation of highly potent metabolites. Individuals with reduced or absent CYP2D6 activity (i.e., intermediate metabolizers [IMs] or poor metabolizers [PMs], respectively) have lower concentrations of potent opioid metabolites and potentially inadequate pain control. The primary objective of this prospective, multicenter, randomized pragmatic trial is to determine the effect of postoperative CYP2D6‐guided opioid prescribing on pain control and opioid usage. Up to 2020 participants, age ≥8 years, scheduled to undergo a surgical procedure will be enrolled and randomized to immediate pharmacogenetic testing with clinical decision support (CDS) for CYP2D6 phenotype‐guided postoperative pain management (intervention arm) or delayed testing wit...
Summary Objectives: Issues related to lack of system usability and potential safety hazards conti... more Summary Objectives: Issues related to lack of system usability and potential safety hazards continue to be reported in the health information technology (HIT) literature. Usability engineering methods are increasingly used to ensure improved system usability and they are also beginning to be applied more widely for ensuring the safety of HIT applications. These methods are being used in the design and implementation of many HIT systems. In this paper we describe evidence- based approaches to applying usability engineering methods. Methods: A multi-phased approach to ensuring system usability and safety in healthcare is described. Usability inspection methods are first described including the development of evidence-based safety heuristics for HIT. Laboratory-based usability testing is then conducted under artificial conditions to test if a system has any base level usability problems that need to be corrected. Usability problems that are detected are corrected and then a new phase i...
Journal of Patient-Centered Research and Reviews, 2019
(HCSRN) is made up of nonprofit health systems with embedded research departments whose scientist... more (HCSRN) is made up of nonprofit health systems with embedded research departments whose scientists are dedicated to public domain research. The network's annual conference serves as a forum for research teams to disseminate study findings, stimulate new collaborations, and share insights about conducting research in realworld care settings. Abstracts accepted for presentation at HCSRN 2019 are published in this supplement of
The widespread adoption and use of electronic health records and their use to enable learning hea... more The widespread adoption and use of electronic health records and their use to enable learning health systems (LHS) holds great promise to accelerate both evidence-generating medicine (EGM) and evidence-based medicine (EBM), thereby enabling a LHS. In 2016, AMIA convened its 10th annual Policy Invitational to discuss issues key to facilitating the EGM-EBM paradigm at points-of-care (nodes), across organizations (networks), and to ensure viability of this model at scale (sustainability). In this article, we synthesize discussions from the conference and supplements those deliberations with relevant context to inform ongoing policy development. Specifically, we explore and suggest public policies needed to facilitate EGM-EBM activities on a national scale, particularly those policies that can enable and improve clinical and health services research at the point-of-care, accelerate biomedical discovery, and facilitate translation of findings to improve the health of individuals and popu...
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Papers by Joseph Kannry