Professional Documents
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Arcadia University’s pioneering,
global, integrated, liberal arts, and
professional learning experience
cultivates leaders who are
intellectually fearless and uniquely
prepared for life and work.
ATP
Wait. Is this a biochem quiz?
ATP
Power for virtually every cell activity
Were MC, Nyandiko WM, Huang KT, et al. Computer-generated reminders and quality of pediatric HIV care in a resource-limited setting. Pediatrics. 2013 Mar;
131(3):e789-96. Epub 2013 Feb 25. PubMed PMID: 23439898.
Central Premise
Intellectually fearless leaders need a great data metabolism
What we (mostly) do today
!
Interpret
Focus
Analyze data
Area
Coalesce data
Go Decision
🌐 Adapted From: Learning Health Care Project
What we (mostly) do today
!
Interpret Publish journal article
Hold inservice
Focus
Analyze data
Area
Coalesce data
Go Decision
🌐 Adapted From: Learning Health Care Project
What we need: Continuous Learning
!
Interpret Deliver Tailored Messages
Focus
Analyze data
Area
Go Decision
🌐 Adapted From: Learning Health Care Project
What we need: Continuous Learning
!
Interpret Deliver Tailored Messages
Persistent and sharable Right time, place, audience, format
knowledge
Focus
Analyze data
Area
Data Science Methods
Adler NE, Stead WW. Patients in context--EHR capture of social and behavioral determinants of health. N Engl J Med. 2015 Feb 19;372(8):698-701. doi: 10.1056/NEJMp1413945. PubMed PMID: 25693009.
Hossein Estiri, Chirag J Patel, Shawn N Murphy; Informatics can help providers incorporate context into care, JAMIA Open, Volume 1, Issue 1, 1 July 2018, Pages 3–6, https://doi.org/10.1093/jamiaopen/ooy025
Fundamental Challenge
The help from Health IT systems is limited by the data within their purview.
Connecting Many Data Sources
Social and community determinants
Lifestyle and behavioral
Health history
Patient-generated
EHR/clinical
Genetics
Basic science
Great leadership needs to draw from a wide breadth of information
However, many forces today are converging
on the need for interoperable health data
📰 Source: POLITICO
Electronic Health Record
vendor adoption of
Application Programming
Interfaces
In Fall 2018, almost 87% of hospitals and
69% of MIPS eligible clinicians are served by
health IT developers with product(s) certified
to the FHIR API standard.
https://www.healthit.gov/buzz-blog/interoperability/heat-wave-the-u-s-is-poised-to-catch-fhir-in-2019
Apple Health Records
Uses Argonaut FHIR API
Eyal Oren
PM, Google
📷 duncan | cc-by-nc
Bright TJ, Wong A, et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med. 2012 Jul 3;157(1):29-43. PubMed PMID: 22751758.
Rajkomar A, Oren E, Chen K, et al. Scalable and accurate deep learning with electronic health records. npj Digital Medicine 2018;1:18. doi:10.1038/s41746-018-0029-1
Our central insight is that rather than explicitly
harmonizing EHR data, mapping it into a highly curated set
of structured predictors variables and then feeding those
variables into a statistical model, we can instead learn to
simultaneously harmonize inputs and predict medical events
through direct feature learning.
Rajkomar A, Oren E, Chen K, et al. Scalable and accurate deep learning with electronic health records. npj Digital Medicine 2018;1:18. doi:10.1038/s41746-018-0029-1
Rajkomar A, Oren E, Chen K, et al. Scalable and accurate deep learning with electronic health records. npj Digital Medicine 2018;1:18. doi:10.1038/s41746-018-0029-1
A deep learning approach that incorporated the entire
electronic health record, including free-text notes,
produced predictions for a wide range of clinical problems
and outcomes that outperformed state-of-the-art traditional
predictive models.
Spears GV, Roth CP, Miake-Lye IM, Saliba D, Shekelle PG, Ganz DA. Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care. 2013 Mar;51(3 Suppl 1):S37-43. PubMed PMID: 23407009.
Spears GV, Roth CP, Miake-Lye IM, Saliba D, Shekelle PG, Ganz DA. Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care. 2013 Mar;51(3 Suppl 1):S37-43. PubMed PMID: 23407009.
…tailor the reminder to existing clinic
setups and workflows.
Spears GV, Roth CP, Miake-Lye IM, Saliba D, Shekelle PG, Ganz DA. Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care. 2013 Mar;51(3 Suppl 1):S37-43. PubMed PMID: 23407009.
Spears GV, Roth CP, Miake-Lye IM, Saliba D, Shekelle PG, Ganz DA. Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care. 2013 Mar;51(3 Suppl 1):S37-43. PubMed PMID: 23407009.
My Summary:
Computers can you help implement EBP, but
changing practice (people) is hard!
Spears GV, Roth CP, Miake-Lye IM, Saliba D, Shekelle PG, Ganz DA. Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care. 2013 Mar;51(3 Suppl 1):S37-43. PubMed PMID: 23407009.
Some words of caution
📰 Source: STAT
Medical information that is revealed to health
care providers is protected by privacy laws such
as the Health Information Portability and
Accountability Act (HIPAA).
📰 Source: STAT
HIPAA
HIPAA Right of Access
Accepts requests by email or fax: Providers may not create a barrier to access
by requiring patients to submit requests in person or by mail.
Sent within 30 days: Provider responds to the request within 30 days of receipt.
insulin pump
+
computerized control system
📰 Source: NEO.LIFE
Putting it all Together
Data is fuel for leaders who
want to make a difference
Human
+
Computer
" Human
Friedman CP. A "fundamental theorem" of biomedical informatics. J Am Med Inform Assoc. 2009 Mar-Apr;16(2):169-70.PubMed PMID: 19074294;
Stead WW, Searle JR, Fessler HE, Smith JW, Shortliffe EH. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34. PMID: 20711055
Although most health
professionals use IT daily in
their work, few know how to
adapt their roles and work
processes to incorporate IT
for the greatest benefit.
Stead WW, Searle JR, Fessler HE, Smith JW, Shortliffe EH. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34. PMID: 20711055
We have frequently heard the opinion from
both faculty and students that medical
students already possess all the basic
skills necessary to function effectively
in an information-rich environment.
Silverman H, Cohen T, Fridsma D. The evolution of a novel biomedical informatics curriculum for medical students. Acad Med. 2012 Jan;87(1):84-90. PubMed PMID: 22104049
We have frequently heard the opinion from
both faculty and students that medical
students already possess all the basic
skills necessary to function effectively
in an information-rich environment.