Personal Statement (March 2022)
The best baseball players are described as possessing five tools. These versatile players hit for average, hit for power, run, field and throw. Analogously, it is possible to characterize six tools of Clinical Informatics: care for the patient, recognize problems in the electronic health record (EHR), solve problems using standard tools, solve problems by building new tools, report on clinical outcomes, and educate other users. My twin careers in Pediatrics and Clinical Informatics have challenged me to become a six-tool informaticist. Nationally, I am known for my innovations and technical contributions with distinct foci on immunizations, decision support, and mentoring.
Context:
My contributions and achievements do not fit the model of the traditional academic clinician. The arc of my career has been shaped by the fact that I was hired by MetroHealth as a general pediatrician at precisely the time that it was installing EpicCare Ambulatory, an electronic health record (EHR) for outpatient care. Over the subsequent 23 years, Epic has grown tremendously in its customer base and reach – it was recently reported that more than 250 million patients worldwide have an Epic health record. [Adams, Katie (April 12, 2021). 31 numbers that show how big Epic, Cerner, Allscripts & Meditech are in healthcare. Becker’s Healthcare. Web. Retrieved December 12, 2021.] This makes it possible for informaticists like me, who have expertise in this software, to exert an impact on patient care at the national or even international level.
My work and expertise are of particular value to the information technology professionals around the nation and world who are tasked with building, customizing, and maintaining Epic’s EHR software. It is in this large arena that I have achieved wide recognition: I have given forty invited lectures about innovations that I pioneered in Epic, and, through my contributions to Epic’s Clinical Programs, my work is offered as a paradigm to be replicated. Other health systems regularly consult me about immunization and pediatric functionality. Solutions I developed for MetroHealth have been implemented nationally to alleviate bottlenecks in patient care; bridge the knowledge gaps of staff, residents, and medical students; and improve patient engagement and access to data.
Immunizations:
Pediatricians play a major role in protecting patients and communities against vaccine-preventable illness. The complexity of the immunization schedule requires substantial mental effort to evaluate dozens of rules about patient eligibility and dose validity. Well-designed software can reduce cognitive burden, save time, and prevent errors.
A significant portion of my Informatics service has been devoted to designing, building, and implementing improved immunization decision support and clinical workflows. I configured Epic’s forecasting engine so that the MetroHealth System could become an early adopter of it. By identifying a list of overdue immunizations, the functionality is helpful. But I saw that we could use the forecast to solve other problems in the immunization workflow: I discovered how Epic was storing the data and had a “Eureka!” moment when I realized that I could sense information hidden in the forecast about exactly which doses were due, and then customize the system to fire clinical alerts and queue up just the right orders for clinicians and trainees.
My industry-first enhancements to Epic’s standard immunization decision support reduced errors of omission and commission, reduced canceled immunization orders, and greatly improved patient throughput. I have since extended the work beyond Pediatrics to adult and geriatric patients. In 2016, I became one of just a few dozen certified physician programmers of Epic’s source code, and this has allowed me to refine my custom immunization work for maximum efficiency and flexibility.
These efforts have been recognized locally and nationally: My immunization decision support was cited as a best practice by a Joint Commission reviewer. It laid the groundwork for a peer-reviewed publication in The Journal of Adolescent Health. I was invited to present at an international immunization conference in Lisbon, Portugal. More recently, I gave an invited lecture to a national audience of Epic users about configuring decision support for pediatric combination vaccines; the session was attended by more than 175 physicians and analysts, and was among the highest ever rated in the series.
There is an innate tension between using vendor-supplied, standard features vs. home-grown, custom-coded functions. My decision support’s reliance on custom programming means that peers at other institutions may have difficulty implementing my solutions. For this reason, I have worked with Epic’s leaders and developers to advocate for inclusion of my custom solutions into their standard product. I have done this service as a three-time elected member of the national Epic Primary Care Pediatrics Steering Board, and through active work on several other invited, national committees. My efforts have begun to bear fruit: Epic has now released at least two standard features based on my work, and all Epic customers now have access to a limited form of the automated-immunization reconciliation system which we first developed at MetroHealth.
Further, I continue to help develop pioneering EHR technology that detects potential immunization adverse events, brings them to clinicians’ attention, and facilitates reporting to the CDC’s Vaccine Adverse Event Reporting System. This work is detailed in our publication in Clinical Infectious Disease and is the subject of an ongoing research project for which I serve as Co-Investigator. A major goal of this new project is to extend the functionality to health systems that use EHRs other than Epic.
Decision Support:
Using a team-based science approach, I have worked with clinicians from many different specialties to employ a variety of decision support tools that encourage safer and more efficient care of patients. My roles on these teams included designing and building the decision support interventions and helping to evaluate and publish the results. Many of the teams involved medical students, Clinical Informatics fellows, and other learners.
In addition to the immunization work I discussed above, I have developed tools which help users recognize pediatric and adult hypertension, appropriately test for vertically transmitted hepatitis C, identify adult sepsis in the Emergency Department, and administer Rh immune globulin to postpartum mothers. Peer-reviewed articles about these successful projects have appeared in JAMA Internal Medicine, The Pediatric Infectious Disease Journal, The Journal of General Internal Medicine, and Critical Care Medicine.
Mentoring:
I feel passionate about teaching and mentoring the next generation of informaticists and clinicians. The diversification of our workforce makes it more likely that each of our patients can have a provider who will advocate for their protection and well-being. But it also brings some challenges.
As a member of an easy-to-identify and sometimes-disfavored religious minority, I am aware of what it feels like to be an outsider. My dress, food, and calendar mark me as different from almost all of my colleagues and patients. The feeling of being an outsider gives me courage to stand up for what I believe is in the best interests of society and my patients. And it makes me work harder to create opportunities for people who lack some of the privileges that I have enjoyed.
The Epic Physician Advisory Council Mentorship Program began with my observation that, on paper, some people from under-represented groups do not seem like strong candidates when they stand for election to Epic's national steering boards. In response, I designed and administer a cross-institution, cross-generation, and cross-specialty initiative. In its 3 years of existence, the program has benefited more than 170 mentees, among whom are physicians, advanced practice providers, and nurses. Success is mostly intangible. But I'm very proud that at least one female pediatrician credits the program with helping her to interview for, and ultimately be named as, the Chief Medical Information Officer of her health system. This speaks volumes for the value of mentorship experiences that help people, who have traditionally lacked power, to get boosted into positions where they can influence the priorities and practices of medicine.
Conclusion:
I can measure the success of my career a project, publication, or degree at a time. Above these incremental successes is the pride that I have in being recognized by my peers with two prestigious, national awards: In 2017, I won the Epic PACademy Award for my “outstanding contributions to the Epic community.” And I was named the 2021 winner of the Byron Oberst Award from the American Academy of Pediatrics for making “significant contributions to the field” of Clinical Informatics in the use of technology, health policy, and education. In the remainder of my career, I look forward to continuing to use my creativity, skills, and national professional standing to help design, implement, evaluate, and train improvements that will help others solve current and future Clinical Informatics challenges.
Context:
My contributions and achievements do not fit the model of the traditional academic clinician. The arc of my career has been shaped by the fact that I was hired by MetroHealth as a general pediatrician at precisely the time that it was installing EpicCare Ambulatory, an electronic health record (EHR) for outpatient care. Over the subsequent 23 years, Epic has grown tremendously in its customer base and reach – it was recently reported that more than 250 million patients worldwide have an Epic health record. [Adams, Katie (April 12, 2021). 31 numbers that show how big Epic, Cerner, Allscripts & Meditech are in healthcare. Becker’s Healthcare. Web. Retrieved December 12, 2021.] This makes it possible for informaticists like me, who have expertise in this software, to exert an impact on patient care at the national or even international level.
My work and expertise are of particular value to the information technology professionals around the nation and world who are tasked with building, customizing, and maintaining Epic’s EHR software. It is in this large arena that I have achieved wide recognition: I have given forty invited lectures about innovations that I pioneered in Epic, and, through my contributions to Epic’s Clinical Programs, my work is offered as a paradigm to be replicated. Other health systems regularly consult me about immunization and pediatric functionality. Solutions I developed for MetroHealth have been implemented nationally to alleviate bottlenecks in patient care; bridge the knowledge gaps of staff, residents, and medical students; and improve patient engagement and access to data.
Immunizations:
Pediatricians play a major role in protecting patients and communities against vaccine-preventable illness. The complexity of the immunization schedule requires substantial mental effort to evaluate dozens of rules about patient eligibility and dose validity. Well-designed software can reduce cognitive burden, save time, and prevent errors.
A significant portion of my Informatics service has been devoted to designing, building, and implementing improved immunization decision support and clinical workflows. I configured Epic’s forecasting engine so that the MetroHealth System could become an early adopter of it. By identifying a list of overdue immunizations, the functionality is helpful. But I saw that we could use the forecast to solve other problems in the immunization workflow: I discovered how Epic was storing the data and had a “Eureka!” moment when I realized that I could sense information hidden in the forecast about exactly which doses were due, and then customize the system to fire clinical alerts and queue up just the right orders for clinicians and trainees.
My industry-first enhancements to Epic’s standard immunization decision support reduced errors of omission and commission, reduced canceled immunization orders, and greatly improved patient throughput. I have since extended the work beyond Pediatrics to adult and geriatric patients. In 2016, I became one of just a few dozen certified physician programmers of Epic’s source code, and this has allowed me to refine my custom immunization work for maximum efficiency and flexibility.
These efforts have been recognized locally and nationally: My immunization decision support was cited as a best practice by a Joint Commission reviewer. It laid the groundwork for a peer-reviewed publication in The Journal of Adolescent Health. I was invited to present at an international immunization conference in Lisbon, Portugal. More recently, I gave an invited lecture to a national audience of Epic users about configuring decision support for pediatric combination vaccines; the session was attended by more than 175 physicians and analysts, and was among the highest ever rated in the series.
There is an innate tension between using vendor-supplied, standard features vs. home-grown, custom-coded functions. My decision support’s reliance on custom programming means that peers at other institutions may have difficulty implementing my solutions. For this reason, I have worked with Epic’s leaders and developers to advocate for inclusion of my custom solutions into their standard product. I have done this service as a three-time elected member of the national Epic Primary Care Pediatrics Steering Board, and through active work on several other invited, national committees. My efforts have begun to bear fruit: Epic has now released at least two standard features based on my work, and all Epic customers now have access to a limited form of the automated-immunization reconciliation system which we first developed at MetroHealth.
Further, I continue to help develop pioneering EHR technology that detects potential immunization adverse events, brings them to clinicians’ attention, and facilitates reporting to the CDC’s Vaccine Adverse Event Reporting System. This work is detailed in our publication in Clinical Infectious Disease and is the subject of an ongoing research project for which I serve as Co-Investigator. A major goal of this new project is to extend the functionality to health systems that use EHRs other than Epic.
Decision Support:
Using a team-based science approach, I have worked with clinicians from many different specialties to employ a variety of decision support tools that encourage safer and more efficient care of patients. My roles on these teams included designing and building the decision support interventions and helping to evaluate and publish the results. Many of the teams involved medical students, Clinical Informatics fellows, and other learners.
In addition to the immunization work I discussed above, I have developed tools which help users recognize pediatric and adult hypertension, appropriately test for vertically transmitted hepatitis C, identify adult sepsis in the Emergency Department, and administer Rh immune globulin to postpartum mothers. Peer-reviewed articles about these successful projects have appeared in JAMA Internal Medicine, The Pediatric Infectious Disease Journal, The Journal of General Internal Medicine, and Critical Care Medicine.
Mentoring:
I feel passionate about teaching and mentoring the next generation of informaticists and clinicians. The diversification of our workforce makes it more likely that each of our patients can have a provider who will advocate for their protection and well-being. But it also brings some challenges.
As a member of an easy-to-identify and sometimes-disfavored religious minority, I am aware of what it feels like to be an outsider. My dress, food, and calendar mark me as different from almost all of my colleagues and patients. The feeling of being an outsider gives me courage to stand up for what I believe is in the best interests of society and my patients. And it makes me work harder to create opportunities for people who lack some of the privileges that I have enjoyed.
The Epic Physician Advisory Council Mentorship Program began with my observation that, on paper, some people from under-represented groups do not seem like strong candidates when they stand for election to Epic's national steering boards. In response, I designed and administer a cross-institution, cross-generation, and cross-specialty initiative. In its 3 years of existence, the program has benefited more than 170 mentees, among whom are physicians, advanced practice providers, and nurses. Success is mostly intangible. But I'm very proud that at least one female pediatrician credits the program with helping her to interview for, and ultimately be named as, the Chief Medical Information Officer of her health system. This speaks volumes for the value of mentorship experiences that help people, who have traditionally lacked power, to get boosted into positions where they can influence the priorities and practices of medicine.
Conclusion:
I can measure the success of my career a project, publication, or degree at a time. Above these incremental successes is the pride that I have in being recognized by my peers with two prestigious, national awards: In 2017, I won the Epic PACademy Award for my “outstanding contributions to the Epic community.” And I was named the 2021 winner of the Byron Oberst Award from the American Academy of Pediatrics for making “significant contributions to the field” of Clinical Informatics in the use of technology, health policy, and education. In the remainder of my career, I look forward to continuing to use my creativity, skills, and national professional standing to help design, implement, evaluate, and train improvements that will help others solve current and future Clinical Informatics challenges.