Welcome to my ePortfolio
I was a practicing hematologist/oncologist for more than 30 years, caring for patients with a wide variety of cancers and blood diseases. Over the course of my career, the exponential growth of biomedical knowledge dramatically improved our ability to help seriously ill patients, but also created serious challenges in developing methods to store, organize, manage, retrieve, transmit, and present large volumes of information so that it can be optimally used for problem solving and clinical decision making in healthcare. As early as 1990, Dr. David M. Eddy, wrote in the Journal of the American Medical Association, “The complexity of modern medicine exceeds the inherent limitations of the unaided human mind.” For years my colleagues and struggled to assemble complete patient information and the medical data needed to guide decision-making together at the point of care exactly when we needed it. How could we navigate the tidal wave of information and use it to interpret the complex patterns of patient narrative, physical findings, laboratory data, and imaging studies.
I have maintained a deep interest in computers and information technology since I was in college. I wrote my first computer program in FORTRAN IV on punch cards in 1969. So I eagerly followed the development of Medical Informatics, the science of using electronic information processing technology to meet the challenge of making this huge body of new medical knowledge accessible and usable to clinicians for patient care, to scientists for medical research, and to administrators for support of healthcare delivery and population health.
I have maintained a deep interest in computers and information technology since I was in college. I wrote my first computer program in FORTRAN IV on punch cards in 1969. So I eagerly followed the development of Medical Informatics, the science of using electronic information processing technology to meet the challenge of making this huge body of new medical knowledge accessible and usable to clinicians for patient care, to scientists for medical research, and to administrators for support of healthcare delivery and population health.
A Problem
In the early part of the 21st century, the medical profession is facing one of the greatest challenges in its history, specifically, the need to provide safer, higher quality patient care, improve population health, and help control the rapid rise in healthcare costs by converting from volume to value based reimbursement. Health information technology (health IT) will play an indispensable role in solving these problems, but the first generation health IT systems we were forced to adopt are not designed with provider-patient interactions or clinical workflow in mind. They often do not format and display data to fit the way physicians think and support clinical decision making. In addition, they can't communicate with each other and exchange data. Electronic health records (EHRs) frequently disrupt physician workflows, decrease clinician efficiency, and distract our attention from our patients' stories and from nuanced clinical reasoning. In 2010, I began to think about ways to help to overcome the user-experience and information-exchange barriers that prevent health IT from reaching its full potential. I helped to found a Physician Information Technology Committee at Boone Hospital Center (BHC) to develop a consensus about what modifications and improvements to our IT systems were most needed by our busy practicing physicians. We developed a Physician IT Resource Center to help medical staff members increase their comfort and facility with the use of information systems. We served as Physician Champions during implementation of Computerized Provider Order Entry (CPOE) and facilitated physician adoption that helped qualify for Stage 1 and Stage 2 Meaningful Use certification. We were influential in upgrading the hospital's cellular and WiFi networks and porting Electronic Health Record (EHR) access to portable devices. We served as subject matter experts and advisory committee members in the development of (CPOE) orders sets and of Clindesk 2, a local longitudinal EMR that documented outpatient hospital encounters and worked with our major vendor inpatient EHR to document care across multiple different admission episodes or different hospitals in our network. Despite these efforts, using our EHR never felt like an intuitive, efficient, productive process to most of our physicians. The usability and interoperability problems which physicians agreed to tolerate "until better systems could be developed," remain unresolved.
Developing Solutions
In 2011, I decided that I needed to learn about the structure, function, and implementation of EHR’s in more depth and to better understand the clinical, operational, legal, and financial constraints which govern the application of information systems within healthcare organizations. I enrolled in the Northwestern University Master of Science Program in Medical Informatics, which is taught online in a distance learning format that fit with my busy clinical schedule. In 2011 and 2012, I worked with and was challenged by a strong faculty and a passionate group of adult learners including physicians, nurses, pharmacists, software engineers, consultants, business professionals, and even one dentist from all over the United States. The variety of backgrounds and perspectives greatly enriched the learning experience. Every student already had a primary career and a full time job, and we were united in our commitment to seeing informatics fulfill its promise of improving healthcare. In some courses my experience in clinical medicine was a great resource I could share, while in other courses I was consulting my classmates for help with material far outside my previous knowledge and training. The level of help and mutual support among students was always inspiring, and I made several new friends along the way. The course work required me to polish up old skills such as reviewing literature, writing long format research papers and shorter pieces for the online Discussion Boards, and learning new software programs (Visio, Access, SPSS, PowerPoint, and Acrobat). More importantly, the work stimulated me to develop new skills such as collaborating with and leading teams of students in complex written projects and oral presentations and evaluating informatics problems from the standpoint of a hospital CEO or a software engineer in addition to my familiar role as a clinician end-user.
After graduating in 2012, I remained active on the BHC Physician IT Committee and continued my Hematology/Oncology practice. From July 2013 to June 2014 I served on the Health Information and Management Systems Society (HIMSS) Physician Committee, and in 2013 I also passed the CPHIMS Examination and achieved board certification in Clinical Informatics as part of the first class of Diplomates in that new medical subspecialty. From July 2014 to June 2016 I served on the HIMSS HIT User Experience Committee, and as liaison between the User Experience Committee and the Physician Committee. In 2014 and 2015 I also served on the United States Oncology (USON) Data Governance Committee, and the USON iKnowMed Generation 2 EHR Physician Advisory Board. I also conducted a summative scenario-based usability research study of the CPOE system at BHC which was presented at the 2015 International Symposium on Human Factors and Ergonomics in Healthcare. From October 2015 to February 2016, I served on the ONC Certified Technology Comparison Task Force, a federal advisory committee evaluating the feasibility of establishing programs to assist providers in the process of comparing and purchasing certified EHR technology products, creating empowered consumers to drive innovation in the industry.
I retired from clinical practice at the end of 2015 and began a second career in clinical informatics consulting and teaching. In 2017 I served as a physician educator and at-the-elbow trainer during the implementation of the Epic EHR at BHC, taught an online master’s degree course in user-centered design and user-based research methods for the University of Alabama at Birmingham (UAB), and joined the Health Level Seven International (HL7) EHR Usability Workgroup which continues working on a new Usability Functional Profile as a companion to the HL7 EHR Functional Profile. In 2018 I continued teaching at UAB and joined the HL7 Reducing Clinician Burden Project, serving as lead of the clinical workflow focus group. Further incremental tweaks of the current data-centric EHR paradigm will not get us where we need to go. My vision is to use disruptively innovative approaches to human factors engineering to turn our EHRs from transactional electronic filing cabinets into process-centric workflow centers. Sophisticated, predictive cognitive support tools which can free well-informed, empathetic physicians from clinical workflow burdens and help them focus on patients and reason more accurately are the way to achieve the safe, high quality, patient-centered, cost effective healthcare system we are all striving for. This website summarizes some of the training and experience which enabled my evolution from practicing clinician to clinical informatician. Thanks for taking the time to review my ePortfolio.