Engaging the next generation of physician-informaticians through early exposure to the field: successes and challenges associated with starting a novel clinical informatics interest group.

Clinical informatics remains underappreciated among medical students in part due to a lack of integration into undergraduate medical education (UME). New developments in the study and practice of medicine are traditionally introduced via formal integration into undergraduate medical curricula. While this path has certain advantages, curricular changes are slow and may fail to showcase the breadth of clinical informatics activities.

Domains, tasks, and knowledge for health informatics practice: results of a practice analysis.

Objective: To develop a comprehensive and current description of what health informatics (HI) professionals do and what they need to know.

Materials And Methods: Six independent subject-matter expert panels drawn from and representative of HI professionals contributed to the development of a draft HI delineation of practice (DoP). An online survey was distributed to HI professionals to validate the draft DoP.

AMIA Board White Paper: AMIA 2017 core competencies for applied health informatics education at the master's degree level.

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master's level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine.

Next generation pathways into biomedical informatics: lessons from 10 years of the Vanderbilt Biomedical Informatics Summer Internship Program.

Objectives: To examine roles for summer internship programs in expanding pathways into biomedical informatics, based on 10 years of the Vanderbilt Department of Biomedical Informatics (DBMI) Summer Research Internship Program.

Materials And Methods: Vanderbilt DBMI's internship program is a research-intensive paid 8-10 week program for high school, undergraduate, and graduate students. The program is grounded in a "Windows, Mirrors, and Open Doors" educational framework, and is guided by an evolving set of design principles, including providing meaningful research experiences, applying a multi-factor approach to diversity, and helping interns build peer connections.

Eligibility requirements for advanced health informatics certification.

AMIA is leading the effort to strengthen the health informatics profession by creating an advanced health informatics certification (AHIC) for individuals whose informatics work directly impacts the practice of health care, public health, or personal health. The AMIA Board of Directors has endorsed a set of proposed AHIC eligibility requirements that will be presented to the future AHIC certifying entity for adoption. These requirements specifically establish who will be eligible to sit for the AHIC examination and more generally signal the depth and breadth of knowledge and experience expected from certified individuals.

Creating advanced health informatics certification.

In 2005, AMIA leaders and members concluded that certification of advanced health informatics professionals would offer value to individual practitioners, organizations that hire them, and society at large. AMIA's work to create advanced informatics certification began by leading a successful effort to create the clinical informatics subspecialty for American Board of Medical Specialties board-certified physicians. Since 2012, AMIA has been working to establish advanced health informatics certification (AHIC) for all health informatics practitioners regardless of their primary discipline.

Accelerating the Global Workforce Demand for Nurse Informaticians: Advanced Health Informatics Certification (AHIC).

Advances in professional recognition of nursing informatics vary by country but examples exist of training programs moving from curriculum-based education to competency based frameworks to produce highly skilled nursing informaticians. This panel will discuss a significant credentialing project in the United States that should further enhance professional recognition of highly skilled nurses matriculating from NI programs as well as nurses functioning in positions where informatics-induced transformation is occurring. The panel will discuss the professionalization of health informatics by describing core content, training requirements, education needs, and administrative framework applicable for the creation of an Advanced Health Informatics Certification (AHIC).

Perceived Reasons for High and Low Quality Observational HIV Research Data.

Audits of data quality in a Latin America HIV research network revealed that study sites collected weight measurements, laboratory results, and medication data of inconsistent quality. We surveyed site personnel about perceived drivers of their high or low quality data. Most sites reported their research teams contained no data specialists and that missing data stemmed primarily from incomplete patient assessments at the point of care rather than inconsistent data recording.

A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.

Problem: How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion ("EHR ergonomics")?

Approach: Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a presurvey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions.

Bridging organizational divides in health care: an ecological view of health information exchange.

Background: The fragmented nature of health care delivery in the United States leads to fragmented health information and impedes patient care continuity and safety. Technologies to support interorganizational health information exchange (HIE) are becoming more available. Understanding how HIE technology changes health care delivery and affects people and organizations is crucial to long-term successful implementation.

Mediating the intersections of organizational routines during the introduction of a health IT system.

Public interest in the quality and safety of health care has spurred examination of specific organizational routines believed to yield risk in health care work. Medication administration routines, in particular, have been the subject of numerous improvement projects involving information technology development, and other forms of research and regulation. This study draws from ethnographic observation to examine how the common routine of medication administration intersects with other organizational routines, and why understanding such intersections is important.

Mediation of adoption and use: a key strategy for mitigating unintended consequences of health IT implementation.

Objective: Without careful attention to the work of users, implementation of health IT can produce new risks and inefficiencies in care. This paper uses the technology use mediation framework to examine the work of a group of nurses who serve as mediators of the adoption and use of a barcode medication administration (BCMA) system in an inpatient setting.

Materials And Methods: The study uses ethnographic methods to explore the mediators' work.

Measuring the quality of observational study data in an international HIV research network.

Observational studies of health conditions and outcomes often combine clinical care data from many sites without explicitly assessing the accuracy and completeness of these data. In order to improve the quality of data in an international multi-site observational cohort of HIV-infected patients, the authors conducted on-site, Good Clinical Practice-based audits of the clinical care datasets submitted by participating HIV clinics. Discrepancies between data submitted for research and data in the clinical records were categorized using the audit codes published by the European Organization for the Research and Treatment of Cancer.

The financial impact of health information exchange on emergency department care.

Objective: To examine the financial impact health information exchange (HIE) in emergency departments (EDs).

Materials And Methods: We studied all ED encounters over a 13-month period in which HIE data were accessed in all major emergency departments Memphis, Tennessee. HIE access encounter records were matched with similar encounter records without HIE access.

Barriers and facilitators to the use of computer-based intensive insulin therapy.

Purpose: Computerized clinical decision support systems (CDSSs) for intensive insulin therapy (IIT) are increasingly common. However, recent studies question IIT's safety and mortality benefit. Researchers have identified factors influencing IIT performance, but little is known about how workflow affects computer-based IIT.

User perspectives on the usability of a regional health information exchange.

Objective: We assessed the usability of a health information exchange (HIE) in a densely populated metropolitan region. This grant-funded HIE had been deployed rapidly to address the imminent needs of the patient population and the need to draw wider participation from regional entities.

Design: We conducted a cross-sectional survey of individuals given access to the HIE at participating organizations and examined some of the usability and usage factors related to the technology acceptance model.

Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance.

Objective: To determine characteristics and effects of nurse dosing over-rides of a clinical decision support system (CDSS) for intensive insulin therapy (IIT) in critical care units.

Design: Retrospective analysis of patient database records and ethnographic study of nurses using IIT CDSS.

Measurements: The authors determined the frequency, direction-greater than recommended (GTR) and less than recommended (LTR)- and magnitude of over-rides, and then compared recommended and over-ride doses' blood glucose (BG) variability and insulin resistance, two measures of IIT CDSS associated with mortality.

Peers, regulators, and professions: the influence of organizations in health information technology adoption.

According to the U.S. National Research Council, current health information technology (HIT) efforts are insufficient and arguably detrimental to healthcare transformation.

Desiderata for a computer-assisted audit tool for clinical data source verification audits.

Clinical data auditing often requires validating the contents of clinical research databases against source documents available in health care settings. Currently available data audit software, however, does not provide features necessary to compare the contents of such databases to source data in paper medical records. This work enumerates the primary weaknesses of using paper forms for clinical data audits and identifies the shortcomings of existing data audit software, as informed by the experiences of an audit team evaluating data quality for an international research consortium.

A computerized provider order entry intervention for medication safety during acute kidney injury: a quality improvement report.

Background: Frequently, prescribers fail to account for changing kidney function when prescribing medications. We evaluated the use of a computerized provider order entry intervention to improve medication management during acute kidney injury.

Study Design: Quality improvement report with time series analyses.

Effects of blood glucose transcription mismatches on a computer-based intensive insulin therapy protocol.

Purpose: Computerized clinical decision support systems (CDSS) for intensive insulin therapy (IIT) generate recommendations using blood glucose (BG) values manually transcribed from testing devices to computers, a potential source of error. We quantified the frequency and effect of blood glucose transcription mismatches on IIT protocol performance.

Methods: We examined 38 months of retrospective data for patients treated with CDSS IIT in two intensive care units at one teaching hospital.

Social, organizational, and contextual characteristics of clinical decision support systems for intensive insulin therapy: a literature review and case study.

Introduction: Evaluations of computerized clinical decision support systems (CDSS) typically focus on clinical performance changes and do not include social, organizational, and contextual characteristics explaining use and effectiveness. Studies of CDSS for intensive insulin therapy (IIT) are no exception, and the literature lacks an understanding of effective computer-based IIT implementation and operation.

Results: This paper presents (1) a literature review of computer-based IIT evaluations through the lens of institutional theory, a discipline from sociology and organization studies, to demonstrate the inconsistent reporting of workflow and care process execution and (2) a single-site case study to illustrate how computer-based IIT requires substantial organizational change and creates additional complexity with unintended consequences including error.

Forecasting emergency department crowding: an external, multicenter evaluation.

Study Objective: We apply a previously described tool to forecast emergency department (ED) crowding at multiple institutions and assess its generalizability for predicting the near-future waiting count, occupancy level, and boarding count.

Methods: The ForecastED tool was validated with historical data from 5 institutions external to the development site. A sliding-window design separated the data for parameter estimation and forecast validation.

A novel information retrieval model for high-throughput molecular medicine modalities.

Significant research has been devoted to predicting diagnosis, prognosis, and response to treatment using high-throughput assays. Rapid translation into clinical results hinges upon efficient access to up-to-date and high-quality molecular medicine modalities. We first explain why this goal is inadequately supported by existing databases and portals and then introduce a novel semantic indexing and information retrieval model for clinical bioinformatics.

Peers, regulators, and professions: the influence of organizations in intensive insulin therapy adoption.

Introduction: Following the landmark Leuven study in 2001, health care organizations implemented intensive insulin therapy (IIT) as the standard of care for critically ill patients. However, a recent meta-analysis showed no mortality benefit and an increased safety risk for patients treated with IIT. IIT affects labor and capital decisions related to nurses, physicians, pharmacists, managers, laboratory personnel, and informatics staff.