Information Leadership Research Articles

Taking a Team Approach: Keep up with the EHR with a Training and Optimization Program.

This study aimed to describe the current landscape of electronic health record (EHR) training and optimization programs (ETOPs) and their impact on healthcare workers' (HCWs) experience with the EHR. A 72-question electronic survey was developed and distributed to healthcare organization (HCO) leaders in clinical informatics through various channels such as national informatics conferences, social media, and email distribution lists of vendors and informatics associations. The survey collected data on the characteristics, resourcing, approach, and outcomes of ETOPs. Descriptive statistics were applied to analyze the data. There were 193 responses from 147 distinct HCOs. Of these, 69% offer ongoing EHR training, and 52% offer some version of an ETOP. Offered ETOPs vary in their timing, modality, audience, team composition, duration, and EHR build strategy. The most commonly measured outcomes were EHR satisfaction, efficiency, and provider burnout, and most ETOPs reported improvement in these areas. The findings suggest that ETOPs are inconsistently implemented across HCOs, and while there are some commonalities, there is a wide variety of design and methods of evaluation for the programs. Though the problems to solve for (EHR efficiency, proficiency, and satisfaction) are the same, the organizational structure and culture of HCOs varies widely, which may partially explain the variability seen in reported ETOPs. When considering the measured outcomes, ETOPs may have direct and indirect effects on HCW burnout by improving EHR efficiency and satisfaction, as well as driving organizational culture towards teamwork and flexible problem solving. For this reason, ETOPs may also serve as a model for addressing other challenges in healthcare delivery. ETOPs are a promising intervention to enhance HCW experience with the EHR and reduce burnout. More research is needed to identify the optimal features, methods, and outcomes of ETOPs, and to disseminate them across HCOs.

Ethical dimensions of clinical data sharing by US healthcare organizations for purposes beyond direct patient care: Interviews with healthcare leaders.

Empirically investigate current practices and analyze ethical dimensions of clinical data sharing by healthcare organizations for uses other than treatment, payment, and operations. Make recommendations to inform research and policy for healthcare organizations to protect patients' privacy and autonomy when sharing data with unrelated third parties. Semi-structured interviews and surveys involving 24 informatics leaders from 22 US healthcare organizations, accompanied by thematic and ethical analyses. We found considerable heterogeneity across organizations in policies and practices. Respondents understood "data sharing" and "research" in very different ways. Their interpretations of these terms ranged from making data available for academic and public health uses, and to HIEs; to selling data for corporate research, to contracting with aggregators for future resale or use. The nine interview themes were that healthcare organizations: (1) share clinical data with many types of organizations, (2) have a variety of motivations for sharing data, (3) do not make data sharing policies readily available, (4) have widely varying data sharing approval processes, (5) most commonly rely on HIPAA de-identification to protect privacy, (6) were concerned about clinical data use by electronic health record vendors, (7) lacked data sharing transparency to the general public, (8) allowed individual patients little control over sharing of their data, and (9) had not yet changed data sharing practices within the year following the US Supreme Court 2022 decision denying rights to abortion. Our analysis identified gaps between ethical principles and healthcare organizations' data sharing policies and practices. To better align clinical data sharing practices with patient expectations and biomedical ethical principles, we recommend: updating HIPAA, including re-identification and upstream sharing restrictions in data sharing contracts, better coordination across data sharing approval processes, fuller transparency and opt-out options for patients, and accountability for data sharing and consequent harms.

The Leaders in Informatics, Quality, and Systems (LInQS) Fellowship.

Leaders in Informatics, Quality, and Systems (LInQS) is a non-ACGME (Accreditation Council for Graduate Medical Education)-accredited 2-year training program developed to enhance training in the fields of health care delivery, quality improvement (QI), clinical informatics, and leadership. This single-institution 2-year longitudinal training program grounded in QI and informed by leadership and clinical informatics includes didactics, coaching, and mentorship, all centered around individualized QI projects. The program has been available to sub-specialty fellows, advanced practice providers, and physicians. From 2019 to 2023, 32 fellows have been accepted into the program with 13 graduates and 16 currently enrolled. Fellows have been predominately female, physicians, and from multiple specialties but predominantly hospital medicine. Fellows' evaluations of the fellowship are highly positive, rating the didactics and mentorship aspects of the curriculum most favorably. Most fellows' projects utilized informatics solutions including clinical decision support tools to increase quality of care, improve patient outcomes, and reduce costs of care resulting in manuscript publications, national presentations, and a national specialty society award. Since matriculation, 50% of fellows received certification as Epic Physician Builders and 34% received leadership positions in clinical informatics, quality, and education. Our experience supports the need to provide health care providers more expansive training in the areas of QI, clinical informatics, and leadership for improving health care delivery. Additional in-depth knowledge and experience in these fields may produce and benefit leaders in these fields.

Evolutionary role of physician leaders in healthcare informatics and health technology

Evolutionary role of physician leaders in healthcare informatics and health technology

Gender and Geographical Representation on Editorial Board Members of Medical Informatics Journals.

Previous work has suggested that gender and geographical distribution (affiliation) of Editors-in-Chief (EiC) and Editorial Board (EB) members are inequitable in representation of scientific communities, and could benefit from increasing diversity of representation. Specifically, previous studies suggest that male and ethnically white (or non-minoritized groups) are overrepresented. Such differences in representation may potentially influence the scientific and scholarly record. This paper aims to build on pre-existing literature by examining the diversity of representation among EiCs and EB members in the top (Q1) journals in the "Medicine-Health Informatics" category (ranked by SCImago Journal and Country Rank, or SJR) in terms of gender as assessed by genderize.io) and geographical distribution of affiliations. Preliminary findings are consistent with those of previous work on the topic: only 25% (8/32) of the EiCs in the selected journals are female, while females only represent 32.7% (426/1303) of the EB members across journals. Furthermore, the US is highly represented in EBs, with more than half of the members, i.e., 52.2% (698/1337), being US-affiliated. Present results suggest the need for an intentional approach to diversifying representation on editorial boards of medical informatics journals. Such intention can be seen as part of a call to action from important stakeholders, including medical informatics leaders and programs, journal management and publishers, and the medical informatics and scientific community more generally.

Understanding enterprise data warehouses to support clinical and translational research: impact, sustainability, demand management, and accessibility.

Healthcare organizations, including Clinical and Translational Science Awards (CTSA) hubs funded by the National Institutes of Health, seek to enable secondary use of electronic health record (EHR) data through an enterprise data warehouse for research (EDW4R), but optimal approaches are unknown. In this qualitative study, our goal was to understand EDW4R impact, sustainability, demand management, and accessibility. We engaged a convenience sample of informatics leaders from CTSA hubs (n = 21) for semi-structured interviews and completed a directed content analysis of interview transcripts. EDW4R have created institutional capacity for single- and multi-center studies, democratized access to EHR data for investigators from multiple disciplines, and enabled the learning health system. Bibliometrics have been challenging due to investigator non-compliance, but one hub's requirement to link all study protocols with funding records enabled quantifying an EDW4R's multi-million dollar impact. Sustainability of EDW4R has relied on multiple funding sources with a general shift away from the CTSA grant toward institutional and industry support. To address EDW4R demand, institutions have expanded staff, used different governance approaches, and provided investigator self-service tools. EDW4R accessibility can benefit from improved tools incorporating user-centered design, increased data literacy among scientists, expansion of informaticians in the workforce, and growth of team science. As investigator demand for EDW4R has increased, approaches to tracking impact, ensuring sustainability, and improving accessibility of EDW4R resources have varied. This study adds to understanding of how informatics leaders seek to support investigators using EDW4R across the CTSA consortium and potentially elsewhere.

Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators.

Web-based patient portals are tools that could support adolescents in managing their health and developing autonomy. However, informatics administrators must navigate competing interests when developing portal access policies for adolescents and their parents. We aimed to assess the perspectives of informatics administrators on guiding principles for the development of web-based health care portal access policies in adolescent health care. We interviewed informatics administrators from US hospitals with ≥50 dedicated pediatric beds. We performed a thematic analysis of guiding principles for developing and implementing adolescent portal access policies. We interviewed 65 informatics leaders who represented 63 pediatric hospitals, 58 health care systems, 29 states, and 14,379 pediatric hospital beds. Participants described 9 guiding principles related to three overarching themes: (1) balancing confidentiality and other care needs, (2) balancing simplicity and granularity, and (3) collaborating and advocating. Participants described the central importance of prioritizing the health and safety of the adolescent while also complying with state and federal laws. However, there were differing beliefs about how to prioritize health and safety and what role parents should play in supporting the adolescent's health care. Participants also identified areas where clinicians and institutions can advocate for adolescents, especially with electronic health record vendors and legislators. Informatics administrators provided guiding principles for adolescent portal access policies that aimed to balance the competing needs of adolescent confidentiality and the usefulness of the portal. Portal access policies must prioritize the adolescent's health and safety while complying with state and federal laws. However, institutions must determine how to best enact these principles. Institutions and clinicians should strive for consensus on principles to strengthen advocacy efforts with institutional leadership, electronic health record vendors, and lawmakers.

Proceedings From the 2022 ACR-RSNA Workshop on Safety, Effectiveness, Reliability, and Transparency in AI

Despite the surge in artificial intelligence (AI) development for health care applications, particularly for medical imaging applications, there has been limited adoption of such AI tools into clinical practice. During a 1-day workshop in November 2022, co-organized by the ACR and the RSNA, participants outlined experiences and problems with implementing AI in clinical practice, defined the needs of various stakeholders in the AI ecosystem, and elicited potential solutions and strategies related to the safety, effectiveness, reliability, and transparency of AI algorithms. Participants included radiologists from academic and community radiology practices, informatics leaders responsible for AI implementation, regulatory agency employees, and specialty society representatives. The major themes that emerged fell into two categories: (1) AI product development and (2) implementation of AI-based applications in clinical practice. In particular, participants highlighted key aspects of AI product development to include clear clinical task definitions; well-curated data from diverse geographic, economic, and health care settings; standards and mechanisms to monitor model reliability; and transparency regarding model performance, both in controlled and real-world settings. For implementation, participants emphasized the need for strong institutional governance; systematic evaluation, selection, and validation methods conducted by local teams; seamless integration into the clinical workflow; performance monitoring and support by local teams; performance monitoring by external entities; and alignment of incentives through credentialing and reimbursement. Participants predicted that clinical implementation of AI in radiology will continue to be limited until the safety, effectiveness, reliability, and transparency of such tools are more fully addressed.

Evaluation of Climate-Aware Metrics Tools for Radiology Informatics and Artificial Intelligence: Toward a Potential Radiology Ecolabel

Radiology is a major contributor to health care's impact on climate change, in part due to its reliance on energy-intensive equipment as well as its growing technological reliance. Delivering modern patient care requires a robust informatics team to move images from the imaging equipment to the workstations and the health care system. Radiology informatics is the field that manages medical imaging IT. This involves the acquisition, storage, retrieval, and use of imaging information in health care to improve access and quality, which includes PACS, cloud services, and artificial intelligence. However, the electricity consumption of computing and the life cycle of various computer components expands the carbon footprint of health care. The authors provide a general framework to understand the environmental impact of clinical radiology informatics, which includes using the international Greenhouse Gas Protocol to draft a definition of scopes of emissions pertinent to radiology informatics, as well as exploring existing tools to measure and account for these emissions. A novel standard ecolabel for radiology informatics tools, such as the Energy Star label for consumer devices or Leadership in Energy and Environmental Design certification for buildings, should be developed to promote awareness and guide radiologists and radiology informatics leaders in making environmentally conscious decisions for their clinical practice. At this critical climate juncture, the radiology community has a unique and pressing obligation to consider our shared environmental responsibility in innovating clinical technology for patient care.

Cancer Informatics for Cancer Centers: Sharing Ideas on How to Build an Artificial Intelligence-Ready Informatics Ecosystem for Radiation Oncology.

In August 2022, the Cancer Informatics for Cancer Centers brought together cancer informatics leaders for its biannual symposium, Precision Medicine Applications in Radiation Oncology, co-chaired by Quynh-Thu Le, MD (Stanford University), and Walter J. Curran, MD (GenesisCare). Over the course of 3 days, presenters discussed a range of topics relevant to radiation oncology and the cancer informatics community more broadly, including biomarker development, decision support algorithms, novel imaging tools, theranostics, and artificial intelligence (AI) for the radiotherapy workflow. Since the symposium, there has been an impressive shift in the promise and potential for integration of AI in clinical care, accelerated in large part by major advances in generative AI. AI is now poised more than ever to revolutionize cancer care. Radiation oncology is a field that uses and generates a large amount of digital data and is therefore likely to be one of the first fields to be transformed by AI. As experts in the collection, management, and analysis of these data, the informatics community will take a leading role in ensuring that radiation oncology is prepared to take full advantage of these technological advances. In this report, we provide highlights from the symposium, which took place in Santa Barbara, California, from August 29 to 31, 2022. We discuss lessons learned from the symposium for data acquisition, management, representation, and sharing, and put these themes into context to prepare radiation oncology for the successful and safe integration of AI and informatics technologies.

Accomplished women leaders in informatics: insights about successful careers.

We sought to learn from the experiences of women leaders in informatics by interviewing women in Informatics leadership roles. Participants reported career challenges, how they built confidence, advice to their younger selves, and suggestions for attracting and retaining additional women. Respondents were 16 women in leadership roles in academia (n = 9) and industry (n = 7). We conducted a thematic analysis revealing: (1) careers in informatics are serendipitous and nurtured by supportive communities, (2) challenges in leadership were profoundly related to gender issues, (3) "Big wins" in informatics careers were about making a difference, and (4) women leaders highlighted resilience, excellence, and personal authenticity as important for future women leaders. Sexism is undeniably present, although not all participants reported overt gender barriers. Confidence and authenticity in leadership point to the value offered by individual leaders. The next step is to continue to foster an informatics culture that encourages authenticity across the gender spectrum.

Is every nurse a leader?

FigureThe adage that “every nurse is a leader” has been prevalent lately in opinion pieces and network conversations, revisiting a decades-old belief. Most say yes, some say maybe, and others assert all nurses should or even must be leaders. A dear colleague puts forward another possibility: every nurse can be a leader. Could all of these be true? Probably. We do know leaders aren't only those in formal positions as we see leadership in many forms at every level, but we could also argue that a title doesn't make anyone a leader either. Can you be a leader without followers or without influence? I don't think so, do you? Personally, I love leading, and I like following just as much depending on the circumstances. Scope of leadership influence could be at the point of care advocating for a patient or family and/or in the community, at micro- to macroorganizational levels, or even in government. It could be locally, nationally, or globally. Nurse influencers are all over social media whether you agree with their messages or not. It's all leadership, and the resulting followership determines the influence. It's not about “style,” although task-oriented leadership practice is just as undesirable as task-oriented clinical practice. Tim Porter O'Grady has been preaching about complexity leadership for years, making the strong case that leadership (whether positional, professional, or as an expert) must face constantly changing dynamics to be effective. Maybe that makes the concept of every nurse being a leader even more complex, but in our healthcare reality, all agree that nurses face constantly changing headwinds from the beside to the boardroom. Every patient, family, team, service line, department, healthcare system, nursing school, and on and on, have different forces involved in every situation. Leadership in a complex world is, well, complex. And possible at every conceivable level. So how do we help nurses lead, and help each other as well? It starts in the preparation of new nurses at the academic level, which is supported by the American Association of Colleges of Nursing's core competencies. That's obviously not enough. We must be role models and expect leadership in the form of escalation, advocacy, critical thinking, teaching, professional contributions, and more starting at onboarding, which isn't possible without a psychologically safe environment. Perhaps we should do more to recognize, facilitate, and publicize leadership and innovation exemplars big and small; that can be inspirational, begetting more of the same. Even more critical, nurses must be willing and able. It's hard to believe a licensed professional RN would be unwilling or unable, but we've all seen it in practice—it's possible. And not acceptable from a role expectations perspective at the point of care and onward. In a Nurse Leader article this year, Godsey and Hayes gave multiple reasons for rebranding nurses as leaders, different from the public perception of nurses solely as caring healthcare workers following physicians' orders. This is our place in society considering our value and impact on healthcare in this country. And we haven't even touched on “nurses on boards,” taking this to yet another level. That brings us full circle. It seems that all nurses can be leaders, are expected and need to be leaders, and our public persona should be that we are leaders. We must use our influence to encourage and uphold nurse leadership in all its forms. It's who we are.Figure[email protected]

Point-of-Care Feedback: Preceptor Cosigning Workflow Promotes Milestone Assessment

In residency training, the Accreditation Council for Graduate Medical Education stipulates feedback from faculty should be frequent, exist in the context of routine clinical care, include multiple evaluators, emphasize competency and milestones, and be in writing so it can be shared with the Clinical Competency Committee.Collecting frequent feedback in the context of ambulatory care is an ambitious ask. Supervision of residents in clinic can be busy, if not chaotic. Assessment surveys can be quick, and they can be web-based or smartphone application-based. Still, collection rates can be lower than is needed. Faculty reminders by email, signs in the supervision area, available program links on workplace computers, and prompts submitted by residents to supervising faculty have all been used to increase assessment completion by faculty.1Oregon Health & Science University's Internal Medicine Clinic is the resident continuity clinic for 44 trainees, supervised by more than 30 part-time faculty preceptors. We tested a method to increase case-specific direct observation feedback by preceptors.We looked to thought leaders in informatics for help in our tool design. The most frequently used clinical decision support tools are directly integrated with electronic medical record (EMR) systems. To design effective point-of-care support tools, our experts stick with these informatics rules of thumb: “Speed is everything,” “Deliver in real-time,” and “Fit into the user's workflow.”2We designed a web-based rapid assessment tool. The evaluator selects content areas or processes to score and enters a narrative comment. Our innovation was to deliver this tool directly within the preceptor workflow: we embedded a link in the cosigning (preceptor attestation) template. The location of the survey link was a game changer for our collection rate.Embedding the link into the cosigning template took some care. So that our survey hyperlink would never become part of the patient chart, we needed disappearing instructional text with automated removal from the chart when the preceptor note was signed. Many EMRs enable “prompts” in templates or text blocks. Our university utilizes EpicCare, and we were able to achieve disappearing text using the function “blank, optional SmartList.” Our function displays as a single line of text at the bottom of the preceptor note in progress, with blue font that is recognized by the clinician as disappearing text. The text contains a hyperlink to our rapid assessment.Within the attestation workflow, a preceptor has a visual reminder to provide the assessment and has the option to enter the assessment survey with a single click. The survey results can be collected at any interval by the clinic medical director, who has access to survey reports.Links to our rapid assessment tool were provided in several lower yield environments before we identified a way to embed a link into the cosigning workflow (Figure). Embedding the link within the existing preceptor workflow of chart attestation resulted in an immediate, meaningful, and sustained increase in the number of submitted assessments.The feedback entered is exceptionally relevant—it is specific and contains colorful clinical performance anecdotes that inform resident competencies. This process has been popular with residents and faculty, and it has markedly enriched our resident feedback process.

Strengths, weaknesses, opportunities, and threats for the nation's public health information systems infrastructure: synthesis of discussions from the 2022 ACMI Symposium.

The annual American College of Medical Informatics (ACMI) symposium focused discussion on the national public health information systems (PHIS) infrastructure to support public health goals. The objective of this article is to present the strengths, weaknesses, threats, and opportunities (SWOT) identified by public health and informatics leaders in attendance. The Symposium provided a venue for experts in biomedical informatics and public health to brainstorm, identify, and discuss top PHIS challenges. Two conceptual frameworks, SWOT and the Informatics Stack, guided discussion and were used to organize factors and themes identified through a qualitative approach. A total of 57 unique factors related to the current PHIS were identified, including 9 strengths, 22 weaknesses, 14 opportunities, and 14 threats, which were consolidated into 22 themes according to the Stack. Most themes (68%) clustered at the top of the Stack. Three overarching opportunities were especially prominent: (1) addressing the needs for sustainable funding, (2) leveraging existing infrastructure and processes for information exchange and system development that meets public health goals, and (3) preparing the public health workforce to benefit from available resources. The PHIS is unarguably overdue for a strategically designed, technology-enabled, information infrastructure for delivering day-to-day essential public health services and to respond effectively to public health emergencies. Most of the themes identified concerned context, people, and processes rather than technical elements. We recommend that public health leadership consider the possible actions and leverage informatics expertise as we collectively prepare for the future.

Challenges to Developing and Implementing Policies for Adolescent Online Portal Access.

After enactment of the 21st Century Cures Act, many health care systems offer adolescents and parents access to electronic health information through online portals. Few studies have evaluated adolescent portal access policies since the implementation of the Cures Act. We performed structured interviews with informatics administrators in US hospitals with ≥50 dedicated pediatric beds. We performed thematic analysis of challenges to developing and implementing adolescent portal policies. We interviewed 65 informatics leaders representing 63 pediatric hospitals, 58 health care systems, 29 states, and 14 379 pediatric hospital beds. Most hospitals provided portal access to adolescents (86%) and parents (95%). Filtering of results sent to parental portals ranged widely, with 14% providing unfiltered access, 31% performing minimal filtering for sensitive information, and 43% offering limited access. Portal access policies also varied widely within states. Challenges to developing policies included legislation and compliance issues, tension between confidentiality and usefulness, clinicians' preferences and concerns, limited understanding and investment of institutions in pediatric issues, and limited focus of vendors on pediatric issues. Challenges to implementing policies included technical challenges, educating end-users, potential for parental coercion, harms of bad news, complex enrollment processes, and informatics workforce limitations. Adolescent portal access policies vary widely across and within states. Informatics administrators identified multiple challenges related to developing and implementing adolescent portal policies. Future efforts should strive to develop intrastate consensus on portal policies and to engage parents and adolescent patients to better understand preferences and needs.

2023 HIMSS-ANI Nursing Informatics Leadership Award Announced.

Beale, Nancy PhD, RN-BC; Hull, Susan C. MSN, RN-BC, NEA-BC, FAMIAEditor(s): Carter-Templeton, Heather PhD, RN-BC, FAAN Author Information

A Brief History of Public Health Informatics-Lessons for Leaders and a Look Into the Future.

A Brief History of Public Health Informatics-Lessons for Leaders and a Look Into the Future.

Digital Tools Adopted by Public Health Agencies to Support COVID-19 Case Investigation and Contact Tracing, United States, 2020-2021.

During the COVID-19 pandemic, public health agencies implemented an array of technologies and digital tools to support case investigation and contact tracing. Beginning in May 2020, the Association of State and Territorial Health Officials compiled information on digital tools used by its membership, which comprises 59 chief health officials from each of the 50 states, 5 US territories, 3 freely associated states, and the District of Columbia. This information was presented online through a publicly available technology and digital tools inventory. We describe the national landscape of digital tools implemented by public health agencies to support functions of the COVID-19 response from May 2020 through May 2021. We also discuss how public health officials and their informatics leadership referenced the information about the digital tools implemented by their peers to guide and refine their own implementation plans. We used a consensus-based approach through monthly discussions with partners to group digital tools into 5 categories: surveillance systems, case investigation, proximity technology/exposure notification, contact tracing, and symptom tracking/monitoring. The most commonly used tools included the National Electronic Disease Surveillance System Base System (NBS), Sara Alert, REDCap, and Maven. Some tools such as NBS, Sara Alert, REDCap, Salesforce, and Microsoft Dynamics were repurposed or adapted for >1 category. Having access to the publicly available technology and digital tools inventory provided public health officials and their informatics leadership with information on what tools other public health agencies were using and aided in decision making as they considered repurposing existing tools or adopting new ones.

Marisa L. Wilson Honored With 2022 HIMSS-ANI Nursing Informatics Leadership Award.

Marisa L. Wilson Honored With 2022 HIMSS-ANI Nursing Informatics Leadership Award.

How to Support the Nursing Informatics Leadership Pipeline: Recommendations for Nurse Leaders and Professional Organizations.

There is a need for nursing informatics leaders. However, there are not enough people educated and trained in informatics and leadership to fill that need. Therefore, the purpose of this study was to understand how professional organizations and nurse leaders support nursing informatics leadership development. This cross-sectional, descriptive study collected data via a scan of Web sites for eight nursing, informatics, and/or leadership professional organizations; interviews and surveys with nursing informatics leaders within the eight organizations; and a review of Web site, interview, and survey findings by nursing informatics leaders involved in leadership development. We found that nursing informatics leaders and professional organizations can support the nursing informatics leadership pipeline several ways. Examples included mentoring, education/training, and providing opportunities for networking and engagement in leadership roles. To help meet the need for nursing informatics leaders, professional organizations and current leaders can engage in various activities that provide training, education, and experiences for emerging leaders.