CLINICAL INFORMATICS & PATIENT-CENTERED TECHNOLOGIES

SPRING 2019 NEWSLETTER

Events of interest

CIPCT 2018 Annual

Meeting & Orientation

September 20-21 2019, Seattle,

WA

American Medical Informatics

Association (AMIA)

2019 Annual Symposium

November 16th-20th

YEAR IN REVIEW

A message from CIPCT Director Drs. Andrea Hartzler and Donna Berry

STUDENT SPOTLIGHT

As the 2018-2019 academic year is coming to a close we celebrate many accomplishments in the pro-

gram and are excited about the next steps.

Embedded in a busy month of June, a group of 6 faculty (3 School of Nursing and 3 Biomedical Infor-

matics and Medical Education) will review 2017 recommendations from previous curriculum commit-

tees and mapping of CIPCT course objectives to 2018 AMIA competencies. All new recommendations

will be evaluated for potential program and course revisions.

Summer is always an exciting time as many of our year 1 students will be identifying their scholarly

projects. Our co-director Dr. Andrea Hartzler is teaching the research methods course this spring quar-

ter and the scholarly proposal development course in summer 2019.

We are also getting ready for our annual meeting and orientation

in September. We look forward to welcoming our 2019 cohort

and second year students. Please check our website for updates.

Spring and summer graduates, we look forward to celebrating

with you at commencement and convocation

This year two of our students Darshan Thota and Liam Toth had the opportunity to present at the American

Medical Informatics Association (AMIA) clinical informatics conference held in Atlanta.

Both clinicians and informaticists are often infatuated by emerging technologies, latest trends, and the most

sophisticated solutions to address the problems of physician burnout, patient experience, and HER inefficien-

cies. Interprofessional collaborative efforts may reveal latent design potential, workflow efficiencies, and

process improvements that positively affect patient care access/satisfaction and end-user engagement. Practi-

cal and financial constraints can limit process improvement projects before they begin. By the end of this

presentation, attendees will be able to recognize the importance of an engaged clinical workforce and how to

utilize preexisting but underused tools within their EHR to better meet the needs of their end users, both clini-

cians and patients.

STUDENT SPOTLIGHT

Jennifer Montances Garcia’s

experience at HIMSS 2019

Attending the HIMSS19 confer-ence in February of this year as a student volunteer was a phe-nomenal experience. HIMSS19 was held in sunny Orlando, Florida at the Orange County Convention Center, with about 47,000 people (e.g. physicians, informaticians, nurses, coders, IT analysts, vendors, students and educators) in attendance this year. I volunteered for the In-teroperability Showcase which featured several big name EHR companies like EPIC, Cerner, AllScripts and others in “use cases” to solve electronic health record information sharing is-sues like clinical exchange and price transparency or coordinat-ed care on a nationwide scale. I also volunteered at the UW CIPCT information booth on University Row. Between my volunteer shifts, I looked in to resources available for students and 1st time attendees. I was pleased to find out that HIMSS’ Program Development department has been making great strides to include stu-dents of all ages and cater to 1st time attendees at this annual global conference. Scheduled events that I attended and strongly recommend for new HIMSS attendees are:

First Timers Orientation- gives an overview of HIMSS organization, its history, facts about the scale of the conference, how to use HIMSS app to find scheduled presentations and events

Student Only Orientation- perks as to why you should join HIMSS (such as the $30 student membership dis-count), highlighted opportunities for jobs/internships and externships, job search resources (Jobmine.himss.org), tips on networking, offering scholarships

Student Institute- Interactive Q&A panel of informatics industry bosses and educators, featured guest speaker/consultant Bonnie Siegel who reviewed the newest advice on resume, Linked In bio and interview prep tips, network opportunity to meet Program Assistants and other volunteer opportunities at HIMSS

Career Fair- offered free headshots, resume review/feedback service, featured several booths for recruiters and job opportunities, display of winner and entries of annual HIMSS student poster contest

Aside from my volunteer shifts and attending the student focused events above, I attended key note speak-ers, other presentations, perused the giant floor room filled with vendor booths and free snacks, and went to a few social events offered throughout the week. As I returned on my flight home, albeit exhausted, I was filled with a sense of gratefulness and wonder. My busy week at the HIMSS19 conference went by in a whirlwind. However, in attending presentations and watching use cases at the Interoperability showcase, I was amazed at the scale of how impactful informatics is and will be to healthcare. Also, attending this conference as student volunteer was a great opportunity to connect with so many knowledgeable people in this space. I highly recommend to all CIPCT students to explore this opportunity and attend a HIMSS conference. As for me, I would love to attend the HIMSS annual conference again next year- hope to see some of you there too! - Jennifer Garcia

SCHOLARLY PROJECTS

Chris Ann Clavey

Smartphone-Integrated Infant Physiologic Monitors: A Descriptive Study of

Parent Perception, Use, and Infant Sleep Safety

This purpose of this scholarly project is to describe parents’ knowledge and attitudes regarding American Academy of Pediatrics (AAP) Safe Sleep recommendations, and their choices and perceptions around the use of wearable physiologic monitors for their infants. Participants were parents with infant(s) under 1 year of age, who were newly enrolled as participants in a community support group. A web-based cross-sectional survey was conducted, employing a questionnaire consisting of three main parts: knowledge and agreement with AAP Safe Sleep guidelines, physiologic monitor use, and socio-demographic characteristics of the participants. A follow-up phone interview focused on monitor use, the reasons that parents either did or did not choose to use physiologic monitors, and their perceptions of the monitors. Results showed little difference in the knowledge or attitudes to the Safe Sleep guidelines between the two groups. Peace of mind, reassurance, reduction of sleep anxiety, and worry are dominant themes that describe the reasons that parents chose to use a monitor as well as the benefits they felt the monitor delivered during use. Among monitor non-users, false alarms, increased anxiety and the amount of data monitors created were reasons parents chose not to use a monitor. This descriptive study showed that parental anxiety and stress are the main drivers of Safe Sleep choices, and emphasized the need for more comprehensive teaching around Safe Sleep strategies to reduce anxiety and improve compliance to Safe Sleep guidelines. Autumn 2018 Committee: Hilaire Thompson, Teresa Ward

Kristina De La Cruz

Patient Reported Outcomes & Patient Generated Health Data using mHealth Technology

The rise in popularity of health technology has encouraged patients to use and share patient-generated health data (PGHD), as well as participate in patient reported outcomes (PRO). PGHD and PRO gather data by using health tools, such as digital questionnaires through wearables, mobile apps, and connected medical devices. These advancements have allowed patients to become more engaged in their health and ultimately stepping closer to patient-centered care. PRO and PGHD implementation provide opportunities for both the patient and provider by giving providers the chance to monitor the status and needs of the patient. The first part of this project is to review the importance of PRO and PGHD in patients. The second part of this project examines mobile apps (or “mHealth”) from healthcare systems throughout Washington. These mobile apps will be analyzed from user reviews, while identifying strengths, barriers, and ways to improve. This project is based on a 2018 research study, directed by Dr. Danielle LaVallee. This project will present a synthesis of literature focusing on PRO and PGHD, as well as to inform how mHealth is an effective tool based on user reviews. Autumn 2018 Committee: Bill Lober, Danielle Lavallee

Each year, the graduating cohort of the CIPCT program completes a number of Scholarly Projects as part of

their degree requirements. This section highlights a handful of our students’ Scholarly Project submissions for

fall and winter quarter 2019.

SCHOLARLY PROJECTS

Sonamjeet Kaur

An Evaluation of Electronic Health Record Adoption at Skilled Nursing Facilities

Background: The purpose of this project was to identify electronic health record (EHR) implementation challenges at Skilled Nursing Facilities (SNF). Era Living is planning to implement an EHR at Broadview Health Care Center (HCC), to consolidate the multiple information systems and paper charting currently in use. Methods: First, we performed a literature review to identify challenges and recommendations for the implementation of an EHR in SNFs. Second, we conducted interviews with nine key informants from SNF organizations affiliated with the UW Post-Acute Network. The overall response rate was 69%. Interviews were analyzed to explore emergent themes in the experiences, challenges, and recommendations in the EHR implementation process. Results: The literature review identified challenges and recommendations on the unintended consequences, advanced staff training methods, end-user feedback, and the need for quality improvement processes. An analysis of the interview responses revealed four overarching themes: the EHR selection process, staff notification of EHR adoption, staff training, and education, and challenges. Conclusion: Most of the key informants promoted a positive exper ience and overall satisfaction with the EHR at their facility. The participants recognized areas of weakness and offered suggestions for improvement. We would recommend the following: Staff Engagement - involve frontline staff in the planning process. End User Training - we recommend training staff from three departments (medical records, nursing, and caregiver staff) to be super users. Staff Training- The training should be curtailed to the job role. Changes to workflow should be mapped and included in training sessions in preparation for go-live.

Autumn 2018 Committee : Baisa Belza, David Masuda

Nicholas Macharia

The Impact of Using Medication Reminder Applications as an Intervention to Improve Medication Adherence in Older Patients: A Literature Review

Lack of medication adherence leads to poor treatment outcome, lower quality of life and

higher health care costs, especially among elderly patients. Medication adherence

intervention is a promising strategy for achieving better treatment outcomes and

reducing health care costs. Interventions focused on reminding elderly patients to take

their medications may increase medication adherence and provide a viable medium for

medication management. However, the utility of reminder applications for medication

management can be limited without addressing the specific needs of seniors and

facilitating the active involvement of care providers. Despite the growing number of technologies that support

medication adherence, such as mobile phone applications (apps), little is known about how effective these

apps are for elderly patients. This literature review has the following goals: (1) present evidence from the

literature regarding the efficacy of medication reminders as an intervention for medication adherence in

elderly patients; (2) describe features required to make an app effective for elderly patients (e.g., plain

English, audible or visual reminder function, ability to share with caregivers, tracking medication history,

medication database, refill reminder, uses visual aids and flexible scheduling); and (3) summarize findings

with recommendations on future directions for application development to support medication adherence in

SCHOLARLY PROJECTS

elderly patients. A comprehensive literature search was conducted using electronic bibliographic databases.

The search strategy included articles published between 2010 and 2017 on medication adherence or

compliance in elderly or older patients, and medication reminder apps. The literature search yielded twenty

studies that met the inclusion criteria. Three studies focused on improving medication adherence in elderly

patients. The studies examined yielded mixed results. Barriers exist in the usability of these application for

elderly patients. One such barrier is the lack of experience using technology in a majority of elderly patients

which results in a lack of interest in using medication reminders. The other, older adults do not see a need for

the medication reminders. The review of the medication reminders applications selected from Google Play

store had many of the desirable features such as plain English, audible or visual reminder function, tracking

medication history, medication database, refill reminder, record medical history, uses visual aids, flexible

scheduling, appointment reminder, tracks other health metrics, and ability to share with caregivers. The

review process used identified medication reminders applications with features that are capable of assisting

elderly patients with their medication management.

Autumn 2017 Committee : Oleg Zaslavsky, Hilaire Thompson

Erika Windsor Hjalseth

An Evaluation of Electronic Health Record Adoption at Skilled Nursing Facilities

Back Ground: The implementation of an EHR system is a complex orchestration of patient care, clinical workforce, clinical workflow processes, information technology, and business systems. The successful implementation of an EHR requires a harmonious relationship between end users that understand the best utilization of technology and patient care, technology components working properly with established clinical workflow, and that all of the end users know how to use the EHR system correctly and efficiently. This report summarizes the interview findings conducted as part of identifying Electronic Health Record implementation challenges faced by Skilled Nursing Facilities to aid Era Living's EHR implementation at Broadview Health Care Center (HCC). Findings are based on interviews that were conducted with nine key informants from local Seattle SNF organizations associated with the UW Post Acute Network in October and November 2018. The interviews explored the experiences, knowledge, successes, and challenges with the EHR implementation in the SNF setting. Method: To begin the interview process, an introductory letter was emailed to thirteen SNF organizations associated with the UW Post Acute Network by the Director of Nursing at HCC (Appendix B). The letter explained that the interviews would be recorded with a transcript of their interview responses to be shared with HCC, but the responses would be anonymous. Thirteen SNF organizations were contacted to participate in a 30-45 minute in-person or phone interview. The key informant were asked interview questions based on the EHR implementation status of their SNF organization: 1) Yes EHR implemented, 2) No EHR not implemented, or 3) EHR in process of implementation (Appendix A and Appendix C). The interviews were conducted between October 25 - November 5, 2018 with a total of 9 key informant interviews, for a response rate of 69%. Interviews were analyzed using both deductive and inductive methods to explore emergent themes in the experiences, challenges, and recommendations in the EHR implementation process. In addition, an in-depth literature review was done to identify challenges and recommendations in the implementation of an EHR in long-term care facilities. Results: An analysis of the interviews revealed four overarching themes across all key informant responses. The interview themes addressed: the EHR selection process, staff notification of EHR adoption, staff training and education, and challenges with the EHR implementation process. The literature identified challenges and

SCHOLARLY PROJECTS

recommendations in the unintended consequences, advanced staff training methods, end-user feedback, and establishment of a quality improvement process for successful EHR implementation. Conclusion: The majority of the key informants promoted a positive experience and overall satisfaction with the EHR at their facility. The participants recognized areas of weakness in the implementation process, and suggestions for improvement correlated with the findings of the literature review. The feedback illuminated common themes such as the lack of staff engagement prior to implementation, low technology skills among staff, end user training during pre/post implementation, and leadership support as critical elements to successful EHR adoption. The key informants recommended establishing a strategic plan to present the EHR adoption process to the staff members in order to gain staff buy in for the project, emphasized the importance of designing a comprehensive training program tailored and specific to the needs of the various disciplines and job roles. Based on the interview responses and literature review, our recommendations for Era Living include Winter 2019 Committee : Baisa Belza, David Masuda

Yazan Gazy Kader

Review of mHealth applications and utilization by homeless individuals: A systematic review

Background: Homeless individuals have increased rates of poorly managing chronic health conditions, which leads to worse healthcare outcomes and greater use of healthcare resources that would otherwise not be necessary. Homeless people are also more likely to have mental health conditions such as depression, personality disorders, and substance misuse. Apps are an emerging technology worth studying to understand if and how they can assist homeless populations in managing medical and mental health conditions. Objective: This nested systematic review closely looked at rigorously evaluated mHealth apps that would be beneficial for homeless persons. Methods: Five electronic databases were searched for rigorously tested mHealth applications. From the final studies included in the parent study, this sub-analysis was done focusing on topics related to homeless individuals. Results: 62 studies met inclusion criteria for the sub-analysis. None of the studies focused on homeless individuals. The included studies were related to diabetes, cardiovascular disease, pulmonary disease, mental health, HIV, and smoking cessation. Conclusion: The lack of studies that focus on rigorously tested mHealth applications on the homeless population indicates a gap in research. mHealth applications with a focus on chronic disease management or mental health would be beneficial for this patient population. Future studies should focus in these areas. Winter 2019 Committee : Sarah Iribarren, Ardith Doorenbos

Kamp K, Herbell K, Magginis WH, Berry D, Given B Facebook Recruitment and the Protection of Human Subjects. West J Nurs Res. 2019 Feb 7

Jabaley T, Underhill-Blazey ML, Berry DL. Development and Testing of a Decision Aid for Unaffected Women with a BRCA1 or BRCA2 Mutation. J Cancer Educ. 2019 Jan 19

Wilson LS, Blonquist TM, Hong F, Halpenny B, Wolpin S, Chang P, Filson CP, Master VA, Sanda MG, Chien GW, Jones RA, Krupski TL, Berry DL. Assigning value to preparation for prostate cancer decision making: a willingness to pay analysis. BMC Med Inform Decis Mak. 2019 Jan 9

Knoerl R, Hong F, Blonquist T, Berry D. Impact of Electronic Self-Assessment and Self-Care Technology on Adherence to Clinician Recommendations and Self-Management Activity for Cancer Treatment-Related Symptoms: Secondary Analysis of a Randomized Controlled Trial. JMIR Cancer. 2019 Jan 8 Boston-Fleischhauer C, Herleth A, Langr M. A Call to Action on Point-of-Care Violence in Hospitals and Health Systems. J Nurs Adm. 2019 Mar Boston-Fleischhauer C. Confronting Clinical Rotations. J Nurs Adm. 2019 Jan Hellwege JN, Stallings S, Torstenson ES, Carroll R, Borthwick KM, Brilliant MH, Crosslin D et al Heritability and genome-wide association study of benign prostatic hyperplasia (BPH) in the eMERGE network. Sci Rep. 2019 Apr 15

Chiang T, Liu X, Wu TJ, Hu J, Sedlazeck FJ, White S, Schaid D, Andrade M, Jarvik GP, Crosslin D et al Atlas-CNV: a validated approach to call single-exon CNVs in the eMERGESeq gene panel. Genet Med. 2019 Mar 20 Zhang X, Veturi Y, Verma S, Bone W, Verma A, Crosslin D et al Detecting potential pleiotropy across cardiovascular and neurological diseases using univariate, bivariate, and multivariate methods on 43,870 individuals from the eMERGE network. Pac Symp Biocomput. 2019 Justice AE, Karaderi T, Highland HM, Young KL, Graff M, Crosslin D et al Protein-coding variants implicate novel genes related to lipid homeostasis contributing to body-fat distribution. Nat Genet. 2019 Mar;5 Safarova MS, Satterfield BA, Fan X, Austin EE, Ye Z, Bastarache L Crosslin D et al A phenome-wide association study to discover pleiotropic effects of PCSK9, APOB, and LDLR. NPJ Genom Med. 2019 Feb Mosley JD, Benson MD, Smith JG, Melander O, Ngo D, Crosslin D et al Probing the Virtual Proteome to Identify Novel Disease Biomarkers. Circulation. 2018 Nov 27 Turner AM, Osterhage KP, Taylor JO, Hartzler AL, Demiris G. A Closer Look at Health Information Seeking by Older Adults and Involved Family and Friends: Design Considerations for Health Information Technologies. AMIA Annu Symp Proc. 2018 Dec 5 Aronson S, Babb L, Ames D, Gibbs RA, Venner E, Connelly JJ, Hartzler AL et al Empowering genomic medicine by establishing critical sequencing result data flows: the eMERGE example. J Am Med Inform Assoc. 2018 Oc t Iribarren S, Demiris G, Lober B, Chirico C. What Do Patients and Experts Want in a Smartphone-Based Application to Support Tuberculosis Treatment Completion? Stud Health Technol Inform. 2018

RECENT PUBLICATIONS FACULTY (Autumn 2018– Winter 2019)

Iribarren S, Stonbraker S, Suero-Tejeda N, Granja M, Luchsinger JA, Mittelman M, Bakken S, Lucero R. Information, communication, and online tool needs of Hispanic family caregivers of individuals with Alzheimer's disease and related dementias. Inform Health Soc Care. 2019 Dell DS, Baldwin K, Bell EJ 3rd, Lehmann CU, Webber EC, Mohan V, Leu MG Characteristics of the National Applicant Pool for Clinical Informatics Fellowships (2016-2017). AMIA Annu Symp Proc. 2018 Dec Liu X, Sutton PR, McKenna R, Sinanan MN, Fellner BJ, Leu MG Evaluation of Secure Messaging Applications for a Health Care System: A Case Study. Appl Clin Inform. 2019 Jan Mueller BU, Neuspiel DR, Fisher ERS Leu MG (collaborator) Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care. Pediatrics. 2019 Feb Feld LG, Neuspiel DR, Foster BA, Leu MG Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018 Dec Li M, Bennette CS, Amendola LM, Ragan Hart M, Heagerty P, Comstock B, Tarczy-Hornoch P et al The Feelings About genomiC Testing Results (FACToR) Questionnaire: Development and Preliminary Validation. J Genet Couns. 2019 Apr Obeid JS, Tarczy-Hornoch P et al Sustainability considerations for clinical and translational research informatics infrastructure. J Clin Transl Sci. 2018 Oct; Zaslavsky O, Thompson HJ, McCurry SM, Landis CA, Kitsiou S, Ward TM, Heitkemper MM, Demiris G. Use of a Wearable Technology and Motivational Interviews to Improve Sleep in Older Adults With Osteoarthritis and Sleep Dis-turbance: A Pilot Study. Res Gerontol Nurs. 2019 Mar 22 Hickey KT, Bakken S, Byrne MW, Bailey DCE, Demiris G Thompson HJ et al Precision health: Advancing symptom and self-management science. Nurs Outlook. 2019 Jan 18 Mikles SP, Haldar S, Lin SY, Kientz JA, Turner AM Trust and Sharing in an Interprofessional Environment: A Thematic Analysis From Child Development Support Work in the Com-munity. AMIA Annu Symp Proc. 2018 Turner AM, Choi YK, Dew K, Tsai MT, Bosold AL, Wu S, Smith D, Meischke H. Evaluating the Usefulness of Translation Technologies for Emergency Response Communication: A Scenario-Based Study. JMIR Public Health Surveill. 2019 Jan 28 Machol K, Rousseau J, Ehresmann S, Garcia T, Nguyen TTM Turner AM et al Expanding the Spectrum of BAF-Related Disorders: De Novo Variants in SMARCC2 Cause a Syndrome with Intellectual Disability and Developmental Delay. Am J Hum Genet. 2019 Jan 3 Wilson LS, Blonquist TM, Hong F, Halpenny B, Wolpin S, et al Assigning value to preparation for prostate cancer decision making: a willingness to pay analysis. BMC Med Inform Decis Mak. 2019 Lybarger K, Yetisgen M, Ostendorf M. Using Neural Multi-task Learning to Extract Substance Abuse Information from Clinical Notes. AMIA Annu Symp Proc. 2018 Dec 5 Lybarger KJ, Ostendorf M, Riskin E, Payne TH, White AA, Yetisgen M. Asynchronous Speech Recognition Affects Physician Editing of Notes. Appl Clin Inform. 2018 Oct;9

RECENT PUBLICATIONS

Key: CIPCT Faculty in bold; CIPCT students in bold italics.

Kohler PK, Akullian A, Okanda J, Otieno G, Kinuthia J, Voss J, Zierler B, John-Stewart G. Distance to HIV and Antenatal Care: A Geospatial Analysis in Siaya County, Kenya. J Assoc Nurses AIDS Care. 2019 Jan 28 Abu-Rish Blakeney E, Lavallee DC, Baik D, Pambianco S, O'Brien KD, Zierler BK Purposeful interprofessional team intervention improves relational coordination among advanced heart failure care teams. J Interprof Care. 2018 Dec 30 O'Connor MR, Carlin K, Coker T, Zierler B, Pihoker C. Disparities in Insulin Pump Therapy Persist in Youth With Type 1 Diabetes Despite Rising Overall Pump Use Rates. J Pediatr Nurs. 2019 Jan Abu-Rish Blakeney E, Wolpin S, Lavallee DC, Dardas T, Cheng R, Zierler B. Developing and implementing a heart failure data mart for research and quality improvement. Inform Health Soc Care. 2019

RECENT PUBLICATIONS STUDENTS

Craig B. Monsen, Joshua M. Liao, Barak Gaster, Kevin J. Flynn, and Thomas H. Payne The effect of medication cost transparency alerts on JMIA 2019 Jan 1 Sadeghian, R., Gooch, R., Phelps, L. A., & Preud’homme, D The Feasibility and Satisfaction of Using Telemedicine to Provide Tertiary Paediatric Obesity Care JISfTeH2018 August 18

Key: CIPCT Faculty in bold; CIPCT students in bold italics.

CIPCT 2019

ANNUAL MEETING AND

ORIENTATION

SEPTEMBER 20th and 21st SEATTLE CAMPUS