Panels

Moderator: Andrew Boyd, University of Illinois at Chicago

Panelists: Zheng, Kai; Kho, Abel; Boyd, Andrew; Parsons, Amanda; Andres, Amy; Armijo, Dan

Abstract: The Office of the National Coordinator (ONC) for Health Information Technology (Health IT) recently released $375 million to 32 non-profit agencies across the country to create Regional Extension Centers (REC).

A number of different organizations and methods are being deployed to assist physicians in the adoption of Health IT. The panel will discuss individual perspectives from the different RECs across the Midwest and East Coast. The goal of this panel is to share initial challenges and lessons learned with a national audience to assist the country moving forward in Health IT adoption. The objectives to meet this goal are to illustrate the organizational structure of the different RECs; and to compare and contrast the different operating models, outreach and technical assistance strategies employed by each. We will also discuss the challenges of deploying REC services in states with different levels/types of physician organization, stakeholder influences and cultural differences. The effective transformation of primary care delivery through HIT adoption requires the sharing of best practices and dissemination of successful strategies to move the country forward in the "meaningful use" of technology in healthcare.

Moderator: Atif Zafar, Indiana University

Panelists: Zafar, Atif; Doebbeling, Bradley; Burton, Matt; Ekbia, Hamid; Lehto, Mark

Abstract: Effectively implementing changes in healthcare system design for quality and process improvement requires an understanding of clinical workflows. These workflows are not just a simplistic linear arrangement of tasks but involve highly complex, evolved, interruptive, distributive, multitasking, collaborative, cognitive, responsive and reactive elements. Thus, no single evaluation methodology can be optimally applied to fully understand them, but rather an integrated approach is needed to assess, triangulate and represent work and information flow.

This discussion consists of a panel of experts from academia, industry and clinical practice who provide concrete examples of the complexity of these workflows and discuss methodologies to best analyze these workflows for development and implementation of informatics tools to support quality, efficiency and process improvement purposes.

Moderator: Charles Safran, Harvard Medical School

Panelists: Brennan, Patricia; Safran, Charles; Delbanco, Thomas; Slack, Warner; deBronkart, Dave

Abstract: In 1970, Warner Slack coined the term "Patient Power" and since then, many in medical informatics have developed tools and conducted research with the goal of making this a reality. Focusing on the clinician perspective, the panel will briefly discuss the evolution of patient-centered computing. Dr. Slack will discuss his work or patient-computer dialogue and describe a current clinical trial of patient entered, internet-based medical histories.

Dr. Tom Delbanco will discuss the development of PatientSite, an early personal health record, and "OpenNotes," a multi-site demonstration and evaluation trial that invites patients to view their PCP’s notes through PHRs, including PatientSite and Epic’s MyChart.

Dr. Patricia Flatley Brennan will discuss the evolution of personal health technologies in Project HealthDesign, a $10-million national program of the Robert Wood Johnson Foundation (RWJF) designed to stimulate innovation in personal health information technology by using PHRs as springboards for action and improved health decision-making.

Dr. Charles Safran will discuss the use of eHealth among populations thought to lack access to the Internet, or experience with eHealth applications. Finally, Dave deBronkar ("ePatient Dave") will respond to the clinician-centric view of patient empowerment.

Moderator: David Buckeridge, McGill University

Panelists: Chapman, Wendy; Buckeridge, David; Brownstein, John; Lober, Bill

Abstract: The last decade has seen considerable advances in the application of informatics methods to public health surveillance. Two areas of particular progress are the development of systems for automated surveillance of emergency department visits and the development of systems for automated media surveillance. The H1N1 influenza A pandemic in 2009 tested the contribution of these two surveillance innovations to public health decision making. The goal of this panel is to describe recent progress in automated syndromic and media surveillance systems, reflect on the performance of these systems in the recent pandemic, and consider the implications of this performance for the ongoing discussion of meaningful use.

The panel will include perspectives on the surveillance system architectures, detection of events within surveillance data, applications of media surveillance, and decision-making with surveillance data. Panelists will summarize the ‘state-of-the-art’ in their area and review lessons learned in the H1N1 pandemic. The panel will conclude with a discussion of the implications of lessons from each area for the ongoing discussion of meaningful use.

Moderator: David Dorr, OHSU

Panelists: Dorr, David; Bates, David; Zai, Adrian; Steele, Andrew

Abstract: Health information technology is a primary part of health care reform efforts. One major set of efforts revolves around redesign for primary care. In both the meaningful use of Health Information Technology legislation and medical home redesign, the use of technology is intended to drive more patient-centered, proactive, evidence-based care.

In this panel, the speakers will explore the facilitators and challenges to adapting current technologies to these tasks. Learning objectives will include the need to understand differences between current EHRs and what is needed for medical homes, describe the development, challenges, and improvements made through development of nine clinical registries, the need to focus on populations at risk through tracking systems, and the use of population data to drive enterprise-wide change. The broad experience of panelists as national policy influencers, system designers and experienced disseminators will help facilitate a rich discussion of next steps.

Moderator: David Lobach, Duke University Medical Center

Panelists: Del Fiol, Guilherme; Kawamoto, Kensaku; Lobach, David; Cooley, Mary; Borbolla, Damian

Abstract: Clinical decision support (CDS) systems have had limited availability in most healthcare settings in spite of demonstrated effectiveness in part because many CDS systems are constrained to a single healthcare organization. In order to foster greater use of CDS, new models of CDS delivery are needed.

In this session, panelists will describe four distinctly different CDS projects implemented in geographically diverse clinical settings using a centralized common CDS service. The projects include 1) chronic disease management for a health system in Durham, North Carolina; 2) population-level medication management across a six-county region of North Carolina; 3) real-time management of multiple symptoms in lung cancer patients in Boston, Massachusetts; and 4) breast cancer screening recommendations based on study results for patients in Buenos Aires, Argentina. Presenters will describe how the Web service framework enabled each implementation and how each system is functioning in a real-world clinical environment along with the challenges and lessons learned from each project.

Additionally, the panelists will convey how this framework has served as the basis for the HL7 Discussion Support Service standard and the plans to create an Open Source reference implementation of the standard that will be contributed to the wider community through Open Health Tools.

Moderator: David Pieczkiewicz, Marshfield Clinic Research Foundation

Panelists: Kaufman, David; Kushniruk, Andre; Patel, Vimla; Pieczkiewicz, David; Thyvalikakath, Thankam

Abstract: As health information technology (HIT) is increasingly deployed across institutions providing care, an understanding of the usability of such systems in actual production becomes crucial. While HIT usability studies exist, they often assess individual components of isolated, idealized systems, rather than the organic, dynamic, multi-vendor implementations present at many institutions. The recent mandates for HIT deployment in the United States and elsewhere provide a window of opportunity for in situ usability studies of "live" HIT systems at the time of their implementation and beyond. This panel will present and discuss current work and thinking on the usability testing of live HIT systems, in clinical medicine, nursing, and dentistry.

Participants will discuss such topics as the theoretical bases for in situ testing;, challenges and lessons learned from prior usability studies; the generalizability of results; the relation of usability to the "meaningful use" of HIT; and the possibilities for the standardization of usability testing in the health care domains.

Moderator: Ellen Harper, Cerner Corporation

Abstract: Meaningful health care quality measurement requires the collection and reporting of precise performance data. Developing and implementing intelligent information systems (IIS) including the electronic health record (EHR) can enhance seamless collection of these data. National comparison of performance requires that all quality indicators measure the same concepts.

The adoption of health information technology (HIT) can effectively automate and simplify these processes. However, implementing solutions to support nurses who also manage medical care for complex patients can be challenging. Electronic information systems can provide real time evidence-based decision support for clinicians while aggregating data for reports, quality improvement and research. This session will share the results and experiences of experts through three funded research projects that explore the use of evidence-based practice support in an EHR and its corresponding impact on patient care and quality outcomes.

The panelists will provide information about how the findings of their work contribute to advancing the understanding for how intelligent information systems (IIS) can support nursing-based improvements in patient care.

Moderator: Ferdinand Velasco, Texas Health Resources

Panelists: Velasco, Ferdinand; Eisenberg, Floyd; Cooper, John

Abstract: Electronic health records (EHRs) have been shown to improve clinical outcomes and patient safety. Ideally, these systems can also support the measurement of improved care processes and health outcomes. However, existing quality measures are poorly suited to being extracted automatically from EHRs.

In this panel presentation, representatives from a healthcare organization, the Centers for Medicare & Medicaid Services, and the National Quality Forum will discuss the challenges with reporting of quality measures from EHRs, the collaborative work underway to retool measures to address these challenges, the current state of development, testing, and implementation of standards for quality data reporting, and a framework for developing future quality measures that exploit the capabilities of EHRs.

Moderator: George Hripcsak, Columbia University

Panelists: Albers, David; Hripcsak, George; Butte, Atul; Szolovits, Peter; Kohane, Isaac

Abstract: Human health is a time-dependent process, and the only truly population-wide human health data sets that are likely to ever exist are electronic health records. Therefore, defining complex phenotypes will require coping with time within the context of medical records. Nevertheless, nearly all time series analysis tools are incompatible with the idiosyncrasies of data present in electronic health records.

This panel will focus on the challenges of and solutions to the analysis of the pathologically incomplete data present in electronic health records where the primary motivation for studying medical records is to derive a phenotype. By the end of the panel, attendees will: (i) understand the challenges of using temporal analysis to devise phenotype definitions; (ii) understand the challenges associated with adapting and applying AI techniques to study EHR data in more novel frameworks; (iii) understand the challenges relating the temporal component of EHR data with genetic data; and (iv) understand the challenges associated with adapting nonlinear science and nonlinear time series analysis techniques to EHR data.

Moderator: Jerry Osheroff, Thomson Reuters

Panelists: Murphy, Robert; Greenes, Robert; Osheroff, Jerry; White, P. Jon; Reider, Jacob

Abstract: The AHRQ Structuring Care Recommendations for Clinical Decision Support project was established to enhance integration of clinical recommendations into EHR systems.

Deliverables include well-accepted evidence-based recommendations, expressed in a structured, formalized, coded manner suitable for further processing into clinical decision support rules suitable for implementation in a wide variety of settings and systems. The major focus is prevention and screening recommendations, based on the United States Preventive Services Task Force A and B recommendations, and clinical management recommendations associated with CDS rules required to achieve meaningful use. Project leads will present an overview of project purpose, methods, deliverables, and dissemination.

Additional panelists that played key roles in the project will share their expert perspectives on implications of the project and its deliverables for information system vendors and implementers, and CDS researchers and developers.

Moderator: Jessica Ancker, Weill Cornell Medical College

Panelists: Kaushal, Rainu; Ancker, Jessica; Block, Rachel; Shih, Sarah

Abstract: As the nation expands its health information technology (HIT) and health information exchange (HIE) infrastructure, health information policy and evaluation are at the forefront of national concerns. Lessons learned at the state and local levels can provide valuable insight nationally. In this panel discussion, three experts will present their experiences in developing policy about HIT and HIE, and evaluating it, from the local and state-wide perspectives in New York.

The panelists include: Rachel Block, deputy commissioner, New York State Department of Health; Sarah Shih, MPH, New York City Department of Mental Health and Hygiene; and Rainu Kaushal, MD, MPH, of Weill Cornell Medical College, and Executive Director of the Health Information Technology Evaluation Collaborative (HITEC).

Both New York State and New York City are relatively advanced in building and evaluating health information infrastructures, so these perspectives and policies may assist other states and regions that are making similar transitions to more fully interoperable health information environments.

The learning objectives of this session are: to understand a statewide model of promoting HIT and HIE through both local and state governmental agencies; to discuss methods of cooperation between local and state agencies; to understand a statewide model for evaluating the resulting programs through partnerships with academic institutions.

Moderator: Joan Kapusnik-Uner, First DataBank

Panelists: Nelson, Stuart; Kapusnik-Uner, Joan; Flannery, Kathleen; Lincoln, Michael; Levin, Randy

Abstract: The NLM produces RxNORM, a standardized nomenclature for normalized drugs names, which is meant to augment or replace the NDC for interoperability data transmissions. Recent efforts have demonstrated the use of RxNORM in medication reconciliation and in e-prescribing.

A variety of propriety drug concepts used in specialized applications are mapped to RxNORM RxCUIs. CMS in 2010 replaced the proxy NDC within their Formulary Reference Files (FRFs) with RxCUIs; files that are intended to be used by Medicare Part D plan sponsors for the purpose of Health Plan Management System (HPMS) formulary submission.

Formulary adjudication functionality called out by "meaningful use" may be facilitated by this CMS action. The FDA has in recent years submitted their NDC data set to be included in the RxNORM, as well as ingredient codes (i.e. UNII). The FDA’s Structure Product Label (SPL) does not directly contain RxCUIs but navigation is possible via mappings to SPL-specific code sets. The Veteran’s Administration, also a producer of terminologies and classifications envisions synergy and navigation capabilities.

Of recent importance is the inclusion of NDFRT into RxNORM. The Pharmacoinformatic Working Groups wishes to bring the RxNORM developers and government early adopters together to discuss expectations, reality and future direction.

Moderator: Jonathan Leviss, Sentillion

Panelists: Kaplan, Bonnie; Keenan, Gail; Leviss, Jonathan; Ozeran, Larry

Abstract: Can the $32B from HITECH improve health care quality and lower costs through HIT implementation or do significant problems in national and local initiatives mean that billions of dollars will be spent without implementing effective systems? The complexity, content, human, and organizational factors associated with implementing HIT are formidable barriers.

Similar problems plague many different types of HIT initiatives, yet HIT remains a lone industry in its focus on learning 'best practices' from successful outcomes rather than analyzing failed initiatives for critical errors that should not be repeated. A panel of experts will share years of experience, misadventures, and lessons learned, plus a framework for reviewing failed HIT projects to pro-actively identify and avoid common mistakes.

With time for discussion and interaction, participants will learn what causes projects to fail and how to apply such shared wisdom so that their own HIT design and implementation initiatives succeed.

Moderator: Jonathan Teich, Elsevier

Panelists: Teich, Jonathan; White, P. Jon; Friedman, Charles; Eisenberg, Floyd

Abstract: Since the passage of the American Recovery and Reinvestment Act (ARRA) in February 2009, there has been a nonstop stream of activities in public and private sectors to define, specify and implement its many health information technology (HIT) provisions. These activities take several broad forms, including funding of a variety of research programs, demonstrations, and tasks; establishment of contracts to implement core component bodies such as the regional extension centers; policy-making to define meaningful use and certification criteria; and work to develop standards, templates, and mechanisms that will make HIT more implementable, sharable, and valuable in its mission of improving the quality and safety of healthcare.

Each activity stands on its own, but they are also knitted together through a vision to realize widely implemented, interoperable HIT that promotes improved healthcare quality and safety, improved communication, and the other principles of meaningful use. In this panel, leaders from key government and industry organizations, including the Office of the National Coordinator, AHRQ, and the National Quality Forum, describe a wide range of recent activities in the domains of clinical decision support (CDS) and quality improvement. They discuss current progress, new initiatives, a unifying vision and framework, and thoughts about the next steps.

Moderator: Joshua Denny, Vanderbilt School of Medicine

Panelists: Denny, Joshua; Pathak, Jyotishman; Masys, Daniel; Kho, Abel; Carrell, David; Peissig, Peggy

Abstract: Wide-spread adoption of electronic medical records (EMRs) containing rich amounts of longitudinal clinical data and the formation of EMR-linked biobanks represent an opportunity to rapidly expand sample sizes and efficiently phenotype subjects for genomic studies. The Electronic Medical Records & Genomics (eMERGE) Network consists of five leading institutions involved in EMR phenotyping with linked DNA biobanks.

The goal of eMERGE is to conduct genome-wide association studies (GWAS) in approximately 19,000 individuals using EMR-derived phenotypes and biorepository-derived genome-wide genotypes. These institutions include Group Health Research Institute, Marshfield Clinic, Mayo Clinic, Northwestern University and Vanderbilt University. Each site has used electronic algorithms to identify both site-specific phenotypes and network-wide phenotypes (applied at all five sites) for genomic analysis. The panel will present data from site-specific and network-wide studies illustrating the strengths and limitations of EMRs for genomic studies.

Panelists will discuss and compare approaches to developing phenotypic electronic algorithms, challenges in implementing algorithms at each site, and approaches to validation of the algorithms and genomic results. Panelists will also present results from initial studies into performing phenome-wide analyses for genetic associations. Finally, the panel will present lessons learned from these efforts.

Moderator: Justin Starren, Marshfield Clinic

Panelists: Evans, Scott; Hripcsak, George; Starren, Justin; Tang, Paul

Abstract: With 556 pages of draft specification and $18 billion in potential stimulus funds hanging in the balance, Meaningful Use constitutes the most critical challenge to applied informatics practitioners in recent memory. By the time of the AMIA conference, the specifications will have been finalized and many groups will be in full gear toward the first compliance targets in 2011. This panel brings together members of the ONC HIT Workgroup on Meaningful Use, Health Care IT Users, Vendors, and Internal Developers to discuss the impact of the meaningful use regulation on systems and organizations.

Moderator: Kenneth Mandl, Harvard Medical School

Panelists: Mandl, Kenneth; Weitzman, Elissa; Hernandez, Manny; Adida, Ben

Abstract: Consumer uptake of Social networks is unprecedented. There are XXX users of Facebook and creative approaches to harnessing information value from crowdsourced data and social network structures are emerging. One is to create applications for network users. For example, there is an expanding set of health applications on Facebook. Another is to create a special-purpose SN. An important, emerging set of SNs are disease-specific sites that engage patients outside the traditional health system. We bring together innovators from academia (computer science, health informatics, social science) and from two leading online social networking sites—TuDiabetes.org, a non-for-profit, and Patientslikeme.com, a for profit site to discuss this evolution long four axes and to lead a discussion with the audience members. (1) Current Practice—safety, privacy, quality, expectations. (2) Technical advances—how are social networking platforms evolving? (3) Online Community leadership—what does it take? And (4) Commercial Potential—Why do Pharma love social networks?

Moderator: Kensaku Kawamoto, Duke University

Panelists: Del Fiol, Guilherme; Kawamoto, Kensaku; Curtis, Clayton; Fry, Emory; Biondich, Paul

Abstract: Open-source, standards-based clinical decision support (CDS) software and services promise to catalyze significant improvements in health and healthcare. In this panel, the co-chairs of the HL7 CDS Work Group (KK and GDF); leaders of multi-institutional initiatives to develop open-source, standards-based CDS software (KK, GDF, CC, and EF); and the co-founder of OpenMRS (PB), a widely adopted open-source electronic health record, will discuss this promising approach to developing highly scalable CDS. The panelists will explain how they leverage open-source in their respective programs including (1) a reference implementation of the HL7 Decision Support Service standard; (2) a reference implementation of the HL7 Infobutton standard designed for integration with the Veterans Health Administration’s Computerized Patient Record System; (3) the Department of Defense’s next-generation CDS framework; and (4) OpenMRS. Each speaker will outline the benefits and challenges of using an open-source, standards-based approach to developing enterprise grade CDS services, and will provide guidance on how interested developers can leverage these resources to their benefit.

Moderator: Lucila Ohno-Machado, Harvard Medical School

Panelists: Gadd, Cynthia; Ohno-Machado, Lucila; Fuller, Sherrilynne; Fraser, Hamish

Abstract: Health Information Technology (IT) has been invigorated by numerous training and research & development programs in the U.S. and abroad. In this panel, we will discuss opportunities and challenges for health information exchange (HIE) across national boundaries. Biomedical informatics expertise is a critical component for the success of global HIE, yet training continues to be extremely heterogeneous in different parts of the world. R&D programs exist primarily in well-resourced regions and there are still relatively few shared tools.

Core competencies for biomedical and public health informatics graduates from U.S. programs may not apply for all international program graduates, given different stages of IT implementation, healthcare and education systems, and national priorities. We will discuss biomedical research and training opportunities and how they have been adapted for different countries.

Moderator: Mark Weiner, University of Pennsylvania

Panelists: Weiner, Mark; Adam, Terrence; Morgan, Stephen; Peifer, Maryanne

Abstract: The growing adoption of the medical home care model has sharpened the focus on team-based approaches to patient management, requiring enhanced communication across care settings, and better coordination among providers and other caregivers. Informatics plays many central roles in the operation of the medical home in terms of facilitating and organizing the communication among providers, conveying critical clinical information, and in providing data to evaluate the impact of the programs on quality of care. This panel will describe informatics infrastructure underlying quality initiatives at 4 academic health systems, explore the outcomes of these initiatives and discuss some potential pitfalls in the assessments of quality.

Moderator: Maxine Rockoff, Columbia University

Panelists: Rockoff, Maxine; Miller, Naomi; Kahn, James; Czaja, Sara; Szerencsy, Adam

Abstract: Patient portals and Personal Health Records (PHRs) attached to a healthcare provider’s electronic medical record (EMR) system hold great promise for the twin goals of better health outcomes and reduced administrative costs. Moreover, CMS is including "providing patients access to their health information" as a "meaningful use" criterion for EMRs. The design and implementation of patient portals and tethered PHRs for underserved patient populations, who tend to be low-literate and low health-literate, present special challenges. These challenges must be addressed to decrease the disparities in health status already experienced by vulnerable and at-risk populations, and to avert a potential widening of the digital divide they already encounter. This panel provides a general overview of the issues, reports on focus groups and usability studies done with a portal intended for disadvantaged patients, and describes the results of implementing a patient portal and a tethered PHR for underserved populations. The panel concludes with a discussion of "MedlinePlus Connect," a new service to enable any EMR, patient portal, or PHR to interface smoothly with MedlinePlus to provide patients with the additional health information they need to help them understand what they see in their own health records.

Moderator: Michael Buck, NYC Department of Health and Mental Hygiene

Panelists: Kukafka, Rita; Buck, Michael; Wu, Winfred; Soulakis, Nicholas

Abstract: In 2007, members of the Primary Care Information Project (PCIP), Department of Biomedical Informatics at Columbia University (DBMI) and Institute for Family Health (IFH) joined together with funding from the Centers for Disease Control and Prevention (CDC) to form the NYC Center of Excellence in Public Health Informatics. Combining its collective strengths in academics, public health and clinical care this center has worked together on multiple initiatives including clinical quality metric development, public health/clinical decision support innovations, syndromic surveillance, EHR system evaluation, among many others. This panel will share the associated lessons learned from four primary areas: 1) cross-vendor meaningful use measurement 2) disease/outbreak surveillance 3) public health decision support alerts at the point-of-care 4) EHR evaluations. This panel is composed of members representing the largest community-wide EHR deployment project in the nation and NYC EHR extension center (PCIP), 2007 HIMSS Davies Public Health Award recipient (IFH), and a 20+ year veteran academic informatics program (DBMI).

Moderator: Michael Cantor, Pfizer, Inc.

Panelists: Cantor, Michael; Shah, Nirav; Lawrence, William; Golden, James

Abstract: The role of HIT in comparative effectiveness research (CER) has gained prominence with the emphasis on and funding for both areas in the American Recovery and Reinvestment Act of 2009 (ARRA). This panel will explore major themes related to the influence of data from electronic clinical systems on CER, leading to recommendations on areas of focus for policymakers and researchers.

The panelists represent diverse stakeholders, and will present their viewpoints on methodological, policy, and translational issues. Learning objectives for the panel include understanding CER methods that could be shaped by HIT; understanding CER priorities, and HIT’s role in shaping those priorities, from the viewpoint of different stakeholders; learning factors for success in multi-stakeholder CER projects; and understanding the role of EHRs in translating the results of CER into clinical care. Among others, panelists will explore issues such as governance around criteria for performing and evaluating CER in light of increasing EHR adoption. They will also explore the issue of what constitutes "valid" data from an EHR system, and how that data may make the case for a particular decision by healthcare providers, policymakers, or payers.

Moderator: Muzna Mirza, CDC

Panelists: Owolabi, Yakubu; McCormack, James; Mirza, Muzna; Wyatt, Matthew; Ancker, Jessica; Smith, Nora

Abstract: Despite the fact that "informaticians/ informaticists are in high demand", it may be challenging for job-seekers to find the right job. Having suitable training or educational credentials can provide an advantage over other non-trained applicants, and thus it is critical for aspiring and early-career professionals to choose the right training/educational program. Therefore, many current students or early-career informaticians/informaticists with different backgrounds and career goals seek information about educational and training programs, to further their careers. There are a variety of options for education and training in informatics and related disciplines, and the prospective students need to carefully choose the program that best suits their skills, aptitude, and personality, as well as prepares them for their 'dream career'.

The AMIA Student Working-Group (ST-WG) proposes a panel of five graduates from various informatics educational or training tracks (10x10, Certificate, Fellowship, PhD, and MS) who will provide information about their programs. The panelists will also share their perspectives and insights regarding the alignment of their educational/training programs and the skills they acquired therein, with their aspired career plans (i.e., dream careers), aptitude and soft skills. They will also share the experience of application of their acquired skills along their career paths.

Moderator: Patricia Dykes, Partners HealthCare

Panelists: Dykes, Patricia; Staggers, Nancy; Benham-Hutchins, Marge; Goldsmith, Denise; Furlong, Debra; Donahue, Moreen

Abstract: Effective communication within the interdisciplinary team is critical for safe patient care. Communication breakdown is a principal cause of medical errors and a frequent contributor to sentinel events. The communication of essential patient information between caregivers or providers at change of shift or across transitions in care is known as "handoff".

An effective handoff process supports the standardized transfer of accurate, timely, critical patient information, and promotes continuity of care and enhanced patient safety. This panel will address the issues related to interdisciplinary handoff communication and will evaluate strategies for decreasing communication error during interdisciplinary handoff.

Moderator: Robert Hsiung, University of Chicago

Panelists: Bates, David; Hsiung, Robert; Hersh, William; Unertl, Kim

Abstract: Two contrasting approaches to promoting the adoption of electronic health records (EHRs) are customization and standardization. We use the metaphors of a pair of pants and a bridge. A range of pants is available, and the product has to fit the user. Bridges are limited in number, however, and users have to fit themselves to the product. Whether to expect EHRs to adapt to the needs of users or users to adapt to the limitations of EHRs may be one of the key questions in informatics today. Robert Hsiung moderates this panel. Kim Unertl discusses the importance of customization through two case studies of workflow, one in chronic disease ambulatory care and another in a regional health information organization.

William Hersh addresses the value of standardization, including how standardization facilitates innovation. He draws on examples including the MS-DOS and HTML standards. Attendees are invited to share their experiences, research, ideas, and opinions. David Bates concludes by summarizing the relative pros and cons of customization and standardization and takes a position on the question: Which approach is better?

Moderator: Ross Koppel, Univ of Penn

Panelists: Koppel, Ross; Ball, Katherine; wetterneck, tosha; Telles, joel

Abstract: There is comparatively little systematic evaluation of workarounds in clinical use of HIT. There is even less systematic research on workarounds’ causes and patient safety outcomes. Workarounds are staff actions that do not follow explicit or implicit rules, assumptions, workflow regulations or intentions of system designers. Workarounds are nonstandard work procedures typically employed because of deficiencies in HIT system or workflow design. In hospitals, workarounds are frequently viewed as acts of disobedience, of rushing, or of sloppiness. Sometimes workarounds are exactly these.

But often workarounds in hospitals reflect intrinsic inefficiencies, vestigial rules, or immature technology. In this session the authors explore workarounds in relation to some of the most promising healthcare information technologies: EHRs, CPOEs and barcode medication administration (BCMA). They examine how these worker adaptations both endanger and enhance patient safety; how workarounds are both the lubricant with which many hospital workplace processes function and the flies in the ointment that deteriorate safety protections.

Moderator: Senthil Nachimuthu, University of Utah

Panelists: Nachimuthu, Senthil; lober, Willian; Tolentino, Herman; Papagari Sangareddy, Sridhar R; Lazarus, Ross

Abstract: The future of innovation in public health research and practice is dependent on the use and dissemination of public health data in the most efficient and effective ways and the ability of skilled informatics practitioners to build on and improve existing software applications and develop novel ones. It is viewed that proprietary and legacy public health information systems being used for this purpose fail to live up to the expectations, in spite of massive amounts of resources invested in them [1]. Prohibitive capital and maintenance costs, lack of "openness" in the design and development, and lack of peer-review of source code are some of the limiting factors of the use of proprietary software in public health domain. Fortunately, we are living in the era of collaborative computing where a number of free and open source solutions are available or being developed to overcome these barriers.

The objective of this panel is to demonstrate the application and benefits of adopting or adapting open source solutions for public health research and practice. Examples of open source solutions include computing platforms, data mining packages, web services infrastructure, surveillance systems and full-fledged health information systems.