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Epic Career Moves - Step Four - AMIA Edition

November 16, 2009
by Joe Bormel
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Here is my presentation from today's

AMIA panel session on informatics career issues. Comments, questions, and points of view, as always, are welcome!

/Media/BlogTopics/2009-11-16e Bormel, panels at AMIA 2009.pdf



Highlights of AMIA this year for me:

I'm not likely to write up a complete report on "what I learned at AMIA this year." But I did put some highlights that I thought might be useful to others in the opening graphic. I will elaborate them.

Note:  I have received feedback that sharing observations about presentations can be experienced as callous, as in, "ha ha, I went to a great presentation and you didn't." Well, first off, sorry.  Not my intent.  Secondly, more detailed information is often available on the Web, easy to get to, and I'm willing to help. Thirdly, most presentations are available for a few bucks from a multi-media service (IntelliQuest).  I am happy to help readers follow-up if I cover something interesting and you're having trouble finding more information.  Post a comment or send an email.

The tutorials at AMIA are always a treat. I've learned about many complex topics over the years in these three hour tutorials. Some of the most memorable were Nancy Lorenzi's on Change Management, Dan Russler/Gunther Shadow's on the Reference Information Model, Charles Friedman on Subjective Evaluation, and one on Bayesian Belief Networks. Each of these topics can effectively be done in a semester long course. The presenters ability to communicate the concepts in three hours is engergizing.

This year, I attended three notable tutorials. The first, T05: Human-Centered Design, was amazing. The presenters, Zhang and Patel did a great job ofcommunicating the importance of clinical workflow, and how that translates into whether systems are useful or burdensome, and safe or error prone. They showed how the DoD's ALTA system was improved using cognitive informatics. I wish a few more vendors could do things like show how long it takes to capture vital signs, do adequate results review or place orders in their production settings, in real client settings.  We only seem to do rigorous, real-world task and process studies when there are problems.

Zhang and Patel also did a case study, as suggested by the Potassium Chloride Injection log shown on the graphic. They showed how inadequate user feedback design led to a patient getting way too much potassium in a commercial vendor's system.  Most of you know that can be lethal.

In a related session by Geissinger's Jim Walker, "hazards" like this, and a discipline to improve HCIT was presented at length. Jim has published a book on this topic. The audio and slides for this will be available.

Another part of the graphic featuring the JAMA cover from 2005 has the title "Role of CPOE in Facilitating Medication Errors." Several presentations focused on the real-world data around HCIT causing unintended consequences. Usually bad ones.

The other two tutorials are really worth mentioning. Cusack, Dixon, and Poon presented "Evaluating Health IT Projects - A Practical Approach." What's notable here is that this AHRA-funded work includes a variety of tools that are freely available through the AHRQ website. Strongly recommended, especially the surveys!

Last but not least, Osheroff, Jenders, Teich and Sittig's tutorial on "Clinical Decision Support - A Practical Guide to Developing Your Program to Improve Outcomes." This is the best selling book in the HIMSS bookstore. I'd like to take a guess why. Outcomes and ARRA-required reporting measures are almost exactly the same thing. The later are better defined and specified, and, oh yeah, are attached with one to two digit million dollar incentive payments. Jerry, Robert, Jonathan and Dean have been honing this tool for about five years and it shows. It's a six=step, highly pragmatic process with lots of tools, examples and insights.

As with most things in this Web era, you can find free versions of significant portions online.  The first chapter is freely available on the AHRQ site. If anyone would care to share other links, please do. I'll also respond to any requests that come as comments to this post.

In the primary blog post above I've placed my panelist presentation from AMIA this week.
Here's the back story.

Many of my friends of 15 years or more were experiencing emotional pain related to AMIA. In short, it was a step-child drama. We felt that we were full-fledged family members of AMIA, from the mid-80s through the mid-1990s. Our AMIA family inspired and nourished us and sent us to college. When we left home and went off to work, however, we somehow became lepers. Literally, our previous family was now avoiding us. We had joined industry, become consultants, or vendors, or pharma or device manufacturers .. part of the informatics problem, rather than participants in the solution.  At least that's how we felt we were treated.  Home, by the way, was large, often fragmented academic medical centers,in big cities, with their own special brand of hubris.

And, they, our estranged family, seemed to be getting feeble themselves, focusing exclusively on themselves, and academic pursuits that, seemingly by design, didn't translate into the real world of healthcare. And wastefully spending tens or hundreds of millions of dollars in grant money with little to show for it.  (That perspective was offered by the provocative plenary speaker at the opening session ... this was not going to be the AMIA of a decade ago!)

Dozens of people, many of whom are long-time friends, were sharing these painful, deeply personal feelings.  Born out of a special appreciation for the earlier, positive formative role that AMIA represented, AMIA played a supportive role in our careers. Then, slowly, AMIA was eliciting in us an unsettling contemptuous rage. That seemed to reciprocate what we felt was coming from the current AMIA leadership. The responsible thing to do was professionally confront the situation. This year's Industry Track and presentation was part of that initiative.

A group of caring people proposed and drove the Industry Track this year. The two panels that I sat on were part of the track of the annual AMIA symposium.

For those who don't have any exposure, the annual AMIA symposium is a scientific meeting of an organization dedicated to the same HCIT-enabled, self-improving healthcare delivery system that is shared by readers of Healthcare Informatics.

Leading executives from industry, including two of the largest and innovative care delivery systems, presented our experiences related to how informatics brings value outside of academia. My part was to describe what informatics-trained professions do at software vendors, and how that translates into business value. The attached slides were not intended to be exhaustive. They were intended to kick-off a discussion, which they did.  Each of the other panels also had about 10 minute presentations to orient the audience to what they and their companies did, at an extremely high level.

The reception of the presentations and this track was clearly and overwhelmingly successful. Of the approximately 2,000 attendees at this event, our sessions drew several hundred attendees, competing well against a dozen or so concurrent sessions.

AMIA was already and independently changing for the better.

In this ARRA/HITECH/Stimulus Dollar era, AMIA's educational mission was internally and externally recognized as highly relevant in a new and important way. Among other campaigns, there was a large crop of 10x10 students invigorating the tutorials and meetings, and AMIA has launched a CMIO boot camp. My CIO friends have shared for years how invaluable CHIME's CIO boot camp was been for them. It's clear that AMIA is on the right track here.

AMIA also had distinct policy contributions, which AMIA is uniquely qualified to address. Almost all of the patient safety, quality improvement, and generally accepted clinical informatics gains of the last two decades were led (and funded) by members that drive AMIA. That includes medication safety work such as 20 years of CPOE experience that's been subjected to scientific exploration and review (unlike the relatively absent impact studies of early commercial systems such as the legendary TDS 4000 and 7000).

AMIA's staff were incredibly helpful and supportive to us in creating and executing the industry track. Their level of service over the last year in the making of the track was exemplary.

In short, readers thinking about their own career growth should take a look at what AMIA is doing. Especially if they haven't looked at AMIA lately. There's a lot of relevant value and passion there, and a renewed spirit and focus on inclusion. It's different and complementary to HIMSS in mission and capability.  The step-child drama has been replaced by a positive family reunion for many of the attendees this year.

In Session 70, Careers in Medical Informatics: Perspectives from Recent Job Searches, several interesting and important perspectives were shared, especially lucidly by Dr Danny Sands and Catherine Craven (AMIA Membership Committee Chair) that are worth repeating here.

1) Candidates need to understand that most job descriptions are ideal. If you're not a perfect fit, realize that few if anyone is.

2) Exude confidence in your ability to get things done and learn. Don't interview with underlying fear. You've been successful in the past and you didn't suddenly get stupid.

3) Keep an open mind and be energetic. Volunteer for committee work. Strive to be helpful. And get out there.

Dan Mays's Annual Year-in-Review is now available:


Beyond standing room only, just like prior years!  Below are the 2009 top ten events; here is the 2008 list.  The literature review for on the link above is where the meat is.