How Geisinger medical school updated informatics training
July 2021—As the role of informatics in the practice of medicine continues to grow, so does the need to move formalized informatics education from the category of luxury to necessity, says Bruce Levy, MD, associate chief medical informatics officer at Geisinger Health System, Danville, Pa., and professor and program director of the clinical informatics fellowship at Geisinger Commonwealth School of Medicine.
The benefits of enhancing Geisinger’s informatics training were top of mind for Dr. Levy and his colleagues when the Geisinger Commonwealth School of Medicine was formed through the merger of Geisinger and The Commonwealth Medical College four years ago. Therefore, one of the priorities of Dr. Levy and other members of the Geisinger clinical informatics team has been to work with the medical school faculty to develop an updated informatics curriculum that blends informatics education with real-world experiences, such as using data analytics to better serve patients. The goal, he says, is to ensure that new generations of physicians will be equipped to use informatics in their medical specialties from day one.
“Pathology informatics is not a one-month rotation in a residency and done—it’s something that has to be threaded throughout the educational experience because it’s something that we are doing every single day as pathologists and as physicians,” Dr. Levy says. Dr. Levy, who is a forensic pathologist and informatician, discussed the role of informatics in medical education at the virtual 2021 Pathology Informatics Summit in May and in an interview with CAP TODAY.
As the first-year students in Geisinger’s school of medicine begin their term this month, they will be introduced to an updated curriculum that formally codifies the components of informatics education that the medical school has tested during the past four years. The incoming class will be the first to use the new four-year informatics curriculum that has been sequentially organized, with different components of informatics education tied to specific years of study and even specific weeks within the school-year calendar, Dr. Levy says.
Dr. Levy
“All of the current [students] that are graduating over the next three years are getting all of this, but not in the same systematic way that we have laid out in the new curriculum,” he says.
The curriculum, which aligns with Geisinger’s informatics governance goals, is organized into two main programs: an informatics education program designed for the medical school’s preclinical education period (which in the new curriculum will be condensed from two years to 18 months) and a clinical informatics program (which will be expanded in the new curriculum from two to two-and-a-half years). A third informatics education curriculum has been developed for Geisinger’s residency program.
Preclinical instruction: learning informatics basics
Preclinical informatics education at the Geisinger Commonwealth School of Medicine begins with basic instruction about the types of data contained in the medical system’s electronic health record and laboratory information system and how to access it, Dr. Levy says. Students then get their first “efficiency training,” which involves learning tips and tricks for using the EHR for specific functions, beginning with chart reviews and moving on to case-based learning experiences after the first year.
While some of the medical school faculty practice informatics as part of their job, full-time clinical and nonclinical informatics experts impart much of the knowledge to students, according to Dr. Levy. The medical school uses prerecorded asynchronous webinars and podcasts to share expertise from Geisinger’s full-time informaticians with students.
“These are busy people, so they are happy to record something, but they don’t have the bandwidth to do this every month, or even several times a year,” Dr. Levy says. The prerecorded webinars are followed by assessments to measure students’ comprehension of the topics covered.
The medical school also teaches analytics through in-person instruction, focusing on demonstrating how analytics is currently used at Geisinger, the impact it has on patient care, and future plans for analytics at the health system.
Toward the end of the preclinical period, students begin using their analytics training in one of Geisinger’s two simulation centers. In the center, they practice providing care to staff who are trained to play patient roles, and they use the center’s EHR to access data for treating the simulation center patients.
“We can literally have our students practice in an EHR environment where we can see what they’ve done, evaluate their work, critique it, and provide feedback before they’re actually doing this in a real EHR in a production environment,” Dr. Levy explains.
To ensure students are comprehending informatics material and benefitting from the hands-on approach, the medical school has included informatics questions in its block exams, semester exams, and cumulative exams.
Clinical training: applying informatics to patient care
As the medical students move into their clinical years, they begin to work with patients more directly, Dr. Levy says. Instead of practicing medicine in a simulated environment, for example, students sit with physicians in the hospital as they provide telemedicine to homebound patients. In some cases, students go into patients’ homes with such tools as laptops and stethoscopes and otoscopes attached to telemedicine equipment and use that technology to help care for patients under remote supervision. “The trials we’ve done this year have been just outstanding on that,” he notes.
Efficiency training during the clinical years is also used for more advanced tasks. Students learn tips for using the EHR to write notes on patient records and order tests and medication, Dr. Levy says. Students also start to learn how Geisinger physicians use EHR analytics to measure and improve patient care and practice population health. In other words, rather than simply searching the system for a specific test result, students might graph glucose results for a time period and look for trends or insights in that data, Dr. Levy explains.
For students who exhibit an interest in informatics, there is time built into the schedule in the third year of medical school to complete a month-long informatics elective. Students who choose this option devise an informatics project to complete under the direction of Dr. Levy and his colleagues in clinical informatics. The elective project was scheduled for the third rather than the fourth year of medical school to give students the option of pursuing their research projects over a longer period of time.
A cornerstone of Geisinger’s new curriculum is a fourth-year health system citizenship project, in which students analyze data in an area such as patient safety or population health. “It’s not so much that it’s an informatics project, but students all need to analyze data, so they are all going to be applying informatics principles as part of that project,” Dr. Levy explains.
At this point in their training, he adds, medical students should have the skills to “self-service” their analytics research. However, they can request help from mentors or faculty if needed.
Residency informatics: increased specialization
The informatics education in Geisinger’s residency program begins with a refresh of the foundational informatics training from the medical school because most residents will come from other medical school programs. Residents who are already familiar with informatics can test out of these training webinars, Dr. Levy says, by successfully completing the assessments rather than rewatching the webinars.
A key difference between the medical school and residency informatics education is the specialty-specific training provided to residents. “The workflows that an internist uses are different from a gynecologist and different from a surgeon,” Dr. Levy says.
“What we have learned as we build out our library of efficiency tools and tricks is that there are some that apply best to certain specialties because [those specialties] have certain areas they struggle with,” he explains. Therefore, Dr. Levy and his colleagues asked each department to share their insights into areas they find challenging in order to develop training focused on specialty-based workflow improvement. “It has been extremely, extremely effective,” he says.
Also beneficial is the process of familiarizing residents with Geisinger’s enterprise analytics hub, which resides on the health system’s intranet and houses approximately 500 analytics tools, including a variety of dashboards. Because Geisinger uses the Epic EHR, residents are trained to use Epic’s “slicer dicer” feature, for example, which makes it easier to pull data that meet specific criteria. These tools are useful as residents complete a research project focused on patient quality or patient safety that is an Accreditation Council for Graduate Medical Education requirement of residency programs, Dr. Levy says.
It is important that graduates of the medical school and residency program not only become familiar with the medical system’s analytics resources but, through their research and training, develop an understanding of how to extract intelligence and insight from data that impacts patient care, Dr. Levy emphasizes.
To any health care system or medical school focused on informatics education, Dr. Levy offers one overarching piece of advice: Use modern educational methods. “Develop, identify, and use asynchronous materials whenever possible,” he advises. “And the material you create, treat it like a precious metal. Reuse it over and over again.” —Renee Caruthers
Ibex Medical Analytics and Indica Labs forge partnership
Indica Labs and Ibex Medical Analytics have announced an agreement to integrate Ibex’s Galen artificial intelligence-based cancer diagnostics platform into Indica’s Halo AP digital pathology workflow platform for anatomic pathology laboratories.
Galen’s AI-powered cancer detection, case prioritization, grading, and other insights will be displayed in the Halo AP platform to alleviate the need for a separate viewer. Applicable data will be communicated with the laboratory or hospital information system automatically.
“By joining forces with Indica Labs, we can jointly offer end-to-end solutions, enabling pathologists to accelerate adoption of new technologies, strengthen the business case for digitization, and improve the quality of cancer care,” said Joseph Mossel, CEO and cofounder of Ibex Medical Analytics, in a press release.
Indica’s Halo AP platform can be fully integrated with an LIS or HIS or operate as a standalone case- and image-management system. It supports a full range of tissue-based assays and synoptic reporting, tumor boards, secondary consults, quantitative analysis, and AI-assisted workflows.
Indica Labs, 505-492-0979
Ixlayer collaborates with FrontRunnerHC
The telehealth company Ixlayer has partnered with the software-as-a-service provider FrontRunnerHC to connect revenue cycle, patient management, and diagnostic testing systems in a virtual environment via a streamlined process.
Integration of FrontRunnerHC’s software into the Ixlayer platform is intended to help ensure that Ixlayer’s clients have up-to-date patient demographic, insurance, and financial information and make the billing process more transparent for patients.
“Our mission is to make diagnostic testing and telehealth services as seamless as possible for administrators, clinicians, and patients,” said Ixlayer CEO Pouria Sanae, in a press release.
The Ixlayer platform allows health care systems, payers, biopharma, and other companies to offer health testing in a virtual environment. It delivers end-to-end solutions for the technical, security, regulatory, and user experience components of complex health testing. The solution can be added to patient-engagement platforms and patient portals to enable real-time testing.
FrontRunnerHC’s portfolio of software features benefits investigation capabilities and is interoperable with patient records and billing systems. It is supported by a team of health care claims and insurance experts.
FrontRunnerHC, 508-746-5500
Proscia upgrades digital pathology platform
Proscia has introduced the next generation of its flagship Concentriq digital pathology platform.
The latest version of Concentriq mimics a microscope-like viewing experience from within a digital pathology environment.
A single deployment of the upgraded software supports an unlimited number of sites and users. It can interface with numerous laboratory information systems and image scanners from a variety of vendors at once.
The platform’s open application programming interface allows users to seamlessly incorporate artificial intelligence applications, developed by Proscia and third parties, into routine operations and view results alongside other pathology data.
Proscia, 877-255-1341
Quest and Paige team up to advance use of AI in disease diagnosis
Quest Diagnostics and Paige have entered a collaboration designed to use artificial intelligence to improve and hasten the diagnosis of cancer and other diseases that rely on pathologic assessment.
The collaboration involves using Paige’s proprietary AI-based software to analyze digitized pathology slides from Quest and its AmeriPath and Dermpath businesses to uncover markers of cancer and other diseases. The partnership initially will focus on solid tumor cancers, such as prostate, breast, colorectal, and lung.
“The parties intend to develop new software products which, following regulatory approval, will be marketed to pathologists, oncologists, and other providers to support disease diagnosis,” according to a press release from Quest. “Near term, the parties also intend to license the insights to biopharmaceutical and research organizations to aid biomarker discovery, drug research and development, and companion diagnostics.”
The agreement involves sharing revenue for reaching certain product and commercial milestones and establishing arrangements for Quest to use software that receives regulatory approval in its pathology operations and joint marketing and research operations with Paige. In addition, Quest’s pathologists will help define pathology workflows in which the products are used to support diagnostic decision-making.
Quest, 866-697-8378
ONC focuses on new health interoperability initiative
The Office of the National Coordinator for Health Information Technology has launched a project called Health Interoperability Outcomes 2030.
The ONC plans to publish, this fall, “a prioritized set of interoperability outcomes that align with ONC’s interoperability vision for the nation and the 2020–2025 Federal Health IT Strategic Plan,” said Steven Posnack, ONC deputy national coordinator for health information technology, in a Health IT Buzz blog post. The project will synthesize and take into consideration public feedback the ONC receives about desirable health interoperability outcomes for the next decade.
“Before anyone gets snarky about ‘having to wait until 2030’ to reach certain outcomes, we view any of the potential outcomes as having a ‘no later than’ timing to them,” Posnack posted. “In other words, some outcomes could and would be expected to be achieved well before 2030.”
To contribute a health interoperability outcome statement for consideration, go to HealthIT.gov/HealthInterop2030. Submissions are due by July 30.
Dr. Aller practices clinical informatics in Southern California. He can be reached at raller@usc.edu. Dennis Winsten is founder of Dennis Winsten & Associates, Healthcare Systems Consultants. He can be reached at dwinsten.az@gmail.com.