Christoph Lehmann | Vanderbilt University (original) (raw)

Papers by Christoph Lehmann

JAMA network open, Mar 20, 2023

IMPORTANCE The 21st Century Cures Act Final Rule mandates the immediate electronic availability o... more IMPORTANCE The 21st Century Cures Act Final Rule mandates the immediate electronic availability of test results to patients, likely empowering them to better manage their health. Concerns remain about unintended effects of releasing abnormal test results to patients. OBJECTIVE To assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal. DESIGN, SETTING, AND PARTICIPANTS This large, multisite survey study was conducted at 4 geographically distributed academic medical centers in the US using an instrument adapted from validated surveys. The survey was delivered in May 2022 to adult patients and care partners who had

International Journal of Medical Informatics, May 1, 2012

The study objective was to determine if computerized provider order entry (CPOE) systems impaired... more The study objective was to determine if computerized provider order entry (CPOE) systems impaired or enhanced workflow in the neonatal intensive care unit (NICU) by comparing the timing of administration of the first dose of antibiotics before and after CPOE system implementation. Methods: We conducted a pre-post intervention comparative study of the length of time between admission and administration of initial antibiotics in neonates before and after a CPOE system was implemented. Clinical information and timing of antibiotic administration were collected on all inborn infants, who were admitted to the NICU in the first 4 h of life and treated with antibiotics, for one year prior to the implementation of computerized order entry and for one year after the implementation. Results: Infants admitted to the NICU were similar in both periods (mean birth weight 2183 g vs. 2091 g, gestational age 33.3 weeks vs. 33.0 weeks). There was no significant difference in mean length of time from admission to antibiotic administration in the pre-CPOE group (131 min [CI 124-139]) compared to the post-CPOE group (125 min [CI 116-133]) (p = 0.07). The mean time to pharmacy verification for a subset of patients was significantly shorter for patients in the post-CPOE group (61 ± 58 min) compared to the pre-CPOE group (88 ± 76 min) (p = <0.001). Conclusions: While the introduction of a CPOE system in the NICU did not significantly improve antibiotic administration times, the timeliness of an important aspect of the medication process, time to pharmacy verification, was improved. These findings imply other factors are impeding workflow. Further studies are needed to evaluate how CPOE systems combined with patient care activities affect workflow and overall patient care.

medRxiv (Cold Spring Harbor Laboratory), Apr 28, 2023

Objectives: Assess ChatGPT's performance on the Clinical Informatics Board Examination (CIBE) and... more Objectives: Assess ChatGPT's performance on the Clinical Informatics Board Examination (CIBE) and discuss the implications of large language models (LLMs) for board certification and maintenance. Materials and Methods: We tested ChatGPT using 260 multiple-choice questions from Mankowitz's Clinical Informatics Board Review book, omitting six image-dependent questions. Results: ChatGPT answered 190 (74%) of 254 eligible questions correctly. While performance varied across the Clinical Informatics Core Content Areas, differences were not statistically significant. Discussion: ChatGPT's performance raises concerns about the potential misuse in medical certification and the future validity of knowledge assessment exams. While ChatGPT is able to answer multiple-choice questions accurately, relying on AI systems for exams will compromise the credibility and validity of at-home assessments and undermine public trust. Conclusion: The advent of AI and LLMs threatens to upend existing processes to board certification and maintenance and necessitates new approaches to the evaluation of proficiency in medical education.

American Academy of Pediatrics eBooks, Apr 3, 2013

Journal of the American Medical Informatics Association, Oct 13, 2022

Pediatrics, Jul 1, 2021

The past decade has seen a substantial increase in the use of electronic health records (EHRs) by... more The past decade has seen a substantial increase in the use of electronic health records (EHRs) by health care providers caring for children. However, gaps in pediatric-specific functionalities continue to exist in some EHR systems, including population-specific growth curves, immunization clinical decision support, weight-based medication dosing with rounding, calculation of pediatric hypertension percentiles, age-specific developmental assessment, newborn bilirubin nomograms, anticipatory guidance reminders, and other functionalities described elsewhere. Implementing pediatric functionalities into EHRs is critical to the provision of safe pediatric care. As an alternative to direct implementation in EHRs, EHR vendor agnostic Web applications, Web services, and application programming interfaces offer an opportunity to provide pediatric functionalities and eliminate the need for each vendor to develop these functionalities. Successful implementation of Web services and related technologies requires responsible attention from both EHR vendors and developers of Web services, Web applications, and application programming interfaces to the use of data terminology standards, adherence to privacy and security requirements, rigorous testing, change management processes, and robust system support and maintenance. Education of health care providers about opportunities to improve pediatric functionalities in EHRs by using these services can facilitate discussions in EHR user groups in which vendors can be lobbied to implement them. This policy statement emphasizes the need to address pediatric-specific functionalities in EHRs by providing insight and recommendations into the development, maintenance, integration, and support of these novel solutions.

JMIR medical informatics, Sep 25, 2015

Journal of the American Medical Informatics Association, May 17, 2022

A discussion and debate on the American Medical Informatics Association’s (AMIA) Ethical, Legal, ... more A discussion and debate on the American Medical Informatics Association’s (AMIA) Ethical, Legal, and Social Issues (ELSI) Working Group listserv in 2021 raised important issues related to a forthcoming conference in Texas. Texas had recently enacted a restrictive abortion law and restricted voting rights. Several AMIA members advocated for a boycott of the state and the scheduled conference. The discussion led the AMIA Board of Directors to request that the organization’s Ethics Committee provide general guidance for principle-based venue selection. This document recommends overarching principles for the venue selection for future AMIA events and conferences. Discussions by the AMIA Board, the Ethics Committee, and the ELSI Working Group informed these recommendations, and this document on guiding principles was approved by the AMIA Board of Directors in April 2022.

Hospital pediatrics, Sep 1, 2019

Fewer than half of children receive all recommended immunizations on time. Hospitalizations may b... more Fewer than half of children receive all recommended immunizations on time. Hospitalizations may be opportunities to address delayed immunizations. Our objectives were to assess (1) prevalence of delayed immunizations among hospitalized patients, (2) missed opportunities to administer delayed immunizations, and (3) time to catch up after discharge. METHODS: We conducted a retrospective cohort study investigating immunization status of patients 0 to 21 years of age admitted to an academic children's center from 2012 to 2013 at the time of admission, at discharge, and 18 months postdischarge. Immunization catch-up at 18 months postdischarge was defined as having received immunizations due on discharge per Centers for Disease Control and Prevention recommendations. x 2 and t test analyses compared characteristics among patients caught up and not caught up at 18 months postdischarge. Analysis of variance and logistic regression analyses compared mean number of immunizations needed and odds of immunization catch-up among age groups. Kaplan-Meier and Cox proportional hazards analyses compared catch-up time by age, race, sex, and insurance. RESULTS: Among 166 hospitalized patients, 80 were not up to date on immunizations at admission, and only 1 received catch-up immunizations before discharge. Ninety-nine percent (79 of 80) were not up to date on discharge per Centers for Disease Control and Prevention recommendations. Thirty percent (24 of 79), mostly adolescents, were not caught up at 18 months postdischarge. Median postdischarge catch-up time was 3.5 months (range: 0.03-18.0 months). Patients 0 to 35 months of age were more likely to catch up compared with those of other ages (hazard ratio 5 2.73; P 5 .001), with no differences seen when comparing race, sex, or insurance. CONCLUSIONS: Pediatric hospitalizations provide important opportunities to screen and immunize children.

Journal of the American Medical Informatics Association

We aimed to assess ChatGPT’s performance on the Clinical Informatics Board Examination and to dis... more We aimed to assess ChatGPT’s performance on the Clinical Informatics Board Examination and to discuss the implications of large language models (LLMs) for board certification and maintenance. We tested ChatGPT using 260 multiple-choice questions from Mankowitz’s Clinical Informatics Board Review book, omitting 6 image-dependent questions. ChatGPT answered 190 (74%) of 254 eligible questions correctly. While performance varied across the Clinical Informatics Core Content Areas, differences were not statistically significant. ChatGPT’s performance raises concerns about the potential misuse in medical certification and the validity of knowledge assessment exams. Since ChatGPT is able to answer multiple-choice questions accurately, permitting candidates to use artificial intelligence (AI) systems for exams will compromise the credibility and validity of at-home assessments and undermine public trust. The advent of AI and LLMs threatens to upend existing processes of board certification ...

Applied Clinical Informatics

Applied Clinical Informatics

In 2009, Schattauer Verlag in Stuttgart, Germany first published the Applied Clinical Informatics... more In 2009, Schattauer Verlag in Stuttgart, Germany first published the Applied Clinical Informatics (ACI) Journal. ACI has served since its inception as an official journal of the International Medical Informatics Association. Later, the American Medical Informatics Association and the European Federation for Medical Informatics named ACI as an official journal. This manuscript describes the history of the journal from its inception to present day including publication measures, challenges, and successes.

Applied Clinical Informatics

Circulation: Cardiovascular Quality and Outcomes, 2018

Background: AHA/ACC/ESC practice guidelines advise an ECG within 10 minutes for all patients with... more Background: AHA/ACC/ESC practice guidelines advise an ECG within 10 minutes for all patients with symptoms suggestive of ST-segment elevation myocardial infarction (STEMI). This facilitates early diagnosis and timely treatment. Earlier treatment, particularly percutaneous coronary intervention (PCI), has been associated with better clinical outcomes. Our objective was to quantify the impact of delayed screening on timely treatment and determine if there may be race, sex or presenting complaint disparities. Methods: We examined the association between time-to-first ECG (door-to-screening, or D2S) and time-to-PCI in a 3-center 1-year retrospective cohort study including all emergency department (ED) patients with acute STEMI per hospital discharge diagnosis who underwent catheterization for PCI. The primary outcome was door-to-balloon time (D2B) and the ED-centric secondary outcome was door-to-cath-lab arrival time (D2CAR). Results: Of 161,920 patients seen in the 3 EDs, 137 (0.08%) w...

Journal of Perinatology, 2022

To quantify initial tidal volume (VT) during neonatal volume-targeted ventilation (VTV) and to ch... more To quantify initial tidal volume (VT) during neonatal volume-targeted ventilation (VTV) and to characterize the agreement of initial VT with the limited-evidence available. STUDY DESIGN: We performed a multi-center retrospective observational cohort study in two Neonatal Intensive Care Units evaluating 313 infants who received VTV as the initial ventilation modality prior to postnatal day 14. We generated descriptive statistics and performed multivariable logistic regression analysis to determine factors associated with initial VT use that agreed with available literature. RESULTS: 154 (49%) infants received an initial VT of 5.0 mL/kg (median 5.0 mL/kg, IQR 5.0-5.1). 45 (14%) infants received an initial VT that was congruent with available literature. A birth weight of 700-<1250 g was significantly associated with an initial VT in agreement with VT literature (aOR 9.4, 95% CI 1.7-50.4). CONCLUSIONS: Most infants receive an initial VT of 5.0 mL/kg.

Essentials of Clinical Informatics, 2019

Decision support is a broad technique that seeks to bring information to bear at the time a clini... more Decision support is a broad technique that seeks to bring information to bear at the time a clinician is taking actions that are driven by other data. Clinical decision-making methodology depends on the complexity of the patient’s case, the certainty of a diagnosis, available treatment and diagnostic resources, reliability of information resources, training of the clinician, and psychological makeup of the clinician. Most clinical decision support efforts seek to improve workflow, enforce best clinical practices, or mitigate adverse drug events. Clinical decision support can reduce medical errors, improve nutrition, prevent orders on the wrong patient, and reduce costs. Clinical and administrative decision support can lead to more effective outcomes, improved quality, and lower costs.

AMIA ... Annual Symposium proceedings. AMIA Symposium, 2018

Immunizations are one of the most cost-effective interventions for preventing morbidity and morta... more Immunizations are one of the most cost-effective interventions for preventing morbidity and mortality. As vaccines, related clinical knowledge and requirements change, clinical applications must be updated in a timely manner to avoid practicing outdated medicine. We use the Centers for Disease Control and Prevention (CDC) as a source for immunization knowledge for our Clinical Information Systems (CIS). After identifying knowledge management related gaps in the CDC's content and email notification service, we developed and adapted a knowledge management tool chain - called COMET - for facilitating automatic processing of the available immunization content to implement mature knowledge lifecycle management practices locally. The implemented features include error and change tracking, content discovery and analytics, and tracking of dependencies to dependent downstream CISs. We demonstrate the creation of a tool that enables content curators to visualize, track, and implement immu...

AMIA ... Annual Symposium proceedings. AMIA Symposium, 2018

We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017... more We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017 clinical informatics fellowship positions. In each year, we collected data on the number of applications that programs received from candidates who were ultimately successful vs. unsuccessful. In 2017, we also conducted an anonymous applicant survey. Successful candidates applied to an average of 4.2 and 5.5 programs for 2016 and 2017, respectively. In the survey, unsuccessful candidates reported applying to fewer programs. Assuming unsuccessful candidates submitted between 2-5 applications each, the total applicant pool numbered 42-69 for 2016 (competing for 24 positions) and 52-85 for 2017 (competing for 30 positions). Among survey respondents (n=33), 24% were female, 1 was black and none were Hispanic. We conclude that greater efforts are needed to enhance interest in clinical informatics among medical students and residents, particularly among women and members of underrepresented m...

JAMA network open, Mar 20, 2023

IMPORTANCE The 21st Century Cures Act Final Rule mandates the immediate electronic availability o... more IMPORTANCE The 21st Century Cures Act Final Rule mandates the immediate electronic availability of test results to patients, likely empowering them to better manage their health. Concerns remain about unintended effects of releasing abnormal test results to patients. OBJECTIVE To assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal. DESIGN, SETTING, AND PARTICIPANTS This large, multisite survey study was conducted at 4 geographically distributed academic medical centers in the US using an instrument adapted from validated surveys. The survey was delivered in May 2022 to adult patients and care partners who had

International Journal of Medical Informatics, May 1, 2012

The study objective was to determine if computerized provider order entry (CPOE) systems impaired... more The study objective was to determine if computerized provider order entry (CPOE) systems impaired or enhanced workflow in the neonatal intensive care unit (NICU) by comparing the timing of administration of the first dose of antibiotics before and after CPOE system implementation. Methods: We conducted a pre-post intervention comparative study of the length of time between admission and administration of initial antibiotics in neonates before and after a CPOE system was implemented. Clinical information and timing of antibiotic administration were collected on all inborn infants, who were admitted to the NICU in the first 4 h of life and treated with antibiotics, for one year prior to the implementation of computerized order entry and for one year after the implementation. Results: Infants admitted to the NICU were similar in both periods (mean birth weight 2183 g vs. 2091 g, gestational age 33.3 weeks vs. 33.0 weeks). There was no significant difference in mean length of time from admission to antibiotic administration in the pre-CPOE group (131 min [CI 124-139]) compared to the post-CPOE group (125 min [CI 116-133]) (p = 0.07). The mean time to pharmacy verification for a subset of patients was significantly shorter for patients in the post-CPOE group (61 ± 58 min) compared to the pre-CPOE group (88 ± 76 min) (p = <0.001). Conclusions: While the introduction of a CPOE system in the NICU did not significantly improve antibiotic administration times, the timeliness of an important aspect of the medication process, time to pharmacy verification, was improved. These findings imply other factors are impeding workflow. Further studies are needed to evaluate how CPOE systems combined with patient care activities affect workflow and overall patient care.

medRxiv (Cold Spring Harbor Laboratory), Apr 28, 2023

Objectives: Assess ChatGPT's performance on the Clinical Informatics Board Examination (CIBE) and... more Objectives: Assess ChatGPT's performance on the Clinical Informatics Board Examination (CIBE) and discuss the implications of large language models (LLMs) for board certification and maintenance. Materials and Methods: We tested ChatGPT using 260 multiple-choice questions from Mankowitz's Clinical Informatics Board Review book, omitting six image-dependent questions. Results: ChatGPT answered 190 (74%) of 254 eligible questions correctly. While performance varied across the Clinical Informatics Core Content Areas, differences were not statistically significant. Discussion: ChatGPT's performance raises concerns about the potential misuse in medical certification and the future validity of knowledge assessment exams. While ChatGPT is able to answer multiple-choice questions accurately, relying on AI systems for exams will compromise the credibility and validity of at-home assessments and undermine public trust. Conclusion: The advent of AI and LLMs threatens to upend existing processes to board certification and maintenance and necessitates new approaches to the evaluation of proficiency in medical education.

American Academy of Pediatrics eBooks, Apr 3, 2013

Journal of the American Medical Informatics Association, Oct 13, 2022

Pediatrics, Jul 1, 2021

The past decade has seen a substantial increase in the use of electronic health records (EHRs) by... more The past decade has seen a substantial increase in the use of electronic health records (EHRs) by health care providers caring for children. However, gaps in pediatric-specific functionalities continue to exist in some EHR systems, including population-specific growth curves, immunization clinical decision support, weight-based medication dosing with rounding, calculation of pediatric hypertension percentiles, age-specific developmental assessment, newborn bilirubin nomograms, anticipatory guidance reminders, and other functionalities described elsewhere. Implementing pediatric functionalities into EHRs is critical to the provision of safe pediatric care. As an alternative to direct implementation in EHRs, EHR vendor agnostic Web applications, Web services, and application programming interfaces offer an opportunity to provide pediatric functionalities and eliminate the need for each vendor to develop these functionalities. Successful implementation of Web services and related technologies requires responsible attention from both EHR vendors and developers of Web services, Web applications, and application programming interfaces to the use of data terminology standards, adherence to privacy and security requirements, rigorous testing, change management processes, and robust system support and maintenance. Education of health care providers about opportunities to improve pediatric functionalities in EHRs by using these services can facilitate discussions in EHR user groups in which vendors can be lobbied to implement them. This policy statement emphasizes the need to address pediatric-specific functionalities in EHRs by providing insight and recommendations into the development, maintenance, integration, and support of these novel solutions.

JMIR medical informatics, Sep 25, 2015

Journal of the American Medical Informatics Association, May 17, 2022

A discussion and debate on the American Medical Informatics Association’s (AMIA) Ethical, Legal, ... more A discussion and debate on the American Medical Informatics Association’s (AMIA) Ethical, Legal, and Social Issues (ELSI) Working Group listserv in 2021 raised important issues related to a forthcoming conference in Texas. Texas had recently enacted a restrictive abortion law and restricted voting rights. Several AMIA members advocated for a boycott of the state and the scheduled conference. The discussion led the AMIA Board of Directors to request that the organization’s Ethics Committee provide general guidance for principle-based venue selection. This document recommends overarching principles for the venue selection for future AMIA events and conferences. Discussions by the AMIA Board, the Ethics Committee, and the ELSI Working Group informed these recommendations, and this document on guiding principles was approved by the AMIA Board of Directors in April 2022.

Hospital pediatrics, Sep 1, 2019

Fewer than half of children receive all recommended immunizations on time. Hospitalizations may b... more Fewer than half of children receive all recommended immunizations on time. Hospitalizations may be opportunities to address delayed immunizations. Our objectives were to assess (1) prevalence of delayed immunizations among hospitalized patients, (2) missed opportunities to administer delayed immunizations, and (3) time to catch up after discharge. METHODS: We conducted a retrospective cohort study investigating immunization status of patients 0 to 21 years of age admitted to an academic children's center from 2012 to 2013 at the time of admission, at discharge, and 18 months postdischarge. Immunization catch-up at 18 months postdischarge was defined as having received immunizations due on discharge per Centers for Disease Control and Prevention recommendations. x 2 and t test analyses compared characteristics among patients caught up and not caught up at 18 months postdischarge. Analysis of variance and logistic regression analyses compared mean number of immunizations needed and odds of immunization catch-up among age groups. Kaplan-Meier and Cox proportional hazards analyses compared catch-up time by age, race, sex, and insurance. RESULTS: Among 166 hospitalized patients, 80 were not up to date on immunizations at admission, and only 1 received catch-up immunizations before discharge. Ninety-nine percent (79 of 80) were not up to date on discharge per Centers for Disease Control and Prevention recommendations. Thirty percent (24 of 79), mostly adolescents, were not caught up at 18 months postdischarge. Median postdischarge catch-up time was 3.5 months (range: 0.03-18.0 months). Patients 0 to 35 months of age were more likely to catch up compared with those of other ages (hazard ratio 5 2.73; P 5 .001), with no differences seen when comparing race, sex, or insurance. CONCLUSIONS: Pediatric hospitalizations provide important opportunities to screen and immunize children.

Journal of the American Medical Informatics Association

We aimed to assess ChatGPT’s performance on the Clinical Informatics Board Examination and to dis... more We aimed to assess ChatGPT’s performance on the Clinical Informatics Board Examination and to discuss the implications of large language models (LLMs) for board certification and maintenance. We tested ChatGPT using 260 multiple-choice questions from Mankowitz’s Clinical Informatics Board Review book, omitting 6 image-dependent questions. ChatGPT answered 190 (74%) of 254 eligible questions correctly. While performance varied across the Clinical Informatics Core Content Areas, differences were not statistically significant. ChatGPT’s performance raises concerns about the potential misuse in medical certification and the validity of knowledge assessment exams. Since ChatGPT is able to answer multiple-choice questions accurately, permitting candidates to use artificial intelligence (AI) systems for exams will compromise the credibility and validity of at-home assessments and undermine public trust. The advent of AI and LLMs threatens to upend existing processes of board certification ...

Applied Clinical Informatics

Applied Clinical Informatics

In 2009, Schattauer Verlag in Stuttgart, Germany first published the Applied Clinical Informatics... more In 2009, Schattauer Verlag in Stuttgart, Germany first published the Applied Clinical Informatics (ACI) Journal. ACI has served since its inception as an official journal of the International Medical Informatics Association. Later, the American Medical Informatics Association and the European Federation for Medical Informatics named ACI as an official journal. This manuscript describes the history of the journal from its inception to present day including publication measures, challenges, and successes.

Applied Clinical Informatics

Circulation: Cardiovascular Quality and Outcomes, 2018

Background: AHA/ACC/ESC practice guidelines advise an ECG within 10 minutes for all patients with... more Background: AHA/ACC/ESC practice guidelines advise an ECG within 10 minutes for all patients with symptoms suggestive of ST-segment elevation myocardial infarction (STEMI). This facilitates early diagnosis and timely treatment. Earlier treatment, particularly percutaneous coronary intervention (PCI), has been associated with better clinical outcomes. Our objective was to quantify the impact of delayed screening on timely treatment and determine if there may be race, sex or presenting complaint disparities. Methods: We examined the association between time-to-first ECG (door-to-screening, or D2S) and time-to-PCI in a 3-center 1-year retrospective cohort study including all emergency department (ED) patients with acute STEMI per hospital discharge diagnosis who underwent catheterization for PCI. The primary outcome was door-to-balloon time (D2B) and the ED-centric secondary outcome was door-to-cath-lab arrival time (D2CAR). Results: Of 161,920 patients seen in the 3 EDs, 137 (0.08%) w...

Journal of Perinatology, 2022

To quantify initial tidal volume (VT) during neonatal volume-targeted ventilation (VTV) and to ch... more To quantify initial tidal volume (VT) during neonatal volume-targeted ventilation (VTV) and to characterize the agreement of initial VT with the limited-evidence available. STUDY DESIGN: We performed a multi-center retrospective observational cohort study in two Neonatal Intensive Care Units evaluating 313 infants who received VTV as the initial ventilation modality prior to postnatal day 14. We generated descriptive statistics and performed multivariable logistic regression analysis to determine factors associated with initial VT use that agreed with available literature. RESULTS: 154 (49%) infants received an initial VT of 5.0 mL/kg (median 5.0 mL/kg, IQR 5.0-5.1). 45 (14%) infants received an initial VT that was congruent with available literature. A birth weight of 700-<1250 g was significantly associated with an initial VT in agreement with VT literature (aOR 9.4, 95% CI 1.7-50.4). CONCLUSIONS: Most infants receive an initial VT of 5.0 mL/kg.

Essentials of Clinical Informatics, 2019

Decision support is a broad technique that seeks to bring information to bear at the time a clini... more Decision support is a broad technique that seeks to bring information to bear at the time a clinician is taking actions that are driven by other data. Clinical decision-making methodology depends on the complexity of the patient’s case, the certainty of a diagnosis, available treatment and diagnostic resources, reliability of information resources, training of the clinician, and psychological makeup of the clinician. Most clinical decision support efforts seek to improve workflow, enforce best clinical practices, or mitigate adverse drug events. Clinical decision support can reduce medical errors, improve nutrition, prevent orders on the wrong patient, and reduce costs. Clinical and administrative decision support can lead to more effective outcomes, improved quality, and lower costs.

AMIA ... Annual Symposium proceedings. AMIA Symposium, 2018

Immunizations are one of the most cost-effective interventions for preventing morbidity and morta... more Immunizations are one of the most cost-effective interventions for preventing morbidity and mortality. As vaccines, related clinical knowledge and requirements change, clinical applications must be updated in a timely manner to avoid practicing outdated medicine. We use the Centers for Disease Control and Prevention (CDC) as a source for immunization knowledge for our Clinical Information Systems (CIS). After identifying knowledge management related gaps in the CDC's content and email notification service, we developed and adapted a knowledge management tool chain - called COMET - for facilitating automatic processing of the available immunization content to implement mature knowledge lifecycle management practices locally. The implemented features include error and change tracking, content discovery and analytics, and tracking of dependencies to dependent downstream CISs. We demonstrate the creation of a tool that enables content curators to visualize, track, and implement immu...

AMIA ... Annual Symposium proceedings. AMIA Symposium, 2018

We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017... more We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017 clinical informatics fellowship positions. In each year, we collected data on the number of applications that programs received from candidates who were ultimately successful vs. unsuccessful. In 2017, we also conducted an anonymous applicant survey. Successful candidates applied to an average of 4.2 and 5.5 programs for 2016 and 2017, respectively. In the survey, unsuccessful candidates reported applying to fewer programs. Assuming unsuccessful candidates submitted between 2-5 applications each, the total applicant pool numbered 42-69 for 2016 (competing for 24 positions) and 52-85 for 2017 (competing for 30 positions). Among survey respondents (n=33), 24% were female, 1 was black and none were Hispanic. We conclude that greater efforts are needed to enhance interest in clinical informatics among medical students and residents, particularly among women and members of underrepresented m...