Welcome to the course, Leading Change in Health Informatics. Myself and Dr. Peter Greene are very excited that you've decided to take this journey with us. Just a brief reminder, that the American Medical Informatics Association talks about health informatics as being a discipline at the confluence of three separate domains, Health, Information Science and Technology, and Social and Behavioral Sciences. In addition to those three core domains, it's expected that students in Health Informatics will be able to express their skills, knowledge and attitudes in a variety of other categories, including that of leadership. So, along those lines, who better to talk about leadership with then our chief medical information officer here at Johns Hopkins, Dr. Peter Greene. Peter, very exciting time to be discussing these topics, right? Sure it is. There are just so many opportunities at this point to transform healthcare and all dimensions of what we do with technology. I think the recurrent theme that hopefully folks will take away from this course is how important leadership is to every aspect of that. We tend to get very excited about the technology or a particular system or what the capabilities are but, there are human beings that have to use these systems and there are some really important lessons and we hope that you all will take away, some important insights as you move forward in your career. Yeah, absolutely. I think that's a great point Peter. The students, we'll recall from Dr. Harold Lehman about asking the importance question, "What is the problem we're trying to solve before jumping to the answer of how we want to solve it, how do we want to accomplish it." I want to step back, you talked about students in their careers. I think some of those watching this particular course from near and far will be wondering about jobs in the field and how different individuals come to create their niche in health informatics. Can you take us back a little bit and share with us a little bit about your career trajectory? Sure. I've been using technology really my entire career in healthcare. I had come here at Hopkins to train in general and cardiac surgery and did that and stayed on as faculty here in cardiac surgery. But throughout that process, was looking for innovative ways to use technology and rolling out systems in the departmental level. I mentioned to folks that my very first exposure to technology as an intern, as a resident, was incredibly painfully. I had to go down to the laboratory over at one of our affiliated hospital, and we would read from a wall where they published all the chemistry panels and all the CBCs, and you had to pick off your patients so then you would write that down and take that back to on-rounds and present that information on-rounds. So, incredible to think now what we can do on a mobile device, and yet I'm not sure that we've really transformed the rounding and communication processes around that. We're still asking people to present as if they had just gathered that data from some separate process. So, I think really interesting looking forward here at what what's next and how could we transform the way we do things. Yeah. I think when we talk about issues related to usability, it's really interesting to hear you talk about that wall with all of the labs, yet this is a time period before the digitization of health records, it's before CPOE, what you're describing and yet providers did it. You would go to that wall, you would pull that and you had a certain workflow that you were used to. I think in addition to the labs on the wall, the other story that I like to hear about is when you were talking about in the ICU and rounding and the trifold, that you would pull vitals from. Yeah, you could walk into the cardiac ICU and the nurse would've had a trifold chart that had all the vital signs, and he or she would have pulled down all the labs for the day and other insights, and it actually was incredibly easy to quickly review a patient. Because you would do it, you would look quickly over what the trends were as you read on specific items, it had been human not computer gathered, and so it was very information dense and very useful and very importantly, you also take that opportunity to have a conversation with the nurse who had been at the bedside and had been gathering that data. So they were coupling your review of the data with what their insights were about having watched the patient or spoken to the family. We're not there yet with information technology. We've replaced lots of the way you gather data but I think we've lost some of the valuable human interaction. Yeah. I think that brings us to one of the seminal articles that providers often talk about, that says, there's issues with usability but now that 50 percent of time can be spent with desktop medicine and how the technology's there. But for users, that's certainly been a source of frustration, as you've been leading change through health IT, can you speak a little bit about some of that frustration with the technology for the end-users? Then we'll move on to talking about some of the ways you're trying to address it. Yeah. I think for those of you taking this class two really important dimensions that I would ask you to focus on would be first of all, authenticity about what we're actually going to be able to get done and an understanding the actual work and the processes. So, those of you who are clinical, play a particularly important role at being able to translate what needs to be done into technology. So, very important that you not get over-excited by any particular informatics dimension or any particular system, and come back to what do we really want to do with this system to the point that you've made. Then the second dimension is one that I like to think of as empathy. That's, as you're designing a system being empathetic towards the end users of that system and seeing it from their perspective. But there's actually another side to this which is brokering team works of clinician and informatics, IT interaction, that are empathetic, also to the person who's trying to construct and support and maintain the system, and to do it within a system that has a set repertoire and maybe can't actually do everything that you might hope that it would do. So, I think we'll come back to this recurrently in this class, how to create that teamwork and how to create that cycle. But those dimensions of authenticity and empathy are immensely important in leaders in this space. Yeah, that's a great point. The authenticity and then that bi-directional flow of the empathy. Because I think one of the concepts that we'll cover is the importance of not just multi-disciplinary collaboration but interprofessional collaboration. Nowhere is it more important than in the domains of health IT and health informatics. It can be a challenge perhaps for those that maybe were trained during different times where that wasn't emphasized in undergraduate medical education, graduate medical education or in other advanced education programs, but really important in this era in health IT. So, Peter, one of the things that I want to talk about that is an exciting prospect is, what's on your plate today and what's most exciting for you? As the students kick off this course, I'm sure they're wondering, what's going on in the world of a CMIO? Oh gosh. There are so many exciting things out there. We are incredibly excited about opportunities with artificial intelligence. Right now I think our clinicians are convinced that the computer systems they use our thorough but maybe not insightful, so there's just an incredible explosion of interest in thinking through ways that we're going to have interaction, and how do we explain the insights of the system back to the end-user. So, that's incredibly valuable. Then more broadly, I think of it as just digital transformation. In healthcare, we just recurrently add another person, unfortunately often a nurse gets added to any process that's broken, and we just have to find ways of letting that technology be more effective. So, I go from having to look at a wall and write down what labs are to earlier this year, I ordered a peripheral for my laptop , and they promised me the peripheral, it was a Saturday, they promised it to me on Monday and it arrived on Sunday. That Sunday was Easter Sunday for goodness sakes. So, it was a holiday and that exceeding expectations of our patients is really where we need to go and we can't afford to deliver the health care that we're doing. So, leaders in this area have got an important and unbelievably valuable mission. During this particular module, you'll be hearing more about Kotter's eight step process for change. Peter and I will be back to discuss a few of those steps. You'll get some real-life examples about step one and two, hearing about patient portals and using them for clinical trial recruitment, hearing about how to raise the level of urgency in an organization, as well as creating a guiding coalition. We again hope you enjoy the course that we have laid out for you and welcome to Leading Change in Health Informatics.
