The Next Frontier in Health Care Reform

May 7, 2010

By Cara Bonnett
Duke Office of News & Communications

Durham, NC — Ed Hammond, who helped design Duke’s first electronic health record 40 years ago, gets a firsthand reminder of the need for personalized medical care every time he visits the doctor. “My son also works at Duke and has the same name as I do,” said Hammond, a professor of community and family medicine and biomedical engineering. “There’s almost a 1 in 10 probability that when I’m seen, it will be my son’s record. It’s understandable: Names are not the best identifier.” Inspired by new efforts to put information technology to work in transforming health care, Hammond, a national expert in data standards and health informatics, came out of retirement last year to head the new Duke Center for Health Informatics.

The center, which brings together Duke’s Schools of Medicine and Nursing, the Pratt School of Engineering and the Fuqua School of Business, will train the next generation of doctors, nurses and health-care administrators in implementing and managing electronic medical record systems to improve patient care. At least 50,000 health-care informatics professionals are needed in the next few years to help meet a federal mandate for digitization of all health records by 2014.

Stimulus Funding from the American Recovery and Reinvestment Act

Ed Hammond, “Curriculum Development Centers,” National Institutes of Health, $1,820,000 for 2 years. Ed Hammond, “Consortia for University-based Training of Health IT professionals in Health Care,” National Institutes of Health, $2,167,121 for 3 years. Hammond has won two stimulus grants under the American Recovery and Reinvestment Act totaling just under $4 million to get the training program started.

Duke’s programs will include a new Master of Management in Clinical Informatics degree, being offered for the first time this fall through Fuqua, as well as degrees from the certificate to the doctoral level. The center builds on a rich tradition of health informatics at Duke, which started one of the nation’s first programs under Hammond’s guidance in the 1970s, said Meredith Nahm, the center’s associate director for academic programs. Bringing together more than 50 Duke faculty, the center will emphasize an approach that includes medicine, nursing, business, economics, biomedical engineering, computer science and public policy. The goal: designing interoperable systems that present customized data for different uses. “Because nurses and doctors use information differently, for example, they’re interested in different aspects of the same information,” Nahm said. “The systems need to pivot to present information in a way that’s appropriate to the situation and a particular user.” System integration issues make it difficult to share the data that clinicians need to see the entire picture of a patient. And incomplete information can result in medical errors, which claim as many as 98,000 lives each year, according to a report by the Institute of Medicine. “As we develop an interconnected health system, medical records can’t exist in silos,” said Constance Johnson, director of Duke’s nursing informatics program. Hospitals have lagged in adopting analytical tools that would allow them to capitalize upon existing data stores to increase efficiency, reduce costs and improve health outcomes, said Jeff Ferranti, the health system’s associate CIO for health analytics and patient safety. The federal government plans to distribute $19 billion to implement electronic medical record systems, now in use by only about 8 percent of the nation’s 5,000 hospitals and 17 percent of its 800,000 physicians. “We’re at a critical crossroad: Our ability to gather data has outpaced our capacity to aggregate information to advance care,” Ferranti said. “That’s the primary motivation for the center. We’re creating a learning health care system, where the data collected isn’t just a byproduct of care but is reintegrated into the process, where it is aggregated and synthesized to identify trends and improve patient care.”

Duke, for example, has collected data since 2004 on patient safety incidents – an estimated 1,800 reports each month – and aggregated the data “to identify problems before they become problems,” Ferranti said. “Before electronic records, we had 23 disparate, paper-based reporting systems. Now we have five years of codified safety information that we can use to study issues from falls to transfusion deviations to adverse drug events.”

The new center will leverage Duke’s strong integration between health system operations and research by offering students access to Duke’s data warehouse, which contains more than 3.8 million patient records from the system’s three hospitals and 100 clinics in the Triangle area. “At the end of the day, what we’re really doing is speeding the translational process from bench to bedside to public health initiative,” Ferranti said. For Hammond, the center offers new hope for putting health data to work to improve the human condition. The past 40 years have brought technological advances that enable new possibilities, he said, from tools that can help doctors tailor treatments to individual patients’ needs to software that researchers can use to identify the best candidates for clinical trials. “We live in a new world, and we need new, innovative thinking to create a seamless system, without boundaries, where we can exchange data across different sites of care, to create a single complete picture of what happens to the patient,” Hammond said. “This is an exciting time.” The creation of the center, which is housed within the Duke Translational Medicine Institute, was supported by a grant from National Center for Research Resources (NCRR) through the American Recovery and Reinvestment Act (ARRA).

Shaw receives F31 National Research Service Award

September 19, 2010

Ryan Shaw, one of the doctoral students in the Duke University School of Nursing, has received a F31 NRSA award for his fellowship proposal entitled “A mixed methods RCT to sustain weight loss among persons with obesity using theoretically tailored mobile telephone short message service (SMS).” The award is for a three-year period, from December 1, 2010, to March 31, 2013, in the amount of $124,140. His fellowship sponsor is Constance Johnson, PhD, RN.

“Intervention strategies that generate successful sustainability and maintenance of health behaviors have proven elusive. The integration of emerging social and behavioral theories with informatics has the potential to advance the science of health maintenance. Technological mediums can be used as tools to deliver tailored information to persuade and transform health behaviors and promote maintenance. This study uses theoretically tailored messages sent via mobile telephones to promote sustainability of weight loss among people with obesity.”

HL7 and IHTSDO Expand Collaborative Efforts



Ann Arbor, MI- Health Level Seven (HL7) and the International Health Terminology Standards Development Organisation (IHTSDO) announced Thursday, July 7th that they have expanded collaborative efforts. According to leaders from both groups, the closer collaboration will foster healthcare information interoperability and lead to improvements in patient safety by futher facilitating the use of IHTSDO standards with HL7 standards.

IHTSDO and HL7 are jointly working on a number of key global healthcare information technology standards initiatives, including:

  • IHTSDO is making SNOMED CT codes and descriptions freely available for release in HL7 products, under  a public good license, in order to improve semantic healthcare interoperability across countries and to improve patient safety. HL7 will use the codesand descriptions to produce a number of SNOMED-enabled products, using universal realm bindings to SNOMED CT where appropriate.
  • HL7 is investigating use of the IHTSDO Workbench to maintain its vocabulary. Use of common tooling will improve harmonization, leading to benefits across the two organizations as well as for users of both standards.
  • HL7 and IHTSDO are jointly reviewing and streamlining the request submissions process, to enable requests for additions and amendments to SNOMED CT codes to be made more effectively. Improvements are being made in HL7’s internal processes, and also in IHTSDO’s request submission process.
  • IHTSDO has announced its support for the development of Release 2 of the Common Terminology Services standard (CTS2) by HL7 and OMG. This standard will provide a consistent interface into terminologies in EHR environments.

According to HL7 Board Chair Bob Dolin, MD, “Expanding on the coordination and collaborative efforts between HL7 and IHTSDO, these joint initiatives signify a major step toward the construction of globally applicable healthcare interoperability standards that will require far less realm-localization. HL7 is committed to working with IHTSDO and other standards bodies to advance the delivery of safe and effective patient care.”

IHTSDO Chief Executive Officer Jan-Eric Slot said, “Making it easier to use HL7 standards with SNOMED CT will facilitate global standards-based healthcare implementations, where it will add the semantic dimension to interoperability.” He continued, “The closer working relationship between these two leading organizations will improve the uptake and effectiveness of these jointly developed standards by members of both HL7 and IHTSDO.”

Health care informatics: the new kid on campus

October 21, 2010

Reconsidering your career? Focusing on your future? Picking a profession? The health information technology field has much to offer.

The Office of the National Coordinator for Health Information Technology has estimated that over the next five years the health care industry will face a workforce shortage of 50,000 qualified HIT professionals. To close the gap, the ONC, through the American Recovery and Reinvestment Act of 2009, is funding informatics training programs at universities and community colleges nationwide.

Ed Hammond, PhD, DCHI director, and Meredith Nahm, PhD, DCHI associate director of academic programs, are quoted in this article.

Read the full article in the CAP e-Newsletter: Health care informatics: the new kid on campus

Duke University Medical Center creates solution for shortages in health informatics

August 27, 2010

By Duke Medicine News and Communications

A national shortage of more than 50,000 information technology professionals is a serious shortfall as hospitals strive to create robust and comprehensive electronic medical records.

One helpful solution is to broaden existing informatics programs to create new professionals of many types. On Aug. 2, 2010, a new certificate in Health Informatics was launched at Duke University Medical Center by broadening an existing informatics post-masters certificate to open access to individuals with a clinical undergraduate or graduate degree.

Read the full press release.

Certificate Student Earns Paid Internship at Allscripts



Amanda Truijillo, a student in the Graduate Certificate in Health Informatics program, was offered a full-time paid internship for the summer at Allscripts with the Care Management team in Professional Services. DCHI hosted a senior management visit to Duke in May following the HIMSS meeting in New Orleans where Allscript’s voiced an  interest in recruiting Duke students.

Informatics Research Seminar: NC AHEC, EHR Adoption

September 15 @ 4:00 – 5:00 pm


Speaker: Ann Lefebvre, MSW, CPHQ
Presented from: UNC-CH



Ms. Lefebvre will discuss the NC AHEC program’s efforts to help primary care providers (especially those in small, rural settings and care for underserved patients) to implement and meaningfully use electronic health record systems to improve their quality of care. The topic will cover the purpose of the Regional Extension Center program as part of the HITECH Act under the Office of the National Coordinator of HIT in the US Department of Health and Human Services. Ms. Lefebvre will also discuss a wide variety of issues and benefits with EHR adoption, including population based reporting strategies and how technology, health information exchange and clinical outcome reporting tie into NC AHEC’s broad mission for the state of North Carolina and the newly passed Federal healthcare reform law the Affordable Care Act.

Reading materials on this subject can be found at:


Ann Lefebvre is an associate Director for the NC AHEC Program at the University of North Carolina at Chapel Hill and oversees statewide quality improvement efforts for NC AHEC. Included in her responsibilities is the function of executive director of the NC regional extension center (REC) and directing the Improving Performance in Practice (IPIP) Program for the state of NC which is part of the North Carolina Healthcare Quality Alliance. In this role, Ms. Lefebvre has developed a program to train and support over 40 staff to perform as consultants in primary care practices across the state that will assist in the adoption and use of technology to improve the provision of quality healthcare in the primary care setting. Additionally, Ms. Lefebvre has an adjunct faculty appointment in the Department of Family Medicine at UNC Chapel Hill and is currently serving as faculty for the Institute for Healthcare Improvement on the Primary Care Practice Coach Professional Development Program. For the past ten years, Ms. Lefebvre has been working in a variety of ambulatory care settings to help providers and their staff use technology and quality improvement techniques to improve clinical outcomes as well as patient and staff satisfaction.

Ms. Lefebvre received a BA in speech and language pathology from the State University of New York at Plattsburgh and a Master of Social Work from East Carolina University in Greenville, NC. She is a certified professional of healthcare quality and has been working in a variety of health care settings since 1991.

Informatics Research Seminar: Overview of the Duke Center for Health Informatics

September 22 @ 4:00 – 5:00 pm


Speaker: W. Ed Hammond, PhD
Presented from Duke University



Dr Hammond will give an overview of the Duke Center for Health Informatics, and our progress over the past year, including DCHI rationale, mission, formation, structure, affiliation with the center, In the presentation, he will also discuss the Health Informatics degree programs at Duke and the objectives of each, recent progress and recent curricular development, and National programs for Health IT education and workforce development.


W. Ed Hammond, PhD is the Director of the Duke Center for Health Informatics (DCHI) and has extensive experience in the design and implementation of electronic health records, starting in 1970.  Dr. Hammond’s academic and industry leadership include, past president of the American Medical Informatics Association (AMIA) and AMIA Board member,  President and Fellow of the American College of Medical Informatics, three terms as Chair of Health Level Seven and HL7 committees, two terms as the Convenor of ISO Technical Committee 215, Working Group 2 and the current  Ambassador to Developing Countries and the chair of the Joint Initiative Council of ISO/CEN/HL7. He was Chair of the Data Standards Working Group of the Connecting for Health Public-Private Consortium and serves on the Board of the eHealth Initiative. He also served as Chair of the Computer-based Patient Record Institute and on the CPRI Board. He was a Chair of ACM SIGBIO, is an advisor to the American Hospital Association on health data standards and related matters, and chair of the Steering Committee for the Rockefeller-sponsored Open Enterprise eHealth Architecture Framework Project.Dr. Hammond served as a member of the Institute of Medicine Committee on Patient Safety Data Standards.  He was a member of the National Library of Medicine Long Range Planning Committee and a member of the Healthcare Information Technology Advisory Panel of the Joint Commission on Accreditation of Healthcare Organizations.  He has served on a number of NIH review committees, testified on a number of occasions for NCVHS, and has presented to several IOM committees. Dr. Hammond has served and is serving on a number of editorial boards, and has published over 300 technical articles.

Informatics Research Seminar: Standards-Based, Open-Source Clinical Decision Support Services: Rationale and Potential Opportunities for Inter-Institutional Collaboration

September 8 @ 4:00 – 5:00 pm


Speaker:  Kensaku Kawamoto
Presented from Duke University



While health informaticists have demonstrated repeatedly how clinical decision support (CDS) systems can improve health and health care, most patient care continues to be conducted with minimal CDS, if any. A promising strategy for enabling CDS at scale is the use of CDS Web services, which are capable of providing patient-specific inferencing capabilities as a software service accessed over a secure Internet connection. At Duke University, Dr. Kawamoto developed a CDS Web service known as SEBASTIAN that is currently in operational clinical use both within and outside of the Duke University Health System. Moreover, Dr. Kawamoto has led the development of a number of international standards required for scaling CDS services across institutions, including the HL7/OMG Decision Support Service standard and the emerging HL7 Virtual Medical Record standard.

Currently, Dr. Kawamoto is leading a multi-institutional collaborative effort to develop a next-generation CDS platform that is fully compliant with relevant international health IT standards and is freely available to the global clinical community. Ultimately, the goal of this effort is to create a widely deployed, Web-accessible CDS infrastructure that will enable evidence-based, computable CDS resources to be developed once and then efficiently shared across many healthcare institutions to improve health and health care, including through the appropriate use of advanced genomic technologies. In this talk, Dr. Kawamoto will describe why standards-based, open-source CDS services have the potential to enable advanced CDS and improved clinical care at scale, and he will seek to stimulate discussions on potential inter-institutional collaboration opportunities beyond those already initiated with key collaborators at UNC Chapel Hill.


Kensaku Kawamoto, MD, PhD is an Assistant Professor of Clinical Informatics with research interests in clinical decision support systems, electronic health record systems, population health management, and genomic and personalized medicine.

Dr. Kawamoto trained in biochemical sciences as an undergraduate at Harvard University, completed a Ph.D. in medical informatics from the Duke University Department of Biomedical Engineering in 2006, and earned an M.D. from the Duke University School of Medicine in 2008.

Dr. Kawamoto has been on the Duke clinical informatics faculty since 2006, and a Member of the Duke Institute for Genome Sciences & Policy since 2008. He has been the author or co-author of over a dozen peer-reviewed manuscripts and two book chapters, including two manuscripts that have been honored as seminal papers in medical informatics by the International Medical Informatics Association.

Beyond academics, Dr. Kawamoto has led the development of an international clinical decision support standard known as the Health Level 7 Decision Support Service standard. Dr. Kawamoto is actively engaged in operational health IT projects within the Duke University Health System, where a clinical decision support technology that he developed is being operationally used to provide patient-specific chronic disease management recommendations at the point of care. Under the mentorship of Dr. Geoffrey Ginsburg, Dr. Huntington Willard, and other senior faculty at the Duke Institute for Genome Sciences & Policy, Dr. Kawamoto is currently pursuing a K01 career development award from the National Human Genome Research Institute to develop a scalable and widely deployable clinical decision support system that could serve as a prototype for a replicable approach to integrating genomic medicine into routine clinical practice. His current areas of focus within genomic medicine include genetically guided warfarin dosing and the genetically guided selection of pharmaceutical interventions in the context of common chronic diseases.