Training Physician Data Scientists:
The Duke LHS Training Program at 1 year
Nick Wysham, MD
AAMC Learning Health Systems Kickoff
February 12, 2015
Outline
•
•
•
•
•
•
•
•
Background
Curriculum
Trainees
Projects
Challenges/ opportunities
Future Directions
Summary
Acknowledgments
Greene et al. Ann Intern Med, 2012;157:207-10.
Evolution in Application of Evidence to Care
It is time for EBM 2.0!
• Evidence is derived from formal research plus
systematic observation of clinical practice
• Need environment where the use of real-time
data
• Drives discovery and continuous improvement
• Becomes a routine part of patient care
• Ultimately improves both individual and population health
• Contemporary clinical practice demands
efficiency, focuses on value, and incorporates
electronic tools
• Data data everywhere
• Physicians have minimal exposure to informatics, data interpretation
and practice based assessment
• Continuous quality improvement models expanding
LHSTP Curriculum Goals
• Teach LHS Concepts
•
•
•
•
•
•
Data use
Clinical informatics
Data quality
Statistics
PDSA-cycles
EHRs and IT solutions to collect and review data
• Infrastructure for trainees to learn
concepts
• Practical projects to apply concepts
•
Align with health system priorities
Curricular Goals
Acquisition of analytic skills
Boot camp
Familiarity with DUHS Data
Introduction to core LHS
concepts
DEDUCE Training
Sessions on research and
statistical methods
Introduction to Performance
Services
Understanding of regulatory
boundaries for QI work
Project Development/Delivery
Working with DUHS operational
leaders to determine systemConnections with key informants wide priorities for projects
in DUHS who can further access
Using analytic skills and data to
systems-based data
understand problems and
possible solutions
Applying project results to drive
iterative improvement and
outcomes assessments
Topics and Lecturers
• Framing a Clinical Question:
– Greg Samsa, PhD statistics
and bioinformatics
• RedCap and eCRF:
– Ursula Rogers, database
analyst
• Data Storytelling:
– RJ Andrews
• Chart Review and Data
Management
– Greg Samsa, PhD
• Longitudinal Data
– Greg Samsa, PhD
• QI in Healthcare
– Jonathan Bae, MD,
Hospitalist and Chief of
Quality for Department of
Medicine
• Overview of the Logic in
Statistical Methods in QI and
LHS
– Alex Cho, MD, MBA and Amy
Abernethy, MD, PhD
• QI Part II
– George Cheely, MD and Joe
Boggan, MD
• NIH Collaboratory
– Rachel Richesson, RN, PhD
• Project Charters
• LHSTP Bootcamp
– Amy Abernethy, MD, PhD
• LHS Frames of Reference
– Erich Huang, MD, PhD,
Department of Surgery and
Bioinformatics and
Biostatistics
Trainees
• Cohort 1
– 3 medicine residents
– 3 fellows (HOx2, and PCCM)
• Cohort 2
– 1 medicine resident
– 3 fellows (Rheum, Nephrology, HO)
– 2 Surgery residents
– 1 anesthesia resident
– 2 neonatology fellows
LHS Projects
• Cohort 1
– Appropriateness of DVT prophylaxis
– Dexemedetomidine for ICU sedation
• Cohort 2
– Maternal Mg and neonatal bowel perforations
for severely pre-term infants
– Nomogram for predicting outcomes in the era
of enhanced recovery colorectal surgery
– Streamlining emergent initiation of chronic
dialysis
Example: Appropriateness of ICU Sedation
• BIG question!
• Findings:
– Health System is outlier with respects to dex
expenditure and ICU LOS
– Institutional sedation practice is not guideline
consistent
– Necessary data is not captured
• RAAS, Pain, Delirium scores
– missing, inaccurate?
– Pain scores not validated
Example: ICU Sedation
• Deliverables:
– Presentation to DUHS leadership: CMO
• Need for reliable metrics
– Interface with performance services data analysts
» Utilization
» Appropriateness
– Nursing education
» Assessments
» Practice standards
• Need for system-wide sedation protocol
– Segued into system-wide initiative
• With LHS trainees in leadership roles
Trainee Feedback
9%
• Web-based Survey:
– 11/15 response rate
27%
64%
– 9/11 endorsed “topics
were of interest”
– 6/9 would recommend
LHSTP to peers
Positive
Negative
Neutral
Trainee Comments
• Initial expectations:
– Centered on acquiring QI and statistical skills
• Project selection:
– Desire to progress towards implementation
•
Desired content:
– Statistics
– Unifying concepts
• Impact on career:
– “How hard "Big data" or "data mining" really are. Data and and insight
are not synonymous terms, and that has become markedly apparent. In
addition the willingness to think through data structure and data
architecture in advance of a major IT system are critically important.
Within EPIC there is some subtle but important nuances that clearly did
not have a clinical input and has made finding data on the back end
more challenging. Overall though there is huge promise to this and
would be helpful moving forward.”
LHSTP Challenges
• Evolving curriculum
– No road map!
– Need to integrate topics
• Diverse expertise/experience
– Targeting offerings to learners
• Time
– Coordinating schedules with clinically active
learners/instructors
• Learning from feedback
– Goal near 100% “recommend to others”
Opportunities
• Fortuitous Collaborations
– Ex. nephrology with surgical
oncology/bioinformatics
• EHR tool to screen for risk to progress to ESRD
– Trainees with hospital leadership
– EHR-based VAE surveillance project
• Enhanced presence in university
• Potential for GME concentration/certificate
Acknowledgements: Funding
• Appreciation/support for AAMC pioneer
award
– Kicked off visibility for program
• Led to presentation to CMO
– Led to significant institutional support
• Office of the Chancellor for Health Affairs, Duke
University
• Duke University School of Medicine, Department of
Medicine
• Duke Institute for Healthcare Innovation (DIHI)
• DCRI Center for Learning Health Care (CLHC)
Future directions
• Statistical and database support for trainees
• Optimize trainee selection
– Ensure trainees can commit time and effort
• Scheduling challenges
– Smaller Cohorts?
• Continued curriculum development
– Unifying themes, cohesiveness
– Can this curriculum to translated to other
centers?
• Carry forward selected projects towards
implementation
– Rapid data feedback cycle
– Complete the circle
Summary
• A program in Learning Health for clinical
trainees is feasible
– Challenges inherent to starting educational
program
• Successful methods include multidisciplinary
expertise and hands-on projects
• Such a program can form the nucleus of
diverse expertise with common goals
– Necessary for implementation of LHS ideal
More Thanks!
• Leaders
– Amy Abernethy, MD, PhD
– Aimee Zaas, MD, MHS
• Lecturers
• Project Mentors
• My fellow “trailblazers”
–
–
–
–
–
Lynn Howie, MD, MA
Aaron Mitchell, MD
Kevin Shah, MD, MBA
Krish Patel, MD
Angela Lowenstern, MD
• 2014-15 Cohort
– Jennifer Hauck, MD
– Leslie Pineda, MD
– Anastasiya Chystsiakova,
MD
– Jeffrey Yang, MD
– Mohammed Adam, MD
– Blake Cameron, MD
– Melissa Wells, MD
– John Yeatts, MD