My major professional interest is the use and evaluation of computer-based medical records in patient care, clinical research, and quality improvement.  Most of my work since completing my fellowship has involved development, selection and installation of computer-based record systems.  In conjunction with colleagues at Group Health Cooperative of Puget Sound I was involved in developing a prototype clinical computing system used to manage both individual patients and patient populations.   At VA Puget Sound, I served as the leader of the team that implemented and supported a computer-based medical record system (CPRS) and a clinical event monitor.

 

In September 2000, I joined the University of Washington as Medical Director of UW Medicine Information Technology Services.  My major activity at UW Medicine currently is implementing the UW Medicine electronic medical record, called the ORCA project.

 

Since 2000, I have worked on several projects related to our EMR implementation, some of which have resulted in papers published in the AMIA proceedings, JAMIA, or elsewhere.  Most recently these papers deal with physician documentation in electronic medical record systems, and how these notes are stored, indexed, and viewed.  A related topic of interest to me is how documents are managed through their "lifecycle," from their inception to ultimate use in an EMR.

 

I've worked with several graduate students on topics of shared interest, including the transition from paper to electronic medical records systems (Jon Nakashima), how often practitioners override alerts occurring during entry of orders (Ping Lin), early warning systems for hospitalized patients (Barry Aaronson), use of natural language processing in electronic medical records (Imre Solti) and others.  In general, research that originates from--and helps to solve--problems we encounter in clinical computing systems are the best fit for me.

 

I coordinate a seminar series on Operating Clinical Computing Systems in a Medical Center that meets each spring.  I am editing a textbook based on the topics in this seminar series.  This series concentrates on the skill and art of operating clinical computing systems after they have been installed.  The premise is that many organizations are installing EMRs and CPOE, but most of these installations have occurred recently.  We need more experienced people to keep these systems in operation and continuously improving.  Informatics trainees and graduates affiliated with care delivery organizations after their graduate or professional training benefit from exposure to the topics we discuss in this series.

 

Questions that interest me:

 

•  How can we help the medical community make the transition from paper/dictation for documentation, to electronic documentation?  Issues such as inappropriate copying/pasting, assuring document workflow requirements are maintained, document authentication, and many others need to be better handled by commercial electronic medical record systems.

•  Why is the user interface used for electronic medical records and CPOE so complicated?  Can't we make it simpler, and reduce the training requirement for new users?

•  How can natural language processing techiques be applied within electronic medical record systems?