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Health informaticians weave medicine, tech and science

Natalie Pageler, M.D., explains the setup of informaticist teams at Stanford Children's Health and what motivates clinicians to join this data-heavy field.

It's no surprise that Natalie Pageler, M.D., sees all aspects behind the role of health informaticians. As chief medical information officer (CMIO) at Stanford Children's Health, based in Palo Alto, Calif., and clinical associate professor of pediatrics critical care and biomedical informatics research at Stanford University, Pageler straddles the line between clinical and health information duties.

Pageler spoke in an interview at HIMSS 2018, the conference for the Healthcare Information and Management Systems Society, about how Stanford coordinates its informatics staff. This Q&A has been lightly edited for clarity and brevity.

We're seeing more interest from readers about the role of health informaticians. Where do you see the state of informatics right now? And how many folks does Stanford Children's employ for health informatics efforts?

Natalie Pageler: There's the more traditional kind of biomedical informatics and machine learning, but for us, clinical informatics is incredibly important at our organization. I think it needs to be highly recognized and funded for most organizations in order to implement information systems well. … Within Stanford Children's, I as a CMIO oversee about 10 to 12 informaticists who have part-time funding through our IT department. The reason I say it's 10 to 12 is it depends [on the project]. We have some who come in just for the length of a project and then some [who] are more operationally based and they have an ongoing appointment. … We have clinical informatics managers, who are mostly nurses by background who are full-time employees under IT, but then we have what we call our nursing informatics program that reports through [IT and] comes from our operational side. They are bedside nurses who have 16 hours a month with us who get special training in clinical informatics, who help with testing of our information systems, implementation of new projects [and] training of their colleagues. 
 

Natalie Pageler, M.D., CMIO at Stanford Children's Health and clinical associate professor at Stanford University.Natalie Pageler, M.D.

And so the point of all of these, for me, is that you have real, active bedside clinicians who are involved in implementing the systems for information services. And that's really the role that clinical informatics plays, to me. You need those people who can be the translators, who can speak both the clinical language and speak the technical language enough to bring both sides together so that you are truly solving real-world clinical problems. 
 
Are there best practices in Stanford's approach that you would recommend to other hospitals?

Pageler: One of the lessons we've learned as we discuss physician burnout and discuss some of the untoward effects of meaningful use is that having frontline physicians -- and specifically in this case, physician involvement in the design of the systems -- is absolutely critical. … [We] did a major vendor conversion four-and-a-half years ago, and [we had] physicians from multiple different areas with dedicated time just to the implementation. And so I think, first and foremost, recognize that you need to have that involvement in the planning, design [and] implementation of major information systems, and you need to resource it because physicians are very busy.

I've seen many [intensive care unit, emergency department and] anesthesia folks involved in informatics.
Natalie Pageler, M.D.CMIO, Stanford Children's Health

And so, if you're expecting them to take time to do this, you have to buy out some of their clinical time to do it. Same goes for any other specialties. So, our operations team has really understood the value of having frontline nurses involved in our systems development. And that's the key principle. 
 
It's fascinating that physicians who've trained all those years can then find themselves becoming health informaticians. What's the draw? Are there certain IT characteristics that appeal to physicians?

Pageler: I was an engineering physics undergrad. So I definitely had that kind of [scientific], mathematical mind in the past. So you see some of that. … I've seen many ICU, ED [and] anesthesia folks involved in informatics. My guess is there is some proclivity towards a more hard-science physiology aspect that ties in nicely with some of the math and science and technology pieces. But really, it's people who want to solve problems who see an issue [and] they want to be part of the solution. They're like, 'This is solvable. I can see this problem clearly. I can see how it can be fixed. I want to be part of making that happen.'

This was last published in April 2018

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How many health informaticians does your organization employ?
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I see the convergence between Genomic Medicine, Bio-medical Informatics and Population Health. The key issue today:is the Physicians do not have the appropriate analytical tools available for them at the point of care within the CDS level of the framework in their workflow, which will enable them to optimize the operational cycle and integrate with the changes of the revenue cycle management for organizational sustainability and survivability. Being involved in Bio-medical informatics research for 10 years the importance of collaboration and interoperability within the Health care Eco system is essential for if we are to succeed as a Nation.
Ranjit J. Silva  MD, CPE. 
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Thank you for writing. I was just interviewing a population health officer this week, and he mentioned the importance in the future of clinicians and revenue cycle teams working together to pinpoint the most useful patient data.

How has your system set up it's biomedical informatics program, in terms of number of employees and mission?
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