Poster for BWH Clinical Innovation Day!

Here is my masterpiece! This little baby took a veeeerrryy long time to get it to look as pretty as it is now so I hope y'all appreciate!

The information presented can be confusing if you don't work with EHRs or in informatics currently so hopefully this brief summary helps. Basically, this was a multi-center project to evaluate the efficacy of the little alerts that pop up in electronic medical record systems when a physician is ordering drugs and there is an interaction. Most systems have interruptive alerts which require action from the user before they can proceed. These measures are implemented on most EMRs so that physician error can be reduced. You can't expect doctors to remember every drug their patient is allergic to or all the drugs that interact adversely so this information is logged in the system. The problem is that many physicians simply ignore the alerts because they get so many of them. Our job is to find an alert design that adheres to a set of guidelines that determine easy uptake by the user. For example, alerts that are color coded based on the level of danger are more useful than alerts that are all one color. This study evaluated alerts from 14 different systems and then ranked them based on how well they did and the result is this poster!

Let me know if you have any questions or comments! I always enjoy talking about my project (probably too much, actually. I must really bore people but oh well, they're learning something!).

BWH Clinical Innovation Day Event!

Ah I know I have been sadly neglectful but I'm taking time from my stupidly busy schedule to write about a fantastic event I was lucky enough to be a part of yesterday so I hope this will serve as my apology.

Brigham & Women's Hospital put on an Clinical Innovations Day yesterday which consisted of an afternoon of panel discussions and a poster session. The poster session was really the highlight because my PI and I submitted an abstract for a poster and it was accepted! Since I was the one who really pushed for us to submit in the first place, I was graced with the responsibility for sending everything in and then revising and getting our poster printed (which turned out to be a lot more time-consuming than I had expected). I'll post a little summary and graphic of our finished product tomorrow because I don't have as much time as I want now to go into the gory details).

At the event I was able to attend all of the afternoon talks which focused on innovation and were all extremely exciting. Some highlights included connected health ideas such as using devices and IT innovation to improve patient care, a talk on support for high-risk pregnant women, a genetics mapping program that provided mutational profiling for every BWH cancer patient, and a recently developed app for the Longitudinal Medical Record at Brigham that allows doctors to add pictures to patient health records.

There was also a panel titled "The Innovator's Journey" that I felt was able to dole out some wisdom that could be applied to many endeavors, including getting into medical school. The panel consisted of four doctors who had made considerable contributions to the clinical field and each stood for a few minutes to discuss how they had gotten to their final product. It was enlightening to see that for many of them, the road to success was a rocky one. Dr. Orgill, who had worked on developing a breakthrough synthetic skin replacement for use by plastic surgeons was very frank when he explained that, had he known how long and how difficult it would be to get to where he was today, he would have given up long ago. He went on to say that maybe that is the saving grace of focusing on the now. If you only concentrate on one thing at a time, you don't get overwhelmed by the big picture. He argued that doing things logically wasn't an option because when you look at a difficult goal overall you see how crazy it is. I think this struck a chord with me because this is the attitude I try to have about becoming a doctor. The idea is kind of far-fetched, there are lots of deterrents and if I looked at it with a calculating eye then my chances are low. But the point is that you can't think like that, you have to take everything one step at a time, take disappointments or triumphs as they come and forge ahead.

Overall the day was a great learning experience for me, I got to present my first poster (I stood in for my PI which was a lot of responsibility but I think it came off well) and I was able to meet some very interesting new people and discuss my work which I always love to do. During the talks these words resonated with me: "we all became physicians to make a difference...doing research has an impact on a great number of patients' lives." At the end of the day I think it helped me to remember why I'm doing the kind of work I do, why I enjoy being involved in the medical research field and what I'm working towards.

On getting published in the research field

A few weeks ago I had a meeting with my current PI and as we were going through the agenda (who should send out which emails, documents that needed to be updated etc.) she casually drops this bomb: "oh by the way, you should probably get started on drafting the manuscript for Aim 1." I know this is an incredibly cliche phrase to use but you LITERALLY could have heard a pin drop. I actually didn't know how to respond so I just nodded, mutely. On the one hand I was THRILLED (excitement level: mentally jumping up and down) and on the other I was terrified because I've never actually written a research paper on my own before, at least not one based on scientific data. Also I've only been on this project for three months! Thankfully my PI went on to explain how she was giving this to me because she has been very impressed with my involvement in the study so far and really wants me to have a publication before I leave (which may or may not be in September but that is still very up in the air). It calmed me down somewhat to know that she has a lot of faith in my abilities and clearly wouldn't be giving me this task if she didn't think I was up for it.
While I've been incredibly lucky and am thankful to have been given several opportunities to get published before applying med school, I don't necessarily think it's completely up to chance. There are definitely things that anyone can do to help get their name on a paper they can include in their resume, CV, or grad school applications.
Probably the most helpful thing you can do for yourself is be proactive. I kind of hate that word because I think it's overused but it works in this case because it means "creating or controlling a situation by causing something to happen" (Google) and that's exactly what you want to do. If you already work in research and you want to get your name on a paper, don't just wait to be approached, talk to your PI about wanting to take on more responsibility and ask about the possibility of being included on a future publication. The worst thing they can say is no and you're no worse off than you were before. You can also talk to fellow RAs and ask if they need any help on their projects that may give you credit. Sometimes this might be tricky to navigate because I know some places are more competitive than others but in my experience I've found that any help offered is often gladly taken and you'll at least get a mention for it.
If you don't already work in research but would like to, start asking around because a lot of RA jobs are filled through recommendations (that's how I got my position). If you feel like you aren't close enough to the people you would ask just do it anyway. We've been looking for someone for our FDA project for months and if my roommate's sister's best friend contacted me asking about working at Partners I'd probably recommend her to HR as long as she wasn't a huge disaster (side note: we're still looking for someone for that project so if you're interested, holla at me).
If you're worried you won't get hired due to lack of experience then stop stressing because you're probably awesome in plenty of other ways. I've talked to several coworkers who have conducted interviews lately and was told that they primarily look for someone who is independent, goal-oriented and willing to learn. What you already know matters a lot less than how hard you work to get better at new things. Also doing all the regular things like showing up on time, not being rude, and dressing nicely really help (seriously, some interviewees don't do this, it's crazy).
Above all else, persevere! I guess it's mostly common sense but if you don't get the first job you interview for or your query about being on a paper is shut down then just keep trying. You'll get there, I promise.

CERT in the news

Today I was alerted to a fair bit of news - my project is being highlighted by ChainOnline - a Clinician-Consumer Health Advisory Information Network (presented by the Centers for Education and Research on Therapeutics). When I read the following paragraph I got so excited because this is me! I'm one of the "CERT researchers" evaluating the alerts, working with providers and rating EMR systems.
“It’s been shown that even if you deliver an important safety warning, doctors often ignore it, partly because the sheer number of alerts can be overwhelming, and partly because many of them are not really relevant,” says Bates. To address these issues, the CERT researchers are evaluating the appropriateness of overriding alerts and working with providers to understand the reasons and patterns behind high override rates. They also are evaluating several of the major commercial EMR systems and rating them according to their effectiveness at delivering relevant warnings, all in the hope of making those systems safer. (my italics)
It's nice to read about how what I'm working on is already making a meaningful difference.
Here is a link to the article (first in a series on CERT) and here is a collection of links to CERT in news elsewhere! Check it out.

Computerized Physician Order Entry & Healthcare

Here is a fantastic link to a brief, concise explanation by +Margaret Rouse  of CPOE and why it is important to our healthcare system in terms of reducing errors and saving massive amounts on healthcare costs. There is also a link within the text to an article on HITECH - the Health Information Technology for Economic and Clinical Health Act which was created by President Obama to encourage widespread implementation of EHRs by healthcare providers.

Both of these topics are extremely relevant not only to what I do at work every day but to every one of us who has ever stepped foot into a doctor's office, emergency room, or medical clinic. We all stand to benefit when the ultimate goal is to deliver a better, more cost-efficient system of healthcare across America. As a (hopeful) future doctor, I think it's exciting to be making a contribution to this kind of research! 

Up to my ears in electronic health record research!

For those of you who don't know, I work for Partners Healthcare doing research on electronic health record systems (EHRs). Information systems in the medical field is a pretty hot topic right now and I'm lucky that I get to work with some amazing people on such a cutting-edge project.
The study that I'm involved with is focused on medication alerts in EHR systems that physicians use in hospitals or private practices. When a doctor is prescribing a medication for a patient, the EHR will look through the patient information and generate alerts about potential drug interactions or allergies that could cause harm. The physician is then prompted to review their order and can cancel or switch medications if needed. Ideally, this would avoid a lot of nasty cases where patients are prescribed something that they're allergic to or that would interact with a drug they're already taking. In reality, it doesn't work quite as well as that.
Last month I went to an informatics seminar that included the shocking statistic that roughly 10% of hospital deaths are due to adverse drug events. That's literally 1 out of every 10 patients dying because of a drug they were given. Most of these are unavoidable (ex. the patient had never had the drug before so there was no history of allergy or bad reaction) but some of these are a result of a resident or attending making a mistake. The problem is that the systems aren't alerting physicians in an effective manner so most of the alerts are either ignored or never noticed. We're hoping to fix that.
It's a big project to take on and so far it's been exciting and I've learned a lot but it's also keeping me really busy so I haven't had much time to write. Hopefully I'll be able to write a more in-depth post soon about the project but for now, here's a picture of the very official nameplate outside my little cube where I work.