This Week Health

June 21: Today on Townhall Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care interviews Dara Mize, Assistant Professor in Biomedical Informatics and Medicine at Vanderbilt University Medical Center on the center’s clinical informatics fellowship program. Who can be a part of the fellowship? How does it differ from a traditional clinical fellowship? What are some next steps and challenges she is seeing for the fellowship?

Transcript

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Today on This Week Health.

One of the things that we recognize and that we've really been working on is making sure that we have a diverse population of applicants who apply. And I think one of the main ways we do that is by introducing clinical informatics earlier into the academic curriculum . So that we can make sure we have the most diverse both from experience and specialties and individual -wise, applying to our fellowship.

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Hello, I'm Jake Lancaster, an internal medicine physician and the chief medical information officer for Baptist Memorial healthcare. And today I'm very excited to be with Dr. D me and endocrinologist, and the program director for the clinical informatics fellowship at Vanderbilt Dara. Welcome to the program.

Thank you, Jake.

Well, I've known Dara for a long time when I was a clinical Matics fellow at Vanderbilt, but for the rest of us or for the rest of the audience, Dara, do you mind just telling us a little bit about yourself and what you do?

Yeah, of course, Jake as you mentioned, I'm an endocrinologist at Vanderbilt and I'm also the clinical informatics fellowship program director.

Additionally, I'm the founding co-director of our two other clinical informatics courses, one for medical students, and one for house staff. So that's residents and fellows who are already training at Vanderbilt.

Well, it's so great to talk with you. can you just tell us a little bit about what a clinical informatics fellowship is for those that might not be as familiar with the, new specialty?

Sure. Yeah, of course. So a clinical informatics fellowship similar to other clinical fellowships is a pathway for physicians who have completed a residency in any specialty to be able to continue their, to deepen their education and learning in the field of clinical informatics.

So it's a two year program. It is ACGME accredited and it, it allows fellows again to, hone their skills in clinical informatic. Really practice those skills and then to be eligible, to sit for the boards for clinical informatics upon completion of their fellowship, this would allow them to be a board certified clinical informatic system to, hopefully incorporate that into their work in some way.

Yeah. So any, specialty can go and do this subspecialty? Right. So I was internal medicine and I did the informatics fellowship, but if you're peds or if you're surgery or something else you can apply and, and do this as well.

Yeah, that's correct. We've had applicants from many different specialties and it's open to anyone who has completed that residency program.

And so, so how's it structured? I mean, it sounds a lot different than a typical fellowship would be since you're not seeing, Patient cases in this particular area. How do you structure this? So that it kind of flows like a other fellowships.

Yeah, it's a good question, Jake.

And then sometimes that can be challenging, but I think over the years we've sort of gotten to a good spot in terms of how we handle that. So, we do have month long rotations for specific. For example, sometimes a clinical decision support rotation, or something maybe that sounds a little less like informatics, that's still very relevant, like, revenue cycle or finance.

So we have rotations in many of these fields, but along the way, our fellows also become involved in different projects. And so I sort of see those projects with kind of the continuity experience that for example, a medicine internal medicine resident would have with continuity clinic, the fellows often also pick up these projects that they sort of work on longit Tood. longitudinally while on their rotations, they be, they meet other people at the organization and the rotation that they're on learn about that field. And then the next month they kind of move to a different rotation, but it has been tricky at times trying to find something that, that looks similar to other clinical fellowships.

But without that direct patient interaction piece of course we do have all of our fellows continue to practice clinically as well.

Okay. And. What would you say are the core aspects of the fellowship that all the fellows need exposure to. So, in internal medicine, we gotta do our general medicine, wards, ICU, outpatient, and then certain specialties we need to really rotate through what is it for informatics.

Yeah, it's a really good question. So I think about it a little bit differently and the way we've tried to evolve our fellowship over time is what I'll describe. So what we've started to do is that other fellows initially come into the program, we try to spend that first, at least six months.

Really trying to get them to hone some of their technical skills. I mean, at the end of the day, we don't expect from most of them to be hands on keyboard. For the majority of their career, some of them may lead more towards that in the future, but that's not exactly where we expect our fellows to spend most of their time, but we do know that they need to have some basic data science skills.

And in our case some skills building tools in our electronic health record. So that's how we have them spend kind of their first several months and while they're honing those skills, they're meeting people at the organization, learning what people do and trying to identify projects or areas where they wanna be more involved and can kind of personalize their fellowship experience from that perspective.

And then as they graduate, you know, as they, go through the fellowship, we like them to then start putting those technical skills into practice by supporting different projects or other initiatives for the medical center on their various rotations, or just, based on relationships they've built during previous rotations for one of those projects, like I mentioned, and then for their last year or last six months, we really want them to.

Kind of leading out on more projects because leadership is in kind of managing that change. That's associated with technology. Implementations is also a big part of informatics. And so that's kind of the evolution that we like to see our fellows have over the course of their fellowship. And then, you know, there's core things , like I mentioned in clinical decisions, support is one really big one that we like them to spend a couple of rotations really understanding that field a little bit better.

So, you talked about projects that fellows would work on trying to get them more involved in certain projects. What are some of the projects that I guess your former or current fellows ha have worked on that have been pretty significant?

Yeah. So, we like all of them to be involved.

As I mentioned in some longitudinal projects, some are involved in many, some are More involved, but in a fewer number. So one of our fellows right now has done some predictive analytics work in liver failure. And so that machine learning predictive analytics world is a place that a couple of our fellows have wanted to be in.

They have a little bit, they try to develop a little bit more technical, so. Skills so that they can do a little bit more of the hands on keyboard work there. One of our other fellows is currently helping us implement a third party vendor that supports pathways that are delivered in the EHR.

So it's, a little bit the type of different type of technical skills. And, but also involves a little bit more of meeting with our customers, meeting with our colleagues to design best practices for these pathways, and then helping to manage that change and promote adoption through implementation.

So I'd say it's a little bit all over the board, as you saw in your fellowship, Jake, other projects that our path that our fellows will be involved in are big implementations or Goli that happen to be occurring when they're there. So some of that is a little timing dependent in terms of if we have one of those happening while the fellow is there, but we definitely like for them to see those initiatives close up, if they have that opportu.

Yeah, I got the help with the epic EHR implementation or estar as, as Vanderbilt branded did. So y'all are gonna do that every year for your fellows.

No, I do look for other opportunities. We haven't had anything quite so significant but they have been able to be involved in some of our other, not quite as large, but still very important uh, Goli and initiatives for Vanderbilt.

Yeah. That was really good experience for me. Probably. Once in a career thing that you would do, hopefully never really wanna do it more than that. . Um, And then you mentioned that the fellows continue to practice clinically. How do y'all balance that? Clinical and, operational administrative time for the fellows?

Yeah, that's a great question, Jay, cuz it's not something that we always had quite figured out early on. So what we do is, I think let me just back up for a minute, say that I think it's critically important for our fellows to continue to maintain their clinical skills. One to build those relationships and two, just to kind of remember what it means to be practicing clinically and, to understand the tools that they're using and the system that they're working in.

So all of our fellows, as we interview them, we also connect them with the clinical department at Vanderbilt to try. Make sure we have a good match there. And so, each of them spend no more than 20% of their time practicing clinically and ours do that typically on nights or weekends to kind of support their so that they can kind of keep their clinical informatic skills for the daytime that still maintain those clinical skills and they're given specialty and they found that to be a good balance, I think.

And I think it's similar to what other programs have done as well.

Yeah, it is incredibly important. To keep practicing. I think it's just, and to understand the tools that you're, building and you're implementing, you really need to be on the, user and inside to, to understand those changes and understand the frustrations and, problems that you're trying to solve.

I completely agree, which is why I tell, every one of our fellows that comes in now that we really wanna make sure that they're able to maintain that practice when they come to Vanderbilt. And we've had great support from our clinical partners on the, in the clinical side of the medical center everyone wants a clinical Matics fellow in their department, so

that's good. That's good. So what have your fellows that have gone through the program gone on to, do you know how many, how many years let's see. I, I think I started in 20. At Vanderbilt. So I'm not sure how many fellows have gone through now or how many have been there since you've been program director?

Yeah. So listening, so, You and then Claude.

So both of you guys went on to be CMIOs at medical centers in the region. Rob Turner graduated last year and he took a kind of a combined AC he's he's at a UT Southwestern practices, ally, but also has a role in their clinical informatics department there. So kind of a hybrid role of clinical and informatics work.

Ashley span will be graduating this year. Now she's going to do an additional clinical fellowship, but also hoping to eventually. Maintain an academic position where she does both clinical work and some informatics work.

That's great. And so what would you say are kind of the future plans for the fellowship next steps or, big challenges that, still lay ahead for this fellowship?

Yeah, I think some of the things that we've talked about One of the things that I think we're in a better place than we were a couple of years ago is helping our fellows get some of those more extensive data science skills. So we didn't quite always have a great environment for them to learn SQL or to learn how to do machine learning and those kinds of things.

And so I think between our, Ashley's band, our current fellow and our former fellow they've really helped us think about how to integrate that into the fellowship. And then, I mean, I think the other thing that we've made is some improvements on is really making sure that every fellow can keep that clinical skills up and their clinical skills up and, practice here.

So in terms of challenges, you know, I think one of the things that we recognize and that we've really been working on is making sure that we have a diverse population of applicants who apply.

And I think one of the main ways we do that is by introducing clinical informatics earlier into the academic curriculum, which is one of the reasons why one of my colleagues, Dr. Travis Osterman, and I really wanted to start our clinical informatics. Training programs or, rotations or experiences for both medical students and house staff so that we can make sure we have the most diverse both from experience and specialties and, individual wise population applying to our fellowship.

I think that's just kind of a challenge for the field moving forward that we need to make sure we're doing that.

well, that's great. And, lastly, so we have a lot of health system leaders that listen to this podcast. Mm-hmm what would you say to more of the operational administrative side about how they can interact and use informatics fellowships or would it be worthwhile for them to create their own.

Yeah, I think so. I mean, I think we've seen that our fellows have played a critically important role in, as you saw Jake with yourself, the, implementation of our electronic health record a couple of years ago, and many of our, our fellows do have that more operational lens. Some of our fellows kind of have a bit of more of a research lens and want to.

Trying to grow their career in that area, but many of them wanna follow a path sort of similar to what you are in and really be able to make that connection between the clinical world, but then also informatics and technology, and to understand how informatics and technology can support clinical practice.

And that wants to provide the best care possible for our patients. So, I, I absolutely think that if they're considering a fellowship, they should reach out and, and discuss some of the advantages of that and, and of training folks to be in those roles in their organiz.

Well, thank you so much.

I know, I, I always get questions about what informatics fellowship was like and, I'm happy to always to talk to those that are interested, but I think this will go a long way in, in kind of getting the word out about, what is the experience like? So, thanks again for coming on. And do you have any last words you wanna say or share regarding fellowship and informatic?

No, I would just kind of, second what you said, which is that I'm having to talk to anybody considering this path. I think there are many different training paths for physicians specifically, but also a lot of other healthcare clinicians. The fellowship is one of them and I'd be happy to talk to folks who are considering a fellowship or weighing what their other options are.

So

well, thanks again, Dara. Thanks Jake.

Bye-bye.

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