Dr. Dale E. Green can still recall the frustrations he experienced with patient records early on in his career as a physician.
“It’s late at night in the emergency room, someone is critically ill, and yet you have a stack of paper charts and 10,000 pages of patient records to go through,” said Green, an associate professor for health policy and management in the College of Public Health. “Typically, the chart you actually needed to deliver the best care was the one that didn’t come with the big stack. There just had to be a better way.”
Today, as one of eight new UGA faculty members recruited through the Presidential Informatics Hiring Initiative, Green is using the big data tools of informatics to improve the delivery of clinical care. And, in his first faculty appointment, Green will expand UGA’s training and research opportunities in the health and clinical informatics fields.
This spring, he introduced the university’s first undergraduate and graduate courses in health informatics and analytics. Topics covered in the class include the history and scope of biomedical informatics, policy and regulatory framework of health information technology, information technology architecture, public health informatics, electronic health records, data standards, privacy and security standards, population health data analytics, as well as a variety of special topics.
“As health care reform has demanded better management of medical information, the need for workers with health informatics skills has grown rapidly in Georgia and across the U.S.,” said Green. “I look forward to working with colleagues in the College of Public Health and across campus to build a world-class health informatics education program at UGA that meets these workforce needs.”
Although health informatics has been around in some form since the mid-1960s, it was the passage of the 2009 HITECH Act that led to the fast-track adoption of health information technology in hospitals and physicians’ offices. From 2008 to 2015, adoption of basic electronic health record technology by nonfederal acute care hospitals rose from 9 percent to 84 percent.
“Initially, health care organizations viewed the transition from a paper to an electronic medium as a means of improving patient record keeping,” Green said. “But the use of electronic health records and other health information technologies has grown tremendously since then, expanding on the idea that easily accessible health data can lead health care providers down the path to better clinical decisions.”
Today, health and clinical informatics focuses on collecting, storing, retrieving and using health care information to foster better collaboration among a patient’s various health care providers. It is an evolving specialization that links information technology, communications and health care to improve the quality, safety and efficiency of patient care.
While electronic health records can codify diagnoses and symptoms to facilitate billing and provide a means to format and abbreviate patient information in a way physicians can quickly absorb, its adoption has not been without challenges.
“The nuances of human communication have largely been obscured in the electronic medium,” Green said. “None of us in the field realized the magnitude of the cultural and workflow change the adoption of this new information technology would present.”
The medium, he explained, is in many ways similar to communicating with tweets.
“On top of that, these systems are very complex and cognitively burdensome to work with,” Green said. “The variety of functions dealing with medications and physiological variables, text data and discrete data elements all align to make it difficult in many cases to actually process the information.”
These usability problems can often put patients at risk, he said. Through his research, Green plans to explore how to better design these health information systems to improve clinical care and patient safety, while decreasing health care costs.
A physician in pulmonary, critical care and sleep medicine, Green began his foray into clinical informatics 14 years ago on the medical staff at Athens Regional Medical Center.
“As a physician at ARMC, I became an advocate for implementing informatics at the hospital and over time it became a full-time job,” he said. “Eventually, I was given the responsibility of being in charge of the whole clinical informatics program.”
Green served as ARMC’s chief medical information and quality officer for eight years, leading the implementation and redesign of the hospital’s electronic health record system, as well as its quality improvement and patient safety programs.
Then the Affordable Care Act, enacted in 2010, shifted health care payment reimbursement in the U.S. from a fee-for-service to a value-based system. Under the new care model prescribed by the ACA, health care providers were to be paid for the value, rather than the volume, of services delivered.
Green sought to expand his expertise as the health care industry evolved to respond to the ACA’s new policies. In 2012, he became chief medical information officer at Cornerstone Health Care, a physician-owned and led multi-disciplinary practice of more than 330 physicians and health professionals and 119 practice locations in communities throughout central North Carolina.
“Rather than being incentivized by sickness, the industry was shifting to become incentivized by wellness,” he said. “The ACA was changing medicine in a dramatic way, and Cornerstone was a national leader in this transition.”
Green soon was playing a large role at Cornerstone’s health care services startup, CHESS, designing and developing the company’s population health program and data analytics program. In 2014, he received his board certification in clinical informatics.
“As a physician, clinical informatics appealed to me because I recognized that better data could lead to better care,” said Green. “Empowered by good health care policy, it has the potential to improve public health as well.”