IU Indianapolis ScholarWorks :: Browsing by Author "Finnell, John T."

Browsing by Author "Finnell, John T."

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An Automated System for Generating Situation-Specific Decision Support in Clinical Order Entry from Local Empirical Data
(2011-10-19) Klann, Jeffrey G.; Schadow, Gunther; Downs, Stephen M.; Finnell, John T.; Palakal, Mathew J.; Szolovits, Peter
Clinical Decision Support is one of the only aspects of health information technology that has demonstrated decreased costs and increased quality in healthcare delivery, yet it is extremely expensive and time-consuming to create, maintain, and localize. Consequently, a majority of health care systems do not utilize it, and even when it is available it is frequently incorrect. Therefore it is important to look beyond traditional guideline-based decision support to more readily available resources in order to bring this technology into widespread use. This study proposes that the wisdom of physicians within a practice is a rich, untapped knowledge source that can be harnessed for this purpose. I hypothesize and demonstrate that this wisdom is reflected by order entry data well enough to partially reconstruct the knowledge behind treatment decisions. Automated reconstruction of such knowledge is used to produce dynamic, situation-specific treatment suggestions, in a similar vein to Amazon.com shopping recommendations. This approach is appealing because: it is local (so it reflects local standards); it fits into workflow more readily than the traditional local-wisdom approach (viz. the curbside consult); and, it is free (the data are already being captured). This work develops several new machine-learning algorithms and novel applications of existing algorithms, focusing on an approach called Bayesian network structure learning. I develop: an approach to produce dynamic, rank-ordered situation-specific treatment menus from treatment data; statistical machinery to evaluate their accuracy using retrospective simulation; a novel algorithm which is an order of magnitude faster than existing algorithms; a principled approach to choosing smaller, more optimal, domain-specific subsystems; and a new method to discover temporal relationships in the data. The result is a comprehensive approach for extracting knowledge from order-entry data to produce situation-specific treatment menus, which is applied to order-entry data at Wishard Hospital in Indianapolis. Retrospective simulations find that, in a large variety of clinical situations, a short menu will contain the clinicians' desired next actions. A prospective survey additionally finds that such menus aid physicians in writing order sets (in completeness and speed). This study demonstrates that clinical knowledge can be successfully extracted from treatment data for decision support.
Characteristics of the National Applicant Pool for Clinical Informatics Fellowships (2016-2017)
(AMIA, 2018) Bell, Douglas S.; Baldwin, Kevin; Bell, Elijah J.; Lehmann, Christoph U.; Webber, Emily C.; Mohan, Vishnu; Leu, Michael G.; Hoffman, Jeffrey M.; Kaelber, David C.; Landman, Adam B.; Hron, Jonathan; Silverman, Howard D.; Levy, Bruce; Elkin, Peter L.; Poon, Eric; Luberti, Anthony A.; Finnell, John T.; Safran, Charles; Palma, Jonathan P.; Forman, Bruce H.; Kileen, James; Arvin, David; Pfeffer, Michael; Pediatrics, School of Medicine
We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017 clinical informatics fellowship positions. In each year, we collected data on the number of applications that programs received from candidates who were ultimately successful vs. unsuccessful. In 2017, we also conducted an anonymous applicant survey. Successful candidates applied to an average of 4.2 and 5.5 programs for 2016 and 2017, respectively. In the survey, unsuccessful candidates reported applying to fewer programs. Assuming unsuccessful candidates submitted between 2-5 applications each, the total applicant pool numbered 42-69 for 2016 (competing for 24 positions) and 52-85 for 2017 (competing for 30 positions). Among survey respondents (n=33), 24% were female, 1 was black and none were Hispanic. We conclude that greater efforts are needed to enhance interest in clinical informatics among medical students and residents, particularly among women and members of underrepresented minority groups.
Developing new pathways into the biomedical informatics field: the AMIA High School Scholars Program
(Oxford University Press, 2016) Unertl, Kim M.; Finnell, John T.; Sarkar, Indra Neil; Emergency Medicine, School of Medicine
Increasing access to biomedical informatics experiences is a significant need as the field continues to face workforce challenges. Looking beyond traditional medical school and graduate school pathways into the field is crucial for expanding the number of individuals and increasing diversity in the field. This case report provides an overview of the development and initial implementation of the American Medical Informatics Association (AMIA) High School Scholars Program. Initiated in 2014, the program's primary goal was to provide dissemination opportunities for high school students engaged in biomedical informatics research. We discuss success factors including strong cross-institutional, cross-organizational collaboration and the high quality of high school student submissions to the program. The challenges encountered, especially around working with minors and communicating program expectations clearly, are also discussed. Finally, we present the path forward for the continued evolution of the AMIA High School Scholars Program.
Does academic practice protect emergency physicians against burnout?
(Wiley, 2020-12-11) Norvell, Jeffrey G.; Baker, Annalee M.; Carlberg, David J.; Diller, David; Dziedzic, Jacqueline M.; Finnell, John T.; Greenberger, Sarah; Kessler, Chad; Lo, Bruce M.; Moungey, Brooke M.; Schiller, Elizabeth; Walter, Lauren A.; Emergency Medicine, School of Medicine
Burnout is a complex syndrome thought to result from long‐term exposure to career‐related stressors. Physicians are at higher risk for burnout than the general United States (US) working population, and emergency medicine has some of the highest burnout rates of any medical specialty. Burnout impacts physicians’ quality of life, but it can also increase medical errors and negatively affect patient safety. Several studies have reported lower burnout rates and higher job satisfaction in academic medicine as compared with private practice. However, researchers have only begun to explore the factors that underlie this protective effect. This paper aims to review existing literature to identify specific aspects of academic practice in emergency medicine that may be associated with lower physician burnout rates and greater career satisfaction. Broadly, it appears that spending time in the area of emergency medicine one finds most meaningful has been associated with reduced physician burnout. Certain non‐clinical academic work, including involvement in research, leadership, teaching, and mentorship, have been identified as specific activities that may protect against burnout and contribute to higher job satisfaction. Given the epidemic of physician burnout, hospitals and practice groups have a responsibility to address burnout, both by prevention and by early recognition and support. We discuss methods by which organizations can actively foster physician well‐being and provide examples of 2 leading academic institutions that have developed comprehensive programs to promote physician wellness and prevent burnout.
Electric Scooters (e-scooters): Assessing the Threat to Public Health and Safety in Setting Policies: Assessing e-scooter policies
(Society of Practitioners of Health Impact Assessment, 2020-11) Comer, Amber R.; Apathy, Nate; Waite, Carly; Bestmann, Zoe; Bradshaw, Jacob; Burchfield, Emily; Harmon, Brittany; Legg, Rebekah; Meyer, Star; O'Brien, Patrick; Sabec, Micha; Sayeed, Jami; Weaver, Alexis; D'Cruz, Lynn; Bartlett, Stephanie; Marchand, McKenzi; Zepeda, Isabel; Endri, Katelyn; Finnell, John T.; Grannis, Shaun; Silverman, Ross D.; Embi, Peter J.; Health Sciences, School of Health and Human Sciences
Objective: To determine self-reported incidences of health and safety hazards among persons who ride rentable electric scooters (e-scooters), knowledge of e-scooter laws, and attitudes and perceptions of the health and safety of e-scooter usage. Methods: A cross-sectional survey of n= 561 e-scooter riders and non-riders was conducted during June of 2019. Results: Almost half of respondents (44%) report that e-scooters pose a threat to the health and safety of riders. Riders and non-riders disagree regarding the hazards that e-scooters pose to pedestrians. Among riders, 15% report crashing or falling off an e-scooter. Only 2.5% of e-scooter riders self-report that they always wear a helmet while riding. Conclusions: E-scooter riders report substantial rates of harmful behavior and injuries. Knowledge of e-scooter laws is limited, and e-scooters introduce threats to the health and safety of riders, pedestrians on sidewalks, and automobile drivers. Enhanced public health interventions are needed to educate about potential health risks and laws associated with e-scooter use and to ensure health in all policies. Additionally, greater consideration should be given to public health, safety, and injury prevention when passing relevant state and local e-scooter laws.
Indianapolis Emergency Medical Service and the Indiana Network for Patient Care: Evaluating the Patient Match Process
(2014-01-03) Park, Seong Cheol; Finnell, John T.; Jones, Josette F.; Kharrazi, Hadi
In 2009, Indianapolis Emergency Medical Service (I-EMS, formerly Wishard Ambulance Service) launched an electronic medical record system within their ambulances and started to exchange patient data with the Indiana Network for Patient Care (INPC). This unique system allows EMS personnel in an ambulance to get important medical information prior to the patient’s arrival to the accepting hospital from incident scene. In this retrospective cohort study, we found EMS personnel made 3,021 patient data requests (14%) of 21,215 EMS transports during a one-year period, with a “success” match rate of 46%, and a match “failure” rate of 17%. The three major factors for causing match “failure” were (1) ZIP code 55%, (2) Patient Name 22%, and (3) Birth Date 12%. This study shows that the ZIP code is not a robust identifier in the patient identification process and Non-ZIP code identifiers may be a better choice due to inaccuracies and changes of the ZIP code in a patient’s record.
Measles: Contemporary considerations for the emergency physician
(Wiley, 2023-09-09) Blutinger, Erik; Schmitz, Gillian; Kang, Christopher; Comp, Geoffrey; Wagner, Emily; Finnell, John T.; Cozzi, Nicolas; Haddock, Alison; Emergency Medicine, School of Medicine
Measles, or rubeola, is a highly contagious acute febrile viral illness. Despite the availability of an effective vaccine since 1963, measles outbreaks continue worldwide. This article seeks to provide emergency physicians with the contemporary knowledge required to rapidly diagnose potential measles cases and bolster public health measures to reduce ongoing transmission.
Mobile Technology to Improve Adherence in Patients with Diabetes: Systematic Review
(2013-08-20) Portillo, Wilfredo; Kharrazi, Hadi; Jones, Josette F.; Finnell, John T.
BACKGROUND: The pathophysiology of diabetes mellitus and the need for vigilant monitoring of serum glucose levels lends itself well to prompt medical intervention by healthcare providers that can significantly reduce morbidity and mortality and improve patient quality of life. The effect of intervention in diabetes can be assessed by following objective laboratory measurements such as hemoglobin A1C, which is abnormal with poorly controlled diabetes and returns to normal with proper management. There are mobile technologies now available that allow for self-monitoring and intervention in this patient population. Using a systematic approach this paper will assess the benefits of Short Message Services and mobile technology in managing patients with diabetes and improving adherence and other outcomes. OBJECTIVE: To assess the benefits and disadvantages the use of mobile technology could have in the management of diabetes. METHODOLOGY: A systematic review of articles on this topic was performed. A total of 759 articles were initially identified by searching various search engines, from which only 39 articles met all of the inclusion/exclusion criteria of this systematic review. FINDINGS: The initial review of literature indicated that the use of mobile technology in patients with diabetes resulted in improved disease outcomes as indicated by parameters such as a decrease in hemoglobin A1C, and an increase in sustainable blood glucose levels. CONCLUSION: Mobile technology is found to be a promising tool in the management of diabetes, but further research is needed because there is a lack of reliable studies, trials, and systematic reviews. Physicians and other healthcare professionals are rapidly adopting mobile technology for use in clinical practice because they understand the rising phenomenon of mobile technology.
Overcoming barriers to promotion for women and underrepresented inmedicine faculty in academic emergency medicine
(Wiley, 2021-12-21) Oh, Laura; Linden, Judith A.; Zeidan, Amy; Salhi, Bisan; Lema, Penelope C.; Pierce, Ava E.; Greene, Andrea L.; Werner, Sandra L.; Heron, Sheryl L.; Lall, Michelle D.; Finnell, John T.; Franks, Nicole; Battaglioli, Nicole J.; Haber, Jordana; Sampson, Christopher; Fisher, Jonathan; Pillow, M. Tyson; Doshi, Ankur A.; Lo, Bruce; Emergency Medicine, School of Medicine
Equity in the promotion of women and underrepresented minorities (URiM) is essential for the advancement of academic emergency medicine and the specialty as a whole. Forward‐thinking healthcare organizations can best position themselves to optimally care for an increasingly diverse patient population and mentor trainees by championing increased diversity in senior faculty ranks, leadership, and governance roles. This article explores several potential solutions to addressing inequities that hinder the advancement of women and URiM faculty. It is intended to complement the recently approved American College of Emergency Physicians (ACEP) policy statement aimed at overcoming barriers to promotion of women and URiM faculty in academic emergency medicine. This policy statement was jointly released and supported by the Society for Academic Emergency Medicine (SAEM), American Academy of Emergency Medicine (AAEM), and the Association of Academic Chairs of Emergency Medicine (AACEM).
A practical method for predicting frequent use of emergency department care using routinely available electronic registration data.
(BMC, 2016) Wu, Jianmin; Grannis, Shaun J.; Xu, Huiping; Finnell, John T.; Department of Biostatistics, Fairbanks School of Public Health
Accurately predicting future frequent emergency department (ED) utilization can support a case management approach and ultimately reduce health care costs. This study assesses the feasibility of using routinely collected registration data to predict future frequent ED visits.

Browsing by Author "Finnell, John T."

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