Non-Traditional Thinking Leads Nick Tatonetti, Ph.D., To Important Advancements In Health, Healthcare

Nick Tatonetti, Ph.D.

Nick Tatonetti solves problems. He has always enjoyed it, and as the informatics community has discovered, he is both creative and proficient in his methods.

Tatonetti, who was recently awarded tenure and promoted to the rank of Associate Professor in the Columbia Department of Biomedical Informatics (DBMI), focuses on the use of advanced data science methods, including artificial intelligence and machine learning, to investigate medicine safety. Using emerging resources, such as electronic health records (EHR) and genomics databases, his lab is working to identify for whom these drugs will be safe and effective and for whom they will not.

His path to DBMI wasn’t a traditional one, but that fits his work. Since joining the department in 2012, Tatonetti has used non-traditional thinking to benefit both health and healthcare.

Data Mining To Save Lives

Utilizing both data mining of medical records and prospective lab experiments, Tatonetti created a methodology for both finding and validating adverse drug reactions and drug-drug interactions. During a two-year collaboration with Pulitzer Prize-winning journalist Sam Roe of the Chicago Tribune, Tatonetti discovered that the drugs ceftriaxone and lansoprazole, when taken together, induces an arrhythmia in the heart.

The data mining identified adverse effects, while the lab experiments established causality. Tatonetti wasn’t specifically looking for a negative reaction of those particular drugs; he had no reason to suspect them.

“We are able to find things that nobody expects to happen because the world of hypotheses we consider is basically everything,” he said. “We consider every possible combination, a type of analysis that would be impossible without a huge data set and significant computational power.”

The work was published in the Journal of the American College of Cardiology in 2016, while Roe’s Tribune feature on it was a 2017 Pulitzer finalist in Public Service.

“Working with Nick was one of the highlights of my career,” Roe said. “Obviously, he is a first-rate, pioneering scientist; his brain-power is off the charts. But what really impressed me was his generosity, enthusiasm and heart. He was extremely encouraging and open-minded about new ideas and not afraid to aim high and say, ‘Let’s go for it!’”

From Emergency (Contact Forms) To Heritability

While Tatonetti’s validated findings in the drug-drug interaction study answered a critical medical issue, his recent findings published in Cell provides a foundation for future research questions.

The Tatonetti Lab invented a method for inferring familial relationships from EHR through emergency contact forms; his findings were published in Cell. (Photos courtesy of Health Research Symposium 2019, The Government of the Hong Kong SAR)

His lab invented a method for inferring familial relationships from EHR through emergency contact forms. Using these, he conducted the largest systematic study of disease heritability to that point and found significant heritability for 500 phenotypes, the vast majority of which have never been studied before.

“We leveraged the electronic health record data set in a way that had not been done before to study the genetic mechanisms of disease without having any genetic data available,” Tatonetti said. “It’s a starting point for further research, and it opens an avenue of research that wasn’t available before. Multiple papers have been published off of those results and my collaborators are looking at screening rates of disease. Before now, the hospital did not have a way to assess whether or not they were screening people effectively.”

One example is the screening methods for celiac disease. He explained that hospitals are advised to screen all first-degree relatives with celiac symptoms, but there was no way to know the relationships between all patients. Tatonetti’s study indicated that only 50% of potential celiac patients were being screened. His lab is also using this method to study other diseases, such as breast cancer.

Journey To Columbia

Tatonetti couldn’t have predicted these accomplishments, and several others, while growing up on a horse farm in northeast Ohio. He may have been a junior national champion rider in his youth — he excelled in reining then, and he recently rediscovered that joy as a jumper — but college itself wasn’t an early motivator for him.

It wasn’t until he tested other professions and studies, including car insurance sales and film school, that he focused on his scientific passion at Arizona State.

Nick Tatonetti continues to investigate ways to partner science and medicine for the benefit of healthcare.

He earned both his master’s and Ph.D. in biomedical informatics at Stanford, where he found his passion for data mining, observational data analysis and machine learning. Technology was always a passion for him, but now instead of designing background image apps for early iPhones — ‘DockSwap’ and ‘Customize’ were two of his more popular creations — he was ready to study medicine safety.

Tatonetti considered staying at Stanford, but Columbia had significant advantages that ultimately brought Tatonetti across the country.

“The integration of the department with the hospital and the access to data is just unparalleled,” he said. “The opportunity to get informatics-type work done here is huge. I knew if I came here, almost immediately, I’d be able to do the type of research I wanted to do. The other reason I came here is because of the students. Everyone has diverse backgrounds, but they have a desire to bring informatics methods and data science methods into medicine.”

Looking Ahead

Building on both the drug safety and cell paper research, the Tatonetti Lab is working on several important medical questions presently.

“We are looking at the genetic mechanisms of adverse drug reactions,” he said. “We are studying novel ways to phenotype patients in the EHR, and to identify the genetic differences in those phenotypes. We are creating integrative methods for drug discovery, whether it is new pharmacological pathways to treat diseases or whole new paradigms for how drugs work. We’re also exploring neural networks for their clinical utility. Can they improve the performance of our phenotyping, or our predictive analytics? Basically, we’re looking for anywhere tech and medicine can be combined to advance scientific discovery.”

 

Dr. Suzanne Bakken Named the Recipient of the 2019 IMIA François Grémy Award of Excellence

Dr. Suzanne Bakken is the first nurse and 10th overall recipient of the IMIA François Grémy Award of Excellence.

The International Medical Informatics Association (IMIA) announced Dr. Suzanne Bakken as the recipient of the 2019 IMIA François Grémy Award of Excellence. IMIA is honoured to recognize the long-lasting contributions Dr. Bakken made through her research, education, development, and application of Biomedical and Nursing informatics and for her outstanding lifetime personal commitment and dedication to the field, both nationally and internationally.

Dr. Christoph Lehmann, the President of IMIA, will present the François Grémy Award of Excellence on Monday, August 25th at the opening ceremonies of MedInfo 2019 in Lyon, France. “It is a momentous occasion for IMIA to recognize Suzanne Bakken as the 2019 recipient of the François Grémy Award,” said Dr. Lehmann. “Dr. Bakken’s tremendous contributions to science and education have made her a leader in our field. Just as importantly, however, honoring Dr. Bakken highlights the importance of nursing informatics to the international community and the International Medical Informatics Association.”

Dr. Bakken is the Alumni Professor of Nursing and Professor of Biomedical Informatics at Columbia University, where she leads an NIH-funded research center and training program. Her research is focused on promoting health and reducing health disparities in underserved populations through application of innovative informatics methods. A major focus of her current grant portfolio is visualization of healthcare data for community members, patients, clinicians, and community-based organizations.

Dr. Bakken is a Fellow and Past-President of the American College of Medical Informatics, a member of the National Academy of Medicine, an inaugural Fellow of IMIA’s International Academy of Health Sciences Informatics, as well as several other prestigious professional bodies with whom she is involved.  She has published over 200 peer reviewed papers, and in 2019, she took the helm as Editor-in-Chief of the Journal of the American Medical Informatics Association.

“It is an honor and a privilege to be the first nurse and 10th recipient of the François Grémy Award of Excellence. IMIA NI is a vibrant component of the IMIA community with a history of leadership. Participation in IMIA and IMIA NI has enriched my career in biomedical and health informatics for more than 30 years,” said Dr. Bakken. “It is particularly special to be receiving this award in Professor Grémy’s home country of France and at a time when our field is increasingly called upon to advance health and health equity through informatics.”

About the IMIA François Grémy Award of Excellence
The IMIA Medical Informatics Award of Excellence was orginally established in 2001. In 2015, the award was renamed the IMIA François Grémy Award of Excellence to honour Dr. François Grémy for his foundational work in the establishment of IMIA and its predecessors, and his lifelong contribution to health and biomedical informatics in his home country of France, Europe, and the world.

The recipient of this Medical Informatics Award of Excellence is an individual whose personal commitment and dedication to medical informatics has made a lasting contribution to medicine and healthcare through her or his achievements in research, education, development, or application in the field of medical informatics.

For more information visit: imia-medinfo.org/wp/imia-award-of-excellence/

(courtesy of the IMIA press release)

Congratulations To Trio Of DBMI Professors Awarded Tenure, Effective July 2019

Nick Tatonetti

Yufeng Shen

Lena Mamykina

Lena Mamykina, Ph.D., Yufeng Shen, Ph.D., and Nick Tatonetti, Ph.D., were awarded tenure and promoted to the rank of Associate Professor in the Department of Biomedical Informatics at Columbia, effective July 2019.

Mamykina’s research resides in the areas of informatics, human-computer interaction, ubiquitous and pervasive computing, and computer-supported collaborative work. Her current research focuses on exploring new ways to use patient-generated data and computational intelligence to support health and wellness management. Her recent projects include development of technology-based lifestyle coaching interventions for individuals with diabetes, especially those within the local Washington Heights Community.

Shen studies human biology and diseases using genomic and computational approaches. His interest is in two broad questions: identifying genetic causes of human diseases, and understanding the dynamics of human adaptive immune system. He develops computational and statistical methods to analyze genomic data and interpret genetic variations. Shen has uncovered association of cell-type specific gene expression and regulation to genetic risk in autism and structural birth defects, and extensive connection of mutations in cancer and developmental disorders.

Tatonetti is focused on the use of advanced data science methods, including artificial intelligence and machine learning, to investigate medicine safety. Using emerging resources, such as electronic health records (EHR) and genomics databases, his lab is working to identify for whom these drugs will be safe and effective and for whom they will not. Among his most prominent work was a discovery of a specific dangerous drug interaction for the heart which otherwise would not have been found without using data mining and informatics methods.

Adelman Study Evaluates Safety of Restricting vs Allowing Multiple Records Open in an Electronic Health Record

In Brief

Jason Adelman, MD, MS

The use of electronic health records (EHR) in healthcare increases daily, and so does the importance of understanding the safest and most efficient methods for their utilization. One seemingly simple feature of EHRs under scrutiny pertains to the number of records that should be allowed open by a clinician at the same time, and whether multiple open records would lead to greater error in documentation and care.

Both the Office of the National Coordinator for Health IT (ONC) and the Joint Commission recommended that clinicians should be limited to one open record at a time. Jason Adelman, who holds dual Columbia appointments in both Medicine and the Department of Biomedical Informatics (DBMI), used his own Wrong-Patient Retract-and-Reorder (RAR) Measure to study this question in a recent randomized clinical trial.

His findings, which were shared in the May 14 issue of JAMA, did not line up with the ONC/Joint Commission recommendations. There was no significant difference in errors between clinicians randomly assigned to a group restricted to one open medical record and those assigned to a group allowed to open as many as four at a time.

Other findings did present questions of their own. Both Adelman and Bob Wachter, chairman of the UCSF Department of Medicine, added insight in the issue of JAMA.

Background

The Agency for Healthcare Research and Quality (AHRQ) funded an earlier Adelman survey that found approximately 40% of hospitals allowed the maximum number of records open for each system, while another 40% limited their clinicians to one open record at a time. Both gave reasonable explanations to their logic, ranging from allowing doctors to multitask to being concerned about wrong-patient errors with multiple open records.

Given that the ONC and Joint Commission recommendations were based on expert opinion, Adelman believed that evidence was critical to study both efficiency and safety in this area of healthcare.

“We wanted to answer the question can doctors safely open multiple records,” said Adelman, whose RAR measure was used with a new EHR system at all sites of a clinical trial. This allowed Adelman and colleagues to track the number of times one or more orders was placed for a patient that were retracted (cancelled) by the same clinician within 10 minutes, and then reordered by the same clinician for a different patient within the next 10 minutes.

What The Study Found

This JAMA abstract highlights the findings from Dr. Adelman and colleagues on restricting concurrently open electronic health records in a randomized clinical trial.

More than 3,300 clinicians were randomized into two groups over a 19-month time period. One group was limited to one open health record (restricted), while the other group could open as many as four at any given time (unrestricted). Nearly 4.49 million order sessions were completed during the study period, and the difference in error rate between the restricted and unrestricted groups was 2.7 per 100,000 orders sessions.

While there was no significant difference between groups overall, there also was no difference broken down by practice settings (emergency department, inpatient, outpatient).

The unrestricted group generated findings that did require greater consideration. The rate of errors generally increased when multiple records were opened, and the majority of orders (66.2%) were placed with one open record at a time, even though clinicians were allowed to open up to four at a time.

“Why are the error numbers going up when you have more records open when we know from the randomized trial that there was no difference?” Adelman said. “The general thinking is that this is what we call ‘confounding,’ and that the problem really isn’t having multiple records open. The problem is that this is often a sign of multitasking. Working on multiple patients at once is the problem, not having multiple records open.”

Why It Matters

As EHRs become central to clinicians’ workflows, further study is needed to determine how to balance efficiency with patient safety.

Wachter shared this opinion in his May 14 JAMA editorial:

“While there was evidence suggesting increasing errors with more open records, the comparison with the restricted group suggests that order-error rates were in fact lowest when clinicians exercised the choice of opening 1 record at a time, rather than being restricted to opening only 1 record. Additional research is necessary to identify modifiable factors contributing to this error rate, including clinician workload. Policies that restrict open records should not be enacted without understanding the broad effects of such policies on safety, throughput, and clinician satisfaction.”

Adelman compared earlier calls for restricted EHR usage to a parachute (do we really need to study if parachutes are useful when jumping from a plane?), and this study shows the importance of evaluating EHR usage instead of simply instituting a recommendation based on reason, not data.

For more information, you can read the study by Adelman and his colleagues, or you can read the editorial by Wachter and his colleagues. Wahcter also spoke on the issue on a JAMA podcast.

Dr. Bruce Forman Leads Hospital’s Mentorship Effort With Inwood Early College

Dr. Forman shared some remarks to the 11th grade class at Inwood Early College to open the celebration at the Morgan Stanley Children’s Hospital Wintergarden plaza.

NewYork-Presbyterian, City University of NY (CUNY), Microsoft, and Inwood Early College (IEC) joined together in 2013 to introduce New York City high school students to information technology in a health care setting. NewYork-Presbyterian recently hosted the IEC 11th graders in the Morgan Stanley Children’s Hospital Wintergarden to celebrate the successful culmination of three years of mentoring.

“It’s always a pleasure to welcome Inwood Early College students to NewYork-Presbyterian and celebrate the completion of another successful cycle of mentoring,”said Dr. Bruce Forman, Associate Professor of Biomedical Informatics at Columbia University Vagelos College of Physicians and Surgeons, who also oversees NewYork-Presbyterian’s collaboration with IEC. “We hope we’ve been able to give the students some guidance over the last three years, and we’ve very much enjoyed their questions and enthusiasm. We’re happy to open our doors and share in their celebration.”

NewYork-Presbyterian has been a proud industry partner of IEC since the 2013-14 planning year. Forman, an original leader on the NewYork-Presbyterian side of this collaboration, is among the approximately 50 hospital staff who mentor the high school students. One Friday each month, these mentors meet with subsets of students between the ninth and 11th grades to introduce and educate them to the many areas within the health and information technology discipline as well as familiarize them with the nature of work, the workplace, and professionalism.

“What we do, as industry partners, is provide work-based learning for the students,” Forman said. “We have sessions on things like how to write a resumé, how one handles a job interview, and aspects of college preparation and college selection.”

Several mentors shared in the Inwood Early College celebration breakfast recently at NewYork-Presbyterian. L to R: Dr. Bruce Forman, Edwin Melenciano-Lopez, Madelin Mejia, Vladimir Morales, and Kelvin Espinal

The students continuously impress Forman and his colleagues with their curiosity about health and information technology. He admitted that the “mentors were more nervous than anybody” at first, but Forman finds great inspiration from these motivated students.

“The only entrance requirement is that you demonstrate an interest in the theme of the school,” said Forman, who is also a Director in Information Services at NewYork-Presbyterian and a Department of Biomedical Informatics (DBMI) faculty member since 1994. “At this stage in my career, education and training are very important to me.”

This partnership also aligns with the National Library of Medicine (NLM) objective of developing a diverse work force. Forman said that approximately 96% of the IEC population are students of Hispanic/Latino or African-American heritage, many of whom travel from the Bronx to the school located in the uppermost neighborhood (Inwood) of Manhattan.

“There are a number of students who haven’t had the easiest time in life, but this school really provides them opportunity,” said Forman, who specifically praised principal Samona Tait’s leadership at IEC. “They are curious. They ask a million questions. And they’re New Yorkers, so they’re not shy.”

Forman shared recent successful results from IEC, including higher SAT scores, Regent scores, graduating percentage, and amount of college credits accrued than the average high school in either New York City or the state of New York.

Success hasn’t been limited to the students. Forman accepted the 2018 New York City Department of Education Career and Technology Education Partner of the Year Award on behalf of NewYork-Presbyterianin December. He looks forward to building upon the partnership and introducing the health and information technology fields to new classes of interested students in the future.

“Partnership and inspiration are at the center of our strong relationship with CUNY, Microsoft, the IEC staff, and most especially the IEC students,” Forman said. “With a little guidance and direction, there is no limit to the opportunities available to these wonderful young people.”

DBMI, Medical Students Collaborate To Impact Future Of Healthcare

Herbert ChaseThe recent availability of enormous amounts of healthcare data has provided physicians and scientists the opportunity to develop technology to improve healthcare outcomes and foster groundbreaking research. One of the missions of the Columbia Department of Biomedical Informatics (DBMI) is to introduce medical students to biomedical informatics so that they become familiar with the cutting-edge methods to answer important healthcare questions, and, perhaps, participate in creating important tools that improve the ability of physicians to provide outstanding, safe, and efficient care.

Dr. Herbert Chase, Professor of Clinical Medicine in Biomedical Informatics, takes the lead in introducing medical students to the field. Chase reaches all medical students with a series of introductory lectures that emphasize the value of electronic health records and the potential of clinical decision support.

To supplement these lectures, Chase created a series of YouTube podcasts on varied topics such as datamining and clinical decision support, geared to medical students to access when needed. His most popular one is entitled Overview Of Biomedical Informatics which has more than 2,100 views.

A second mission of the department is to identify outstanding students who may want to be clinical informaticians. “It’s about recruitment in a maturing field with a generation of tech-savvy kids who see the potential of technology in medical practice,” Chase said.

The department offers a variety of research opportunities for students who demonstrate a deeper interest in informatics such as the scholarly research project. He also advises students working on a project with a faculty member in a clinical department who may want to use biomedical informatics methods.

The Department also offers an elective in biomedical informatics for residents and fellows, regardless of their computational science background, to set up conversations with each department member to learn about the various and diverse aspects of the field.

This elective has provided important connections for trainee physicians who may not ultimately end up in the biomedical informatics field. Instead, they can find modern ways of researching important medical questions using the tools discovered through their DBMI interactions. Through these interactions, clinicians often provide insights in their own specialties to help informaticians build the next generation of tools. About 35 residents took this elective during the 2018-19 academic year.

Some of these residents may want to do a clinical informatics fellowship. A particularly exciting milestone for the department’s training mission was the creation of the Clinical Informatics Subspecialty Fellowship, a two-year program accredited by the Accreditation Council for Graduate Medical Education (ACGME).

“We are seeking to train the in-between person,” Chase said, “the person who knows clinical medicine, and who understands the ecosystem of electronic health records and the methods of biomedical informatics. They can identify worthy clinical questions thanks to their clinical knowledge, and can also determine what are the interventions that would require a computational component and what that component would look like.”

Medical students, residents and fellows can benefit from DBMI interactions. As their understanding of informatics potential grows, so too will their vision on how they can positively impact the evolution of medicine and healthcare.

Columbia DMBI Celebrates 2019 Ph.D. and Master’s Graduates

The Columbia Department of Biomedical Informatics (DBMI) honored its 2019 Ph.D. and master’s degree graduates Monday, May 20, during an afternoon celebration in NewYork-Presbyterian Hospital.

“We’re very proud of every member of our training program, and we’re excited to see their growth and how they impact healthcare and health,” said Noemie Elhadad, Director of the Graduate Program.

Mollie McKillop, Drashko Nakikj, and Joseph Romano each completed the Ph.D. program in Biomedical Informatics.

Marissa Burgermaster, Huanyao Chen, Megan Houterloot, Kathleen LaRow, Jeremy Lew, Xinhang Li, Ziran Li, Olga Lyudovyk, Nenad Macesic, Kamileh Narsinh, Liana Tascau, Kernyu Park, and Natnicha “Numfa” Vanitchanant each completed the master’s program.

Prospective students who are interested can learn more about the DBMI Ph.D. program or the master’s program.

 

2002 Ph.D. Graduate Eneida Mendonca Joins Regenstrief As VP Of Research Development

Eneida Mendonca, M.D., Ph.D., a 2002 Ph.D. graduate from the Columbia Department of Biomedical Informatics, joined the Regenstrief Institute to hold the newly created position of vice president for research development.

As VP for research development, she will build upon and enhance the successes of the institute’s faculty investigators across biomedical informatics, health services research, aging research and implementation science. Mendonca also will have an appointment as professor of pediatrics at Indiana University School of Medicine, with a secondary appointment as a professor of biostatistics.

“I had earned my medical degree from Universidade Federal de Pelotas in Rio Grande do Sul, the southernmost state in Brazil, before I came to New York to pursue a Ph.D. Enrolling in Columbia’s Department of Biomedical Informatics was one of the best decisions I’ve ever made,” said Mendonca following her appointment at Regenstrief. “I especially valued the department’s family atmosphere, which created a climate very open to learning. Students were friends with faculty, but were expected to achieve at a high level. One of the highlights of my graduate school experience was working, in collaboration with the local hospital system, on the development of an EHR system, enabling me to experience and learn in a real-world setting.”

“My graduate training plus five additional years as a junior faculty member at DBMI launched me on a career which has taken me to the University of Chicago, University of Wisconsin, and recently to the Regenstrief Institute as its inaugural Vice President for Research Development,” Mendonca added. “It’s very exciting to be at this prominent place in my career in biomedical informatics and Columbia provided me with the essential foundation to attain this goal.”

Congratulations To Our 2019 HIT Certification Program Honorees

Congratulations to the nine honorees who earned their Health Information Technology Certification of Professional Achievement on May 10 during a celebration inside the Columbia Department of Biomedical Informatics.

Patricia Falto, Amy Kim, Mariam Mohsin, Gul Moonis, Cynthia Polynice, Maria Juana Romero, Claudette Tiru, Johanna Wenderoth and Tracey Whyte were each honored after successfully completing their two-semester, competency-based Certification of Professional Achievement program.

Steven Posnack, executive director of the Office of Technology, enhanced the celebration with his keynote “There and Back Again: Perspectives on Health IT, Interoperability, and Policymaking,” and he joined the graduates later for a photo on the roof of NewYork-Presbyterian Hospital.

“May 10th was a great day,” said Virginia Lorenzi, Director of the Columbia HIT Certification Program. “I am so proud of our Health IT graduates, loved seeing program alumni, and am very thankful to the vendors who exhibited at the career fair.”