then and now - Blue & White Online

Emily’s journeyBefore leaving for Chapel Hill, Pfaff considered the ideaof entering the medical field, but quickly realized she wasn’tcut out for healing the sick.“I got a job with the psychiatric department doing databasedesign with them and I realized that I never wanted tobe a doctor because I’m squeamish,” she says.It was then, in 2009, that Pfaff chose to enroll in themaster’s program in information science at UNC-CH.Halfway through her master’s program, Pfaff again decidedto change directions, though not as drastically as she hadbefore. Pfaff turned to health informatics after finding outabout the Carolina Health Informatics Program, or CHIP,which was just getting started.Simply put, health informatics is the applied use of informationtechnology for serving and improving health care,says Dr. Javed Mostafa, a professor in the School of Informationand Library Science and director of CHIP. Students inhealth informatics study a mixture of information science,computer science and health science to optimize the acquisition,storage, retrieval and use of information in health andbiomedicine.Health informatics has emerged out of the need to becomemore efficient in collecting data in hospitals.CHIP was born as a reaction to the growing use of healthinformatics in hospitals, a technology that UNC Hospitalsnow uses throughout the system. The program is part of ajoint effort between UNC-CH and Duke University.With it, Mostafa says, medical researchers can trackgroups and populations of people, which is becomingespecially valuable with the ever-changing demographicsin America. The increasing number of aging baby boomersis a specific cause for concern, as doctors expect substantialincreases in the number of cases using outdated, paper-basedsystems of filing data.Professionals have noticed this problem and are lookingto develop programs and systems of filing and retrieving datato handle the upcoming influx of cases.Government officials have also recognized the need for anexpansion of this field, and have put their checkbooks behindimproving the nation’s health care system.“Going back to the Bush era, there was a real recognitionthat this area requires federal support,” Mostafa says. “In theearly Obama era, there was a very significant investment.”That was an investment worth $44 billion, set aside specificallyfor health information technology, says Rich Medlin,a graduate of the certificate program and employee in theDepartment of Emergency Medicine at UNC Hospitals.Along with Duke, UNC-CH applied for a federal grantand received $3 million to start the graduate certificateprogram in August 2010, Medlin says.After becoming the first CHIP graduate in August,Pfaff is now a product of this influx of funding, working forNorth Carolina Translational and Clinical Sciences Institute(NC TraCS) with the Carolina Data Warehouse for Health(CDW-H) as a research analyst. And she doesn’t regretchanging to such a growing and in-demand field.“I probably would be unemployed right now if I hadn’tdone the program,” she says.CHIP TechnologyUNC Hospitals has found use for health informatics bycompletely removing paper from their records system, andinstead plugging records into computers.“Hospital information systems were initially designed forlogistics, billing, appointments. Records were still on paperlong after, so hospitals sort of realized it would be great tolook at these records in more than one place,” Mostafa says.Bringing all of the patient records out of UNC Hospitalsand into one place is what CDW-H strives to do.CDW-H has over two million hospital records in itssystem so far, dating from 2004 to the present, with newupdates occurring every 24 to 48 hours.“The ability now for different medical institutions toshare their data is going to allow large scale studies of conditionsand treatments to really make huge changes at a muchgreater pace,” Pfaff says.The warehouse was created in early 2009, in collaborationwith International Business Machines (IBM).CDW-H serves as a research portal to allow UNC-CHresearchers to search and identify cohorts with relevant criteria,so that they may study groups of people with the samediseases and understand them more comprehensively.When a researcher has a data request for the warehouse,it’s Pfaff’s job to query the data warehouse and come up witha list of results.“They come to me with requests for data like, ‘I need alist of all patients who have this disease and they need to bethis race,’” she says.Over 100 data requests have been processed in the warehouse’stwo-and-a-half years in operation, Pfaff says.This resource is crucial for researchers looking for answerson how to improve patient care—the main goal of healthinformatics as a comprehensive operating system.“Clinics can share records to learn more about commondiseases,” Mostafa says. “New data about some diseases cancome through the system and provide new insight for thepatient.”Problems with TechnologyAs with any form of technology, health informatics is notwithout its share of problems.Medlin, who was the first physician to enroll in thecertificate program, says some aspects of new data storagetechnology are impractical.He says he enrolled in the program because he wanted tobe able to better understand the health information systemshe was using at work, but the new technology has turned outto be a source of frustration at times.“A lot of places just bolted on these electronic doctorsystems and the last thing that they considered was their usabilityby clinicians,” Medlin says.The technology is in its infancy, and thus Medlin saysthere are a lot of roadblocks in the system that have yet tobe fixed and expedited. In his hospital work, spanning morethan a decade, Medlin says he’s often found himself inputtingirrelevant information into the system.“It’s just so incredibly complicated,” he says. “So basicallymy frustration with that and the products on the market waswhy I applied to the program—so I could work on the userinterfaces.”There is also a lot of red tape around the process of accessinginformation in the data warehouses. The process for gettingpatient information follows rigid guidelines. Researchershave to go through the Internal Review Board before theycontact patients and can’t start their projects without IRBapproval.Sometimes approval only takes weeks. Other times, Pfaffsays, the convoluted, bureaucratic approval system can stallresearch projects for years.But what’s more of an issue is that some researchers don’teven get to file a request for data. The technology is new andexpensive, making it difficult for small practitioners to affordthe software that comprises a health informatics system.What’s NextWith UNC Hospitals’ millions of dollars in grant money,access to data warehouses is a nonissue. And with billionsof dollars being invested in health informatics, expansion isMostafa’s first priority.Next up for CHIP is expanding to include a public healthinformatics graduate certificate. Mostafa says it will focuson how one may detect bioterrorism in a community usinginformation technology, such as preventing major disastersbefore they happen, like food poisoning.Mostafa says he hopes CHIP can be a part of solvingthese real-world problems—and live up to UNC-CH’srenown as a leader in the health field.“Essentially, we want to create an effort which is worthyof UNC-CH’s status and reputation,” he says. “It’s the best ofboth worlds—you have a big heart and want to help people,but you’re also somewhat nerdy.”&photo by Pablo Viojo“You have a big heart and want to help people, butyou’re also somewhat nerdy.” -Dr. Javed Mostafa14 September 2011 www.blueandwhitemag.com 15