Learning Health Systems Around the World: Travel with Charles Friedman, PhD, Department of Learning Health Sciences (DLHS) Chair
I’m delighted to report that interest in Learning Health Systems (LHSs) is spreading across the globe, both as a concept and a working reality. Our engagement with these efforts is feeding new ideas and increased energy and resources to the work of our department. I’m excited to share a few examples of the Global LHS from my own direct experience.
Switzerland: The Swiss have started the only official government-funded and nationwide LHS initiative. Based at the University of Lucerne it engages 10 partners across the country. I have had the privilege of visiting Lucerne twice to advise on this project, and DLHS’ Anne Sales will be visiting there later this year.
United Kingdom: There are strong nodes of LHS activity across the country. These include an effort within NHS Digital, spearheaded by Thomas Foley, now NHS Digital’s Chief Medical Officer, who conducted a nationwide Learning Healthcare Project. Other efforts include an LHS for asthma that spans Scotland and the Connected Health Cities project in Northern England. In all, our department has established relationships with over ten individuals and groups with LHS-related interests.
Canada: British Columbia has started a province-wide LHS initiative through a 2018 meeting: “ The System Awakens.” A follow-up meeting, held earlier this year in Vancouver, has given clear momentum to this movement and a focus on improving diabetes care in the province. I have had the opportunity to speak at both meetings and see great potential for this effort, which is now attracting interest across Canada.
Taiwan: Spurred by its vast storehouse of clinical data, Taiwan has recognized the potential for a nationwide LHS. Our department has been funded by the National Health Research Institutes of Taiwan to provide technical infrastructure for this work.
China: Our department is developing a collaboration, applying LHS methods to kidney disease, through the Peking University-University of Michigan Joint Institute.
LMICs: We also see great potential for LHSs to improve health in low and middle income countries. We know of potential interest in Malawi, Nepal, India and Cameroon. We plan soon to engage individuals from these countries to see how this potential could transform into reality.
A truly global Learning Health System has been an appealing idea since the LHS concept first surfaced in the U.S. in 2007. In light of the activities noted above, and others undoubtedly in place but unknown to us, we move closer to making this idea into a reality.
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DLHS Offering a Precision Health Graduate Certificate This Fall
Beginning in fall 2019 U-M graduate students will have the opportunity to obtain a Precision Health Graduate Certificate from the Department of Learning Health Sciences (DLHS) and U-M Precision Health.
Precision Health is a growing field with a variety of career paths opening up in academia as well as in the pharmaceutical industry, healthcare policy, informatics and IT.
A minimum of 10 graduate credit hours of coursework will be required from at least two of the following competency domains:
- Ethical, Legal and Social Implications of Precision Health
- Data Science & Predictive Health Analytics
- Biosocial Determinants of Health / Policy / Economics
- Human Genetics In Health & Disease/Molecular Medicine
- Bioinformatics / Computational Genomics
- Implementation Science and Learning Health Systems
Developed by U-M Precision Health's Education and Training Workgroup, the certificate will be administered by DLHS with Gretchen A. Piatt, MPH, PhD, Associate Professor and Associate Chair for Educational Programs in DLHS, serving as chair of the certificate program.
Keep up with the launch of the certificate and look for application dates on our Precision Health Graduate Certificate webpage.
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Lorelei Lingard, PhD, Brings Her Collective Competence Message to HPE Day 2019
The 5th annual HPE day took on a new rhythm this April 2, beginning with a breakfast mix and mingle in the Michigan League Ballroom and continuing with a warm welcome from Caren Stalburg, MD, MA, co-chair of the event. Next up was Carol Bradford, MD, MS, Executive Vice Dean for Academic Affairs, Medical School, who introduced this year’s stellar keynote speaker, Lorelei Lingard, PhD.
Lingard commanded the attention of a packed house of health science professionals, scholars and students during her talk, Are We Training for Collective Incompetence? Common Education Assumptions & Their Unintended Impacts on Healthcare Teamwork.
Known around the world for her 20 years of work studying healthcare team communication and collaboration, she currently serves as Professor in the Department of Medicine and Director of the Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada.
During her talk Lingard, a rhetorician, used patient case studies to illustrate how often competent individuals involved in a patient’s care end up forming an incompetent team. Those observations challenge an established medical training assumption that focusing on individual competency will result in successful teams later on.
She described many obstacles to healthcare team communication including how the same problem will seem unique in the mind of each team member and reminded the audience that healthcare problems do not “stay still in time” as people are working to solve them. Additionally, she highlighted how the word “teamwork” implies members are pulling together in the same direction when often the opposite is occurring.
Her answer for addressing these persistent phenomena in medical training is to move from a machine model, a complicated system defined by placing the value on individual parts working for the whole, to a biological model. A flock of migrating birds, for instance, is a complex system where the relationship between those individual parts is what facilitates a successful effort toward a common goal.
The event continued with a session of nearly 70 posters that presenters created to showcase their research, many attendees praising the connection between the substance of the keynote and their own work. Reza Amini, PhD, MD, MPH, and Laura Power, MD, MPH, presented their poster along with other Interprofessional Leadership Fellows, Diane Asher, BSN, MS, FNP, RN and Carrie Bell, MD, entitled “Inter-Professional Education: Developing Communication Competency Module.”
Amini expressed how “Dr. Lingard’s talk was aligned with so many aspects of our project as we discuss some barriers to effective communication.” Power took away how Lingard’s ideas encouraged her to reassess her teaching approach, “Her presentation challenged my assumption that learners need a certain level of competence in order to participate in interprofessional education.”
For her part, Lingard was impressed by the HPE Day poster session noting a kind of democracy in the common presentation requirement for everyone from students to faculty. “It was nice to see one format regardless of who they are or where they come from.” She has an encouraging message for those working to foster an interprofessional approach in healthcare, “IPE work is rowing upstream, but it’s important to try!”
Capping off the day for the first time were the Awards for IPE Innovation and Excellence celebrating those who are successfully making interprofessional education work:
- Gundy Sweet, Clinical Professor of Pharmacy, PharmD (Faculty Award)
- Stuart Hammond and Sally Salari (Student Award)
- Carol Anne Murdoch-Kinch, DDS, PhD (Award for Distinguished Leadership in IPE)
A co-effort between the DLHS Division of Professional Education, the Michigan Center of Interprofessional Education, the Center for Research on Learning and Teaching, and the Office of Academic Innovation, HPE Day will return next year on April 14, 2020.
“We’ve had such success bringing this community of educators together.” says Stalburg as she reflects on the impact of HPE Day, “I know that the IPE community will continue to improve our patient care and the experiences for our learners to lead in collaborative care.”
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What is LHS for OHCA in Livingston and Washtenaw Counties?
A stranger, a co-worker, a family member collapses and stops breathing – they may be experiencing a cardiac arrest, an electrical malfunction of the heart that disrupts blood flow to the brain and other vital organs. Would you know what to do?
According to the American Heart Association (AHA) over 356,000 Out-Of-Hospital Cardiac Arrests (OHCA) occur each year in the U.S., and of those who experience a sudden cardiac arrest only about 10% will survive – Michigan’s survival rates are even lower. Since October 2018 a new local community of first responders, emergency medicine professionals, survivors of cardiac arrest, members of DLHS and other engaged stakeholders have been coming together with the goal to raise OHCA survival numbers in Livingston and Washtenaw Counties.
This learning community, called the LHS for OHCA, is bringing the action-minded Learning Health System (LHS) principles of continuous learning and implementation to optimize the multi-step system of care for OHCA. During their first meetings members identified key data points that can be used to inform future strategies and recommendations.
- When and where did cardiac arrest occur?
- When was CPR first administered?
- At what point was the AED (automated external defibrillator) used?
One of the group’s local leaders is Robert Domeier, MD, EMS Medical Director of the Washtenaw/Livingston Medical Control Authority. “I think this process has presented good opportunities for collaborative discussions about strategies to improve OHCA survival,” says Domeier. “It also encourages continued dialogue between the various participants in the Chain of Survival for OHCA patients.”
That dialogue has produced some common goals already: Identifying ways to engage bystanders to call 911 and start hands only CPR, increasing cardiac arrest awareness and CPR training in communities, making AEDs more accessible and improving patient “handoffs” from first responders to hospital providers.
What began as conversation between U-M Emergency Medicine Chair, Robert Neumar, MD, PhD, and DLHS Chair, Charles Friedman, PhD, in June 2018 has developed quickly with the help of established organizations such as SaveMiHeart.
Learning community coordinator and DLHS Department Strategist, Emilee Coulter-Thompson, LMSW, RYT, notes that LHS for OHCA hopes to make a big impact on Michigan, “As this two-county pilot gathers momentum and shows results, the goal is to spread and scale its lessons statewide.”
Every minute matters when someone is experiencing a cardiac arrest. To be ready to help, find a AHA CPR course near you. For those interested in becoming part of the LHS for OHCA learning community, get in touch via email at LHS-OHCA-info@umich.edu.
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Project Partners DLHS with Hospital in Addis Ababa
Three DLHSers took their professional skills to Ethiopia recently on a mission to support maternal care at the Center of Excellence in Reproductive Health at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa.
Caren Stalburg, MD, MA, Deborah Rooney, PhD, and Astrid Fishstrom, LMSW, are part of a collaboration between DLHS and the Center for International Reproductive Health Training (CIRHT) that began in the summer of 2018 with three aims: to develop a curriculum/toolkits package; help expand the skill-set of local educators; and later to strengthen measurement and assessment for the education arm of CIRHT.
The groundwork was laid in November 2018 with project manager Fishstrom's first visit along with Stalburg, the project lead. Stalburg conducted workshops and gave a talk around measurement and assessment. The two women used the opportunity to forge relationships and hear first-hand from the SPHMMC faculty and staff what their gaps or needs are around teaching family planning and OB/GYN care.
Simulation-based training was on the agenda for the next visit in late March. This time Fishstrom was accompanied by Rooney, Director of Education and Research in Simulation at the U-M Clinical Simulation Center (U-M CSC).
They worked with their partners at SPHMMC, which has a newly built clinical simulation center, on development training for OB/GYN faculty interested in implementing simulation-based training and assessment programs.
Rooney shared U-M CSC best practices and was able to discuss with the director, Leyouget Abebe, BSC, MSW, MHPE, challenges they had in common such as promoting a new center. Rooney was impressed by the facility, “I found their center to be well-designed, the resources to be thoughtfully selected, and faculty and leadership to be committed to sustained success.”
She collaborated with Abebe on developing a presentation to highlight the center’s resources and Rooney delivered a talk “Creating an Instructional Plan for Sim-based Education” to faculty and staff from OB/GYN, Surgery, Pediatrics and the Health Sciences Education Development Unit.
The project will wrap up in December 2019 and DLHS has already tackled a fair number of its goals. A beta version of the toolkit (a database to search materials like curricula, videos, lesson plans and assessments) has been created, training and information exchanges have taken place and Stalburg will soon conduct two webinars on the flipped classroom and team-based learning. Rooney is also hoping to continue the simulation support with short webinars.
Other DLHS participants contributing to the project include Charles Friedman, PhD, Larry Gruppen, PhD, Kathleen Young and Anne Murphy, MBA, FACHE, while HITS’ Barbara Eckstein and Chris Chapman, as well as Marisa Conte and Chase Masters from Taubman Health Sciences Library, lent a hand with the toolkit.
Meals with their local partners, enjoying a coffee ceremony and cultural visits were an added benefit for the three travelers but they are proudest of difference this work can make for Ethiopian women. As Fishstrom points out, efforts at SPHMMC are already reducing maternal mortality. “It was a delightful opportunity,” said Fishstrom, “working on something that is so meaningful.”
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OUR PEOPLE, THEIR PURSUITS
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Staff Profile: Dawn Harris, Jack of All MHPE Trades
Chances are if you’ve had occasion to engage with the Master of Health Professions Education (MHPE) program, you’ve had the pleasure of speaking with Dawn Harris, Student Affairs Program Manager for the competency-based graduate program.
On any given day Harris has a wide range of responsibilities. She might be recruiting, helping a new student navigate the program, setting up an event, connecting with alums or juggling any number of other tasks that keep the wheels going on the year-round MHPE bus.
A recent, and rare, U-M snow closure that just happened to coincide with the MHPE bi-annual retreat tested Harris’ improvisational skills. She had students in town and nowhere for them to meet.
“I pulled together a half day of two virtual meeting sessions,” recounts Harris who was coordinating well into the previous night to give 15 participants the learning opportunity they expected. This is often par for the course in a program that is competency-based, which means each learner’s course is unique to their professional work. This requires Harris to remain unflappable, “Everything I run into needs some kind of adaptation.”
A native Michigander, Harris took a detour at 14 when her family moved to Decatur, Alabama for her father’s work. She weathered the culture change, choosing to attend the University of Alabama to get her degree in Industrial Management.
The single mother of two grown boys eventually settled back in Michigan and has been at U-M for 18 years in administration, 12 of those in DLHS and its predecessor. Her favorite part of the job is working with the diverse learners that the program attracts and finding solutions to the unique curriculum challenges that accompany competency-based learning.
Next time you sign up for an M-Healthy boot camp or strength training class Harris may be your instructor. She teaches fitness classes twice a week and is also a runner, both of which gets her prepped for her travels. She’s been to Belize, the Caribbean, and will soon head to Japan for her son’s high school graduation trip.
Harris’ sense of adventure extends to her work. In 2018 she trekked to Basel, Switzerland for the inaugural World Summit on Competency-Based Medical Education meeting where she not only completed a first for her, presenting a poster, but also climbed a couple peaks in the Alps.
Dawn M. Harris is Student Affairs Program Manager for the MHPE program
To learn more about the MHPE program contact mhpe@umich.edu
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Faculty Profile: V.G. Vinod Vydiswaran, PhD - Language Processing is a Natural Fit
Long before fake news became a campaign buzz-word, V.G.Vinod Vydiswaran, PhD, Assistant Professor of Learning Health Sciences and Information, was researching his dissertation on “news trustworthiness” at University of Illinois at Urbana-Champaign for his PhD in Computer Science.
When his dissertation work touched on health information on topics such as autism and vaccination, the foundation for his current focus on health informatics and natural language processing (NLP) began to develop. That led him to a fellowship in 2013 at the U-M School of Information where he further delved into health data on an Mcubed 1.0 grant with the School of Public Health and the Medical School.
The human element is at the center of Vydiswaran’s work. “I call myself an applied researcher. I want to build new algorithms, tools, and systems, but also want to see how they can impact users/people.” Once he became faculty, Vydiswaran embraced opportunities to teach two graduate courses, create the popular Applied Text Mining in Python MOOC and to pursue more collaborations via an Mcubed 2.0 grant that examined health disparities using tweets to determine how people in specific geographic locations are, or are not, making healthy food choices. This research resulted in paper entitled Bacon, Bacon, Bacon: Food-Related Tweets and Sentiment in Metro Detroit.
His interdisciplinary approach continues with a newly awarded Mcubed 3.0 grant for TRxANSCRIBE: Automated Transcription of e-Prescription Directions. Teaming with Corey Lester of Pharmacy and Yun Jiang from Nursing, this project addresses how to reduce the wide variation across healthcare in prescription directions for the same medication – thus reducing harm from medication error.
Vydiswaran grew up in the large Indian city of Pune, known for its cultural sites and educational institutions, yet his family were also frequent travelers which exposed him to other languages and ways of life. He got his BE in Computer Engineering close to home at the University of Pune and then ventured a couple hours north to Mumbai where he earned his Master of Technology from the Indian Institute of Technology Bombay. He went on to work at the Yahoo! Research Labs in Bangalore on large-scale information extraction from the Web.
His initiation to the U.S. was as a graduate student at Illinois before finding his academic home in Ann Arbor. “I love interacting with students…to combine research and teaching.” Says Vydiswaran, who did just that last year when his class participated in the National NLP Clinical Challenge (n2C2), an international competition for natural language processing of clinical data. The student team not only got real world experience with a new data set, but came in second. Although Vydiswaran is quick to point out that statistically it was a tie for first.
Vegetable gardening is a family past-time for Vydiswaran and his wife, who works at the U-M School of Public Health. They are enjoying raising their 6-year old son in Ann Arbor with its Midwest vibe, smaller city walkability, and access to nature.
V.G. Vinod Vydiswaran, PhD, is Assistant Professor of Learning Health Sciences and Assistant Professor, School of Information
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The March 22 nd Health Infrastructures and Learning Systems (HILS) Seminar played host to some familiar faces, Michael Roth MSA, MS ( left) and Jeffrey Vlasic MD, MS, ( right) managing partners of Vlasic & Roth LLC, a management consulting firm based in Northville, Michigan. The two men each hold the distinction of being the first graduates of the HILS master degree program and came to share their real-world experience employing the principles of Applied Implementation Science in their growing business with current students.
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Noteworthy...
July 18 and 19 participate in the MCBK Annual Meeting - Registration is open now! Those interested in Mobilizing Computable Biomedical Knowledge will convene at the Natcher Conference Center in Bethesda, MD.
Apply by April 19 for the RISE fellowship. Research. Innovation. Scholarship. Education (RISE), a new Michigan Medicine initiative to support individuals who want to develop and implement novel medical education ideas is seeking applicants to become a RISE Innovation Fellow. All Michigan Medicine faculty, staff and learners are eligible apply now through April 19, 2019.
MESP and PASQUAL Deadlines: Apply by May 7 for the Medical Education Scholars Program (MESP). To apply for the Patient Safety & Quality Leadership (PASQUAL) program have your application in by June 1.
Seeking ELSI-LHS Abstracts by May 22: The annual Ethical, Legal and Social Implications of Learning Health Systems symposium on November 6-7, 2019 is accepting abstracts for presentations and work groups. Find out how to submit on the ELSI-LHS website.
HILS Class Online! One of the foundational classes of the Health Infrastructures and Learning Systems (HILS) graduate program is coming to computer near you. LHS 621: Implementation Science in Health 1 will soon be available online for Fall 2019.
DLHS Donates to Food Gatherers. On April 11 a large group of DLHS staff transported food items collected in our offices to the Food Gatherers Warehouse. Once there, they sorted, packed and generally helped out with the organization's work "to alleviate hunger and eliminate its causes in our community." Thanks to everyone who participated in giving, sorting and transporting - especially Kate Kloss for organizing!
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