Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors.

BACKGROUND: In 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures. OBJECTIVES: The aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses. METHODS: We created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021. RESULTS: We invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities. CONCLUSION: CI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.

A Career Life-Cycle Perspective on Women's Health and Safety: Insights From the Defense Health Board Report on Military Women's Health.

OBJECTIVE: Women's health has demanded more attention from employers as women integrated into the workforce. Traditionally male-dominant fields and occupations require special attention to workplace design, physical standards for entry, employment practices, equipment, and health monitoring. This editorial summarizes the Defense Health Board's (DHB) review of Active Duty Women's Health and its recommendations grounded in a woman's career life-cycle. METHODS: The DHB reviewed the Department of Defense and foreign militaries' current women's health services, relevant policies and practices, peer-reviewed scientific literature, and subject matter expert interviews. RESULTS: The DHB's recommendations centered on a comprehensive approach to education, health care access and treatment, professional workforce development, workplace standards and equipment, and accountable outcomes metrics to guide improvement. CONCLUSIONS: Employers can learn how to reduce morbidity, leading to a healthier and more productive female workforce.

EMR quantity autopopulation removal on hospital discharge prescribing patterns: Implications for opioid stewardship.

WHAT IS KNOWN AND OBJECTIVE: Prescription drug stewardship is critical. Autopopulation(AP) of medication quantities may influence prescriber behaviour. We investigate the impact of AP removal(APR) on opioid prescribing. METHODS: Inpatient and emergency department(ED) discharges with opioid pain medications 2 years before and after APR were identified. Milligrams of morphine equivalents(MMEs) prescribed were recorded. Group comparisons were performed using Mann-Whitney U tests. Spearman's rho was used to analyse correlations between pain level and quantity of prescribed opioids. Mann-Kendall tests assessed trends in prescription patterns. Generalized estimating equations assessed trends in total quantity of prescribed MME. RESULTS AND DISCUSSION: A total of 53 608 patient encounters were included for analysis. In surgical patients, there were no trends in the frequency of prescriptions below, at or above the AP quantity pre-APR. Post-APR, there was a decrease in the percentage of prescriptions written for the AP quantity(τ = -.493, P = .001) and an increase in prescriptions for <30 tablets(τ = .468,P = .001). In non-operative patients, the pre-APR period was associated with a lower percentage of prescriptions >30 tablets and a greater percentage of prescriptions for <30 tablets. Interestingly, APR reversed this trend in prescriptions for >30 tablets and resulted in an increase in larger prescriptions. Multivariate analysis of the total prescribed quantity of MME found no significant trend across months for inpatients prior to and after APR (0.997, P = .065 and 1.003, P = .142; respectively). The ED model found a monthly downward trend in amount of prescribed MME prior to and after APR (0.986, P < .001 and 0.990, P < .001; respectively). In the inpatient setting, pain was positively correlated to discharge MME (ρ = .028, P < .001); with those reporting the highest pain receiving the greatest amount of opioids both pre- and post-APR. Interestingly, in the ED, this finding was negatively correlated (ρ = -.086, P < .001); with those reporting the lowest pain receiving the greatest amount of opioids both pre- and post-APR. WHAT IS NEW AND CONCLUSIONS: AP removal may have unintended consequences, such as increased prescriptions for greater quantities. To drive down prescription amounts, lower anchor values may be of more utility than APR. The poor correlation of pain values with prescribed medications warrants further investigation.

Utility of area curve ratio electrocochleography in early Meniere disease.

BACKGROUND: Electrocochleography (ECochG) is useful in supporting the diagnosis of Meniere disease (MD). Possible MD (early disease as defined by the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium) is a readily treatable form of MD. OBJECTIVES: To identify whether ECochG summating potential/action potential (SP/AP) area curve measures are more sensitive than conventional SP/AP amplitude ratios in detecting possible MD. PATIENTS AND METHODS: A retrospective chart review of a 3-year period (1997-2000) was conducted. All charts of patients diagnosed as having MD who had undergone tympanic ECochG were examined to identify those with possible MD. Exclusion criteria were incomplete workup, ECochG performed using a prior system, cochlear microphonic spike obscuring ratio measurements, and prior otologic surgery. A control group of patients with normal SP/AP ratios and ECochG data were identified. SP/AP amplitude and area curve ratios for both groups were measured. RESULTS: Of 138 patients with MD reviewed, 20 (14%) had possible MD, and 8 passed exclusion criteria. An audiologist blinded to patients' diagnoses performed all measurements. The upper limit of normal for SP/AP amplitude and area curve ratios from the control group of ears (n = 13) (alpha =.05) were similar to previously published results. Of the 8 patients with possible MD, 4 had an abnormal SP/AP amplitude ratio, and 7 had an abnormal SP/AP area curve ratio; the difference between groups was statistically significant (P =.03, chi2). CONCLUSIONS: The SP/AP area curve ratio significantly improves ECochG diagnostic sensitivity in possible MD. This ECochG refinement will allow earlier intervention to preserve inner ear function in MD.