I was recently reminded by a reader of my blog (thanks Al) that I had not followed up on a comment that I was going to post a second part to a blog that was posted on 7.7.2015 – “Physician Data Scientists – Why and What Type? Part I“. Now that I am in between classes, I have the time to work on this. Looking back at this original post, I am somewhat amazed at all that has happened in the last 1 1/2 years.
I am currently the interim Chief Information Officer (CIO) and Chief Medical Information Officer (CMIO) for our integrated healthcare system. I stepped into the interim CIO role (helped in part by my Northwestern University MSPA Master of Science in Predictive Analytics coursework) after the departure of our previous CIO last year. Prior to that I had been one of our systems CMIO’s – facilitating and communicating the needs for technology to help improve clinical outcomes to IT, while communicating back to Physicians and Leadership the limitations of current technologies. I never really aspired to become either the interim CIO or a CMIO, these opportunities simply arose because of my journey to become better educated about the use of data and analytics to improve clinical outcomes – ie to become a Physician Data Scientist. I will explain how I ended up in my current role.
My interest in data and analytics is a fairly recent phenomenon, occurring because of a chance meeting with someone who has since become one of my closest friends – Curt Lindberg – who has a PhD in Complexity Science, and is the Director of our Complexity in Healthcare Center. I met him during a project to improve our process for getting patients into our healthcare system from outside facilities more efficiently. At that time I was a practicing Emergency Physician and the Medical Director of our MedFlight Air Ambulance service. Curt introduced me to complexity science and my life has not been the same – it was a transformational career moment for me. I ended up being part of a small group of researchers who were trying to develop smarter patient monitoring systems. Their work has inspired me to try and contribute in my own way to this field – called predictive monitoring.
Predictive monitoring is an unofficial term for what this group is trying to accomplish. While the technology inside the monitors has changed drastically since the 1970’s, what the monitors do has not. These monitors display certain physiologic markers of interest – blood pressure, pulse rate, temperature, oxygen level, ekg pattern, etc. You can see what is happening to the patient right at that time, or you can go back and review what happened to them in the past (minimally), but there is no information about predicting what will happen to them in the future (are they predicted to get better, go into sudden cardiac arrest, stop breathing, or develop an overwhelming infection called sepsis, etc). The goal is to incorporate predictive algorithms into these monitoring systems.
I have been fortunate to meet some giants in this field. Dr. J. Randall Moorman from the University of Virginia, who developed the first commercial predictive monitoring system – the HeRO monitor. The largest ever randomized clinical trial in neonatal patients (premature babies) was conducted using this monitor. It showed that the monitor was able to identify certain physiological patterns, and translate those patterns into a risk for developing an overwhelming infection (late onset neonatal sepsis). This risk was detected an average of 18 hours before a clinical diagnosis was made, allowing for earlier treatments and interventions. This translated into a 22% reduction in mortality. Dr. Andrew Seely is a Thoracic Surgeon at the University of Ottawa who has developed a model to predict the success of removing a breathing tube from a patient and not have to replace it because they weren’t ready to have it removed. We got to participate in that clinical trial. We also got to participate in a trial conducted by Ryan Arnold, now at Christiana Care in Newark Delaware, on trying to predict clinical outcomes using heart rate variability analyses.
In addition to collaborating with these researchers working on their projects, I became especially fascinated with a research article written by one of the countries leading trauma surgeons, Dr. Mitchell Cohen and his colleagues at San Francisco General Hospital and the University of California San Francisco – Identification of complex metabolic states in critically injured patients using bioinformatic cluster analysis. I will confess that I felt frustrated when I talked with the researchers about the underlying mathematical concepts and analytical techniques they were using, because I just did not understand them well. This ignorance ignited what I will freely admit is now an obsession to understand these concepts and techniques.
I started off trying to educate myself using text books, taking on-line MOOC’s – Massive Online Open Courses, and enrolling in courses offered on the web. I still felt very frustrated because these courses didn’t really go into the depth that I thought I needed. When I look at the giants in this field of predictive analytics, these few researchers seemed to have both the clinical knowledge and understanding of why this research was so important, and they were also able to understand the mathematical and analytical concepts and techniques necessary to do research in this field. I wanted to be like them.
I became very interested in becoming a data scientist at that point. I eventually enrolled in Northwestern University’s Master of Science in Predictive Analytics (MSPA) program. I have not regretted this decision. I currently am halfway through the program, and am finally into the especially relevant coursework. I just finished the major foundational course – Linear Regression and Multivariate Analysis. The courses up until then had been preparing me to take this course. I realized I had come full circle when I re-read Mitchell Cohen’s article, and realized that I now finally understood the concepts and results. That was an extremely satisfying moment for me.
This has been quite the educational journey for me. I feel like I have a much better understanding of statistics. I am getting somewhat competent in a few programming languages – R, Python, and SAS. I am using Jupyter Notebooks for my programming work. I have dabbled with data science platforms like KNIME, and this quarter will be learning to use virtual machines, IBM Watson Analytics, ANGOSS, and Microsoft Azure machine learning – as part of my next class on Generalized Linear Models.
I finally feel as if I am able to start applying what I have been learning for the last 1 1/2 years – to start developing predictive models to improve clinical outcomes. A few of my goals are to help our organization become more data driven, and to continue to work on developing predictive algorithms that could be incorporated into beside monitoring systems, further improving the outcomes of patients.
This is my journey to date from becoming a practicing Emergency Physician with no interest in data or analytics, to where I am now, halfway finished with my Master’s program. The real journey of applying what I have learned to real world problems has just started but will get more robust as I learn more.