I’m interested in speeding up knowledge translation –from bench to bedside in less than 17 years. This requires an understanding of how new knowledge travels and can travel from where it is discovered to where it is used for the benefit of patients. I’m particularly interested in the design of clinical IT architectures that can help us achieve the goal of knowledge transfer.
I’m a practicing clinical IT architect. I design IT architectures for researchers. This is where I am able to practice my craft and test out my hypotheses in the real world.
I have been involved in many health related primary care IT projects over the last 20 years. My work on physician willingness to pay for electronic medical records (EMR) with McMaster University in the late 1990’s led to the EMR subsidy model that was used across Canada to encourage EMR uptake. Today, Canada has over 80% of physicians using an EMR.
I have been involved in 2 large randomized controlled trials (RCTs) on clinical decision support (CDS) in primary care. We integrated CDS into EMR in early adopter sites in Ontario. The CDS had good impact on processes of care, but not on outcomes of care. Initially, we thought that was because our implementation of CDS was poor. Subsequent studies by others demonstrated the same thing. Our (re)-interpretation of those findings is that physicians are probably doing a good job, but that patients need a lot more help in implementing the recommendations given to them by their physicians than they’re currently getting.
I have also been involved in developing interoperability standards for Canada. I was the physician subject matter expert on Canada Health Infoway’s e-prescribing standards and interoperable electronic health record standard and on their Blueprint 2015 project.
I also architected Canada’s Primary Care Chronic Disease Surveillance System (www.cpcssn.ca). The system has grown since its inception. As of mid-2015, CPCSSN is extracting surveillance and research data from 12 different EMRs from across Canada from the offices of over 1000 physicians. There is clinical data on over 1,000,000 patients in the CPCSSN research database. CPCSSN’s policies and governance are to make the data readily available to researchers across Canada.