Researchers at Washington University School of Medicine in St. Louis are exploring different ways technology can improve patient safety. One of those researchers, Joanna Abraham, PhD, associate professor of anesthesiology at the School of Medicine, centers her scientific research around informatics and workflow. More specifically, her research sits at the intersection between medical informatics and social computing. Her research has uncovered barriers to communication in clinical settings with the goal of designing health information technologies and tools to address these communication failures and their root contributors. “Over the last 10 years, I have been applying and leveraging my background in computer science and information systems, along with my postdoctoral training in human factors and cognitive science, to healthcare problems,” she says.
“She’s really a leader in this space,” says Philip Payne, PhD, chief data scientist at the School of Medicine and director of the Institute for Informatics (I2). “She’s not just designing solutions in the laboratory. She’s implementing them and evaluating them in the complex, real-world environment where we deliver care to our patients.”
One problem that Abraham is investigating involves the flow of information when healthcare providers transfer care of patients, including during shift changes, when patients are transferred between clinical settings, and when patients are discharged.
“That’s an area that is not well-understood or well-studied, but it is where errors and omissions occur most frequently,” Payne says. “If we want to improve quality and safety of care, we need to start with making sure that the information continuum is solid across the entire care experience.”
Reducing Readmissions for People with COPD
Working through the COVID-19 pandemic has allowed Abraham to explore how healthcare providers communicate in both virtual and in-person environments. For instance, Abraham is one of the principal investigators on a five-year, multisite project that is examining how people with chronic obstructive pulmonary disease (COPD) can manage their health at home after being released from the hospital.
The project, which will receive $2 million in funding over five years from the Agency for Healthcare Research and Quality (AHRQ), focuses on helping people with COPD manage their medication and treatment at home. COPD patients often need to be hospitalized when their condition flares up, and they are typically sent home with an inhaler and other medications. “We found that once they go back home, it’s hard for them to adhere to what was given to them. Sometimes they just don’t understand how to use their inhalers,” Abraham says. “Then they get very sick and are frequently readmitted for acute exacerbations. Our goal is to reduce readmissions using innovative, sustainable, and scalable telehealth interventions for in-home virtual follow-up visits.”
This project builds on Medicare’s existing Hospital Readmission Reduction Program (HRRP). Its goal is to help reduce COPD readmissions by integrating a virtual pharmacist visit for in-home inhaler training and medication reconciliation. The project, which launched pre-pandemic, aims to foster communication and care coordination via telehealth visits between pharmacists and older COPD patients. “We want to ascertain patients’ journeys from hospital to home, specifically the barriers to care transitions and the contributors to avoidable readmissions. Informed by these insights, we plan to design, implement, and evaluate telehealth education intervention to support care transitions for COPD patients,” Abraham says.
As the project moves forward, researchers will evaluate different implementation factors and strategies that could impact successful adoption and sustainability. For example, they’ll look at how long each virtual session lasts, how many sessions are needed to complete the education, and whether pharmacists or other health professionals should be the ones who are counseling patients.
Ultimately, the project could roll out to other institutions due to its virtual format that makes it easier to scale, compared to projects that require in-home visits.
A Recognized Leader in the Field
Abraham’s work is gaining recognition. She was selected as a Fellow of the American Medical Informatics Association (AMIA) for the class of 2022, an honor that recognizes experts who are using informatics to improve healthcare. “The fellowship recognizes people who have made significant contributions in research and applications to advance the field,” Abraham says. She also won the AMIA’s New Investigator Award in 2019.
In addition, Abraham won the AMIA’s Diana Forsythe Award twice, first in 2010 and again in 2021. This award honors peer-reviewed papers or articles that focus on the intersection of informatics and social sciences, an area where Diana Forsythe was a pioneer. “The idea is that technology is not neutral. It’s who uses the technology — understanding user behaviors and their interactions with technology — that’s the most important element in designing usable and user-friendly technology,” Abraham says.
Her award-winning 2021 paper, “Moving Patients from Emergency Department to Medical Intensive Care Unit: Tracing Barriers and Root Contributors,” which was published in the International Journal of Medical Informatics, highlighted the patient transfer process interdependencies that underlie care transitions from the emergency room (ER) to the intensive care unit (ICU). “It’s not just understanding the patient transfer process, but understanding patient transfer within the context of what’s going on right now,” she says. For example, how is the process different when the ER is not busy, compared to when it is busy? “The goal of this kind of research is not about quantifying everything. It’s about examining the nuances in the process and understanding them within the context so we can design workflow tools that can address those nuances within the context.”