Informatics Student Innovator with IWK Health Centre

Abstract

This summer I have worked with IWK Health Centre and their Informatics Department in a novel position titled ‘Student Innovator in Health Informatics’, seeking to bring a health informatics based solution of my design to reality. The position is the result of Dr Brett Taylor, a graduate of the Master of Health Informatics at Dalhousie, and hospital administrators, recognizing the growing importance of bringing technology to healthcare, hope to foster innovation and provide support to health informatics students with a vision. I was fortunate enough to be the first student in this position. This position is unique in that, while there is ample clinical and technical support, the majority of the work is selfdirected. I designed, planned, adapted, and taught myself that which was necessary for the project. With the help and feedback of my advisors, supervisor and clinical consultants, the project nears completion. The goal is to create a system that would enable diabetic patients to record, display, analyze and understand data from their lives, including blood sugar, insulin doses, carbohydrate consumption and exercise sessions. As well, to prepare this data for transfer to their care team in a clinically meaningful way. At present, this data is addressed with their care team, but it is often presented incomplete or recorded with pen and paper. The project is ongoing and will continue after the internship comes to a close, but together we have built a near complete application for iOS mobile devices that accomplishes most of these goals. Design decisions were deeply informed by clinical observation in hospital with Dr Arati Mokashi and the diabetes team at the Pediatric Endocrinology Department at IWK. Many aspects of health informatics are involved in bringing an information technology solution like this to a health care problem. Fitting seamlessly into existing clinical workflow, technical system design choices, statistical analysis, and creating a clinically meaningful tool that can also operate as a patient teaching tool are all aspects that I addressed in the design and implementation of this project. This report will detail many facets of these informatics associated topics, and will seek to justify the continuation of this substantial position for future students. Discussed herein are two specific informatics topics that were among the more complex addressed this summer. The first is a visual data representation of blood glucose, carbohydrate consumption and insulin action relative to time of day. This is a chart adapted from observations of patientcaregiver discussions about their blood sugar readings at home. The second is a novel algorithm for calculating a specific measure of glycemic variability, the mean amplitude of glycemic excursions. This is a well studied and validated measure of blood glucose swings that has been noted to be difficult to compute. (Marics et al., 2015) Both these challenges were solved using personal research, support from my advisors, knowledge taken from my course work and experimentation. The chart will visually support and improve the conversation between caregiver and patient about blood sugar at specific times of days. The algorithm demonstrates taking a clinical concept and translating it to computer understandable code. The project as a whole has been challenging as well as deeply rewarding. Entrusting a student that seeks to bring informatics solutions to healthcare, and having project success be contingent on their ability is extremely motivating. The volume of information and technical skills

I have acquired to see this project through are ample evidence of how important a position like this can be. Certainly, this experience should contribute greatly to future opportunities in the health informatics field. I also have a great deal of gratitude to the institution for giving me this opportunity and intend to contribute to the continuation of the Student Innovator position as well as the Informatics Department at IWK in the future in any way I can. Beyond what I personally have taken from this position, we also have a patientcentered data recording and analysis tool prototype that compares very favorably to existing products. I feel it will improve the experience of recording blood sugar for patients and of dissecting the data for physicians The unique elements of this position allowed me to see informatics from a both a top down and bottom up perspective. Mapping clinical context to technical choices and then implementing those technical choices allowed me to apply everything I have learned in health informatics to a real world project. The position required confidence, humility, curiosity and implicit motivation to accomplish what I set out to. I sincerely hope that future students have this opportunity and that my advisors and the institution see the value that this position has had for me. Health informatics is a field that is evolving quickly. That evolution and the extent to which we can transform healthcare with technology will depend on the sort of support to bring an idea from concept to reality that I have had this summer.