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October 2017 Edition
In this Issue: Collaborating to Improve Colonoscopy Prep  |  HILS Summer Projects  |  CSC Simulating Into the Future  |  DLHS Profile: Cheryl Moyer  |  DLHS Profile: Colin Gross & Nathaniel Gotten  |  Shorts & New MHPE Video

Opening Remarks: Charles Friedman, PhD, LHS Department Chair

I hope you enjoy this Fall issue of our department's newsletter, The Loop. Published three times per year, it highlights the projects and people that make Learning Health Sciences a vibrant and stimulating academic home to a very talented group of people that I have the privilege of leading. In this issue we are proud to tell you about our ongoing collaboration with the Division of Gastroenterology to establish a learning community to improve patient care. Also featured are the summer projects of two graduate students in our Health Infrastructures and Learning Systems (HILS) program. We are thrilled that the Clinical Simulation Center, soon to double its size in newly renovated space, will be the focus of the President's and Regent's Tailgate prior to the Ohio State game in November. Accordingly, this issue features an update on the Center's activities. Further on, we spotlight the global health research of Professor Cheryl Moyer and introduce two relatively new members of our staff--Colin Gross and Nate Gittlen--who are making enormous contributions to the work of our Division of Learning and Knowledge Systems.
If your perusal of these articles generates any questions or ideas for future collaborations, I would love to hear from you.
Collaborating to Improve Colonoscopy Prep

No one really wants to talk about their bowel preparation for a colonoscopy, maybe that’s why 10% to 12% of the 14,563 Michigan Medicine patients who showed up for this common procedure in 2016 had not performed the sufficient prep required for their test.
Since August of that year, a team from the Department of Learning Health Sciences (DLHS) and a group of committed health care professionals from Gastroenterology (GI), initiated by Dr. Jacob Kurlander and Dr. Sameer Saini, have been conferencing monthly to apply the DLHS Learning Cycle approach to the problem of inadequate bowel preparation – they call themselves the Gastroenterology Learning Community or GI-LC. 
The 35-member GI-LC quickly designed and implemented a Patient Communication Package with three interventions:
  • First, they revamped the patient instructions, reducing the number of pages and increasing clarity, resulting in 8 versions which GI staff can match to each patient’s specific medical situation.
  • Second, they tailored generic notifications to highlight essential preparations for the patient’s upcoming procedure. 
  • Lastly, automated reminder calls now specify, within the confines of HIPPA, that the patient’s colonoscopy requires an important preparation regime. 
Members of the GI-LC also reached out across the institution to enlist the help of Compliance, MiCHART and other Michigan Medicine groups. Patient Educator in the GI Medical Procedures Unit, Jenn Bijarro, describes an all-hands-on-deck scenario to ensure a successful implementation, “The collaboration between nurses, myself, and the GI-LC in getting the prep instructions revised has been crucial.”
The new interventions are being used at four sites: the Michigan Medicine Medical Procedures Unit, East Ann Arbor, Livonia and Northville. Program Manager Lisa Ferguson, MSI points out this kind of collaboration with a clinical department on a specific problem of interest is a valuable opportunity to execute DLHS’s mission of creating continuous learning opportunities to improve health. Next, the group hopes to work on other problems of interest such as reducing cancelations and no-shows as well as contributing to a system-wide improvement for anti-coagulant patients to prepare for procedures.
Anecdotal reports from GI patients indicate the new measures are working. The GI-LC’s core workgroup run by DLHS’s Emily Dibble completed a patient survey to measure the impact on colonoscopy prep. Based on that feedback the group will continue to tweak the interventions, always working toward a goal of increasing the number of patients who arrive perfectly prepped for their Michigan Medicine colonoscopy.
Article subjects Mike Roth (second row/4th from left) and Nik Koscielniak (second row/right end) pictured with the current HILS cohort as well as the program's director, Anne Sales, associate director Gretchen Piatt, and professor Jodyn Platt.

HILS Students Get to Work with Summer Implementation Projects

Students pursing a graduate degree in the new Health Infrastructures and Learning Sciences (HILS) program are taking advantage of the opportunity to blaze their own trail in the field of advancing health care.
Start-up veterans, health care professionals and pure academics make up the current HILS crop who have just completed their Summer Implementation Projects. An experiential learning requirement for all students after their first year of study, the projects are highly customized to incorporate implementation science principles, and the seven learning health system core competencies, with the students’ own specialized interests.
Nik Koscielniak, MS, MPH has his sights set on a HILS PhD as the culmination of his past work in public health and occupational therapy. His project revolves around a survey of some diabetes patients currently in faculty member Gretchen Piatt’s PRAISE 2 study on diabetes self-management and education. After conducting the survey, his next step was to identify health barriers based on each patient’s responses and then design a specific diet intervention for each participant. Koscielniak, a member of the U-M IT Council and a graduate representative in the Rackham Student Government, is excited about how the HILS curriculum allows the incorporation of other offerings across the university. “There’s a lot of independence and flexibility in the program for interdisciplinary learning, the program allows you to create your own track.”
Masters student Michael Roth, MSc knows something about creating his own track. He came to HILS with a diverse background in technology, health care and supply chain consulting and will be one of the program’s first graduate when he completes his masters this December. Quality improvement is the focus of Roth’s project, which is extending beyond the summer. He is working with the Michigan Bariatric Surgical Collaborative to attempt to reduce the number of emergency room visits by patients after their laparoscopic surgery.  An entrepreneur at heart, Roth is launching a health care consulting firm, with fellow HILS student Jeffrey Vlasic, MD, MS, to marry the lessons of HILS with his business experience. “I’ve done implementations for 20 years,” explains Roth. “In the HILS program I can understand the science behind the decision-making and sustainable health care implementation.”
With the arrival of the fall semester, program director Anne Sales, PhD, RN stresses the importance of the Implementation Science in Health 2 class where students will debrief projects with their peers. Sales describes how students will then take those projects to the next level, “They will also work on academic products based on their project, like posters and papers. Or for the more business-minded, maybe set up a business case example.”
A program on the move, HILS is now actively recruiting for fall of 2018.  Those interested in a doctorate must apply by December 1, 2017.  Potential master students should submit an application by May 31, 2018.  HOW TO APPLY

CSC Simulating into the Future

21st century medical training is increasingly about leveraging technology, and the U-M Clinical Simulation Center (CSC) continues to rise to the occasion. 
Over in the Medical Science Building II, walls are already going up in a second CSC location creating a new 7,500 square foot state-of-the-art learning and teaching facility. When the CSC -Med Sci II opens in early 2018 it will drastically increase the available curricula, expanding learning opportunities for all Michigan Medicine nurses, staff, residents, fellows, faculty and medical students.
In the meantime, CSC staff continue to innovate for improved training and patient safety. Using 3D printers, the CSC collaborates with research and teaching faculty to design more realistic models in order to replicate specific anatomical conditions that can then be used to train medical students. An even bigger leap into the future is coming as the CSC team explores adding immersive Virtual Reality simulation.
To increase ultrasound opportunities for trauma training, vascular access and other procedures, 10 new streamlined machines were recently added to the CSC stable. A new Obstetrics Ultrasound model with a high fidelity fetal anatomy, made possible by generous donations from U-M alumni and friends, has also recently arrived for use in the iSim, 24/7 independent simulation space, at CSC - Towsley G2314.
Always reaching out to the U-M medical community, the CSC has awarded four Clinical Simulation Research Grants in 2017-18 to projects that advance simulation-based research. Alumni and hospital group visits are also on the horizon. These hands-on experiences are available upon request and not only highlight current CSC offerings but also provide a vehicle for participants to brainstorm potential uses for this unique facility that go beyond training. 
The CSC is excited to be featured at the U-M President’s and Regent’s Tailgate before the Ohio State football game. Those wishing to help the CSC stay on the leading edge of medical education and patient safety can explore the giving page on our website or target your Giving Blueday contribution on November 28, 2017 to the CSC.


DLHS Profile: Cheryl Moyer Works to Reduce “Near-Misses” in Ghana

Two or three times a year Cheryl Moyer packs her bags, turns off her cell phone and boards a plane for Ghana. Once on the ground she works with communities, regional health directors and decision-makers in the capitol to identify the clinical, social and cultural reasons for maternal and infant mortality there and then design specific interventions.
Using social autopsy, Geographic Information Systems (GIS) technology and good old-fashioned community engagement, Moyer’s team from U-M, as well as locals in Ghana, form a micro learning health system. Says Moyer, The point is to get information to people in a way they can understand it and act upon it.” In the case of near-miss incidents where mother or baby nearly die, the team works with local chiefs or assembly people to pass on data, funding, or supply something as simple as maps showing near-miss proximity to health centers.
Back in Ann Arbor, the University of North Carolina at Chapel Hill and U-M grad teaches spinning classes so she and husband, Otolaryngologist Jeffrey S. Moyer, MD, can keep up with a middle schooler and high schooler (both travel soccer players) as well as a yellow Labrador and a Rhodesian Ridgeback.
A founding member and former managing director of U-M Global REACH, Moyer looks forward to continuing her 10-year history with Ghana citing a strong affinity for the sub-Saharan African nation. “Something about my personality appreciates the laughter, the laid back culture, the warmth and connectedness of the people.”
Cheryl A. Moyer, MPH, PhD is Assistant Professor of Learning Health Sciences and Assistant Professor of Obstetrics and Gynecology. She is co-investigator on a new Interprofessional Exchange (IP-X) Research Stimulus Grant: Michigan Interprofessional Consortium for Health-Global Action Network (MICH-GAN).

DLHS Profile: Colin Gross & Nathaniel Gittlen on the KGrid case

The Knowledge Grid (KGrid), DLHS’ innovative open software that makes medical knowledge computable, has added two new staff members to push the project forward: Software Developer Nathaniel (Nate) Gittlen and Colin Gross, Applications Programmer/Analyst.
Gittlen came to software development when he made the switch to computer science from economics at The College of Wooster, a liberal arts college in Ohio. After stints at local start-up Health Media Inc., a tailored health interventions company, and DTE, working on their automated response system, the Ann Arbor native was happy to find a position that allows him to remain close to family. 
At Michigan State University, Gross studied Microbiology & Molecular Genetics which led him to a job at the National Cancer Institute in Washington DC. There he interacted directly with patients, working on sequencing tumor and normal human genome. The move to U-M was both personal and professional.  Firstly, his soon-to-be wife lived in Michigan and he was also excited to work with Zach Landis-Lewis, PhD, MLIS.  Landis-Lewis’ lab is trying to solve the problem of giving doctors the most accurate informational tools to then deliver the best care. Gross describes the challenge this way, “How do you show medical professionals a picture (representations of data) and make sure they walk away with the right conclusion?”
Gittlen appreciates that his work on the KGrid can have big impact in how quickly medical knowledge reaches those who are giving the care, noting that beyond current standards for health publishing, “there’s a better way of sharing this information.” Gross elaborates that the KGrid provides a new framework, adding “methods, data and results should be separable and reusable” to maximize the accurate dissemination of medical knowledge.
Gross, an avid runner, also wields a paintbrush in his free time. This summer Gittlen took a break from the indoor recreation of board and video games to trek across Canada, camping in nine of our northern neighbor’s national parks.

 DLHS Shorts & New MHPE Video

  • November 15: The second annual Ethical, Legal and Social Implications of Learning Health Systems (ELSI) symposium is coming to U-M Palmer Commons. The symposium will lay out the ELSI of data sharing and translation in learning health systems that strive to be both FAIR (findable, accessible, interoperable, and reusable) and fair. The day will also include an interactive workshop to address critical issues on data and knowledge sharing. Speakers include:  Peter Embi, Kenneth Goodman, Warren Kibbe, Debra Mathews, Elizabeth Pike, John Wilbanks, and Joon-Ho Yu.  Register Today!
  • Recently: Charles P. Friedman, PhD, chair of U-M Department of Learning Health Sciences, was elected by The International Medical Informatics Association (IMIA) to become part of the inaugural class of the International Academy of Health Sciences Informatics (IAHSI).
  • Now Online: It’s all about Patient Empowerment and The Learning Health System in the latest edition of the Learning Health Systems Online Journal, Vol.3. Check it out.
Hear first-hand about the virtues of the competency-based Master of Health Professions Education (MHPE) program from its recent graduates.

About Us

The Department of Learning Health Sciences is a basic science department focused on the sciences that can make learning effective, routine, and scalable, from individuals up to systems that span states and nations.

The Loop is published three times per academic calendar year by the University of Michigan Department of Learning Health Sciences.

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