Clinical Informatics for Surgeons, Episode 1: What Is Clinical Informatics, and Why Should Surgeons Care?

audio1504629331: ~Good morning~

~Good morning. All right. Um, this is gonna be fun. Um, I am- I'm really excited I am too. Um, I am in a hotel room, so I don't know if it looks bizarre or not. No. So ~

Ep1ClinicalInformaticsForSurgeons: ~No...I'm ~

audio1504629331: ~just gonna tell you that up front. Okay. And, ~

Ep1ClinicalInformaticsForSurgeons: ~like ~

audio1504629331: ~nothing is set up the way it should. It's a little dark it feels. Let's see.~

~There's a few shadows, yes. Is that better?~

~Is that any better? A little bit I put a little- Yeah. How's that? How's that? No, it doesn't- You look like you're in a spotlight now. I have no idea. Like, I'm in a room with a desk and there's a light Okay But that's a little better now That, that looks better now. Yeah. Okay. Yeah. Okay~

~And then we're just waiting for Tevin~

~Okay. Thank you for putting so much work into the, uh, script. Oh. It's amazing. I don't know if that's helpful or not. I have no ~

Ep1ClinicalInformaticsForSurgeons: ~idea. No, ~

audio1504629331: ~it is. It is. But the only thing I wanted at the end is I was like, "Well, I wanna say the word learning health systems." 'Cause I'm s- I spend, now I'm spending a lot of time doing that, and I want...~

~If they don't know what informatics is, they'll never know what a learning health system is. Yes, yes. Um, how's your year going? Are you looking forward to going back to clinical? Um, you know, there's pros and cons. Um- Yeah... I'm enjoying all the time getting to see my husband and my dog. Yeah. My dog- Yeah... is gonna be in shell shock when I go back.~

~She- Oh. She's getting, like, two walks a day-... and it's just not gonna happen. I ~

Ep1ClinicalInformaticsForSurgeons: ~Interesting. ~

audio1504629331: ~When I'm trauma chief, it's just not... I don't think it's... Yeah, yeah. Um- Are you guys busy? Oh, yes. Thought of- Yes, yes, yes. Yeah. I bet. Yeah. Very busy. ~

Ep1ClinicalInformaticsForSurgeons: ~Yeah. ~

audio1504629331: ~Um, I'm at... So I'm at Tampa General. Um- Yeah... we're building a, a new tower right now too, 'cause we're just...~

~It, it's, it's crazy how many people want to flock to our hospital on an island. So, it's... And so there's limited space, right? 'Cause it's a manmade island, and there's this just massive hospital on there. It's, it's kinda funny.~

~But yeah, we're adding, I believe, 34 more ORs in the tower, so. Oh my gosh. Uh-huh. Oh, yeah. Wow. It's gonna be crazy. It's funny. Um, I'm in, uh, Minnesota, and I'd always been at places that had, ~

Ep1ClinicalInformaticsForSurgeons: ~like,~

audio1504629331: ~huge,~

~huge hospital systems. And I came there, and it's small. It's really small. Like, but they consider our hospital, like, huge.~

~But, ~

Ep1ClinicalInformaticsForSurgeons: ~like, ~

audio1504629331: ~by normal standards, not at all. Yeah. And they'd be like... And they're like, "Oh my gosh." I'm like, "You guys, you have no idea, like, what a big hospital is." Yes. Like, yeah. Yeah. No idea. They have no idea. Ugh, I've gotten lost in, in my hospital multiple times, but- Oh. Or gotten locked out. That's my favorite, 'cause I love to take the stairs 'cause that's my exercise, you know?~

~So, um, one time I took the stairs, and it led me outside. And before I could turn around and, like, go back in, the door shut. Of course it did. Of course. And then it wasn't a badge door s- and it was locked. And I was like, "Okay, I guess I'm just walking around the hospital then."~

~Oh, goodness. Hi, Colin. Oh, hey. Good morning. Morning. Good morning. All right. Me- Kevin, do you have to run to the OR or anything? I just want to be- Nope... cognizant of your time. ~

Ep1ClinicalInformaticsForSurgeons: ~Nope, nope. Okay. I, I'm good. I was about ~

audio1504629331: ~to say, he's not in scrubs right now. I don't think- Yeah, no, I'm- Okay, ~

Ep1ClinicalInformaticsForSurgeons: ~so we're ~

audio1504629331: ~safe. It, it's 5:00 AM in Washington here, so we're, nothing happening for a little bit.~

~If that's all right. Oh my gosh. I am so sorry. All right. We could have done that around your calendar a little bit. No, no, no, no, no. This is, this honestly, it's, this is a good time for me. 5:00 AM, you don't get bothered by anything? Mm-mm. Okay. So true. All right. Um- I even wore my little jacket since you said we're recording.~

~Yes. So I could- You dressed up for this. Yeah, I like it. I know, I need my merch. I never got a- Yeah... I never got a T-shirt. I'll tell Lisa. I know. I, I should. I'll, I'll, tell ~

Ep1ClinicalInformaticsForSurgeons: ~I'll tell her. ~

audio1504629331: ~I should. Um, and then, uh, Genevieve, how do I pronounce your last name? I wanna make sure I, I do it correctly. Mm-hmm. Yeah. Well, um, it's not correct the way I pronounce it.~

~Uh, so it's, it's Mucs. Mucs. Um, yeah. Okay. The way to think about it is it rhymes with pukes, but my husband would kill me for saying that. Um, so I probably went, like, almost ~

Ep1ClinicalInformaticsForSurgeons: ~10 ~

audio1504629331: ~years being married, um, and I would say Mo, because that's the correct French pronunciation. Mm-hmm. And at some point he's like, "I have the same last name as you," 'cause he t- he, he's also Milton Mucs, and he's ~

Ep1ClinicalInformaticsForSurgeons: ~like, "~

audio1504629331: ~If people are gonna call me Mr.~

~Milton, you're gonna be Mucs." So that's how we say it. Mucs. Okay. So Dr. Milton- It's Kentucky eyes... Mucs. Okay. I like it. Yeah. Kentucky eyes. And then Kevin, your last name is ~

Ep1ClinicalInformaticsForSurgeons: ~Neery? ~

audio1504629331: ~No, actually, so yeah, it's funny, I have the same similar story, but, uh, we say Canary. Uh, yeah. Canary? Canary, yeah. Like a bird. Okay.~

~Yep. Canary. Exactly. All right.~

~All right Mason's like, "I have no idea what I'm gonna do now." ~

Ep1ClinicalInformaticsForSurgeons: ~Kamari ~

audio1504629331: ~and Muks. Okay. If I just- Mm-hmm... have it correct once, I could edit it. Oh, really? Sure. So ~

Ep1ClinicalInformaticsForSurgeons: ~if I ~

audio1504629331: ~mess it up, it's fine. Um, and we're already recording, so, um, if you guys don't have any questions, we can go ahead and start. Um- All right, yeah, let's just do it.~

~Okay, cool. ~

Ep1ClinicalInformaticsForSurgeons: ~Coffee's ~

audio1504629331: ~hitting, so let's go.~

~Oh, am I starting? Yes.~

~All right, let me put my phone on silent real quick. Oh, yeah, that's a great idea. All right. It's 5:00 in the morning, Kevin. You never know. Or ~

Ep1ClinicalInformaticsForSurgeons: ~I ~

audio1504629331: ~know, I know. Maybe, yeah. Um, all right.~

~Okay,~ welcome back to Behind the Knife. I'm Kevin

Ep1ClinicalInformaticsForSurgeons: and

Kevin Kniery: I wanted to start with a confession. Every single day I operate, there's a computer in that room making decisions about my patient, and until Mason dragged me into this, I never really

Ep1ClinicalInformaticsForSurgeons: thought

audio1504629331: about it. That should probably bother me more than it does, so we're kicking off a new miniseries, Clinical Informatics for Surgeons.

And when Mason first

pitched it, my honest reaction was, "Informatics? Isn't that IT?" ~Uh, I,~ I'm gonna be standing in for every surgeon who's never thought about this, and I'll ask the dumb questions on your behalf. Mason, ~uh,~ you built this. Introduce yourself. Thanks, Dr. Kniery. I'm Mason Pearce, general surgery resident and clinical informatics fellow, as well as one of the BTK educational fellows.

And that reaction you just had, that informatics equals the help desk, that's the reason I wanted to record this series, because it isn't the help desk, and the gap between what surgeons think it is and what it actually does is quietly costing us, and I wanna close that gap. All right, so who did you help bring to straighten this

out?

~The best person possible, Dr. Genevieve Melton~

~M- M-~

~M- how do I pronounce it again? Sorry. Mueks. Mueks. Mueks. Mueks, Mueks. Okay. Don't say- you cannot say that. I'm gonna have that as a show note, uh, blooper. Um- All right.~ The best possible person, Dr. Genevieve Melton-Meaux, a practicing colon and rectal surgeon who is also one of the leaders in this entire field.

She's senior associate dean for health informatics and data science at the University of Minnesota, deputy director of the university's AI hub, and the first ever chief health

informatics officer of the American College of Surgeons. She also directs the Center for Learning Health System Sciences, and she chairs the board of AMIA, the main professional society for informatics.

And in 2024, she was elected to the National Academy of Medicine. Dr. Melton-Meaux, thanks for being here. And thanks for having me,

and thank you for doing this. Kevin, to start off, I'm gonna put you at ease, because thinking of informaticians as the people who fix your printer and reboot Epic is completely normal.

Most surgeons feel exactly that way. My goal today is to show you that these systems and the data that they generate are already part of your

operating day, whether you've noticed them or not. And to be clear upfront, I have never wanted to turn surgeons into programmers. But what I do want to do for surgeons is that each of us can understand how information, data, and technology are shaping the care we deliver every day.

Because once you start looking through that lens, you realize that it's bigger than the EHR, it's bigger than the alerts, and even bigger than AI. In fact, there's an entire emerging area and field today called a learning health system, where the care we deliver today continuously generates knowledge

that improves the care we deliver tomorrow.

We're not gonna dive into that today, because that's really its own conversation, but it's where many of these ideas ultimately lead. For now, let's start with the practical question: How do data, information systems, and the technology already, ~um,~ influence the decisions surgeons

make every day, even without us even realizing it?

And before we throw Dr. Kniery into the deep end, I want people to hear why this matters to us as surgeons. ~Dr. Melton ~

Ep1ClinicalInformaticsForSurgeons: ~M- ~

audio1504629331: ~oh my goodness, it's gonna, it's gonna kill me every time. ~Dr. Melton-Meaux, you're a colorectal surgeon who ~ca-~ became one of the architects of this field, the surgeon informatician.

Why? Honestly, it came together naturally for

me. Before I went to medical school, I studied math and computer science, so I've always been drawn to systems data and problem-solving. Ironically, I went to medical school because I wanted a career where I would never sit behind a cubicle. Instead, I wanted to be directly taking care of and serving people.

Early on,

I explored basic science and immunology, but I wanted to do work that felt more directly connected to patient care. Then by chance, during my first clinical rotation in medical school, I met a physician who was trained in informatics. He introduced me to this emerging field, which I had never considered, and ultimately this led me to

spend two years of research during my surgical training in biomedical informatics.

At the time, both my program director and department chair questioned whether this field would even have a future. Ultimately, I realized that as a surgeon, I could perform a technically excellent operation for the patient in front of me,

but so much of what helps or harms each of our patients happens outside the operating room.

It happens in how the information is captured, communicated, and acted upon. It happens in the systems that support the clinical decisions and shape care delivery. Surgery allows me to impact one patient at a time,

which is incredibly meaningful. Informatics gives me a chance to improve the care that affects thousands of patients and clinicians every day.

At its core, it's about making care safer, better, and more reliable. Couldn't agree more, and it's the same pull for me. I got into it because I care about patient safety and

quality, and informatics, like you said, is a rare place in medicine where you get to help a lot of patients at once, plus the residents, the staff, and the surgeons around them.

The whole organization really, not just the person on the table Okay. You guys, ~I,~ I'm starting to become ~a,~ a believer, but, ~um,~ sell it to the skeptics out there. ~Why,~ why does this matter ~to...~ Why do we need to know about this?

Because it's already deciding how you practice. Let's prove it. Dr. Kniery, picture a normal shift.

You admit a chronic limb-threatening ischemia, you open the chart, you click the vascular surgery order set, and in about ~s-~ 10 seconds you've ordered labs, imaging, medications, and nursing communications. Pretty

sweet, huh? Yeah, I love the order sets. ~What's,~ what's the problem? No problem with using it, but here's a question I bet you never asked.

Who decided which orders are in that set? Which ones come pre-checked? And which Ones do you have to go dig for? Because whatever's pre-checked is what most people end up ordering. The

default is steering the care of every patient who hits it. Somebody chose it. Was it a surgeon? Yeah, I'm not really sure ~Um,~ likely not.

~Um, a,~ a person definitely built it, but let's keep going. ~Uh,~ you order a medication and a ~red ~drug, interaction alert fires. What do you do with it? Yep, I try to ~quick th- uh,~ click through it as fast as possible, find the,

override button, something like that And that's the whole problem in one story.

A 2024 systematic review and meta-analysis in the Health Informatics Journal pooled 11 studies and more than half a million prescriptions, and found physicians override drug interaction alerts about 90% of the time. 90%. When

a safety system is wrong so often that we've trained ourselves to ignore it, the system is the problem, and someone designed that threshold, and someone can change and redesign it The harm isn't

Ep1ClinicalInformaticsForSurgeons: just

audio1504629331: the extra click.

The real danger is that the one alert that could prevent a serious adverse event gets lost amongst a bunch of other

alerts, and that adds little to no value. And that's why alert fatigue is the most extensively studied challenge in informatics. It's not only a usability issue, it's a patient safety issue.

When clinicians stop trusting the system, the system can no longer do its job. And what's also interesting about this is that the

people who often know the most about these problems are the clinicians who use the system every day. Like several other health systems, we have a program that asks clinicians to share these pain points so that we can help to fix them.

The program is modeled after an idea from Ashton. They called it Getting Rid of Stupid Stuff in the Electronic

Health Record. We recently shared our experience over two rounds of our program, but we framed it positively, Joy in Practice, where we crowdsourced EHR improvement ideas from frontline physicians, nurses, and staff.

We received more than 500 suggestions over the first two rounds, ranging from confusing

workflows to unnecessary documentation and inefficient order entry. Some required significant redesign, but many were surprisingly simple fixes that saved thousands, and in some cases, hundreds of thousands of clicks each year.

One of the important lessons here is that improving healthcare technology isn't just

about ~bu-~ building new tools. It's about listening to the people doing the work and continuously improving the systems around them Exactly. Then there's the risk score that's in the corner of the chart, the number saying this patient is high risk for sepsis or readmission.

Where did that come from? To be honest, I've, ~uh,~ never really looked at it, ~um,~ so I'm not sure

Somebody built the model behind it, and most of us couldn't tell you how it works. Here's the one that should stick with some of our listeners. The most widely deployed proprietary sepsis ~model, sepsis~

Ep1ClinicalInformaticsForSurgeons: prediction

audio1504629331: model in the country, the Epic sepsis model, was externally validated by Wong and colleagues in JAMA Internal Medicine in 2021.

The vendor

advertised an area under the curve in the high 70s to low 80s. On real hospitalized patients, it scored 0.63. It missed 67% of sepsis cases, and it fired alerts on 18% of all hospitalizations to do it. So that tool, ~like,~ actually

missed two-thirds, ~um,~ of the thing it was supposed to catch? That's what independent validation showed.

And I've watched a sepsis score in the chart flip a post-op patient to high risk when he was just tachycardic from pain and overdue for his meds. So the last piece, your actual operation, the way your case gets slotted onto the OR schedule, the block time,

the turnover math, that's a system running on data and rules, too.

So the order set, the alert, the risk score, the OR schedule, those are four things that shape your entire day, and you

Ep1ClinicalInformaticsForSurgeons: decided

audio1504629331: none of them ~Yeah. So sorry, let's check on that one~

~Okay, now I see what you're saying. Um, these, these things really are making big... Uh, how do I say this? Uh. I don't like how it wrote it, so I'm trying to, uh~

Yeah, I see what you're saying. This really does have a big impact on, ~uh,~ taking care of patients

~Kevin, you are calling the clinical shots here. Um, so I don't know if this is gonna work. Um~

~Okay, I'll try. Um, hmm~

~Yes, it does have a big impact on patients, and surgeons are still, um, at the center of it, but I don't, I don't think that's gonna work. I have no idea how to lead from this. You are calling the clinical shots~

~Okay. Um, I'll just sc- okay Let me just go down to the next one. Uh- No, no, I can, uh~

In the operating room, you'd never

let someone rearrange your tray or change your defaults without asking you first. In the digital environment, it happens constantly, and most surgeons never notice. The order set default, the alert threshold, the risk model, the scheduling logic, those are all clinical decisions.

They're just dressed up as technical ones.

Informatics is the field that decides how care delivery occurs and how many important care decisions get made, and often who's in the room when they do Yeah, so honestly, ~I'm,~ I'm excited to hear that there are surgeons that are helping, ~um,~ this field and design this, ~um,~ for us because ~I,~ I'm starting to want to see how important this is and, ~um,~ I'm glad we

have advocates on our side.

~Um,~ so define it for me. ~Um,~ it's not a help desk, it's not IT. ~Um,~ kind of explain it, ~uh,~ at a kindergarten level for me a ~little,~ little further. Well, the simplest version is that clinical informatics is the science of using the data, the information, and the technology to help us take better care of patients.

When the subspecialty, the clinical informatics ~s-~ subspecialty, was formally established, the definition was essentially that, applying information sciences and information technology to improve healthcare delivery. So the field lives at the intersection of clinical practice, data and information sciences, like

computer science and statistics, technology, and human factors, including workflow.

~So~ IT keeps the computers running. Informatics helps determine what those computers should show you, when they should show it, and whether it actually helps you care for your patient. Exactly. As you said, clinical informatics is the intersection of

clinical care, information technology, and the health system.

And that third piece, the system itself, is the part that people typically forget. And this is not a committee people get voluntold for. It's a real board-certified physician subspecialty. Yeah, ~that,~ that's interesting. ~I,~ I had no idea. ~Um,~ is it like a fellowship? ~How,~ how do you get boarded in this?

Exactly like that.

So the American Board of Medical Specialties approved clinical informatics as a subspecialty in 2011 for all boarded and board-eligible specialties. And the first board exam was administered October 2013. It's administered jointly through the American Board of Preventative Medicine and American Board of Pathology, and it's open

to physicians of any primary boarded specialty.

So even a vascular surgeon like you, Dr. Kniery, could get boarded in it. And the training pathway is now a real GME program, not a weekend course. ~Clinical informatics fellowships are accredited by ACGME, the same organization that accredit to, that accredits... Okay. Um,~ clinical informatics fellows are accredited by the ACGME, the same organization that accredits

surgery residencies and fellowships.

Currently, the clinical informatics fellowship is the pathway to take the board examination and the board certification. The old grandfathering pathway for those who are already practicing or formally trained in the field with a graduate degree has closed. So when you meet a boarded

clinical informaticist today, they've completed formal fellowship training in the specialty.

Wow, okay. So definitely not an IT hobby. ~Um,~ this is board-certified physicians, ~um,~ and this ~so it~ even has an ACGME fellowship. I had, honestly had no idea.

Right.

So in surgery specifically, what are we

talking about? What are the competencies of this field? So a group of us wrote specifically about that intersection between surgery and informatics.

~Uh,~ we published a paper in the Journal of Surgical Research, The Value of a Surgeon Informatician, to try to spell this out. We did this in part because the surgical side

of informatics was less well-defined and one of the least developed areas. We still continue to have too few surgeons in the field.

So we defined three core areas of focus. The first is clinical decision-making and care process improvement, much of what we've just talked about: order sets, alerts, decision support, and workflows, ~uh,~

that help make surgical care safer and more effective. Health information systems, data, and analytics, the EHR systems, registries, data platforms, and increasingly AI tools that generate insights and solve real problems for surgical teams and patients.

Ep1ClinicalInformaticsForSurgeons: And

audio1504629331: then finally, leadership and change

management. This is the one that surgeons, and I would say frankly most ~informa-~ informaticians, ~um,~ underestimate and skip. ~Knowing the right fix is useless unless you can't... Hmm.~ Knowing the right fix is useless if you can't get a hospital or the actual frontline clinical teams to actually adopt the new tool.

You have to be able to change workflows, build consensus, and help

organizations adopt better ways of delivering care. ~And I'll point out that Dr., ~I'll point Out that Dr. Melton-Meaux is one of the authors on that paper, so when she describes a field, she's describing something she helped define. That's literally the expert. Yeah, exactly, and that's exactly who you want writing the definition. ~Uh,~ that's a surgeon

advocating for us. ~Often... Hmm.~

~Sorry, did I-- should I have said the middle thing? ~

Ep1ClinicalInformaticsForSurgeons: ~the middle? No, ~

audio1504629331: ~it's okay. No. Okay. ~

Ep1ClinicalInformaticsForSurgeons: ~Um, ~

audio1504629331: ~yeah.~ Often leadership in change management is the whole game. ~Most failed informatics product, um...~ Most failed informatics projects didn't fail because the technology doesn't work. The solutions fail because people don't adopt the solution.

We sometimes call this the last mile problem. The hard part is aligning clinicians,

workflows, and organizational priorities around a better way of working. Surgeons do that every day. We're trained to lead teams, make decisions under pressure, and drive change. ~Those skills turn out to be just import-~ Those skills turn out to be just as important in informatics as they are in the operating room ~Yeah.~

Okay, yeah. It's really kind of starting to, take shape in my head. ~Um,~ and

this kind of leaves the, the main question is, ~like,~ as a surgeon, ~like, you know,~ I'm never gonna do a fellowship in this, you know. ~What,~ what more should I know about this? How can I interact with this? Why should any of us care about this?

You should care about this because when surgeons aren't in the room for the design, the tools get built by people who don't do what we do, and it

shows. Order sets that don't match how a surgeon cares for a patient, alerts that fired at the worst moment of a case, ~risk scores never validated on surgical patients that use them, uh, and it, and it is used on--~ risk scores that were never validated on surgical patients that get used on them anyway.

The result is technology that doesn't fix the work. Instead of helping, it creates friction, and you spend

your career working around them instead of with them. And beyond the technology, even if someone does not become an informatician, surgeons who lead quality improvement, patient safety, operations, or clinical transformation in a hospital today really do benefit from having a working

knowledge of informatics in AI, because that's becoming essential today.

You don't need to be an informaticist, but you ~nee-~ do need to be informed as a leader. And the data on how absent we are is stark. A twenty twenty-five study by Anderson and colleagues in the Journal of Surgical Education surveyed general

surgery residents across seven academic programs. Of the one hundred and forty-six who responded, about a third of those asked, roughly two-thirds, sixty-four percent, called themselves aware but inexperienced.

Only about a quarter had any prior informatics experience, and only sixteen percent had any informatics training in medical

school. The Clinical Informatics Board Certification data tells a similar story. Only a small minority of surgeons pursue formal training in the field

Yep, that's, ~uh,~ me to a T. I know it exists, but I have no clue how it works. Right. And in that same study, how familiar a resident was with informatics tracked with how

important they thought it was. The more they understood it, the more they valued it. So the low interest isn't because it doesn't matter, it's because nobody has shown them why it does.

And that's not a new finding. Years before that study, Lyu, Doherty, and Landman made that same argument. Informatics has

become an important part of surgical practice, yet most residents received little formal training in it. ~Now we're having that same conversation in the middle of an AI algorithm. Hmm.~

Now we're having that same conversation in the middle of an AI era where algorithms, decision support tools, and predictive models are increasingly influencing how care is delivered. The stakes have never been

higher Yeah, no, ~I,~ I can see, ~uh,~ why this could deserve more curriculum time, but there's also lots of other priorities, whether it's ethics, global surgery, wellness.

You know, residency has finite education hours. ~Uh,~ why should informatics jump the line ~of,~ of these other, ~uh,~ disciplines? That's a fair challenge, Kevin, and I

won't pretend that every topic can win. But here's my honest answer. Informatics is different because it's not competing with your clinical training.

It's the medium of clinical care, and your clinical training now runs through it. You can opt out of global surgery elective. You cannot opt out of the

electronic health record, AI solutions, and the changes that digital health transformation are bringing. It touches every order, every note, every case, every day.

So it isn't one more elective fighting for hours. It's literally a literacy layer under everything you already do. And that's exactly

why the college's position changed Yeah, ~and,~ and kind of a question I'm trying to wrap my head around is, ~um,~ you know, ~I,~ I don't really wanna-- I'm not a tech person. ~I, I,~ I don't know how to code, ~um,~ and this sounds very sort of tech-heavy.

~Um, and~ so why is this my job, ~um,~ and not the informatics people's job? And then also, ~what--~ how much, ~like, ~

Ep1ClinicalInformaticsForSurgeons:

tech knowledge

audio1504629331: ~and, um...~ do you ~have to~ have to get involved in something like this? And that's fair, and honestly, I feel that tension too. I'm a surgeon. Most days, I'd rather be in the operating room than talking about workflows and technology.

I'll push back on the overall framing. ~Uh,~ being informatics literate or even fluent isn't the same as coding or being an

informaticist, just like reading a lab result isn't the same as running the lab. You don't have to build the analyzer to know a potassium of seven is an emergency and then to act upon it.

What I'm advocating for is much simpler than people think. Understand where these tools come from, know their limits,

and know how to speak up when one of them is wrong. You can carry that into every case without spending an extra hour at the keyboard by being an informed user, an advocate for your patients, and a voice in how these tools are designed and used And this is now the official position of our largest professional body, not just an

opinion.

The American College of Surgeons recognizes that data, informatics, and AI are becoming central to surgical practice. In 2024, the ACS created its first chief health informatics officer role, a position that Dr. Melton-Meaux now serves in. The college has also launched new efforts

around data, informatics, and AI education as part of a broader strategy to help surgeons in their daily practice.

The message is clear: this is no longer a niche interest for the surgeons who happen to like computers. As surgery becomes increasingly data-driven, informatics is becoming a core professional

competency. That's exactly why I took the role. The ACS has spent decades building some of the most important clinical registries and quality programs in healthcare.

The next step is to help surgeons harness all of the data more effectively, whether through quality improvement, clinical decision support, predictive analytics, or

AI. The ACS now has a clinical data strategy that is part of a multi-year effort to modernize and transform the college's data assets, including its clinical registries.

The vision is that we will be able to make our registries increasingly digital, interoperable, AI-enabled, and automated,

reducing manual data collection while turning data into actionable insights that improve patient care. But the bigger goal of the ACS isn't to turn every surgeon into an informaticist.

It's to ensure that every surgeon can engage thoughtfully with the tools that are increasingly shaping care. ~It's to ensure that every surgeon can thoughtfully-- ooh, it says it twice or I read it ~ If a model is

helping determine who gets an operation, a surgeon should understand enough to ask whether it was developed appropriately ~and to validate--~ and was validated in patients like the one sitting in front of them.

If an order set is influencing care across a service line, a surgeon should be able to say, "That default doesn't reflect best practice.

Let's fix it." You don't have to build the tool, but you do need to understand it well enough to evaluate it and improve it. All right. This all sounds great, but let's make it concrete for the surgeon who buys the argument.

What does this literacy actually look like on a regular Tuesday? ~Um,~ well, it's about

developing a few simple habits. When a risk score pops up in a chart, get curious. Ask what it's predicting, what data it was built on, and whether it was validated on patients like yours. You'll be surprised how often those questions don't have clear answers, and that's important information.

Here's another example. When an

alert is wrong or irrelevant, don't just click through it in silence. There's a way to report it, and someone on the informatics team genuinely wants that feedback. If everyone quietly works around a problem, the people who can fix it may never know it exists. When an order

set doesn't match how surgical care is actually delivered, speak up.

Those order sets don't appear by magic. They're reviewed and maintained by committees that would love a surgeon in the room, and usually we can't find one. Ask questions about the data your practice generates. Who owns it? How is it being

used? Whether it's in the operative note, the device data, images, or surgical video, those answers increasingly matter for quality improvement, research, and AI development

Yeah, no, ~I,~ I can definitely, ~um,~ get involved, ~um,~ immediately in improving the order sets and, ~um,~ plan to do so. One of the ones I always complain about

is, ~uh,~ the DVT, ~um,~ risk score, and I'm always, like, in a consultant, and I have to click through it. So I just complain to the resident about, you know, ~why,~ why don't the primary team ever address these and...

But yeah, so, you

know,

~who,~ who should I complain to instead? So that's exactly the shift that

we're advocating for. ~Um,~ most surgeons are identifying the problems just as you are, but it is that next step of taking the complaint you're already making and turning that complaint into the improvement by engaging with the right teams.

Right.

~And every one of those questions, um, that we have about the order sets or ~

Ep1ClinicalInformaticsForSurgeons: ~any ~

audio1504629331: ~CDS tools within the, uh, EHR, that's a, a door that opens into maybe a committee, um, uh, let me, let me... Um, let's see.~

Ep1ClinicalInformaticsForSurgeons: ~Chhh~

audio1504629331: And every one of those questions ~is a,~ is a door. Ask about the

risk score once, and you can end up on the committee that governs it. And that's honestly how a lot of us got into it. No master plan, just one alert that annoyed us enough to finally do something about it. So ~Dr. Melton Mo- uh,~ Dr. Melton-Meaux, give us the take-home points.

Well,

three things. One, your normal day

is already running on informatics, and every piece of it was designed by someone. You're allowed to ask who and why. Two, literacy isn't coding. It's knowing where a tool came from, what it can't do, what it can do, and how to flag it when it's wrong. It's a potassium of seven,

not building the analyzer.

And this literacy is increasingly important as our world, including surgery, is increasingly digital, data, and AI-enabled. Three, you have more influence than you think. The surgeons who learn even a little of this are the ones who end up shaping the tools everyone

else is stuck with. Be one of them Yeah, I'll admit, Mason, when you, ~uh,~ roped me into this I was a little skeptical.

~Um,~ but now ~I'm,~ I'm really seeing, ~you know, ~why this is important. ~Um, and,~ and I, ~you know, ~I think, ~you know,~ we should all be involved. So Mason, ~where,~ where do we go from here?

Right, this

was the foundation. So from here we open up the pieces. ~Next episode we get into one of the most contested questions in surgery right now.~

~When you operate on a robot, who actually owns the data ~ Dr.

Melton-Meaux, thank you for setting the table for this whole series.

Ep1ClinicalInformaticsForSurgeons: My

audio1504629331: pleasure. And Kevin, keep asking the beginner questions. They're usually the ones everyone in the room was afraid to ask.

Yeah, I'm happy to be that guy. ~Um, work through the reading in this mo- references I was shown. Thanks for what? Work through the reading in this mo- Okay.~

~Well,~

~yeah, I, I, I'm happy to be that guy.~ And, ~uh,~ thank you again, Dr. Melton-Meaux. ~Uh,~ this has been a fantastic, ~uh,~ introductory episode to

informatics. ~Um,~ thanks everyone for listening and, ~um,~ from all of us, dominate the day.

Dominate the day. Woo. Dominate the day.

~Cool. All right. I think it went well. Yeah. Um- Is this editable? I have my work cut out for me- Oh, yeah. Oh, yeah... for the editing, but it'll be great. These will turn out fine. Do you use- I'm not gonna worry about it. Do you use Descript, Descript? Yes, yes. Cool. Yeah. Yeah. Great. So it'll, it'll be fine. It'll be fine.~

~Uh, thank you both for your time, I really appreciate it. And for- Absolutely... bearing with me on, on the script. I know it's not perfect. ~

Ep1ClinicalInformaticsForSurgeons: ~Um, ~

audio1504629331: ~I wonder, and just for, I think next time if we can leave a little more open-ended on some of these. Like, I had a few, ~

Ep1ClinicalInformaticsForSurgeons: ~like, ~

audio1504629331: ~questions ~

Ep1ClinicalInformaticsForSurgeons: ~I ~

audio1504629331: ~didn't quite know how to get them in.~

~Like, like I think for you guys, me asking you these questions is, ~

Ep1ClinicalInformaticsForSurgeons: ~like, ~

audio1504629331: ~just nothing. Like, it's easy questions that I have. Um, and so if we can give a little more space or just even have just a outline that we can sort of follow, I'd, I'd like that too. Okay. Mm-hmm. Sounds good. Um, but yeah. All right. Awesome, y'all.~

~Awesome. Thank you. Thank you. Thank you. Take care. Have a good one. Okay, bye. ~

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