Chart Biopsy

A lack of understanding and research about various racial and ethnic backgrounds can prevent patients from getting the best treatments to improve their health.

Now, as we modify existing technologies and launch new communications systems to improve the medical field, experts are attuned to avoiding the missteps of our past.

According to PIK Professor Kevin Johnson, the U.S. healthcare system is broken. As one of the most expensive systems in the world, and with the highest mortality rate among our peer countries, medical care in the U.S. has a lot of room to improve. We have a lot of work to do, Johnson says, to deliver on what we spend.

One root of the problem can be solved through Johnson’s area of expertise—biomedical informatics. A relatively new field, informatics is the area of medicine that deals with patient medical records and access to that information.

Johnson is no stranger to biomedical informatics. Prior to coming to Penn, he served as Chair of the Department of Biomedical Informatics at the Vanderbilt University School of Medicine and Senior Vice President for Health Information Technology at Vanderbilt University Medical Center from 2012 to 2021. There, he was charged with the hospital’s transition to EPIC, the now nearly ubiquitous patient information system that many people use to view bloodwork, medical records, and doctor appointments online.

“We delivered that transition on time and under budget,” Johnson says. But the biggest outcome—at least for Johnson personally—was an unwavering resolve to rekindle his love of research. A pediatric physician scientist by training, he saw a huge need to improve scientific and medical communication during Vanderbilt’s transition to the EPIC system. He observed that improvements in the ways and means of medical communication would do wonders for addressing some of the major problems in the field.

Now a PIK Professor at Penn with dual appointments in the Perelman School of Medicine and the School of Engineering and Applied Science, Johnson is laying the groundwork for a new lab to spearhead his work. Tentatively named the Center for Healthcare and Informatics Communication, this research group will take on projects that recognize a synergy between communication and medical information.

Exactly how will this happen?

According to Johnson, the Center’s overarching goal is to develop better methods of communicating to peers, patients and communities so they can better interpret and act on information impacting their health. Since scientific and medical research is constantly evolving, society must grapple with new—and sometimes conflicting—information on a somewhat regular basis. If messages are not delivered with the audience’s mindset and experience in mind, important messages can fall flat. Miscommunication can frustrate or even cause alarm.

“Dr. Fauci’s recent dilemma is a perfect example of this,” Johnson explains. “He is an internationally known scientist with a highly visible job. During the pandemic, he faced an incredibly unfair situation. As the science evolved, he had to deliver conflicting information and conflicting recommendations for action that challenged his credibility.”

In addition to improving medical communication, Johnson also wants to build better health information technology. “Our healthcare system has been hijacked by tech that provides more cognitive burden than cognitive support,” he says. “Sometimes, even in the same care setting, we’re facing information gaps, information overload, and misinformation.”

Electronic health records (EHRs) are still very much in their infancy, relative to the history of medicine, according to Johnson. They were designed by scientists like Dr. Johnson, but also influenced by other stakeholders compelled to monitor the quality of care or to regulate the processes of care. Some of these “enhancements” came at the expense of delivering efficient and effective care. Solutions, such as patient portals and telemedicine, do not equally benefit marginalized populations, as recent studies have shown.

According to Johnson, we need to refine the existing technologies—such as EHRs—to lighten the cognitive burden on clinicians and to dramatically improve their ability to provide cognitive support to clinicians and patients. Communication tasks must be easy to complete, and they must serve patient interests well, he says.

Johnson points out information overload can be one source of cognitive burden in the medical space. With hundreds of automated alerts and reminders each day, clinicians seek to “quiet the noise” and may override up to 90% of well-intentioned computer messages daily. “We need to build more cognitive supports into the systems to make it easy for doctors and nurses to do the right thing,” he says.

Johnson recognizes that solving the science communication problem won’t happen overnight. He is doing his part to help ready the field of biomedical informatics for the future. By working with the Annenberg School, Johnson also hopes to build more bridges between communication and science. He hopes to design classes for engineers and medical students to gain the experience and practice they need to communicate effectively to the many different audience groups they will serve in the future careers.

And Johnson is starting with students who are even younger, too. He is bringing his new book, Who Me? I’m a Biomedical Informatics Expert Now!, to schools in multiple metro areas to inspire fifth graders to get into the field.

For more on the promises and pitfalls of Johnson’s vital work, check out his podcast, Informatics in the Round.

Listen here