Health Informatics

“Our goal is to understand how to make health information technology practical in ways that directly engage patients and providers.”

James D. Ralston, MD, MPH
Kaiser Permanente Washington Health Research Institute Associate Investigator
Washington Permanente Medical Group, Internal Medicine

Research overview

Research on health informatics at Kaiser Permanente Washington focuses on developing and using health information technology (IT) to transform health care delivery. By testing new paradigms of care that provide more opportunities to engage patients, this research is supplying valuable evidence that is helping shape federal policy and guiding innovative redesign of health care.

“We’re working to understand how to make health IT practical so patients and care teams find it useful and engaging,” explained Kaiser Permanente Washington Health Research Institute (KPWHRI) Senior Investigator James Ralston, MD, MPH. “We want to find ways to use information technologies to support patients and providers together, both inside and outside the office.”

Integral to this support is designing technologies that are user-friendly and meet the needs of both patients and providers. By applying human-centered methods that focus on needs, use, and usability, KPWHRI researchers inform the design of health IT with direct participation from users.

Groundbreaking methodological work by KPWHRI health informatics researchers includes developing natural language processing (NLP) to analyze text such as notes and written reports in electronic health records (EHRs). Assistant Investigator David Carrell, PhD, leads in the area of using NLP and machine learning to identify patient phenotypes, or specific health characteristics such as possible heart disease, risk of opioid overdose, or suggestion of colon cancer. This information can assist researchers in studying how genetics and other factors influence disease.

Other examples of KPWHRI health informatics research include projects using EHRs and secure electronic communications such as:

using a patient-shared EHR to improve care for chronic illnesses such as depression, diabetes, hypertension, and heart disease;
understanding the effects of technologies such as OpenNotes, which gives patients access to notes that their doctors write during office visits;
understanding and addressing differences in patient use of online health care services that could lead to disparities in care;
testing NLP to target mentions of specific words and phrases in EHRs to supplement or replace skilled chart abstraction—providing faster access to “big data” and actionable information about patients who may need follow up.

Examples of KPWHRI research in mobile health (mHealth) and user-centered design include:

evaluating mHealth smartphone tools: 1) to improve primary care for alcohol use disorders, 2) to support patients after bariatric surgery, and 3) to change smoking behavior;
the VITAL and Seeing Priorities studies to apply user-centered processes to learn how health care providers can elicit and honor what is most important to patients living with multiple chronic health conditions;
the REMIND project applying user-centered methods to redesign clinical reminders and notifications for patients with chronic and preventive health care needs;
the landmark Electronic Communications and Blood Pressure (eBP) study of home blood pressure monitoring and web-based care to increase hypertension control without office visits.

“Our studies on using health IT to improve care are showing that we can achieve better outcomes when we shift care from the doctor’s office to where people live: in their homes—and online,” said Senior Investigator Beverly B. Green, MD, MPH.

Recent publications on Health Informatics

Anttila V, Bulik-Sullivan B, Finucane HK, Walters R, Bras J, Duncan L, Escott-Price V, Falcome G, Gormley P, Malik R, Patsopoulos N, Ripke S, Wei Z, Yu D, Lee PH, Turley P, Grenier-Boley B, Chouraki V, Kamatani Y, Berr C, Letenneur L, Hannequin D, Amouyel P, Boland A, Deleuze J-F, Duron E, Vardarajan BN, Reitz C, Goate Am, Huentelman MJ, Kamhoh MI, Larson EB, Rogaeva E, St George-Hyslop P, Hadonarson H, Kukull WA, Farrer LA, Barnes LL, Beach TG, Demirci FY, Head E, Hulette CE, Jicha GA, Kauwe JSK, Kaye, Leverenz JB, Levey AI, Lieberman AP, Pankratz VS, Poon WW, Quinn JF, Saykin AJ, Schneider LS, Smith AG, Sonnen JA, Stern RA, Van Deerlin VM, Van Eldik LJ , Harold D, Russo G, Rubinsztein DC, Bayer A, Tsolaki M, Proitsi P, Fox NC, Hampel H, Owen MJ, Mead S, Passmore p, Morgan K, Rossor M, Lupton M, Hoffmann P, Kornhuber J, Lawlor B, McQuillin A, Al-Chalabi A, Bis JC, Ruiz A, Boada M, Seshadri S, Beiser A, Rice K, van der Lee S, De Jager PL, Geschwind DH, Riemenschneider M, Riedel-Heller S, Rotter JI, Ransmayr G, Hyman BT, Cruchaga C, Alegret M, Winsvold B, Palta P, Farh KH, Cuenca-Leon E, Furlotte N, Kurth T, Ligthart L, Terwindt G, Freilinger T, Ran C, Gordon S, Borck G, Adams H, Lehtimäki T, Wedenoja J, Buring J, Schürks M, Hrafnsdottir M, Hottenga J-J, Penninx B, Artto V, Kaunisto M, Vepsäläinen S, Martin N, Montgomery G, Kurki M, Hämäläinen E, Huang H, Huang J, Sandor C, Webber C, Muller-Myhsok B, Schreiber S, Salomaa V, Loehrer E, Göbel H, Macaya A, Pozo-Rosich P, Hansen T, Werge T, Kaprio J, Metspalu A, Ferrari M, Belin A, Maagdenberg A, Zwart JA, Boomsma D, Eriksson N, Olesen J, Chasman D, Nyholt D, Avbersek A, Baum L, Berkovic S, Bradfield J, Buono R, Catarino CB, Cossette P, Jonghe P, Depondt C, Dlugos D, Ferraro T, French J, Hjalgrim H, Jamnadas-Khoda J, Kälviäinen R, Kunz W, Lerche H, Leu C, Lindhout D, Lo W, Lowenstein D, McCormack M, Møller R, Molloy A, Ng P-W, Oliver K, Privitera M, Radtke R, Ruppert A-K, Sander T, Schachter S, Schankin C, Scheffer I, Schoch S, Sisodiya S, Smith P, Sperling M, Striano P, Surges R, Thomas NG, Visscher F, Whelan CD, Zara F, Heinzen E, Marson A, Becker F, Stroink H, Zimprich F, Gasser T, Gibbs R, Heutink P, Martinez M, Morris H, Sharma M, Ryten M, Mok B, Pulit S, Bevan S, Holliday E, Attia J, Battey T, Boncoraglio G, Thijs V, Chen WM, Mitchell B, Rothwell P, Sharma P, Sudlow C, Vicente A, Markus H, Kourkoulis C, Pera J, Raffeld M, Silliman S, Perica VB, Thornton LM, Huckins LM, Rayner NW, Lewis CM, Gratacos M, Rybakowski F, Keski-Rahkonen A, Raevuori A, Hudson JI, Reichborn-Kjennerud T, Monteleone P, Karwautz A, Mannik K, Baker JH, O'Toole JK, Trace SE, Davis OSP, Helder S, Ehrlich S, Herpertz-Dahlmann B, Danner UN, van Elburg AA, Clementi M, Forzan M, Docampo E, Lissowska J, Hauser J, Tortorella A, Gonidakis F, Tziouvas K, Papezova H, Yilmaz Z, Wagner G, Cohen-Woods S, Herms S, Julia A, Rabionet R, Dick DM, Ripatti S, Andreassen OA, Espeseth T, Lundervold A, Steen VM, Pinto D, Scherer SW, Aschauer H, Schosser A, Alfredsson L, Padyukov L, Halmi KA, Mitchell J, Strober M, Bergen AW, Kaye W, Szatkiewicz JP, Cormand B, Ramos-Quiroga JA, Sánchez-Mora C, Ribasé M, Casas M, Hervas A, Arranz MJ, Haavik J, Zayats T, Johansson S, Williams N, Dempfle A, Rothenberger A, Kuntsi J, Oades RD, Banaschewski T, Franke B, Buitelaar JK, Vasquez AA, Doyle AE, Reif A, Lesch KP, Freitag C, Rivero O, Palmason H, Romanos M, Langley K, Rietschel M, Witt SH, Dalsgaard S, Børglum A, Waldman I, Wilmot B, Molly N, Bau C, Crosbie J, Schachar R, Loo SK, McGough JJ, Grevet E, Medland SE, Robinson E, Weiss L, Bacchelli E, Bailey A, Bal V, Battaglia A, Betancur C, Bolton P, Cantor R, Celestino-Soper P, Dawson G, De Rubeis S, Duque F, Green a, Klauck SM, Leboyer M, Levitt P, Maestrini E, Mane S, Moreno-De-Luca D, Parr J, Regan R, Reichenberg A, Sandin S, Vorstman J, Wassink T, Wijsman E, Cook E, Santangelo S, Richard Delorme, Rogé B, Magalhaes T, Arking D, Schulze TG, Thompson RC, Strohmaier J, Matthews K, Melle I, Morris D, Blackwood D, McIntosh A, Bergen SE, Schalling M, Jamain S, Maaser A, Fischer SB, Reinbold CS, Fullerton JM, Guzman-Parra JG, Mayoral F, Schofield PR, Cichon S, Mühleisen TW, Degenhardt F, Schumacher J, Bauer M, Mitchell PB, Gershon ES, Rice J, Potash JB, Zandi PP, Craddock N, Ferrier IN, Alda M, Rouleau GA, Turecki G, Ophoff R, Pato C, Anjorin A, Stahl E, Leber M, Czerski PM, Cruceanu C, Jones IR, Posthuma D, Andlauer T, Forstner AJ, Streit F, Baune BT, Tracy Air T, Sinnamon G, Wray N, MacIntyre D, Porteous D, Homuth G, Rivera M, Grove J, Middeldorp C, Hickie I, Pergadia M, Mehta D, Smit JH, Jansen R, de Geus E, Dunn E, Li Q, Nauck M, Schoevers RA, Beekman ATF, Knowles JA, Viktorin A, Arnold P, Barr C, Bedoya-Berrio G, Bienvenu O, Brentani H, Burton C, Camarena B, Cappi C, Cath D, Cavallini M, Cusi DDarrow S, Denys D, Derks E, Dietrich A, Fernandez T, Figee M, Freimer N, Gerber G, Grados M, Greenberg E, Hartmann A, Hirschtritt M, Hoekstra P, Huang A, Huyser C, Illmann C, Jenike M, Kuperman S, Leventhal B, Lochner C, Lyon G, Macciardi F, Madruga-Garrido M, Malaty IA, Maras A, McGrath L, Miguel E, Pablo Mir P, Nicolini H, Okun MS, Pakstis A, Piacentini J, Pittenger C, Plessen K, Ramensky V, Ramos EM, Reus V, Richter M, Riddle M, Robertson M, Roessner V, Rosário M, Sandor P, Stein D, Tsetsos F, Van Nieuwerburgh F, Weatherall S, Wendland J, Wolanczyk T, Worbe Y, Goes F, McLaughlin N, Nestadt PS, Grabe H-J, Depienne C, Konkashbaev A, Lanzagorta N, Valencia-Duarte A, Bramon E, Buccola N, Cahn W, Cairns M, Chong S, Cohen D, Crespo-Facorro B, Crowley J, Davidson M, DeLisi L, Dinan T, Donohoe G, Drapeau E, Duan J, Haan L, Hougaard D, Karachanak-Yankova S, Khrunin A, Klovins J, Kucinskas V, Keong JLC, Limborska S, Loughland C, Nnqvist JL, Maher B, Mattheisen M, McDonald C, Murphy K, Nenadic I, Os J, Pantelis C, Pato M, Petryshen T, Quested D, Roussos P, Sanders A, Schall U, Schwab S, Sim K, So H-C, Stögmann E, Subramaniam M, Toncheva D, Waddington J, James Walters J, Cheng W, Cloninger R, Curtis D, Frans Henskens F, Mattingsdal M, Oh S-Y, Scott R, Webb B, Churchhouse C, Breen G, Bulik C, Mark Daly M, Dichgans M, Faraone SV, Guerreiro R, Holmans P, Kenneth Kendler, Koeleman B, Mathews CA, Price A, Scharf J, Sklar P, Williams J, Wood N, Cotsapas C, Palotie A, Smoller J, Sullivan P, Rosand J, Corvin A, Neale BM, on behalf of the Brainstorm consortium. 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Mroz TM, Andrilla CHA, Garberson LA, Skillman SM, Patterson DG, Larson EH. Service provision and quality outcomes in home health for rural Medicare beneficiaries at high risk for unplanned care. Home Health Care Serv Q. 2018 Jun 11:1-17. doi: 10.1080/01621424.2018.1486766. [Epub ahead of print]. PubMed

Smith DH, Kuntz J, DeBar L, Mesa J, Yang X, Boardman D, Schneider J. A qualitative study to develop materials educating patients about opioid use before and after total hip or total knee arthroplasty. J Opioid Manag. 2018 May/Jun;14(3):183-190. doi: 10.5055/jom.2018.0448. PubMed

Lee CI, Pandharipande PV. Identifying and disseminating more best practices. AJR Am J Roentgenol. 2018;210(6):1179-1180. doi: 10.2214/AJR.18.19997. PubMed

Yitshak-Sade M, Bobb JF, Schwartz JD, Kloog I, Zanobetti A. The association between short and long-term exposure to PM2.5 and temperature and hospital admissions in New England and the synergistic effect of the short-term exposures. Sci Total Environ. 2018;639:868-875. doi: 10.1016/j.scitotenv.2018.05.181. Epub 2018 May 26. PubMed