Reflections of a Clinical Informatics Fellow: Q&A With Sameh Saleh, MD

Sameh Saleh, MD

Editor's Note: Sameh Saleh, MD, discusses the value of his two-year clinical informatics fellowship in the Department of Biomedical and Health Informatics at Children's Hospital of Philadelphia.

Applications are currently being reviewed for the 2024 CHOP Clinical Informatics Fellowship Program. The deadline to submit your application is Sept. 30, 2023.

How did you first learn about the fellowship program?

I first learned about the existence of the CHOP fellowship program through the American Medical Informatics Association's (AMIA) website for clinical informatics fellows. I gained more insight speaking with a mentor who had completed another clinical informatics fellowship and, ultimately, I found detailed information about the program on CHOP's website.

What motivated you to apply?

Several factors motivated me to apply for this fellowship program. It is one of the first clinical informatics programs, which speaks to its pioneering nature, credibility in the field, and established infrastructure. Second, I was impressed by the number of physicians who are board-certified in clinical informatics at CHOP and the impressive track record of the program's previous graduates. Third, the emphasis on experiential learning grounded in robust didactics seemed like an ideal balance of application and theory. Lastly, the program's partnership with the University of Pennsylvania would allow me to understand both adult and pediatric lenses, understand different health system infrastructures, and have no shortage of research and innovation opportunities, which aligned well with my career goals.

What project did you work on as a clinical informatics fellow?

One of my main projects as a clinical informatics fellow revolved around the development of a clinical algorithm, clinical education, and go-live support within the Penn Medicine enterprise that involved interpretation and workflow for high sensitivity troponins. Because they are more sensitive compared to conventional troponins, the deltas between values are critical in identifying myocardial injury warranting the need for serial testing at defined time intervals using an algorithm.

In this project, with mentorship from another clinical informatician, I took on the role of lead clinical informatician, collaborating with the Epic and Information Services teams. Together, we designed and implemented a clinical decision support system using Epic Care Paths to automate navigation through the intermediate steps of the algorithm, providing timely information, integrated lab collection, and automated calculation and interpretation.

This system went live June 2, 2022, across five hospitals within the Penn Medicine enterprise, covering both emergency (ED) and inpatient (IP) contexts. Additionally, the tool incorporated adjustments for both HS troponin T and I, which required different interpretations.

Throughout the project, I independently built 208 Epic records and assisted in creating at least 50 more, considering the widespread use of troponins in the healthcare system. I played an active role in conducting formative testing for the ED visualization and facilitated integrated testing with the lab. I also delivered approximately 20 demos and presentations to various stakeholder groups, and my efforts led to approvals from six governance committees.

Furthermore, I contributed to the development and recording of four education modules (ED nurse, ED provider, IP nurse, IP provider) on the changes in PennChart, which were disseminated to thousands of providers and nurses across the health system. Finally, I collaborated with the Data Analytics Center to lead post-implementation analyses of process and outcome level measures, ensuring continuous improvement and optimization.

The tool, which has received positive feedback, was used over 40,000 times in the first year and resulted in a 30% decrease in observation disposition for emergency patients presenting with a chief complaint of chest pain. It was presented at Epic's national XGM conference, and several health systems have reached out to replicate the work.

What were the main benefits or advantages of participating in the fellowship program?

The program provided formalized didactic training that enriched my knowledge base and understanding of clinical informatics principles. The flexible time and resources allocated to fellows enabled me to build a solid foundation in informatics and then cultivate a niche within the field. The hands-on experience and diverse projects led to a robust project portfolio covering various informatics areas, further enhancing my credibility as a clinical informatics professional and was key in my job search.

How would you describe the support and guidance provided by the program directors, coordinators, and mentors?

Anthony Luberti, MD, is a wonderful program director. His unwavering dedication and accessibility made him an invaluable resource throughout the fellowship journey. He was always readily available, responsive, and struck a great balance between providing guidance and allowing fellows to explore and learn independently. The entire team exhibited a commitment to offering iterative feedback and improvement, fostering a nurturing environment for growth and learning.

The faculty's support played a crucial role in making my fellowship experience enriching and rewarding. Given my unique role and career goals, I was able to quickly form an amazing mentorship committee with nationally known clinical informaticians that helped me navigate my successful job search.

In what ways did the fellowship enhance your career, network, and connections within your field?

Participating in the fellowship significantly enhanced my career prospects and network within the field of clinical informatics. CHOP's reputation and affiliation with Penn Medicine opened doors to various research and innovation opportunities, allowing me to collaborate with distinguished professionals in the informatics domain.

Through the fellowship, I had the chance to work on meaningful projects and build a strong project portfolio, which added value to my professional profile. Additionally, the connections I established during the fellowship have been instrumental in expanding my network and creating lasting professional relationships.

Did the program meet your expectations? If so, in what ways?

Absolutely, the program met my expectations. The depth of experience I gained during the fellowship was unparalleled. The program's comprehensive approach to learning and its emphasis on hands-on projects exposed me to real-world challenges and best practices in clinical informatics.

Its resources and infrastructure were exceptional, setting me up for success but allowing me the autonomy to lead and navigate new projects. The commitment to iterative feedback and improvement ensured that the program continuously adapted to meet the evolving needs of the different informatics fellows, each with different backgrounds.

What advice would you give to someone considering applying to this fellowship?

If you are considering applying to this fellowship, I would recommend first evaluating your goals and aligning them with the program's offerings. Take the time to understand the various opportunities and projects available, and choose those that best match your experience and aspirations. Highlight a project you are truly proud of in your application, as this will serve as a foundation for expanding on during the interview process.

Additionally, be prepared to fully immerse yourself in the program's offerings, and don't hesitate to seek guidance and support from the program directors, coordinators, and mentors. This fellowship can be a transformative experience, so embrace it with enthusiasm and a willingness to learn and grow.

To learn more about CHOP's Clinical Informatics Fellowship Program, please visit www.research.chop.edu/services/clinical-informatics-fellowship.