Dr. Ashwini Davison, Director of Strategy and Transformation for the Informatics Education Program at Johns Hopkins University – Data’s Big Impact on Care and Careers

Van Ton-Quinlivan: Welcome to WorkforceRx with Futuro Health, where future-focused leaders in education, health care and workforce development explore new education to work approaches and innovations. I’m your host Van Ton-Quinlivan, CEO of Futuro Health. My guest today is Dr. Ash Davison.  She has forged a fascinating career that has traversed clinical medicine, industry, consulting and academia. So, it won’t surprise you to learn that she is a believer in the power of professional pivots. As a faculty member at Johns Hopkins, she is an assistant professor in general internal medicine with leadership roles in both the School of Medicine and the School of Public Health.

In addition to many other hats that she wears, Dr. Davison is a director of Strategy and Transformation for the Informatics Education Program at Johns Hopkins. This position allows her to bring all of her personal and professional experiences to bear in creating learning programs and opportunities for students at the intersection of healthcare, technology, education and research. She has a special interest in empowering people to take the leap into clinical informatics, population health management and other domains of health systems science, and is a believer in active learning. She also mentors faculty members who are new to the distance learning landscape as they launch courses in precision medicine analytics, digital health, entrepreneurship, natural language processing, EHR simulation and other in-demand topics. Thank you very much for joining us today, Dr. Davison.

Dr. Ashwini Davison: Van, thank you so much for having me on today and for the excellent work that you’ve been spearheading at Futuro Health.

Van Ton-Quinlivan: Well, Dr. Davison, career pivots are a particular interest of yours, so I thought we’d start by learning your story of venturing from being a physician to ultimately landing in your current strategy and transformation role at Johns Hopkins School of Medicine. What drove you to make that change?

Dr. Ashwini Davison: Great question, Van. I’d be happy to discuss my career trajectory, which has really involved plenty of upskilling and reskilling along the way. I was an internal medicine resident at Johns Hopkins during the time of the HITECH Act in 2009. As everyone knows, it ushered in this era of Meaningful Use and increased Electronic Health Record adoption. My career in clinical informatics took me to Inovalon, a company based out of Maryland, where my work as a medical director involved helping Medicare Advantage plans with improving their patient outcomes, risk score accuracy, quality measures, providing clinical quality oversight for a nursing call center, and designing clinical algorithms with a group of other medical directors, and really being at the forefront of informatics in industry. I went on to start my own consulting company and had the opportunity to serve as a clinical subject matter expert for health care I.T. companies across the United States. Then in 2016, if you think about it, that’s when the American Medical Association first launched their new textbook on health system science to teach the third pillar of medical education, beyond basic and clinical science. Yet, for the past seven years, I’d been living the health system science journey with my career.

So, I feel that many steps of the way, Van, my career naturally progressed to being at this cutting edge of the “next big thing”, whether that be clinical informatics or subsequently, online education. As you mentioned, my role is in growing online education offerings in the School of Public Health and the School of Medicine at Johns Hopkins, and this was even before Covid-19 made online education a ubiquitous term. The other place where my career has been a bit ahead of the curve would be regarding precision medicine. At Hopkins, we have several precision medicine centers of excellence and part of my task has been partnering with other faculty, the Technology Innovation Center, our Applied Physics Lab and School of Medicine to make sure that there’s enough of a workforce that can staff these precision medicine centers of excellence for years to come. So, really, it’s been a wonderful trajectory and I can’t wait to see what the future holds.

Van Ton-Quinlivan: Well, Dr. Davison, for those of us who are not trained in medicine, this area of precision medicine sounds so interesting. Could you just give our audience an explanation of what precision medicine is, or maybe an example?

Dr. Ashwini Davison: Absolutely. So, Van, precision medicine takes us past the one size fits all approach that traditionally been used in healthcare. Because of big data, because of cloud computing, because of our advanced understanding of genomics and proteomics, the potential to equip providers in the health care system with information about an individual’s genetic makeup and background on their environment and lifestyle really has the potential to change the way we diagnose, prevent and treat disease. So, precision medicine, we always say at Hopkins, “It’s not just genomics”, even though that’s a big part of it. It’s taking into account the vast array of factors that make each of us who we are in order to really account for individual variability when managing conditions and improving the health of populations.

Van Ton-Quinlivan: It’s so exciting hearing you talk about this field. We are so delighted to have you, a pioneer working on cutting edge areas, joining us today. One of the fields you are empowering people to pivot into is clinical informatics and, in fact, you are board certified in that field. Help our listeners understand what it is and what role it plays in the provision of care, but also the business of care.

Dr. Ashwini Davison: Happy to do so. As a fellow of the American Medical Informatics Association, I, of course, want to make sure that I point out that AMIA has published the definition of what biomedical informatics is. It’s a question that often comes up, whether it’s with medical students or other faculty, Van, because informatics is a term that certainly has been thrown around. And so I really want to take a moment to provide the definition from AMIA, which is “biomedical informatics is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information and knowledge for scientific inquiry, problem solving and decision making driven by efforts to improve human health.” I state that broad definition, Van, because I think it’s important for folks to have a sense of the broad scope and breadth of the discipline and to understand that it’s much more than just theoretical. There’s technology involved. There’s a human and social context involved. I’m proud to be an individual who was in the second cohort of physicians who received subspecialty certification in clinical informatics. When I was a resident, this wasn’t even a possibility. But in 2014, I was able to take my subspecialty board exam, because I’m already boarded in internal medicine, and I’m proud to be one of only several thousand around the globe with this particular distinction — being a diplomat in clinical informatics.

Van Ton-Quinlivan: Well, you are a diplomat in the future of care. I suspect, because you had mentioned you had worked on algorithms in the past, that there will be applications of artificial intelligence and machine learning pertinent to clinical informatics. But let me confirm by asking you, what do you see?

Dr. Ashwini Davison: There are many applications of artificial intelligence and machine learning and it’s not just the future of care. A lot of that is being explored and piloted now, whether it’s related to diagnostics, therapeutics, preventive medicine or creating learning health systems, where every day the data and the lessons being learned are feeding back into the health system to make the delivery of care and to improve patient outcomes without waiting 17 years for something to necessarily, you know, go from research to being incorporated into practice. So, what I will say, Van, is although AI and machine learning are gaining increased attention, there is certainly work that’s remaining to be done in determining the specific skill sets for AI-related education.

One of the most widely cited papers when it comes to competencies in clinical informatics is from Hersh et al, who published on this topic of 21st century clinicians and what they need to know regarding clinical informatics. Although the original set of medical student competencies in informatics was published by the group several years ago, it was in 2020 that they added in a 14th competency.  This was regarding the need to have medical students be able to apply machine learning applications in clinical care, including being able to discuss the applications of artificial or augmented intelligence in clinical settings, and the ability to describe the limitations and potential biases of data and algorithms. So, Van, this is an exciting time where we’re starting to see the competencies and skill sets trickle down. It will be a little while longer until it makes its way to accreditation bodies, but we’re starting to incorporate those lessons into medical student education in the United States today itself.

Van Ton-Quinlivan: That makes for a very different type of medical student. How interesting. Now, I’m curious, Dr. Davison, Futuro Health is all about creating opportunity and not everyone can go the distance to a masters, a bachelor’s degree or the medical education. Are there any sub-baccalaureate paths to entering the clinical informatics field as a way to get started?

Dr. Ashwini Davison: I really like how on the Futuro Health website you talk about how in the 1970s only one in four jobs required any post-secondary education but today, two in three jobs require at least some post-secondary education. Yet, when it comes to allied health care professionals and the workforce, we’re seeing shrinking budgets and increased demand in the workplace, rising student loans and student debt and I think this concept of ensuring that we have a workforce that might not go the distance is very important. And that’s where I will always be so thankful for this partnership with Futuro Health and Coursera. When we first got the call at Johns Hopkins, I guess it was April or May of 2020, from our partners at Coursera saying that there was this opportunity to enhance workforce development with health care I.T. support roles, we knew we wanted to jump on this opportunity.

It was really a call to arms early in the pandemic, and what a labor of love it was to put this specialization onto the Coursera platform. They are, of course, a leader in Massive Online Open Courses or MOOCs. To be able to partner with your teams at Futuro Health to ensure that there was accessible learning available for entry-level positions as end user computer support specialists who could work at a healthcare help desk or rise to an analyst role, that was really meaningful to us. Part of what we did in designing that course was making sure that individuals had a sense of the various roles in I.T. support that are common in health care I.T. and the critical role that they can play in many different health care venues. That it’s not just the clinic, the hospital, and the emergency room, but the skilled nursing facility, ambulatory surgical center, virtual care setting, or even a patient’s home where health care I.T. support roles are crucial in no small part due to the pandemic. On any given day, health care I.T. support staff interact with nurses, physicians, pharmacists, and physical therapists, and I really am glad that in this era where there’s an openness to digital learning we’ve been able to put this MOOC online and it doesn’t require someone to have any credentials in advance. They can finish this up, go on to the Google IT professional certificate, put that together with the IBM training that Futuro Health has offered, and really put their best foot forward in seeking out an entry level job.

Van Ton-Quinlivan: We are so pleased to be in this partnership with you and Coursera. The education you created really is unlocking opportunity for hundreds of individuals, adults, who’ve begun to enroll.  I hope over time they will make the distance and move into bachelor’s and master’s and more advanced degrees.

Dr. Ashwini Davison: Van, it’s so interesting! I was just looking at it this morning and on the Coursera platform, we’ve actually had over 13,000 recent views of that specialization that we just launched a few months ago. The exciting thing is once you finish that specialization, those individuals might be going for their first job interview and they’ll have upward mobility or they can access some of our more advanced specializations.  For example, our health care informatics five-course specialization that includes a capstone. That’s something that we launched about two years ago, and we’ve actually had over 13,000 individuals enrolled in that. So, because of cloud computing, because of Internet access, because of the rise of MOOCs, I think this upward mobility is something that will continue to be a possibility no matter where someone is starting from.

Van Ton-Quinlivan: One of the things we discovered in our years of working in workforce development was that there was such limited awareness for all these wonderful careers that are out there. You know, over the dinner table, a typical family may talk about becoming a doctor or an engineer or maybe a nurse, but very few people talk about becoming a specialist in informatics, for example. So, whatever we can do to expose people to the range of careers, I think it’s wonderful in terms of setting them on a path to opportunity. Now, Dr. Davison, it’s been said that “data is the new gold”. Do you believe this to also be true in health care? Can you give some examples of how or where this is becoming true?

Dr. Ashwini Davison: So, Van, I do think that data is gold, but I would have to say it’s not new gold in medicine. It’s been the gold, but just hasn’t been tapped into as widely and as effectively as it could be. As with other domains, data in medicine lets us have a comprehensive view of what’s happening at the patient level, at the population level, whether it’s with dashboards or alerts.  We are able to detect anomalies, whether it’s cybersecurity issues related to ransomware or abnormal breathing patterns in Covid-19 patients who are admitted to the hospital. We can identify the root causes of complex systems and improve our ability to diagnose conditions. I talked about precision medicine and the ability to provide targeted treatments, but perhaps what’s most exciting, of course, is predicting the future. Now, I’m not just talking about who’s going to be hospitalized in the next 30 days. That’s so 2010. (laughs) What I’m really talking about is at the molecular level, predicting who’s going to benefit from a treatment. Who isn’t? Reducing inefficiencies and wasted treatments. Moving away from this trial-and-error approach. Data and the role of cloud computing is going to be invaluable in making that a reality, a more widespread reality across health care.

Van Ton-Quinlivan: Let’s talk about mobile devices for a second. It’s surprising how much data people are willing to collect via their mobile devices. What are your favorite examples and do you see a future where this type of data can be of value in health outcomes?

Dr. Ashwini Davison: With smartphones being ubiquitous in society today, the potential for deriving actionable insights from big data has never been greater. When it comes to mobile health, what I find truly promising is when companies partner together to bring the best of both their worlds. Just like health care has been so siloed, I think that when it comes to mHealth, one of the challenges has been the siloed approach that’s historically taken place where one particular vendor has a strength in one area and another one has another, and before you know it, a health system is having to partner with multiple different vendors and there we go, repeating that historical pattern of siloed health care. But things are changing. A recent example would be the Livongo and Teladoc merger in the summer of 2020. Full disclosure: I’m a clinical advisor for Livongo and have consulted for them since 2015. But I bring up the strategic partnership because I think it’s a great example of how you can have one particular organization expert in telemedicine with a footprint in the industry, and the other with this domain expertise in smart glucometers, ambulatory blood pressure monitoring, and all of a sudden you take one plus one and it doesn’t equal two. It equals three. The great thing is, the outcomes aren’t something just of the future, but there’s already reports and published data on how health outcomes have been improved. I think as adoption, as awareness with providers, and as patient preferences continue to be taken into account, the value of the nudges provided by these types of platforms will only increase.

Van Ton-Quinlivan: At Johns Hopkins School of Medicine, you’ve launched and enhanced a variety of degree and certificate programs and are a proponent of applied learning. In the world of workforce training, applied learning is the only way to go. Tell us some examples of the changes you’ve made.

Dr. Ashwini Davison: So, I have to credit my partner in crime at Johns Hopkins, Paul Nagy. Paul is a force and the deputy director of the Technology Innovation Center. He’s an associate professor, and has really spearheaded the initiative to making the precision medicine analytics platform more accessible to medical students, graduate students, faculty and staff. PMAP, as we call it, was launched to users at Hopkins in May of 2019. It’s a secure analytics environment that allows clinical researchers to identify relationships in different data types so that they can understand and transform the treatment of diseases. Talk about applied learning, right, Van? It’s one thing if we have a multiple-choice quiz question that says “Would you use an ICD-10 code to identify a patient with diabetes or would you use a CPT code or a DRG?” We can ask questions about standardized vocabularies, people can choose multiple choice questions, or we can give them access to a database of sixty thousand de-identified patients with asthma and see, “Hey, in this asthma population, can you identify the patients with diabetes by actually writing the code and querying the platform?”

That’s how we’ve really gone from this knowledge and recall based approach to active learning experiences where the students are working together to query the platform and gain experience with the entire arc of data science. I just think that is something that’s invaluable when it comes to training the workforce of healthcare I.T., precision medicine and clinical informatics of the future.

Van Ton-Quinlivan: What a wonderful example of applied learning. We had Dr. Walter Greenleaf of Stanford appear on one of our prior podcasts. He was very bullish on the use of virtual simulations — like augmented and virtual reality — for the treatment of various mental health issues and for instruction and learning. Where do you think this rise in virtual learning can make medical education better?

Dr. Ashwini Davison: First off, Walter is brilliant and has been so prolific when it comes to medical applications of virtual reality technology. And I’m, of course, glad that you had someone from my alma mater on the podcast already. So, it’s amazing, right, Van? The global augmented reality and virtual reality market is projected to account for revenue of over one trillion dollars in 2030. Although gaming has led the way, as my elementary aged son can tell you (laughs), the use in healthcare and e-commerce is something that certainly has plenty of potential. Actually, I think the global virtual reality in healthcare market was only valued at two billion dollars in 2019, but is projected to reach 33 billion dollars in the next seven years. What I’ll say is, as a physician advisor for the Technology Innovation Center at Johns Hopkins, one trend I’ve noticed is that as we have entrepreneurs join our accelerator program for early-stage medical software, a lot of the pitches have moved in this direction of VR. Seeing the trends in pitches each year has always been a harbinger for larger industry trends, in my opinion. And what I’ve been seeing is a rise of virtual reality health care startup ideas in pain management, patient care, education and training, rehab, therapy and plenty in the realm of behavioral health. So, I’m with Walter when it comes to feeling bullish on that.

Van Ton-Quinlivan: Prior to the pandemic my experience was that higher education faculty, in general, did not embrace teaching online, just as doctors were slow to embrace telemedicine. Of course, the pandemic didn’t give anyone a choice but to go virtual. One of your roles is guiding faculty to be more effective in teaching online. What has that been like and what are some of the key strategies you impart to them?

Dr. Ashwini Davison: Thanks for asking, Van. I think it’s time I shared with you perhaps what, to date, has been the most intense, challenging, yet exhilarating and rewarding time of my professional career. Everyone has their own “what I was doing when the world shut down as a result of Covid-19 story”, but if I can take a moment to share with you, in March, President Ron Daniels of Johns Hopkins University put the announcement out there that we were closing campus. I felt that it was truly a call for me to play an important role in helping our medical school go online. Because, like I mentioned at the beginning, Van, I’d been doing online education both in the School of Public Health and the School of Medicine for many years, but so many of my colleagues hadn’t been. So, on “day one” itself, after we canceled classes, I was able to support our associate dean in the medical school and became a part of our core Distance Learning team setting up virtual command centers and partnering with our Office of Online Education, and supporting the faculty who had never used Zoom, or perhaps hadn’t recorded a voiceover for a PowerPoint on their own before. This was such an intense time period in March where we have these brilliant 70-year-old physicians who might not be able to see on their keyboard where to click to share their screen in Zoom. It was a lot of handholding, setting up the virtual command center and then eventually getting it to scale.

It was an intense time and I will always be so proud of playing a part in getting our fourth-year medical students to be able to graduate by contributing to the 27 new electives that were designed in order to create these opportunities for them to still learn, whether it be telemedicine, ethics of Covid-19 or applications of informatics for tackling novel infectious diseases. Talk about workflow reengineering! It took a virtual village to get the medical school online and I will always remember those seven days a week, 15-hour days of supporting the institution in a role that, again, hadn’t been created before. There was no guidebook. But everyone came together and we were able to really learn a lot.

Van Ton-Quinlivan: Well, congratulations for making lemonade out of a lemon. Let’s end by getting your prediction on the future of care. Let’s have you look ahead at the 5-to-10-year horizon. If you were advising a friend’s niece or nephew who’s starting out on the vast opportunities out there in health and medicine, what is your advice to them now?

Dr. Ashwini Davison: I think I have seven key tips that I would want to pass along. One of them is to gain familiarity with cloud computing, machine learning and artificial intelligence. The second tip is, what I just said doesn’t mean that you need to be solely concentrated in those fields. Find a home in healthcare — be it medicine or social work or psychology or nursing, any allied healthcare profession — but complement that domain expertise with some additional context and learning in these technological domains. Tip number three, focus on the “omics” — genomics, proteomics radiomics. Precision medicine is here to stay and will be playing an important role in the delivery of care and patient outcomes at a rapidly increasing rate in the years to come. Tip number four, in every aspect of healthcare, come to the scenario asking yourself “How can I help ensure that all of the players are working at the top of their license?” We have a lot of inefficiencies in health care, Van, and I think those who will be most successful are the ones who can really take a systems thinking approach and move beyond the status quo. Tip number five, in most of the positions I’ve had in my career, there wasn’t a predecessor that handed me a rule book. Be a quick study and you’ll be OK. Number six, don’t burn bridges. Upward mobility means that the person reporting to you today or taking your course today could be conducting your annual review in five years. And finally, I would just say for anyone interested in clinical informatics and health I.T., be rest assured that when you’re done with the particular course, or a quarter, a certificate, a credential or a masters, that’s not the end of your training. You will receive plenty of on-the-job training when you start a new role and it’s just the beginning of the next step in your journey.

Van Ton-Quinlivan: Seven awesome tips! Thank you very much, Dr. Davison, for being with us today.

Dr. Ashwini Davison: Thank you so much for having me, Van.

Van Ton-Quinlivan: I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future-focused workforce in America.