Profile in Innovation - Daniel Imler, MD
Recently, Daniel Imler, MD of Stanford’s Department of Emergency Medicine was awarded the American Academy of Pediatrics EBSCO Health/DynaMed Plus Award for Technological Innovations in Pediatric Emergency Medicine Award for his work in creating Curbside, an online physicians-first decision optimization tool.
Much has been written about the origin of discovery, particularly in Silicon Valley, but in truth, there is no easy formula for innovation, and our emergency medicine pioneers come in all sizes. However, if you are looking for takeaways to model from Imler’s story, you will note:
· He is rarely satisfied with the status quo.
· He embraces skills that cross disciplines.
· He has a clear sense of the why.
When confronted with the variability of experience-based decision making in the emergency department, Imler embarked on a quest facilitate the rapid creation of standardized decision-making pathways.
Typically, when an institution creates a pathway, they might hold many meetings over many months to bring together stakeholders from different disciplines and divisions. Input from all sides is critical but scheduling everyone in the same room can be a Sisyphean task. To expedite, Imler created an online management system, Curbside, where all stakeholders can create, comment, and edit pathways quickly. Equally important, institutions can adopt and adapt each other pathways. “If an asthma pathway is 95% the same across hospitals, why not copy and customize?” he posits.
Imler grew up programming, a far cry from the emergency department. When he did turn to medicine, he thought he would focus on healthcare economics. It was only after he completed a pediatric emergency medicine rotation that he switched gears. Imler now serves as assistant director for Stanford Pediatric Emergency Department as well as a pediatric hospitalist at Stanford Children’s Health. Previously he has also served as physician lead of web informatics at Lucile Packard Children’s Hospital.
Through his many roles, Imler became aware that scientific knowledge was starting to outstrip an individual’s capacity to keep pace. “Our evidence base has grown so large so quickly it is impossible to keep everything in your head, especially for generalists in the ED,” he explains. His background in programming informed his decision to create an electronic remedy.
“Humans are great at making complex decisions with incomplete information,” Imler notes. “What we are not as good at are routine decisions made over and over, while constantly updating our choices with the best knowledge.” According to Imler, if this process is, to some extent, automated, physicians are freed to practice the art of medicine and to make the very human connections that are critical to extracting complex information from patients.
Knowing the Why
While the system is designed to facilitate improved care, of equal importance to Imler is the ability for physicians to gauge their work and impact. “Doctors need to know the impact of the decisions that they are making on a daily basis,” Imler comments. “The system provides feedback data that can help elevate our understanding of the impact we are having to generate a personal continuous improvement cycle.”
Currently six hospital systems are utilizing Curbside with two others incorporating the pathways into their electronic health records ordering system, with care pathways embedded in the physicians workflow.