MedStar Researchers Use Visualization Dashboards to Enhance Situation Awareness of COVID-19 Telehealth Initiatives

A collaborative team of researchers from across MedStar Health published a case report which examined the need for improved situation awareness of all telehealth operations to effectively monitor and proactively manage patient experience, healthcare provider experience, and platform performance.  The team included investigators from MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, MedStar Simulation Training and Education Lab, MedStar Telehealth Innovation Center, and Georgetown University School of Medicine.

“Rapid Development of Visualization Dashboards to Enhance Situation Awareness of COVID-19 Telehealth Initiatives at a Multi-Hospital Healthcare System” was published in Journal of the American Medical Informatics Association.  The COVID-19 pandemic has required the need for prompt acceleration of telehealth programs to lessen community spread while providing safe patient care.  The researchers used a situation awareness model and five-step process to identify operational end-user needs, along with design and develop visualizations to meet those needs.  Three stakeholder groups (healthcare system executives, telehealth leaders, and telehealth managers) were identified and provided with visualization dashboards to seek their relative needs.

The multidisciplinary visualization team used a five-step process to support the launch and ongoing development of the telehealth program. The five steps were:

  • Subject Matter Expert Interviews to Increase Domain Knowledge
  • User Needs Analysis and Feature Identification
  • Processing Telehealth Data Sources
  • Visualization Design, Development, and Testing
  • Dissemination and Iterative Refinement

The results show that executive stakeholders needed weekly awareness of high-level metrics and trends to convey telehealth activity across the MedStar Health system. Telehealth leaders requested daily awareness of key operational indicators to monitor telehealth operations.  Telehealth managers and team members needed detailed information about their respective areas with the ability to diagnose where issues such as increased patient volumes, poor patient experiences, or dropped calls were occurring.

User feedback suggests the visualizations improved situational awareness and may have provided valuable information to better inform operational decisions. In the future, the researchers plan to improve data accessibility and gather more feedback from end-users for dashboard optimization.

The study team included Raj M. Ratwani, PhD; Ethan Booker, M.D; Ram A. Dixit, M.S; Stephen Hurst, Katharine T. Adams, Christian Boxley, Kristi Lysen-Hendershot, and Sonita S. Bennett, M.S.

Journal of the American Medical Informatics Association, DOI: 10.1093/jamia/ocaa161/5866982

July Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in July 2020. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation.

Congratulations to this month’s authors! We look forward to seeing your future research.

View the full list of publications on PubMed.gov here.

Selected research:

  1. Functional mitral regurgitation
    Current Opinion in Cardiology,DOI: 10.1097/HCO.0000000000000770
    Asch FM, Medvedofsky D.

  2. Infections in Burn Patients: Innovations in Infection Prevention and Treatment
    Surgical Infections, 2020. DOI: 1089/sur.2020.202
    Tejiram S, Shupp JW.

  3. Lymphoma survivors have an increased long-term risk of chronic kidney disease
    Leukemia & Lymphoma, DOI: 10.1080/10428194.2020.1786555
    Desai SH, Al-Shbool G, Desale S, Veis J, Malkovska V.

  4. Head Repositioning during Neurointerventional Procedures to Optimize Biplanar Imaging
    Journal of Neuroimaging, 2020. DOI: 1111/jon.12750
    Dowlati E, Zhou T, Stewart J, Felbaum DR, Liu AH, Mai JC, Armonda RA.

  5. Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department
    Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, DOI: 10.5811/westjem.2020.4.45918
    Nhoung HK, Goyal M, Cacciapuoti M, Day H, Hashemzadeh T, Magee M, Jarris YS.

Conflict of Interest Questionnaire for MedStar Health Researchers Joins with Georgetown

As of July 1, 2020, a single COI platform is available to all Researchers employed by MedStar Health (to include those located at MedStar Georgetown University Hospital (“MGUH”) or elsewhere on the Georgetown University campus). With the launch of a single COI platform for MedStar Health employed Researchers, the need for separate submissions through a MedStar Health platform and a Georgetown University platform will be eliminated. Both Georgetown University and MedStar Health have agreed to use the MedStar Health COI Platform for MedStar Health employed Researchers. The Questionnaire will be accessible to Researchers to submit disclosures throughout the entire fiscal year (July 1st – June 30th).

The COI-Smart platform will meet both organizations’ research COI reporting requirements. This new process will eliminate the Georgetown University COI disclosure for those Researchers who formerly completed a MedStar Health COI questionnaire and a Georgetown University questionnaire. MedStar Health and Georgetown University COI reviewers will have access to the information reported, will review transactions and implement a consolidated research management plan.

At the onset of a new study routing through MedStar Health/MedStar Health Research Institute or Georgetown University, in accordance with current practices, Researchers must update their COI questionnaire or verify that it is up-to-date. You will access the COI system in the same manner that you have in the past. If you held a research role at MedStar in fiscal year 2020 (FY20), you may have already entered data into the COISmart system during the fiscal year. If you have completed the questionnaire as a researcher during FY20, a link to the conflict of interest disclosure should have been sent to you.

MedStar Health policies require that all individuals engaged in the conduct of research complete the annual conflict of interest disclosure. The annual research conflicts of interest disclosure process is designed to manage financial and nonfinancial research interests. 

MGUH Researchers may contact Mary Schmiedel at [email protected] to establish a COI-Smart COI account. If you have any questions on the COI-Smart application, please contact Carol Mason at [email protected] or 410-772-6607 or Lauren Brummell at [email protected] or 410-772-6578.

MedStar Investigators Report on Myocardial Injury from COVID-19

MedStar Health researchers published a report highlighting two cases of COVID-19 infection with myocardial involvement with distinct mechanistic pathways and outcomes. The cases discussed the important decision strategies for these critically ill patients, such as the timing of cardiac catheterization (when indicated) and requirement of early hemodynamic support. “COVID-19 (SARS-Cov-2) and the heart – An ominous association” was published in Cardiovascular Revascularization Medicine.

Cardiovascular manifestations of COVID-19 can be diverse and complex, including myocardial injury, infarction, myocarditis simulating ST-segment elevation myocardial infarction, non-ischemic cardiomyopathy, coronary vasospasm, pericarditis, or stress(takotsubo) cardiomyopathy.  The publication discussed that based on the initial experience from Wuhan, China, that approximately 27.8% (52/187) of patients with COVID-19 exhibited myocardial injury. Myocardial injury was associated with worse out-comes of COVID-19, whereas the prognosis of patients with underlying cardiovascular disease but without myocardial injury was comparatively favorable.

The cases described in this report are patients with COVID-19 infection and myocardial involvement. The authors indicated that during the COVID-19 pandemic, management of patients with acute coronary syndrome and COVID-19 remains critically important.  Underlying cardiovascular disease and associated risk factors such as hypertension, coronary heart disease, and cardiomyopathy put patients at higher risk of developing myocardial injury during the course of their COVID-19 infection.

The team included Nauman Khalid, MD; Yuefeng Chen MD, PhD; Brian C. Case, MD; Evan Shlofmitz, DO; Jason P. Wermers, Toby Rogers, MD, PhD; Itsik Ben-Dor, MD; and Ron Waksman, MD.

Cardiovascular Revascularization Medicine, 2020, DOI: 10.1016/j.carrev.2020.05.009






Collaborative Research from MedStar Investigators Evaluates Racial Variations in Takotsubo Cardiomyopathy Outcomes

A collaborative team of researchers from across MedStar Health and partners published their work to assess the effect of race on in-hospital outcomes of takotsubo cardiomyopathy (TC) in a large nationwide sample. The team included investigators from MedStar Washington Hospital Center, MedStar Health Research Institute, MedStar Heart and Vascular Institute, Georgetown University, and National Heart, Lung and Blood Institute.

“Racial Differences in Takotsubo Cardiomyopathy Outcomes in a Large Nationwide Sample” was published in ESC Heart Failure. Takotsubo Cardiomyopathy or stress-induced cardiomyopathy is characterized by transient ventricular impairment, often preceded by emotional or physical stressors. Gender, racial, and ethnic differences have been reported with respect to incidence and prognosis of cardiovascular diseases including heart failure and acute myocardial infarction, in part due to variability in genetic, biological and socio-economic factors. Studies have reported increased in-hospital complications in African American patients presenting with TC; however, the effect of race on TC remains unknown

The research included data obtained from the National Inpatient Sample (NIS) database. Of 97, 650 patients included: 83,807 were women; 89, 624 identified as Caucasian; 8,026 identified as African American. Between the two races, demographic characteristics and insurance variables were significantly different.  African American patients were younger, having a higher percentage of men and lower median household income. The rate of TC hospitalizations increased in both races. Mortality rates initially increased from 50 cases (1–2%) to 340 cases (5–6%) and subsequently remained stable around 5–7% with fluctuations but with no overall significant difference between races.  Multivariate regression models were created to adjust for potential confounders.

In unadjusted analysis, African American patients had more cardiac arrests, invasive mechanical ventilation, tracheostomies, acute kidney injuries, and longer hospital stays compared with Caucasians.  After the adjustment for differences in age, gender, comorbidities, hospital location/teaching status, and socio-economic factors, all differences were significantly reduced or eliminated. The adjusted risk was lower in African Americans compared with Caucasians, for cardiogenic shock, mechanical ventilation and intra-aortic balloon pump insertion.

The research concluded that African American patients overall have worse outcomes including longer hospitalizations, higher rates of cardiac arrests, invasive mechanical ventilation, tracheostomies, and acute kidney injury compared with Caucasians. Overall, African American patients have more in-hospital complications; however, the differences are driven by racial disparities in demographics, comorbidities, and socio-economic factors.

The team included Raja Zaghlol,MD; Ana Barac, MD; Amit K. Dey; and Sameer Desale.

ESC Heart Failure, 2020.  DOI: 10.1002/ehf2.12664






June Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in June 2020. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

View the full list of publications on PubMed.gov here.

Selected research:

    1. Sex-Associated Differences in Cardiac Reverse Remodeling in Patients Supported by Contemporary Left Ventricular Assist Devices
      Journal of Cardiac Failure, 2020. DOI: 10.1016/j.cardfail.2020.03.005
      Mehta N, Mazer-Amirshahi M, Schulman C, O'Connell F, Pourmand A.
    2. Differentiated Thyroid Cancer and Hashimoto Thyroiditis: Utility of the Afirma Gene Expression Classifier
      Journal of  Surgical Oncology, 2020.
      DOI: 10.1002/jso.25875
      Papoian V, Rosen JE, Lee W, Wartofsky L, Felger EA.

    3. Varying Rates of Patient Identity Verification When Using Computerized Provider Order Entry
      Journal of the American Medical Informatics Association, 2020. DOI: 10.1093/jamia/ocaa047
      Fortman E, Hettinger AZ, Howe JL, Fong A, Pruitt Z, Miller K, Ratwani RM.

    4. Racial Disparity in Postpartum Readmission Due to Hypertension Among Women With Pregnancy-Associated Hypertension
      American Journal of Perinatology, 2020. DOI: 10.1055/s-0040-1712530
      Chornock R, Iqbal SN, Kawakita T.

Increased Cybersecurity Risks Related to COVID-19

Since March, organized crime and other threat actors have used the COVID-19 crisis as a basis for increased attacks on computer systems and phishing campaigns designed to obtain sensitive or personal information. 

Through social engineering, these threat actors attempt to take advantage of the COVID-19 pandemic by prompting associates to provide personal information or passwords, click on or open malicious links or attachments, or transfer money. These attacks can come through phishing emails, texts or voice calls to a workstation, smartphone, or other devices.

The threat actor may spoof a known source for COVID-19 information, such as the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), MedStar Human Resources, or a local school district. Phishing attempts may also come from vendors purporting to have or sell Personal Protective Equipment (PPE) or other supplies. 

To avoid these risks, follow these important recommendations: 

  • Take your time when reviewing email or text messages. Be careful before you click!
  • Be alert for phishing messages in your email inbox. Since phishing emails arrive from outside of the network, determine whether the email is legitimate. All external emails include a tag of [EXTERNAL] in the email subject line and a banner:

** ATTENTION: This email originated from outside the MedStar network.
** DO NOT CLICK links or attachments unless you recognize the sender and know the content is safe.

  • If you don’t know the sender and it looks suspicious, delete the email. Do not click on any attachments or links within the body of the email. 
  • Look for spoofed addresses. For example, if an email appears to come from an associate and the sender’s address is not @medstar.net, it is not a legitimate email.
  • If you receive a text message from a number you do not know, delete the text message. Do not click on any links within the text message. 
  • Report suspicious emails to [email protected] or [email protected]. Call the IS Service Desk at 877-777-8787 with any questions.

Thank you for your efforts to protect our network, important data, systems, and organization.

Conflict of Interest Questionnaire for MedStar Health Researchers

MedStar Health policies require that all individuals engaged in the conduct of research complete the annual conflict of interest disclosure. The annual research conflicts of interest disclosure process is designed to manage financial and nonfinancial research interests. As you probably know, MedStar Health Research Institute is required to manage conflicts of interests as a condition of receiving federal funding for research.

If you held a research role at MedStar in fiscal year 2020 (FY20), you may have already entered data into the COISmart system during the fiscal year. If you have completed the questionnaire as a researcher during FY20, a link to the conflict of interest disclosure will be sent to you in July. You will be required to ensure that the disclosure on file for FY20 accurately reflects any external relationships you have for the entire fiscal year. When you receive that email in July, please follow the link in that email to certify your previous disclosure if it already reflects all external relationships you have had during FY20. Use the “revision” links in the questionnaire to update your answers if necessary and resubmit the questionnaire to ensure that it accurately reflects a full fiscal year of reporting (July 1, 2019, through June 30, 2020).  As a researcher, the FY 2021 questionnaire is also available for you to complete between July 1, 2020, and June 30, 2021.

If you have any questions about the conflict of interest policy or accessing the COISmart system to make disclosures, contact Christine Kyak, Entity Compliance Officer at (202) 510-6876 or [email protected].

MedStar Investigates Point of Care Lung Ultrasound for COVID-19 Patients

Recently published research evaluated lung ultrasound findings in patients admitted to the internal medicine ward with COVID-19. “Point-of-Care Lung Ultrasound Findings in Patients with Novel Coronavirus Disease (COVID-19) Pneumonia” was published in The American Journal of Tropical Medicine and Hygiene. The study sought to diagnose and monitor patients who received point-of-care ultrasound and assess the findings.

The research was led by Kosuke Yasukawa from the Department of Medicine at MedStar Washington Hospital Center, in collaboration with Taro Minami from Care New England Medical Group and The Warren Alpert Medical School of Brown University.

Patients with COVID-19 typically present with bilateral multilobar ground-glass characteristics. Chest CT has been used in the diagnosis and management of patients with COVID-19. However, CT is not always readily available and the disinfection of CT machine after the use of a patient with COVID-19 may result in a delay of care for other patients requiring CT examination. While the utility of point-of-care ultrasound has been suggested, detailed descriptions of lung ultrasound findings are not available.

The research team retrospectively evaluated lung ultrasound images of 10 patients who received point-of-care ultrasound and were diagnosed with COVID-19. The images were stored and reviewed to determine demographics, comorbidities, laboratory, and radiographic findings. The findings showed that characteristic glass rockets with or without the Birolleau variant (white lung) were present in all 10 patients. One patient required transfer to intermediate care unit, and another patient required transfer to intensive care unit. Four of the patients required administration of oxygen via a non-rebreather mask. Abnormal lung ultrasound findings were detected in all of the patients. Two patients had septal rockets and small subpleural consolidations were detected in five patients. Although glass rockets and the Birolleau variant can be seen in patients with cardiogenic pulmonary edema, none of the patients were diagnosed with decompensated congestive heart failure.

The results found confluent B lines and thick, irregular pleural lines present in all patients evaluated. The glass rockets, confluent B lines, thick irregular pleural lines, and subpleural consolidations are likely not specific to COVID-19. However, these findings can be an aid for diagnosis during the COVID-19 pandemic when pretest probability is high.

The American Journal of Tropical Medicine and Hygiene, 2020. DOI: 10.4269/ajtmh.20-0280





Collaborative Research from MedStar Investigators Evaluates Surgical Outcomes of Minimally Invasive Surgery for Colorectal Cancer

Recently published collaborative research examined temporal trends and surgical outcomes of minimally invasive surgery approaches for colorectal cancer by hospital type. “Minimally Invasive Surgery for Colorectal Cancer: Hospital Type Drives Utilization and Outcomes” was published in the Journal of Surgical Research. The study sought to assess these relationships to improve access to high-quality surgical care for CRC patients.

The study collected data from the National Cancer Database which organizes oncology data from more than 1500 accredited cancer facilities across the United States and Puerto Rico. The main outcome variable was the performance of minimally invasive surgery for the associated cancer type. Secondary outcome variables included surgical margin, conversion to open, length of stay, 30-day unanticipated readmission rate, 30-day mortality, 90-day mortality, and overall survival. The main independent variable was hospital type and facility-level variables included location by US region, center type, and average center volume.

The results of the study found that of 234, 935 cases, 48.5% of colorectal cancer surgeries were performed in comprehensive community hospitals, 28% in academic, 12.5% in community, and 11.1% in integrated networks. Many procedures performed in community hospitals were open, while all other hospital types primarily performed minimally invasive surgery. The percentage of robotic surgeries was highest in academic hospitals (7.9%) and lowest in community centers (3.3%).

The study findings showed rates of MIS utilization overall (40.1%), as well as for laparoscopic (36.8%) and robotic (3.3%) procedures specifically, were lowest in community hospitals compared with comprehensive community (46.2% laparoscopic; 5.7% robotic), integrated network (47.7% laparoscopic; 6.8% robotic), and academic (46.3% laparoscopic; 7.9% robotic) centers.

MIS utilization rates varied substantially by hospital type for both the laparoscopic and robotic approaches however were generally lower at community centers for both cancer types. Also, compared with laparoscopic colon surgery at academic centers, community centers treated lower grade tumors with higher 30-day and 90-day mortality. In conclusion, “Future research and healthcare policy must address these trends at the community level to facilitate safe, effective access to these techniques across the US.”

This research was supported by a grant from the Georgetown Howard Universities Center for Clinical and Translational Science and The Lee Folger Foundation.

The research team included researchers from the MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute, and MedStar-Georgetown University Hospital: Anthony M. Villano MD, Alexander Zeymo MS, Brenna K. Houlihan MD, Mohammed Bayasi MD, Waddah B. Al-Refaie MD, FACS and Kitty S. Chan PhD.

Journal of Surgical Research, 2020. DOI: 10.1093/jbcr/irz168