Merging Informatics and Clinical Care: Q&A With Robert Grundmeier, MD

Dr. Robert Grundmeier received the Byron Oberst Award for his significant contribution to pediatric clinical informatics.

Editor's Note: The American Academy of Pediatrics (AAP) honored Robert Grundmeier, MD, section chief of Informatics in the Division of General Pediatrics and director of Clinical Informatics at Children's Hospital of Philadelphia, with the Byron Oberst Award at the AAP National Conference and Exhibition. The Council on Clinical Information Technology presents the Oberst Award to an AAP fellow who has made a significant contribution to pediatric clinical informatics by educating child health professionals in the use of clinical information technology, creating health policies that promote better use of pediatric clinical information systems, and improving pediatric clinical information systems. In this Q&A, Dr. Grundmeier discusses what this award means to him, and his path toward a career in clinical informatics.

What does the Byron Oberst Award represent to you?

I was honored to receive this award. To me, it is the highest award that a pediatrician working in the field of clinical informatics can receive. Byron Oberst was a pediatrician in Nebraska for most of his practice, and he made incredible contributions to pediatrics, while working in a private practice. I feel humbled to be receiving an award that's named after an individual who is truly a giant in the field.

While reading about Dr. Oberst, there was an interview in which he was asked what he thought were the three biggest things to affect healthcare during his time as a professional. His answer was "antibiotics, immunizations, and computers."

What led you to focus on pediatric clinical informatics?

It has a lot to do with the people who mentored me along the way. My first exposure to informatics was as an undergraduate at Massachusetts General Hospital. My mentor there was Octo Barnett, MD, who was one of the pioneers of the clinical informatics profession. I had a wonderful time working in his lab and learning, but then I set informatics aside while I went to medical school.

After medical school, I had an opportunity to do research with Kevin Johnson, MD, who is also involved in clinical informatics. Dr. Johnson is a prior recipient of the Oberst Award. He opened my eyes to the exciting things that could happen, specifically in pediatrics, with regards to informatics. I credit him with instilling my passion for putting together a career around informatics that aligned with my interest in pediatrics.

What do you find most interesting about how the field has evolved since you began your career in informatics?

One of the wonderful things about this profession is that you will never be bored. The field remakes itself every five years. Every so often, I take stock of what I am doing, and it often involves things that I could not have imagined would be important five years earlier. When I started doing rules-based decision support, it was state-of-the-art to write rules for expert systems to make recommendations for best care practice. Then there was a shift to machine learning approaches, where you give large amounts of data to algorithms, and those algorithms figure out what one should do in certain situations. Now, there is a focus on how we make these algorithm outputs usable and useful to clinicians.

Right at this moment, the profession is undergoing a major transition, as artificial intelligence (AI) platforms were released last fall and we are starting to grapple with the potential opportunities of using large language models as a way of supporting informatics, supporting research, streamlining clinical care, and hopefully, improving care delivery. AI platforms will change things in a way that I don't think we can fully imagine yet.

Is there a particular aspect of your work or a specific project you are most proud of?

The projects that mean the most to me are the ones that are important from a clinical perspective, not just for the sake of informatics. They are aligned with real world health problems where informatics can improve care delivery in a way such that children may have better health.

My first real informatics project was to improve immunization rates, which I worked on in collaboration with Alex Fiks, MD, MSCE, director of Clinical Futures, a CHOP Research Institute Center of Emphasis. I provided the informatics expertise in alignment with his clinical objective of improving immunization rates.

Working together, we built a system that significantly improved the vaccination rates among children in our catchment area. This immunization reminder system almost certainly prevented some cases of illnesses, particularly pertussis and influenza, due to the increased vaccination rates.

My other favorite project was also a collaboration with Dr. Fiks using patient portal technology to help asthma management. This project began when patient portals to electronic health records were new. We put together a system in which we would periodically collect surveys about symptoms from patients and provide them with care recommendations, but also use that information to engage the clinical team to reach out if someone was experiencing a deterioration in asthma symptoms. The impact of this project was quite impressive in terms of decreasing asthma flares sufficiently so that parents missed fewer days of work. Again, the clinical impact is what motivates me with my projects.

What do you think is the next big thing in the clinical informatics field?

I think large language models will come to the clinical bedside in some fashion. I'm not yet sure what form this may take, but I do theorize we will use these models to improve the way we interact with our health information technology as clinicians. One of the goals we need to keep our eyes on is how to improve the satisfaction of clinical teams who are using technology as part of their job. I am hopeful that with some of the newer tools such as large language models, we will come up with creative ways to make it much easier for clinicians and other health professionals to get their work done.

Additional thoughts?

The field of informatics is a bridge discipline that connects many disciplines together. The most interesting work involves multidisciplinary collaborations. I encourage trainees to seek opportunities to collaborate with individuals who are not in the field of informatics to bring greater relevance to their work. I also encourage mid- to senior-career individuals to make themselves available as mentors for the next generation because it's important to share the years of experience and inspiration that helped to motivate our own careers.