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Thomas McGinn, M.D., M.P.H.

Tom McGinn

Thomas McGinn, MD, MPH serves as the David J. Greene Professor of Medicine, Chair of the Department of Medicine, and Senior Vice President and Executive Director of the Medicine Service Line at Hofstra North Shore-LIJ School of Medicine and Health System. Understanding that changes in care are only possible if clinical prediction rules (CPRs) are utilized at the point of care, Dr. McGinn’s current research focuses on implementation science as it applies to health IT. His recent federal grants have used the electronic medical records as a vehicle to implement CPRs at the point of care.

In this month’s Member Spotlight, Dr. McGinn discusses key steps to engaging in collaborative research, and shares information about his successes at both NSLIJHS and previously at Mount Sinai Medical Center. Learn more in the Member Spotlight Q&A below or download Dr. McGinn's ROCC Star Profile .

Q: The Research on Care Community (ROCC) highlights members and institutions who succeed in connecting and integrating research into clinical and educational efforts. Please describe a project of yours, or one at NSLIJHS, where research aligns with education and clinical goals.

A: We have several examples where research aligns with clinical goals and educational goals in our various research projects. Since our group’s focus has been on decision making and integrating evidence at the point of care, our research has an immediate impact on clinical care and clinical programs. For example, we are working on integrating an EBM tool to help make more accurate decisions regarding the need for CT angiography for patients suspected of pulmonary embolus. These forms of decision support are complex and their integration is complicated by complex workflows. We therefore need input from patients, nursing, triage providers, and trainees to make sure these tools smoothly integrate into the workflow of the emergency room.  This type of project allows us to educate our trainees on how to use EBM at the point of care and at the same time enhances the quality of our clinical care but reducing unnecessary testing and waste, which is a major focus of our group’s work. 

Q: What suggestions do you have for researchers interested in engaging/collaborating with clinicians and colleagues across disciplines?

A: Our SBRIT project crosses three disciplines; Internal Medicine, Emergency Medicine, and Psychiatry. The goal of the project was to implement an automated streamline screening for substance abuse in our emergency rooms and primary care settings across our entire health system which has over 16 hospitals and ERs. The project is funded jointly by state and federal dollars and set high expectations and targets for recruitment and referral of thousands of patients to treatment for risky behavior. The project has been an overwhelming success and has established systems for future system-wide studies. The key to the project’s success has been its interdisciplinary nature and process with shared leadership and input from all departments on the project. In addition, all three chairs from the involved departments have been fully committed to the project, have made it a priority for their departments, and have mobilized resources and focus to enable the projects to continue. Without buy-in at the top of each department and the project’s collaborative interdisciplinary nature, the project would not have been accomplished.

Q: Given your recent work on examining how usability testing can improve implementation and adoption of clinical prediction rules, what are the biggest opportunities for health IT? What are the biggest barriers?

A: True meaningful use involves the frontline decision making processes that providers engage in all day. We as a medical community have not truly harnessed the full capabilities of the EMR - to help providers make rapid evidence based decisions. Realizing the full potential of EMR will take research and significant funding into usability testing and workflow analysis. Each area of care; primary care centers, ERs, radiology offices, private or public settings, teaching or nonteaching environments, all have different challenges to overcome in the usability process and need to be studied and addressed.

Q: In a recent ROCC member polling, the top three reported critical issues facing implementation researchers were funding/protected health professionals’ time, health system priority setting, and access to/integration of clinical and administrative data. Please share a project which successfully overcame one of these barriers.

A: Priority setting for a large health system is extremely important. We aligned our projects with the concerns of the health system. Examples of studies we are engaged in are: over utilization of CTA in the evaluation of pulmonary embolus, risk stratifying patients for risk of thrombosis in the inpatients setting, and identifying high risk patients for developing C-Diff diarrhea.  All three projects align with health system initiatives and concerns. We can then use health system resources to address these concerns while we attempt to get independent funding. Still barriers and difficulties occur in collecting data and finding protected time for interested faculty. But as we gain success and build infrastructure, each project has become easier.