With a background in cognitive science, health economics and public health, Elise Boventer, MD, MPH, entered medical training with a strong interest in systems improvements. When a guest lecturer to her MD-MPH program encouraged students to challenge the status quo to improve medicine, it instantly sparked her interest in the emerging field of informatics.
Patient safety researcher, “Dr. Gordon Schiff, spoke to us about asking questions, thinking about how medicine could be better and not accepting the current state as the best state—and it influenced how I wanted to approach medicine,” Dr. Boventer remembered. “Informatics pushes us to be innovative and think about how things could be different and better. Sometimes, you lose that in the day-to-day of medicine.”
Today, Dr. Boventer brings this critical thinking and data-driven mindset to both patient care and digital health initiatives as an internist and medical informatics strategist at Northwell Health. Most recently, her expertise has been instrumental in helping to lead Northwell Health’s transition to Epic as its new EHR.
Northwell Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
For Dr. Boventer, leaning into clinical informatics offers a meaningful way to influence and drive positive change in today’s challenging health care environment that continues to grapple with physician burnout and the growing complexities of patient care.
“Digital health and informatics are great ways to advocate for both patients and physicians,” she said. “Sometimes, there’s a feeling of frustration and helplessness from frontline workers in how broken the system feels. But being able to change the environment you practice in is a great way to make a tangible impact. That kind of empowerment itself is a way to combat burnout.”
Dr. Boventer also noted that the widespread adoption of EHRs, augmented intelligence (AI)—also known as artificial intelligence—and health information systems data has opened the door to improving care, patient safety and system usability in powerful new ways. That is why she encourages physicians and other health professionals to get involved in digital health initiatives to help shape the future of medicine.
From AI implementation to digital health adoption and EHR usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors. That includes recently launching the AMA Center for Digital Health and AI to give physicians a powerful voice in shaping how AI and other digital tools are harnessed to improve the patient and clinician experience.
In an interview with the AMA, Dr. Boventer discussed her journey in clinical informatics, the mentors who shaped her path and her insights on representation, leadership and reducing physician burden.
AMA: Why does the field of clinical informatics need physicians?
Dr. Boventer: There are so many flavors of informatics—it isn’t just AI, computer programming or data analytics. As a physician, you are probably already working in a system with an EHR. So, if you’re interested in quality improvement, burden reduction or using the EHR data for research, you’re probably already more familiar with, and better at, informatics than you think.
The digital health and informatics fields need clinicians, especially those still practicing. Those who have to look patients and colleagues in the eye and can see firsthand how a poor system design impacts the ability to provide quality care. No one understands these effects better than those working in a flawed system, and it’s a very unique and privileged position to be in to be able to advocate for positive change.
AMA: As a woman physician in digital health, what barriers have you faced?
Dr. Boventer: The challenges often mirror those in medicine. Like women physicians and women in STEM, it sometimes feels like you need to assert yourself or demonstrate competency earlier on.
Having already navigated that in medicine was helpful for me. My strategy has been to put in 150%, stay organized and detail oriented, and understand both the technical and big-picture issues. Usually, after people work with me for a little bit, any assumptions they had are quickly overcome.
In general, though, people are very open and collaborative in informatics, being a very interdisciplinary field. So, in some ways, it felt a little easier than starting in medicine. Of course, coming in as a physician provides some built-in credibility, so you’re not entirely starting at square one.
AMA: Why do you think it’s important to have female representation in clinical informatics?
Dr. Boventer: We know there are practice differences between male and female physicians. Studies have found that women physicians have higher rates of burnout and spend more time in the EHR outside of working hours. They also tend to receive more messages from patients, and there are often societal expectations for women physicians to be more responsive and empathetic. So, it’s crucial to have representation from women to ensure systems are built with these different practices and perspectives in mind. We also have to consider that some clinical specialties, such as primary care, ob-gyn and pediatrics, are female dominated. Those specialties may not be adequately represented without women working in digital health.
Also, many roles for physicians in informatics are also leadership positions, so having representation and mentors in these positions is important to support increasing involvement by women physicians. Many of my influential mentors have been women and I may not have gone down this path without seeing that representation.
AMA: How did your mentors help guide your informatics journey?
Dr. Boventer: During residency, I worked with Dr. Michelle Gong and Dr. Tina Chen, pulmonary critical care physician researchers working on predictive analytics and data-driven approaches to system improvements in the ICU. They taught me how to critically evaluate and leverage data to answer important clinical questions in a way that resonates with clinicians and health systems. It was through this work that reaffirmed my decision to pursue informatics fellowship.
During my fellowship, I had the opportunity to work with many influential mentors, including Dr. George Hripscak, former chair of the Department of Biomedical Informatics at Columbia. From him, I learned the importance of collaboration and open support, something that is integral to informatics, which is still a relatively small but fast-growing field. Advancements can’t be made in silos and the more connection and collaboration, the better for informatics and health care as a whole.
Also, until fellowship, my experience in informatics had been mostly research-centered and working with Dr. Richard Trepp, the chief medical information officer at NewYork-Presbyterian Hospital, showed me not only how operations differs from research, but how you can significantly and directly impact patient care and provider experience using data and thoughtful system design.
My biggest influence in informatics, though, probably has been Sarah Rossetti, RN, PhD, also in the Department of Biomedical Informatics at Columbia and chair of American Medical Informatics Association’s 25x5 Documentation Burden Reduction Task Force. We share a common interest in usability and reducing provider burden and with her guidance I’ve been able to further develop my interest and skills in this area.
AMA: How did your mentors help drive your passion for finding ways to ease clinical burden?
Dr. Boventer: Many of my mentors and colleagues all share a desire to reduce clinician burden. Even in residency, a lesson I took away from my associate program director, Dr. Serena Roth, was that one way to combat burnout is feeling empowered to enact change, which is one of the reasons I advocate for physician involvement in informatics. I also learned from Dr. Trepp to always consider the potential impact on physician burden when discussing operational or system design changes.
Currently, due to the support of Dr. Rossetti, I’ve become involved as one of the workstream leads of the American Medical Informatics Association 25x5 Documentation Burden Reduction Task Force, where we’re involved in activities around the measurement of documentation burden, burden reduction strategies and their impacts.
Being part of a national effort like the task force, with members from all over the country, different practice settings, research and operations, is another great example of the importance of collaboration and sharing of various diverse perspectives to improve the state of informatics and healthcare.
AMA: How do you see Northwell Health’s EHR implementation helping to reduce clinical burden?
Dr. Boventer: One of the main reasons health systems implement Epic is the interoperability and availability of sharing information between different inpatient and ambulatory sites. Having to call around to different clinics or hospitals to get records not only impacts patient care, but it also creates a huge administrative burden and is also seen as excessive.
Excessive burden is work physicians do that they don’t feel contributes to patient care which is more likely to cause burnout. Automating anything that falls into that category will hopefully reduce the actual time and effort spent but also the cognitive and emotional frustration that comes with having to take on tasks that you don’t feel like were necessary.
AMA: If you could reimagine one aspect of the physician technology relationship five years from now, what do you hope it looks like?
Dr. Boventer: A tenet of clinical informatics is that the computer plus the person is better than just the person. I’d like to see technology as a solution for burden, not a source of it. To get there, we need more involvement from physicians and clinicians in developing and implementing these technologies and shaping the regulations that govern them.
It’s been surprising how often I'll see an idea or an algorithm, either from industry or research, where there clearly wasn't much thought about how to integrate it into the workflow or the impact it has on physicians.
For example, if there is a new generative AI tool that summarizes data, I’d ask: How many pages long is the output that the physicians are now expected to read? When in the care process are they expected to read it and what is the liability if something is missed? And how does reading the output change management?
Usability, clinical utility and workflow integration should be considered from the very beginning, not identified as issues after implementation.
