Vishnu Mohan

VishnuMohan
Office: BICC 409
Phone: 503.494.4469
Fax: 503.346.6815
E-mail: mohanv [at] ohsu [dot] edu

Biography

Vishnu Mohan, MD, MBI, MBCS, FACP

Program Director, clinical informatics subspecialty fellowship

Dr Mohan is a clinical informaticist and primary faculty at DMICE. He is board certified in internal medicine and clinical informatics, and a graduate of the certificate and MBI programs at DMICE. 

He is a clinician, an educator, a researcher, and an avid gamer (not necessarily in that order, as he is quick to point out). He is also a Qel. That's Klingon for physician, as any hard-core Trekkie can tell you. ("For a while, every time I entered a patient's room," Mohan says, "instead of my usual "how can I help you today?" I would start each visit with "please state the nature of the medical emergency". With the exception of a single medical student who was rotating with me at the time, no-one else got it. Alas.")

Mohan studied medicine at Maulana Azad Medical College, the University of Delhi. "It was a weird experience because I entered medical school when I was a teenager", he says, "and to this day I think it was a little strange to be legally allowed to prescribe morphine to patients when I wasn't even legally old enough to drink beer."

After finishing med school, Dr Mohan then decided to pursue further training in the US. "On the one hand, I didn't really want to leave India," he says, "But on the other hand, there was a huge brain drain occurring at the time –almost everyone I knew from med school was emigrating either to the US or the UK. I grew up for a while in the UK (if anyone from Moss Hall Junior School in Finchley, London reads this, email me!), so it made more sense at the time to try and experience life in the US. So I thought to myself, 'my 5-year mission is to explore strange new worlds, to seek out new life and new civilizations…'"

And sure enough, he boldly went where no Mohan had gone before –to Pittsburgh, PA, to be precise, where he completed his residency in internal medicine, and started clinical practice.

"I was perfectly happy in Pittsburgh," Mohan says, "that place has a way of creeping up on you, and soon you say "yinz" instead of "you all" and "pop" instead of "soda" and words you never knew existed like "dippy" and "doll baby" n'at. And finally you begin to enjoy your French fries *in* your sandwich rather than on the side (if anyone reading this happens to be going to Primanti Brothers soon, send me a care package!) and then one day you cut yourself and this unfamiliar black and gold fluid drips out of your veins and that's when you realize that you no longer have Georgia on your mind…"

But alas, Mohan's wife (who used to live in Georgia at one time) had other ideas, and he ended up in Portland working for Legacy Health, where he practiced internal medicine, was on the faculty of the internal medicine training program at Emanuel and Good Samaritan Medical Centers, precepted residents, and served as clerkship coordinator at Good Sam for medical students from OHSU and Western University of Health Sciences. "As time went on I got sucked in more and more into GME", he says, "mainly thanks to Stephen Jones MD, who was Chief of Medicine at Legacy and who got me hooked on resident and med student education, and in teaching diagnostic reasoning."

Mohan served as associate program director program director for medical informatics for the Legacy internal medicine training program before moving to OHSU. During that time he won multiple teaching awards, including the Dean L McGinty MD Faculty Teaching Award in 2006 and the Best Outpatient Faculty Award for 2010."

The funny thing about teaching awards is that you are humbled and awed when you get your first award, and after a while when you steadily get a bunch of them, why then you are humbled when you attend a resident graduation ceremony and *don't* get an award. But seriously, I am fortunate to have the opportunity to receive the approbation of my students, and continue to be awed by the trust and appreciation that the endorsement of every teaching award entails."

Dr Mohan was involved in the design and implementation of a comprehensive electronic health record while at Legacy Health, and his interest in clinical informatics prompted his enrollment in the clinical informatics program at OHSU in 2006, where he earned a certificate and then a MBI in 2009. "I was rounding on patients at the ICU at Meridian Park Hospital," he says, "and Joan Ash (Professor at DMICE) showed up with a giant retriever in tow (it was a therapy dog, and Joan's husband Paul is an eminent local neurologist and a colleague). One minute I was writing orders on a patient, and the next minute I was being licked by a friendly dog and this strange woman materialized behind me and proceeded to tell me that both she and her husband thought I should sign up for the informatics program at DMICE, and that I should call Andrea (Ilg, our Educational Programs Administrator) and enroll. It was a surreal experience, and while it was nowhere as profound as the Constantine's vision in 312 AD at the Milvian Bridge before his battle with Maxentius, it was profound enough that I ended up calling Andrea the very next day (and if you are on the fence about formal informatics training, and reading my story was surreally profound enough to influence you too, then you can reach her at 503 494 2547!). And you know this is a true story, because you can't make stuff like this up even if you try."

At the time, OHSU was awarded a rather large grant by the Office of the National Coordinator for Health IT (ONC) that set up the infrastructure to create curricular materials that would be used by consortia of community colleges to build and deploy courses for entry level HIT workers to bolster the nation's clinical informatics workforce. DMICE Chair Bill Hersh convinced Mohan that this was a worthy challenge, and that "the needs of the many outweigh the needs of the few", and so Mohan became a full-time assistant professor in DMICE in 2010.  

While his primary appointment at OHSU is with the Department of Medical Informatics and Clinical Epidemiology, his secondary appointments are in General Internal Medicine and with the Division of Management. Mohan says, "In retrospect, accepting Bill's offer was probably the best decision I ever made, because I am now in the fortunate position of having an extraordinary amount of professional fulfilment associated with the ability to grow in many different dimensions rather than just in one (clinical) plane."

Currently, Mohan teaches three courses in the biomedical informatics graduate program. In BMI 512, Clinical Information Systems, offered twice a year, he teaches both basic concepts and practical applications of clinical information systems, with emphasis on electronic health records. "BMI 512 is probably one of the most valuable clinical informatics experiences you are going to have at DMICE as a student," he says, "whether you are signed up for the certificate, the masters or the PhD program, this course has something that will prove to be useful to you."

The related BMI 513 course, which Mohan teaches twice a year, is an electronic health record laboratory, which introduces students to an electronic health record and familiarizes them with the clinical informatics operating environment. "I realized that we had students at DMICE who would complete advanced formal training, such as the masters of PhD programs and throughout their time at DMICE they would never get their hands wet with an EHR", Mohan says, "and it became increasingly important to make sure we would be able to give them the opportunity to interact and get hands-on exposure to an EHR. The EHR lab course that I developed originally utilized the VistA, the EHR used by the VA, but DMICE was fortunate to partner with Epic Systems and offer educational activities, and so we now offer students in BMI 513 the opportunity to interact with Epic."

Finally, each winter term Mohan teaches BMI 560: Design and Evaluation in Health Informatics, a required course that provides an overview of the concepts, vocabularies, and strategies needed to design and evaluate projects in biomedical informatics. "What BMI 560 really is at its core is a methods course," Mohan says, "and I try to familiarize you with the tools that you will find useful when designing and evaluating the informatics projects you will encounter in your professional career, whether you are doing research or engaging in operational informatics."

Dr Mohan also teaches in the OHSU-PSU Joint MBA in Healthcare Management program, where his course "Healthcare IT for Managers" is an informatics survey course designed to familiarize managers and future leaders in healthcare with IT-related concepts, which Mohan says is important because "not only does it help them sound knowledgeable during meetings, but it also helps them to be active agents of change in a complex and often dangerous technology-rich environment."

In addition to his clinical responsibilities at OHSU, Dr Mohan continues to be faculty at Legacy Health –he says "although my heart now beats for OHSU, careful auscultation reveals that there's a small area over my left ventricle where the heart sounds always spell Legacy."

With respect to research, Dr Mohan is interested in how clinicians make decisions, how they interact with technology, and how technology influences their decision-making. He is also passionate about improving patient safety, and actively pursues research interests that espouse the safe delivery of healthcare. "It's funny," he says, "when I was in residency I thought that the EHR would save healthcare and make it safer. As I have grown older and wiser, I have realized that the addition of extra layers of technology to fix the issues often caused by technology in the first place is probably not the best way to do things."

He was associated with Joan Ash's POET team at DMICE, and was involved, amongst other activities with the group, in developing the ONC-sponsored SAFER guides. He has also become increasingly interested in using high-fidelity simulation to improve the use and safety of electronic health records. With Jeffrey Gold MD, Professor of Medicine and Director of the new state-of-the-art Simulation Center at OHSU, he uses eye-tracking hardware and software to examine clinician interactions with the EHR interface. "This is the first step in achieving our ultimate goal, which is to build a Voight-Kampff machine." he says, "Such a machine will not only help us identify Replicants, but also generate royalties that will allow us to retire to the new life that awaits us in the off-world colonies - a chance to begin again in a golden land of opportunity and adventure! And in the meantime, if our research helps make healthcare safer by reducing clinician-generated errors, why then that's good too."

Mohan also serves as the Director of the ACGME accredited OHSU clinical informatics subspecialty fellowship program, which began in July 2015. "Throughout my professional career, I have always been a part of established medicine and graduate medical education," he says, "and yet now I find myself in a strangely unfamiliar place, at the Final Frontier of GME –clinical informatics is a brand new subspecialty, far away from the Voyage Home, where First Contact with other (equally new) clinical informatics GME programs is few and far between. The only thing that we are afraid of as we chart this Undiscovered Country is the Wrath of Khan ACGME. And the challenge associated with standing up a brand new fellowship and clinical discipline is a big reason why this new voyage is so very exciting and interesting."

In his spare time, Dr Mohan likes to travel. Like any other observant high-level night elf druid, he first spends some time at Moonglade and hangs out with his Cenarion Circle buddies before heading out to explore more exotic locations in Azeroth.

Selected publications:

1. March CA, Scholl G, Dversal RK, Richards M, Wilson LM, Mohan V, Gold JA. Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes. Journal of Graduate Medical Education 2016 8:2, 237-240

2. Mohan V, Scholl G, Gold JA. Intelligent Simulation Model To Facilitate EHR Training. AMIA Annu Symp Proc. 2015;2015: 925–932.

3. Doberne JW, He Z, Mohan V, Gold JA, Marquard J, Chiang MF. Using High-Fidelity Simulation and Eye Tracking to Characterize Workflow Patterns among Hospital Physicians. AMIA Annu Symp Proc. 2015;2015: 1881–1889.

4. Redd TK, Doberne JW, Lattin D, Yackel TR, Eriksson CO, Mohan V, Gold JA, Ash JS, Chiang MF. Variability in Electronic Health Record Usage and Perceptions among Specialty vs. Primary Care Physicians. AMIA Annu Symp Proc. 2015;2015: 2053–2062.

5. Gold JA, Stephenson LE, Gorsuch A, Parthasarathy K, Mohan V. Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation. Health Informatics J. 2015 Jul 3. [Epub ahead of print]

6. Ash JS, Sittig DF, McMullen CK, Wright A, Bunce A, Mohan V, Cohen DJ, Middleton B. Multiple perspectives on clinical decision support: a qualitative study of fifteen clinical and vendor organizations. BMC Med Inform Decis Mak. 2015 Apr 24;15:35.

7. Lehmann CU, Longhurst CA, Hersh W, Mohan V, Levy BP, Embi PJ, Finnell JT, Turner AM, Martin R, Williamson J, Munger B. Clinical Informatics Fellowship Programs: In Search of a Viable Financial Model: An open letter to the Centers for Medicare and Medicaid Services. Appl Clin Inform. 2015 Apr 15;6(2):267-70.

8. Valerius J, Mohan V, Doctor D, Hersh W. Collaboration leads to enhanced curriculum. Appl Clin Inform. 2015 Mar 25;6(1):200-9

9. Stephenson LS, Gorsuch A, Hersh WR, Mohan V, Gold JA. Participation in EHR based simulation improves recognition of patient safety issues. BMC Med Educ. 2014 Oct 21;14:224.

10. Mohan V, Gold JA. Collaborative Intelligent Case Design Model To Facilitate Simulated Testing of Clinical Cognitive Load. Workshop on Interactive Systems in Healthcare, 2014.

11. Lipkin M, Schoenthaler A, Mohan V. "The Medical Interview" chapter in "Behavioral Medicine in Primary Care: 4rd Ed." McGraw Hill, Inc., 2014.

12. Searight R, Gafford J, Mohan V. "International Medical Graduates and Residency Education" chapter in "Behavioral Medicine in Primary Care: 4rd Ed." McGraw Hill, Inc., 2014.

13. Hersh WR, Gorman PN, Biagioli FE, Mohan V, Gold JA, Mejicano GC. Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education. Adv Med Educ Pract. 2014 Jul 1;5:205-12.

14. Mohan V, Hersh WR. Development and evaluation of an electronic health record configuration and customization laboratory course for clinical informatics students. Stud Health Technol Inform. 2013;192:1122.

15. Mohan V, Abbott P, Acteson S, Berner ES, Devlin C, Hammond WE, Kukafka R, Hersh W. Design and evaluation of the ONC health information technology curriculum. J Am Med Inform Assoc. 2013 Jul 5. [Epub ahead of print]

16. March CA, Steiger D, Scholl G, Mohan V, Hersh WR, Gold JA. Use of simulation to assess electronic health record safety in the intensive care unit: a pilot study. BMJ Open. 2013 Apr 10;3(4).

17. Borbolla D, Gorman P, Del Fiol G, Mohan V, Hersh W, Otero C, Luna D, Gonzalez Bernaldo De Quiros F. Physicians perceptions of an educational support system integrated into an electronic health record. Stud Health Technol Inform. 2013;186:125-9.

18. Weinfeld JM, Davidson LW, Mohan V. Electronic health records improve the quality of care in underserved populations: a literature review. J Health Care Poor Underserved. 2012 Aug;23(3 Suppl):136-53.

19. Mohan V, Hersh WR. EHRs and health care quality: correlation with out-of-date, differently purposed data does not equate with causality. Arch Intern Med. 2011 May 23;171(10):952-3

20. Ash JS, Sittig DF, McMullen CK, McCormack JL, Wright A, Bunce A, Wasserman J, Mohan V, Cohen DJ, Shapiro M, Middleton B. Studying the vendor perspective on clinical decision support. AMIA Annu Symp Proc. 2011;2011:80-7.

21. Searight R, Gafford J, Mohan V. "International Medical Graduates and Residency Education" chapter in "Behavioral Medicine in Primary Care: 3rd Ed." McGraw Hill, Inc., 2008

Grants and awards:

Current research support:

-Agency for Healthcare Research and Quality (AHRQ) - EHR solutions for accurate reporting of data on interprofessional ICU rounds. Creating toolboxes to facilitate the creation of EHR generated rounding tools.

-Association of American Medical Colleges / Donaghue Foundation - Electronic Health Record Simulation to Improve Communication and Safety in the Intensive Care Unit. Utilizing EHR simulation to improve quality and function of interprofessional ICU Rounds. 

-Agency for Healthcare Research and Quality (AHRQ) - Use of Simulation to Improve Use and Safety of Electronic Health Records. Using high-fidelity simulation to improve EHR safety. 

Completed research support

-Office of the National Coordinator for Health Information Technology (ONC) - Safety Assurance Factors for EHR Resilience (SAFER) Project. Developing tools to improve EHR safety. 

-Office of the National Coordinator for Health Information Technology (ONC) - OHSU HITECH Curriculum Development Grant / National Training and Dissemination Center. Developing health information technology curricula for informatics training programs as well as serving as the National Training and Dissemination Center. 

-Agency for Healthcare Research and Quality - Clinical Decision Support Consortium. Creating and providing clinical decision support tools and services, defining best practices of CDS deployment and knowledge management lifecycle. 

-National Library of Medicine Clinical Decision Support Community Hospitals Grant. Developing best practices for clinical decision support (CDS) 

-National Library of Medicine Clinical Decision Support Community Hospitals Grant. Developing best practices for clinical decision support (CDS).