Bio

Clinical Focus


  • Clinical Informatics
  • Neonatology

Academic Appointments


Administrative Appointments


  • Associate Program Director, Clinical Informatics Fellowship, Stanford University Medical Center (2014 - Present)
  • Medical Director, Clinical Informatics/Analytics, Lucile Packard Children's Hospital (2012 - Present)
  • Associate Medical Director, Clinical Informatics, Lucile Packard Children's Hospital (2009 - 2009)
  • Physician Lead, Neonatal Informatics, Lucile Packard Children's Hospital (2008 - 2008)

Honors & Awards


  • First Place, Innovate 4 Healthcare Challenge, Johnson & Johnson; University of Maryland School of Business (2012)

Professional Education


  • Board Certification: Pediatrics, American Board of Pediatrics (2008)
  • Board Certification, Clinical Informatics, American Board of Preventive Medicine (2013)
  • Board Eligible, Neonatal/Perinatal Medicine, American Board of Pediatrics (2012)
  • MS, Biomedical Informatics, Stanford University School of Medicine (2012)
  • Fellowship:Lucile Packard Children's Hospital (06/2012) CA
  • Residency:Lucile Packard Children's Hospital (06/2008) CA
  • Medical Education:University of Florida (2005) FL

Research & Scholarship

Current Research and Scholarly Interests


Clinical informatics: optimization of commercial EMRs to support complex clinical workflows in newborn intensive care; clinical decision support; real-time clinical dashboards; electronic sign-out tools; and IT-supported patient/family communication.

Analytics: LPCH's enterprise data warehouse; reporting of business and clinical metrics; and mining clinical data to generate new knowledge.

Projects


  • Clinical Informatics Fellowship, Stanford University Medical Center

    Location

    Palo Alto, CA

    Collaborators

    • Christopher Longhurst, Clinical Associate Professor, Pediatrics - Systems Medicine; Program Director
    • Natalie Pageler, Clinical Assistant Professor, Pediatrics - Critical Care; Associate Program Director
    • Christopher Sharp, Clinical Associate Professor, Medicine - General Medical Disciplines
    • Pravene Nath, Clinical Assistant Professor (Affiliated) , Surgery - Emergency Medicine
    • Todd Ferris, Associate CIO, SoM - Information Resources & Technology

    For More Information:

Publications

Journal Articles


  • Neonatal Informatics: Transforming Neonatal Care Through Translational Bioinformatics. NeoReviews Palma, J. P., Benitz, W. E., Tarczy-Hornoch, P., Butte, A. J., Longhurst, C. A. 2012; 13 (5): e281-e284

    Abstract

    The future of neonatal informatics will be driven by the availability of increasingly vast amounts of clinical and genetic data. The field of translational bioinformatics is concerned with linking and learning from these data and applying new findings to clinical care to transform the data into proactive, predictive, preventive, and participatory health. As a result of advances in translational informatics, the care of neonates will become more data driven, evidence based, and personalized.

    View details for PubMedID 22924023

  • Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit JOURNAL OF PERINATOLOGY Palma, J. P., Sharek, P. J., Longhurst, C. A. 2011; 31 (5): 311-317

    Abstract

    Objective:To evaluate the impact of integrating a handoff tool into the electronic medical record (EMR) on sign-out accuracy, satisfaction and workflow in a neonatal intensive care unit (NICU).Study Design:Prospective surveys of neonatal care providers in an academic children's hospital 1 month before and 6 months following EMR integration of a standalone Microsoft Access neonatal handoff tool.Result:Providers perceived sign-out information to be somewhat or very accurate at a rate of 78% with the standalone handoff tool and 91% with the EMR-integrated tool (P < 0.01). Before integration of neonatal sign-out into the EMR, 35% of providers were satisfied with the process of updating sign-out information and 71% were satisfied with the printed sign-out document; following EMR integration, 92% of providers were satisfied with the process of updating sign-out information (P < 0.01) and 98% were satisfied with the printed sign-out document (P<0.01). Neonatal care providers reported spending a median of 11 to 15 min/day updating the standalone sign-out and 16 to 20 min/day updating the EMR-integrated sign-out (P = 0.026). The median percentage of total sign-out preparation time dedicated to transcribing information from the EMR was 25 to 49% before and <25% after EMR integration of the handoff tool (P < 0.01).Conclusion:Integration of a NICU-specific handoff tool into an EMR resulted in improvements in perceived sign-out accuracy, provider satisfaction and at least one aspect of workflow.

    View details for DOI 10.1038/jp.2010.202

    View details for Web of Science ID 000289982300003

    View details for PubMedID 21273990

  • Anti-Ge3 causes late-onset hemolytic disease of the newborn: the fourth case in three Hispanic families. Transfusion Pate, L. L., Myers, J. C., Palma, J. P., Viele, M., Galel, S. A., Ferrer, Z., Gonzalez, C. L., Benitz, W. E., Garratty, G., Fontaine, M. J. 2013; 53 (10): 2152-2157

    Abstract

    BACKGROUND: The Gerbich (Ge) blood group system consists of 11 antigens carried on red blood cell (RBC) membrane glycophorins C and D; of these, Ge:3 antigen is of high prevalence, and the anti-Ge3 is found to be clinically significant. CASE REPORT: A 34-week neonate born to a Hispanic mother with anti-Ge3 developed late-onset hemolysis with hyperbilirubinemia and was successfully treated with transfusions from her mother. Relevant clinical findings and laboratory results for this case are summarized and compared to three other previously reported cases; all babies were born from a mother of Hispanic ethnicity. CONCLUSION: Hemolytic disease of the fetus and new born associated with anti-Ge3 is rare but should be considered when working up a broadly reactive RBC antibody screen in women of Hispanic ethnicity. Early identification of pregnant women with anti-Ge3 is recommended for prenatal transfusion planning and close monitoring of the newborn infant for evidence of late-onset anemia.

    View details for DOI 10.1111/trf.12027

    View details for PubMedID 23241141

  • Immunization registries in the EMR Era. Online journal of public health informatics Stevens, L. A., Palma, J. P., Pandher, K. K., Longhurst, C. A. 2013; 5 (2): 211-?

    Abstract

    The CDC established a national objective to create population-based tracking of immunizations through regional and statewide registries nearly 2 decades ago, and these registries have increased coverage rates and reduced duplicate immunizations. With increased adoption of commercial electronic medical records (EMR), some institutions have used unidirectional links to send immunization data to designated registries. However, access to these registries within a vendor EMR has not been previously reported.To develop a visually integrated interface between an EMR and a statewide immunization registry at a previously non-reporting hospital, and to assess subsequent changes in provider use and satisfaction.A group of healthcare providers were surveyed before and after implementation of the new interface. The surveys addressed access of the California Immunization Registry (CAIR), and satisfaction with the availability of immunization information. Information Technology (IT) teams developed a "smart-link" within the electronic patient chart that provides a single-click interface for visual integration of data within the CAIR database.Use of the tool has increased in the months since its initiation, and over 20,000 new immunizations have been exported successfully to CAIR since the hospital began sharing data with the registry. Survey data suggest that providers find this tool improves workflow and overall satisfaction with availability of immunization data. (p=0.009).Visual integration of external registries into a vendor EMR system is feasible and improves provider satisfaction and registry reporting.

    View details for DOI 10.5210/ojphi.v5i2.4696

    View details for PubMedID 23923096

  • Neonatal Informatics: Optimizing Clinical Data Entry and Display. NeoReviews Palma, J. P., Brown, P. J., Lehmann, C. U., Longhurst, C. A. 2012; 13 (2): 81-85

    Abstract

    Displaying the vast amount of clinical data that exist in electronic medical records without causing information overload or interfering with provider thought processes is a challenge. To support the transformation of data into information and knowledge, effective electronic displays must be flexible and guide physicians' thought processes. Applying research from cognitive science and human factors engineering offers promise in improving the electronic display of clinical information. OBJECTIVES: After completing this article, readers should be able to: Appreciate the importance of supporting provider thought processes during both data entry and data review.Recognize that information does not need to be displayed and reviewed in the same way the data are entered.

    View details for PubMedID 22557935

  • Impact of an EMR-Based Daily Patient Update Letter on Communication and Parent Engagement in a Neonatal Intensive Care Unit. Journal of participatory medicine Palma, J. P., Keller, H., Godin, M., Wayman, K., Cohen, R. S., Rhine, W. D., Longhurst, C. A. 2012; 4

    Abstract

    To evaluate the impact of using electronic medical record (EMR) data in the form of a daily patient update letter on communication and parent engagement in a level II neonatal intensive care unit (NICU).Parents of babies in a level II NICU were surveyed before and after the introduction of an EMR-generated daily patient update letter, Your Baby's Daily Update (YBDU).Following the introduction of the EMR-generated daily patient update letter, 89% of families reported using YBDU as an information source; 83% of these families found it "very useful", and 96% of them responded that they "always" liked receiving it. Rates of receiving information from the attending physician were not statistically significantly different pre- and post-implementation, 81% and 78%, respectively (p = 1). Though there was no statistically significant improvement in parents' knowledge of individual items regarding the care of their babies, a trend towards statistical significance existed for several items (p <.1), and parents reported feeling more competent to manage information related to the health status of their babies (p =.039).Implementation of an EMR-generated daily patient update letter is feasible, resulted in a trend towards improved communication, and improved at least one aspect of parent engagement-perceived competence to manage information in the NICU.

    View details for PubMedID 23730532

  • Neonatal Informatics: Computerized Physician Order Entry. NeoReviews Palma, J. P., Sharek, P. J., Classen, D. C., Longhurst, C. A. 2011; 12: 393-396

    Abstract

    Computerized physician order entry (CPOE) is the feature of electronic medical record (EMR) implementation that arguably offers the greatest quality and patient safety benefits. The gains are potentially greater for critically ill neonates, but the effect of CPOE on quality and safety is dependent upon local implementation decisions. OBJECTIVES: After completing this article, readers should be able to: Define the basic aspects of CPOE and clinical decision support (CDS) systems.Describe the potential benefits of implementing CPOE associated with CDS in a neonatal intensive care unit (NICU).

    View details for PubMedID 21804768

  • Neonatal Informatics: Information Technology to Support Handoffs in Neonatal Care. NeoReviews Palma, J. P., Van Eaton, E. G., Longhurst, C. A. 2011; 2011 (12)

    Abstract

    Communication failures during physician handoffs represent a significant source of preventable adverse events. Computerized sign-out tools linked to hospital electronic medical record systems and customized for neonatal care can facilitate standardization of the handoff process and access to clinical information, thereby improving communication and reducing adverse events. It is important to note, however, that adoption of technological tools alone is not sufficient to remedy flawed communication processes. OBJECTIVES: After completing this article, readers should be able to: Identify key elements of a computerized sign-out tool.Describe how an electronic tool might be customized for neonatal care.Appreciate that technological tools are only one component of the handoff process they are designed to facilitate.

    View details for PubMedID 22199463

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