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James E Gray, MD

Contact Information

Professional Interests

Innovative uses of clinical informatics methods
Patient Safety
Family Centered Care
Economic analysis

Biography

My major focus is on advancing patient safety and improving the quality of newborn care. To this end, I develop innovative improvements to neonatal intensive care and the methods used to assess them in a rigorous program of research that has been recognized at the local, regional and national levels. This work has been supported by 4 million dollars in federal and foundation support and has resulted in invitations to serve as a faculty member and consultant to national quality and safety organizations.

I have leveraged my unique combination of clinical care, informatics, epidemiology, and health services research skills to create novel approaches to significant clinical problems. In 1996, I helped to pioneer the use of WWW technologies in medical care with the creation of Baby CareLink. This uniquely multifaceted telemedicine application leveraged emerging information technologies including the WWW and videoconferencing to support to families of high risk newborns. Our evaluation demonstrated the feasibility and value of Baby CareLink in NICU care. Commercialization of this system lead to its use in NICUs nationwide and resulted in spin-off projects in adult cancer care.

With expanded use of the electronic health record (EHR), my work has capitalized on innovative uses of data routinely collected during patient care to promote improvements. I helped to improve newborn screening effectiveness throughout Massachusetts by detecting unexpectedly high rates of failure to screen among NICU patients and well newborns discharged home early. I worked with state, regional and hospital leaders to implement successful programs to decrease incomplete screening in these high risk situations. In addition, I used EHR data to uncover and quantify the risks of NICU patient misidentification. As a faculty member of the Vermont-Oxford Network, these results have been applied in work with leaders from across the country to reduce the risk of NICU patient misidentification.

I am currently leading work that seeks to understand the complex clinical and operational systems that exist in healthcare using methodologies drawn from systems and complexity science. I have created new paradigms for examining dissemination strategies for new device technologies. In this work, we have demonstrated that agent based modeling provides a powerful approach to understanding regionally distributed systems of care. This approach is likely to prove useful in policy-making for neonatal care, emergency services, and health services in emerging medical systems. Along with Dr. Steven Ringer and others in the Department of Pediatrics, I am exploring how this type of modelling could be used to create a more rational approach to the provision of neonatal intensive care and transport services in Northern New England.

Finally, I am applying network analytic techniques to data collected incidentally by an EHR to understand the impact of clinical care team structure on episodes of preventable harm in newborns. I am leading the tool development that will both bring these analytic methods into the mainstream of clinical quality improvement and safety efforts. The broad-based value of these approaches is signified in part by my recent development of collaborations and funding to expand the use of these analytic techniques to the domain of adult care. With colleagues in nursing and informatics at Dartmouth Hitchcock Medical Center I am exploring how my previously developed StaffLynx system may be incorporated into DHMC eco-system. In addition, I am working to finalize the design and implementation of a clinical decision support system that would provide suggest optimal approaches to creating shift-wise nurse patient assignments within clinical units.

In preparing this document, I note that a slight drop-off in my productivity may be seen in the period between 2015 and 2016. During this time I gained “experience” as an intensive care family member in the course of my wife’s hospitalization and subsequent care for a ruptured cerebral aneurysm. Those experiences from the initial worrisome times driving to the hospital with my children, through our emergency room, intensive care unit, rehabilitation and post discharge period were a major focus of my time. I mention these experiences not as an excuse for my activities during this time, but because they have prompted me to add to my focus on improving the family experience within the ICU and to partner even more closely with NICU parents to help the continued evolution of the interactions that exist between families and the NICU team. They have provided the impetus not just for heightened focus on these activities but also content for a series of lectures and bedside teaching used to enhance family centered care.

I believe that this collective experience provides evidence of my ability and expertise in developing pioneering efforts that capitalize on my diverse skill base to create broadly applicable innovations that change and improve care models across multiple care dimensions and age groups.