Faculty Spotlight: Clay Musser, MD

Meet Clay Musser, MD, a DGIM hospitalist and board certified clinical informatician. Clay is a well-respected leader in the deployment of Duke’s electronic medical record, Maestro Care. He contributes significantly to clinical content architecture across the entire enterprise of Duke. Notice the impact of mentors in his career path.

How long have you been at Duke?
I arrived at Duke in 2000 as a medicine intern in the primary care / academic generalist track and finished residency in 2003. While pursuing training in medical informatics (the interface between medicine and IT), I was only loosely affiliated with the division, so when I finally joined DUH Hospital Medicine in 2009, I could really appreciate the value of having a distinct clinical home, a wonderful peer group, and strong administrative support.


What are your responsibilities in the medical center?
In addition to my clinical work as an inpatient hospitalist at DUH, I serve as a provider champion and clinical content architect for Maestro Care, representing and working for the IT needs of prescribers (physicians, NPs, and PAs). In that role, I try to serve as liaison between the clinical side and the IT side, helping to translate between them and design optimal solutions. And although many projects are intended to benefit general medicine specifically, my primary goal is to meet the needs of Duke prescribers across all departments and divisions.

A typical day of front-line clinical rounding is immersive, challenging, and rewarding, and it gives me valuable insight into the needs of the Maestro Care user. A day of informatics work is extremely varied, ranging from meetings with a wide range of clinical staff (from many departments, divisions, and disciplines) to actually getting into Maestro Care and building modules like order sets and note templates. My particular focus is on our “knowledge management” efforts to keep Duke’s order sets, alerts, and other forms of clinical decision support effective, up to date, and organized.


Will our EHR facilitate research?
Although our focus in informatics over the years has largely been on operational support — implementing systems like CPOE (by McKesson) and then Maestro Care (by Epic) and then working through the seemingly endless wish list of improvements, I remain hopeful that we can build more actual research into this work. I have yet to find an EHR vendor that actually promotes or facilitates strong informatics research, such as making it simple to randomize a decision support intervention by user or by patient. But I was impressed to learn of some recent work in cardiology to configure pop-up alerts (BPAs) in Maestro Care that appear only to a subgroup of the faculty so that the effects can be teased out. We all know how tedious and aggravating interruptive alerts can be, so I think we need a lot more research like that if we are going to achieve the potential of health IT to improve both patient outcomes and provider satisfaction.

How did you get into the field of informatics?

Musser Family

The Musser Family celebrating Duke football’s long-awaited bowl victory!

By the end of residency in 2003, I had realized my particular passion was for informatics. Duke’s formal training program of the 1990s no longer existed, but I found vital support from Duke Biomedical Engineering, who gave me great freedom in designing a relevant master’s degree curriculum, and the wonderful mentorship of Ed Hammond, PhD, the father of medical informatics at Duke (and a founding father internationally). Cardiologist Jimmy Tcheng integrated me into the burgeoning team that in 2004 started implementing CPOE (computerized provider order entry), which was a great way to apply what I was learning in class. DHTS leadership, particularly pulmonologist Mike Russell, continued to nurture my informatics work and enabled me to assist with some new developments in Duke’s eBrowser. In 2011, I was excited to start helping with the transition to Maestro Care, which finally gave Duke a complete, integrated EHR. And last year I became board-certified in the young specialty of Clinical Informatics.


How has your subject area changed or where do you see future changes? 
Change is certainly the name of the game in informatics, and we’ve all experienced the ups and downs of the EHR transition. Our pockets remind us every hour how quickly mobile computing is changing both our work and personal lives. I also hope to see us find ways to use IT to actually lessen the burden of digital paperwork, possibly by recording aspects of our clinical encounters.


Have you recently read any books that would be of interest to the division?
I found The Digital Doctor, by Bob Wachter, MD, to be a remarkable book that not only explains much of the frustration and angst physicians everywhere have felt toward technology (not just work inefficiency, but also safety concerns) but also rekindles optimism about how much we will ultimately achieve through technology to benefit both patients and clinicians.


Fun Fact!  I grew up less than 30 miles from one of the hotbeds of football — the University of Oklahoma — yet I watched very few games growing up. But now that I work for this basketball school, I find myself a football season ticket holder and part of a family of Duke alums that do their best to attend even the bowl games at the bitter cold end of the season!

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