William M Tierney

Regenstrief Institute, Inc., Indianapolis, Indiana, United States

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Publications (406)1954.04 Total impact

  • Sian Chisholm · Aatish M Patel · William M Tierney · Mohammad Madhoun ·
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    ABSTRACT: Colon cancer is the third leading cause of cancer among men and women in the United States. Colonoscopy is largely used as a screening tool to detect pre-cancerous polyps and to detect colorectal cancers early. Optimal bowel preparation prior to colonoscopy allows the endoscopist the ability to increase adenoma detection rates and perform the procedure more safely. This article reviews the various bowel preparations on the market today with evidence based findings on optimal use, safety profiles, timing and adjuncts.
    The Journal of the Oklahoma State Medical Association 09/2015; 108(7):311-7.
  • William M. Tierney · Eric M. Meslin · Kurt Kroenke ·
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    ABSTRACT: Pharmaceutical and device manufacturers fund more than half of the medical research in the U.S. Research funding by for-profit companies has increased over the past 20 years, while federal funding has declined. Research funding from for-profit medical companies is seen as tainted by many academicians because of potential biases and prior misbehavior by both investigators and companies. Yet NIH is encouraging partnerships between the public and private sectors to enhance scientific discovery. There are instances, such as methods for improving drug adherence and post-marketing drug surveillance, where the interests of academician researchers and industry could be aligned. We provide examples of ethically performed industry-funded research and a set of principles and benchmarks for ethically credible academic-industry partnerships that could allow academic researchers, for-profit companies, and the public to benefit.
    Journal of General Internal Medicine 08/2015; DOI:10.1007/s11606-015-3495-z · 3.45 Impact Factor
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    ABSTRACT: Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers' satisfaction with the EMR. Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers' work patterns, but the nurses' and the clerks' patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training. We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses' and the clerks' patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Journal of the American Medical Informatics Association 08/2015; DOI:10.1093/jamia/ocv074 · 3.50 Impact Factor
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    Journal of the American Medical Informatics Association 05/2015; 22(5). DOI:10.1093/jamia/ocv066 · 3.50 Impact Factor
  • Sumit Ahluwalia · Mohammad F. Madhoun · Hussein Bitar · William M. Tierney ·

    Gastrointestinal Endoscopy 05/2015; 81(5):AB296. DOI:10.1016/j.gie.2015.03.1413 · 5.37 Impact Factor
  • Mohammad F. Madhoun · Hassaan Zia · Salman Nusrat · William M. Tierney ·

    Gastroenterology 04/2015; 148(4):S-406. DOI:10.1016/S0016-5085(15)31367-6 · 16.72 Impact Factor
  • Owais I. Bhatti · Hussein Bitar · William M. Tierney · Mohammad F. Madhoun ·

    Gastroenterology 04/2015; 148(4):S-758-S-759. DOI:10.1016/S0016-5085(15)32592-0 · 16.72 Impact Factor
  • William M Tierney ·

    Gastroenterology 03/2015; 148(5). DOI:10.1053/j.gastro.2015.03.020 · 16.72 Impact Factor
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    ABSTRACT: Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient-control over EHR data displays was complex and required ethical, clinical, database, and programming expertise and difficult choices to overcome technical and health system constraints. Assessing patients' preferences for access to their EHRs and applying them in clinical practice requires wide-ranging technical, clinical, and bioethical expertise, to make tough choices to overcome significant technical and organization challenges.
    Journal of General Internal Medicine 12/2014; 30(1). DOI:10.1007/s11606-014-3055-y · 3.45 Impact Factor
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    ABSTRACT: Previous studies have measured individuals' willingness to share personal information stored in electronic health records (EHRs) with health care providers, but none has measured preferences among patients when they are allowed to determine the parameters of provider access. Patients were given the ability to control access by doctors, nurses, and other staff in a primary care clinic to personal information stored in an EHR. Patients could restrict access to all personal data or to specific types of sensitive information, and could restrict access for a specific time period. Patients also completed a survey regarding their understanding of and opinions regarding the process. Of 139 eligible patients who were approached, 105 (75.5 %) were enrolled, and preferences were collected from all 105 (100 %). Sixty patients (57 %) did not restrict access for any providers. Of the 45 patients (43 %) who chose to limit the access of at least one provider, 36 restricted access only to all personal information in the EHR, while nine restricted access of some providers to a subset of the their personal information. Thirty-four (32.3 %) patients blocked access to all personal information by all doctors, nurses, and/or other staff, 26 (24.8 %) blocked access by all doctors and/or nurses, and five (4.8 %) denied access to all doctors, nurses, and staff. A significant minority of patients chose to restrict access by their primary care providers to personal information contained in an EHR, and few chose to restrict access to specific types of information. More research is needed to identify patient goals and understanding of the implications when facing decisions of this sort, and to identify the impact of patient education regarding information contained in EHRs and their use in the clinical care setting.
    Journal of General Internal Medicine 12/2014; 30(1). DOI:10.1007/s11606-014-3054-z · 3.45 Impact Factor
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    Kelly Caine · Spencer Kohn · Carrie Lawrence · Rima Hanania · Eric M Meslin · William M Tierney ·
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    ABSTRACT: Electronic health records change the landscape of patient data sharing and privacy by increasing the amount of information collected and stored and the number of potential recipients. Patients desire granular control over who receives what information in their electronic health record (EHR), but there are no current patient interfaces that allow them to record their preferences for EHR access. Our aim was to derive the user needs of patients regarding the design of a user interface that records patients' individual choices about who can access data in their EHRs. We used semi-structured interviews. The study was conducted in Central Indiana. Thirty patients with data stored in an EHR, the majority of whom (70 %) had highly sensitive health EHR data, were included in the study. We conducted a thematic and quantitative analysis of transcribed interview data. Patients rarely knew what data were in their EHRs, but would have liked to know. They also wanted to be able to control who could access what information in their EHR and wanted to be notified when their data we re accessed. We derived six implications for the design of a patient-centered tool to allow individual choice in the disclosure of EHR: easy patient access to their EHRs; an overview of current EHR sharing permissions; granular, hierarchical control over EHR access; EHR access controls based on dates; contextual privacy controls; and notification when their EHRs are accessed.
    Journal of General Internal Medicine 12/2014; 30 Suppl 1(1). DOI:10.1007/s11606-014-3049-9 · 3.45 Impact Factor
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    ABSTRACT: Applying Fair Information Practice principles to electronic health records (EHRs) requires allowing patient control over who views their data. We designed a program that captures patients' preferences for provider access to an urban health system's EHR. Patients could allow or restrict providers' access to all data (diagnoses, medications, test results, reports, etc.) or only highly sensitive data (sexually transmitted infections, HIV/AIDS, drugs/alcohol, mental or reproductive health). Except for information in free-text reports, we redacted EHR data shown to providers according to patients' preferences. Providers could "break the glass" to display redacted information. We prospectively studied this system in one primary care clinic, noting redactions and when users "broke the glass," and surveyed providers about their experiences and opinions. Eight of nine eligible clinic physicians and all 23 clinic staff participated. All 105 patients who enrolled completed the preference program. Providers did not know which of their patients were enrolled, nor their preferences for accessing their EHRs. During the 6-month prospective study, 92 study patients (88 %) returned 261 times, during which providers viewed their EHRs 126 times (48 %). Providers "broke the glass" 102 times, 92 times for patients not in the study and ten times for six returning study patients, all of whom had restricted EHR access. Providers "broke the glass" for six (14 %) of 43 returning study patients with redacted data vs. zero among 49 study patients without redactions (p = 0.01). Although 54 % of providers agreed that patients should have control over who sees their EHR information, 58 % believed restricting EHR access could harm provider-patient relationships and 71 % felt quality of care would suffer. Patients frequently preferred restricting provider access to their EHRs. Providers infrequently overrode patients' preferences to view hidden data. Providers believed that restricting EHR access would adversely impact patient care. Applying Fair Information Practice principles to EHRs will require balancing patient preferences, providers' needs, and health care quality.
    Journal of General Internal Medicine 12/2014; 30 Suppl 1(1). DOI:10.1007/s11606-014-3053-0 · 3.45 Impact Factor
  • Kelly Caine · William M Tierney ·
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    ABSTRACT: Information collection, storage, and management is central to the practice of health care. For centuries, patients' and providers' expectations kept medical records confidential between providers and patients. With the advent of electronic health records, patient health information has become more widely available to providers and health care managers and has broadened its potential use beyond individual patient care. Adhering to the principles of Fair Information Practice, including giving patients control over the availability and use of their individual health records, would improve care by fostering the sharing of sensitive information between patients and providers. However, adherence to such principles could put patients at risk for unsafe care as a result of both missed opportunities for providing needed care as well as provision of contraindicated care, as it would prevent health care providers from having full access to health information. Patients' expectations for the highest possible quality and safety of care, therefore, may be at odds with their desire to limit provider access to their health records. Conversely, provider expectations that patients would willingly seek care for embarrassing conditions and disclose sensitive information may be at odds with patients' information privacy rights. An open dialogue between patients and providers will be necessary to balance respect for patient rights with provider need for patient information.
    Journal of General Internal Medicine 12/2014; 30(1). DOI:10.1007/s11606-014-3061-0 · 3.45 Impact Factor
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    ABSTRACT: Doublecortin-like kinase 1 (DCLK1), a putative tumor stem cell marker has been shown to be highly expressed in the stromal and epithelial compartments in colon and pancreatic cancer as well as Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). To prospectively investigate whether the immunohistochemical expression of DCLK1 was associated with detectable DCLK1 plasma expression in patients with existing BE and EAC. Immunohistochemistry was performed on paraffin-embedded sections using DCLK1 antibody and scored based on staining intensity and tissue involvement. Purified human plasma samples were subjected to Western blot and ELISA analysis. Forty (40) patients were enrolled: 10 controls (normal endoscopy) and 30 with BE/EAC (13 nondysplastic BE [NDBE], 9 dysplastic BE [DBE] and 8 EAC). Mean epithelial DCLK1 staining was as follows: controls = 0.11, NDBE = 3.83, DBE = 6.0, EAC = 7.17. Mean stromal DCLK1 staining was as follows: NDBE = 5.83, DBE = 5.375, EAC = 10.83. DCLK1 was detected by plasma Western blot in 1 control and in all patients with BE/EAC p < 0.0005. Plasma DCLK1 was elevated by ELISA in EAC compared to other groups, p < 0.05. Increased expression of DCLK1 was observed in the epithelium, stroma and plasma of patients with BE/EAC. Furthermore, the presence of detectable DCLK1 in plasma of BE/EAC patients may provide a less invasive, detection tool in those patients as well as represent a novel molecular marker distinguishing between normal esophageal mucosa and BE or EAC.
    Digestive Diseases and Sciences 10/2014; 60(2). DOI:10.1007/s10620-014-3347-4 · 2.61 Impact Factor
  • William M. Tierney ·

    Gastrointestinal Endoscopy 09/2014; 80(3):492–494. DOI:10.1016/j.gie.2014.04.050 · 5.37 Impact Factor
  • William M Tierney ·

    Annals of internal medicine 08/2014; 161(4):307. DOI:10.7326/L14-5016-7 · 17.81 Impact Factor
  • Mohammad F. Madhoun · Tauseef Ali · William M. Tierney · John T. Maple ·
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    ABSTRACT: Background Anti-spasmodic drugs may facilitate mucosal inspection during colonoscopy. The impact of hyoscine N-butyl-bromide (HBB) on polyp detection rate (PDR) and adenoma detection rate (ADR) is unclear.Methods We conducted a reproducible literature search of multiple databases. Two reviewers independently compared manuscripts for PDR, ADR, advanced adenoma detection rate (AADR), and rates of complications. Pooling was conducted by fixed-effects and random-effects models. Relative risk (RR) estimates were calculated (95% CI). I-squared index (I2) assessed heterogeneity.ResultsPatient demographics were comparable. The pooled analysis showed a trend toward improving PDR and ADR among the HBB group compared with the placebo group but failed to reach statistical significance, (46% vs. 43%, RR = 1.08 [0.94, 1.25], p = 0.27), (31% vs. 28%, RR= 1.12 [0.97, 1.29], p=0.11) respectively.ConclusionsHBB during colonoscopy may provide marginal improvements in ADR and PDR. However, heterogeneity in the available data precludes firm conclusions at this time.
    Digestive Endoscopy 08/2014; 27(3). DOI:10.1111/den.12340 · 2.06 Impact Factor
  • Brian E Dixon · Cyril Colvard · William M Tierney ·
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    ABSTRACT: Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.
    Informatics for Health and Social Care 06/2014; 40(4):1-15. DOI:10.3109/17538157.2014.924949 · 0.74 Impact Factor
  • Matthew Austin · Mark Mellow · William M. Tierney ·
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    ABSTRACT: In recent years, Clostridium difficile infections has become more frequent, more severe, more refractory to standard treatment, and more likely to recur. Current antibiotic treatment regimens for Clostridium difficile infection alter the normal gut flora, which provide colonization resistance against Clostridium difficile. Over the past few years, there has been a marked increase in the knowledge of the gut microbiota, and its role in health maintenance and disease causation. This has, fortuitously, coincided with the use of a unique microbial replacement therapy, fecal microbiota transplantation, in the treatment of patients with multiple recurrent Clostridium difficile infections. We briefly review current knowledge of the gut microbiota's functions. We then review the indications for use of fecal microbiota transplantation in Clostridium difficile infection, the techniques employed, and results of treatment. Fecal microbiota transplantation has been shown to be efficacious for patients with multiply recurrent Clostridium difficile infections (reported cure rates of 90%), with an excellent short-term safety profile and has been included in the American College of Gastroenterology treatment guidelines for this troublesome disease.
    The American journal of medicine 06/2014; 127(6). DOI:10.1016/j.amjmed.2014.02.017 · 5.00 Impact Factor
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    ABSTRACT: Endoscopic procedures are frequently performed on patients chronically on opioids, raising concerns about the safety and efficacy of conventional sedation. We hypothesized that chronic opioid use is associated with longer procedure times, higher dosages of sedation medications, and an increase in adverse effects. This is a retrospective review from June 2012 to June 2013. Patients on chronic opioids (opioids use ≥12 weeks) were compared to randomly selected patients matched for age, race, and sex. Multivariate regression analysis was performed to identify factors that were independently predictive of longer procedure times. Patients on chronic opioids required higher doses of fentanyl (122.0 ± 45.3 vs. 105.8 ± 47.2 µg; P < 0.0001) and midazolam (5.3 ± 5.3 vs. 4.4 ± 2 mg; P = 0.0037) and were more likely to receive diphenhydramine (42.8 vs. 22.6 %; P < 0.001). The induction period (11.3 ± 8.8 vs. 7.5 ± 4.0 min), duration of procedure (39.1 ± 17.5 vs. 33.4 ± 14.1 min), and recovery times (38.7 ± 15.3 vs. 33.8 ± 12.1 min) were significantly longer for patients on chronic opioids. In the multivariate regression analysis, opioid use was an independent predictor of longer procedure duration (P < 0.05). Hypotensive episodes did not differ between groups (2.8 vs. 2.7 %; P = 0.8). However, patients on chronic opioids experienced more pain (13.4 vs. 5.9 %; P 0.001) and hypertensive episodes (8.1 vs. 2.8 %; P 0.002). Patients on chronic opioids represent a high-risk population with longer procedural times and more discomfort, despite higher dosages of sedative agents. Prospective studies are required to define the risks and benefits of more costly alternative sedation strategies for patients on chronic opioids.
    Gastrointestinal Endoscopy 05/2014; 79(5):AB204. DOI:10.1016/j.gie.2014.05.035 · 5.37 Impact Factor

Publication Stats

14k Citations
1,954.04 Total Impact Points


  • 1984-2015
    • Regenstrief Institute, Inc.
      Indianapolis, Indiana, United States
  • 2009-2014
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
    • Philadelphia ZOO
      Philadelphia, Pennsylvania, United States
    • University of Chichester
      Chichester, England, United Kingdom
  • 2005-2014
    • University of Oklahoma Health Sciences Center
      • • Section of Digestive Diseases and Nutrition
      • • Department of Internal Medicine
      • • Section of Gastroenterology and Nutrition
      Oklahoma City, Oklahoma, United States
    • Portland VA Medical Center
      Portland, Oregon, United States
  • 1980-2014
    • Indiana University-Purdue University Indianapolis
      • • Department of Medicine
      • • Division of General Internal Medicine and Geriatrics
      • • Department of Biostatistics
      Indianapolis, Indiana, United States
  • 2013
    • University of Toronto
      Toronto, Ontario, Canada
  • 2003-2010
    • Moi University
      • Department of Medicine
      Nairobi, Nairobi Province, Kenya
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 2008
    • VA Puget Sound Health Care System
      Washington, Washington, D.C., United States
  • 2006
    • University of Oklahoma
      Norman, Oklahoma, United States
    • Indiana University Bloomington
      Bloomington, Indiana, United States
    • American Society for Gastrointestinal Endoscopy
      Oak Brook, Illinois, United States
  • 1994-2006
    • Indiana University-Purdue University School of Medicine
      • Department of Medicine
      Indianapolis, Indiana, United States
  • 1995-2005
    • Richard L. Roudebush VA Medical Center
      Indianapolis, Indiana, United States
    • Purdue University
      West Lafayette, Indiana, United States
    • Indianapolis Zoo
      Indianapolis, Indiana, United States
  • 2001
    • Emory University
      Atlanta, Georgia, United States
  • 2000
    • University of Aberdeen
      Aberdeen, Scotland, United Kingdom
  • 1999
    • University of Texas MD Anderson Cancer Center
      Houston, Texas, United States
  • 1991
    • Spokane VA Medical Center
      Spokane, Washington, United States
  • 1982
    • University of North Carolina at Pembroke
      North Carolina, United States