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Juliet Rumball-Smith

2016-17 Harkness Fellow Chief Clinical Advisor New Zealand Ministry of Health


Placement: Southern California Evidence-based Practice Center for the RAND Corporation

Mentor: Paul G. Shekelle, M.D., Ph.D. (Co-Director, Southern California Evidence-based Practice Center for the RAND Corporation)

Co-Mentor: Cheryl L. Damberg, Ph.D. (RAND Distinguished Chair in Health Care Payment Policy, Principal Senior Researcher, Professor, Pardee RAND Graduate School)

Project Title: Implementation of Health Information Technology: Impacts on Quality of Care and How It Can Be Used to Reduce Overuse in Health Services

Juliet Rumball-Smith, M.B.Ch.B., Ph.D., is a 2016-17 New Zealand Harkness Fellow in Health Care Policy and Practice. She is currently a public health physician and medical officer of health in the Northland District Health Board. In her role at Northland District Health Board, she works on the development and implementation of public health policies, with a particular focus on the use of health analytics and maximizing the effectiveness of population-based strategies such as immunization. Rumball-Smith has held previous international positions, including as a senior research fellow in the Institute for Health Policy, Management and Evaluation at the University of Toronto, where she worked on analysis, interpretation, and reporting of cross-national primary care survey data, investigating the association between quality of care for patients with chronic disease and multi-disciplinary provider teams. She was also awarded a post-doctoral research fellowship in the Institute for Health and Social Policy at McGill University, where she focused on investigating unemployment and health outcomes; and a clinical training fellowship from the Health Research Council of New Zealand, to explore ethnic disparities in hospital quality of care. Rumball-Smith received a degree in medicine and surgery, a Ph.D. in epidemiology, and an M.P.H., all from the University of Otago. She is a Fellow of the Faculty of Public Health Medicine, Royal Australasian College of Physicians.

Project Abstract:

This research aims to identify and explore how health information technology functionalities (such as, a registry for a chronic disease, automated reminder for an overdue lab test, etc.) are associated with quality of care, with a particular focus on the process and human factors that are beneficial to patient outcomes. The project uses a multi-stage mixed-methods approach. Using survey data, facilities that are similar in structural characteristics and setting, with variation in health information technology and quality of care indicators, will be compared to identify key health information technology factors that may drive differences in quality. Case studies of 3-4 exemplars of high quality organizations will then be employed to identify critical success factors in health information technology implementation and functionality that may account for better performance. The research will also examine how electronic health record platforms can be used to help reduce overuse within the context of the ‘Choosing Wisely’ program - an international educational initiative that aims to reduce the use of low value health services.

Harkness-Related Publications:

J. Rumball-Smith, J. Fromkin, B. Rosenthal, D. Shane, J. Skrbin, T. Bimber, R.P. Berger. “Implementation of routine electronic health record-based child abuse screening in General Emergency Departments,” Child Abuse and Neglect. 2018.

J. Rumball-Smith, D. Bates. “The Electronic Health record and health IT to decrease racial/ethnic disparities in care,” Journal of Health Care for the Poor and Underserved. 2018.

J. Rumball-Smith. “Reducing Racial/Ethnic Inequities in Care: A Clinician-Led Approach,” NEJM Catalyst 2018.

J. Rumball-Smith, J. Gurvey, M. Friedberg. “Personalized Hospital Ratings: Transparency for the Internet Age,” NEJM. 2018.

J. Rumball-Smith, P. Shekelle, C. Damberg. “Electronic health record ‘Super-users’ and ‘Under-users’ in ambulatory care practices,” American Journal of Managed Care. 2018.

J. Rumball-Smith. “Uniquely Identified: The Impact of a National Health Index,” NEJM Catalyst. 2017.

J. Rumball-Smith, P. Shekelle, D. Bates. “Using the EHR to understand and minimize overuse,” JAMA Viewpoint. 2017.

Career Activity Since Fellowship:

Director of Health Intelligence and Translational Medicine, Northland District Health Board

Chief Clinical Advisor, New Zealand Ministry of Health (current position)