Career Summary

Nathan Hulse, PhD, is a senior medical informaticist at Intermountain Healthcare. Dr. Hulse manages a software engineering team responsible for the development of Intermountain Healthcare's clinical knowledge management infrastructure, including databases, middle-tier, and front-end tools for thousands of clinical users in the company. These tools facilitate the creation, search, update, review, and distribution of clinical knowledge (e.g., order sets, nursing guidelines, patient education, clinical forms) throughout tools and portals in the company. His team also develops dashboards and reports that help content teams understand usage patterns and inter-dependencies on the content they produce.

He has been a member of the international health IT standards body Health Level Seven (HL7) since 2006. As part of his HL7 work, Dr. Hulse has accrued working experience with the standards created by the Clinical Decision Support Workgroup, including both the OpenCDS and OpenInfobutton projects. He worked previously with clinicians on a number of development projects, including the development of both patient and provider-facing applications with strong ties to clinically relevant patient education materials.

Research interests for Dr. Hulse include the intelligent delivery of relevant information at the point-of-care, especially that of the "infobutton," a tool that serves as a context-aware information delivery resource embedded within clinical information systems. He is also interested in consumer-facing informatics projects, including capture and intelligent use of patient data as it relates to their own health. Current projects in this space involve connecting activity/diet data streams from consumer-oriented apps and fitness trackers to providers and EHRs. He is also involved in Intermountain’s efforts surrounding detailed, pedigree-based family health history collection and risk assessment.

Dr. Hulse earned his doctorate in Medical Informatics from the University of Utah School of Medicine in 2005.

Areas of Focus

  • Clinical Knowledge Management
  • Automated feedback streams for content enhancement
  • Contextual, anticipatory information delivery to patients and providers
  • Consumer Health Informatics
  • Family Health History
  • Clinical Decision Support
  • Individualized Risk Assessment
  • Infobuttons

Significance to Patient Care

Dr. Hulse's work helps provide safe patient care at Intermountain Healthcare in that it facilitates clinicians' ability to quickly and accurately answer questions as they arise at the point of care. Studies have shown that doctors have at least three clinical questions raised for every two patients they see, and that the majority of these remain unanswered. By bridging this gap and getting answers to providers without interrupting their workflow, patients are treated with fewer "unknowns." Further, the work that his team facilitates allows best practice to be delivered to the front-line, in the form of order sets, nursing guidelines, and other mediums that reflect current best practice.

On the content creation side, Dr. Hulse's work helps content teams better understand how effectively their work is used by caregivers, and even makes recommendations on how to improve it. As it relates to consumer health informatics, his projects help fill important gaps in understanding how patients care for themselves and what is and isn’t working.  Even more importantly, these applications help build a real sense of shared accountability and ownership between patients and providers clinical care.  These types of engagements are vital in the current climate of accountable care organizations and population health.

Selected Bibliography

Hulse, Nathan C, Jaehoon Lee, Tim Borgeson: Visualization of Order Set Creation and Usage Patterns in Early Implementation Phases of an Electronic Health Record; Accepted for presentation at AMIA 2016 Annual Symposium; 11/2016.

Long, Jie, Nathan C Hulse, Cui Tao: Infobutton usage in Patient Portal MyHealth. 08/2015; 2015:112-6. AMIA 2015 Annual Symposium; 11/2015.

Hulse, Nathan C, Jie Long, Xiaomin Xu, Cui Tao: Enabling locally-developed content for access through the infobutton by means of automated concept annotation. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2014; 2014:700-8.

Ranade-Kharkar, Pallavi, Guilherme Del Fiol, Janet L Williams, Nathan C Hulse, Peter Haug: Analysis of family health history based risk assessment algorithms: classification and data requirements. Studies in health technology and informatics 08/2013; 192:1205.

Hulse, Nathan C, Jie Long, Cui Tao: Combining infobuttons and semantic web rules for identifying patterns and delivering highly-personalized education materials. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2013; 2013:638-47.

Hulse, Nathan C, Joel Galland, Emerson P Borsato: Evolution in clinical knowledge management strategy at Intermountain Healthcare. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2012; 2012:390-9.

Hulse, Nathan C, Pallavi Ranade-Kharkar, Herman Post, Grant M Wood, Marc S Williams, Peter J Haug: Development and early usage patterns of a consumer-facing family health history tool. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2011; 2011:578-87.

Greenes, Robert, Meryl Bloomrosen, Nancy E Brown-Connolly, Clayton Curtis, Don E Detmer, Robert Enberg, Douglas Fridsma, Emory Fry, Mary K Goldstein, Peter Haug, Nathan Hulse, Tonya Hongsermeier, Saverio Maviglia, Craig W Robbins, Hemant Shah: The Morningside Initiative: Collaborative Development of a Knowledge Repository to Accelerate Adoption of Clinical Decision Support. The Open Medical Informatics Journal 12/2010; 4:278-90. DOI:10.2174/1874431101004010278.

Hulse, Nathan C, Peter J Haug: Metadata extraction routines for improving infobutton performance. AMIA Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2010; 2010:326-30.

Hulse, Nathan C, Grant M Wood, Peter J Haug, Marc S Williams: Deriving consumer-facing disease concepts for family health histories using multi-source sampling. Journal of Biomedical Informatics 04/2010; 43(5):716-24. DOI:10.1016/j.jbi.2010.04.003.

Hulse, Nathan C, Guilherme Del Fiol, Richard L Bradshaw, Lorrie K Roemer, Roberto A Rocha: Towards an on-demand peer feedback system for a clinical knowledge base: A case study with order sets. Journal of Biomedical Informatics 03/2008; 41(1):152-64. DOI:10.1016/j.jbi.2007.05.006.

Hulse, Nathan C, Guilherme Del Fiol, Roberto A Rocha: Modeling end-users' acceptance of a knowledge authoring tool. Methods of Information in Medicine 02/2006; 45(5):528-35.

Roemer, Lorrie K, Roberto A Rocha, Guilherme Del Fiol, Richard L Bradshaw, Timothy P Hanna, Nathan C Hulse: Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients. Studies in health technology and informatics 02/2006; 122:440-4.

Hulse, Nathan C, Guilherme Del Fiol, Roberto A Rocha: Development and validation of XML-based calculations within order sets. AMIA Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 02/2005.

Hulse, Nathan C, Roberto A Rocha, Guilherme Del Fiol, Richard L Bradshaw, Timothy P Hanna, Lorrie K Roemer: KAT: A flexible XML-based knowledge authoring environment. Journal of the American Medical Informatics Association 07/2005; 12(4):418-30. DOI:10.1197/jamia.M1701.