James Schreiner, PHDSEE 2016

Emily Scott

Schreiner, a Lieutenant Colonel with the United States Army, has served for over twenty years on active duty, including tours in Korea, Kuwait, Afghanistan, and Iraq. He earned his bachelor’s degree from Marquette University and went on to earn his master’s degree at the University of Colorado. He is now an Assistant Professor in the Department of Systems Engineering at the United States Military Academy at West Point. His most recent assignment was as a deputy commander for the U.S. Army Corps of Engineers Chicago District before he was selected for the PhD program at ISE in 2013.

He says he initially liked the program at ISE for its flexibility and mix of industry experts.

“Folks here were willing to work with me and the time constraints the Army provided,” Schreiner says. “The faculty is incredibly engaged. On my committee I had a professor from computer science, a professor from education, Professor (Kesavadas) . . . it was just a really great mix.”

During his time at ISE, PhD student James Schreiner studied an under-researched problem involving the health care industry and emerging proprietary risk technologies. Schreiner’s research — in collaboration with Professor Deborah Thurston and OSF Saint Francis Medical Group in Peoria, Illinois, and funded by the Jump Trading Simulation and Education Center — analyzed how new technologies impact the quality of patient discharge decision making by inpatient case managers.

Schreiner and his collaborators employed a series of qualitative and quantitative techniques to look at the health care system and then see how new risk technologies, which are partially integrated into electronic health records, could affect how decisions are made. Schreiner also looked at a set of cognitive biases that could be affected by these new technologies.  The aim of the research was to facilitate training and policy strategies which could leverage the new systems in balance with expert-based decision heuristics currently employed.

“We came out with kind of a mixed set of results,” Schreiner says. “In some cases, we were definitely able to say yes, there is going to be an impact on the types of decisions that are being made. In others, it turned out that the technology wasn’t impactful in any way, shape or form, which is also good to know.”

The research identified problem areas and cognitive processes that could change with the implementation of new technology. The work was recently presented to OSF Saint Francis Medical Center in what Schreiner describes as “almost an advisory role,” providing recommendations on how these problems may be mitigated.

Schreiner explains that unplanned 30-day patient readmissions have been a significant problem in the health care industry, and that they are estimated to cost the industry $42 billion a year. Additionally, the Affordable Care Act created a pay-for-performance business model which places partial fiscal responsibility on hospitals to improve the quality and effectiveness of discharge care.

“The idea [of this research] is if you bring on a proprietary technology that’s going to help nurses and social workers better see and understand what’s going on with the patient, that will help improve the quality of their decision making, and residually reduce the number of times that a patient’s coming back in an unplanned way,” Schreiner says.

Schreiner says he believes that his military career working as a US Army Engineer Officer, performing duties such as developing infrastructures in struggling economies, has parallels to this research.

“Everybody laughs when I say that,” Schreiner says. “Building roads and schools and water systems in Iraq is like taking care of a patient here in Peoria, Illinois? Helping to make or facilitate decisions on the health and welfare of a community, or an individual patient do require a heavy dose of expert judgment balanced with normative models. The community and the patient are complex systems which require socio-technical systems to deliver quality decisions. Technologies are meant to enable or reduce cognitive load, so understanding their strengths and weaknesses is important in decisions which might impact the quality of life.”

He says his goal when he returns to West Point is to see if there are opportunities to extend his research into the Veterans Administration, where he sees a lot of similar challenges.

From there, Schreiner says his career goals are open but that he has interest in working in the private sector or as a researcher or professor.

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"Scott visits with Kesh Kesavades, the director of the Health Care Engineering Systems Center at the University of Illinois, on how devices like an Echo are playing a role in health care."