Engaging Physicians from the Inside Resident Informatics Program
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1 Engaging Physicians from the Inside Resident Informatics Program Kevin Baldwin, MPH CPHIMS Strategic IT Engagement Manager, UCLA Health Program Administrator
2 4 hospitals 952 Inpatient beds ~60,000 hospital encounters 250+ outpatient practices 1.5 mil outpatient annual visits
3 Learning Objectives / Deliverables Share technological advances impacting higher education Develop Physician Career Development Strategies Understand Interdepartmental Relationship Management Review Team Decision Making and Collaboration Tools Discuss Academic Program Implementation Tools 4
4 700 years ago
5 Today
6 Acceleration of Technology
7 Can we keep up?
8 The Future of Technology 9 4/13/2015
9 200 years ago
10 Today Retrieved from Google Images
11 History/evolution of Health IT 1970 s Vendor-supplied financial applications Hospitals developed much of their own software 1980 s Hospitals still developed much of their own software IT Vendors bought hospital-developed software systems, packaged and marketed them Initial clinical information systems included order-entry, like CPOE today
12 Current Healthcare environment & Health IT Imperative Institutes of Medicine 2000, 2001 published sentinel studies To Err Is Human study 98,000 people die unnecessarily due to medical errors in US hospitals each year identifies HIT/EHR systems needed to reduce those errors (2000) Crossing the Quality Chasm identified EHRs as one of a few necessary requirements to improve healthcare quality in US (2001) January 2004 President Bush s state of the union addressed launched an initiative to make electronic health records available to most Americans within the next 10 years.
13 Current Healthcare environment & Health IT Imperative 2006 CMS defined its role as providing: support for development of Electronic Health Records. American Recovery and Reinvestment Act of 2009 (ARRA) Investing $36 billion to stimulate implementations of electronic health records (EHR) meaningful use criteria must be met for physicians and hospitals to receive incentive payments Significant training grants awarded to train needed 51,000 HIT workers
14 Current Healthcare environment & Health IT Imperative February The HITECH act is signed into law. Beginning in fiscal year 2012, CMS will rank hospitals based on 30-day readmission rate for heart attack, heart failure and pneumonia. Those in bottom quartile nationally from the prior year will have a percent of total Medicare payments withheld. March President Obama signed the Patient Protection & Affordable Care Act. Provisions in the Act strengthened the HITECH Act. Physicians and hospitals need to prove that they have met different functional objectives with their use of an EHR product to be considered meaningful users.
15 History of Health IT and the EHR October Final Rules for ACOs. The Final Rules for ACOs strengthen the need for robust EHRs, with more financial incentives for rural docs and hospitals; digital data collection of 33 performance measures June The Supreme Court upholds the Affordable Care Act (ACA) by a vote of 5-4. Many items in the ACA warrant the rapid transition to electronic medical records for skilled providers Summary: market & regulatory forces driving the rapid transition to EHRs in acute and post-acute care. 16 4/13/ 2015
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18 UCLA Health Epic Implementation March 2013 Big-bang go-live; full functionality across health system February 2015 Upgrade from version 2010 to 2014
19 But
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21 The end of Medical Paternalism
22 Resistance to Change Financial and business barriers Expensive systems Loss of productivity Structural barriers System silos Technical barriers Lack of integration Cottage industry Cultural barriers Time and experience Resistance to change
23 Resident Champion (RC) Program 24
24 Addressing Physician Engagement physician engagement 2014:
25 26
26 Healing humankind, one patient at a time. 27
27 Resident Informaticist Program Overview & Goals 28
28 Evolution of the Program Resident Champion Program Big Bang Go-Live Resident Informaticist Program Optimization Phase Resident Informaticist Program Epic 2014 upgrade 29
29 Resident Champion (RC) Program Resident Champion Program precursor to Resident Informaticist Program Objectives: Engage residents in the EHR implementation planning process Obtain feedback and participation from frontline physicians Develop & conduct high-quality, specialty specific training 30
30 Resident Champion (RC) Program RC Program was a one year program Each core residency program recruited 1 champion; more from the larger departments (1:30 ratio) Stipend for one year commitment: $500, paid by Hospital Provided resident physicians with the knowledge and skills to: effectively use CareConnect to deliver high quality patient care optimize workflow efficiency promote (champion) system use proficiency liaison workflow and content optimization between end users and CareConnect Team 31
31 Resident Informaticist (RI) Program Built on experiences with Resident Champion Program to develop Resident Informaticist Program, providing greater exposure of resident physicians to the field of Health Information Technology Year 1: Year 2:
32 Resident Informaticist Program Vision Education Disseminate best practices related to education, quality improvement, technical redesign, and academic research as it pertains to health informatics and implementation of our EHR. Develop clinical informatics as a professional discipline at UCLA Health. Quality Resident Informaticists Research Provide a forum for cross-disciplinary discussion and collaboration on informatics practices. Technical 33
33 Resident Informaticist Program: Goals & Objectives Expose residents to Health IT with goals of developing informatics skills they can take into their future career Support ongoing upgrades & system enhancements of specialty-specific customized clinical content Enhance clinician participation in continuous health informatics organizational improvements Strengthen the enterprise clinical health informatics research infrastructure Create a pipeline for attracting and developing outstanding candidates to careers in clinical informatics at UCLA 34
34 Education Program Design Quality Resident Informaticists Technical Research 1. Resident Informaticists enroll in one of the following tracks to focus their Health IT interests: Program Track Research Quality Education Technical Track Focus Design and conduct a health informatics academic research study Engage in departmental and/or health system quality initiatives Evaluate and design CareConnect clinical training materials Participate in system testing and build 2. RIs select and complete an independent program practicum by the end of the program 3. RIs meet with project team and mentors for more focused instruction regarding projects. 35
35 Education Program Design Group Lectures Quality Resident Informaticists Technical Research The entire group receives high level, didactic instruction during the monthly meetings on aspects of all 4 Program Tracks. Ensures that all RIs receive broad exposure to concepts of Health IT 36
36 Education Overall Program Curriculum Quality Resident Informaticists Technical Research Research Quality Education Technical Data Analytics Data Quality BI/CI Emerging Technologies: Mobile health, telehealth, and remote monitoring Care Quality and Safety Incentive Programs Meaningful Use Decision Support History and Evolution of Health Care Information Systems Health Care Information Regulations, Laws, and Standards HIT Adoption in the US Privacy & Security User Interfaces Environments Change Control Process Health Information Exchange & Interoperability 37
37 Education Program Design Interactive Quality Resident Informaticists Technical Research Assigned reading from textbook Demiris, G. Integration of Telemedicine in Graduate Medical Education. JAMIA 2003 Monthly Journal Club Bobb AM, et al. Viewpoint: Controversies surrounding use of order sets for clinical decision support in computerized order entry. JAMIA
38 Track Design Education Quality Resident Informaticists Research Technical 39
39 Education Research Track Quality Resident Informaticists Technical Research RIs within Research Track paired with and mentored by Physician Informaticist Leaders with an expertise in informatics research Good research design Statistical analysis Approach to performing proper EHR research 40
40 Education Research Project Example Quality Resident Informaticists Technical Research Incorporating cost into antibiotic ordering information Display standardized price-per-dose within the orders for commonly prescribed antimicrobials in the hospital Compare ordering patterns before vs. after the price is displayed 41
41 Education Education Track Quality Resident Informaticists Technical Research RIs within Education Track paired with and mentored by Physician Informaticist Leaders with dual roles as clinical departmental educators Review and optimize tools for EHR training utilizing best educational approaches to system training 42
42 Education Education Project Example Quality Resident Informaticists Technical Research Billing Education Initiative, UCLA Family Health Center Assess accuracy of residents assignment of level of service Improve resident billing education with a note template that informs and educates at each use Improve accuracy of resident billing 43
43 Education Quality Track Quality Resident Informaticists Technical Research RIs within Quality Track paired with and mentored by Physician Informaticist Leaders with experience in Quality Measures Learn concepts of quality improvement, measures and indicators in general Implement tools within CareConnect for improving health quality 44
44 Education Quality Project Example Quality Resident Informaticists Technical Research Introducing Quality Care Indicators for Benign Prostatic Hyperplasia into CareConnect 1. Introduce a BPA for providers to make sure a urine analysis and PVR are included in the orders/note for all those about to undergo a procedure for BPH 2. Goals: 1. Curb use of BPH medications post procedure, 2. Reduce % of patients requiring 3 or more visits within 90 days after BPH surgery, 3. Reduce costs over the course of the following academic year. 45
45 Education Technical Track Quality Resident Informaticists Technical Research RIs within Technical Track paired with and mentored by Physician Informaticists/Builders Learn technical build aspects of the Epic System Train RIs to build smarttexts, smartsets and ordersets, etc. in PLY Work to improve current build of system 46
46 Education Technical Project Example Quality Resident Informaticists Technical Research Restraint Workflow for Inpatient Psychiatry Goal 1. Assess current compliance rates for inpatient restraint orders in NPH Goal 2. Optimize build to improve psychiatry restraint navigator 47
47 Education Project Awards Quality Resident Informaticists Technical Research elearning Modules for new users Developed new orthopedic modules to follow workflow, using patient scenarios Development of text processing tools for extraction of stroke quality measure data Separated inpatient and outpatient lessons Eliminated redundant or ineffectual lessons Recognized missing lessons that needed to be created 48
48 Resident Informaticist Program Logistics 49
49 Leadership Jennifer Singer, MD Physician Informaticist Associate Professor, Urology Director of Education Kevin Baldwin, MPH, CPHIMS Program Administrator 50
50 Program Faculty UCLA Physician informaticists are UCLA physicians who are engaged in all aspects of understanding and promoting effective organization, analysis, management, deployment, build, and use of clinical information in CareConnect. Michael Pfeffer, MD Interim Chief Information Officer Chief Medical Informatics Officer Assistant Clinical Professor of Medicine 51
51 Program Faculty 52
52 Engage UCLA School of Medicine Leadership Obtained approval from UCLA School of Medicine s Graduate Medical Education Office Compliance with resident work hours Enough time to find the program rewarding? Enough time to complete program practicum? Compliance with stipend payments within resident and fellow contracting Distributed letter to Program Directors and Department Chairs requesting permission to include their trainees in RI Program 53
53 Availability/Expectations - What is the time commitment of this program? Attend all monthly sessions Complete the program practicum Present findings of their program practicum 54
54 Recruitment & Retention Recruitment Advertising & Promotional Strategy Unique Opportunities Retention Financial Incentives Robust Engagement 55
55 Above: Resident Informatics group tours Oppenheimer data center to learn why UCLA Health is Most Wired 56
56 Current Resident Informaticist Cohort ( ) 17 Residents Anesthesiology Emergency Medicine Family Medicine Infectious Diseases Internal Medicine Medicine/Endocrinology Neurology Ophthalmology Orthopaedic Surgery Pediatric Hematology/Oncology Psychiatry Radiation Oncology Radiology Surgery Urology Count Residency Year Residency Year 57
57 Resident Informaticist (RI) Feedback Year 1: Please describe the degree to which the resident informaticist program benefitted your professional development 58
58 Next Steps Expand Resident Informaticist Program Formally integrate resident project work into ITPMO Send Resident Informaticists to Epic Physician Builders Course Group Meeting Meetings 59
59 Next Steps Launch ACGME-accredited Clinical Informatics Fellowship 60
60 Questions? Kevin Baldwin, MPH CPHIMS Strategic IT Engagement Manager, UCLA Health Program Administrator
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