Introduction & Overview

Transcription

1 From Informatics Leadership to Student, Why More Education? Kevin L. Smith, RNC, FNP, MSN Leadership in Health Information Technology for Health Professionals (LHIT-HP) Student, DNP Student Introduction & Overview : The accidental informatacist Retail Health concept originated Starting with a blank page: EHR Version1.0 From 5 clinics in one state to 500 clinics in 25 states Gaps in informatics skills and knowledge? 1

2 3 K. L. Smith 2011 Harv Bus Rev Sep-Oct;78(5):102-12, 199. Informatics & Evidence Based Practice 4 the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Sackett, DL, Rosenberg, WMC, Gray, JA, et al. Evidence-based medicine what it is and what it isn t. BMJ. 1996;12,

3 Informatics & Clinical Practice Guidelines 5 Institute of Medicine 1990: systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Key term: assist. Early Informatics: The dark ages to the present 6 Fast forward to 2011 One decade and a quantum leap for EHRs Early issues related to EHR use Impact on patient care A new barrier to communication? Unintended consequences? Impact on workflow What do we do with all of this data? 3

4 7 Why go back to school to study Informatics? Part 1: The early sparks or curiosity 8 Exploring Best Practices: Guidelines and CDSS Issues 4

5 Motivator: Room for Improvement 9 An October 2007 report showed that children in the U.S. received indicated ambulatory care less than 50% of the time. R. Mangione-Smith, A.H. DeCristofaro C.M., Setodji CM, et al. The quality of ambulatory care delivered to children in the United States. New England Journal of Medicine 357 (2007): Motivator: Room for Improvement health care quality indicators found that U.S. adults receive approximately half of recommended preventive, acute, and chronic care services. E.A. McGlynn, S.M. Asch, J. Adams, et al. The quality of health care delivered to adults in the United States. New England Journal of Medicine 348 (2003):

6 11 Quality of care US Data Adherence to Quality Indicators, according to Type of Care and Function % of Recommended Care Received Preventive Acute TYPE OF CARE Chronic Screening Diagnosis FUNCTION Treatment Follow-up E.A. McGlynn, S.M. Asch, J. Adams, et al. The quality of health care delivered to adults in the United States. New England Journal of Medicine 348 (2003): Interest in CDSS: Electronic Rx Safety 12 in the emergency department, computer-assisted prescriptions were shown to be more than three times less likely to contain errors and five times less likely to require a pharmacist clarification compared to hand written prescriptions. Bizovi KE, Beckley BE, McDade, MC, et al. The effect of computer-assisted prescription writing on emergency department prescription errors Acad Emerg Med. 2002:9(11);

7 CPOE and Rx Errors 13 Agency for Healthcare Research and Quality: Prescribing errors are the most common medication errors in primary care practices Use of computerized physician order entry (CPOE) systems could prevent up to 57 percent of prescribing errors. "Medication errors reported by US family physicians and their office staff, Grace M. Kuo, Pharm.D., M.P.H., (et al) in Quality and Safety in Health Care 17, pp , See AHRQ Four factors were the main correlates of successful CDSS implementation providing alerts/reminders automatically as part of the workflow 2. providing the suggestions at a time and location where the decisions were being made 3. providing actionable recommendations 4. computerizing the entire process Kawamoto K, Houlihan CA, Balas EA, et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ Apr 2;330(7494):765. 7

8 When these four factors present: 15 clinical practice was significantly improved 94% of the time. Kawamoto K, Houlihan CA, Balas EA, et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ Apr 2;330(7494): On the other hand? Recent Study, CDS & Quality Our findings indicate no consistent association between EHRs and CDS and better quality. Study Limitations? Observational data collected , what type of CDS was available? Was there CDS available for the measures studied? Provider experience with CDS? Note: Further study needed regarding CDSS impact on Quality Romano MJ, Stafford RS (2011) Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Archives of Internal Medicine, VOL 171 (10). 8

9 17 CDSS: Keys to Success Provider education regarding the evidence based guidelines and CDSS tool (and buy-in) Decision support built into the workflow within the EHR EHR available during the patient encounter Computer based support for treatment recommendations provided CDSS and alerts gone wild? 9

10 Why go back to study informatics? 19 Part 2 Obvious needs for nursing input Several Interests EHR clinical analytics/quality Improvement Clinical Decision Support Systems Standardization of best clinical practice Nurse / provider user interface issues Innovative access to online health services and care Why go back to study informatics? (cont.) 20 Informatics generalist, niche expert, or leader Broad informatics education important for HIT leaders Interdisciplinary aspects of informatics (nursing, medicine, bio-informatics, PH informatics, etc.) Rapidly changing technologies, policy, and practice issues Value of organized informatics community 10

11 Education in the Informatics Age Occupations with the Largest Projected Need between 2006 and ,200 1, Registered Nurses Personal & Home Care Aids Home Health Aides Nursing Aides, Orderlies, & Attendants Licensed Practical Nurses Physicians & Surgeons Medical Assistants Pharmacy Technicians New Jobs Replacements Sources: U.S. Department of Labor, Bureau of Labor Statistics, National Employment Matrix, employment by industry, occupation, and percent distribution, 2006 and projected

12 Wanted: Skilled Health Technology Professionals 23 AHIMA looking to bolster U.S. health IT workforce 50,000 new positions that will be needed to implement the U.S. health system s transition to electronic health records (EHR). June 06, 2011 Diana Manos, Healthcare IT News Clinical informatics officers, IT specialists wanted new positions are being created have a focus on quality and data. June 02, 2011 Molly Merrill, Associate Editor A definition of health informatics 24 -It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. -It is the study of how clinical knowledge is created, shaped, shared and applied. -Ultimately, it is the study of how we organise ourselves to create and run healthcare organisations. Guide to health informatics 2nd Edition. Coiera E: Clinical Decision Support Systems. Arnold, London, 2003;

13 Isn t this an IT thing? Many players 25 EHR development & deployment Computerized Physician Order Entry (CPOE) Clinical Decision Support Systems (CDSSs) Telemedicine & Telehealth ehealth, mhealth Health Information Exchange (HIE) Health IT adoption & use, public policy, ethical issues Consumer health Knowledge representation & discovery Clinical quality analytics Standards & Interoperability Workforce building & education Many potential roles for nursing 26 Chief Nursing Information Officer (CNIO) System analysts, developers, implementation specialists, trainer Super Users User group member Subject Matter Expert (SME) Business analysts Educator 13

14 Why do nurses need informatics skills (why not just docs and IT?) 27 Nurses are in the frontline of care delivery Nurses can advocate for patients, not just systems Better documentation Can improve decision making or process of care Medication safety Quality of care requires timely availability of information (information glut) Improved Patient education Nursing Health Informatics knowledge 28 Nurses of today need to understand Information Technology and Informatics ON TOP OF nursing knowledge and skills, Physiology, Pharmacology, communication skills, etc. BUT technical or informatics skills must also include the intellectual components related to knowledge management and decision making 14

15 Alliance for Nursing Informatics (ANI) 29 Nurses Are Integrators of Information Nurses as Full Partners in Decision Making Nurses are effecting change in the development and adoption of interoperable systems across Collaboration between all stakeholders is needed to develop, adopt, and integrate standards into practice Alliance for Nursing Informatics Position to the ONC Federal Information Technology Strategic Plan Informatics Coursework: A Solid Foundation 30 Examples Systems analysis and design Clinical Decision support theory Population based health informatics Health Care data bases Consumer health informatics Knowledge Representation and Interoperability 15

16 TIGER Competencies 31 Basic Computer Competency (Skills) From browsers to utilities Information Literacy Effective use of information Clinical Information Management Competencies From Allergies to Treatment plans 32 National Initiatives Facilitate adoption of EHRs Hospitals and provider groups Government entities Expand access Apply recognized standards Healthcare Information Technology Standards Panel (HITSP) Certification Commission for Healthcare Information Technology (CCHIT) Role of Personal Health Record (PHR) 16

17 Thank you! Kevin L. Smith, RNC, FNP, MSN TIGER 2011 K.L. Smith 2009 References 34 Bain, KT. Barriers and Strategies to Influencing Physician Behavior. Am J Med Qual 2007; 22; 5. Berner, Eta, S.. (2007). Clinical Decision Support Systems: Theory and Practice. Health Informatics. Retrieved, from Cabana, MD, Rand, CS, Powe, NR. Why don t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999; 282: Coiera E Guide to health informatics 2nd Edition. Clinical Decision Support Systems. Arnold, London, 2003; Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293: Greenes, Robert A. Clinical decision support : the road ahead. Amsterdam ; Boston : Elsevier, c2007. Kawamoto K, Houlihan CA, Balas EA, et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ Apr 2;330(7494):

18 References cont. 35 McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348: McGregor JC, Weekes E, Forrest GN, et al. Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial. J Am Med Inform. Assoc. 2006; 13(4): Sackett, DL, Rosenberg, WMC, Gray, JA, et al. Evidence-based medicine what it is and what it isn t. BMJ. 1996;12, Shea AM, DePuy V, Allen JM, et al. Use and Perceptions of Clinical Practice Guidelines by Internal Medicine Physicians. Am J Med Qual 2007;22: Woodburn JD, Smith KL, Nelson GD. Quality of Care in the Retail Health Care Setting Using National Clinical Guidelines for Acute Pharyngitis Am J Med Qual. 2007;22: