DRAFT. Medical School Health IT Curriculum Topics. Matthew Swedlund, John Beasley, Erkin Otles, Eneida Mendonca

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1 Medical School Health IT Curriculum Topics DRAFT Matthew Swedlund, John Beasley, Erkin Otles, Eneida Mendonca PC3. Use information technology to optimize patient care. 1. Attributes relating to appropriate design and use of HIT a. Human Factors Considerations in HIT design and implementation i. Explain the determinants of human cognitive capacity for complex decision making, including decision making and decision analysis, and error fatigue/hard stops. ii. Describe the fundamentals of usability (easy to learn, use, remember, few errors, pleasing to use) as related to medical error reduction, information chaos, and fatigue iii. Describe key information flows (between patients and clinicians, clinicians and clinicians, and clinicians and information systems), and how they interact with one another with regard to information chaos, distractions, workflow, screen and display design, and types of data entry. iv. Analyze socio-technical systems to find root-causes of systemic performance issues. v. Describe the impact of systemic performance issues on the following: a. Error fatigue/hard stops b. Physician workload/burnout c. Social structure in relation to quality and satisfaction vi. Conduct usability assessments on health IT systems b. Cognitive functions for the care process i. Describe how HIT design and implementation can support or fail to support cognitive processes required to establish situational awareness with a patient, develop a differential diagnosis, and prioritize diagnostic and therapeutic interventions. ii. Explain how the cognitive processes differ in ambulatory, inpatient and remote settings (i.e. telemedicine, MyChart) and how HIT design and implementation can support these processes c. Team Function i. Communication among team members 1. Describe the impact of effective use of HIT on team based care including patient outcomes and medical costs 2. Compare and contrast different styles of communication across medical teams, including asynchronous and synchronous styles 3. Describe how HIT design and implementation can support team cognitive processes ii. Social Impact 1. Explain how technology can impact social relationships among team members and how it can impact overall team function. d. Data i. Databases

2 1. Describe the different types of data used in clinical settings (structured vs unstructured, categorical vs. numerical, etc.) 2. Discuss the differences between how applications store data in memory (tables, trees, etc.) compared to human memory ii. Data Mining / Machine Learning / Big Data / Artificial Intelligence 1. Explain the use of analytical methods in parsing, encoding, and analyzing health records 2. Describe how Natural Language Processing can be used to parse and encode physician notes and other free text reports 3. Explain the importance of analytical methods in advancing evidence based medicine (e.g. Cancer bioinformatics, Predicting patient readmissions, Personalized/Precision Medicine) iii. Data Lifecycle 1. Identify the ways data are collected, stored, and used for the purposes of healthcare delivery 2. Articulate the interactions between parts of the data lifecycle (e.g. badly collected data makes later usage difficult/impossible) 3. Describe the role of interoperability of data across systems, applications and devices. e. Patient Safety i. Explain how HIT can improve patient safety. (e.g. Improvement in issues with note or order legibility, Clinical Decision Support), as well as how it can propagate errors. ii. Explain differences between system errors and user errors as well as errors inherent to the EHG specifically: 1. Drop down list inappropriate selection 2. Medication look alikes 3. Prescribing errors due to multiple fields requiring input/update iii. Explain ways in which HIT can be used to address patient safety concerns 2. Use of HIT in clinical care a. Building patient relationships i. Use of HIT in exam room 1. Explain the impact that HIT use in the exam room has on the clinician-patient relationship and how it can be used effectively to reduce the negative impacts it has on patient interactions (e.g. Maintain eye contact with patient, RESPECTS pneumonic supplement, Screen-sharing). 2. Demonstrate the ability to use HIT in the exam room while still appreciating nonverbal cues and communication from patients. ii. Patient use of online medical information 1. Describe the advantages and limitations of publicly available online medical resources. 2. Demonstrate the ability to counsel patients about quality online medical resources and to respond to patients with questions or concerns generated by their review of online medical resources and appropriately adapt their plan of care.

3 3. Explain the role of disease-specific websites in helping patients with chronic illness to manage their diseases. iii. Personalized/genomic medicine 1. Direct to consumer genome testing a. Discuss current and pending consumer genetic testing and their limitations. b. Demonstrate ability to counsel patients appropriately about consumer genetic testing results. 2. Medical genetic testing a. Explain the current role of genetic testing in medicine and the limitations of currently available genetic medicine. b. Describe the impact of human cognitive limitations with respect to interpretation of patient genetic data and the dangers or pitfalls associated with genetic testing (ie diagnosis without available cure or treatment, long term implications on insurance) iv. Wearable Health Technology 1. Discuss currently available wearable health technologies. 2. Demonstrate the ability to engage patients in their health using wearable health technologies (fitbit, smartphone fitness apps, blood glucose recording, home diagnostic testing) b. Communication with patients i. Communicating test results 1. Describe the importance of timely communication of test results with patients 2. Utilize different modalities to communicate lab results (EHR, care teams, direct communication with patients), and explain when different methods of communicating results with patients are appropriate ii. Discharge plan of care paperwork 1. Explain the importance of a clear and concisely communicated discharge plan of care and the components of that plan that are necessary to aid patient understanding of their health and improve patient outcomes. 2. Demonstrate the ability to generate thorough, effective and understandable discharge plans of care appropriate to different patients including when one-on-one communication is best iii. After visit summaries (AVS) 1. Explain the importance of a clear and concise visit summary to help patients recall instructions and plans from outpatient visits. 2. Identify the components necessary for an optimal AVS 3. Demonstrate the ability to generate thorough and understandable patient instructions in the after visit summary. 4. Show effective use of disease-specific instructions available by the EHR and the ability to use with customized instructions when appropriate.

4 iv. Digital communication 1. Engaging patients with personal health record a. Describe the importance of engaging with patients in their health and demonstrate use of the EHR to effectively communicate with and engage patients in their health. b. Demonstrate use of the EHR to generate secure patient messages to communicate with patients 2. Communicate with Colleagues with the EHR a. Explain when digital communication ( or EHR) versus direct synchronous communication (telephone, discussion in person) is appropriate b. Demonstrate use of the EHR to communicate with colleagues. c. Entering and retrieving data i. Effectively find relevant clinical information from the health record 1. Demonstrate the ability to find relevant clinical information from the electronic health record and the effective use of cross-platform tools such as filters to improve the efficiency of information retrieval 2. Find and compare discrete patient information in the inpatient and outpatient setting. (ie vitals, labs, glucose monitoring, patient scoring tools, questionnaires) 3. Use the EHR to display discrete data in different formats to aid interpretation, including flowsheets and graphs. 4. Explain the importance of a consistent approach to reviewing the patient record and demonstrate that approach in practice. ii. Generate usable notes 1. Describe the role of effective, appropriate and thorough documentation in patient safety and explain the role of narrative in notes to aid clinicians understanding and facilitate communication. 2. Describe the problems associated with excessive use of templates and blowing in unnecessary data (ie note bloat). 3. Demonstrate the ability to generate readable notes in the inpatient and outpatient setting that contain relevant information without unnecessarily pulling in discrete data from the EHR. iii. Maintain an accurate problem list 1. Explain the importance of the problem list in optimal patient care and describe the potential dangers associated with an out-of-date problem list 2. Demonstrate the ability to generate and maintain an accurate and thorough problem list iv. Computerized Provider Order Entry (CPOE) 1. Describe the advantages of CPOE with respect to patient safety and the disadvantages of CPOE with respect to patients safety and increased time demands on clinicians.

5 2. Discuss alternatives to CPOE (e.g. scribes, MA s entering orders) 3. Demonstrate the ability to use CPOE to input orders for medications, diagnostic tests and physician consults. v. Picture Archiving and Communication System (PACS) 1. Explain the benefits and limitations of PACS systems, including the impact of lower resolution images on systems not optimized for PACS viewing. 2. Demonstrate the ability to use a PACS system to find, view and compare radiographic images. vi. Best Practices/Errors 1. Explain the role of best practice alerts (BPAs) and error messages in the EHR to improve patient safety and appropriateness of orders. 2. Describe the difference between hard and soft stops in error messages and BPAs, and describe the disadvantages of excessive use of hard stops 3. Explain the danger of excessive use of best practice alerts and error messages due to error fatigue. 4. Demonstrate the ability to use BPAs in the EHR to improve patient care. d. Improving clinical care i. Clinical Decision Support (CDS) 1. Explain how integrated CDS tools can help improve patient care and identify the different types of CDS commonly in use 2. Demonstrate the use of CDS in providing optimal patient care ii. Performance metrics 1. Development of metrics a. Explain the purpose of performance metrics and how they are selected as well as their limitations e. Technical/Design Issues i. Technical/Design Issues 1. Explain how combining use of paper data recording with HIT can augment function compared to paperless documentation. ii. Screen design 1. Describe the how usability heuristics can be used to optimize screen design. iii. Hardware Choices 1. Describe how different hardware can augment usability of HIT (e.g. wide screen, dual monitor, laptop, tablet) 2. Explain how devices that are able to communicate directly can improve information flow. 3. Explain how physical layout of HIT allows technology to facilitate rather than serve as a barrier between patient and clinician f. Health Information Exchange (HIE) i. Explain the risks of fragmentation of care from receiving care in different medical systems.

6 ii. Describe the role and limitations of HIE and the legal limitations to its use iii. Utilize HIE to access medical records for a patient from difficult medical systems to improve patient care. g. Telemedicine i. Describe telemedicine and its different applications in medical care (ie eicu, econsults, etc.) h. HIT Vendors i. Describe the relationship between HIT vendors and medical organizations and explain the difference between HIT vendor support personnel and organizational HIT support 3. Use of HIT for population management a. Methods to extract population data i. Identify different sources of population data currently available and the use of that data to improve patient care b. Strategies for analysis of population data i. Describe techniques of aggregating patient data to the level of populations or subpopulations. ii. Articulate importance of using clinical outcome measures in evaluating health of population. c. Mapping/GIS as a tool for population management i. Describe how mapping/gis can be used to aid in the care of populations of patients including how to develop plans to address specific health issues 4. Ethical and Legal Considerations for development and use of HIT a. HIPAA i. Explain the background and purpose of HIPAA law. ii. Explain the implication of HIPAA with respect to digital patient care records. iii. Using knowledge of HIPAA privacy laws, discuss how social media use can violate HIPAA and be used to avoid such violations. iv. Explain institutional rules regarding the use of cloud storage and how cloud storage can violate HIPAA b. Ethics of digital media use i. Describe the advantages and disadvantages with respect to privacy and security of electronic patient records ii. Describe the ethical issues around use of social media as a clinician c. Meaningful Use/HITECH Act i. Explain the rationale behind the HITECH act and meaningful use as well as the stages of meaningful use and their impact on clinicians and health care systems. ii. Discuss the limitations of meaningful use rules. d. Security/Compliance i. Discuss the purpose and importance of compliance departments in medical systems. ii. Explain the security challenges inherent in HIT and how security is maintained. e. Note originality

7 i. Describe the legal and professional ramifications of note copying ii. Explain the dangers of use of excessive templates in notes from the standpoint of billing and concerns for Medicare fraud iii. Demonstrate the ability to consistently generate original notes with appropriate use of templates, scribes and/or dictation to improve efficiency 5. Careers in HIT a. Describe the role physicians play in HIT development and implementation especially as super users or champions b. Describe how increasing the involvement of practicing physicians in HIT development can improve usability c. List different careers for physicians in HIT such as CMIO and as a physician working for HIT vendor

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