informatics & technology in nursing

Informatics & Technology in NursingNawanan Theera‐Ampornpunt, M.D., Ph.D.Faculty of Medicine Ramathibodi Hospital, Mahidol University

2003 M.D. (First‐Class Honors) (Ramathibodi)2009 M.S. in Health Informatics (U of MN)2011 Ph.D. in Health Informatics (U of MN)2012 Certified HL7 CDA Specialist

• Deputy Executive Director for Informatics (CIO/CMIO)Chakri Naruebodindra Medical Institute

• Lecturer, Department of Community MedicineFaculty of Medicine Ramathibodi HospitalMahidol University

nawanan.the@mahidol.ac.thhttp://groups.google.com/group/ThaiHealthIT

www.SlideShare.net/Nawanan

Introduction

• Health & Health Information• Health IT• Informatics as a Discipline• Nursing Informatics• Summary

Outline

Health & Health Information

Let’s take a look at these pictures...

Image Source: Guardian.co.uk

Manufacturing

Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3

Banking

ER - Image Source: nj.com

Healthcare (On TV)

(At an undisclosed nearby hospital)

Healthcare (Reality)

• Life‐or‐Death• Difficult to automate human decisions

– Nature of business– Many & varied stakeholders– Evolving standards of care

• Fragmented, poorly‐coordinated systems• Large, ever‐growing & changing body of knowledge

• High volume, low resources, little time

Why Healthcare Isn’t Like Any Others

Back to something simple...

To treat & to care for their patients to their best abilities, given limited time & resources

Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen)

What Clinicians Want?

• Safe• Timely• Effective• Patient-Centered• Efficient• Equitable

Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy

Press; 2001. 337 p.

High Quality Care

Information is Everywherein Healthcare

Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.

“Information” in Medicine

16

16

WHO (2009)

Components of Health Systems

17

17

WHO (2009)

WHO Health System Framework

Health & Health Information• Health IT• Informatics as a Discipline• Nursing Informatics• Summary

Outline

Health IT & eHealth

(IOM, 2001)(IOM, 2000) (IOM, 2011)

Landmark IOM Reports

• To Err is Human (IOM, 2000) reported that: – 44,000 to 98,000 people die in U.S.

hospitals each year as a result of preventable medical mistakes

– Mistakes cost U.S. hospitals $17 billion to $29 billion yearly

– Individual errors are not the main problem– Faulty systems, processes, and other

conditions lead to preventable errorsHealth IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare ‐ Lecture d

Patient Safety

• Humans are not perfect and are bound to make errors

• Highlight problems in U.S. health care system that systematically contributes to medical errors and poor quality

• Recommends reform• Health IT plays a role in improving patient

safety

IOM Reports Summary

Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy‐heads/ (Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg

To Err Is Human 1: Attention

Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital

To Err Is Human 2: Memory

• Cognitive Errors - Example: Decoy Pricing

The Economist Purchase Options

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Ariely (2008)

16084

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6832

# of People

# of People

To Err Is Human 3: Cognition

• It already happens....(Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013)

What If This Happens inHealthcare?

Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, Schmidt HG. Effect of availability bias and reflective reasoning on diagnostic accuracy

among internal medicine residents. JAMA. 2010 Sep 15;304(11):1198-203.

Cognitive Biases in Healthcare

Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80.

Cognitive Biases in Healthcare

Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781‐3.

“Everyone makes mistakes. But our reliance on cognitive processes prone to bias makes 

treatment errors more likely than we think”

Cognitive Biases in Healthcare

• Medication Errors

– Drug Allergies

– Drug Interactions

• Ineffective or inappropriate treatment

• Redundant orders

• Failure to follow clinical practice guidelines

Common Errors

Why We Need ICT in Healthcare?

#1: Because information is everywhere in healthcare

Why We Need ICT in Healthcare?

#2: Because healthcare is error-prone and technology

can help

Why We Need ICT in Healthcare?

#3: Because access to high-quality patient information

improves care

Why We Need ICT in Healthcare?

#4: Because healthcare at all levels is fragmented &

in need of process improvement

HealthInformation Technology

Goal

Value-Add

Tools

Health IT: What’s In A Word?

Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

Health Information Exchange

Health & Health InformationHealth IT• Informatics as a Discipline• Nursing Informatics• Summary

Outline

Biomedical & Health Informatics

as a Discipline

• “Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health.” (AMIA, 2012)

Biomedical Informatics

• Provide Patient-Centered Care• Work in Interdisciplinary Teams• Employ Evidence-Based Practice• Apply Quality Improvement• Utilize Informatics

Core Competencies of Health Professionals

(IOM, 2003)

(Shortliffe, 2002)

Informatics As A Field

(Hersh, 2009)

Informatics As A Field

Biomedical/Health

Informatics

Computer & Information

Science

Engineering

Cognitive &

Decision Science

Social Sciences

(Psychology, Sociology, Linguistics,

Law & Ethics)

Statistics &

Research Methods Medical

Sciences & Public Health

Management

Library Science,

Information Retrieval,

KM

And More!

Informatics & Other Fields

Health & Health InformationHealth ITHealth Informatics as a Discipline• Nursing Informatics• Summary

Outline

Nursing Informatics

• Nursing Informatics is the “science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide.” (IMIA Special Interest Group on Nursing Informatics 2009).

Nursing Informatics

AMIA Nursing Informatics Working Group

Nursing Informatics

Source: http://nursingfile.com/nursing-informatics/road-to-the-future-nursing-informatics.html

• Standards to support evidence-based practice, research, and education

• Data and communication standards• Research• Information presentation and retrieval to support

safe patient centered care• ICT to address inter-professional workflow needs

across care• Development, design, and implementation of ICT• Healthcare policy to advance the public’s health

Core Areas of Nursing Informatics

AMIA Nursing Informatics Working Group

• Nursing Informatics Standards– Omaha System

Examples of Nursing Informatics Works

• Health IT in Clinical Settings– Electronic Nursing Records– e-Kardex– Careplanning– Electronic Medication Administration Records

(e-MAR)– Barcoded Medication Administration– Other nurse-related workslows

Examples of Nursing Informatics Works

Ordering Transcription Dispensing Administration

CPOEAutomatic Medication Dispensing

Electronic Medication 

Administration Records (e‐MAR)

BarcodedMedication 

Administration

BarcodedMedication Dispensing

Medication Process

• Health IT for Consumers/Patients– Personal Health Records– Telemedicine

– Web Sites for Patient Education & Engagement– mHealth & Social Media

Examples of Nursing Informatics Works

Images from HealthVault.com, American Telecare, Inc. & WHO

Health & Health InformationHealth ITHealth Informatics as a DisciplineNursing Informatics• Summary

Outline

Summary

• Information is important & everywherein healthcare (and nursing)

• Health IT helps improve quality of care and reduces errors by health workers

• Informatics is an interdisciplinary field, with nursing informatics as one key sub-field

• Nursing informatics plays important roles in today and future’s patient care

Summary