informatics & technology in nursing
TRANSCRIPT
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
[email protected]://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
• Economist.com subscription $59• Print subscription $125• Print & web subscription $125
Ariely (2008)
16084
The Economist Purchase Options
• Economist.com subscription $59• Print & web subscription $125
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