Medical Informatics: A Primer Ken Ong, MD, MPH December 20, 2013 Physician Webinar Series #1

Welcome to the Physician Community Webinar Series

• Complimentary virtual event that will be held monthly & offer continuing education hours

• Will cover a wide range of topics on Medical Informatics, HIEs (Health Information Exchange), Standards & Interoperability, eMeasures & Quality Initiatives and more

• More information www.himss.org/physician or contact Lauren Kaderabek lkaderabek@himss.org

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Objectives

• Explore the history of informatics, define medical informatics as a specialty and understand how informatics principles are used to define the value of IT.

• Analyze landmark publications on patient safety, medical informatics and diffusion innovation to prepare the learner to translate theory into practice.

• Illustrate real world case studies on the applied use of informatics in the electronic health record on improving quality and reporting in HIV care and stroke education.

Agenda First, A little about Ken…

Medical Informatics Defined

History of Medical Informatics

Informatics Areas & Hot Topics

Landmark Informatics Publications

Resources

HIMSS14 Continuing Education Credit Save the Date: Physician Community Webinar Series

FIRST, A LITTLE ABOUT KEN…

Ken Ong, MD, MPH, FACP, FIDSA, FHIMSS, CPHIMS

Employment: Chief Medical Informatics Officer of New York Hospital Queens, a member of the New York-Presbyterian Healthcare System. After more than 20 years in clinical practice (including former deputy commissioner in the New York City Department of Health and Mental Hygiene), he has devoted the last dozen years to clinical informatics in hospitals located in New York.

The second edition of Ken's award winning 'Medical Informatics: an Executive Primer' was published 2011.

Professional activities: Member, Health Information Management and Systems Society Board of Directors (HIMSS); Member, Healthcare Association of New York State's Health Information Strategy Group; Member, Greater New York Hospital Association Health I.T. Steering Committee; past president of the New York State chapter of HIMSS; past president and board member of Medical Informatics New York.

Academic affiliation: Adjunct faculty at Columbia University’s Mailman School of Public Health and Health Informatics Certificate Program. Ken's medical informatics seminar was among the top rated in 2005.

Training: Residency-trained and board certified in Family Practice, Internal Medicine, and Infectious Diseases. Fellow of the American College of Physicians, the Infectious Disease Society of America, HIMSS, and the New York Academy of Medicine. MPH - Columbia University, MD - Wayne State University, and BS - University of Michigan.

Recognition: Modern Healthcare - top 25 clinical informaticists in 2012; HIMSS Book of the Year 2007; Previous recipient of the AMDIS Award In Applied Medical Informatics; and, the Centers for Disease Control Charles C. Shepard Science Award.

Ken’s I.T. Experience

Cerner Pharmnet – Hospital Pharmacy System

Epicare – AIDs Clinic

Dragon Speech recognition – Radiology

Premier Clinical Advisor – Business/Clinical Intelligence

PatientKeeper -- Mobile Charge Capture

Telehealth – Heart Failure

Allscripts Sunrise • CPOE • CDS: Order Sets, ClinDoc, MLMs • Full electronic physician documentation • MU1 -> MU2

Product names are for informational purposes only.

ONE OF MY EARLY EXPERIENCES WITH INFORMATICS

A RECENT INFORMATICS PROJECT…

Stroke & the Electronic Health Record: Improving Quality and Reporting

Ken Ong, MD, MPH; Bebe Z. Rahamatalli, RPA-C, MPAS; Jean Versace, RN,BS; Edward Chai, MD; Anna Delios, MD; Helena Hizon, RN, MS; Alfred Caligiuri, PA, MBA; Karen J. Nefores, RN, BSN, MBA

Agenda First, A little about Ken…

Medical Informatics Defined

History of Medical Informatics

Informatics Areas & Hot Topics

Landmark Informatics Publications

Resources

HIMSS14 Continuing Education Credit Save the Date: Physician Community Webinar Series

Medical Informatics Defined

http://prezi.com/cgtbsvhuzzyt/copy-of-the-history-of-health-informatics/

15 Intriguing Facts About the History of Informatics http://mastersinhealthinformatics.com/2011/15-intriguing-facts-about-the-history-of-informatics/

1. The first computer is widely considered to be the Abacus. However, an interesting bronze construction, with a crank, might actually be a computer of sorts. It’s called the Antikythera Mechanism, and it was dated to as far back as 100 B.C. There is speculation that it might have provided mechanical (albeit analog) computation.

15 Intriguing Facts About the History of Informatics http://mastersinhealthinformatics.com/2011/15-intriguing-facts-about-the-history-of-informatics/

2. The first modern computer is credited to John Atanasoff and Clifford Berry. The first electronic-digital computer was built sometime between 1939 and 1942. It was a collaboration between professor Atanasoff and his graduate student, Berry, at Iowa State university.

15 Intriguing Facts About the History of Informatics http://mastersinhealthinformatics.com/2011/15-intriguing-facts-about-the-history-of-informatics/

3. The first professional informatics organization was started in 1949 — even before computers gained widespread acceptance (although computers did exist). Gustav Wagner founded a professional organization in Germany, and from there it spread.

4. Countries that first embraced specialized training for informatics included Germany, France, Belgium and The Netherlands. These specialized informatics training programs became popular during the 1960s.

5. Health care informatics started out with a variety of different names. Some of these names included medical computing (which is still used today), computer medicine, medical electronic data processing, medical information science, and medical automatic data processing. These different names mostly fizzled out, to be replaced by the term informatics.

15 Intriguing Facts About the History of Informatics http://mastersinhealthinformatics.com/2011/15-intriguing-facts-about-the-history-of-informatics

6. The term “informatics” was introduced in the 1960s in France – a French version of the word, of course: Informatique. And, of course, it makes sense to use the informatics, since the whole field of health care and medical informatics is based on data and information.

7. Computation for medical purposes was first done in the 1950s. It was used for dentistry. Robert Ledley at the National Bureau of Standards tested out the usefulness of using computers in medicine.

8. Clinical operations had a programming language all its own for quite some time. It was known as MUMPS, a name developed from the Massachusetts General Hospital Utility Multi-Programming System, where it was first developed and implemented. Even though this programming language is no longer used heavily, the U.S. Veterans Affairs hospitals used a descendent of MUMPS for a long time.

15 Intriguing Facts About the History of Informatics http://mastersinhealthinformatics.com/2011/15-intriguing-facts-about-the-history-of-informatics

9. One of the reasons that informatics is so important in todays world is due to the development of the Internet. However, the precursor to the Internet was ARPANET, a Defense Department funded research project. It linked universities and other research centers all over the country. The first two nodes on the project were UCLA and Stanford. Interestingly, the third node was the University of Utah, located in Salt Lake City. Without the Internet that eventually developed from ARPANET, we wouldn’t have access to all the medical information we have today.

10. MEDLINE is one of the oldest medical information sharing databases around. The National Library of Medicine began using MEDLINE as a way to retrieve medical information and articles in 1965. However, since then, the database has expanded to include archives going all the way back to 1950. This is one of the finest examples of medical informatics, since it arranges data in a way that is easy to retrieve.

15 Intriguing Facts About the History of Informatics http://mastersinhealthinformatics.com/2011/15-intriguing-facts-about-the-history-of-informatics

11. One of the founding fathers of medical informatics in the United States was Homer R. Warner. In 1972, he founded an entire department devoted to medical informatics at the University of Utah. The Department of Biomedical Informatics has had many names since then. With such a history, is little surprise that the University of Utah has a good medical program, and that it focuses a great deal on technology as it relates to medicine.

12. Electronic medical records (also called electronic health records) have been in existence since the 1970s. Having access to this information can be useful for patients and doctors. Indeed, it is becoming more common to see health care informatics presented this way so that it is easy for health care providers and patients to quickly see the medical data that relates to them. One of the goals of those pushing the use of medical informatics is to try to increase the access to electronic medical records, and encourage their widespread use.

13. One of the countries to really push the development of medical informatics along early was Brazil. In 1968, Brazil was using computers for medicine and health care. The country was also among the first to begin installing computer mainframes in hospitals at university hospitals. Additionally, the country was an early adopter of the idea of using programmable calculators to aid in medical research and enhance informatics. Brazil has been quick to embrace advancing technology and incorporate it in its health care system, and use it to help in medical settings, including for diagnostics, research and treatment.

15 Intriguing Facts About the History of Informatics http://mastersinhealthinformatics.com/2011/15-intriguing-facts-about-the-history-of-informatics

11. In 1978, the term bioinformatics was coined to describe a subset of medical informatics. The idea was to look at biological systems, and compile data on them. Bioinformatics focuses a great deal on DNA sequencing for informational purposes, and the technologies developed to aid in that area. Additionally, bioinformatics has provided a great deal of additional information on biology, and the way our bodies work as systems.

12. More recently, health care informatics got a boost from its inclusion the American Recovery and Reinvestment Act of 2009. Some of the informatics related projects that have received funding as a result of the Act include electronic health records, tracking disease and health, as well as DNA sequencing. Medical informatics are gaining more attention every day, and more people are recognizing how information technology can contribute in the health care arena..

Agenda First, A little about Ken…

Medical Informatics Defined

History of Medical Informatics

Informatics Areas & Hot Topics

Landmark Informatics Publications

Resources

HIMSS14 Continuing Education Credit Save the Date: Physician Community Webinar Series

INFORMATICS AREAS & HOT TOPICS

INFORMATICS AREAS

Translational Bioinformatics

Clinical Research Informatics

Clinical Informatics

Consumer Health Informatics

Public Health Informatics

Medical Informatics: Hot Topics… • Accountable care / Care coordination: “Accountable Care Organizations (ACOs) are groups of

doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.” - CMS

• Ambulatory Care Information System: Information systems to deal with the care of outpatients. -- HIMSS

• Clinical & Business Intelligence: Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making. -- HIMSS

• Clinical Decision Support: A process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery. Information recipients can include patients, clinicians and others involved in patient care delivery; information delivered can include general clinical knowledge and guidance, intelligently processed patient data, or a mixture of both; and information delivery formats can be drawn from a rich palette of options that includes data and order entry facilitators, filtered data displays, reference information, alerts, and others. -- HIMSS

Medical Informatics: Hot Topics… • Consumer - Patient Engagement: e-connect with patients and families

through engagement with personal health records, patient portal adoption, social media, mHealth and other emerging health related technologies. -- HIMSS

• eMeasures: Electronic measures (eMeasures) are standardized performance measures in an electronic format. eMeasures can promote greater consistency in measure development and in measuring and comparing performance results. They also can provide more exact requirements about where information should be collected, and drive greater standardization across the measures and greater confidence in comparing outcomes and provider performance. – National Quality Forum

• Health Information Exchange: A secure method of sharing vital patient information electronically. – Healthit.gov

Medical Informatics: Hot Topics…

• Meaningful Use: Meaningful use is the set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria.

• mHealth: The use of mobile and wireless devices to improve health outcomes, healthcare services and health research -- Health Resources and Services Administration (HRSA)

• 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

• Patient Centered Medical Home: The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be." Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care. – National Committee for Quality Assurance

Medical Informatics: Hot Topics…

• Project Management: the application of knowledge, skills and techniques to execute projects effectively and efficiently. -- Project Management Institute

• Regional Extension Center: The ONC’s Regional Extension Centers (RECs), located in every region of the country, serve as a support and resource center to assist providers in EHR implementation and HealthIT needs. As trusted advisors, RECs “bridge the technology gap” by helping providers navigate the EHR adoption process from vendor selection and workflow analysis to implementation and meaningful use. – Healthit.gov

• Usability: Usability is the effectiveness, efficiency and satisfaction with which specific users can achieve a specific set of tasks in a particular environment -- Schoeffel R. ISO Bulletin. 2003;34:6‐7.

• Value of HIT: How do we know Health IT works? How does Health IT improve patient care? Can others achieve the same type of value using their systems? – HIMSS Health IT Value Suite

Let’s Talk About These Hot Topics

VALUE OF HEALTH I.T.

http://www.himss.org/ValueSuite

92% of the recent articles on health information technology reached conclusions that were positive overall.

Benefits of the technology are beginning to emerge in smaller practices and organizations, as well as in large organizations that were early adopters.

However, dissatisfaction with electronic health records among some providers remains a problem and a barrier to achieving the potential of health information technology.

The Benefits Of Health Information Technology: A Review Of The Recent Literature

Shows Predominantly Positive Results Buntin et al. 10.1377/hlthaff.2011.0178. HEALTH AFFAIRS 30, NO. 3 (2011):

464–471

The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results Buntin et al. 10.1377/hlthaff.2011.0178. HEALTH AFFAIRS 30, NO. 3 (2011): 464–471

CLINICAL DECISION SUPPORT

What does this cicada have in common with clinical research?

Please answer in the open polling section.

12/19/2013

Average Of 17 Years To Implement Clinical Research Results Into Clinical Practice Balas. Journal of the American Medical Informatics Association Volume 8 Number 4 Jul / Aug 2001

12/19/2013

If you read 2 articles every night after work, how long would it take to read a year’s worth of published medical studies?

Please answer the question in the open polling section.

Select one: 1 year 10 years 100 years 1000 years

12/19/2013

If a clinician who endeavored to keep current with all the professional literature read two articles every night, she would be 1,225 years behind at the end of the first year (Stead 2005).

Domain Number Diagnoses ? Medications ? Procedures ? # Interventions per patient in critical care per 24 hours

?

Medicine is Complex Atul Gawande. The Checklist Manifesto. 2009

Please answer in the open polling section.

Domain Number Diagnoses 14,000 Medications 6,000 Procedures 4,000 # Interventions per patient in critical care per 24 hours

178

Medicine is Complex Atul Gawande. The Checklist Manifesto. 2009

ICD Version Number of Diagnoses

ICD-9 14,000 ICD-10 68,000

International Classification of Disease Going Live October 2014

CDS Interventions A Cornucopia of tools…

• Alerts and reminders

• Clinical guidelines

• Clinician patient assessment forms

• Data flow sheets

• Diagnostic support and suggestions

• Extended-time guideline and protocol followers

• Order facilitators (order sets, order consequents, order modifiers)

• Patient data reports and dashboards

• Patient self-assessment forms

• Patient summaries for hand-offs between clinicians • Performance dashboards with prompts for areas needing attention

Clinical Decision Support Tools

• Procedure refreshers, training, and reminders • Protocol/pathway support • Reference information delivered • Relevant data displays • Smart documentation forms or documentation templates • Targeted reference, including contextually relevant medical

references or info buttons • Task assistants for tasks such as drug dosing and

acknowledging laboratory results • Tracking and management systems that facilitate task

prioritization and whole-service management

Clinical Decision Support Tools

Clinical Decision Support (CDS) Fact Sheet. HIMSS, 2009. (http://www.himss.org/content/files/CDSFactSheet3-17-09.pdf; last accessed 8/7/2010). Osheroff JA, Editor. Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide. Chicago: HIMSS; 2009. Clinical Decision Support Workshop Meeting Summary, August 25 – 26, 2009. Office of the National Coordinator for Health Information Technology (http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_898639_0_0_18/ONC%20CDS%20Workshop%20Meeting%20Summary_f.pdf; last accessed 8/8/2010)

PROJECT MANAGEMENT

Project: a definition

“A project is a temporary activity that becomes progressively elaborated as you move through the lifecycle, and produces a unique product, service, or results.”

– Time-limited; ends when objectives achieved or when decision made to terminate

– Can last weeks to years

– Elaboration of tasks as project progresses, not uncontrolled scope creep

PROJECT TOOL BOX

Project Charter http://office.microsoft.com/en-us/templates/TC011414181033.aspx?CategoryID=CT101445011033

1.Project Charter Purpose 2.Project Executive Summary 3.Project Overview 4.Project Scope

a) Goals And Objectives b) Departmental Statements Of

Work (SOW) c) Organizational Impacts d) Project Deliverables e) Deliverables Out Of Scope f) Project Estimated Costs &

Duration

5.Project Conditions a) Project Assumptions b) Project Issues c) Project Risks d) Project Constraints

6.Project Structure Approach 7.Project Team Organization

Plans 8.Project References 9.Approvals

Project Objective Setting: Get SMART! Adapted from http://en.wikipedia.org/w/index.php?oldoldid=414800273

Letter Major Term Minor Terms S Specific Significant, Stretching, Simple M Measureable Meaningful, Motivational, Manageable A Attainable Appropriate, Achievable, Agreed,

Actionable, Action-oriented, Ambitious, Aligned, Aspirational

R Relevant Realistic, Results / Result-focused / Results-oriented, Resourced, Rewarding

T Time-bound Time-oriented, Time framed, Timed, Time-based, Timeboxed, Timely, Time-Specific, Timetabled, Time limited, Trackable, Tangiable

Project Management Triangle, aka the Iron Triangle, the Triple Constraints

Gantt Chart

For that you, can thank Henry…

Henry Gantt (1861-1919), the father of planning and control techniques, e.g., the Gantt Chart

CONSUMER – PATIENT ENGAGEMENT

“Patient Engagement is the Blockbuster Drug of the Century” Leonard Kish

Controlling for differences in age, sex, and the severity and types of clinical alerts between the study and control groups,

the addition of patient messaging increased

compliance by 12.5% (P<0.001). This increase primarily because of improved responses to alerts

regarding the need for screening, diagnostic, and

monitoring results.

Supporting the Patient’s Role in Guideline Compliance: A Controlled Study Rosenberg et al. Am J Manag Care. 2008; 14(11):737-744

NATIONAL EHEALTH COLLABORATIVE:

PATIENT ENGAGEMENT FRAMEWORK

National eHealth Collaborative Patient Engagement Framework

Inform Me Engage Me Empower Me

Partner With Me

Support My e-

Community

Aligned with Meaningful Use

http://www.nationalehealth.org/patient-engagement-framework

Agenda First, A little about Ken…

Medical Informatics Defined

History of Medical Informatics

Informatics Areas & Hot Topics

Landmark Informatics Publications

Resources

HIMSS14

Continuing Education Credit Save the Date: Physician Community Webinar Series

Landmark Informatics Publications • Engage! Transforming Healthcare Through

Digital Patient Engagement Edited by Jan Oldenburg, Dave Chase, Kate T. Christensen, MD, and Brad Tritle, CIPP (2013)

• Health IT and Patient Safety: Building Safer Systems for Better Care (2012) By Institute of Medicine

• Improving Outcomes with Clinical Decision Support: An Implementer's Guide, Second Edition By Osheroff et al (2012)

• Diffusion of Innovations, 5th Edition By Everett M. Rogers (Aug 16, 2003)

• Crossing the Quality Chasm: A New Health System for the 21st Century (2001) By Institute of Medicine

• To Err Is Human: Building a Safer Health System (2000) By Institute of Medicine

Resources

• Medical Informatics: An Executive Primer

• Use MEDINFO2013 at check-out for 20% off, valid from Dec 20-31

• To purchase today, please go to:

• http://bit.ly/1fq95bP (Hard Copy)

• http://bit.ly/JI3vXE (eBook)

HIMSS Bookstore www.himss.org/store www.ebooks.himss.org

Q&A Ken Ong, MD, MPH kro2@columbia.edu www.kenongmd.com

www.himssconference.org

Continuing Education Credit

• This program has been designated for 1 hour of CAHIMS Credit

• This program has been designated for 1 hour of CPHIMS Credit

• Download forms at www.himss.org/physician

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