Informatics for librarians: the core of the onion
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This document provides an overview of health informatics and the role of librarians. It defines key terms like electronic health records, health information technology, and meaningful use. It discusses stages of meaningful use and how health informatics tools can improve care delivery and outcomes. The document also explores potential roles for librarians in areas like patient education, training, and research support within the health informatics field.
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Informatics for librarians: the core of the onion
- 1. INFORMATICS FOR LIBRARIANS: THE CORE OF THE ONION Jacqueline Leskovec, MLIS, MA, RN Outreach, Planning & Evaluation Coordinator National Network of Libraries of Medicine Greater Midwest Region June 2012
- 2. Objectives Participants will: •Be able to define health informatics •Understand the role of legislation in health care reform •Understand the relationship between health informatics and HIT •Be able to list at least 5 HIT tools •Explore ideas on the roles of librarians within the realm of HIT
- 3. Health Informatics • Health informatics or medical informatics is the application of information technology to the healthcare profession with the aim of creating tools and procedures that can help doctors, nurses, and other healthcare personnel diagnose and treat patients more accurately and efficiently. http://healthinformatics.uic.edu/history-of-health-informatics/
- 5. “It isn't just about computer science anymore…” http://www.ischools.org/
- 6. Health Information Technology • Health information technology (health IT or HIT) makes it possible for health care providers to better manage patient care through secure use and sharing of health information. Health IT includes the use of electronic health records (EHRs) instead of paper medical records to maintain people's health information. The Office of the National Coordinator for Health Information Technology: http://healthit.hhs.gov/
- 10. Health Information Management • 1898: AML • 1907: MLA ____________ • 1928: ARLNA • 1938: AAMRL • 1970: AMRA • 1991: AHIMA Grace Whiting Myers
- 11. Informatics Pyramid Dalrymple 2011
- 12. Health Informatics Librarians! http://www.ukchip.org/
- 14. June 29, 1956 February 13,2009
- 15. The HITECH VISION Courtesy: Office of the National Coordinator for Health Information Technology
- 16. Health Informatics Applications • Electronic Medical Records • ePrescribing • Personal Health Records • Remote Monitoring • Secure Messaging • Telehealth http://www.toonpool.com/
- 17. EMR? EHR? HIE? • EMR: Electronic Medical Record • Electronic record of health-related information on an individual • Within one health care organization • EHR: Electronic Health Record • Electronic record of health-related information on an individual • Across more than one health care organization • HIE: Health Information Exchange • Electronic movement of health-related information among organizations • Involves networks • Local, state, and national HIE initiatives
- 18. Health information exchange is a team sport.
- 19. Who uses the EMR?
- 20. The Most Important User
- 21. Medical Model Vs. Patient-Centered Model
- 22. Being a Meaningful User • By adopting electronic health records in a meaningful way, clinicians can: • Know more about their patients. • Make better decisions. • Save money. • Be eligible for CMS incentive payments.
- 23. (Intended) Results of MU: • Improved clinical health outcomes • Improved population health outcomes • Increased efficiency in the health care system • Empowered individuals • Learning health care system
- 24. Stage 1: Meaningful Use • Focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health inform
- 25. MU Stage 1 – Key Components • Computerized Provider Order Entry (CPOE) • Clinical Decision Support (CDS) • Electronic Prescribing (E-prescribing) • Structured documentation of quality measures • Up-to-date Problem Lists and Diagnoses • Provide patients with health information electronically • Information exchange • Report clinical quality measures to CMS Glossary of Selected Terms Related to Health IT http://healthit.hhs.gov/portal/server.pt/community/health_it_hhs_gov__glossary/1256
- 26. Stage 2: Meaningful Use • Expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.
- 27. Stage 3: Meaningful Use • Focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.
- 28. Physicians’ Readiness For Ten Stage 1 Core Objectives, By Intention To Apply, 2011. Hsiao C et al. Health Aff doi:10.1377/hlthaff.2011.1315 ©2012 by Project HOPE - The People-to-People Health Foundation, Inc.
- 29. The Human Factor: HCI • Multi disciplinary • Usability job titles • Methods define the expertise http://www.toonpool.com/
- 30. Roles for Librarians • Patients who can access their own health information are likely to have questions they couldn’t articulate previously • Patients will be much more effective if they are taught to use these tools • Public libraries as well as medical libraries are appropriate venues for classes and support Maxine l. Rockoff, PhD Department of Biomedical Informatics Columbia University December 2010
- 31. IFH’s Tutorial Modules • Sign in • Review Health Summary • Review lab results • Renew a prescription • Schedule an appointment • Send a message to your doctor • Get health information from MedlinePlus
- 32. All Your Health Info, All in One Place • Veterans, active duty Servicemembers, their dependents and caregivers • Account upgrades with IPA
- 33. MLA/NLM Joint Task Force: PHR • PHR user support is a new role for medical librarians. • Medical librarians need to be proactive in their communities to educate consumers about PHRs. • Given the dynamic nature of this market, medical librarians should make a concerted effort to stay abreast of trends in this area. J Med Libr Assoc. 2010 July; 98(3): 243–249. PMCID: PMC2900995
- 34. Standards • Continuity of Care Document (CCD) • ASTM Continuity of Care Record (CCR) • Clinical Document Architecture (CDA) • Digital Imaging and Communications in Medicine (DICOM) • Good Electronic Health Record (GEHR) • Health Level Seven (HL-7)
- 35. Hospitals as Information Environments • “…altogether the most complex human organization ever devised.” • Peter Drucker, 1993 American Hospital Association http://www.aha.org/aha/resource-center/Statistics-and-Studies/index.html
- 36. Why FPs don’t use EMRs… I don’t type………….8.3% AAFP 2003
- 37. HIT and Educational Content • Training and education opportunities everywhere • Physicians and Nurses • Nursing • Other staff • Patient/Family Education
- 38. Infobutton http://solutions.wolterskluwer.com/blog/
- 39. • ICD-9-CM • SNOMED CT® • CORE Problem List Subset codes • RXCUI • NDC http://apps2.nlm.nih.gov/medlineplus/services/demo.html
- 40. Patient Education • Trusted source of information – Your doctor – Your hospital • Develop online patient education libraries – Well developed content – Easy to find what you need
- 41. Training. Free. Yes, FREE. • Practice workflow and Information and Information Management Redesign Specialist • Clinician/Practitioner Consultant • Implementation Support Specialist • Technical/Software Support Staff • Implementation Manager • Trainer http://www.onc-ntdc.org/ Time (and money!) is running out!
- 42. Trainer • Workers in this role design and deliver training programs, using adult learning principles, to employees in clinical and public health settings. • The previous background of workers in this role includes experience as a health professional, health information management specialist, or medical librarian. Experience as a trainer in the classroom is also desired.
- 44. EMR Optimization • “We are running out of time, let’s just get it up and running and fix the problems later.”
- 45. 1 The right to view and/or obtain a copy of your health information 2 The right to accurate and complete health information 3 The right to request changes to your health information 4 The right to know who receives your health information and how it is used 5 The right to request limitations on the uses and releases of your health information 6 The right to expect your health information is private and secure 7 The right to be informed about privacy and security breaches of your health information 8 The right to file a complaint or report a violation regarding your health information
- 46. Safety and Error Prevention • Information system configuration/use • Process design • Communication • Labeling • Education
- 47. Research - Clinical Guidelines
- 49. Doing what we do best… •What are you doing??
- 50. • Librarians have a unique perspective and understanding of the application of medical information resources to meet clinical user needs. Karen M. Albert Medical Reference Services Quarterly Vol. 26, Iss. 3, 2007
- 51. Questions/comments? • leskovec@uic.edu • SlideShare: leskovec • 1.800.DEV-ROKS This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N-276-2011-00005-C with the University of Illinois at Chicago.
Notes de l'éditeur
- As a result of today’s session,
- Health informatics as a discipline has a long and interesting history that would be impossible without Charles Babbage’s ideas about the first analytical computer system (originated the concept of a programmable computer) way back in the nineteenth century. Even though there was talk about using computers in medicine as technology advanced in the early twentieth century, it was not until the 1950s that informatics really took off in the United States. Robert Ledley, who would later invent the first full body CT scanner, is often credited as one of the founding fathers of U.S. informatics. His use of computers in dental projects with the National Bureau of Standards set the stage for later advancements in applying information technology to medicine
- 31 iSchools /developing healthcare informatics programs, Informatics education has recently undergone a growth spurt in the United States, and according to a 2008 survey, courses of study leading to degrees at several levels are offered by over 175 institutions in the United States. health information technologies (HIT) that promise to advance the quality of patient care, reduce costs, increase data security and improve coordination between physicians and hospital develop much-needed and qualified health IT leaders for private and public health care organizations The iSchools are interested in the relationship between information, people and technology. This is characterized by a commitment to learning and understanding the role of information in human endeavors. The iSchools take it as given that expertise in all forms of information is required for progress in science, business, education, and culture. This expertise must include understanding of the uses and users of information, as well as information technologies and their applications. “ It isn't just about computer science anymore, either. That isn't where you go to find out how technology changes people's lives, and where it fails them, or how to make it less intrusive and more humane . Those are the questions people are taking up at the Schools of Information that have sprung up at research universities like UCLA, Toronto and Washington — iSchools, for short. It's a different i-, but it too stands in for a connection between technology and the social world.” Everything from a certificate to a PhD The iSchools organization was founded in 2005 by a collective of Information Schools dedicated to advancing the information field in the 21st Century. These schools, colleges, and departments have been newly created or are evolving from programs formerly focused on specific tracks such as information technology, library science, informatics, and information science. While each individual iSchool has its own strengths and specializations, together they share a fundamental interest in the relationships between information, people, and technology.
- With the help of health IT, health care providers will have: Accurate and complete information about a patient's health. That way they can give the best possible care, whether during a routine visit or a medical emergency. The ability to better coordinate the care they give. This is especially important if a patient has a serious medical condition. A way to securely share information with patients and their family caregivers over the Internet, for patients who opt for this convenience. This means patients and their families can more fully take part in decisions about their health care. Information to help doctors diagnose health problems sooner, reduce medical errors, and provide safer care at lower costs. Widespread use of health IT can also: Make our health care system more efficient and reduce paperwork for patients and doctors. Expand access to affordable care. Build a healthier future for our nation.
- Tablets said to date back to 2000 B.C. represent the earliest medical writings so far discovered. The history of the medical library (defined as a place where a collection of medical writings is kept) is traced through ancient and medieval civilizations, and the dependence of advancement or decline on the attitude toward learning and knowledge is demonstrated. The oldest medical library, though, is the Pennsylvania Hospital library (1763). Its first catalog was published in 1790 Paper chart has been used for decades. In 1901 Dr. Henry Stanley Plummer, a very young "techie doc" joined the Mayo Clinic. By all accounts Dr. Plummer had both the peculiarities and the single mindedness of true genius. He was, of course an excellent physician, but his largest contribution to modern medicine was the Medical Record. In 1907 Dr. Plummer and his assistants deployed a novel way of keeping patient records. Up to that point patient records were kept in ledgers. The multiple offices at Mayo each had its own ledger. Once the initial visit was entered in a ledger, all following visits and procedures were added to that page, sometimes in crowded text on the margins. One patient could have entries scattered across a multitude of ledgers. Dr. Plummer introduced a centralized medical record consisting of a big envelope where all doctors would aggregate all the information regarding a particular patient. Each patient was assigned a unique identifier and his/her own dossier of clinical documents. The medical record would follow the patient everywhere at Mayo and all physicians would have access to all records. Paper chart often dismissed as primitive, archaic, useless…Focus on limitations and problems Rich history of information design discarded in EMR. Designed to support care, search and retrieval – with clinicians Managed, maintained and designed by professional medical librarians!
- Data are sometimes hard to find. Though data are stored in a way that makes it easier for physicians to query information or do population health reports, finding a particular piece of patient data in an EHR sometimes isn’t as easy as flipping through a paper chart. “ When they are trying to find pieces of data or pieces of an encounter, it’s hard for them to find it, because it’s not in a form they are accustomed to,” Mueller said.
- Here’s another, more colorful version that I think replicates the tab ideas of the paper chart and the HIT tools that can make It also reminds me of the interface for a familiar integrated library system
- One of the first librarian members of MLA, Grace Whiting Myers of Massachusetts General Hospital's Treadwell Library Grace Whiting Myers was the Massachusetts General Hospital’s first librarian, working with medical records from 1879 to 1925 . She was also a pioneer in medical records management. In addition to being a force for introducing professional concerns of librarians into the affairs of MLA, she was instrumental in the founding of an association for medical record professionals. In 1912, she wrote of the link between library materials and patient records. Medical Library Association, American Health Information Management Association The Medical Library Association (MLA) is founded as the Association of Medical Librarians on May 2, 1898 , by four librarians and four physicians in the office of the Philadelphia Medical Journal at the invitation of George M. Gould, M.D., editor of the journal. The object of the association was the fostering of medical libraries and the maintenance of an exchange of medical literature among its members. Membership was limited to librarians representing medical libraries of not less than 500 volumes and with regular library hours and attendance. 1907: The name of the association is changed to the Medical Library Association. AHIMA traces its history back to 1928 when the American College of Surgeons established the Association of Record Librarians of North America (ARLNA) to "elevate the standards of clinical records in hospitals and other medical institutions." This farsighted recognition of the importance of medical record quality to patient care and research underlies the organization today. Since its formation, the organization known now as AHIMA has undergone several name changes that reflect the evolution of the profession. In 1938 the Association changed its name to the American Association of Medical Record Librarians (AAMRL) for a more succinct representation of the membership. AAMRL moved forward with the creation of standards and regulations that established its members as medical record experts. When the Association became the American Medical Record Association in 1970, medical record professionals had increased their involvement in hospitals, community health centers, and to other health service facilities outside the hospital. They had also begun to play a critical role at their institutions in the administration of federal programs such as Medicare. As the healthcare industry underwent restructuring and decision-making became increasingly driven by data, the Association changed its name in 1991 to the American Health Information Management Association. Its current name captures the expanded scope of clinical data beyond the single hospital medical record to health information comprising the entire continuum of care. If there is a hospital library, records should be kept in close proximity to it, and, if possible, come under the supervision of the library. With theory and fact thus brought into close relation, an atmosphere is created of study and investigation which to the doctor has a value beyond estimate [2].
- Knowledge mangement Data: symbols Information: data that are processed to be useful; provides answers to "who", "what", "where", and "when" questions Knowledge: application of data and information; answers "how" questions Understanding: appreciation of "why" Wisdom: evaluated understanding.
- "the knowledge, skills and tools which enable information to be collected, managed, used and shared safely to support the delivery of healthcare and promote health". http://www.ukchip.org/?q=page/Professionalism-Health-Informatics What Is Informatics? Although the literature of health informatics can be traced as far back as the 1970s, interest increased during the 1980s [1]. It has been international in scope from its outset, with programs in Europe recognized as early leaders. Also, in Europe, the term informatics has not been so tightly tied to a specific domain as it has in North America. Here, informatics is generally used in conjunction with a specific domain such as health or biomedicine –¬ or to other fields such as law, resulting in terms such as health informatics, biomedical informatics or legal informatics. (An allied field known as social informatics is not domain specific and refers to the socio-technical aspects of information and communications technologies.)
- Specifically with the EHR, President George W Bush set the goal in 2004 that every American would have an EHR by the year 2014 Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- America’s Interstate Highway System celebrates 55 years On Feb. 13, 2009, Congress passed the American Recovery and Reinvestment Act of 2009 at the urging of President Obama, who signed it into law four days later. A direct response to the economic crisis, the Recovery Act has three immediate goals: Create new jobs and save existing ones Spur economic activity and invest in long-term growth Foster unprecedented levels of accountability and transparency in government spending The Recovery Act intended to achieve those goals by providing $787 billion in: Tax cuts and benefits for millions of working families and businesses Funding for entitlement programs, such as unemployment benefits Funding for federal contracts, grants and loans
- Health Information Technology for Economic and Clinical Health Signed into law February 17 2009
- Practically speaking, the widespread adoption of electronic medical records will probably be the most significant application of health informatics in the foreseeable future. http://healthinformatics.uic.edu/history-of-health-informatics/
- Lots of new language to learn. These three terms give a good picture, I think, of the potential for HIE EMR: An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization. EHR: An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.
- Office of the National Coordinator for Health Information Technology David Blumenthal, MD 2010 Disaster, such as hurricanes Rita & Katrina The need for universal EHRs became particularly apparent after Hurricane Katrina where thousands were left without any medical records…all those except the ones thru US Dept of Veterans affairs Dr. Farzad Mostashari is the new National Coordinator for Health Information Technology Read more: http://emrdailynews.com/2011/04/10/dr-farzad-mostashari-is-the-new-national-coordinator-for-health-information-technology/#ixzz1vi1MEXoZ
- The EMR is becoming ubiquitous in the hospital Touches almost every job US hospitals employ 5 million people * Hospitals support 1 out of 10 US jobs 1.9 trillion of economic activity EMR/HIT implementation a growing profession Our inpatient EMR went live in January 8,000/11,000 staff trained on use of EMR ≈ 50% are non-clinicians 269 EMR Roles (and counting) 900+ parameters define a role Physician, Nurse Practitioner, Nurse, Counselors, Therapists, Technicians, Clerks, Environmental Services, Billing, Report analysts, Finance, Research and more Those who never use the EMR, but are influenced by its functionality and data Executives and management
- The Patient! It is their chart and their care Patient as EMR users EMR vendors building “patient portal” applications Connect the patient to their physician(s), hospital, clinics Scheduling, refills, lab results… Access to their patient information Patient education Hospital as trusted source of medical information Shared Decision Making (SDM) Physicians and patients using technology to collaborate and decide on treatment jointly Consumer or Patient Centered Health
- HIM is integral to this patient-centered movement, as evident in recent federal laws like HIPAA and ARRA that specify rights patients have over their health information. HIPAA established basic patient rights to access information; ARRA extends many of those rights through modifications to the HIPAA rules. Patient-centered care is based on the idea that patients are active participants in developing a health strategy for themselves. This means that both physicians and patients have responsibilities in communicating information and concerns. Moving from passive to active pt role Pt as recipient vs. partner Physician dominating conversation to collaborating with pt Disease centered care to quality of life centered care Less talking and more listening Increased likelihood of pt adhering to treatment plant Patient-centered healthcare “in some respects challenges the traditional medical model and gives patients a role in decision making,” McGraw says. “Which means patients have to have information in their hands as well.
- Electronic health records and health information exchange can help clinicians provide higher quality and safer care for their patients. By adopting electronic health records in a meaningful way, clinicians can: Know more about their patients. Information in electronic health records can be used to coordinate and improve the quality of patient care. Make better decisions. With more comprehensive information readily and securely available, clinicians will have the information they need about treatments and conditions – even best practices for patient populations –when making treatment decisions. Save money. Electronic health records require an initial investment of time and money. But clinicians who have implemented them have reported reductions in the amount of time spent locating paper files, transcribing and spending time on the phone with labs or pharmacies; more accurate coding; and reductions in reporting burden. MEDICARE AND MEDICAID EHR INCENTIVE PROGRAMS Through the Medicare and Medicaid EHR Incentive Programs, the Centers for Medicare & Medicaid Services (CMS) is providing incentive payments to eligible health care professionals and hospitals who adopt certified EHR technology and achieve meaningful use. Registration for the Medicare and Medicaid EHR Incentive Programs began January 3, 2011.
- Electronically capturing health information in a standardized format Using that information to track key clinical conditions Communicating that information for care coordination processes Initiating the reporting of clinical quality measures and public health information Using information to engage patients and their families in their care Pediatricians and obstetrician-gynecologists are critical to the future of health information exchange as they care for patients at the moment when a life-long electronic health record would ideally begin The Department of Health and Human Services set three stages for eligible professionals to meet meaningful-use requirements by gradually integrating these technologies into clinical practice. Eligible professionals have until 2014 to meet the first, or stage 1, EHR objectives,4 which include capabilities such as recording patients’ demographic information and prescription history as well as reporting on quality measures. http://www.healthit.gov/buzz-blog/meaningful-use/meaningful-health-information-technology/
- More rigorous health information exchange (HIE) Increased requirements for e-prescribing and incorporating lab results Electronic transmission of patient care summaries across multiple settings More patient-controlled data
- Improving quality, safety, and efficiency, leading to improved health outcomes Decision support for national high-priority conditions Patient access to self-management tools Access to comprehensive patient data through patient-centered HIE Improving population health
- Physicians’ Readiness For Ten core objectives Physicians’ Readiness For Ten Stage 1 Core Objectives, By Intention To Apply, 2011 "SOURCE Authors’ analysis of data from the National Ambulatory Medical Care Survey Electronic Medical Records Supplement, 2011. NOTES Formula. Does not include physicians missing various types of data; see text. For details on the ten capabilities required for readiness for stage 1 core meaningful-use objectives, see text. aFigure does not meet standards of reliability or precision." Stage 1 Core Objectives, By Intention To Apply, 2011
- Sometimes called as Man-Machine Interaction or Interfacing, concept of Human-Computer Interaction/Interfacing (HCI): “ HCI in the large is an interdisciplinary area. It is emerging as a specialty concern within several disciplines, each with different emphases: computer science (application design and engineering of human interfaces), psychology (the application of theories of cognitive processes and the empirical analysis of user behavior), sociology and anthropology (interactions between technology, work, and organization), and industrial design (interactive products).” Computer science : provide knowledge about the capability of the technology and idea about how this potential can be harnessed Psychology and cognitive science: • understanding human behaviour and the mental processes that underlie it (information processing) • understanding the nature and causes of human behaviour in the social context Sociology and anthropology • interactions between technology, work, and organization • Industrial design • interactive products Ergonomics • understand the user’s physical capabilities • Linguistics; artificial intelligence; business; graphics design; technical writingThe main terms that should be considered in the design of HCI: functionality and usability Library/information science: information retrieval, organizing, searching for, and managing Usability Job titles: User-Centered Design, User Experience, User Interaction Design, User Interface Design, Information Architect, User Experience Architect, Usability Specialist… Methods (not job titles) define the expertise: From how users are studied through design and development Centered on information based tasks
- My Chart, My Health The Institute for Family Health’s Implementation of Epic’s Patient Portal EHRs and Librarians Symposium December 6, 2010 Provide terminals for waiting areas Partner with libraries and community centers Utilize HealthCorps members and students
- IFH developed these modules to use in classes, so the staff and volunteers at the IFH as well as the public librarians or staff in community-based organizations with which we partner will have an “expert trainer” available to help them as they train Also putting the modules on the MyChart MyHealth with a “Help” button so patients can access them “just-in-time” And available for android and iPhone
- My HealtheVet is the VA's Personal Health Record. It was designed for Veterans, active duty Servicemembers, their dependents and caregivers. My HealtheVet helps you partner with your health care team. It provides you opportunities and tools to make informed decisions. All users who have a My HealtheVet account are able to view their self-entered information. If you are a Veteran enrolled at a VA facility and have an *upgraded account, you may be able to view: Information you self-entered into My HealtheVet Parts of your official VA health record (as it becomes available) Your Department of Defense (DoD) Military Service Information *To get an upgraded account you must complete a one-time process called In-Person Authentication (IPA). You can upgrade your account at your local VA Medical Center (VAMC) or Community Based Outpatient Clinic (CBOC). Managing your health information - appointments, prescriptions, labs, blood tests and even exchanging messages with your health care team - has never been easier on My HealtheVet. The Blue Button is a feature that packages all your available health records into a single file that you can safely share with doctors, nurses, clinicians, even family members. All Your Health Info, All In One Place
- The PHR field is very dynamic. While most PHR products have some common elements, their features can vary. PHRs can link their users with librarians and information resources. MLA and NLM have taken an active role in making this connection and in encouraging librarians to assume this assistance role with PHRs. A variety of personal health records (PHRs) exist with some tied to medical health records and others offered as standalone products. Librarians can be connected to PHR users through inclusion of an assistance statement in PHRs. PHRs offer librarians another means of providing consumers with quality health information.
- A number of the existing PHRs used particular standards and might employ more than one standard. Others indicated that they were monitoring the development of standards and would adopt them in the future. Standards might be related to structure of the records or to the nomenclature used by the records. Structural standards (some of which were subsets of one another) that were specifically mentioned by the PHR vendors were: Continuity of Care Document (CCD) ASTM Continuity of Care Record (CCR) ASTM International, formerly known as the American Society for Testing and Materials Clinical Document Architecture (CDA) HL7′s Clinical Document Architecture (CDA) stores or moves clinical documents between medical systems. Documents are things like discharge summaries, progress notes, history and physical reports, prior lab results, etc. The CDA uses XML for encoding of the documents and breaks down the document in generic, unnamed, and non-templated sections Digital Imaging and Communications in Medicine (DICOM) Good Electronic Health Record (GEHR) Health Level Seven (HL-7) Health Level Seven International ( HL7 ) is the global authority on standards for interoperability of health information technology
- Locating policies. Creating policies. Maintaining policies. Context sensitive linking of important policy documents is an advantage over online repositories that have to be searched Poorly managed Updated frequently Access at point of care when/where it is needed 5815 hospitals in the US (2008)* Community, academic, for profit, government, rural, urban, large, medium, small… Annual stats (2008)* 950,000 inpatient beds, 35 million inpatient admissions 118 million ED visits 481 million outpatient visits 4 million births Expenses = $700,000,000,000 1/3 hospitals operate at a loss All motivated to implement an EMR/HIT Investment in HIT promises to pay back with Medicare/Medicaid reimbursements - Meaningful Use All facing implementing some of the most complex technology ever
- 1. There is no guaranteed gain in productivity. Although many heath IT proponents are known to make claims of increased efficiencies with an EHR, many physicians have been disappointed to learn that improved efficiencies don’t equate to increased productivity. In fact, after weeks or months of decreased productivity postimplementation, many are happy to match pre-EHR productivity levels eventually. The reason for the productivity issues is that physicians are doing more with an EHR. Mueller said EHRs are configured to collect more data than physicians are used to collecting when using paper charts, and that takes time. They must ask more questions than they are used to asking, and documenting data elements they are not used to documenting.
- Training and education is everywhere Physicians and Nurses Continuing physician and nurse training required for certification Continuing Medical Education (CME) and Contact Hours Nursing Massive additional training requirements The Nurse Educator Other staff Everyone in the hospital receives training on infection control, safety, fire… and much more . Environmental services Patient/Family Education How can the educational resources of a hospital be delivered to patients?
- The Infobutton is designed to contribute to the solution of this problem. The Infobutton is a key standard, originally developed at Columbia University by Dr. Jim Cimino and others and now being developed as an HL7 standard. The Infobutton has been very quickly accepted and implemented by the vendor community. The beauty of the Infobutton is that it can be tailored to the class of the user – one set of information for the professional, another for the lay person. The Infobutton provides context-sensitive links to information that can be seamlessly built into the clinical information system. It uses an SOA framework, sending queries to the CDSS using data from the EHR. The CIS places an Infobutton next to a data element such as a diagnosis, lab result (which may be abnormal) or a drug. When clicked, the Infobutton causes a query based on the context of the interaction, the patient, the data, the activity and the user. This context-sensitive interaction between data and knowledge is an extremely powerful tool. http://solutions.wolterskluwer.com/blog/2010/10/infobuttons-for-clinical-decision-support/
- MedlinePlus Connect is a free service of the National Library of Medicine (NLM), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS). This service allows health organizations and health IT providers to link patient portals and electronic health record (EHR) systems to MedlinePlus, an authoritative up-to-date health information resource for patients, families, and health care providers. MedlinePlus Connect accepts requests for information on diagnoses (problem codes) and medications. NLM mapped MedlinePlus health topics to two standard diagnostic coding systems used in EHRs: ICD-9-CM and SNOMED CT CORE Problem List Subset. When an EHR submits a problem code to MedlinePlus Connect, the service returns the mapped health topic as a response. MedlinePlus Connect also links EHR systems to drug information written especially for patients. For medication codes, MedlinePlus Connect accepts RXCUIs and NDCs. The service also conforms to the HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge Request URL-Based Implementation specification. MedlinePlus responds to problem code requests in either English or Spanish. Currently, it supports requests for drug information in English only. NLM is working on adding laboratory test responses to MedlinePlus Connect. It will also support an XML-based Web service at a future date. Advantages of MedlinePlus Connect Implementing MedlinePlus Connect has a number of advantages: It is FREE – no licensing or registration. It may help your hospital or practice group achieve one of the 10 menu criteria for Meaningful Use of Health Information Technology. For more information about meaningful use, see: The “Meaningful Use” Regulation for Electronic Health Records. Blumenthal D, Tavenner M. N Engl J Med 2010 Aug 5; 363(6):501-4 (See PMID 20647183). There is no need to use MedlinePlus Connect exclusively – most systems can be configured to link to more than one source of patient information. Implementing MedlinePlus Connect will make a global change; you do not need to create individual links. MedlinePlus Connect utilizes existing standards. Health Care Organizations Organization Name Location Aurora Health Care Eastern WI and Northern IL Buffalo Medical Group, P.C. Buffalo, NY Cleveland Clinic Cleveland, OH Halifax Regional Medical Center Roanoke Rapids, NC Indian Health Service Serves members of federally-recognized Tribes Institute for Family Health New York, NY LSU Health Shreveport, LA NewYork-Presbyterian Hospital/ Columbia University Medical Center New York, NY Texas Health Resources Arlington, TX University of Utah Salt Lake City, UT EHR Systems Product AlphaFlexCMS 1.0 ChiroSuite EHR ClinicTree ComChart EMR Dexter Solutions eZDocs Epic MyChart MedcomSoft Patient Portal MedcomSoft Record 5.0.6 Procentive Resource and Patient Management System (RPMS) EHR Rise Health Patient Relationship Manager SmartPHR ICD-9-CM (International Classification of Diseases, 9th edition, Clinical Modification) SNOMED CT® (Systematized Nomenclature of Medicine, Clinical Terms). Note: MedlinePlus Connect coverage of SNOMED CT focuses on CORE Problem List Subset codes (Clinical Observations Recording and Encoding) and their descendants. For medication requests, MedlinePlus Connect supports: RXCUI (RxNorm Concept Unique Identifier) NDC (National Drug Code)
- Choose training in one of these six roles: Practice workflow and Information Management Redesign Specialist Assists in reorganizing workflow and operations to take full advantage of health information technology to improve health care. Clinician/Practitioner Consultant Emphasizes the background and experience of a professional licensed health care practitioner in a leadership role to improve workflow and operations. Applicants must have a degree and/or credential to provide clinical care. Implementation Support Specialist Provides on-site user support before and during the implementation of health IT systems. Technical/Software Support Staff Supports the technology deployed in the clinical/public health setting on an ongoing basis. Maintains systems, including patches and upgrades to software and help desk support. Implementation Manager Provides on-site management of mobile adoption support teams for the period of time before and during implementation of health IT systems. Trainer Designs and delivers training programs, using adult learning principles, to employees in clinical and public health settings. Columbia University Duke University Johns Hopkins University Oregon Health & Science University University of Alabama at Birmingham
- Competencies Workers in this role will be able to: Be able to use a range of health IT applications, preferably at an expert level. Communicate clearly both health and IT concepts as appropriate, in language the learner/user can understand. Apply a user-oriented approach to training, reflecting the need to empathize with the learner/user. Assess training needs and competencies of learners. Accurately assess employees’ understanding of training, particularly through observation of use both in and out of classroom. Design lesson plans, structuring active learning experiences for users and creating use cases that effectively train employees through an approach that closely mirrors actual use of the HIT in the patient care setting. Maintain accurate records of training events. Maintain accurate training records of the users and develop learning plans for further instruction. Trainers: Six month certificate program for health professionals or health information management specialists
- EMR implementations as only the first step “ Optimization” as reconfiguring the EMR to meet objectives for clinicians, patients, outcomes… For many, this can only be realized once the system has been deployed May be an opportunity for LIS professionals to be integrated in the process EMR training and experience However, difficult to arrange and expensive for those outside the build team Education: Many in LIS may be perfectly suited as EMR trainers (and receive EMR training themselves) Integration of the EMR to educational content repositories Data base and reporting skills Data is the “raw material” of information in healthcare IT often demonstrates skills at the system end LIS can provide the next step – providing information that people can use Clinical experience Familiarity with clinical environments, roles, tasks, workflow… Research methods Analysis of EMR impact, before, during and after implementation Contribute to new evidence based decision support systems
- Consumer Health Information Bill of Rights [Spanish] 9/28/11 a model for protecting health information principles (Spanish edition) As the nation gears up for the mass digitization of personal health information, patients ought to have a right to know exactly who accesses their records, and that those who gain unauthorized access will be held accountable for violations, a leading health-information technology group says. Privacy and security are among the top points outlined in a new Health Information Bill of Rights for patients being promoted by the Chicago-based American Health Information Management Association. The seven-point platform is offered as a model to encourage providers to give strict protections to personal health information and to assuage patients’ fears about information security by increasing transparency. Providers across the country are preparing to install or improve their electronic health-record systems just as consumers are hearing reports about an increasing number of abuses of access, accuracy, privacy and security by providers. Such incidents violate “the most basic rights of individuals, whose trust has been betrayed and dignity compromised,” AHIMA President Vera Rulon said in a news release. The Health Information Bill of Rights, which is designed to be posted in hospitals and carried in wallet-sized cards, seeks to advance several ideas: patients ought to have free access to their records, even during treatment, including knowing who has accessed their records; health records should be accurate and protected by a national standard for data security; providers should be held accountable for violating privacy and security laws and policies; and patients ought to have a private right of action to bring lawsuits if a security breach of their health information causes harm. Read more: HITS Alert: AHIMA establishes Health Information Bill of Rights for patients - Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20091005/INFO/310059983#ixzz1uVFgMtHZ ?trk=tynt
- A Chicago area hospital has agreed to pay $8.25 million to settle a lawsuit brought by the parents of an infant boy who died at the institution after a series of medical errors. The hospital determined that a pharmacy technician had entered information incorrectly when processing an electronic IV order for the baby, resulting in a massive sodium chloride overdose in the solution. The problem would have been identified by automated alerts in the IV compounding machine, but those were not activated when the customized bag was prepared for the baby. The hospital also found that the outermost label on the IV bag administered to the baby didn’t reflect its actual contents. And while a blood test on the infant had shown abnormally high sodium levels, a lab technician assumed the reading was inaccurate.
- CDS: Clinical decision support
- Organize Structure Store and Retrieve information on demand
- Integrating Knowledge-Based Resources into the Electronic Health Record Karen M. Albert Medical Reference Services Quarterly Vol. 26, Iss. 3, 2007 Libraries and librarians have traditionally served clinicians by providing authoritative, knowledge-based medical resources to support information requests and current awareness needs to accommodate rapid changes in medical discovery and practice. The librarian has historically been involved in linkages of information to the patient record in a variety of ways. From LATCH (Literature Attached to the Chart) to IAIMS, to the clinical librarian and informationist concepts, librarians have been at the forefront of efforts to provide knowledge to clinicians at the point of care. In the past few decades, libraries have transformed themselves from mostly print repositories to fully embracing the wealth of Web-based resources and tools available for medical information support. With regard to EHR/information resource linkages, librarians are ideally suited to take on the role of “facilitator, publisher, integrator, and educator,”67 as well as selector and evaluator of these important systems.58 The LATCH idea68,69 of providing literature based on physicians’ patient-specific requests and attaching it to the chart presaged similar current practices, like Vanderbilt Library’s EHR-linked search service. 50,51 These approaches capitalize on the expert searching skills of librarians, who have been noted as achieving higher precision in their search results than physicians.21 Karen M. Albert 11 Downloaded by [University of Illinois Chicago] at 13:33 27 April 2012 This expertise was leveraged at the point of care with establishment of clinical librarian services70 and the more recent development of the informationist. 71 The clinical informationist operates as “a professional member of the healthcare team,” and “acts as an expert in identifying and addressing the complex evidentiary needs of the team.”51 At Vanderbilt University, the advanced searching and evidence syntheses performed by library staff informationists are now linked to the EHR.50 The unique success of Vanderbilt’s program is likely due to its top priority in the library’s budget, as well as the institution’s cultural acceptance of its value and importance.72 Lindberg and Humphreys’ article on the future of medical libraries alludes to EHR-embedded physician literature search requests, suggesting that MDs send librarians pointers to relevant patient records to add context and background to information requests.73 Libraries have also historically employed IAIMS grants to implement early linkages of knowledge to the patient record. As Richard West opined in an interview about IAIMS, “I always said that the librarian must be involved. They’d say why. I’d say, well, the librarian is the one person on the campus most knowledgeable about the organization of knowledge and how information is best put together and provided as a service.”74 The libraries at Columbia-Presbyterian, Indiana University Medical Center, and many other IAIMS sites were involved in providing point-of-care access to clinical resources.75,76 One of the earliest advanced EHR linkages to information resources was accomplished via IAIMS with strong librarian involvement at the University of Washington in the mid-1990s. A partnership between health sciences librarians and clinical informatics groups led to the development of MINDscape, a heavily used Web view of the patient medical record with integrated knowledge resources, including linkages to drug information, automated term-based contextual MEDLINE searches, and many other Web-accessible information resources. Fuller and colleagues emphasized the critical role librarians had in this forwardthinking project. They also made a convincing case for needing the “ creative thinking” of librarians and their collaboration with clinicians and computer specialists to successfully build future health care information systems.67 The skills librarians brought to bear in IAIMS projects could also make them valuable participants in the EHR/knowledge integration process. As noted at a recent Medical Library Association (MLA) annual meeting session, librarian roles in this area could include selection, evaluation, marketplace monitoring, and user education.46,58 Librarians play an additional role at Vanderbilt University by updating and maintaining the discussing the challenges of information integration and changing user environments and information products, Lindberg and Humphreys project similar central roles for libraries: In 2015, a library continues to be the logical entity to manage this complexity on behalf of the institution, to make decisions about inevitable and substantial expenditures, to adapt information services to new realities, and to provide essential user training and support.73 Librarians’ valuable contributions to the EHR-linking process are yet to be realized in many health care institutions and may depend not only on organizations’ cultural and political realities, but also on librarian activism and acceptance of changing roles. Opportunities abound for librarians to join the clinicians, medical informaticians, and computer systems specialists to produce successful EHR/knowledge resource linkages and thereby positively impact health care delivery. CONCLUSION Clinicians’ substantial unmet information needs can result in delayed and uninformed decisions leading to medical errors and substandard patient care quality.4 Time pressures, lack of awareness of information resources, and how best to use them, along with failures of information retrieval systems to supply ready answers, can lead to physicians’ poor uptake of needed medical information3,13 and suboptimal application of evidence-based medical practices. Significant advances have been made in CDSSs, which integrate knowledge-based resources directly into the electronic medical record. A variety of academic medical center implementations, commercial CIS offerings, and content vendor options have made this an exploding area of potentially powerful applications for providing critical information at strategic points in the patient care process. The Leapfrog Group has advocated CPOE, with implied inclusion of clinical decision support as one of their three main quality criteria for evaluating EHR systems,77 and CDSSs have been shown to improve practitioner performance.31-33,59 System success can vary depending on local design and institutionspecific factors. More investigation of EHR/knowledge resource implementations needs to be done, and new installations should heed advice Karen M. Albert Librarians can take a leading role in this area, by encouraging adoption and lending expertise in the selection, evaluation, application, and use of these systems, along with identification of user needs and optimal structuring of answers to clinical queries at the point of care. For complex questions, librarians or informationists can provide in-depth responses to clinical search requests, which can be linked to the EHR. Challenges remain, including increasing system complexity, proliferation of knowledge-based resources, changing and expanding user information needs, continuous system evaluation,46 maintenance of knowledge base currency, and development of integration and terminology standards. Most importantly, what remains unknown and understudied is how best to implement these systems to successfully impact patient outcomes.78 Nonetheless, advances in clinical information systems and associated decision support, along with the wide variety of high-quality online content available, should mean that effective integration of these entities has tremendous potential to change the practice of medicine for the