Evidenced-Based Practice Using Your Palm Pilot and Other Technology November 20, 2001 Suzanne...
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Transcript of Evidenced-Based Practice Using Your Palm Pilot and Other Technology November 20, 2001 Suzanne...
Evidenced-Based Practice Evidenced-Based Practice Using Your Palm Pilot and Using Your Palm Pilot and
Other TechnologyOther Technology
Evidenced-Based Practice Evidenced-Based Practice Using Your Palm Pilot and Using Your Palm Pilot and
Other TechnologyOther Technology
November 20, 2001
Suzanne Bakken, RN, DNSc, FAANSchool of Nursing & Department of Medical
InformaticsColumbia University
PurposePurpose
• Overview of informatics framework for evidence-based practice
• PDA products and resources• PDA projects at Columbia University
– Entry to Practice Program– Nursing Informatics Subspecialty– PalmCIS
What’s the Problem in What’s the Problem in Practice?Practice?
• Avoidable errors• Under-utilization of services• Overuse of services• Gap between “best” practice and
actual practice
What is Evidence-Based What is Evidence-Based Practice?Practice?
What is Evidence-Based What is Evidence-Based Practice?Practice?
• Traditional conceptualizations– Research utilization– Clinical trials-based– Clinical practice guidelines
• Application of domain knowledge to patient care– Evidence as a continuum
• Evidence-based medicine is the practice of making medical decisions through the judicious identification, evaluation, and application of the most relevant information (Friedland, 1998)
What Data Do We Need for What Data Do We Need for Evidence-Based Practice?Evidence-Based Practice?
• Information about the patient• Information about the context of care• Domain information and knowledge
(“the evidence”) from systematic inquiry and other sources
Informatics Supports:Informatics Supports:Informatics Supports:Informatics Supports:
• Building the evidence• Accessing/retrieving the evidence• Analyzing the evidence• Applying the evidence
Foundation for Evidence-based Foundation for Evidence-based PracticePractice
Foundation for Evidence-based Foundation for Evidence-based PracticePractice
• Standardized terminologies• Digital sources of evidence• Standards that facilitate health care
data exchange• Informatics competencies• Informatics processes that support the
acquisition and application of evidence to a specific clinical situation
MotivationMotivation• Costing and reimbursement for nursing
services• Education of students• Documentation of nursing contributions
to patient care outcomes• Development of nursing knowledge• Support for evidence-based practice• Inclusion of nursing terms in computer-
based systems including decision support systems
“If we cannot name it (nursing),we cannot control it, practice it, research it, teach it, finance it or put it into public policy.”
N. Lang, 1991
Standardized TerminologiesStandardized Terminologies
• Diagnoses/judgments– NANDA Taxonomy II– Georgetown Home Health Care
Classification – Patient Care Data Set– Omaha System– International Classification of Nursing
Practice
Standardized TerminologiesStandardized Terminologies
• Interventions– Nursing Interventions Classification– Georgetown Home Health Care
Classification – Patient Care Data Set– Omaha System– International Classification of Nursing
Practice
Standardized TerminologiesStandardized Terminologies
• Outcomes– Nursing Outcomes Classification – Georgetown Home Health Care
Classification– Omaha System– International Classification of Nursing
Practice
• Goals – Patient Care Data Set
Standardized TerminologiesStandardized Terminologies
System Problem/Dx Interventions Outcomes
NANDA Taxonomy 1 x
Current Procedural Terminology x
Nursing Interventions Classification x
Omaha System x x x
Home Health Care Classification x x x
International Classification of Diseases x
SNOMED Clinical Terms x x x
Nursing Outcomes Classification x
Medcin x x x
First Data Bank Pharmacy KB x x
Types and Sources of Digital Evidence
Types and Sources of Digital Evidence
• Bibliographic– Primary literature– Synthesized
• Practice parameters– Standards of care– Practice guidelines– Disease management plans
• Comparative databases• Knowledge bases
– Diagnostic decision support systems– Pharmacy
Standards for Healthcare Standards for Healthcare Data Exchange for EBPData Exchange for EBP
• Data and knowledge representation• Messaging• Privacy, confidentiality, and security• Digital library
Informatics CompetenciesInformatics CompetenciesInformatics CompetenciesInformatics Competencies• Acquire various types of data, information, and
knowledge• Organize data, information, and knowledge• Critically analyze and synthesize data, information,
and knowledge• Apply data, information, and knowledge in the
clinical decision making and care provision process• Use informatics-based approaches and information
technologies in clinical decision making and care provision process
Informatics-based Informatics-based ApproachesApproaches
• Integration of disparate sources– MedWeaver
• Task-specific information retrieval– Infobuttons
• Tailored delivery of informational and educational interventions– PatCIS
Tailored Delivery of Tailored Delivery of Informational and Educational Informational and Educational
InterventionsInterventions
PDA ProductsPDA Products
•Pharmacy knowledge bases•Prescription writing•Medication calculators•Other sources of evidence•Clinical documentation
PDA Projects at Columbia PDA Projects at Columbia UniversityUniversity
•Entry to Practice Program•Nursing Informatics Subspecialty
•PalmCIS
Accessing/Retrieving Evidence: Accessing/Retrieving Evidence: ETPETP
•ePocrates medication knowledge base
•ePocrates infectious disease knowledge base
•Future – PDA interface to WebCIS through PalmCIS project
Building and Examining Knowledge from Building and Examining Knowledge from Practice:Practice:
ETP Clinical Encounter Documentation and ETP Clinical Encounter Documentation and AnalysisAnalysis• How
– Documentation of individual encounters• Pick list of subset of nursing diagnoses and interventions• Look-up database of other diagnoses, interventions, and
definitions
– Based on standardized terminology (Home Health Care Classification)
– Upload to central database for aggregation and analysis
• Why– Examine individual practice– Aggregate comparisons– Tie to required clinical competencies
Documenting Encounters with Documenting Encounters with HHCCHHCC
Diagnosis: Chronic pain (Q45.2)Interventions
� Pain control – Assess (Q47.0.1)� Pain control – Perform (Q47.0.2)� Pain control – Teach (Q47.0.3)� Medication Administration – Perform
(H24.0.2)
Competency (observed, supervised, independent)
Informatics CompetenciesInformatics Competencies
•Just-in-time for PDA-specific computer literacy competencies
•Informatics for Evidence-based Practice (3 units)
Nursing Informatics Nursing Informatics SubspecialtySubspecialty•Courses
– Informatics for Evidence-based Practice (3 units)
– Interactive Health Communication (3 units)– Informatics residency–Medical informatics elective
• Incorporation of informatics competencies throughout NP curriculum
•Clinical encounter documentation–Similar to ETP plus ICD and CPT codes