Making sense of results - a workshop for healthcare librarians
Exploring Opportunities for Librarians in Healthcare Information Technology
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Transcript of Exploring Opportunities for Librarians in Healthcare Information Technology
Exploring Opportunities for Librarians in Healthcare Information Technology
Philadelphia Regional ChapterMedical Library Association, Annual Meeting
April 18, 2013
Dean Karavite, MSICenter for Biomedical Informatics (CBMi)
Children’s Hospital of Philadelphia (CHOP)
Center for Biomedical Informatics (CBMi)
Applying information technology to healthcare research
30-40 staff Clinicians, researchers, analysts,
statisticians, developers, study coordinators, education specialists and more
Human Computer Interaction (HCI)
Multi disciplinary field Human factors, information science,
experimental psychology, cognitive psychology, computer science, industrial design, anthropology and more
Research and methods applied to the design of information technology
Usability “The capacity of a system to allow users to
carry out their tasks safely, effectively, efficiently and enjoyably”
Study people and information and develop systems that support working with information in new ways
Connection Between HCI and Medical/Health Science Librarians?
University of Michigan, School of Information Evolved from SILS in 1996
Expanded curriculum to apply LIS methods and research to IT
LIS, Archives, HCI and more Recently developed new health
informatics program Jane Blumenthal – key role in
Michigan program Prudence Dalrymple - Drexel
iSchool has a similar program
NLM Helped Create My Job
NLM Challenge Grant Create EMR based clinical decision
support (CDS) for complex patients
Premature infants during first two years of life Multiple preventative health issues
Growth Nutrition Development Blood pressure screening Retinopathy of prematurity (ROP) Respiratory syncytial virus (RSV)
Fifth Presentation to Librarians
Participated in workshops put together by P.J. Grier “Peeling the Onion, Informatics
for Librarians”
Librarians Can’t “Get a Seat at the HIT Table” Why don’t those working with
HIT understand how health science librarians can contribute?
Meaningful Use
http://www.healthit.gov/policy-researchers-implementers/meaningful-use
The EMR Build
The build process is the configuration of the EMR One of the most complex IT projects imaginable Can take years, hundreds of IT staff and hundreds of millions of dollars
EMRs are built on database hierarchies representing every single component of a healthcare organization Buildings, floors, units, rooms, beds… Equipment, instruments, supplies… Meds, labs, procedures… Clinicians, doctors, nurse practitioners, nurses, techs…
EMR Build Example in the OR
Vendor, IT and OR staff working to design the OR status board Somewhat analogous to the flight
status screen at an airport, but with more information on each OR
Nobody thought to review existing literature on the design and assessment of these systems
EMR is Full of Search/Retrieval Tasks
Lists, lists and more lists Almost every task requires a search activity
Medications, diagnosis, procedures, instruments, supply items… endless
Poor EMR search design and/or poor EMR build = difficulty in search and retriveal Poor data quality
Assessing the patient1. Chief complaint2. Problem list3. Medications4. Immunizations5. Encounter history6. Surgical history7. Specialists visits/notes
Managing the visit1. EMR documentation template2. Immunizations to order3. Medications to order4. Procedures to order5. Patient education materials6. Referral to order7. Diagnostic code8. Follow up code
15 Search Tasks in 15 Minutes: Pediatric well visit + ear infection*
* After well visit and upper respiratory infection, ear infections are the most frequent reason for a pediatric visit
Preemie Assistant
Epiphany?
The reason people working in HIT don’t understand how health science librarians can help them is... Because they aren’t ready for you They are overwhelmed with building the EMR
So, what about when they are done?
EMR Optimization
EMR implementation is only the first step Many issues cannot be addressed in the build process Many issues aren't foreseen until the system goes live Vendors are constantly releasing upgrades with new features Meeting meaningful use criteria
“Optimization” is reconfiguring (rebuilding?) the EMR to meet objectives for clinicians, patients, outcomes, safety, errors… Optimization is endless
Optimization Example: Growth Charts for Preemies
EMR does not select/display correct charts for premature infants Even though it has the data to do so
Typical EMR optimization Make the EMR select/display the
correct charts Advanced EMR optimization
Augment the correct charts with additional information and integrate growth with nutrition, patient education and clinical documentation
Cataloged Growth Chart Collection
Preemie Assistant: Growth/Nutrition
Growth Chart Results
Data, Information, Knowledge Paradigm
DATA
Gestational Age = 29 weeksChronological Age = 5 monthsICD9 = 770.7
INFORMATION
This is a premature infant with chronic lung disease
KNOWLEDGE
According to the American Academy of Pediatrics policy statement, premature infants with CLD are at risk for RSV and should receive Palivizumab
Evidence Based MedicineGuideline Translation Process: Overview
GuideLines Into DEcision Support (GLIDES), Yale School of Medicine, AHRQ FundedProcess and tools toward translating clinical guidelines into EMR based decision support
Connecting the EMR to Knowledge Resources
“Info Button” HL7 International Context-Aware
Information Retrieval standard Search integrated with the EMR
Originally developed at Columbia over a decade ago
Search Code/Parameters
http://msnappdw001:8123/ebm.aspx?&age.v.u=mo&age.v.v=8&assignedAuthorizedPerson.id.root=AMBATTENDING&encounter.c.c=AMB&mainSearchCriteria.v.c=486&mainSearchCriteria.v.cs=2.16.840.1.113883.6.103&mainSearchCriteria.v.dn=Pneumonia&mainSearchCriteria.v.ot=Pneumonia&patientPerson.administrativeGenderCode.c=F&patientPerson.administrativeGenderCode.dn=Female&performer=PROV&taskContext.c.c=DIAGLISTE
Embedded in all that is the following information :“I am a primary care pediatrician seeing a female patient of 8 years old in the outpatient setting and I’m looking at the diagnosis list”Or“I am a nurse in a pediatric hospital emergency department seeing a 2 year old male.”
Up to Date
VisualDX
CHOP Labs
CHOP Intranet
AHRQ Guideline Clearing House 1/2
AHRQ Guideline Clearing House 2/2
Pub Med
EMR as Online Library =Many Opportunities for Librarians
Search Analytics and Search Engine Optimization (SEO) Technique used by Information Architects (a field that evolved directly
from library science) to assess and improve the effectiveness of web based search for corporate intranets and commercial websites
EMR with Info-button opportunities for EMR search analytics+ Evaluate systems to purchase/include Key role in implementing these systems Continual monitoring and optimization
Our CMIO get’s it – developing business case for hiring a librarian to manage this and similar work
Design / Education Surprise with Otitis Media (Ear Infections)
Added EMR educational materials for residents and medical students
Physicians used these materials, but not with their students, they used them with patients (parents) “Here is what an infected ear drum
looks like” “Here is why your child does NOT need
an antibiotic today”
Graphic presentationof clinical pathways
Instructionalimages
Education for Premature Infants
Physician comments from usability test:“Oh this is nice. ““This is awesome.”“Who the hell knew we even had all this?” “I have never given out one of these.”“In 15 minutes there isn’t time to cover everything. Patient education is the most important thing we do.”
Patient Portals and Shared Decision Making
Personal Health Record, Personal Medical Record, Patient Portal... EMR based systems that connect patient to hospital/physician
Very basic yet useful Prescriptions, lab results, messaging, scheduling,
immunization records... Can be integrated with education systems, but
yet another EMR “build” No excuses this time - librarians are a must
Expand portal capabilities to support shared decision making Asthma: Connecting parents and clinicians + education ADHD: Add teachers, psychologists and others to the mix
3 Organizations Partnering to Study PHRs for People With Disabilities
Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR)
WGBH, National Center for Accessible Media (NCAM)
Pioneer of assistive media technology
Inglis Foundation 135 years managing the care of people with
disabilities
Center for Biomedical Informatics, The Children’s Hospital of Philadelphia
Enhancing decision support capabilities of EMR and PHR in a research setting
Potential Opportunities Left on the Cutting Room Floor
Genomics and full exome sequencing Identifying actionable results by mapping results continually evolving research Mapping actionable results to guidelines, pathways, CDS tools, education for
clinicians, patients and families Taxonomies, Codes and Concepts
ICD9/ICD10, CPT, Snomed-CT, LOINC, RxNorm... Hospital Reporting
Information analysis and display for clinical and administration Hospitals as education environments
Education content for clinicians Hospital staff – basic hospital training and professional development Organizing EMR training content
Ideas on “Getting a Seat at the HIT Table”
Find allies/champions Like our CMIO, someone who “get’s it” Clinicians, research, nursing education, patient education, genetics... IT?
Demonstrate: Show people what a librarian can do (and nobody else can) Do a lit search addressing some issue or challenge with the EMR Study Meaningful Use and identify a criteria you can help address If you can’t directly work on some issue, develop a proof of concept, create a mockup, storyboard,
prototype or write a report, analysis of some solution/approach Evaluate some knowledge system before/after purchase
Write a grant proposal and/or seek others to write one with you Publish an article in an informatics journal, blog, your website...
EMR/PHR training and experience If they won’t pay for it, see if you can sit in on classes, access online courses… Examine your own PHR or sign up for Microsoft Health Vault, Patients Like Me... Download health apps and experiment with them
Questions / Comments?
CBMi Informatics Symposium http://www.research.chop.edu/programs/cbmi/
Or Google “CBMi CHOP” Friday, April 26, Sheraton
$200
Monthly (or so) informatics talks at CHOP We can put you on the mailing list