Informatics and Evidence-based Practice M8120 Fall 2001 Suzanne Bakken, RN, DNSc, FAAN School of...
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Transcript of Informatics and Evidence-based Practice M8120 Fall 2001 Suzanne Bakken, RN, DNSc, FAAN School of...
Informatics andInformatics andEvidence-based PracticeEvidence-based Practice
M8120Fall 2001
Suzanne Bakken, RN, DNSc, FAANSchool of Nursing & Department of Medical
InformaticsColumbia University
What’s the Problem in What’s the Problem in Practice?Practice?
• Avoidable errors• Under-utilization of services• Overuse of services• Variation in services• Gap between “best” practice and
actual practice
Ways of Knowing for Ways of Knowing for PracticePractice
• Tradition• Authority• Personal experience• Trial and error• Intuition• Logical reasoning: inductive or
deductive• Systematic inquiry
What is Evidence-Based What is Evidence-Based Practice?Practice?
• 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 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
What Data Do We Need for What Data Do We Need for Evidence-Based Practice?Evidence-Based Practice?
• Information about the patient• Domain information and knowledge
(“the evidence”) from systematic inquiry and other sources
Informatics Supports:Informatics Supports:
• Building the evidence• Retrieving the evidence• Analyzing the evidence• Applying the evidence
Foundation for Evidence-based Practice
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
Standardized Terminologies
• Capture patient care data in a standardized fashion
• Facilitate data re-use and aggregation
• Index information resources• Facilitate information retrieval
Standardized TerminologiesSystem 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 International x x x
Nursing Outcomes Classification x
National Health Service Clinical Terms (Read) x x x
Medcin x x x
First Data Bank Pharmacy KB x x
Outcomes of Interest• Traditional
– Mortality– Morbidity– Health services utilization
• Clinical phenomena (e.g., pain, decubitus ulcers)• Patient health status• Knowledge• Caregiver• Family• Community
M8120• Strengths and weaknesses of
existing terminologies• National and international
standardization efforts related to representing concepts in computer-based
• Unified Medical Language System
Foundation for Evidence-based Practice
• Standardized terminologiesDigital 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
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
M8120• Bibliographic sources
– Primary– Cochrane Collaboration
• Diagnostic decision support systems
• Clinical practice guidelines
Foundation for Evidence-based Practice
• Standardized terminologies• Digital sources of evidenceStandards that facilitate health care data
exchange• Informatics competencies• Informatics processes that support the
acquisition and application of evidence to a specific clinical situation
Standards for Healthcare Data Exchange for EBP
• Data and knowledge representation• Messaging• Privacy, confidentiality, and security• Digital library
M8120
• Data and knowledge representation• Messaging• Privacy, confidentiality, and security
Foundation for Evidence-based Practice
• Standardized terminologies• Digital sources of evidence• Standards that facilitate health care
data exchangeInformatics competencies• Informatics processes that support the
acquisition and application of evidence to a specific clinical situation
Informatics 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
Basic Computer Literacy Basic Computer Literacy Skills Required for M8120 Skills Required for M8120
AssignmentsAssignments• Access and download documents from WWW• E-mail and e-mail attachments• Word-processing• Power point slide presentation
These will not be taught in M8120! Classes available on campus.
M8120 Informatics M8120 Informatics CompetenciesCompetencies
• Acquire various types of data, information, and knowledge– Retrieve EBP literature from a variety of
sources (Medline, CINAHL, CliniWeb, Cochrane Collaboration)
• Organize data, information, and knowledge– Organize literature retrieved using a
systematic approach (e.g., EndNote)
M8120 Informatics M8120 Informatics CompetenciesCompetencies
• Critically analyze and synthesize data, information, and knowledge– Prognosis– Diagnosis– Clinical practice guideline– Therapy
• Apply data, information, and knowledge in the clinical decision making and care provision process– Evidence-based practice synthesis– Assessment of practice relevance in critiques– Expected value decision making– DXplain
Foundation for Evidence-based Practice
• Standardized terminologies• Digital sources of evidence• Standards that facilitate health care data
exchange• Informatics competenciesInformatics processes that support the
acquisition and application of evidence to a specific clinical situation
Informatics-based Informatics-based ApproachesApproaches
• Patient care systems• Integration of disparate sources
– MedWeaver– Skolar and Skolar RN
• Task-specific information retrieval– Infobuttons
• Alerts and reminders related to practice guidelines• Tailored delivery of informational and educational
interventions– PatCIS– MI Heart
• Elicitation of client preferences• Expected value decision making (decision analysis)
Patient Care Systems• Electronic health records• Care management (e.g., care
plans, critical pathways)• Ancillary systems
– Laboratory– Radiology– Pharmacy
Integration of Disparate Integration of Disparate SourcesSources
Task-Specific Information Task-Specific Information RetrievalRetrieval
Tailored Delivery of Tailored Delivery of Informational and Educational Informational and Educational
InterventionsInterventions
Elicitation and Incorporation of Elicitation and Incorporation of Client PreferencesClient Preferences
Standard gamble
Expected Value Decision MakingExpected Value Decision Making
A Simple Decision TreeA Simple Decision Tree
Operate
Do not operate
Disease present
Disease absentDisease present
Disease absent
Survive
Operative death
Palliate
Operative death U=0Operative death U=0
Survive
Survive
No cure
Cure
Cure
No Cure
No cure
Cure
p=.10
p=.90
p=.10
p=.90
p=.90
p=.10
p=.02
p=.98 p=.10
p=.90
p=.10
p=.90p=.90
p=.10
p=.01
p=.99
Try for the cure
U=2
U=20U=2
U=20
U=20
U=2
U=20
U=0
M8120• Electronic health records• Dxplain• Alerts and reminders • Expected value decision making
(Data 3.5)• Interactive health communication