INFORMATICS FOR LIBRARIANS:THE CORE OF THE ONION

Jacqueline Leskovec, MLIS, MA, RNOutreach, Planning & Evaluation Coordinator

National Network of Libraries of Medicine

Greater Midwest Region

June 2012

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

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/

http://cctsi.ucdenver.edu/SiteCollectionImages/Informatics/

William Hersh

“It isn't just about computer science anymore…”

http://www.ischools.org/

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/

The Medical Record

Disciplines & Departments

Health Information Management

• 1898: AML• 1907: MLA

____________• 1928: ARLNA• 1938: AAMRL• 1970: AMRA• 1991: AHIMA

Grace Whiting Myers

Informatics Pyramid

Dalrymple 2011

http://www.ukchip.org/

Librarians!

Health Health InformaticsInformatics

June 29, 1956

February 13,2009

The HITECH VISION

Courtesy: Office of the National Coordinator for Health Information Technology

Health Informatics Applications• Electronic Medical Records• ePrescribing• Personal Health Records• Remote Monitoring• Secure Messaging• Telehealth

http://www.toonpool.com/

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

Health information exchange is a team sport.

Who uses the EMR?

The Most Important User

Medical Model Vs. Patient-Centered Model

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.

(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

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

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 IThttp://healthit.hhs.gov/portal/server.pt/community/health_it_hhs_gov__glossary/1256

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.

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.

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.

The Human Factor: HCI

• Multi disciplinary

• Usability job titles

•Methods define the expertise

http://www.toonpool.com/

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 supportMaxine l. Rockoff, PhD

Department of Biomedical Informatics

Columbia University

December 2010

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

All Your Health Info, All in One Place• Veterans, active duty Servicemembers, their dependents

and caregivers• Account upgrades with IPA

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

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)

Hospitals as Information Environments

• “…altogether the most complex human organization ever devised.”• Peter Drucker, 1993

http://www.aha.org/aha/resource-center/Statistics-and-Studies/index.html

American Hospital Association

AAFP 2003

I don’t type………….8.3%

Why FPs don’t use EMRs…

HIT and Educational Content• Training and education opportunities everywhere

• Physicians and Nurses• Nursing• Other staff• Patient/Family Education

Infobutton

http://solutions.wolterskluwer.com/blog/

• ICD-9-CM• SNOMED CT®• CORE Problem List Subset codes• RXCUI• NDC

http://apps2.nlm.nih.gov/medlineplus/services/demo.html

Patient Education

• Trusted source of information–Your doctor–Your hospital

• Develop online patient education libraries–Well developed content–Easy to find what you

need

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!

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.

http://www.onc-ntdc.org/

EMR Optimization• “We are running out of time, let’s just get it up and running

and fix the problems later.”

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

Safety and Error Prevention

• Information system configuration/use

• Process design• Communication• Labeling • Education

Research - Clinical Guidelines

Doing what we do best…

•What are you doing??

• Librarians have a unique perspective and understanding of the application of medical information resources to meet clinical user needs.

Karen M. AlbertMedical Reference Services QuarterlyVol. 26, Iss. 3, 2007

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.