Evolution of Informatics

Posted on February 2, 2012 by afernando

 

I’d like to thank my readers who emailed me for information about informatics. I thought I would write a post for everyone to read instead of emailing everyone with the same information. 

The term informatics is confusing to some people as many healthcare disciplines have their own specific definition of informatics.  There are healthcare informatics, medical informatics, nursing informatics, consumer informatics, bioinformatics, dental informatics, bioinformatics, clincial health informatics, and public health informatics. It’s easy to become confused and will decipher the differences between all of these disciplines.

What is Informatics?

Informatics is the science and art of turning data into information. The term informatics orginated in France and is from the French term informatique, which means computer milieu (Saba 2001).  The broad definition of informatics is “the study of the application of computer and statistical techniques to the management of information”.

The term informatics has been applied to various disciplines such as medicine, nursing, dental, and public health just to name a few. Healthcare informatics is a broad term for all fields using technology.

Health informatics is the general terminology to describe educational technology for healthcare clients or the general public.  Medical informatics is used as a broad term to refer to all disciplines in the field of medicine with specific health-related areas beneath it including nursing informatics and consumer informatics.

Discipline specific definitions of informatics

Medical informatics:  refers to the application of information science and technology to acquire, process, organize, interpret, store, use, and communicate medical data in medical education, practice, research, patient care, and health management

Nursing informatics:  specialty that integrates nursing science, computer science and information science to manage and communicate data , information, knowledge, and wisdom in nursing practice.  Nursing informatics faciliates the integration of data, information, knowledge, and wisdom to support patients, nurses, and other providers in their decision making in all roles and settings. This support is acccomplished through the use of information structures, information procesess, and information technology (ANA, 2007).

Health informatics:  application of computer and information science in all basic and applied biomedical services to facilitate the acquistion, processing, interpretation, optimal use, and communication of health related data. The patient is at the center and the process of care.  The goal is to enhance the quality and efficiency of care provided.

Bioinformatics:  application of computer and information technology to the management of biological information including the development of databases and algorithms to faciliate research.

Consumer health informatics:  branch of medical informatics that studies the use of electronic information and communication to improve medical outcomes and the healthcare decision-making process form the patient/consumer perspective (AMIA, 2007)

Dental informatics:  computer and information sciences to improve dental practice, research, education, and management

Clinical health informatics:  multidisciplinary field that focuses on the enhancement of healthcare through clinical information management;  improvement of information processes, implementation of clincial information systems; the use of clinical decision support tools to improve the effectiveness, quality, and the value of services rendered

Public health informatics:  application and information and computer science and technology to public health practice, research, and learning

I hope these definitions of informatics help you decipher through the healthcare terminology jungle.  There are other informatics disciplines that I did not mention such as radiology informatics but fall under the umbrella of medical informatics.

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CPM and Evidence Based Practice

Posted on January 30, 2012 by afernando

The Clinical Practice Model (CPM) is a third party software that can be utilized with any electronic application and is also evidence based practice. CPM is evidence based clinical content.  In addition, care plans and patient education are seamlessly integrated into the electronic medial record.

Evidence based practice is hot right now.  One of the leaders in evidence based practice is the company Clinical Practice Model Resource Center (CPMRC).  This company was founded by Bonnie Wesorick over 25 years ago and is located in Grand Rapids, Michigan.

In our fast paced world in healthcare,  many nurses become task oriented just to get the job done.  Ms. Wesorick felt there was an incongruency between what is believed to be how care is supposed to be delivered in an individualized, quality health care  to what was being lived everyday in a systems driven fast paced world of medical care.  A pattern of performing tasks led to a strong task dominated, hierarchical and dehumanized work culture interfered with the health of providers and recipients of care.  Bonnie Wesorick founded the CPM Resource Center framework  to create a new reality.  This framework for culture and professional practice was designed to sustain healthcare transformation over time.

The CPM resource center framework  is designed to have the patient in the center along with their families, community, and caregivers.  From the center,  are six clinical practice guidelines.

These clinical guidelines are:

  •  Health and Healing Care Model:  Patient focused/family centered model of care assures health and healing across the life span and in all settings where healing occurs.  This model assures a safe, respectful caring environment which supports those who give and receive care
  • Partnership Culture Model:  This model represents both the infrastructure and the cultural environment necessary to deliver professional healthcare in a transformed world.
  • Interdisciplinary Integration Model:  This partnering model represents integrated processes of care for the interdisciplinary team as evidenced by coordinated, integrated services across the continuum.
  • Applied Evidence -based practice model:  This model is designed to support the care providers in clinical inquiry, reasoning and judgement and apply best practice as the point of care.  Evidence based clinical documentation and over 200 clinical practice guidelines (CPG’s) are available to the practitioner.
  • Health Informatics Model:  brings the science of Health Informatics to the CPM framework by applying the theoretical concepts of data/information/knowledge/wisdom to intentionally designed documentation tools.
  • International Consortium Model:  gathers a group or like-minded organizations who unite a common vision for sustainable healthcare transformation

 As you can see from the six different clincial models that CPM is very robust and that is why there are two people including myself that manages the CPM content in our institution.

Two of my colleagues and I  attended the CPM training course last October and we are now certified in CPM. What does that mean and how does it apply to informatics?  We manage the CPM information in the electronic medical record.  There are numerous CPM flowsheet templates, groups, and rows, patient education records and the care plan records that we keep track of. In addition, we analyze the CPM content to see if the department will need the information or not. 

If you would like more information about CPM or CPM Resource Center, website information can

 

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311 Days til Go-Live

Posted on January 26, 2012 by afernando

 

Every other week we have workflow sessions with our end users to demonstrate the future state workflows. This week was a workflow week for us and its 311 days til go-live.  For those of you who have not heard of the word “go-live,” its when the new electronic medical record  (EMR) is turned on and the old one is turned off.  Since the hospital I am working at already has an EMR, it has been a challenging process.  Our end users are computer savvy and have been through a big bang implementation already five years ago.  Some hospitals are still on paper charts and to implement a system from paper to electronic is alot easier.

So far the workflows demonstrated are admission, transfer, and discharge of a patient. In addition, other workflows demonstrated were blood administration, medication administration, ordering labs, resident sign-off, and OR to PACU (operating room to post anesthesia care unit) to name a few.  The weeks that are non-workflow weeks we are preparing for the upcoming workflows weeks.  How we prepare is to make sure all of the logistics are in places such as the rooms, hardware, and presentation equipment are in place.  We also prepare the agenda, powerpoint presentation, and practice our demonstration.  Practicing what we will say is key since we demonstrate with the computer while we are talking to the audience.  We need to maintain eye contact with our audience while showing the electronic medical record and maneuvering the mouse.  In addition to all of this practicing, we actually need to design and build the system.  Building the pieces of an electronic medical record is not easy. It was quite challenging and requires many hours of our time, especially when we need to troubleshoot something that is not working.

It was a good week for the project team since the clinicians liked the workflows and one of the nurse managers even commented how she was impressed with the content and the overall graphical user interface.  This comment is something we are happy to hear! Our hard work is paying off.

The project team continues to be busy.  I am the most happiest when I get something done off of my to-do list.  I have met all of  my build deadlines so far and have other deadlines looming. 

For those of you who thrive on excitement, stress, and deadlines, I recommend finding a job implementing an electronic medical record.  The next question may be how do I find a job implementing an electronic medical record?  I suggest going to the Human Resource department at your local hospital and speaking to the hiring manager to see if there are any open positions as a systems analyst or trainer.  Each hospital has different titles so its imperative to read the job description first.  If this type of job interests you and if you know someone in the field, ask them for an informational interview or if you can follow them for the day.  Another recommendation is to join Linked In or other job search engines and search for either systems analysts or informaticists jobs to see what is available in your area.

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Countdown to Go-Live: 322 Days

Posted on January 16, 2012 by afernando

Incredible Countdown Clock

{image:  credit} 

This past week we had our kick-off to our workflow sessions. Our vice president explained the vision and goals of the hospital and why the hospital chose this particular vendor.  This vendor is the top of the line in healthcare information systems.   They provide the best integrated health information system  from patient registration to hospital discharge.  More importantly, the patient’s primary care physcian will be able to access their inpatient chart,resulting in higher quality of health care. 

In addition, the vice president explained the importance of meaningful use, real time documentation, medication barcode administration, third party content from Clinical Practice Model,  patient education resources and becoming completely electronic, read – paperless.  Real time documentation and becoming paperless will prove to be a challenge for our clinicians since they rely heavily on paper.

The project team demonstrated the functionality of the software by reviewing the most common workflows for patient admissions, transfers, and discharges.  I believe it went extremely well.  The team worked so hard to present the workflows in a way that our clinicians – physicians, nurse practitioners, physician assistants, nurses, patient care associates, dieticians, physical therapists, occupational therapists, recreational therapists, speech pathologists, pharmacists, and other ancillary staff – can understand.  We provided time at the end of our sessions for questions and comments and many of our clinicians are concerned how this new software will affect the way they work. 

From a project team perspective, this new software we are implementing will change their current state of workflows and I don’t think the clinicians fully understand that.  Of course, the project team and hospital leadership will provide support.  We have already provided content review sessions where the project team reviewed the content of the flowsheet templates and rows.  In the future, we planned focus groups to help with gap analysis.

Being an informaticist for the past 8 years, I have faced many challenges and have seen clinicians overcome these challenges.  I am confident enough that the clinicians and ancillary staff will overcome the challenges brought to them.  In fact, it will help them embrace change as new technology arises.  There is an inspirational quote that says it all from Deepak Chopra, “All great changes are preceded by chaos”.

 

 

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Johns Hopkins Hospital – Applied Health Informatics

Posted on January 12, 2012 by afernando

I received an email from my former professor encouraging qualified applicants to apply for the Fall 2012 Applied Health Informatics program at Johns Hopkins.  Additional funding has been received that will allow to fund up to THIRTY (30) ONC Health IT Scholars.

Qualifications:

 This interdisciplinary program requires that you have a minimum of a Bachelors degree and healthcare experience – but it does NOT require that you are a nurse. This is a 9-month post-baccalaureate program that is offered online.  A 16-week on-site practicum (one 8-hour day per week) in a site convenient to the student is required. 

 Importantly, this will be the last year that HITECH funding will enable us to offer $10,000.00 worth of tuition support to qualified applicants.   In order to qualify for tuition support as an ONC Health IT Scholar, applicants must meet the following criteria:

  • Only U.S. citizens or permanent U.S. residents are eligible
  • Federal employees may apply for funding if their employer has certified there is no conflict of interest or potential for dual compensation
  • Those who have already received HIT training and/or who hold a position in health IT are not eligible
  • Those awarded the subsidy must successfully complete all certificate requirements within 9 months
  • Applications for those interested in tuition support must be complete and received by February 15, 2012

Please note that these guidelines and requirements are for applicants seeking tuition support only. Additional instructions, including application guidelines and instructions, can be found on the printable tuition support application form at: http://nursing.jhu.edu/academics/programs/post_degree/online/applied_informatics/. 

The regular admission period for the AHI program (i.e. those not requesting funding) will remain open until May 1, 2012.  The tuition is $12,500 and 12 fully accredited Masters level credits are earned in this program.  If you are awarded one of our ONC Health IT funding supports – the cost of the program (after application of the tuition support) reduces to $2,500.

I encourage you to take advantage of the funding that is available and will be competitively awarded.  Apparently, this is the final cohort that will be supported via this particular mechanism!

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University of Maryland, Baltimore – Masters and PhD Program in Nursing Informatics

Posted on January 9, 2012 by afernando

I am proud to have gone to school at the University of Maryland, Baltimore and obtain Masters in Nursing Informatics.  At the time I attended, the University o Maryland was the second school in the nation to offer a Masters in Nursing Informatics.

Masters in Nursing Informatics

The program is only offered to nurses with a BSN- hence the name Nursing Informatics.  Nurses with a BSN may apply to this program.    The curriculum includes nursing core courses, management, informatics, and electives.

This program opens doors to many graduates as the professors are the top in the field of informatics.  Many of the professors are published and shares their love of informatics.

Doctor of Philosophy

In addition to the Masters in Nursing Informatics, a doctoral degree in nursing informatics is also offered.  Here are the reasons to choose the PhD program at the University of Maryland:

  • Highly accomplished, diverse faculty with broad practice and research interests
  • Ranked 21st among nursing programs receiving research funding from the National Institute of Nursing Research, National Institutes of Health
  • First PhD nursing program in Maryland
  • Students carefully chosen to complement faculty mentors
  • Full- and part-time programs available
  • Scholarships and fellowships available
  • Graduates hold key leadership positions in academia, research, and administration
  • Location in the Baltimore-Washington, D.C. region allows unique research opportunities

There are two tracks in the PhD program:  Post-master’s and BSN to PhD.

Here are the requirements for admission (Post-master’s):

  • A master’s degree with a major in nursing from an accredited nursing program, a Master’s in Public Health, or an equivalent degree from a comparable foreign institution
  • A cumulative grade point average of at least 3.0 or a 4.0 scale for all previous coursework (baccalaureate, master’s, and any subsequent coursework)
  • Statement of goals or objectives
  • Professional vitae or current resume
  • Evidence of personal and professional qualifications from three professionals familiar with applicant’s ability, work experience, contributions to nursing, and potential to succeed in the PhD program
  • Verification of an active licensure for the practice of nursing in at least one state in the U.S. or in a foreign country
  • Official scores on the aptitude portion of the Graduate Record Examination (GRE).  Test must have been taken within five years of application date. Minimum score of 1,000 (verbal and quantitative combined)

Below are the requirements for the BSN to PhD:

  • Must be currently enrolled in UMSON’s master’s program
  • Baccalaureate degree with a major in nursing from a regionally-accredited college or university, or an equivalent degree from a comparable foreign institution
  • A cumulative grade point average of at least 3.0 or a 4.0 scale for all previous coursework
  • Statement of goals or objectives
  • Professional vitae or current resume
  • Evidence of personal and professional qualifications from three professionals familiar with applicant’s ability, work experience, contributions to nursing, and potential to succeed in the PhD program
  • Verification of an active licensure for the practice of nursing in at least one state in the U.S. or in a foreign country
  • Official scores on the aptitude portion of the Graduate Record Examination (GRE). Test must have been taken within five years of application date.  Minimum score of 1,000 (verbal and quantitative combined)

 

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University of Utah – PhD Program

Posted on January 5, 2012 by afernando

I recently became interested in obtaining my PhD in nursing informatics.  On the top of my head, I know the University of Maryland, Baltimore and the University of Utah offers this degree.  I  attended a webinar last November and someone on the call informed the participants that the University of Utah offered a PhD distance program in nursing informatics.  My ears perked up when I heard this.  Can you guess why?  I didn’t know of a PhD program offering a distance program, especially of the caliber of the University of Utah.  The University of Utah is the first school to offer nursing informatics. I was excited when I heard this and after the webinar, I quickly went to the University of Utah website. I specifically looked for the PhD program in nursing informatics but couldn’t find it.   I emailed the program director and he sent me a link to the website.

 I realized why I couldn’t find the website. The website is specific to the PhD program in nursing and not nursing informatics.   I was a bit surprised to see the application deadline for the Fall 2012 term was January 15, 2012, only weeks away.  I looked at the admission requirements and realized I would not be able to take my graduate record examination (GRE) and write my goals statement in two weeks.

The minimum qualifications for the BS to PhD are:

  • Bachelor’s degree (BSN, BS) from an accredited nursing program with a major in nursing.
  • Recommended undergraduate GPA of a 3.3/4.0 or higher.
  • Required Graduate Record Examination (GRE) within the last 5 years. Favorable GRE scores are greater than 50th percentile on the verbal and quantitative tests and greater than 4.0/6.0 on the analytical writing test.
  • Extraordinary potential for a research career with leadership potential in nursing and health care


 

 The minimum qualifications for the MS-PhD program are:

  • Master’s degree with a major in nursing. Individuals with a Master’s degree in other fields will be considered.
  • Recommended Graduate GPA of 3.5/4.0 or higher.
  • Required Graduate Record Examination (GRE) within the last 5 years. Favorable GRE scores are greater than 50th percentile on verbal and quantitative tests and greater than 4.0/6.0 on the analytic writing test.
  • Extraordinary potential for a research career with leadership potential in nursing and health care

 If you think the University of Utah is the right school for you, I encourage you to contact them for additional information or go to their website.  Good luck on your educational journey!

 

 

 

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Resources for Health Informatics

Posted on January 3, 2012 by afernando

I’ve compiled a list of health informatics journals in case there is a subject area that I am not touching upon that you would like more information on.

  • ADVANCE for Health Information Executives Online
  • Artificial Intelligence in Medicine
  • Bioinformatics
  • BioSystems
  • British Journal of Healthcare Computing & Information Management
  • Computerized Medical Imaging and Graphics
  • Computer Methods and Programs in Biomedicine
  • Computer Methods and Programs in Biomedicine
  • Computers in Biology and Medicine
  • Computers, Informatics, Nursing
  • European Journal of Information Systems
  • Health Data  Management
  • Health Informatics Europe
  • Health Informatics Journal
  • Health Information & Libraries Journal
  • Healthcare Information Management and Communications Canada
  • Health Management Technology Online
  • Healthcare Informatics Online
  • Informatics in Primary Care
  • Informatics Review
  • International Journal of Medical Informatics
  • International Journal of Technology Assessment in Healthcare
  • Journal of Biomedical Informatics
  • Journal of the American Medical Informatics Association
  • Journal of Clinical Monitoring and Computing
  • Journal of Healthcare Information Management
  • Journal of Medical Internet Research
  • Journal of the Medical Library Association
  • Journal of Telemedicine and Telecare
  • LinuxMed News
  • Mathematical and Computer Modeling
  • MD Computing
  • Medical and Biological Engineering and Computing
  • Medical Computing Today
  • Medical Decision Making
  • Medical Engineering & Physics
  • Medical Informatics and the Internet in Medicine
  • Medical Science Monitor
  • Methods of Information in Medicine
  • Micron
  • Neural Networks
  • Online Chronicle of Distance Education and Communication
  • Online Journal of Nursing Informatics Corporation
  • RN Palm:  The Journal of Mobile Informatics
  • SCAR News:  Society for Computer Applications in Radiology
  • Telemedicine Today Magazine

 

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Conducting Workflow Analysis

Posted on December 29, 2011 by afernando

 

 

we ARE the technology

I attended a webinar in November hosted by ANIA-CARING.  The speaker was Cheryl Parker and the webinar was titled, ” Conducting Workflow Analysis – Don’t Get Trapped by How.”

Part of the job of a systems analyst are conducting current state workflows and helping departments to adopt the future state workflows that the electronic medical record will bring to their department.

The topic of workflows are of a particular interest to me since I have participated in many workflow analyses in my career.  The last workflow analysis I participated in was this past summer.  In each organization I have worked at the workflow process is similar with some minor details.

Dr. Cheryl Parker is the Chief Nursing Officer  for Rubbermaid Medical Solutions.  Dr. Parker also teaches nursing informatics in Walden University.  My overall key takeaway from this webinar is to not think about the “how” of a worflow analysis but the  “what” of a  workflow analysis.  In this webinar, Dr. Parker suggests to follow this particular workflow process: 

1.)  Find the what first

2.)  Define the how

3.)  Focus on value

4.)  RAEW Analysis

5.)  Goldilocks Prinicple:  Not too much and not too little – Don’t get bogged down with too many details

Find The What

Here are the “what’s” of a workflow analysis:

  • Process exists to achieve a desired outcome
  • A person’s job is to achieve the desired outcome not just complete steps in a workflow
  • The “what’s” are the desired outcome
  • Outcome verbs:  acquire, deliver, create, generate

I learned in school about the traditional workflow analysis:  How to Conduct a Workflow Analysis.  This is what I learned:

  • Interview the people who do the job
  • Document what these people tell us they do
  • Don’t make assumptions or ask questions
  • After meeting, figure out a better way to do their job
  • Implement changes
  • Reassess

Define the How

The problem with conducting the “how” of a workflow analysis are the:

  • people you are interviewing, their answers are subjective and unreliable; for example, interview three people in the same department and you get three answers
  • people you interview will always say “this is how we have always done it”
  • or they will answer, “I was taught this way”
  • people you interview may be blind to the big picture and you will not get desired outcomes
  • people in the department that you interview may be stuck in a workflow and may become argumentative.  Do we do A or B and who does it?

Focus on Value

The questions you may ask yourself about values are:

1.)  Are the people you chose to interview a high value for the organization?  The definition of high value are:

  • concerned with safety
  • contributes to bottom line
  • competitive differentation
  • customer satisfaction

RAEW Analysis

RAEW analysis forms the human/managerial components of the workflow process

R = Responsibility – does the person have responsibility for the actions/decisions

A = Authority – controls/prohibits the actions of others

E = Expertise – special skill, knowledge, judgement

W = Work – physical or mental effort directed at doing something

Beware of these red flags:

  • authority with no responsibility
  • responsibility with no authority
  • other roles with no expertise

 Apply the Goldilocks Principle

The Goldilocks principle is having just the right amount information in your workflow analysis.  Having too much information will bog you down and you may never finish.  In addition, data collection will be burdensome.

This webinar had some key learnings for me. I have always accomplished my workflow process with the how’s first and the what’s second.  In addition, I always felt like I needed to capture every single workflow a department does and often got overwhelmed with the information I collected.  This webinar proved helpful for me and the next time I do a workflow analysis, I will certainly follow Dr. Parker’s process.

 {image:  found via Flickr by alyceobvious’}

 

 

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16 Types of Health Informaticist Jobs

Posted on December 27, 2011 by afernando

job search legal pad.jpeg

One reason why I became a nurse is I love helping people.  Whether it’s with the small stuff like helping people get out of bed or educating them about their disease.  Being in the health informatics field, I help people in many other ways now, whether its helping them with the actual work or helping them with their career or helping people break into the field.  I have been receiving many emails about how to break into the field.  But, I want to address the possiblities of jobs out there.  A “typical”  health informatics position does not exist.  In fact, there are a myriad of positions available in health informatics.

1.)  Superuser – Serves as a local resource person and has advance knowledge than the average end user

2.)  Clinicial Liason – clinicians who represent the interest and needs of other clinicians and communicates issues with the technology team during system design or implementation

3.)  Help desk personnel – first line of user support within an organization; these individuals require excellent communication skills and technical knowledge in order to troubleshoot end user problems and issues

4.)   PC specialist – provides information and training on commonly used productivity software and helps users with new equipment.  These specialists have technical training or a baccalaureate degree in computer science or related area

5.)  Clinical Information Analyst – supports process improvement, safety projects, quality initiatives that previously relied on time and labor intensive manual paper chart audits.  The Clinical information analyst can work on a organization’s patient satisfaction surveys, wait times for treatment, medication use, and adverse events.  This role usually requires a clinical background and is supports evidence-based practice.

6.)  Programmer – writes programming codes or instructions that tells a computer what to do.  Most programmers do not have a clinical background and often needs a clinical liason to interpret the needs of the clinician.

7.)  Information sytems manager/supervisor – size and complexity of an information technology department requires a coordinated effort of a team leader or manager.  Since each professional on the team comes with different skill sets and talents, team lead manages each individual.

8.)  Network Administrator – responsible for planning, managing, and expansion of networks.

9.)  Trainer – responsible for educating clinical users and non-clinical personnal to use the electronic medical record.  Some trainers may not have a clinical background but is not necessary.

10.)  Security Officer – reponsible for ensuring measures exist to protect information privacy

11.)  Chief Information Officer – have a broad view of the needs of the institiution and the design, implementation, and evaluation of information systems.  Responsiblities include strategic planning, policy development, budgeting, information security, recruitment and retention of information management staff, and overall management of the enterprise’s information systems.

12.)  Chief Privacy Officer – protects personal health information of patients, both paper and electronic, this position is required by the federal government

13.)  Chief E-health officer – this role was created as a part of a strategy for expanding the use of the Internet beyond Informational Web sites to encompass a range of new services electronically

14.)  Compliance Officer – designated to ensure federal and state regulations and accrediting requirements are met both via paper and automated records and systems

15.)  Project Manager – manages the scope and timeline of a project, may or may not be a clinician

16.)  Interface Engineer – ensures information is exhanged between disparate systems and isolates and corrects problems behind the scenes to the users of the system

 

 

DISCLAIMER:  This list is not an inclusive list.

 

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