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Clinical Informatics:
From Dirt Roads to Superhighways Patricia Korolog Mulberger, MSN, RN-BC
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Objectives
Journey
Roles
Trends
Whose Driving
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Domains of Clinical Informatics
http://samples.jbpub.com/9781284049961/9781284027006_CH01_Final.pdf
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The Reality of Clinical Informatics
• Multidisciplinary • Medicine
• Nursing
• Public Health
• Pharmacy
• Radiology
• Other Relevant Fields • Information
Management
• Computer Science
• Cognitive Science
• Science of Terminologies & Taxonomies
• Heuristics
• Library Sciences
• Archival Science
• Mathematics
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Very Early Origins
• Hippocrates Medical record should accurately reflect
Course of disease
Probable cause of disease
“I believe that it is an excellent thing for a
physician to practice forecasting. He will
carry out the treatment best if he knows
beforehand from the present symptoms
what will take place later”
http://www.historylearningsite.co.uk/hippocr
ates.htm
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“First Informatics Nurse”
https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-
8#q=florence%20nightingale%20polar%20area%20diagrams
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• Mechanical Calculator
Mid 1600’s
Automated mechanical computer
1830’s Census
Early IBM
Late 19th
Century Binary Code 1940 WWII 1943
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ENIAC 1946
1st computer used in clinical practice
1952 Mobile Telephone 1956 Robert
Ledley 1959 Dept of Medical Methods Research
1961
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EHR Software 1969
ATARI
IBM Personal Computer
1980 WWW 1989-
90 NwHIN 2004
More Driving Forces
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Human Genome Project
1984-2003
ARRA 2009 Need Grows for clinical
informaticists NOW
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My Journey
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Paths To Clinical Informatics Career
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Nursing Formal/Academic
• Undergraduate Level • Informatics Nurse (IN)
• RN w/ interest/experience in informatics field
• Mostly on the job learning
• Graduate Level • Informatics Nurse Specialist (INS)
• Post Graduate Focus • PhD or DNP
• Academic (PhD)
• Faculty
• Applied Practice (DNP)
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Credentialing ANA
Nursing Informatics is a nursing specialty (1992)
Scope and Standards of Practice 1994 1st Edition
2015 2nd Edition
American Nursing Credentialing Center Nursing Informatics
HIMSS
Certified Professional in Healthcare Information and Management Systems
American Board of Imaging Informatics
Certified Imaging Informatics Professional
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American Healthcare Informatics
Professional Organizations
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The Promises
https://www.youtube.com/watch?v=t-aiKlIc6uk
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Trends
• Emphasis on change in delivery models
• Providing care outside of hospital setting
• More cost efficient
• Clinically relevant
• Outcome based
• Patient Engagement
• Population Health
• Bioinformatics
• Genomics
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Trends
• Rise of Analytics
• Opportunities to participate, create, and shape
tomorrow’s healthcare
• Population Health
• Community Health
• PBM (Pharmacy Benefit Manager) companies
• Wellness care
• Quality/performance measure
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NowTrending.HHS.gov
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Individual Apps
Monitoring, Tracking and Trending
Connecting
Digital Coaching
Disease oriented cookbooks
Body Measurements.
HR, RR, Steps, Stairs, Calories
http://medicaleconomics.modernmedicine.com/medical-
economics/content/tags/android/top-10-apps-physicians-recommend-their-
patients?page=full
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Past Challenges Meet Future Trends
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New Healthcare Data Sources • RFID
• Streaming Device Data
• Physiological Monitors
• Ventilators
• Wearables
• Social Media
• Geographic Information System (GIS) Data
• Open Data
• www.data.gov
• Internet of Things (IoT)
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FHIR – The “Public API” for Healthcare?
Huff, S., McCallie, D HIMSS 2015
FHIR = Fast Health Interoperability Resource
• Builds on previous HL7 data structures to describe data formats and
elements
• More powerful & less complex than HL7 V3
• Easier to implement
• Uses web-based http application programming interface
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FHIR – The “Public API” for Healthcare?
FHIR Resources
• Well-defined, simple snippets of data that capture core clinical
entities
• Build on top of existing HL7 data types
• Resources are the “objects” in a network of URI reference linksWe
Huff, S., McCallie, D HIMSS 2015
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SMART Platform –Open Specification
for Apps
• “Substitutable Medical Apps”
• Kohane/Mandl – NEJM (2009)
• A SMART App is a Web App
• HTML5 + JavaScript
• Remote or embedded in EHR
• URL passes context & FHIR li nk
• EHR Data Access via FHIR
Huff, S., McCallie, D HIMSS 2015
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Who is driving the train!
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New Drivers
• Cognitive and Behavioral Psychology
• User Experience
• Human & Computer Interaction
• Devices
• Wearables
• Patients & Family
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Now on the Team
• AND ALL OF YOU
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Contact Information
Patricia Korolog Mulberger
(406) 250 – 3413