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Lessons Learned in Selection/ Implementation of EHRs and Informatics Tools
Bonnie L. Westra, PhD, RN, FAAN, FACMIAssociate Professor
Director
Center for Nursing Informatics
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University of Minnesota – AHC
• School of Dentistry
• Medical School
• School of Nursing *
• College of Pharmacy
• School of Public Health*
• College of Veterinary Medicine
Institute for Health Informatics*
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Informatics – School of Nursing
• Bachelor of Science in Nursing (BSN) Program
• Master of Nursing (MN) Program
• PhD Program
• Doctor of Nursing Practice Program
– 13 Specialties – includes Nursing Informatics
• Leadership in Health Information Technology for Health Professionals Certificate
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Interprofessional Informatics Education
• UMN - Coordinating Center for Interprofessional Education and Collaborative Practice
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Adopt (Assess, Plan, Select)
• Key functions of EHR
• EHR use, documentation, communication, and professionalism skills for patient care
• EHR to support interprofessional patient care and teamwork
• Include the re-use of data for research
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Needs Assessment• Needs assessment of key faculty across programs &
health system (using Epic)
• Learners – level, number
• Competencies – what is taught, when, specific competencies
• Classes – schedules, delivery method
• Existing resources (health system partner)
• Hardware, support, costs
• Competing priorities
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Where to Begin
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Plan• Know the fit
– Timing
– Courses and competencies
– Faculty/ student training• Baby steps
– Specific assignments
• Faculty champion
• Support team
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Select
• Requirements
– “Show me” – clear requirements
• Use by other academic centers
– Patients, use cases, reset database (?)
• Negotiating and contracting– Purchase cost and process
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Select
• NURS5115 Interprofessional Health Informatics
– Nightingale Notes (EHR)
• Informatics specialty courses
– NURS7108 Population Health Informatics
• Nightingale Notes
– NURS7113/NURS7114Clinical Decision Support
• Applied Pathways
• Start up company’s EHR
• Goal is to pilot – then offer more widely
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IMPLEMENT
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Nightingale Notes• Community-based EHR
– Integration of standardized language (Omaha System) in a community-based EHR
– Evaluation the usability of EHR software by conducting a small-scale usability study
– Visualization and interpretation data
• Generalist –– Design -> documentation -> secondary use of data
• Informatics Specialist – Population Health Informatics– Design -> documentation -> secondary use of data
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13
CDS applied pathways
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14
Visual Care Pathways™ EditorPrecise list of operations performed in specific order
Process designed in flowchart format
Component icons are abstractions of XML based rules
Each icon is defined as a unique, re-usable, extensible “asset”
Properties Editor
Define and embed component attributes:
• Content & format
• Concept & label
• Index & classify
• Industry codes
• References
• Embedded Media
• Version control
Component operations
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iCare Academic EHR (start-up)
• Clinical Decision Support Practicum
• Systems requirements for evidence-based practice guidelines linked to an interface and HIE terminology (CCC and SNOMED CT)
• Systems analysis & Design - Analyze current system, principles of system design, own experience, design workflow
• Evidence-based practice (knowledge source)
• Terminology mapping to EBP guidelines
• Usability testing
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Summary
• Approach – big bang or incremental
• Requirements and all costs
• Champion and fit with learning objectives
• Next steps
– Effective use
– Exchange - future