electronic health record and residency training threats, opportunities, realities an informatics...

Electronic Health Record and Residency TrainingThreats, Opportunities, RealitiesAn Informatics Perspective on the EHR

Genevieve Melton-Meaux, MD, MA, FACSAssistant Professor, Department of Surgery

Faculty Fellow, Institute for Health Informatics

University of Minnesota, Minneapolis, MN

ASSOCIATION OF PROGRAM DIRECTORS IN SURGERY2011 ANNUAL MEETING; BOSTON, MASSACHUSETTS

March 26, 2011

APDS Presentation March 26, 2011 2

Overview

Informatics Challenges with EHR Systems, Informatics,

and Surgery Next Steps


Overview



Informatics – Realities/Facts


Informatics - Facts

Broadly the science of information Studies the structure, algorithms, behavior, and

interactions with information Utilizes foundations from other fields

Computer science, statisticsDecision and cognitive scienceSocial engineering Information and library scienceUnderlying application (healthcare, medicine)


Biomedical and Health informatics Medical informatics Bioinformatics

Definition: Discipline of improving healthcare, biomedical research, and public health through better use of information (Hersh, 2009)

About information, not technology

Informatics - Facts


Informatics - Facts

*Adapted from Friedman C. “A ‘Fundamental Theorem’ of Informatics.” JAMIA 2009.

notthis


Fact: Informatics is Critical for EHR Success

Improved use of information for quality, safety, and integration of care is a critical aspect of healthcare reform Even more important with ARRA/HITECH and

ACA legislation

Benefit of HIT? Systematic reviews show HIT intervention benefit Most studies in small number of academic centers*

*Garg. Effects of computerized clinical decision support on practitioner performance and patient outcomes: A systematic review. JAMA 2005.*Chaudhry. Systematic review: impact of HIT on quality, efficiency & costs. Ann Int Med 2006*Goldzweig. Costs and benefits of HIT: new trends from literature. Health Aff 2010.


Facts: Problematic HIT

HIT implementation can be problematic Failure often to lack of understanding of clinical

environment and workflow (Leviss, 2010; Einbinder, 2010)

Example: CPOE conflicting outcomes Children’s Hospital of Pittsburgh Pediatric ICU: mortality

rate increased from 2.8% to 6.6% (Han,2005) Finding not seen at other centers with CPOE (Del Baccaro,

2006; Jacobs, 2006) Adverse outcomes may have been avoided by changes in

workflow and other best practice adherence (Phibbs, 2005; Sittig, 2006)


Overview



Challenges with EHR Systems, Informatics, and Surgery - Threats


Vendor Dominated HIT - Threats HIT system implementations are complex

Bulky legacy systems underlie each implementation

Each build is different/customized

Landscape of EHR systems/HIT dominated by large vendors Limits our abilities to customize or refine HIT Vendors remain non-liable for errors or problems

(“hold harmless” clause)*

*Koppel. HIT Vendors “Hold Harmless” Clause. JAMA. 2009.


HIT Fallacies - Threats

Multiple fallacies with HIT (12)+

Purchasing and using an EHR system does not mean that it will work

HIT is not a device – little oversight Clinician “bad apple” fallacy (why do we resist?)We computerized the paper, so we can go paperless

fallacyOne size fits all fallacy

+Karsh. HIT: Fallacies and Sober Realities. JAMIA 2010.


Surgery Information Needs - Threats

Information needs of surgeons are great Surgical care has unique characteristics

High-impact encounters Time-sensitive information needs Resource intensive Multi-disciplinary care Transitions in care, particularly 1) pre-operative

assessment/planning and 2) post-operative care

Melton. Biomedical and Health Informatics for Surgery. Advances in Surgery. 2010.


Surgery Information Needs - Threats

EHRs not optimized for surgeon workflow Detailed surgical information difficult to find Not designed for peri-operative information needs Flow of information between care settings

Surgeons have not been at the table Most systems have been designed for primary care

physicians/internists in mind Lack of stakeholders historically

Melton. Biomedical and Health Informatics for Surgery. Advances in Surgery. 2010.


Overview



Next Steps - Opportunities


Surgeons should leverage successes

Model Implementations of Secondary Data UseSociety of Thoracic Surgeons DatabaseNSQIPMultiple successful registries (i.e., trauma)

Focus on improving automation of these and similar programs“Collect Data Once” and “Use Many Times”

Become stakeholders in HIT and Informatics


Opportunities - NIH Clinical and Translational Science Awards (CTSAs)

NIH University-based infrastructure awards to medical centers to improve and transform how biomedical research is conductedTotal of 60(+) centers (NIH Roadmap)

Informatics and automation of clinical (and biomedical) data for research is key to CTSAsMost centers with CTSAs will or currently have

improved access to EHR data for research


Organizations AMIA – American Medical Informatics Association

Academic home for informaticians Actively involved with HIT policy

HIMSS – Healthcare Information and Management Systems Society Organization geared towards HIT implementers/leaders

(CIO/CMIO/IT) Some but inconsistent connections to informatics Integrally connected with vendors


Training Opportunities

Graduate programs in informatics Masters, PhD NLM-NIH Training Programs (T15 fellowship)

AMIA 10X10 certificate program New ONC Initiatives (Stimulus Bill) Clinical Specialization in Informatics (via

Preventative Medicine) https://amia.org/informatics-academic-training-

programs


Opportunities - HITECH Aims for ~50,000: Workforce Development

Community College Consortia to Educate HIT Professionals Program ($70M) Five regional consortia of 70 community colleges offering short‐term

training for 10,000 individuals per year

Curriculum Development Centers Program ($10M) Competency Exam for Community College Programs ($6M) Program of Assistance for University‐Based Training ($32M)

Funding for education of individuals requiring university‐level training at 9 universities (including UMN)

Emphasis on short‐term certificate programs delivered via distance learning


Overview




Summary

EHR systems increasingly important Informatics can help improve our ability to

implement and utilize EHR systems effectively Surgery Informatics is a wide open area

Few stakeholders Much at stake

Many opportunities to become a stakeholder


Questions?

Genevieve Melton-Meaux

[email protected]

electronic health record and residency training threats, opportunities, realities an informatics...

Documents

informatics factsbroadly

medicineapds presentationmarch

hit intervention

impact of hit

benefits of hit

public health

health aff

aca legislationbenefit