Informatics & Technology in Nursing
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  • 1. Informatics & Technology in Nursing Nawanan Theera‐Ampornpunt, M.D., Ph.D. Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • 2. 2003 M.D. (First‐Class Honors) (Ramathibodi) 2009 M.S. in Health Informatics (U of MN) 2011 Ph.D. in Health Informatics (U of MN) 2012 Certified HL7 CDA Specialist • Deputy Executive Director for Informatics (CIO/CMIO) Chakri Naruebodindra Medical Institute • Lecturer, Department of Community Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University nawanan.the@mahidol.ac.th http://groups.google.com/group/ThaiHealthIT www.SlideShare.net/Nawanan Introduction
  • 3. • Health & Health Information • Health IT • Informatics as a Discipline • Nursing Informatics • Summary Outline
  • 4. Health & Health Information
  • 5. Let’s take a look at these pictures...
  • 6. Image Source: Guardian.co.uk Manufacturing
  • 7. Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3 Banking
  • 8. ER - Image Source: nj.com Healthcare (On TV)
  • 9. (At an undisclosed nearby hospital) Healthcare (Reality)
  • 10. • Life‐or‐Death • Difficult to automate human decisions – Nature of business – Many & varied stakeholders – Evolving standards of care • Fragmented, poorly‐coordinated systems • Large, ever‐growing & changing body of  knowledge • High volume, low resources, little time Why Healthcare Isn’t Like  Any Others
  • 11. Back to something simple...
  • 12. To treat & to care  for their patients  to their best  abilities, given  limited time &  resources Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen) What Clinicians Want?
  • 13. • Safe • Timely • Effective • Patient-Centered • Efficient • Equitable Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p. High Quality Care
  • 14. Information is Everywhere in Healthcare
  • 15. Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8. “Information” in Medicine
  • 16. 16 16 WHO (2009) Components of Health Systems
  • 17. 17 17 WHO (2009) WHO Health System Framework
  • 18. Health & Health Information • Health IT • Informatics as a Discipline • Nursing Informatics • Summary Outline
  • 19. Health IT & eHealth
  • 20. (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark IOM Reports
  • 21. • To Err is Human (IOM, 2000) reported that: – 44,000 to 98,000 people die in U.S. hospitals each year as a result of preventable medical mistakes – Mistakes cost U.S. hospitals $17 billion to $29 billion yearly – Individual errors are not the main problem – Faulty systems, processes, and other conditions lead to preventable errors Health IT Workforce Curriculum Version  3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare ‐ Lecture d Patient Safety
  • 22. • Humans are not perfect and are bound to make errors • Highlight problems in U.S. health care system that systematically contributes to medical errors and poor quality • Recommends reform • Health IT plays a role in improving patient safety IOM Reports Summary
  • 23. Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy‐heads/  (Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg To Err Is Human 1: Attention
  • 24. Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital To Err Is Human 2: Memory
  • 25. • Cognitive Errors - Example: Decoy Pricing The Economist Purchase Options • Economist.com subscription $59 • Print subscription $125 • Print & web subscription $125 Ariely (2008) 16 0 84 The Economist Purchase Options • Economist.com subscription $59 • Print & web subscription $125 68 32 # of People # of People To Err Is Human 3: Cognition
  • 26. • It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013) What If This Happens in Healthcare?
  • 27. Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, Schmidt HG. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA. 2010 Sep 15;304(11):1198-203. Cognitive Biases in Healthcare
  • 28. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80. Cognitive Biases in Healthcare
  • 29. Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781‐3. “Everyone makes mistakes. But our reliance on  cognitive processes prone to bias makes  treatment errors more likely than we think” Cognitive Biases in Healthcare
  • 30. • Medication Errors –Drug Allergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  • 31. Why We Need ICT in Healthcare? #1: Because information is everywhere in healthcare
  • 32. Why We Need ICT in Healthcare? #2: Because healthcare is error-prone and technology can help
  • 33. Why We Need ICT in Healthcare? #3: Because access to high- quality patient information improves care
  • 34. Why We Need ICT in Healthcare? #4: Because healthcare at all levels is fragmented & in need of process improvement
  • 35. Health Information Technology Goal Value-Add Tools Health IT: What’s In A Word?
  • 36. Hospital A Hospital B Clinic C Government Lab Patient at Home Health Information Exchange
  • 37. Health & Health Information Health IT • Informatics as a Discipline • Nursing Informatics • Summary Outline
  • 38. Biomedical & Health Informatics as a Discipline
  • 39. • “Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health.” (AMIA, 2012) Biomedical Informatics
  • 40. • Provide Patient-Centered Care • Work in Interdisciplinary Teams • Employ Evidence-Based Practice • Apply Quality Improvement • Utilize Informatics Core Competencies of  Health Professionals (IOM, 2003)
  • 41. (Shortliffe, 2002) Informatics As A Field
  • 42. (Hersh, 2009) Informatics As A Field
  • 43. Biomedical/ Health Informatics Computer & Information Science Engineering Cognitive & Decision Science Social Sciences (Psychology, Sociology, Linguistics, Law & Ethics) Statistics & Research Methods Medical Sciences & Public Health Management Library Science, Information Retrieval, KM And More! Informatics & Other Fields
  • 44. Health & Health Information Health IT Health Informatics as a Discipline • Nursing Informatics • Summary Outline
  • 45. Nursing Informatics
  • 46. • Nursing Informatics is the “science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide.” (IMIA Special Interest Group on Nursing Informatics 2009). Nursing Informatics AMIA Nursing Informatics Working Group
  • 47. Nursing Informatics Source: http://nursingfile.com/nursing-informatics/road-to-the-future-nursing-informatics.html
  • 48. • Standards to support evidence-based practice, research, and education • Data and communication standards • Research • Information presentation and retrieval to support safe patient centered care • ICT to address inter-professional workflow needs across care • Development, design, and implementation of ICT • Healthcare policy to advance the public’s health Core Areas of  Nursing Informatics AMIA Nursing Informatics Working Group
  • 49. • Nursing Informatics Standards – Omaha System Examples of  Nursing Informatics Works
  • 50. • Health IT in Clinical Settings – Electronic Nursing Records – e-Kardex – Careplanning – Electronic Medication Administration Records (e-MAR) – Barcoded Medication Administration – Other nurse-related workslows Examples of  Nursing Informatics Works
  • 51. Ordering Transcription Dispensing Administration CPOE Automatic  Medication  Dispensing Electronic  Medication  Administration  Records  (e‐MAR) Barcoded Medication  Administration Barcoded Medication  Dispensing Medication Process
  • 52. • Health IT for Consumers/Patients – Personal Health Records – Telemedicine – Web Sites for Patient Education & Engagement – mHealth & Social Media Examples of  Nursing Informatics Works Images from HealthVault.com, American Telecare, Inc. & WHO
  • 53. Health & Health Information Health IT Health Informatics as a Discipline Nursing Informatics • Summary Outline
  • 54. Summary
  • 55. • Information is important & everywhere in healthcare (and nursing) • Health IT helps improve quality of care and reduces errors by health workers • Informatics is an interdisciplinary field, with nursing informatics as one key sub-field • Nursing informatics plays important roles in today and future’s patient care Summary