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Exploring Opportunities for Librarians in Healthcare Information Technology


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Presentation given at the Medical Library Association, Philadelphia Regional Chapter, Annual Meeting, 4/18/13

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Exploring Opportunities for Librarians in Healthcare Information Technology

  1. 1. Exploring Opportunities for Librarians in Healthcare Information Technology Philadelphia Regional Chapter Medical Library Association, Annual Meeting April 18, 2013 Dean Karavite, MSI Center for Biomedical Informatics (CBMi) Children’s Hospital of Philadelphia (CHOP)
  2. 2. Center for Biomedical Informatics (CBMi)  Applying information technology to healthcare research  30-40 staff  Clinicians, researchers, analysts, statisticians, developers, study coordinators, education specialists and more
  3. 3. Human Computer Interaction (HCI)  Multi disciplinary field  Human factors, information science, experimental psychology, cognitive psychology, computer science, industrial design, anthropology and more  Research and methods applied to the design of information technology  Usability  “The capacity of a system to allow users to carry out their tasks safely, effectively, efficiently and enjoyably”  Study people and information and develop systems that support working with information in new ways
  4. 4. Connection Between HCI and Medical/Health Science Librarians?  University of Michigan, School of Information  Evolved from SILS in 1996  Expanded curriculum to apply LIS methods and research to IT  LIS, Archives, HCI and more  Recently developed new health informatics program  Jane Blumenthal – key role in Michigan program  Prudence Dalrymple - Drexel iSchool has a similar program
  5. 5. NLM Helped Create My Job  NLM Challenge Grant  Create EMR based clinical decision support (CDS) for complex patients  Premature infants during first two years of life  Multiple preventative health issues  Growth  Nutrition  Development  Blood pressure screening  Retinopathy of prematurity (ROP)  Respiratory syncytial virus (RSV)
  6. 6. Fifth Presentation to Librarians  Participated in workshops put together by P.J. Grier  “Peeling the Onion, Informatics for Librarians”  Librarians Can’t “Get a Seat at the HIT Table”  Why don’t those working with HIT understand how health science librarians can contribute?
  7. 7. Meaningful Use
  8. 8. The EMR Build  The build process is the configuration of the EMR  One of the most complex IT projects imaginable  Can take years, hundreds of IT staff and hundreds of millions of dollars  EMRs are built on database hierarchies representing every single component of a healthcare organization  Buildings, floors, units, rooms, beds…  Equipment, instruments, supplies…  Meds, labs, procedures…  Clinicians, doctors, nurse practitioners, nurses, techs…
  9. 9. EMR Build Example in the OR  Vendor, IT and OR staff working to design the OR status board  Somewhat analogous to the flight status screen at an airport, but with more information on each OR  Nobody thought to review existing literature on the design and assessment of these systems
  10. 10. EMR is Full of Search/Retrieval Tasks  Lists, lists and more lists  Almost every task requires a search activity  Medications, diagnosis, procedures, instruments, supply items… endless  Poor EMR search design and/or poor EMR build = difficulty in search and retriveal  Poor data quality  Assessing the patient 1. Chief complaint 2. Problem list 3. Medications 4. Immunizations 5. Encounter history 6. Surgical history 7. Specialists visits/notes  Managing the visit 1. EMR documentation template 2. Immunizations to order 3. Medications to order 4. Procedures to order 5. Patient education materials 6. Referral to order 7. Diagnostic code 8. Follow up code 15 Search Tasks in 15 Minutes: Pediatric well visit + ear infection* * After well visit and upper respiratory infection, ear infections are the most frequent reason for a pediatric visit
  11. 11. Preemie Assistant
  12. 12. Epiphany?  The reason people working in HIT don’t understand how health science librarians can help them is...  Because they aren’t ready for you  They are overwhelmed with building the EMR  So, what about when they are done?
  13. 13. EMR Optimization  EMR implementation is only the first step  Many issues cannot be addressed in the build process  Many issues aren't foreseen until the system goes live  Vendors are constantly releasing upgrades with new features  Meeting meaningful use criteria  “Optimization” is reconfiguring (rebuilding?) the EMR to meet objectives for clinicians, patients, outcomes, safety, errors…  Optimization is endless
  14. 14. Optimization Example: Growth Charts for Preemies  EMR does not select/display correct charts for premature infants  Even though it has the data to do so  Typical EMR optimization  Make the EMR select/display the correct charts  Advanced EMR optimization  Augment the correct charts with additional information and integrate growth with nutrition, patient education and clinical documentation
  15. 15. Cataloged Growth Chart Collection
  16. 16. Preemie Assistant: Growth/Nutrition
  17. 17. Growth Chart Results
  18. 18. Data, Information, Knowledge Paradigm DATA Gestational Age = 29 weeks Chronological Age = 5 months ICD9 = 770.7 INFORMATION This is a premature infant with chronic lung disease KNOWLEDGE According to the American Academy of Pediatrics policy statement, premature infants with CLD are at risk for RSV and should receive Palivizumab
  19. 19. Evidence Based Medicine Guideline Translation Process: Overview GuideLines Into DEcision Support (GLIDES), Yale School of Medicine, AHRQ Funded Process and tools toward translating clinical guidelines into EMR based decision support
  20. 20. Connecting the EMR to Knowledge Resources  “Info Button”  HL7 International Context-Aware Information Retrieval standard  Search integrated with the EMR  Originally developed at Columbia over a decade ago
  21. 21. Search Code/Parameters http://msnappdw001:8123/ebm.aspx? &age.v.u=mo&age.v.v=8& G&encounter.c.c=AMB&mainSearchCriteria.v.c=486&mainSearchCriteria. v.cs=2.16.840.1.113883.6.103&mainSearchCriteria.v.dn=Pneumonia&mai nSearchCriteria.v.ot=Pneumonia&patientPerson.administrativeGenderC ode.c=F&patientPerson.administrativeGenderCode.dn=Female&performer =PROV&taskContext.c.c=DIAGLISTE Embedded in all that is the following information : “I am a primary care pediatrician seeing a female patient of 8 years old in the outpatient setting and I’m looking at the diagnosis list” Or “I am a nurse in a pediatric hospital emergency department seeing a 2 year old male.”
  22. 22. Up to Date
  23. 23. VisualDX
  24. 24. CHOP Labs
  25. 25. CHOP Intranet
  26. 26. AHRQ Guideline Clearing House 1/2
  27. 27. AHRQ Guideline Clearing House 2/2
  28. 28. Pub Med
  29. 29. EMR as Online Library = Many Opportunities for Librarians  Search Analytics and Search Engine Optimization (SEO)  Technique used by Information Architects (a field that evolved directly from library science) to assess and improve the effectiveness of web based search for corporate intranets and commercial websites  EMR with Info-button opportunities for EMR search analytics+  Evaluate systems to purchase/include  Key role in implementing these systems  Continual monitoring and optimization  Our CMIO get’s it – developing business case for hiring a librarian to manage this and similar work
  30. 30. Design / Education Surprise with Otitis Media (Ear Infections)  Added EMR educational materials for residents and medical students  Physicians used these materials, but not with their students, they used them with patients (parents)  “Here is what an infected ear drum looks like”  “Here is why your child does NOT need an antibiotic today” Graphic presentation of clinical pathways Instructional images
  31. 31. Education for Premature Infants Physician comments from usability test: “Oh this is nice. “ “This is awesome.” “Who the hell knew we even had all this?” “I have never given out one of these.” “In 15 minutes there isn’t time to cover everything. Patient education is the most important thing we do.”
  32. 32. Patient Portals and Shared Decision Making  Personal Health Record, Personal Medical Record, Patient Portal...  EMR based systems that connect patient to hospital/physician  Very basic yet useful  Prescriptions, lab results, messaging, scheduling, immunization records...  Can be integrated with education systems, but yet another EMR “build”  No excuses this time - librarians are a must  Expand portal capabilities to support shared decision making  Asthma: Connecting parents and clinicians + education  ADHD: Add teachers, psychologists and others to the mix
  33. 33. 3 Organizations Partnering to Study PHRs for People With Disabilities  Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR)  WGBH, National Center for Accessible Media (NCAM)  Pioneer of assistive media technology  Inglis Foundation  135 years managing the care of people with disabilities  Center for Biomedical Informatics, The Children’s Hospital of Philadelphia  Enhancing decision support capabilities of EMR and PHR in a research setting
  34. 34. Potential Opportunities Left on the Cutting Room Floor  Genomics and full exome sequencing  Identifying actionable results by mapping results continually evolving research  Mapping actionable results to guidelines, pathways, CDS tools, education for clinicians, patients and families  Taxonomies, Codes and Concepts  ICD9/ICD10, CPT, Snomed-CT, LOINC, RxNorm...  Hospital Reporting  Information analysis and display for clinical and administration  Hospitals as education environments  Education content for clinicians  Hospital staff – basic hospital training and professional development  Organizing EMR training content
  35. 35. Ideas on “Getting a Seat at the HIT Table”  Find allies/champions  Like our CMIO, someone who “get’s it”  Clinicians, research, nursing education, patient education, genetics... IT?  Demonstrate: Show people what a librarian can do (and nobody else can)  Do a lit search addressing some issue or challenge with the EMR  Study Meaningful Use and identify a criteria you can help address  If you can’t directly work on some issue, develop a proof of concept, create a mockup, storyboard, prototype or write a report, analysis of some solution/approach  Evaluate some knowledge system before/after purchase  Write a grant proposal and/or seek others to write one with you  Publish an article in an informatics journal, blog, your website...  EMR/PHR training and experience  If they won’t pay for it, see if you can sit in on classes, access online courses…  Examine your own PHR or sign up for Microsoft Health Vault, Patients Like Me...  Download health apps and experiment with them
  36. 36. Questions / Comments?   CBMi Informatics Symposium   Or Google “CBMi CHOP”  Friday, April 26, Sheraton  $200  Monthly (or so) informatics talks at CHOP  We can put you on the mailing list