APTA CSM 2012 Presentation. Daniel Vreeman and Steven Wilkinson.

1. CSM 2012 – Chicago, IL
Informatics Competencies in
Physical Therapy Education:
A Proposed Framework
Steven G. Wilkinson, PT, PhD
St Luke's-Elks Rehab
Idaho State University
Daniel J. Vreeman, PT, DPT, MSc
Assistant Research Professor, Indiana University School of Medicine
Research Scientist, Regenstrief Institute, Inc
02.11.2012 © 2012

2. Overview
1. Informatics in Physical Therapy
education core documents
2. Informatics competencies in
other disciplines
3. A framework and proposed
informatics competencies
photo via Vernio77

3. Objectives for Today
By the end of the session, you’ll be able to:
1. Describe the current state of health
informatics in physical therapist education
2. Appreciate informatics competencies
prevalent in other healthcare disciplines
3. Discuss the informatics competencies
necessary for clinicians to be effective in the
emerging electronic age

5. Entering the era of
“big data”

6. Adoption of health information technology has become a
top national priority... Failing to prepare clinicians with the
appropriate competencies in information and knowledge
management will hamper progress towards our profession’s
goals of fully availing ourselves of technologies that can
facilitate more effective and efficient care.
Wilkinson SG, Chevan J, Vreeman DJ. Establishing the centrality of health informatics in physical therapist education: if not now, when? J Phys Ther Educ. 2010;24(3):10-15

7. Informatics in PT education
core documents
Already established concepts that are part of the eld

8. Core Documents
• Evaluative Criteria for Accreditation of Education
Programs for the Preparation of Physical Therapists
[Evaluative Criteria]
• Guide to Physical Therapist Practice
• A Normative Model of Physical Therapist Professional
Education: Version 2004
• Minimum Required Skills of Physical Therapist
Graduates at Entry-Level
• Vision 2020
• RC 6-08 “Support of Electronic Health Records in
Physical Therapy”

9. Minimum Required Skills of Physical
Therapist Graduates at Entry-Level

10. http://www.dailymail.co.uk/news/article-1381464/Bunny-rabbits-compete-jumping-course-Dressage-set-world-storm.html

11. Normative Model
Expectation Content Currently Included
Professional Duty Recognizes and values multiple methods to acquire
knowledge and skills in support of lifelong learning and
professional development…
Clinical Use simple heuristics in improving decision-making under
Reasoning uncertainty
Use current technology resources to gather information
about health personnel supply and demand, models of
health care delivery, and efficacy of practice
Evidence-based Consistently use information technology to access sources
Practice of information to support clinical decisions
Manages knowledge and information using online
databases, disease registries, electronic medical records,
and other information technology systems to facilitate the
delivery of health care (informatics)

12. Normative Model (cont’d)
Expectation Content Currently Included
Professional Duty Devote time, energy, and resources to advancing the
profession
Accountability Understands security protections such as access
control, data security, and data encryption related to
the use of information technology in practice
Directly addresses ethical and legal issues related to
the use of information technology in practice
Communication Uses information technology such as word
processing, presentation, data analysis software, e-
mail, and electronic records to improve clarity and
efficiency of communications.
Education Develop expertise in the use of technology available
for patient/client or clinical staff education and
consultation

13. Informatics competencies
in other disciplines
Calls for informatics competencies for health professionals

14. Core Competency:
effective and appropriate use of communication
and information technology.

15. Core Competencies for All Clinicians:
provide patient-centered care, work in
interdisciplinary teams, employ evidence-
based practice, apply quality improvement,
and utilize informatics.

17. Recognizes that there are
different educational needs for
clinicians who use technology
in their everyday practice than
for the specialists who make up
the domain.

18. Top priority for all health professionals:
Efficient information processing and
effective use of information and
communication technologies.

19. “ Although most health
professionals use IT daily in
their work, few know how to
adapt their roles and work
processes to incorporate IT
for the greatest benefit.
Stead WW, Searle JR, Fessler HE, Smith JW, Shortliffe EH. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011
Apr;86(4):429-34. PMID: 20711055

20. Informatics education in
nursing
Always pushing the envelope

21. 1977
First undergraduate course on
applying computers in nursing.
Ronald JS. Computers and undergraduate nursing education: a report on an experimental introductory course. J Nurs Educ. 1979;18:4-9.

22. 1980
The term “Nursing informatics”
is coined.
Scholes M, Barber B, Bryant Y. The Impact of Computers on Nursing: An International Review. North Holland, Amsterdam: North-Holland; 1983.

23. 1984
First textbook published on
using computers in nursing.
Ball MJ, Hannah KH. Using Computers in Nursing. Reston, VA: Reston Publishing; 1984.

24. 1992
ANA approves nursing
informatics as a new specialty.
American Nurses Association Database Steering Committee. Nursing Data Systems: The Emerging Framework. Washington, DC: American Nurses Publishing; 1995.

25. 1998
School of Nursing Accrediting Agencies, American
Association of Colleges of Nursing, and National
League for Nursing Accrediting Commission identify
essential informatics competencies and required their
inclusion in curricula.
Ronald JS. Evolution of nursing informatics education. http://www2.amia.org/history/presentations/EvolutionOfInformatics.pdf. Accessed March 27, 2009.

26. 2007
A comprehensive vision for informatics in
nursing education and practice.
Identi ed competencies needed in:
basic computing, clinical information
management, and information literacy
Technology Informatics Guiding Education reform. The TIGER initiative: evidence and informatics transforming nursing: 3-year action step toward a 10-year vision. http://
www.aacn.nche.edu/Education/pdf/TIGER.pdf. Accessed March 27, 2009.

27. Informatics education in
medicine
From medical school to fellowship, board certi cation, and
everywhere in between

28. 40+ years of training
opportunities for informatics
specialists

30. Gardner RM et al; AMIA Board of Directors. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc. 2009 Mar-Apr;16(2):153-7. Epub
2008 Dec 11. PMID: 19074296
Safran C et al; AMIA Board of Directors. Program requirements for fellowship education in the subspecialty of clinical informatics. J Am Med Inform Assoc. 2009
Mar-Apr;16(2):158-66. Epub 2008 Dec 11. Erratum in: J Am Med Inform Assoc. 2009 Jul-Aug;16(4):605. PMID: 19074295

31. In 1980s, early calls for physician
informatics competencies.
In 1999, AAMC recognized med school
curricular changes needed.
Made recommendations across 5 informatics-roles:
lifelong learner, clinician, educator, researcher,
manager

32. Triola MM, Friedman E, Cimino C, Geyer EM, Wiederhorn J, Mainiero C. Health information technology and the medical school curriculum. Am J Manag Care.
2010 Dec;16(12 Suppl HIT):SP54-6. PubMed PMID: 21314222

33. Stead WW et al. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34. PubMed PMID: 20711055.

34. Silverman H, Cohen T, Fridsma D. The evolution of a novel biomedical informatics curriculum for medical students. Acad Med. 2012 Jan;87(1):84-90. PubMed PMID: 22104049

35. Incorporating Biomedical
Informatics in PT education
A framework to “capture the sky”

36. Thanks for your email and your interest and efforts in
this area - truly BMI is an interdisciplinary sport and I
am excited to hear of your efforts to introduce this into
your PT programs.
--Howard Silverman
Academic Medicine, Vol. 87, No. 1 / January 2012

37. “
A considerable number of technologies the
students have a far better grasp than the
instructors from their usage in previous course
work or in their personal lives.
“ Many items in question 4 are already known by all
graduate students. We may refer them elsewhere
for learning about technologies not used due to
their lack of knowledge.
“ Students must have a BS or BA degree before they
are admitted into our program. Therefore, they all
have had experiences in most of the above
technology prior to coming to our program.

38. “ This seems like a funny thing to
study. My students all drive cars,
but I don't teach them about
internal combustion engines.
Technology is a tool and when
used, it is expected that students
will gain the expertise. We offer
a PT degree rather than an
informational technology degree.

39. Framing Thoughts

40. Informatics underpins other
competency domains:
patient-centered care
working in interdisciplinary teams
employ EBP
applying quality improvement
Stead WW et al. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34. PubMed PMID: 20711055.

41. We recommend viewing
informatics as a
longitudinal theme across
all curricular elements.

42. A journey.
Not a destination.

43. Proposed Competencies
in Informatics
photo via Justin Ornellas

44. Role of Life-long Learner
Professional Practice Expectation 5: Professional Duty
Support of life-long learning with biomedical informatics
requires more than computer literacy.
We need cognizance of the broad range of medical information
resources, devices, and technologies available and their relative
value for particular needs, the know-how to use them, and the
motivation to use them routinely.
Connection to Vision 2020:
“ While fully availing themselves of new technologies, as well
as basic and clinical research, physical therapists will…

45. Role of Life-long Learner
Professional Practice Expectation 5: Professional Duty
Current Content Examples
• Recognizes and values multiple methods to acquire
knowledge and skills in support of lifelong learning and
professional development
• Maintains continued competence in clinical practice through
a variety of lifelong learning strategies
Additional Competency Examples
• Recognize how to develop information habits to maintain
currency in emerging technologies and biomedical devices.

46. Core Informatics Competency
Understanding the domain fundamentals enough to
adapt their roles and work processes to incorporate
HIT for the greatest bene t.
Competency Examples
• De ne and describe the evolution of Biomedical Informatics
• List and de ne the four major application areas of Biomedical Informatics
• cite examples of the common theoretical foundations of these four areas
• Describe why process redesign is important to care quality improvement
• Explain effective approaches to the review and redesign of clinical processes
• Explain socio-technical and other barriers to effective use of process redesign
• Review ontologies and data standards, explain how they are used and
why are they important

47. Clinical Reasoning
Current Content Examples
• Use current technology resources to gather information
about health, personnel, supply and demand, models of
health care delivery, and efficacy of practice.
Additional Competency Examples
• Make critical use of decision support
• Demonstrate knowledge of the available sources of decision support, which range
from diagnostic expert systems to advisories issued from an EHR
• Describe probabilistic clinical reasoning and its advantages and
disadvantages
• Discuss common heuristics that are employed in making judgments
under uncertainty which lead to systematic and predictable errors.

48. Evidence-based Practice
Professional Practice Expectation 9
Current Content Examples
• Consistently use information technology to access
sources of information to support clinical decisions.
• Manages knowledge and information using online
databases, disease registries, electronic medical
records, and other information technology systems
to facilitate the delivery of health care (informatics).

49. We recommend
establishing Electronic
Health Record (EHR)
literacy as a separate
expectation.

50. “ Healthcare is an information
business. The quality,
effectiveness, and efficiency of
care depend on our ability to
manage information. You just
can't do it without EHRs.
Bill Tierney, AMIA 2011 Keynote

51. Electronic Health Record Literacy
Clinicians must acquire information about the patient,
make clinical decisions based on available information,
and document and communicate ndings.
Additional Competency Examples
• Review the maturational history and functional evolution of EHRs
• Demonstrate uency with EHRs for patient-speci c:
• Retrieval of subsets of information
• Documenting all aspects of patient/client management
• Sharing information with other providers
• Explain how EHRs can be used to develop, implement, and monitor
compliance with patient care protocols and other best practices
• Make critical use of decision support
• Describe Personal Health Records (PHRs) and their pros/cons

52. We recommend
establishing use of HIT as a
knowledge management
tool for advancing the
science of physical therapy.

53. We recognize that formal
“research” activities are
performed by a relatively
small proportion of physical
therapists.

54. But, physical therapists need
analytic skills to leverage the
tools for retrieval and analysis
of aggregate data for quality
reporting, practice
improvement, and
benchmarking.

55. HIT for Advancing the Science of PT
Additional Competency Examples
• Determine what data exist relative to a clinical question or
formal hypothesis, demonstrating the following:
• The ability to use information resources to locate existing data sources.
• local and external (e.g. national registry)
• Develop a plan for data collection and analysis, including:
• Selecting an appropriate database for collecting and organizing data
• Represent data in a form that is useful and supports computer-based
analysis
• Analyze, interpret and report ndings, demonstrating the
ability to:
• Select an appropriate software tool for analysis of data and perform simple
statistical analysis and portray the results graphically
• Interpret the reports of statistical software analysis

56. Accountability
Professional Practice Expectation 1
Current Content Examples
• Understands security protections such as access control,
data security, and data encryption related to the use of
information technology in practice
• Directly addresses ethical and legal issues related to the use
of information technology in practice
Additional Competency Examples
• Respect patient con dentiality and data security
demonstrating the ability to use security-directed features of
an electronic health record system

57. Communication
Professional Practice Expectation 6
Current Content Examples
• Uses information technology such as word processing, presentation,
data analysis software, e-mail, and electronic records to improve clarity
and efficiency of communications
Additional Competency Examples
• Demonstrate pro ciency with information and telemedicine technologies for
• virtual teamwork
• remote diagnostic / intervention techniques
• clinician-patient communication
• Effectively employ written, electronic, and oral communication:
• Use software to create visual materials that effectively support oral presentations
• Create a handout that includes simple graphics and tables for use in teaching or
patient education
• Collaborate across multiple sites using electronic mail, discussion lists,
teleconferencing, and related communication technologies

58. Education
Professional Practice Expectation 10
Current Content Examples
• Develop expertise in the use of technology available for
patient/client or clinical staff education and consultation.
Additional Competency Examples
• Select and use information resources for professional and
patient education, demonstrating:
• Practical knowledge of instructional technologies and resources
available via the Internet, video teleconferencing, and other media.
• The ability to effectively leverage various computer-based
instructional tools, including electronic tutorials and patient
simulations.

59. danielvreeman.net/speaking
photo via milos milosevic