clinical informatics: some lessons learned
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Clinical Informatics:Lessons from the U.S.Wen Dombrowski, MD, MBA
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Clinical InformaticsNurse
PhysicianPharmacist
Physio Psychologist
Allied Health
Who’s here?
interdisciplinary &work with nonclinicians @HealthcareWen #HIC16
Clinical InformaticsHealthcare I.T. is more than engineering Value proposition – clinicians understand:
diseases, assessment, treatment, & clinical workflow
patients & families – the human stories
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Why involve clinicians early?Lessons learned from…
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Usability & WorkflowMany U.S. clinicians frustrated with EHR’s
Time-consuming data entryData not meaningful nor accessible
Not technology per se, but designHappiest users when organizations…
Invest TIME to design UI’s & workflowsInvolve CLINICIANS to select, design, implement
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Understand what clinicians & patients need adapt techUser Experience (UX): how person feels
when interacting with software or taskUsability: easy to useWorkflow: sequence of processes/stepsUser-Centered Design: ask users, watch
users, see from their perspectivePsychology & Behavior @HealthcareWen #HIC16
Gov can hinder or catalyzePolicy, regulationsFunding, incentivesConvening
Example: U.S. 2009 HITECH Act (“Meaningful Use”)$$Billions for hospitals & doctors to implement EHRPros: vision for digital communication & analyticsCons: reality… @HealthcareWen #HIC16
Interop & Data ArchitectureU.S. gov did not require interoperabilityHundreds of competing EHR’s developed
disparate systems data silos
Costly workarounds: integration engines, API’s, data warehouses, HIE’s @HealthcareWen #HIC16
Interop & Data ArchitectureNeed strategic foresight of end goals
while setting up systemsInterop is foundational prerequisite to all
data-dependent initiatives/activities:
Clinicians know what info useful
Patient CareQuality MeasurementAnalytics
Population HealthDecision SupportResearch
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Interop & Clinical Mapping:Not easy to create Diabetes Report because…
Haemoglobin (Hb) ≠ Heamoglobin A1C (HbA1c)and...
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Patient Care Quality Measurement Analytics
Population Health Decision Support Research
Interop & Clinical Mapping:Example of pitfalls when Non-clinicians set up Clinical Information Systems
Automating thousands of errors@HealthcareWen #HIC16
Health & Care beyond hospitals and doctor’s officesHome & Community-based careCare coordination & communication toolsTelehealth remote monitoringTelemedicine virtual visitsOnline triage & Home diagnosticsPatient-generated dataLogistics & BPM platforms
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Vendor RelationsInvolve clinical + tech experts when evaluatingUnderstand your org’s needs make checklistBeware of sales pitch B.S.Due diligenceTotal cost of ownership Contract obligations & pay contingent Learning collaborativesIncubate startups @HealthcareWen #HIC16
Clinical Informatics RolesExecutive Leadership: CMIO, CNIO, CHIO Practitioner: Hands on, planning, implementing, managingResearcher: Academia, EBM, safety & efficacy, theory
Translational science & disseminating best practicesEntrepreneurship (startups) or Industry (vendors)Workforce development (courses & practicum)Executive buy-in & dedicated time to do jobOrganizational culture change (see http://bit.ly/dhinnovationdna )
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Clinical Informatics ValueHealthcare I.T. is more than engineering Clinicians understand:
diseases, assessment, treatment, & clinical workflow
patients & families – the human stories
@HealthcareWen #HIC16