Health Informatics

Perspectives from the Field

Helen Edwards RN MN Director – Clinical Informatics and Technology Assisted Programs Hospital for Sick Children

IHPME GSU Education

April 2, 2013

Health Informatics - Definitions

The intersection of clinical IM/IT and

management practices to achieve better

health.

COACH

• Health informatics is a discipline focused on the use of information and information technology to support clinical care, health services administration, research and teaching.

• It deals with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health care. Health informatics tools include not only computers, but also clinical guidelines, formal medical terminologies, and information and communication systems.

• Today, health informatics research and application requires expertise and skills which normally reside in diverse disciplines such as health, computer science, statistics, queuing theory, information science, library science, ethics, law, communications science and engineering.

• Subdomains of health informatics include: clinical informatics, medical informatics, nursing informatics, imaging informatics, consumer health informatics, public health informatics, dental informatics, research informatics, bioinformatics and pharmacy informatics.

Nursing Informatics The integration of nursing science, computer science

and information science to manage and communicate

data, information and knowledge in nursing practice.

Nursing informatics facilitates the integration of data,

information and knowledge to support patients, nurses

and other providers in their decision-making in all roles

and settings. This is accomplished through the use of

information structures, information systems and

information technology.”

Staggers & Thompson, 2002

History of Nursing Informatics

• 1950s/1960s – Nurses’ image improved

– Nursing practice was growing in scope/complexity

– Health care facilities grew in number

– Nurses Stations became the hub for

communication

– Computers in hospitals used primarily for basic

business, accounting and financial operations

– Clinical computer application development was

very slow

History of Nursing Informatics cont’d

• 1970s – American hospitals were required to report stats to

local, state and federal agencies as well as third

party payers

– Nurses started to see the value of clinical

applications for use in care – particularly for

documenting and evaluating care given

– Nursing applications started to emerge – staff

scheduling, statistics collection

History of Nursing Informatics cont’d

• 1980s – PCs with improved computing power made

computers more affordable, accessible and user-

friendly for nurses

– Nursing informatics became a recognized

specialty

– Hospital Information Systems became more

common, with the need for nursing-specific

software becoming more evident

History of Nursing Informatics cont’d

• 1990s and beyond – The computer age that was affecting all aspects of

peoples’ lives impacted health care as well

– Smaller computers, mobile devices, web-based

applications, on-line evidence-based resources –

allow nurses to access applications at the point of

care

– Nurses recognized as “knowledge workers” – a

shift away from tasks

Knowledge Work

• Non-repetitive, non routine work that entails

substantial levels of cognitive activity

• Includes professional and specialist’s work

• Involves analyzing information and applying

specialized expertise to solve problems,

generate ideas, teach others, or create new

products or services

• Often results in new information or knowledge

Drucker

Transformation from Data to Knowledge

Complexity

Human Intellect

Data

Information

Knowledge

Transformation from one state

to another is Informatics…..

• Data into information

• Data and information into knowledge

• Knowledge into decisions, designs,

and discoveries (wisdom)

Almost Forty Years Ago…..

“There is a lack of a uniform and integrated

system for maintaining health records of

individuals…

…essential data are scattered in many

locations: in physicians’ offices, hospital

records, clinics, etc.”

Lalonde Report – 1974

A New Perspective on the Health of Canadians

Almost Thirty Years Later…..

“To take full advantage of the potential of

information, evidence and ideas in the health

care system, the necessary information

infrastructure must be in place.”

“Electronic health records are one of the keys

to modernizing Canada’s health system and

improving access and outcomes for

Canadians.”

Roy Romanow, 2002

Building on Values: The Future of Health Care in Canada

Why the Delay?

• Slow emergence of acceptable clinical IT solutions

• Limited clinical input to IT solution designs

• Compared to business- limited demand for IT solutions in health care

• Limited number of formal informatics training programs and curricula integration

• Limited skilled IT professionals in health care

• Limited organizational support and valuing of clinicians’ participation in IT projects

• Multiple competing priorities with limited health care organization budgets

• Economics of IT!

Key Challenges

• Meeting expectations to enhance electronic documentation and provide data/reports that assist with decision-making – as quickly as staff would like

• Providing sufficient patient and reference information on a mobile device

Role of IT in Healthcare

• Safety

• Effectiveness

• Patient-Centred Care

• Timely Delivery of Care

• Efficiency

• Equity in Health Care Access

(IOM 2001)

Emerging Technologies • Nanomedicine

• 3D Bioprinting

• Digital Pathology Scanners

• Healthcare Assistive Robots

• Master Data Management

• Workflow/BPM for Care Coordination

• Interactive Patient Care Systems

• Location- / Condition-Sensing Technologies

• Big Data for Healthcare and Life Science

Research

• Healthcare Provider Disease Management

Systems

Change Management -

Common Principles

1. Plan for change from a solid base.

2. Identify discrepancies between formal and

informal practices.

3. Control expectations about the proposed

changes.

4. Select change agents carefully.

5. Build support among like-minded people.

6. Identify those opposed to the change and try to

neutralize them.

7. Avoid future shock.

• Everett Rogers’ Diffusion of Innovation Theory

• John Kotter’s Change Model

• Kurt Lewin’s Change Theory

• Gordon Stanley (Change Mgt in Education)

Key Success Factors

• Hospital engagement

• Communication mechanisms

• Education Model

• Go-Live Support Model

• Post Go-Live Support Model

• Pay attention to Lessons Learned in each

phase and prepare accordingly for next

phase

My Personal Career Journey

Education • CEGEP – Diploma in

Nursing

• University – BA in Health

Studies

• University – MN

Work • Peripheral Hospital –

bedside

• SickKids

– Bedside

– Educator

– Hospital-wide project

Team Lead

– Project Manager

– Director

Tips

• Look for opportunities within your own

organization o Volunteer for committees/working groups where

your knowledge/skills can be profiled,

recognized and acknowledged – enhances

credibility

o Find out what additional skills/knowledge would

be of benefit – project management

(formal/informal); leadership

o Connect with leaders in departments where you

would like to hold a position – keep them

updated on your progress and acquisition of

skills/knowledge

Tips cont’d

• Look for opportunities in other

organizations - may not be exactly

what you want to do, but there are lots

of stepping stones o Companies that have a health care department

that include junior positions

o Entry level positions with opportunity for

advancement

• Join associations that allow for

education/networking opportunities.