Changing Health Informatics

Education to “Hardwire”

Collaboration and Team Skills

Cynthia Coviak, PhD, R.N.

Professor (Retired), Clinical Part Time Faculty Kirkhof College of Nursing

Guenter Tusch, PhD

Professor and Chair Health Informatics and Bioinformatics Graduate Program

School of Computing and Information Systems

Padnos College of Engineering & Computing

Challenges for practicing health professionals

“ All health professionals should be educated to provide patient-

centered care as members of an interdisciplinary team, emphasizing

evidence-based practice, quality improvement approaches, and

informatics.” (emphasis added)

(Institute of Medicine, Health professions education: A bridge to quality, 2003, p. 45)

• Provide patient-centered care

• Work in interdisciplinary teams

• Employ evidence-based practice

• Apply quality improvement

• Utilize informatics

Diagram reproduced from Institute of Medicine (2003) Health professions education: A bridge to quality, p. 46.

Core competencies of health professionals

Interprofessional education defined

“…when two or more professions learn with, from and about each

other to improve collaboration and the quality of care”

(Barr, H., 2002, Centre for the Advancement of Interprofessional Education [CAIPE].

https://www.caipe.org/about-us )

Issues from the current health professions

education approaches

Interprofessional Collaboration Competency Domain requires:

Values/ethics for interprofessional practice

Interprofessional communication practices

Interprofessional teamwork & team-based practices

Roles & responsibilities for collaborative practice

(IPEC, 2016, Core Competencies for Interprofessional Collaborative Practice: 2016 Update, p. 9)

• Provide patient-centered care

• Work in interdisciplinary teams

• Employ evidence-based practice

• Apply quality improvement

?? Utilize informatics

• Provide patient-centered care

• Work in interdisciplinary teams

• Employ evidence-based practice

• Apply quality improvement

• Utilize informatics

Current IPE within health professions Needed IPE, health professions and

health informaticists

Informatics competencies for health professionals

Issues for informatics competency

development for health professionals • How can they develop Interprofessional Collaboration Competencies

related to informatics, which require:

Values/ethics for interprofessional practice

Interprofessional communication practices

Interprofessional teamwork & team-based practices

Roles & responsibilities for collaborative practice

without interprofessional education?

• How can informatics students without clinical backgrounds develop competencies as described above become part of the team?

AMERICAN MEDICAL INFORMATICS

ASSOCIATION (AMIA)

Health Informatics Competencies

Background

Scope of Health Informatics

• Clinical informatics

• Medical, nursing, pharmacy and dental informatics

• Population informatics

• Public health and global health informatics

• Consumer health informatics

• Clinical and public health informatics

• Translational bioinformatics

• Bio-, structural and clinical informatics

• Clinical research informatics

• Clinical trial, population informatics and clinical informatics

Competence vs. Competency

• ‘Competence’ refers to the state of being able

to do something. If a person has

competence, then they are able to do a

certain task.

• ‘Competency’, on the other hand, means a

set of skills or characteristics; the ability to

perform a task based on the required assets.

Source: Kianna. (2018, January 9). Difference Between competence and competency. Retrieved from

http://www.differencebetween.net/language/difference-between-competence-and-competency/

Cognitive domain of learning

Benjamin Bloom

Six levels of cognitive complexity

– KNOWING

• The higher the level, the more

complex the mental operation

Source: Wilson, L. O. (2017). Anderson and Krathwohl –

Bloom’s Taxonomy Revised. Retrieved from:

http://thesecondprinciple.com/teaching-essentials/beyond-

bloom-cognitive-taxonomy-revised/

Miller’s Pyramid of Assessment Miller’s Pyramid of Assessment – [a] framework for assessing (clinical) competence in (medical) education that can assist (clinical) [educators] in matching learning outcomes… competencies…with expectations of what the learner should be able to do at any stage.

Sources: Tennessee Osteopathic Medical Education Consortium. (n.d.). Miller's Pyramid of Assessment. Retrieved

from https://tomec.lmunet.edu/files/assessment_and_feedback_for_residents_and_students.pdf

Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9), S63-7.

• Learner does the procedure of chest tube placement and implements post-procedure care.

• Learner shows how to place a chest tube.

• Learner knows, given an appropriate clinical scenario, how to place a chest tube.

• Learner knows the indications, contraindications, and risks associated with the placement of a chest tube.

Miller’s

Pyramid of

Assessment

(Example)

Adapted from: Walsh, C. M. (2016). In-training gastrointestinal endoscopy competency assessment tools: types of tools, validation and impact. Best Practice & Research Clinical Gastroenterology, 30(3), 357-374.

The Foundational Domains

of Applied Health

Informatics From Content to Competencies

Knowledge, Skills and Attitudes

K1. Health

K3. Social and Behavioral

Science

K2. Information Science and Technology

Three major domains

Three major domains – background knowledge

F1. Health

Define key concepts and problems in health science and practice

F2. Information Science and Technology

Reproduce key theories, methods and products from computer and

information sciences and information technology practice

F3. Social and Behavioral Science

Define key theories, methods and studies from social and behavioral

science and practice

K1. Health

K3. Social and Behavioral Science

K2. Information Science and Technology

K6. Social and Behavioral

Aspects of Health

K5. Human

Factors and

Socio-technical

Systems

K4. Health Information

Science and Technology K7. Soc.,Beh.,

IS, Technology

applied to

Health

Foundational

Domains

(cont’d)

Foundational Domains (cont’d)

F4. Health Information and Technology

Illustrate the use of information science and information technology in addressing

health problems

F5. Human Factors and Socio-technical Systems

Explain the use of social and behavioral science for improving technical solutions

F6. Social and Behavioral Aspects of Health

Explain the use of social and behavioral science for addressing health problems

F7. Social, Behavioral and Information Science and Technology applied

to Health

Apply theories and methods from biomedical informatics to health technology

The foundational

domains

of applied health

informatics

Graphic: Christina Lorenzo, MS in Biomedical Visualization, 2017, Department of Biomedical and Health Information Sciences, University of Illinois at Chicago

Example:

F9. Interprofessional Collaborative Practice Knowledge: Define and discuss the scope of practice and roles of different health professional stakeholders including patients, as well as the principles of team science and team dynamics to solve complex health and health information problems.

Skills: Apply relationship-building skills and the principles of interprofessional communication in a responsive and responsible manner that supports a team approach to solve complex health and health information problems

Attitude: Recognize the importance of mutual response and shared values, as well as one's own role, the role of other professions and stakeholders including patients, and the role of teamwork and team science to solve complex health and health information problems.

Example (cont’d):

F9. Interprofessional Collaborative Practice Assessment Construct

KNOWS - Define and discuss the scope of practice and roles of different health professionals

SHOWS HOW - Apply relationship-building skills and the principles of interprofessional communication in a responsive and responsible manner

DOES – Displays mutual respect and shared values

Assessment Method

KNOWS - Assess knowledge through student and team presentations; assess online discussion forums; instructor observations during in class and online discussions about team science and methods

SHOWS HOW – Observations of the student’s ability to work well in a team setting (e.g., team project); peer evaluation of team participation; “field work” observations by mentors if internships, rotations, or projects are available.

DOES - Peer evaluation in team projects; instructor assessment of student understanding of team role and performance in team projects; mentor assessments in Master’s projects; instructor observations in class and online in discussion forums.

Workplace interprofessional informatics

competency development strategies • Educational prerequisites (what your team should have already):

• Knowledge about the healthcare field, clinical environment and technology used in healthcare (e.g., EHR)

• Experience with interprofessional team projects (e.g., semester projects) with rotating team leadership and project management with clear guidelines

• Weekly/monthly provider-informatics staff mini-workshops

• Informatics staff workflow analysis of selected health providers’ roles OR “job shadow”

• “Grand rounds” during lunch/staff meetings in which the data gained or communicated through electronic means is highlighted, or informatics team members are asked to suggest ways of improving the care through technology

Workplace interprofessional informatics

competency development strategies

• Quality grand rounds—use analytics from EHR to determine how care meets

benchmarks; OR set goals with informatics staff at the table so as to plan

appropriate reports

• “Design a query” sessions—clinician & informatics specialist work sessions

for helping each professional better understand how to request reports (and

how informatics specialist can design them for ease of understanding)

• As team, plan methods of recording social-behavioral determinants of health

in ways useful to clinicians.

GVSU Health Informatics Interprofessional

Certificate (planned 2019) Designed to:

• prepare individuals interested in gaining comprehensive knowledge and skills in the design, utilization, evaluation, and clinical processes of health informatics

• provide health professionals with the knowledge and skills to act as expert collaborators in developing HIT for the care of clients and populations

• provide those who are computer and information science professionals the opportunity to develop interprofessional skills and to effectively utilize expertise of clinicians in design of HIT. (Wishlist: Internships in interprofessional environments to work on clearly defined limited projects (2-4 months))

Thank you!

Cynthia Coviak coviakc@gvsu.edu

Guenter Tusch tuschg@gvsu.edu