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Electronic Health Record and Residency Training Threats, Opportunities, Realities An Informatics Perspective on the EHR Genevieve Melton-Meaux, MD, MA,

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Presentation on theme: "Electronic Health Record and Residency Training Threats, Opportunities, Realities An Informatics Perspective on the EHR Genevieve Melton-Meaux, MD, MA,"— Presentation transcript:

1 Electronic Health Record and Residency Training Threats, Opportunities, Realities An Informatics Perspective on the EHR Genevieve Melton-Meaux, MD, MA, FACS Assistant Professor, Department of Surgery Faculty Fellow, Institute for Health Informatics University of Minnesota, Minneapolis, MN ASSOCIATION OF PROGRAM DIRECTORS IN SURGERY 2011 ANNUAL MEETING; BOSTON, MASSACHUSETTS March 26, 2011

2 APDS PresentationMarch 26, 2011 2 Overview  Informatics  Challenges with EHR Systems, Informatics, and Surgery  Next Steps

3 APDS PresentationMarch 26, 2011 3 Overview  Informatics  Challenges with EHR Systems, Informatics, and Surgery  Next Steps

4 Informatics – Realities/Facts

5 APDS PresentationMarch 26, 2011 5 Informatics - Facts  Broadly the science of information  Studies the structure, algorithms, behavior, and interactions with information  Utilizes foundations from other fields  Computer science, statistics  Decision and cognitive science  Social engineering  Information and library science  Underlying application (healthcare, medicine)

6 APDS PresentationMarch 26, 2011 6  Biomedical and Health informatics  Medical informatics  Bioinformatics  Definition: Discipline of improving healthcare, biomedical research, and public health through better use of information (Hersh, 2009)  About information, not technology Informatics - Facts

7 APDS PresentationMarch 26, 2011 7 Informatics - Facts *Adapted from Friedman C. “A ‘Fundamental Theorem’ of Informatics.” JAMIA 2009. not this

8 APDS PresentationMarch 26, 2011 8 Fact: Informatics is Critical for EHR Success  Improved use of information for quality, safety, and integration of care is a critical aspect of healthcare reform  Even more important with ARRA/HITECH and ACA legislation  Benefit of HIT? Systematic reviews show HIT intervention benefit  Most studies in small number of academic centers* *Garg. Effects of computerized clinical decision support on practitioner performance and patient outcomes: A systematic review. JAMA 2005. *Chaudhry. Systematic review: impact of HIT on quality, efficiency & costs. Ann Int Med 2006 *Goldzweig. Costs and benefits of HIT: new trends from literature. Health Aff 2010.

9 APDS PresentationMarch 26, 2011 9 Facts: Problematic HIT  HIT implementation can be problematic  Failure often to lack of understanding of clinical environment and workflow (Leviss, 2010; Einbinder, 2010)  Example: CPOE conflicting outcomes  Children’s Hospital of Pittsburgh Pediatric ICU: mortality rate increased from 2.8% to 6.6% (Han,2005)  Finding not seen at other centers with CPOE (Del Baccaro, 2006; Jacobs, 2006)  Adverse outcomes may have been avoided by changes in workflow and other best practice adherence (Phibbs, 2005; Sittig, 2006)

10 APDS PresentationMarch 26, 2011 10 Overview  Informatics  Challenges with EHR Systems, Informatics, and Surgery  Next Steps

11 Challenges with EHR Systems, Informatics, and Surgery - Threats

12 APDS PresentationMarch 26, 2011 12 Vendor Dominated HIT - Threats  HIT system implementations are complex  Bulky legacy systems underlie each implementation  Each build is different/customized  Landscape of EHR systems/HIT dominated by large vendors  Limits our abilities to customize or refine HIT  Vendors remain non-liable for errors or problems (“hold harmless” clause)* *Koppel. HIT Vendors “Hold Harmless” Clause. JAMA. 2009.

13 APDS PresentationMarch 26, 2011 13 HIT Fallacies - Threats  Multiple fallacies with HIT (12) +  Purchasing and using an EHR system does not mean that it will work  HIT is not a device – little oversight  Clinician “bad apple” fallacy (why do we resist?)  We computerized the paper, so we can go paperless fallacy  One size fits all fallacy + Karsh. HIT: Fallacies and Sober Realities. JAMIA 2010.

14 APDS PresentationMarch 26, 2011 14 Surgery Information Needs - Threats  Information needs of surgeons are great  Surgical care has unique characteristics  High-impact encounters  Time-sensitive information needs  Resource intensive  Multi-disciplinary care  Transitions in care, particularly 1) pre-operative assessment/planning and 2) post-operative care Melton. Biomedical and Health Informatics for Surgery. Advances in Surgery. 2010.

15 APDS PresentationMarch 26, 2011 15 Surgery Information Needs - Threats  EHRs not optimized for surgeon workflow  Detailed surgical information difficult to find  Not designed for peri-operative information needs  Flow of information between care settings  Surgeons have not been at the table  Most systems have been designed for primary care physicians/internists in mind  Lack of stakeholders historically Melton. Biomedical and Health Informatics for Surgery. Advances in Surgery. 2010.

16 APDS PresentationMarch 26, 2011 16 Overview  Informatics  Challenges with EHR Systems, Informatics, and Surgery  Next Steps

17 Next Steps - Opportunities

18 APDS PresentationMarch 26, 2011 18 Surgeons should leverage successes  Model Implementations of Secondary Data Use  Society of Thoracic Surgeons Database  NSQIP  Multiple successful registries (i.e., trauma)  Focus on improving automation of these and similar programs  “Collect Data Once” and “Use Many Times”  Become stakeholders in HIT and Informatics

19 APDS PresentationMarch 26, 2011 19 Opportunities - NIH Clinical and Translational Science Awards (CTSAs)  NIH University-based infrastructure awards to medical centers to improve and transform how biomedical research is conducted  Total of 60(+) centers (NIH Roadmap)  Informatics and automation of clinical (and biomedical) data for research is key to CTSAs  Most centers with CTSAs will or currently have improved access to EHR data for research

20 APDS PresentationMarch 26, 2011 20 Organizations  AMIA – American Medical Informatics Association  Academic home for informaticians  Actively involved with HIT policy  HIMSS – Healthcare Information and Management Systems Society  Organization geared towards HIT implementers/leaders (CIO/CMIO/IT)  Some but inconsistent connections to informatics  Integrally connected with vendors

21 APDS PresentationMarch 26, 2011 21 Training Opportunities  Graduate programs in informatics  Masters, PhD  NLM-NIH Training Programs (T15 fellowship)  AMIA 10X10 certificate program  New ONC Initiatives (Stimulus Bill)  Clinical Specialization in Informatics (via Preventative Medicine)  https://amia.org/informatics-academic-training- programs

22 APDS PresentationMarch 26, 2011 22 Opportunities - HITECH Aims for ~50,000: Workforce Development  Community College Consortia to Educate HIT Professionals Program ($70M)  Five regional consortia of 70 community colleges offering short ‐ term training for 10,000 individuals per year  Curriculum Development Centers Program ($10M)  Competency Exam for Community College Programs ($6M)  Program of Assistance for University ‐ Based Training ($32M)  Funding for education of individuals requiring university ‐ level training at 9 universities (including UMN)  Emphasis on short ‐ term certificate programs delivered via distance learning

23 APDS PresentationMarch 26, 2011 23 Overview  Informatics  Challenges with EHR Systems, Informatics, and Surgery  Next Steps

24 APDS PresentationMarch 26, 2011 24 Summary  EHR systems increasingly important  Informatics can help improve our ability to implement and utilize EHR systems effectively  Surgery Informatics is a wide open area  Few stakeholders  Much at stake  Many opportunities to become a stakeholder

25 APDS PresentationMarch 26, 2011 25 Questions? Genevieve Melton-Meaux gmelton@umn.edu

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