EMR Strategy

I was sent this 119 page pre-publication report on EMR strategies.  Below are some elements I found to be important:

• Computer science as a discipline does not subsume health/biomedical informatics, although computer scientists can and do make major contributions to that field.  Health/biomedical informatics is more than medical computer science, drawing also on the decision, cognitive, and information sciences as well as engineering, organizational theory, and sociology with a health and biomedical emphasis that is largely lacking in the world of computer science research.

• Specialists in health/biomedical informatics can serve a bridging function between the computer science community and the world of biomedicine with which computer science researchers are largely unfamiliar

• In the future, health care providers will need to rely increasingly on information technology (IT) to acquire, manage, analyze, and disseminate health care information and knowledge.

• Any systematic effort to change the medical and health information management paradigm from one based on paper to one based on IT must address two basic challenges:

• using the best technology available today to build and deploy systems in the short term and

• identifying the gaps between the best of today’s technology and what is ultimately needed to improve health care.

Principles for Evolutionary Change

1. Focus on improvements in care —technology is secondary.
2. Seek incremental gain from incremental effort.
3. Record available data so that today’s biomedical knowledge can be used to interpret the data to drive care, process improvement, and research.
4. Design for human and organizational factors so that social and institutional processes will not pose barriers to appropriately taking advantage of technology.
5. Support the cognitive functions of all caregivers, including health professionals, patients, and their families.

Principles for Radical Change

1. Architect information and workflow systems to accommodate disruptive change.
2. Archive data for subsequent re-interpretation, that is, in anticipation of future advances in biomedical knowledge that may change today’s interpretation of data and advances in computer science that may provide new ways of extracting meaningful and useful knowledge from existing data stores.
3. Seek and develop technologies that identify and eliminate ineffective work processes.
4. Seek and develop technologies that clarify the context of data.

This analysis leads to six important recommendations for the federal
government:

• Incentivize clinical performance gains rather than acquisition of IT per se.
• Encourage initiatives to empower iterative process improvement and small scale optimization.
• Encourage development of standards and measures of health care IT performance related to cognitive support for health professionals and patients, adaptability to support iterative process improvement, and effective use to improve quality.
• Encourage interdisciplinary research in three critical areas: (a) organizational systems-level research into the design of health care systems processes and workflow; (b) computable knowledge structures and models for medicine needed to make sense of available patient data including preferences, health behaviors, and so on; and (c) human-computer interaction in a clinical context.

• Encourage (or at least do not impede) efforts by health care institutions and communities to aggregate data about health care people, processes, and outcomes from all sources subject to appropriate protection of privacy and confidentiality.
  

• Support additional education and training efforts at the intersection of health care, computer science, and health/biomedical informatics. Current programs of the National Library of Medicine and other institutes of the National Institutes of Health are exemplars of such support.

The senior management in health care institutions and health care payers have often taken the lead in the deployment of IT for health care. They should:

• Organize incentives, roles, workflow, processes, and supporting infrastructure
  to encourage, support, and respond to opportunities for clinical performance
  gains.
• Balance the institution’s IT portfolio among automation, connectivity, decision
  support, and data-mining capabilities.
• Develop the necessary data infrastructure for health care improvement by
  aggregating data regarding people, processes, and outcomes from all sources.
• Insist that vendors supply IT that permits the separation of data from
  applications and facilitates data transfers to and from other non-vendor
  applications in sharable and generally useful formats.
• Seek IT solutions that yield incremental gains from incremental efforts.

 

Let me know what you think of this report!

Thanks!
Andrew

Computational Technology for Effective Health
Care: Immediate Steps and Strategic Directions
Willam W. Stead and Herbert S. Lin, editors;
Committee on Engaging the Computer Science Research
Community in Health Care Informatics;
National Research Council

This free PDF was downloaded from:
http://www.nap.edu/catalog/12572.html

Administrative Internship Tips

I’ve been approached by a few people with questions regarding summer internships, so I thought I would blog about some tips that first years might hopefully find helpful in their search for the right internship.

1. Deadlines. Most internship application periods are open in January with deadlines due in mid to late February. So this is prime time to be asking questions, sending in resumes and application forms. Don’t hesitate to reach out to your mentors if you have any questions about the process.

2. Finding an internship. There is not just ONE way to find an internship and this is usually the hardest part about the whole internship process. One of the roadblocks I encountered was the fact that some, if not, most internships aren’t even advertised. Some internships are offered through alums, networking, and a little bit of luck. If there is a particular place that interest you, find out if we have alum who are working there and ask around. Also, since some internships aren’t advertised, if they offer a fellowship, you can ask their main contact person whether they offer an internship as well. You can also check out this website from MGMA, which lists opportunities by state: http://www.mgma.com/pd/default.aspx?id=694. Go to “Student Benefits” and click on “ MGMA and ACMPE Internship-Residency Directory.” Be sure to look for “paid” internships and the length of them (12 weeks). In addition, attending the ACHE Congress is also a great way to locate your future preceptor. An intern I met during my internship found his through Congress and interviewed with his preceptor during the four day event.

3. Don’t get discouraged. Candy and Dr. DeGraaff will ensure that you will be placed somewhere for the summer. Don’t fret if you haven’t gotten one by March or if you didn’t get your first choice. Everything always works itself out in the end and usually for the better. Most of us didn’t know where we were going until late April. A lot of organizations will not make their final decisions until then.

4. Don’t limit yourself. This can be said for the type of organization and geography. Many of us know about the top academic medical centers who are usually recognized through U.S. News and World Report but if medical centers aren’t your interest, don’t hesitate to reach out to consulting firms, pharmaceutical companies and health associations. Many of them offer internships that will provide you with great exposure to management and leadership. In addition, this is one of the few times that you’ll be able to check out a completely new city for a short period of time, so don’t be afraid to absorb yourself in new experiences.

I hope that these tips will give you better insight in finding a great internship.

Best Wishes,
Anna

First HMI-MedZou Meeting!!!

Hello HMIGSAers!

I hope you all had a good break and you're looking forward to a few more weeks of rest, relaxation and wellness. We had our first meeting of 2009 for MedZou today! A lot was discussed, but an important topic was the integration of HMI students. I asked for the new directors to think of how they could best utilize the competencies of the HMI department. I hope we'll have a better idea by next week.

I would personally like to call any student interested to help Chris and I write an IT grant proposal. I think it was be a great experience for all involved and it would really help serve MedZou.

Below is an overview of what we discussed during the meeting.


Minutes for 1/5/2009

We will hold clinic on Thursday 1/8

(1) We had two pediatric pts last clinic. They should have SCHIPs, but for some reason they did not. The solution was for the pts to talk with Angie.
(2) Documentation Issues
- Labs & Scripts
- No Calling in Scripts!
- Issues with forgetting to write scripts (we still need a plan)
(3) F/U for pts to ensure pts follow med instructions
- Working with Dr. Howestine in Block 3 to better educate M1 students about health literacy
(4) Information Management
- Mike Lynch came and told us the clinic’s documentation was adequate!! He will possibly help us leverage EMR integration
(5) Directorship of Clinic
- We decided that 2 new directors and 1 old director would help with clinic operations for the next month
(6) Council of Chairs
- We are inviting Dr. Churchill to the clinic for a tour (Kayla and Vincent)
(7) Scheduling Clinical Students
- Jessica is working to start a Google Calendar for Med students to sign up
(8) IT Grant
- Andrew and Chris are going to get together to discuss writing a grant for $25,000 to use for a website competition
(9) Data Management
- Ryan suggested we have a single person handle collection of data for the clinic. Kayla suggested Brett S.
(10) Labs expansion
- Training people is the biggest issue with expanding labs. The protocol is written.
(11) Nursing Oversight
- Ryan has arranged for two nursing students to help us at the clinic and his faculty advisor will serve as the nursing liason.
(12) Defining Roles
- Serve people mentioned the need for creating clearly defined roles for incoming nursing students. I suggest we do not stop there. I think it would be a good idea to record as many roles as possible within the clinic to reduce confusion during turnovers and transitions. I really like the idea Emily advocating of a true team mentality when it comes to running the clinic. Perhaps a strategic plan coupled with a solid vision, mission and goals will be the best bet.
(13) Areas where IT can help?!?!?
- Organization of Documents (HIPAA Training, Lab Training, Labs, Scripts, Pt. Records)
- Scheduling (Calendars, Invites, Appt. Requests)
- Document Collaboration (Grant Writing)
- Data Collection (RYAN’s Bag, Recording Nursing Hrs)
- Knowledge Management (Access to Articles, Chronic Disease Algorithms)

It seems like information technologies are the new frontier in health care (actually it started in the ‘80s, but who’s counting). President-Elect Obama has made it very clear that one of his first initiatives when entering office is the widespread implementation of EMRs in healthcare and internet access for healthcare providers across the nation. I think it is fantastic that all of you are ready and willing to accept the use of IT in MedZou. It can only serve to benefit yourself and your community in the future.