• November 3-7, Chicago

    AMIA 2012 Annual Symposium

    Informatics: Transforming Health and Healthcare

State of the Practice Presentations

AMIA 2012 offers participants access to the best thinkers and practicians the informatics field.  

The specific time and date of all sessions, speakers names and abstracts are available in the Itinerary Planner. It is an excellent tool for building your AMIA 2012 Symposium experience.

 

Safer electronic health records: Using the science of informatics to develop safety assessment guides

Dean F. Sittig, The University of Texas Health Science Center;  Joan S. Ash, Oregon Health & Science University; Adam Wright, Brigham and Women’s Hospital; PhD, Hardeep Singh, Michael E. DeBakey Veterans Affairs Medical Center

Following the IOM report, “Health IT and Patient Safety: Building Safer Systems for Better Care,” the Office of the National Coordinator for Health Information Technology sponsored a project to address safety concerns in electronic health record-enabled (EHR) healthcare systems.  To address the complexity of EHR-related errors and the difficulty in eliminating them, we designed the SAFER project (Safety Assurance Factors for EHR Resilience) to proactively identify potential safety issues and best practices for addressing them.  We take into account the full sociotechnical context of EHR implementation and use.  Our iterative work is grounded in several recently developed informatics-based scientific methods including: 

  1. Review of scientific clinical informatics literature
  2. Use of Rapid Assessment Process mixed-methods approaches developed for evaluating EHR-enabled healthcare systems in context
  3. A semantic wiki for asynchronous collaboration
  4. An 8-dimension socio-technical model of safe and effective EHR use 

We are developing and piloting self-assessment “checklist-type” tools using a unique mix of methods based on the science of biomedical informatics. As the country continues its rapid EHR deployment, we believe that these tools are essential to ensure that the safety of the “EHR-enabled healthcare system” continues to improve.

 

Electronic Tools for Cognitive Support During Resident Handoffs: State of the Practice and Future Directions

Karen Dunn Lopez, Andrew D. Boyd, G Andrew Johnson , Gail M. Keenan, Diana Wilkie, University of Illinois at Chicago; Vineet Arora, University of Chicago

In the years following reduced resident work hours, single resident accountability for patient care has disappeared and replaced by frequent care transitions and shared responsibility between residents as the necessary paradigm for delivery of care in acute care settings.  With this change, there has been increasing patient acuity and complexity as well as increased cognitive demands for clinicians, potential for miscommunication at care transitions, and preventable errors.  Importantly, forgetting to transmit needed information during handoffs is a major contribution to overall suboptimal care processes including: delays in diagnosis and treatment, task omissions, work redundancies and near misses. To address these quality and safety problems, electronic tools embedded in the electronic health record are beginning to emerge. These tools when designed to provide cognitive support for intradisciplinary sharing of care can play a role in reducing information overload, miscommunication, and omission of patient care tasks. Less common are electronic tools that are designed for interdisciplinary information sharing. These interdisciplinary tools have greater potential for decreasing system inefficiencies and improving the overall quality of care delivery than intra-disciplinary tools. This presentation will provide an overview of existing electronic handoff tools and the design implications for future tools.

 

The Life Cycle of Clinical Decision Support (CDS): CDS Theory and Practice from Request to Maintenance

Joseph Kannry, Mount Sinai Medical Center; David Bates, Brigham and Women’s Hospital; Tonya Hongsermeier, Partners Healthcare; Michael Krall, Kaiser Permanente; Thomas Yackel, Oregon Health and Science University  

The promise of Clinical Decision Support (CDS) has always been to transform patient care and improve patient safety with delivery of timely and appropriate recommendations that are both patient-specific and more often than not appropriately actionable.  However, the users of CDS, providers, are frequently bombarded with inappropriate and inapplicable CDS that is frequently neither informational, integrated into the workflow, patient-specific, and may present out of date and irrelevant recommendations.  The life cycle of Clinical Decision Support begins with a request for CDS, continues with design and implementation, and concludes with ongoing knowledge maintenance. 

This State of the Practice will look at how using the best science and latest knowledge regarding CDS can create request and maintenance processes that work in the real world.  Dr. David Bates will present the best science and knowledge behind CDS that works. Dr.’s Joseph Kannry and Thomas Yackel will present case studies of CDS requests and design processes that use this science to generate useful, useable, and timely patient-specific recommendations. Dr. Tonya Hongsermeier will present best practices in knowledge maintenance. Finally, Dr. Michael Krall will present a case study of knowledge maintenance from Kaiser Permanente that results in appropriate and up-to-date CDS.

 

The Science Behind Health Information Technology Implementation: Understanding Failures and Building on Successes 

Kim M. Unertl, Laurie L. Novak, Cindy S. Gadd, Nancy M. Lorenzi, Vanderbilt University School of Medicine

Everyone attending the AMIA conference has likely either heard about or had firsthand experience of a failed health information technology implementation. The line dividing failed implementations from successful ones frequently seems perilously thin, dependent on people and organizational factors as much as on technology design. What implementation lessons have informatics researchers and practitioners learned from prior failures and successes? Can the research domain of Implementation Science assist practitioners to improve implementation planning and execution? Implementation Science draws on multiple disciplines and perspectives (e.g., clinical, organizational, engineering, behavioral, social science) to understand technology adoption, explore patterns of technology use, and define organizational strategies for sustainable deployment. Through two case study presentations and a series of questions, our presentation will actively engage the audience in a discussion of what an evidence-based approach to implementation might mean at different institutions and explore practical implications of Implementation Science for decision-makers and technology implementers. The presentation will translate research on implementation into implementation lessons and practical strategies for practitioners.  

 

Managing the Flood of Codes: maintaining patient problem lists in the era of Meaningful Use and ICD10

S. Trent Rosenbloom, Ed Shultz, Vanderbilt University Medical Center; Adam Wright, Brigham and Women's Hospital and  Partners HealthCare

In a medical record, the problem list is a centralized place where healthcare providers can summarize key clinical information about patients. While problem-oriented medical records have been promulgated since Larry Weed described them in 1968, recent advances in health information technologies, evolution in clinical workflows and the emergence of several federal programs have elevated the importance of up to date problemlists. However, each of these forces have also added requirements to how problem lists are structured, formatted and used. For example, current federal programs encourage healthcare providers using electronic health record systems to document problem lists using either SNOMED CT or ICD-9, while federal reimbursement practices are migrating towards ICD-10. None of these problem list standards have been demonstrated to be usable for direct problem list entry. Busy healthcare providers have found it challenging to maintain patient problem lists that accommodate these requirements while also performing other necessary tasks, such as electronic prescribing and test ordering. In this presentation, we will discuss the state of science around creating and maintaining structured problem lists that accommodate numerous external requirements, and demonstrate examples of tools that put this science into practice.  

 

The Practice of Clinical Decision Support: Applying Standards and Technology to Deliver Knowledge- Driven Interventions

Robert A. Jenders, US National Library of Medicine and Georgetown University; Guilherme Del Fiol, Kensaku Kawamoto, University of Utah

Clinical decision support (CDS) delivered in the context of electronic health record systems is receiving increasing attention as a way to help improve clinical practice and health behaviors.  Nevertheless, multiple technologies exist to implement and maintain CDS, and there is little consensus on their use.  The use of health information technology (HIT) standards for encoding data, representing knowledge and delivering knowledge-based interventions can help facilitate implementation of CDS.  However, many standards from numerous standards development organizations (SDOs) exist that are variously incorporated into vendor software, and consensus on the use of these standards is lacking.   

Accordingly, the purpose of the presentation is twofold.  First, the presenters, who are co-chairs of the Health Level Seven CDS Work Group, will survey the state of the art regarding HIT standards that are applicable to CDS.  In this analysis of the standards landscape, the presenters will emphasize those standards concerning knowledge representation and delivery as well as convey the latest developments regarding these standards and related efforts to develop new standards.  Second, the presenters will show how this work has been translated into software tools and actual implementations that are used to deliver knowledge interventions and to provide CDS.