Basic Informatics July 2015



so my name is Brittany Watson and I work as a practice consol in professional practice and the purpose of today's session obviously is to do a little bit of an introduction on informatics and my portfolio within professional practice is clinical informatics so it's somewhat fitting to be here so that's a bit of an icebreaker before we begin I have put up on this screen and with the question that says can you guess the meaning of these words was anyone able to guess the meaning of any of these words Julia what did Wayne say the last one is technology yes you are right that's super so so if you're thinking that you're gonna learn Dutch then you're kind of in the wrong session but I put this up for a very distinct reason and the reason being is that when we talk about informatics it's kind of been this buzzword over the last little while and we've heard ok electronic health record informatics what actually is this so I thought it might be helpful for able to relate informatics to something that we are familiar with so essentially when we talk about learning about informatics we're essentially asking you to learn a new language so if you're interested these are actually what the words actually do stand for but as I started doing a little bit of research then about what does it mean when we're learning a new language and what are some principles about second language acquisition I thought that they might be helpful to explain just because they provide some reference and a reference point for as we go through this session as to what we're actually trying to do so one of the first principles when it comes to learning a second language is that we want to provide opportunity for the language and the terminology that we're using to be we want to present the words frequently so that people are able to actually learn the word so the more often that we present them the more often we hear them the more likely we are to retain them the second principle when we think about learning a second language is that we want to present foreign words in a in the context that we are familiar with so for example if I was to go to France it'd be much easier to learn French in my current setting where I understand English as opposed to going to France and then having to learn french fare so say when it comes to informatics we are wanting to teach about informatics now within a context that we're familiar with so for example our SCM system so that when we do get a new information system we'll be able to leverage the learning that we've done currently and then the third principle to keep in mind is that learners require time to understand the words and we want them to learn at their own pace so instead of us having to force people to learn informatics at the time when we implement a new information system and an electronic health record we want to provide opportunity now to go about learning so that we can maximize that potential when we do have our new system so just some things to keep in mind as we move forward so we are here for basic informatics for leaders and I do just before we begin just wanna acknowledge Krista loosin I know most of you have are familiar with him and he has come to your programs and he's done a little bit of teaching with the nurses but he's been a great help to me so thank you Chris for all of your support so if you were at elf during July Shelley Fraser and I presented on the education strategy for informatics here at Providence and basically all that I want to summarize for this presentation is that this is the first education series within or the first education session within a series that will happen for leaders with regards to informatics at Providence so stay tuned for further sessions as we move forward so the objectives primarily of today are that we're just we wanted to write awareness to how we're currently using informatics in practice then we want to just provide some opportunity to appreciate what are some informatics concepts and terminology that we should be aware of and then lastly we'll go into a little bit of computer literacy and what is our role in preparing ourselves and our leaders for for that so when you walked in hopefully you picked up a sheet of paper that has informatics related questions on it the purpose of that sheet of paper is to provide a little bit of structure for yourselves when it comes to learning and all of these five questions will be answered in the presentation today and basically they're there for yourself I'm not going to be looking at it I'm not marking it it's for your own learning and it's basically a tool for self-reflection so at the end of today you're able to recognize maybe where there's opportunity for you to continue to do some of your own learning hopefully at the end of this session if someone was to ask you like what's an electronic health record you'd be able to say well this is what Brittney told me and if not well then maybe you and I can meet next week but that being said it's for yourself so hopefully it does help with this session so I thought it might be helpful before we get into some of the content to provide a little bit of background as to why all of a sudden informatics is this this hot topic why are we talking about it how come where there's so much emphasis on it why are we speaking about Cerner and CST how did that all come to be so I think if we can all appreciate our desire for a healthcare as practitioners is that we want to be able to provide health care that's collaborative patient centered that's based on evidence and that maximizes on access for patients however we also recognize the fact that we work within healthcare and it's complex it's challenging to get access for patients often information for patients lives in multiple locations sometimes we duplicate tests for patients and sometimes it's hard to keep up our standards keep them up to date so what we have here is Canada health info ways so Canada health info II is a nonprofit organization that is funded by the federal government and they have been tasked with the responsibility of supporting each province across Canada in moving towards this vision of collaborative patient centered and evidence-based health care delivery and their method of doing that is through the implementation of an electronic health record so this electronic health record is not something that's solely happening within British Columbia but it's a project that has taken place across Canada so Ontario for example has already implemented many electronic health records and NBC we are beginning that work here but this is not something that we can say is only within our province but something that is happening across the country so what is an electronic health record what when we hear that word what do we think of essentially any electronic health record you can think of as a complete record of a patient's health care over the course of their lifetime so what that means is that an electronic health record it talks to other services it doesn't just stay within the hospital so it talks to pharmacies it talks to labs it it is a complete record of all the care that the patient has has received over the course of their lifetime but you might have also heard terms such as electronic medical record and a personal health record so how do we distinguish between all of these terms so the two primary ways to distinguish are to look at the custodianship of the record and to look at the completeness of the record so an electronic medical record the custodian of that record isn't is the healthcare team however these records primarily live within one office so we consider them to be a partial record of a patient's health care to healthcare that they've received over the course of their lifetime so what that means is that here in Vancouver for example we have many electronic medical records that live within positions like a family for this physician's office but those records do not talk to any other service outside of that that family physician office where as a personal health record can be either a complete record or kimbley a partial record of a patient's health care over the course of their lifetime and the custodian of that record is the patient themselves so that's why it could be a partial or a complete record because it's dependent on the patient for them to update the record record accordingly so here within our CST project we're implementing an electronic health record so that record should be a complete record over the course the patient's life and it will allow multiple services to document and have access to it so I thought it might be helpful as we're talking about this electronic health record to get a better sense of what people are saying about it and what are some of the advantage of advantages of it if we look at what clinicians across Canada their perspective on this electronic health record so the video is quite short it's only two minutes and then we'll continue on with the presentation information is power and information allows you to appropriately manage the patient access to information is key in terms of making good decisions for patients of connect citizens tendencies FMS inaudible actually really pleased the decision they'll go at 9 o'clock in the morning that have their blood drawn by 10 o'clock the result will be on my screen so that's a huge improvement it's a portable accurate record that many different healthcare providers can access all the blanks get filled in and all the gaps are covered because we're able to see what other health care workers are doing as well it really sort of helps be sort of a bigger picture and everything being all together in that one chart the duplication that will be decreased will be enormous definitely streamlined communications amongst primary healthcare providers that's been a really critical link for us it's gonna change workflows in a clinic it can give opportunity for electronic scheduling it can give an opportunity for quick decision making it can save extra appointments the faster things are in motion the quicker you can actually give the patient the right treatments in fact the opportunity for us I should use that record to dialogue with the patient is fantastic as well as and powering clients to be able to take on some of their own healthcare so now we have email now we have text messaging now we have video text messaging it's just the way of the future if we don't do it beyond a generation are going to look at us and say there's folks didn't do anything for us saku-dono only knows now the Durbin says so it made their nest yesterday Papa the frock on in the gallery we really have a truly comprehensive system that is in the interest of the best quality care and experience for patients in this country and that whole picture of the patient provides the best possible care okay so I think one of the key messages that comes through from that video is that with the implementation of an electronic health record we truly have an opportunity to transform practice this is more than just a technology project but we have the opportunity to make changes to the way that healthcare is delivered and ultimately through that hopefully to improve patient outcomes so Canada health info wait they decided to do a research project across Canada and one of the key factors that they were looking at in this research project was to try and understand what are the key enablers or the key drivers that lead to a successful technology project that includes technology and when they were looking at this research when they looked at the data that they were able to discover what they they found out was that engaged and visible leadership was the primary enabler of a successful change project that involved technology and I say that because I think that's important to recognize but then when we look back at our or at our organization we also can renew preciate the fact that we have many intelligent and bright leaders here but most of us went to school and finished off our schooling at a time when informatics was not a part of our education curriculums so we're asking people to perform and to succeed within an area of practice that they might not have any formal training within and I think that another statistic that further emphasizes this is that if we look at the west coast of North America there are 36 schools that offer some form of a master's degree in nursing 13 of those schools have a requirement for an from attics course and that's in current state today so that's not even half of our current schools are providing the opportunity for our our clinicians our leaders to be trained within informatics so with that in mind we know that here at the Health Authority we have the an opportunity and a responsibility to educate our leaders within informatics and to give them the opportunity to become acquainted with this area of practice so that's part of the reason why we're here engaging you so what I'd like you to do is with the people just around you just take a few minutes and discuss when you hear the word health informatics what does that mean to you what do you think of well if I was to tell you even the most simplest terms what health informatics is I would tell you that health informatics is concerned with information flow and communication within practice education and research to support patient outcomes decision-making and workflow so essentially what we're doing is we're looking at how data is transferred from one place to another and how we can use that data to help make decisions and to port to making decisions that are going to improve patient care so what about IT because we often hear well isn't informatics the same as information technology how do they how do they differ so when we talk about information technology or IT we are essentially referring to the hardware and the software that we use so when I say hardware what I mean is the computers the laptops our cell phones the tablets that's all considered hardware the software would be all of the applications that we load on to the hardware so for example Microsoft Office Windows 7 our current system of SCM those are all applications software applications that are loaded onto our hardware so essentially though IT and informatics as much as they are separate they do work together in the sense that in firmat informatics helps IT work well and it helps at work of Lee so what do I mean by that well if we're to look at this example here this top screenshot as many of you would be familiar with is a screenshot of our lab results with an SEM and if you look at the yellow line there that yellow line is highlighting the sodium values for a patient so in order for us to recognize whether or not the patient sodium values are trending downwards or trending upwards and whether we need to make a decision to call the physician for further intervention we have to look at every data point and then compare them to understand whether or not the value is getting higher or lower from the normal so that can take time an in in fermentation would come and they would look at this and they would produce a graph that looks like the bottom graph and as we can see if we were to look at that bottom graph very quickly we can make a decision and recognize that that patient sodium level is trending downwards and that we're comfortable with the fact that it is going towards the lower end towards the baseline and therefore at this point we don't need to make a decision to contact the physician so if we go back to our definition of Informatics that's looking at communication to help improve decision-making we can see here that the way that this data is being communicated in the bottom graph does support our decision-making because we're able to make a decision much more quickly so with that in mind once again we're just with the people around you I'd like you to take a few minutes and discuss what are some examples of informatics that you use in your current daily work life or just your daily life outside of work what are some things that you can think of so taking two minutes and then we'll come back okay so do we have some examples that people are willing to share online banking absolutely yes Julia my hell yep absolutely yep for sure great session yep for sure any other examples Google yeah cellphone yes texting yep those are all good examples great so just a few examples that I have here so cell phones are one example of how we're using informatics in current practice so as many of you are would be aware the more that you text or that you write emails on your cell phone the more that your cell phone then begins to recognize the words that you use so for example I know that now when I start to type the first three letters of my name or the first four letters sometimes be RIT my cell phone will automatically populate with TA and Y so I don't need to type those letters I just need to press ENTER and then my name will be populated in the email that I am writing further to that another example here is just sometimes when we start to write the prefix of a word the first part of a word then the cellphone our BlackBerry's will will populate with different endings that we can choose from and that's all related to informatics so once again it's helping our workflow because it's making our typing of an email more efficient and more accurate another example that we have here within our sunrise clinical system is Auto paging so Auto paging is an example of informatics because we know that when we input an order for an OT referral or a PT referral we put this order into SCM we click Submit and then there's no further action that we need to take in order for that message to end in the hands of the occupational therapist or the physiotherapist after we click Submit an SCM we don't have to pick up the phone and dial a number we don't have to submit further information we can rely upon the system to inform that healthcare provider that we need them to come and see the patient so once again Auto paging is a way of helping with our workflow and last but not least is our workload measurement tool so this workload measurement tool as many of you would be familiar with on the clinical wards if this can be used at times to help give a numerical value for for the workload of an individual practitioner and these workflow measurement tools the values that are produced can then be used for decision making when it comes to staffing and when it comes to the the care model that's chosen within that unit so once again this is an example of how data can be used to help with decision making so if we're already using informatics in current day practice then what's going to be so different with an implementation of an electronic health record and I know that this fruit tree might look a little bit silly but I think that it is and one of the easiest analogies in hopes of understanding what will be different with an implementation of an electronic health record so if I was to ask you to go to pick fruit from this tree most of us would likely go to the tree and we would pick the the fruit that we had the most readily available access to and that would likely be the lowest hanging fruit one we can go we can easily access it it doesn't require a whole lot of additional strategy and we're able to receive the outcome that we had hoped for we're able to achieve the received the fruit that we had set out to to get but once all about lower level fruit is gone then in order to get to the next level and to get the fruit that's at a higher part of the tree we're going to need additional strategy so whether that be we're going to have to learn how to climb or we'd have to have a ladder with us we're going to require something in addition in order to access that fruit that we cannot currently reach or that we might not even know even exists at this time and that eula electronic health record is like that additional strategy it will allow us to access data that one we currently do not have access to or two that we currently don't even know exists so if we think of a clinical example about 15 years ago one of the key measurements that we were looking at in order to predict somebody's outcomes after they had a myocardial infarction or a heart attack was we were very curious to know their door-to-balloon time so otherwise known as the time at which they were diagnosed with it with a heart attack and then at the time that they got to the catheter lab in order to have a stent put in to relieve the blockage so we use data vary in many different ways in order to improve that that process and our door-to-balloon times when we first heard it off where our boat at about four hours which have now decreased to about ninety minutes which is an acceptable measure but in order for us now to further improve that process of maximizing somebody's outcomes after a heart attack we need to look at different data we need access to different data to better understand what other parts of this process can we improve upon to further support the patient and with an electronic health record we'll have access to that other kind of data that we currently don't have access to so are we doing okay yes okay so just before I go into the next subject I just want to summarize quickly so we've talked a little bit about Canada health info weight and what their their vision is with the implementation of an electronic health record we've talked about what is an electronic health record the difference between informatics and information technology and then some examples of informatics and current practice so the next thing that I'd like to speak about is just some of the competencies that we are going to look at within when we're working within an electronic health record and I think it's key to note that these competencies are not competencies that we're saying that we were asking you to become an expert with in informatics but it's more or less just to what are some of the key things that you need to be aware of when it comes to in informatics and when we look at a global level it's challenging to look at what are the universal competencies that that these informatics associations are telling us that leaders require because they vary from Association to Association so these competencies are coming from coach which is the Canadian Association for in for informatics so the first competency that we're going to look at it's information management which includes both understanding and interpreting healthcare data so before we can actually look at what is data I think it's important if we just understand what the definitions and the differences are between data information and knowledge because these terms often are used in interchangeably so if we look at data first data in and of itself is facts that have not had any analysis so basically facts for which there is no context so for example if I was to give you this number this number is a piece of data because there's if I don't tell you anything about it all that you know is that it is a number there's nothing to to reference it but if we look at formation information is data that has been analyzed so data that has some context to it so if I tell you that this is my phone number no that data is no longer just a piece of data but now it is information because I'm giving you context to what that number actually refers to and then knowledge is the combination of data and information that helps us make decisions so for example the knowledge that can come from this example is if somebody calls this number they're gonna know that they're calling me so I think that helps kind of break down what's the difference between data information and then how data information build towards knowledge so if you were at elf back in July this activity might be familiar to you but I'd like you with the people just next to you to describe what you see on this on the screen so take a few minutes and describe what do you see on the screen okay so I think it's fair to say that if we were to try and compare all of our descriptions of what we saw on this screen it's unlikely that this entire group used the exact same words to describe what is on what is on the picture and when we use different words to describe something we're at the risk of misinterpretation because we often are all using a different way different vocabulary to go to go about explaining something and in the midst of that we are all there's possibilities that because we're using differ words in different vocabulary we're explaining something differently there's opportunities for people to misinterpret us and we often spend more time trying to explain what we saw as opposed to actually using the information to make a decision so when we're building an electronic health record one of the one of the solutions that we can build into this record is something that's called a standardized terminology and essentially a standardized terminology is like a common language and what it allows for is a shared understanding to be transferred across a continuum of care so what I mean by that is that if we refer back to that example of the cake the overall concept that we had there was a dessert but within a standardized terminology all of the synonyms that would align with a dessert are built into our record underneath the concept so that's thought they're all coded the exact same so they all all of the words would share the same numerical code so that means that I could describe that picture using one set of vocabulary Chris could describe that picture using a different set of vocabulary but the system would know that because of the words and the synonyms that we're using essentially we are both describing a dessert so that is important because what it allows for is that it allows for information to be shared in a in a more powerful way and it also allows for improved clarity and accessibility to the data so when we look at data it's important to understand data but then it's also important that we analyze the data within within the context that it is being presented to us so if we look at these two graphs up here the red bars of our representative of a national average and the blue bars are representative of an average within a community of care and the first graph that we have there says hospitalized acute myocardial infarction event rate and this graph shows us that within within this community of care the our population is healthier than the national average there are fewer people that are having heart attacks but if we look at the next graph there it says 30-day acute myocardial infarction in hospital mortality rate and there within this community of care it's showing us that even though within the community we have a lower a lower rate of heart attacks when it comes to the hospital setting more patients are dying in hospital who have had heart attacks than the national average so it would be easy with when looking at these two graphs to think well maybe there is a mistake or that doesn't really make sense but that's where I when I say we need to analyze the data within the context that it's presented to us that's where we have to be careful because the first graph is showing us a is showing us a community on average whereas the second graph is referring more to a processed measurement so that's within within within the hospital so they are showing two different pieces of information so that's why it's important to understand the context which in which the data is being presented even though they both are showing statistics on myocardial infarctions okay and that's the last competency that I would like to speak about today is computer literacy so as many of you are aware Chris came around and he just talked with with some of the nurse educators and some of the staff about what are some of where do you think your staff are when it comes to computer literacy how familiar do you think they are with a computer and we were able to take some of that some of that data and we'll present some of those findings a little bit later but basically when we're talking about computer literacy what we're looking at is we want to know that our staff are comfortable using a computer but further to that that they're comfortable troubleshooting a computer so that if they are to encounter encounter an issue they understand how they can go about fixing it so why is this important well it's important for user readiness when it comes to implementation of an electronic health record because as we currently know we work within a system where we can have staff that necessarily don't have to know how to use a computer but when it comes to an electronic health record but there's no workarounds everybody will have to be familiar with a computer and how it works and further to that we know that computer literacy does support a successful implementation even though it doesn't guarantee proficiency within an electronic health record but it does help with supporting a successful implementation of an electronic health record so one of the interesting pieces of information just to give a little bit of context as to maybe where some where we can invest some energy and and some work is when Chris was speaking with with some of the staff he found out that some staff would tell him that if for example the sunrise clinical manager log in if that page wasn't opened up on the desktop nurses would go about to a different computer to find a computer where that was open so that they could log into that into the computer meanwhile if that is not up on the desktop screen all that a nurse has to do is click the computer that's circled in right there and that will bring the the login screen up so that's one example of how we can improve upon helping nurses troubleshoot our our current computer system further to that and this is all very anecdotal data that that we that we we gathered so I'm not saying that this is 100% accurate but more or less just to bring awareness to to our current state nurses would rate themselves anywhere between two to five on a scale of 10 if we were to ask them with zero being I do not feel comfortable using a computer and 10 I feel very comfortable using a computer so it's interesting when it comes from a nurse's perspective that they are recognizing some of their own inadequate he's with working within a computer and then finally just reiterating once again that we do know that our current our current system does not require a nurse to have to know how to use a how to use a computer so nurses have told us that they will swap tasks with others so that they don't have to enter their orders with on the on the computer they can have somebody else enter the orders and then they'll go ahead and they'll do something for the other nurse further to that we have unit coordinators we're very blessed to have them and they do a lot of our order entry forests um some sites have our units have been 24 hours a day so that in and of itself helps decrease their the responsibility on a nurse in our current state to have to learn how to enter orders within or how to use the electronic system so that being said Deanna trifa Nova who is the education lead over at CST she has been working to create a computer literacy toolkit and within that computer literacy toolkit there's a computer literacy assessment and that assessment tool I will um hand out today at the end of this session and that is something that I think that as leaders we can do for ourselves at this point to understand where our computer literacy sits but further to that that will be something that we will be eventually giving to the clinical and end-user to use as well to be able to assess their computer literacy and then to recognize where their knowledge gaps are what they need to do moving forward within that a toolkit there are resources as well so that nurses can go online and help support their learning in their competency with in computer literacy so to end off I just reiterate the the questions once again that we talked about at the beginning that are on that self assessment tool so the hope is that through this session you were able to just to gain a little bit of understanding about some of the inter Mattox knowledge and some of the informatics competencies that we are hoping to help build here amongst our leaders and that being said as well if there's any opportunity that you think that Britney can you come and meet with me and and talk further about this or engage with our staff like I'm more than happy to come and meet and help explain things as necessary so please feel free to contact me if that would be of any support and I'm happy to engage with you so that's the end of today's presentation if you have any questions I'm happy to take them if not

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