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MIE2009 – Monday morning keynote – Ed Hammond August 31, 2009

Posted by peterjmurray in conference, EFMI, Europe, Plenary, speaker.
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The first keynote of the morning here at MIE2009 in Sarajevo is from Ed Hammond on “Realizing the potential of healthcare information technology to enhance global health”. He began by acknowledging that challenges facing Europe also will apply to USA in terms of healthcare , and that sharing experiences are important. In all countries in developed world, cost of healthcare is excessive and rising rapidly – in part, due to technology. How do we justify use of technology if it increases costs of healthcare? Is there evidence that using technology in healthcare saves money? – this is justification often given, but is it true? why do some countries have better health outcomes at half the cost?

Technology should not be the master – but often technology drives what we do – often create solutions and then look for problems – this is not right approach? Outcomes of healthcare do not always match the amount of money. Evidence has NOT shown that increasing amount of money results in better outcomes. Need to spend the money on the right things – need to look at preventive care. Ed stresses he is not anti-technology – but need to use it appropriately. Technology usually does not save money, it costs money – misleads people and can result in problems.

Imaging costs money – but is it always effective to use more images? They can have major impact on quality and effectiveness of care, but may be overdone. With adequate data, we should be able to eliminate errors, and increase amount of knowledge about what works best. Need to improve consistency of care of patients – physicians often influenced by recent outcomes. Geo-coding can be increasingly important in management of disease – why is there geographic disparity in disease incidence and healthcare outcomes? National statistics and population data is important for many countries in managing healthcare – rather than the current strong focus on individuals.

There is trade-off between cost of care and quality of life – often down to individual choice, but needs to be part of the debate. Many of drugs and treatments used are used globally, not just locally – need to aggregate this data to help everyone improve outcomes. Why do some electronic systems mimic paper? – this is limiting on the potential.

What is the purpose of an electronic health record?  Doomed to repeat mistakes if people say ‘that’s not the way we do it’. We often solve the wrong problem in addressing healthcare issues. Need to recognise that query is where value lies, and EHRs need to support queries. patient-centric means one person, one EHR.

EHR so far are a reflection of how data are collected – and we need to move beyond this to proper, comprehensive use of data; needs to be re-usable. Systems need to re-evaluate patient when new data are added to EHR and health IT systems. More data does not mean more information – need intelligent ways to filter data.

Public health has been a neglected component of healthcare in many countries, especially in USA. Needs to be at the forefront of IT use in healthcare. With rare diseases, affecting few people, need to aggregate global data to support clinical trials. Need to strike balance between sharing information for health and needs for privacy etc. Healthcare is a team process – but need to convince the person to engage in health behviour changes.

We need to understand what treatments are effective and what aren’t. We need to convince both patients and providers of the effectiveness or otherwise of high tech and high cost treatments; less costly tests may be better for health in the long run. Should not be rewarding physicians for simply buying systems – should be rewarding them for improving care, and making differences in outcomes. We can have perfect systems, but if they don’t make a difference, what use are they? We can afford failure in small steps if in the long run we make improvements. Need to ‘do once and share’ at global levels to solve problems, and enhance understandings of problems. Need to understand and accommodate different cultures. Need to re-examine and think out of the box; need to push the limits of the technology, so as to level the playing field for all countries. Can we take the best of outcomes from around the world and repeat, from lessons, in other places.

For other reports, see @omowizard and @CiscoGIII tweets.

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Opening session SINI 2009 Wednesday 07.22.09 July 22, 2009

Posted by Scott Erdley in conference, Keynote, Plenary, SINI2009, speaker, Uncategorized, USA.
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Photo by Heather Sobko.

Official welcome and introductions by Patricia Morton (Professor & Associate Dean for Academic Affairs, UM School of Nursing), Judy Ozbolt, Program Chair, SINI 2009, Professor & Program Director of Nursing Informatics, UM School of Nursing, and Amar Kapadia, Director of Acute Care, AccuNurse by Vocollect Inc. Overall casual scanning of the attendees at the opening indicates a good number in attendance. However, number of in-person attendees given by Judy Ozbolt indicates a fair decrease from previous years (this year quoted as 350 in-person attendees). Judy also announced her retirement at the end of this year. New co-chairs for next year include Marietta Mills & Marisa Wilson along with Judy until her retirement on December 31, 2009.

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Photo by Heather Sobko.

Keynote speaker is James J. Cimino, MD, titled “Informatics as a Bridge to Knowledge at the Bedside”. He is Chief, Laboratory for Informatics Development, NIH, Clinical Center Senior Scientist, Lister Hill National Center for Biomedical Communication, NLM.

He further divides the topic into 3 sub-topics: bedside environment, knowledge to support care and informatics as the bridge of these two. He reviews informatics research issues associated with bridging ‘problem’ as a 7 step process (information needs of users). Very personable with his presentation style; well received by the audience. Findings of observational studies are information needs occur often, often unresolved and computer-based resources are under used.

James includes a fair number of screen shots to support statements and assertions made in presentation. Patient information is not easily available to providers at bedside. Health knowledge (such as Pubmed, textbooks, and so forth) has multiple sources; needs to be included for use at bedside / concurrent with patient information access / use. Third point is procedural knowledge. All of these are under the heading of Informatics, delivering knowledge. Procedural includes or requires perhaps refreshing what one already knows, BMI calculator, and so forth.

Informatics: Integration is the bridge. One issue is workflow. One way to ascertain workflow is observational studies. Another area is in expert systems and how integrated into workflow. third area is ‘intelligent retrieval’. Infobutton and Infobutton-like systems somewhat answer this last topic of intelligent retrieval. Examples include Vanderbilt’s PC-POETS, LDS HELP system, Partner’s Healthlink, and Columbia’s Infobutton Manager (speaker’s research project). Describes, now, this project with supporting screen shots (examples include laboratory tests, drugs, organism cultures, and so forth). Information is linked to term or item. Minimal number of clicks is something strived for (2-3 clicks to get answer). 5 year use history of infobutton use shows topics (lab manual, Micromedex, Pubmed, up-to-date, Harrisons, national guidelines, patient instructions. User analysis indicate nurses are major users of patient instruction topic.

Summary of presentation findings at this point. 1st – knowledge to support care (1/3 each for patient, wellness & disease, practice). 2nd – bedside environment (patient, clinician and technology). 3rd point – informatics as bridge; understanding knowledge needs (clinician & patient); delivery of patient information health knowledge, procedural knowledge; finally about integration of workflow, expert systems and intelligent retrieval). Conclusions: (1) putting patient, nurse & tech in same room is not sufficient; (2) informatics is needed to understand the info needs and provide the resources and integrate ‘them’ into the workflow; (3) big topics – cognition, terminology & knowledge representation provide the bridges.

Q&A session, since session completed early (3:45pm with schedule to complete 4:30pm), will be ‘extended’.

Well done opening talk. There is a meet the keynote speaker session from 4:30p – 5:30p (east coast time) with James J. Cimino following this keynote opening talk. More information at http://www.infobuttons.org

Afternoon plenary speaker – Dr. Charles Friedman 06.29.09 1315 – 1400 June 29, 2009

Posted by Scott Erdley in conference, health informatics, NI2009, Plenary, speaker.
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Topic is ‘The National eHealth Initiative in the United States’ for Dr. Friedman today. He was pushed up to this status due to the illness of the opening speaker. He is a US government employee but is on holiday and so none of his talk is official US policy and such. Made this disclaimer to open his speech. Opening salvo by ‘Chuck’ is a review of US health system to provide a backdrop for the rest of the presentation.

Part two of the presentation is a review of HIT, on a national health level, from 2004 – 2008 (development of the Office of National Coordinator / ONC and so forth). The process of adoption, viewed in 2004 and still viewed, needs to move through the ‘tipping point’ (whatever this is) of technology adoption to facilitate health care IT adoption. Adoption in hosptials of HIT (Jha et al. NEJM, 2009) statistics are cited illustrating little adoption of HIT in hospitals as aggregate perspective. Looking at specific applications, though, raises the rate significantly (lab/rad reporting and medication lists for example). Graphic depicting what is called ‘The Nationwide Health Information Network’ to show what this is and what is coming in the near future.

Chuck then moved to current status and support of President Obama and appointment of Dr. David Blumenthal as the National Coordinator for Health IT (author of ‘The Federal Role in Promoting Health Information Technology, Commonwealth Fund, 2009’). Outlined next is the Recovery Act and its sub-act of HITECH, which supports with increased funding of health IT adoption. This support via dollars in the US was a major change in health care. HITECH highlights are permanent ONC for national coordination, payment incentives to providers & hospitals, 6 supportive grant programs, and enhanced privacy & security provisions (aka ‘enhanced trust’). He postulates these ‘hopefully’ will enable acceleration of the HIT in the US.

Final comments by Chuck include addressing the definition of the concept ‘meaningful use’ and the process underway to define this concept. Such definition is needed as financial support is tied to this concept. He had to squeeze through, due to time, and so did discuss in-depth additional points raised during the entire presentation.

On to afternoon sessions!

Opening keynote 06.29.09 morning session – Dr. David Bates June 29, 2009

Posted by Scott Erdley in conference, health informatics, NI2009, nursing informatics, patient safety, Plenary, Uncategorized.
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Keynotes today are shifted due to severe health problems of the original speaker. So, David Bates, scheduled for later today, is the opening speaker. Dr. Charles Friedman will be the opening afternoon speaker.

David Bates’ talk is about IT & patient safety (“Improving safety & quality using HIT: Keys for nursing”). Talk will range from background to using HIT for safety, in various settings, then crossing issues and final thoughts / issues. He cites the IOM report “To Err is Human” as a primary compelling force behind current interest in patient safety & HIT. Provides a list of 10 top priorities for patient safety research in developing countries (see very recent BMJ article). Nurses impact adverse events from pressure ulcers to adverse drug events, too. He describes the US efforts and considers US to be near ‘tipping point’. LL Weed cited as to use of external aids to promote change in health care; patients could participate in decision-making (their own). Ways IT to improve safet include error prevention / adverse events to more rapid resonse after adverse event to tracking & feedback of adverse events.

Bates then outlines 7 main strategies for preventing errors & adverse events, via HIT, including improving communication to accessible knowledge to providing key information, calculation assistance, real-time ‘checks’ to monitoring assistance and finally decision support. He then cites specific examples such as CPOE to smart pumps / monitoring and so forth. A specific example / research project is titled ‘NEPHROS’, which looked at renal insufficiency patients (Chertow et al, JAMA 2001). Another specific area of patient safety is medication administration, in particular, several US major adverse events surrounding use of heparin. Some ‘easy’ solutions are BMA (bar code administration) as well smart pumps (Rothschild et al, Crit Care med 2005). Most of Bates’ discussion centered on inpatient / acute care environment. He also, though, did discuss outpatient environment, which may be termed ‘medical home’. Nice use of a Dilber cartoon to state where he believes health care is today. Future areas for NI include personal health records as well as decision support (e.g.: computer ‘think along’ with provider), interoperability, and so forth. Quality from IT and its transforming ability from ehr (poc decision support, registry tools & ‘team’ care) and measure performance; safety need to increase processes reliability (e.g. check lists, new CPOE approaches). IS helps with communication, cost holding, quality accessible, and such.

Keys for NI include tools to track risk, digital documentation (vital signs), computerized handovers / report, nursing decision support, multidisciplinary communcation, and key roles in medical home patients / outpatient settings. Sytems future possibilities range from ‘better provider cockpit’ to communcation to quality measurement and NI needs higher profile in most organizations, all leading to safer care with use of IT. Ended with Yogi Berra quote “I don’t want to make the wrong mistake.” Nice ending and nice talk. Time for Q&A at this point. One question justly asked had to do with public health disease / pandemic condition tracking and monitoring (infections, H1N1, and so forth).

Personal thought – not sure if talk content is anything startlingly new but may instead be a reminder of what NI persons can or should do regarding patient safety. Scott Erdley