Copyright, 1996 © Dale Carnegie & Associates, Inc.

Informatics: Substance and Style

Patricia Flatley Brennan, RN, PhD, FAAN

Moehlman Bascom ProfessorUniversity of Wisconsin-Madison Support from the NIH 1988-2004 (NR 2001; AG 8614; NR 6432; LM/NR 9443)

Goals for this presentation

Explore the state of development in health informatics and health care

Draw implications for nursing and allied health science education: Substance

what does a health professional need to know?

Style the dual benefit of informatics-driven education

Health Informatics: What is it?

“... the application of computers, communications, and information technology and systems to all fields of medicine” (Morris Collen)

“...transformation of data to information, information to knowledge” (M. ‘Scott’ Blois)

“...Integration of clinical disciplines, their information and information management, with information processing and communications technology to support world health” (IMIA)

Scientific Foundations of

HEALTH INFORMATICS

Computer & Information Science

Clinical & Basic Biomedical Sciences

Cognitive Science

Decision Science

Public Health Science

OrganizationalScience

Scientific Foundations of

HEALTH INFORMATICS

ACCOMPLISHMENTS IN HEALTH INFORMATICS:

~50 YEARS OF GROWTH

Brigham & Women's

PITT

Vanderbilt

Duke

RegenstriefWashington U

Univ Utah/LDS/Intermountain

Yale

Columbia

UCSF

MayoMGH

Computer-based Patient Records

Stanford SMI

Brigham & Women'sPITT

Univ Utah/LDS/Intermountain

UCSF

BIDMC

MGH

Knowledge at thePoint of Care

Duke

Regenstrief

Stanford SMI

Univ Washington Brigham & Women'sPITT

Yale

Baylor

Columbia

OHSU

Imaging and Bioinformatics

Univ WashingtonBIDMC

Colorado

Univ Wisconsin

OHSU

Mayo

Georgia

MIT

Consumer Health & Telemedicine

U Iowa

Missouri

Kaiser-Permanente

Health Information InfrastructureUnified Medical Language SystemIAIMS

On the horizon...

Integration of different data types, with particular emphasis on time-variant data

Intelligent agents and meta-data that support efficient use of knowledge resources (text, images, sound)

Merging of public health and personal health data

Re-engineering of clinical practice to capitalize on informatics advances

GRAND CHALLENGE IN Health Care

Translational Medicine

the marriage between new discoveries in

basic science and

valid treatments in clinical practice

The Importance of Health Informatics to Translational Medicine:

Fast-tracking

Accelerating the trajectory from bench to bedside

Rapid synthesis of research evidence and clinical data at the point of care

Patients and Translational Medicine

???

? ?

? ?

‘SMART’ Patients

Self-assuredMotivatedAwareResourcefulTalented

ScaredMinors!ReluctantAnxiousTime

consuming

Health Informatics Support for Translational Medicine

Basic Research

Clinical Research

Health Services

Bioinformatics and image management

Knowledge resources (literature, gene, images)

Intelligent access to distributed resources

Researcher’s workstation & network

Health Informatics Support for Translational Medicine

Basic Research

Clinical Research

Health Services

Common terms and data models

Participant recruitment

Research Registries and Data Repositories

Virtual reality environments

Health Informatics Support for Translational Medicine

Basic Research

Clinical Research

Health Services

Organized, accessible clinical data

Common terms and standard definitions

Intervention infrastructure

Guidelines delivered to the point of care

AN INVESTMENT MODEL for

HEALTH INFORMATICS +

Health Care

Infrastructure DevelopmentInformatics ApplicationsIntegrated Training

Programs

Infrastructure Development

Pathways and Networks (NGI, NII)Reference Data ModelNaming Conventions

Informatics Applications

Data capture devices New tools that deliver

clinical interventions Substantive content

specific to selected clinical trials

Treat informatics like statistics: expect it in every project!

Integrated Training

Link informatics research training with basic and clinical research training

Interdisciplinary research and practice models begin with interdisciplinary training

WHAT’S LEFT UNDONE?

Scaleable, portable applications that support distributed access to knowledge resources

Integration of health information technologies into the work-life of busy clinicians

Policies and regulations that support privacy while enhancing access to key health data

Tools that support ‘SMART’ patients

Educational implications

Who needs to be educated?

What do they need to learn?

How can it be taught?

Who needs to be educated?

Health Informatics Professionals Applications-oriented: Nursing informatics specialists,

medical librarians (master’s level) Inquiry-oriented: generators of new knowledge (PhD)

Health Professionals Entry-level degree candidates Life-long learners

Patients Basic Health information competence Just-in-time learning

What needs to be learned:The Substance of InformaticsKnowledge Management

Distributed knowledge Integrated records Formal languages and vocabularies

New Data Types Images Time-variant data

Clinical Practice Factors Patients and lay people as legitimate users Practice-enhancing technologies Organizational change

Educational needs of health informatics professionals

Knoweldge management

New Data Types

Clinical Practice Factors

Knowledge representation

Emerging technologies Integration strategies Impact of information

and information technology on individuals and organizations

Educational needs of nursing and allied health professionals

Knowledge management

New Data Types

Clinical Practice Factors

Acquiring information for practice

Using emerging technologies to advance practice goals

Re-engineering practice to capitalize on technology Share the workload Extend practice options

Educational needs of patients

Knowledge management

New Data Types

Clinical Practice Factors

Acquiring, evaluating, interpreting, and applying consumer health information

Accessing emerging technologies

Becoming an informed and informing user of health information

Journey to theCurriculum

Education & Informatics

Both content and process!Substance: Educating about informaticsStyle: Educating people about health

science using informatics Informatics-enhanced clinical experiences Distance learning Informatics-enhanced classroom strategies

Deciding what belongs in the curriculum

Evaluate contemporary practice Clinical interventions Practice Models

Exploit emerging technologies Clinical Technologies (translational medicine) Informatics Technologies

Critically appraise what must be learned in anticipation of practice, and what must be delivered in the context of practice --and choose from the former, not the latter!

General Guidelines

Information is inseparable from structure So informatics must be integrated throughout Therefore, informatics is everyone’s job

To the extent possible, the skills used in the educational experience should mimic those employed in the practice world

Technology should enhance learning

General Guidelines

Information is inseparable from structureTo the extent possible, the skills used in

the educational experience should mimic those employed in the practice world Knowledge resource access Information Integration Distributed records management

Technology should enhance learning

General Guidelines

Information is inseparable from structureTo the extent possible, the skills used in

the educational experience should mimic those employed in the practice world

Technology should enhance learning Skill development Individualized progression Tailoring to personal preferences and styles

Incentives and mandates for the Faculty

Using Informaticsto accomplish clinical science learning goals

Informatics that advance clinical learning

Reliance on Aggregate Data and Databases

Privacy, confidentiality and integration

Telemedicine, including Just-in-time, point-of-service learning systems and distributed knowledge systems

Strategies to use Informatics to accomplish clinical science curricular goalsInclude terminology and knowledge

representation activities along with clinical exercises

Require J-I-T identification and synthesis of distributed knowledge resources

Employ simulated environments judiciously to develop skills for asynchronous practice

Cyberscalpel: Precise Surgical training methods

Surgical techniques can be practiced with precision

Haptic devices provide resistance feedback

Visualization confirms image

Faculty Responsibilities

Technological CompetenceCurricular controlResponsive, Reflective,

collaborative learning environments

Patient-centered Informatics Education

Establish a philosophy of patient-centered practice and adhere to it!

Where possible, introduce informatics tools congruent with the philosophy of patient-centered practice

Be explicit about discrepancies between the curriculum philosophy and that of clinical agencies

Education direct to patients

Collaborate with other health education initiatives in primary schools and public libraries

Evaluate the relevance of professional literatures and materials for consumer use

Initiate patient-accessible records systems and the knowledge resources to support them

Map patient vernacular to formal health care languages