Medical Informatics and the role of the CHIO

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					Medical Informatics and the role of
the Chief Health Informatics Officer
      “ A local perspective”

         David P. Lin, M.D.
         Agenda


• Define Medical/Health Informatics

• VHA Executive Decision Memo

• VA’s Current Problems

• Where should we          ?
         Informatics


• Informatics is the science of information

• The practice of information processing

     What is informatics?
• The engineering of information systems

• Informatics has computational, cognitive and
  social aspects, including study of the social
  impact of information technologies
            What is medical informatics?
• The intersection of information science,
  computer science, and health care
   – Resources
                                       Healthcare
   – Devices
   – Acquisition, storage,
     retrieval, and use of             Medical
                                     Informatics
     health information
• Health informatics tools
   – Computers
   – Clinical guidelines
   – Formal medical terminologies
   – Information and communication systems
               What is informatics? (Simplified)

• Flow of information
   – Sharing and imparting knowledge
   – Making others aware!
   – Suggesting solutions


• Communication!
   – Not just the content
   – Method or process of communication
      • Paper, voice, e-mail, text messaging, secure
        messaging, video (conferencing and tutorials)

• The right information to the right person at the right time
            VHA Executive Decision Memo
• Establish field based informatics leadership

• Informatics knowledge throughout VHA

• Each VISN and VAMC site to create an
  “informatics leader” position

• “Informaticists” are ideal candidates

• Implement nationally approved Health
  Information System configurations (e.g. ICU CIS
  and ARK)
            The Informatics Leader

• Advance national solutions for managing
  workflow and knowledge in clinical systems

• Support local implementation of software

• Assist in supporting facility clinical operations
  and accreditation activities

• Ensure timely, appropriate, and relevant “end-
  user” training is conducted
           Chief Health Informatics Officer (CHIO)

• Field-based CHIO will serve as a critical
  liaison between the clinical end-user, OI&T
  and management

• Translates the clinical and health care
  operations needs to the OI&T
  – Planning solutions
  – Planning innovation
  – Evaluating new technologies.


• This role is being requested by both the OI&T
  leadership and VHA leadership
“If underlying problems with processes are not
remedied, the IT investment can be wasted or
diluted. Existing processes will continue to perform
poorly, only faster.”

      - John Glaser, CIO of Partners Healthcare,
parent of Massachusetts General Hospital and
Brigham and Women’s Hospital.
                                    Medical Informatics (Tools)




Source: HIMSS Analytics™ Database (derived from the Dorenfest IHDS+ Database™
                                                                                11
Complicated Tool




                   12
Memory Dump
Simpler Tool
Simpler Tool




               14
    Simpler Tool


            ?!

?                  ?




    ?
             ?




                       15
             VA’s Current Problems

• New tools and added processes are without
  adequate training

• Communication is disjointed

• No chain of command exists in informatics

• Difficult for VHA leadership to implement
  informatics related initiatives at the field level.

• Difficult for the field to communicate and
  articulate effectively with VHA leadership
  about informatics-related issues
            VA’s Problems

• Complacency and
  indifference about
  training and education of
  our end-user

• Indifferent about the
  needs of our end-users
  and front line staff

• IT tries to dictate clinical
  work processes
              EHR Consequences

                Unsigned
 Incomplete
 Encounters      Notes
                                      Copy &
                             EKG       Paste
                            Name
                           Mismatch   Notes
                                                Medication
                                               Reconciliation


Incomplete
  Clinical
Reminders
               Where should we focus?




"The people in the field are closest to the problem, closest to
the situation, therefore that is where the true wisdom is"

Colin Powell
            Education and Training

• Set user expectations

• High quality user training

• User-focused software
  settings

• Re-evaluating the
  organizational workflow
                Information Diagnostician
• Evaluate business processes in light of
  IT, and IT in light of our business
  processes – with the goal of creating an
  optimal solution

• Look at the whole work process including
  ancillary services.

• Be a resource --- a Service to the service
  providers

• Advocate for the end-user

• Refocus and re-direct when end-users go
  off course
         Education House Calls



• Informatics rounds (Needs Assessment)

• Knowledge gap analysis

• Provide one to one sessions or group
  sessions
         Education Methods


•Face to face - “See one, do one, teach one!”

•Quick Tip videos on the local web page

•Share Ideas and share processes



•It’s all about the End-User
“The day soldiers stop bringing you their problems is
the day you have stopped leading them. They have
either lost confidence that you can help them or
concluded that you do not care. Either case is a
failure of leadership.”

Colin Powell
Thank you!!

				
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