1. Informatics & Technology in Nursing
Nawanan Theera‐Ampornpunt, M.D., Ph.D.
Faculty of Medicine Ramathibodi Hospital, Mahidol University

2. 2003 M.D. (First‐Class Honors) (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
2012 Certified HL7 CDA Specialist
• Deputy Executive Director for Informatics (CIO/CMIO)
Chakri Naruebodindra Medical Institute
• Lecturer, Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Mahidol University
nawanan.the@mahidol.ac.th
http://groups.google.com/group/ThaiHealthIT
www.SlideShare.net/Nawanan
Introduction

3. • Health & Health Information
• Health IT
• Informatics as a Discipline
• Nursing Informatics
• Summary
Outline

4. Health &
Health Information

5. Let’s take a look at
these pictures...

6. Image Source: Guardian.co.uk
Manufacturing

7. Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3
Banking

8. ER - Image Source: nj.com
Healthcare (On TV)

9. (At an undisclosed nearby hospital)
Healthcare (Reality)

10. • Life‐or‐Death
• Difficult to automate human decisions
– Nature of business
– Many & varied stakeholders
– Evolving standards of care
• Fragmented, poorly‐coordinated systems
• Large, ever‐growing & changing body of
knowledge
• High volume, low resources, little time
Why Healthcare Isn’t Like
Any Others

11. Back to
something simple...

12. To treat & to care
for their patients
to their best
abilities, given
limited time &
resources
Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen)
What Clinicians Want?

13. • Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
High Quality Care

14. Information is Everywhere
in Healthcare

15. Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(11):1227-8.
“Information” in Medicine

16. 16
16
WHO (2009)
Components of Health Systems

17. 17
17
WHO (2009)
WHO Health System Framework

18. Health & Health Information
• Health IT
• Informatics as a Discipline
• Nursing Informatics
• Summary
Outline

19. Health IT &
eHealth

20. (IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports

21. • To Err is Human (IOM, 2000) reported
that:
– 44,000 to 98,000 people die in U.S.
hospitals each year as a result of
preventable medical mistakes
– Mistakes cost U.S. hospitals $17 billion to
$29 billion yearly
– Individual errors are not the main problem
– Faulty systems, processes, and other
conditions lead to preventable errors
Health IT Workforce Curriculum Version
3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare ‐ Lecture d
Patient Safety

22. • Humans are not perfect and are bound to
make errors
• Highlight problems in U.S. health care
system that systematically contributes to
medical errors and poor quality
• Recommends reform
• Health IT plays a role in improving patient
safety
IOM Reports Summary

23. Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy‐heads/
(Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg
To Err Is Human 1: Attention

24. Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err Is Human 2: Memory

25. • Cognitive Errors - Example: Decoy Pricing
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Ariely (2008)
16
0
84
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68
32
# of
People
# of
People
To Err Is Human 3: Cognition

26. • It already happens....
(Mamede et al., 2010; Croskerry, 2003; Klein,
2005; Croskerry, 2013)
What If This Happens in
Healthcare?

27. Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C,
Schmidt HG. Effect of availability bias and reflective reasoning on diagnostic accuracy
among internal medicine residents. JAMA. 2010 Sep 15;304(11):1198-203.
Cognitive Biases in Healthcare

28. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):775-80.
Cognitive Biases in Healthcare

29. Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781‐3.
“Everyone makes mistakes. But our reliance on
cognitive processes prone to bias makes
treatment errors more likely than we think”
Cognitive Biases in Healthcare

30. • Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors

31. Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare

32. Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help

33. Why We Need ICT
in Healthcare?
#3: Because access to high-
quality patient information
improves care

34. Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement

35. Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s In A Word?

36. Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Health Information Exchange

37. Health & Health Information
Health IT
• Informatics as a Discipline
• Nursing Informatics
• Summary
Outline

38. Biomedical & Health
Informatics
as a Discipline

39. • “Biomedical informatics (BMI) is the
interdisciplinary field that studies and
pursues the effective uses of biomedical
data, information, and knowledge for
scientific inquiry, problem solving, and
decision making, motivated by efforts to
improve human health.” (AMIA, 2012)
Biomedical Informatics

40. • Provide Patient-Centered Care
• Work in Interdisciplinary Teams
• Employ Evidence-Based Practice
• Apply Quality Improvement
• Utilize Informatics
Core Competencies of
Health Professionals
(IOM, 2003)

41. (Shortliffe, 2002)
Informatics As A Field

42. (Hersh, 2009)
Informatics As A Field

43. Biomedical/
Health
Informatics
Computer &
Information
Science
Engineering
Cognitive
&
Decision
Science
Social
Sciences
(Psychology,
Sociology,
Linguistics,
Law &
Ethics)
Statistics
&
Research
Methods Medical
Sciences &
Public
Health
Management
Library
Science,
Information
Retrieval,
KM
And More!
Informatics & Other Fields

44. Health & Health Information
Health IT
Health Informatics as a Discipline
• Nursing Informatics
• Summary
Outline

45. Nursing Informatics

46. • Nursing Informatics is the “science and
practice (that) integrates nursing, its
information and knowledge, with
management of information and
communication technologies to promote
the health of people, families, and
communities worldwide.” (IMIA Special
Interest Group on Nursing Informatics
2009).
Nursing Informatics
AMIA Nursing Informatics Working Group

47. Nursing Informatics
Source: http://nursingfile.com/nursing-informatics/road-to-the-future-nursing-informatics.html

48. • Standards to support evidence-based practice,
research, and education
• Data and communication standards
• Research
• Information presentation and retrieval to support
safe patient centered care
• ICT to address inter-professional workflow needs
across care
• Development, design, and implementation of ICT
• Healthcare policy to advance the public’s health
Core Areas of
Nursing Informatics
AMIA Nursing Informatics Working Group

49. • Nursing Informatics Standards
– Omaha System
Examples of
Nursing Informatics Works

50. • Health IT in Clinical Settings
– Electronic Nursing Records
– e-Kardex
– Careplanning
– Electronic Medication Administration Records
(e-MAR)
– Barcoded Medication Administration
– Other nurse-related workslows
Examples of
Nursing Informatics Works

51. Ordering Transcription Dispensing Administration
CPOE
Automatic
Medication
Dispensing
Electronic
Medication
Administration
Records
(e‐MAR)
Barcoded
Medication
Administration
Barcoded
Medication
Dispensing
Medication Process

52. • Health IT for Consumers/Patients
– Personal Health Records
– Telemedicine
– Web Sites for Patient Education & Engagement
– mHealth & Social Media
Examples of
Nursing Informatics Works
Images from HealthVault.com, American Telecare, Inc. & WHO

53. Health & Health Information
Health IT
Health Informatics as a Discipline
Nursing Informatics
• Summary
Outline

54. Summary

55. • Information is important & everywhere
in healthcare (and nursing)
• Health IT helps improve quality of care
and reduces errors by health workers
• Informatics is an interdisciplinary field, with
nursing informatics as one key sub-field
• Nursing informatics plays important roles
in today and future’s patient care
Summary