School of Nursing - University of Minnesota



Nursing Knowledge: Big Data Research for Transforming

University of Minnesota, School of Nursing, Center for Nursing Informatics

August 12 – 13, 2013

Developed by: Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN

Vision of how Informatics Enables a Transformed Health System

1 Advancing the vision of a transformed health system

Informatics and health IT have been identified as potential solutions to reshape our health system by adding speed, efficiency, accuracy, and insight into improving healthcare delivery. This can be accomplished, in part, by eliminating paper-based systems, manual processes, enhancing workflow, and ultimately identifying best practices through clinical decision support and analytic algorithms.

Ideally, the promise of informatics and health IT will lead to a more coordinated structure where information can be easily and safely shared among patients, consumers and providers to enable improved outcomes, quality of care and lower costs. Progress towards this goal is being demonstrated in the U.S. by the HITECH Act in which the federal government has invested billions of dollars to encourage hospitals, clinics, and physician practices to adopt electronic health records (EHRs) and then to demonstrate the meaningful use of these systems to improve healthcare delivery and outcomes.

However, simultaneously, the value of health IT is being challenged on a frequent basis through mainstream news articles, high profile EHR implementations, clinicians, and congressional committees. While we may try to address these criticisms claiming they are the result of politics, inadequate research sample sizes, or part of the expected learning curve of clinicians new to HIT, there is an overall lack of comprehensive evidence that health IT and informatics are producing value in the delivery or the transformation of our health system. Currently there are a number of key drivers for informatics’ role in enabling a transformed health system.

2 Key drivers for informatics’ role in enabling a transformed health system

Both the Patient Protection and Affordable Care Act (PPACA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the American Recovery and Reinvestment Act of 2009 (ARRA), acknowledge the importance of health IT in improving the quality and cost efficiency of healthcare. We are at the beginning of a transformation of our health system from a volume based to a value based model. Among the many factors that will contribute to the success of providers in the midst of this transformation is a focused health IT roadmap that aligns their organization's resources with its goals and objectives for accountable care. CCHIT has developed such a roadmap titled A Health IT Framework for Accountable Care.[1]

The framework emphasizes the following primary health IT requirements for accountable care:

• Information sharing among clinicians, patients and authorized entities;

• Data collection and integration from multiple clinical, financial, operational and patient-derived sources;

• HIT functions supporting patient safety; and

• Strong privacy protections.

Advances in EHR adoption and data analytics are also enabling the use of clinical and business intelligence to elicit outcomes. The application of clinical analytics is rapidly expanding, and several technologies that are in the hands of innovators and early adopters will become mainstream over the next several years. Some trends, such as expanding settings of care in the data warehouse, can proceed incrementally while building on current capabilities. Other trends, such as the personalization of patient care, will require the adoption of new management philosophies and clinical processes and implementation of new technologies. More information on the expanding scope and use of clinical data can be found in this HIMSS resource.[2]

Expectations are also high that mobile technology will increase access to care and transform healthcare into less expensive, prevention-based and patient-focused systems. A global research study was performed to explore the opportunities and challenges of mobile health from the perspective of patients, payers and providers. [3] Roughly one-half of patients surveyed predict that mHealth will improve the convenience, cost and quality of their healthcare in the next three years. And six in ten doctors and payers believe that its widespread adoption is inevitable in the near future. Others think that healthcare’s strong resistance to change will slow the adoption of innovative mHealth.

3 What is the role/purpose of the health record?

The basic structure of the health record has remained stable over many decades. The author of this opinion piece, Dr. Robert Foote, notes that the medical record has taken this form because it reflects how clinicians think, and the structures help clinicians make sense of the disorderly flood of information that represents every patient. [4] This article describes the role, purpose and functions of a health record to observe, record, tabulate and communicate as an important tool in the care of the patient.

4 Nursing’s role in the transformation

The transition to EHRs has significantly changed how clinicians record, retrieve, and communicate information about their patients. Concern is frequently expressed that it is difficult to retain the patient’s story when documenting in a fragmented, check box-focused electronic record. Nursing informatics can play a role in leveraging health IT to represent the patient’s story in a fully implemented EHR system. Rhonda Struck DNP, RN describes a successful program designed to gather information located throughout the EHR and present it in a collated manner, on the patient’s homepage, in an interactive, interprofessional summary.[5]

5 A transformed health system

In a transformed health system, all providers, health systems, hospitals, patients and consumers must have access to real-time, accurate and actionable health information. In 2009, the Lucian Leape Institute, established by the US National Patient Safety Foundation to provide vision and strategic direction for the patient safety work, identified five concepts as fundamental to the endeavor of achieving meaningful improvement in healthcare system safety. [6] These five concepts are transparency, care integration, patient/consumer engagement, restoration of joy and meaning in work, and medical education reform. This seminal paper, authored by some of the key industry leaders of the past decade, introduced the five concepts and illustrates the meaning and implications of each as a component of a vision for healthcare safety improvement.

In a transformed health system, evidence-based care is improving outcomes and promoting health. More than a decade ago, Suzanne Bakken RN, DNSc described the necessary informatics infrastructure to evidence-based practice. [7] The five components are proposed as the building blocks of an informatics infrastructure: 1) standardized terminologies and structures (i.e., terminology models), 2) digital sources of evidence, 3) standards that facilitate healthcare data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. It may be useful to revisit these components in light of the current informatics and health IT environment.

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[1] CCHIT (2013). A Health IT Framework for Accountable Care.

[2] HIMSS (2013). Clinical & Business Intelligence Primer: Future Direction for Clinical Business Intelligence (Module 6).

[3] PricewaterhouseCoopers (2012). Emerging mHealth Paths for Growth.

[4] Foote, R.S. (2013). The Challenge to the Medical Record. JAMA Internal Medicine, 173 (13), 1171-2.

[5] Struck, R. (2013). Telling the patient’s story with electronic health records. Nursing Management: July 2013 - Volume 44 - Issue 7 - p 13-15.

[6] L Leape, D Berwick, C Clancy, J Conway, P Gluck, J Guest, D Lawrence, J Morath, D O’Leary, P O’Neill, D Pinakiewicz, T Isaac, and the Lucian Leape Institute at the National Patient Safety Foundation (2009). Transforming healthcare: a safety imperative. Qual Saf Health Care 2009;18:424–428. doi:10.1136/qshc.2009.036954.

[7] Bakken, S. (2001). An Informatics Infrastructure is Essential for Evidence-based practice. J Am Med Inform Assoc. 2001;8:199–201.

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