We are overloaded with information—reports, web posts, newscasts, clinical updates, and even new coffee flavors clamor for our attention. How do we sift through it all? Is there a meaning to be distilled from all the data before us? This general cultural problem in our information age has become a particular hindrance in clinical decision-making.
More than ever before, health centers collect vast amounts of data via electronic health records, financial accounting systems and individual grant templates. We capture superfluous information for reports, but important patient information like immunization status may be missing entirely at the clinical level, yet available in an ill-defined administrative database. Many times, the full picture of a patient’s health information is only captured in paper records, narrative reports, and electronic summaries.
Electronic health record systems lack interoperability
We haven’t quite made a full transition to a patient-centered medical home when it pertains to health information. Most health centers struggle to communicate digitally with their local hospitals and outside consultants because different electronic health record systems lack interoperability. Similarly, agencies may utilize different parameters for seemingly straightforward subjects, like immunizations, when preparing grant reports. Year-to-year comparisons may also be difficult to interpret as definitions vary by vaccine type, age of interest, and number of doses.
This problem is widely recognized but often seen as an immovable obstacle that must be addressed by designing roundabout mechanisms to approximate our desired outcomes. We typically include all sorts of caveats that warn of our limitations or our oddly formed outcomes. We utilize cumbersome methods to extract actionable information from the captured data previously inputted. The burden of data collection contributes to clinician burnout, while the demand for more meaningful data accelerates.
The relatively new specialization of clinical informatics is trying to change this frustrating paradigm. Through including clinical experts with hands-on experience in health care settings, the design of information technology is being adapted to better fit the real-time patient-provider experience. Clinical informatics standardizes medical terminology across multiple-use settings, increases access to pooled data, and interprets outcomes in ways that are meaningful to both clinicians and administrators. Efforts focus on collecting useful and important information, reducing wasted time and clinician burden.
Clinical informatics combines health care and technology
NACHC is at the forefront of incorporating clinical informatics to its internal work as well as its external program assistance. Heading the recently created division of health information technology (HIT) is Julia Skapik, MD, MPH. Julia is a practicing internist and a specialist in clinical informatics. She sees her role as advancing the public good at the intersection of health care and technology. In response to seeing how technology development is so often separated from the people and processes it affects, Julia integrates workflows and personal narratives into HIT design.
Personal narratives in HIT design are key in what Julia terms as “human-centered design.” Designated as “personas,” characteristics of patients as well as providers are carefully described before any design is initiated. Social determinants of health, such as language and literacy, are understood at the front end of design and incorporated into both intervention and data collection planning so that outcomes measure the impacts of all important variables. Understanding workflows allows discernment of the most efficient and effective points of contact for program processes and for recording both qualitative and quantitative information.
If this sounds too abstract, Julia is ready with concrete examples. When health centers need to report birth outcomes and postpartum visits, many find they can extract a record of postpartum visits but can’t easily tie those in with data on live births. The live birth data is in a pediatric chart or outside hospital record. Health centers must do manual chart audits of postpartum records to find the birth information, sometimes noted on a summary sheet, but in narrative style. Information such as gestational age and weight of the infant is valuable but disconnected to the workflow and patient-provider HIT interface. By understanding how that information is collected, specialists in HIT can communicate with health centers and hospitals to create seamless data entry through interoperable EHR connections. For those who can’t get data seamlessly, HIT specialists can still modify the center’s EHR so that postpartum encounters have retrievable data fields for infant gestational age and birthweight.
Recently Raymonde Uy, MD, MBA; Andrea Price, EdM, PMP; Jayson Osika, MSc; Pedro Carneiro, MPH; Morgan Campbell and Efetobore Omadevuae joined the expanding HIT team at NACHC. Under Julia’s leadership, the team centers their work around the Data, Information, Knowledge, and Wisdom (DIKW) framework. The framework serves as a guiding principle for best data collection practices that inform practical clinical operations. However, when asked, Raymonde emphasized that collaboration and cooperation must take place between clinicians and HIT personnel for the optimal implementation of improved data collection practices.
Centering clinical information systems around patients and providers
Often times generalizations are made about populations due to lack of data specificity. For instance, a medical director may state that many of their patients have substance use disorders. They may even be able to give a percentage or raw number to support that claim. But is this data based on historical information? Current use? What substances are being referred to? What are the associated outcomes that are being seen with specific subcategories of substance users? Have any interventions been shown to be more effective than others?
In order to affect real change in substance use disorder, clinicians need to know this sort of information instead of just the headlines. Whether it is subgroups within the inadequately housed population or immigrant population or the uncontrolled diabetes population, clearer and more concise data outcomes are needed. And that only happens efficiently through effective input and design at the front end.
The informatics team uses a set of personas that drive their work. They are committed to refining clinical information systems so that they are patient-provider centric, they care deeply about eliminating health disparities and working for health justice, they live and work with communities served by health centers and they have relationships with each other that go beyond running charts and working on the latest data portrayal tool. When asked what brings them joy in work, it’s not creating a new code—it is finding balance in their work, gathering for a retreat and knowing for certain that they helped someone else enjoy their work with more confidence and clarity. Certainly, NACHC will have great impact data to share from the efforts of this HIT team.
Great information and team concepts but no written inclusion of medical record specialists who in some cases serve in duel roles i.e. medical risk, clinical auditors, etc.
Comments are closed.