Why do we need to transform Healthcare Education and Professionals Training Introducing some Disrupt

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Why do we need to transform Healthcare Education
and Professionals Training? Introducing some
Disruptive InnovationsTowards a Smarter, Safer
Healthcare System !

• California
• October 2009

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Marion J. Ball, Ed.D

• Senior Advisor Healthcare and Life Sciences
  Institute, IBM Research,
• Professor Emerita, Johns Hopkins University
• Member, Institute of Medicine
• Member of the Board Of Regents of the National
  Library of Medicine
• Past President, International Medical Informatics
  Association ( IMIA)
• Fellow American College of Medical Informatics
  (ACMI),
• Past Board member and Fellow of the Health
  Information Management and Systems Society(
  HIMSS), American Health Information Management
  Association (AHIMA) Medical Library Association
  (MLA) and the College of Health Information
  Management Executives (CHIME)

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This mandate for change is a mandate for
smart.WE MUST ASKWHAT DOSE THE CARE GIVER NEED
TO ENABLE HIS OR HER PRACTICE?
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Everyone thinks of changing the world but no one
thinks of changing himself (oneself
LHR) Loren Roth - Leo Tolstoy
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Transforming Health Care
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• Doing the right thing and doing the right thing
  right
• Michael Millenson, Demanding Medical Excellence
  Doctors and Accountability in the Information
  Age, 1997

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• Standards

The Tower of Babel, 1563 Pieter Bruegel, 1525
-1569
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Evolving Healthcare Environment

• Care delivery models
• EMRs, EHRs, PHRs
• Remote monitoring
• Disease management
• Telehealth
• Consumers assume increased responsibilities
• Clinical care
• Financial risk
• Trends and Issues Facing the Healthcare Industry
  in 2010 and Beyond
• Charlene Marietti, Executive Director of
  Editorial Initiatives, Vendome Group LLC

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84 of all health care professionals are not
physicians - Loren Roth
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U.S. Health Care Workforce - Nursing

• Nearly 3 million practicing nurses in the U.S.
• More than 55 of all health care workers
• Nurses are knowledge workers
• Aging workforce and estimated severe shortage by
  2020
• Nursings workforce as well as other clinicians
  must be capable of innovating, implementing, and
  using health communications and information
  technologies

There is no aspect of our profession that will
be untouched by the informatics revolution in
progress. Angela McBride Distinguished
Professor and University Dean Emeriti Indiana
University School of Nursing
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A huge chunk of our clinical work force is
Nursing !! Nursing and the other allied health
professions are the bulk of the Healthcare work
force! Thus the birth of TIGER
Technology Informatics Guiding Education Reform
( TIGER)
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9 Collaborative Teams
Created from combining all 3-year action steps
into common themes/topics

• Standards and Interoperability
• Healthcare IT National Agenda/HIT Policy
• Informatics Competencies
• Education and Faculty Development
• Staff Development/Continuing Education
• Usability/Clinical Application Design
• Virtual Demonstration Center
• Leadership Development
• Consumer Empowerment/Personal Health Record

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Two Themes TIGER has realized to address our
immediate needs

• Workforce Development
• Informatics Competencies
• Education Faculty Development
• Staff Development
• Leadership Development
• Virtual Demonstration Center
• Health Information Technology Influence
• Standards Interoperability
• National Health IT Agenda
• Usability Clinical Application Design
• Consumer Empowerment PHRs

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TIGER RECOMMONDATIONWheres the beef? Virtual
Demonstration Center

• Demonstrate the breadth and depth of IT resources
  in use by nurses to enhance their practice.
  Collaboration between industry, healthcare
  organizations academic institutions, and
  professional organizations to create educational
  modules for nurses that are based upon
  informatics competencies that are integrated into
  their training.
• Use practice examples from different practice
  environments that can demonstrate best practices,
  results of research, case studies and lessons
  learned by partnering with nursing professional
  organizations
• Provide universal accessibility to the
  demonstration center for all clinical
  stakeholders, and integrate this resource into
  the curriculum

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Lessons Learned
The clinician must see and experience the fact
that the new approach using enabling technology
can help him, or her, be a more capable, more
responsible health care provider.
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Where are we now? Phase III TIGER Initiative

• Launched TIGER Phase III Executive Committee
  Chaired
• by Dr. Patricia
  Hinton Walker
• Book in Press Nursing Informatics where
  Technology and Caring Meet.
• Ball, Douglas, Walker
  TIGER editors.
• TIGER SUMMIT To disseminate the 9 Collaborative
  recommendations and embrace the other healthcare
  professions toward an Interdisciplinary team
  effort for the patient.
• Building the Virtual demonstration center.
• Put the 9 recommendations into action over the
  coming years.
• Standards Interoperability
• National Health IT Agenda
• Informatics Competencies
• Education and Faculty Development
• Staff Development
• Usability Clinical Application Design
• Virtual Demonstration Center
• Leadership Development
• Consumer Empowerment Personal Health Records

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SCIENCE TECHNOLOGY ENGINEERING AND MATHEMATICS
(STEM)
Strengthen Education K-12Graduate,
Continuing Education Vocational Education Thought
the NSF and other federal state and local
institutions and encourager partnerships
with universities industry community centers, etc.
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Very Simple things can make a difference in
workforce retention.----------------------------
--------------------------------------------------
-----

• The following are just an example of research
  finding at Johns Hopkins Hospital in Baltimore
  Maryland.

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I know the names of the personnel that I worked
with during my last shift
of respondents who agreed
Source Bryan Sexton. Looking in the Mirror
Assessing and Improving Culture in Medicine 2004
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Teamwork Climate is perceived differently by MDs
and RNs
Source Bryan Sexton. Looking in the Mirror
Assessing and Improving Culture in Medicine 2004
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ICU Physicians and ICU RN Collaboration
Source Bryan Sexton. Looking in the Mirror
Assessing and Improving Culture in Medicine 2004
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Talking with your feet the subtle but pernicious
effects of teamwork, three years later

• RNs reporting high levels of collaboration 3
  year 23 turnover
• RNs reporting low levels of collaboration 3 year
  40 turnover

Source Bryan Sexton. Looking in the Mirror
Assessing and Improving Culture in Medicine 2004
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Why is health IT hard?

• Doesnt solve the physicians problem
• Little attention to workflow
• Introducing technology is disruptive
• Benefits accrue to others
• Incentives are misaligned
• Lack physicians and nurses with informatics
  training

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U.S. hospitals climbing up the EMR Adoption Model
As the EMR market matures, more hospitals are
deploying increasingly advanced EMRs and related
technologies, enabling hospitals to ascend to the
upper stages of the HIMSS Analytics EMR Adoption
Model.
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How can we work smarter,and find new ways in
which healthcare organizationswill embrace
enabling technologies? ---------------------------
------------------------------------------
ANSWER! WE NEED TO THINK OUT OF THE BOX!
A Disruptive Technology!
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No problem can be solved within the same
consciousness which caused it.
Insanity Continuing to do the same thing and
expecting different results.
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What Will IT Take to Fix This 40 Year Old
Problem? A SMARTER HEALTHCARE PLANET
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PHRs as Disruptive Technology

• Access to routine telemedicine or telehealth
  services
• At home, at work, on vacation or in shopping
  areas at private health kiosks and Minute
  Clinics (at less cost!)
• Access to personal health and fitness tracking
  and benchmarking
• A giant step toward wellness
• MJ Ball, C Smith, RS Bakalar. Winter 2007.
  Personal Health Records Empowering Consumers,
• JHIM 2007 21(1)76-86

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Special Thanks for the following slides To

• David Sharbaugh
• UPMC Director of Quality Improvement and
  Informatics
• The Smart Room Project

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The Smart Room
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The Smart Room
Physician Nurse Aide Dietary Phlebotomist
MR. JAMES SMITH ALLERGIES LATEX 123-43
1/2/1965
1234567 890 ABC 10.5 DEF
12.7 CHHXa S CS kjhc aks ahc kjah ckhasc
Asdsd Da dh dhK s j c chc
das CHHXa S CS kjhc aks ahc kjah ckhasc
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Healthcares Major Problem

• We have to stop adding work.we must to find a
  way to take hard work away and make success easy
  for the front line.
• These features are designed to take extra steps
  away. To subtract!!!

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The Medical Home Concept!

• The Medical Home puts the customer at the center
  of the new healthcare model !

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Patient-Doctor Relationship
Medical Home is a Relationship
A long-term comprehensive relationship with your
Virtual Care Team, led by your Personal Physician
and empowered with the right technology and tools
to produce better overall family health
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Care delivery processes have been decomposed and
tailored specifically to meet medical home
requirements
Assess Health
Select Care Providers
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Gather Individual Health Information
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Design Care Plan
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Enroll Patient in Programs
Provide On-going Care
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Improve Process
Pay for Products Services
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Measure Reward
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Harriet Lane ClinicA Comprehensive Community
Clinic Model
Parent Support
Safety ResourceCenter
Medical, Dental, Mental Health, Nutrition Services
Social Work Child Life Services
Family-Centered Pediatric Primary Care
Acute Care
Preventive Care
Reach Out Read Literacy Program
Legal Advocacy Services
Youth Fitness Circle
Chronic Care
Developmental Services
Specialty Communication
Education
Developmental Assessment Services
Considering College Program
Project HEALTH Family Resource Desk
Educational Support
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A proactive, value-based health system should
help move people move people from right to left
and keep them there
Health care spending
Health Status
Healthy/ Low Risk
At-Risk
High Risk
Active Disease
Early Symptoms
20 of people generate 80 of costs
A value-based health care system
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• So,
• Whats the Problem
• Failure to Provide Clinicians Useful IT Systems
  !!

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SOLUTION!

• Anticipate needs have data/information ready
  before clinician needs it
• Understand the individual clinicians work flow
• Context is everything ? So is speed
• Hide complexity with simplicity (magical IT)
• Support clinician in office, hospital, home, car
  with scalable appliances and same interface
• Build for Utility

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Goethe
"Knowing is not enough we must apply.
"Willing is not enough we must do.
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The Challenge for you in the audience. Who will
step up to the plate and take the action? TO

• Reform our education and training needs?
• Address the Point of Care issues?
• Adopt the disruptive innovations.
• Implement the tools and exemplars that exist
  today that will meet the need of the caregiver at
  the point of care!!
• YOU CAN MAKE A DIFERENCE!!

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