Please be advised that we are currently in a controlled vendor - - PowerPoint PPT Presentation

Please be advised that we are currently in a controlled vendor environment for the One Person One Record project. Please refrain from questions or discussion related to the One Person One Record project.

Informatics…

utilizes health information and health care technology to enable patients to receive best treatment and best outcome possible.

Clinical Informatics…

is the application of informatics and information technology to deliver health care.

• AMIA. (2017, January 13). Retrieved from https://www.amia.org/applications-

infomatics/clinical-informatics

Conflict of Interest Declaration

• I do not have an affiliation (financial or otherwise) with a

pharmaceutical, medical device, health care informatics

• rganization, or other for-profit funder of this program.
• (Speakers who have no involvement with industry should

inform the audience that they cannot identify any conflict of interest.)

• I have/had an affiliation (financial or otherwise) with a

pharmaceutical, medical device, or communications

• rganization, or other for-profit funder of this program.

The Let’s Talk Informatics series meet the criteria outlined in the Manipro+ Certification guide for 1 credit by providing content aimed at improving computer skills as applied to learning and access to information. A certificate of attendance will be sent to you to personalize, along with the link for the evaluation. Thank you for attending today’s event.

This Group Learning program has been certified by the College of Family Physicians of Canada and the Nova Scotia Chapter for 1 Mainpro+ credit.

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A Program’s Journey Clinical Knowledge and Content Management (CKCM)

Presenters: Debbie Pinter Executive Director, CKCM Chief Medical Information Office (CMIO) Jon Beeby Enterprise Architect Chief Medical Information Office (CMIO)

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Objectives for Session

• 1. Setting the context
• 2. Clinical Knowledge Vision
• 3. Knowledge and Clinical Information System (CIS)

Integration

• 4. The CKCM Program
• 5. Supporting a Learning Organization
• 6. Intro to Clinical Modelling
• 7. Wrap Up & Questions

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SETTING THE CONTEXT

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AHS’s History

• In 2008 Alberta united 12 formerly separate health entities into a

fully-integrated health system

• Also brought together three provincial programs:

– Alberta Alcohol and Drug Abuse Commission (AADAC), – Alberta Mental Health Board – Alberta Cancer Board

• Ground ambulance service were moved from municipalities to AHS

in 2009

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Who is AHS now?

• Alberta Health Services (AHS):

– delivers health services to over four million people – has ~ 108,000 employees (nurses and allied health) – is supported by almost 9,300 physicians – works with 15,600 volunteers

• Services divided into five Zones

– has 106 acute care hospitals and five stand-alone psychiatric facilities – 8,471 acute care beds – 23,742 continuing care beds/spaces and 208 community palliative and hospice beds – 2,439 addiction and mental health beds plus equity partnership in 42 primary care networks

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Standards galore?

• A “quick” search of the term “assessment”, revealed

1285 “hits”

• Thousands of Order Sets!

– Calgary Zone ~ 2400 order sets in EHR – Edmonton Zone ~ 130 ambulatory care order sets in EMR – Rural Zones have many personalized order sets – ~ 10,000 paper order sets

• Huge variation in ordering tests and surgical procedures

– At least 10 different ways to order electrolytes (panels/individual lab tests) – 24,000 surgical procedures = standardized is about 2000 to 3000

• Early analysis indicates over 6000 Nursing Policy and Procedure type documents

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Alberta’s Clinical Information Systems (CIS)

• Cross continuum electronic health record in South,

North and Central zones

Meditech

• Calgary Zone – urban sites

Allscripts

(SCM)

• Edmonton Zone ambulatory

Epic

(eClinician)

• Cross continuum provincial EHR

Provincial CIS (TBD)

• Lab, Pharmacy, Diagnostic Imaging, etc.

Other

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CLINICAL KNOWLEDGE VISION

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Provincial CIS solution Zone CIS initiatives Strategic Clinical Networks Actionable evidence at the point of care Recruit = clinical “street smarts” about what works Key to reduced variability is effective engagement Standardize data & meta data Define positive & negative deviance Compare practice patterns Continuous clinical improvement Manage core clinical knowledge centrally Build consensus Conserve intellectual resources Adjudicate provincially

Why a Provincial CKCM Program?

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Why build in Alberta?

Essential activity of a learning healthcare organization

• Build capacity for evidence-informed practice and policy
• Process of CKCM drives curiosity and change

Pragmatic adoption – not re-invention

• Use best available provincial, national, international guidance
• Leverage existing AHS orderset experience (thousands)
• Focus on what works with the evidence (practice-based

evidence)

Key to CIS adoption and meaningful use

• Uptake eased by clinician participation in adaptation of guiding

content.

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Why build CKCM in Alberta?

Process more important than content

• Grows capacity to select, adapt, adopt and sensibly

use standards (analytics, research, sharing)

• Engage clinicians in development of content to reduce

inappropriate practice variation, inefficient practices and suboptimal outcomes

• Select and configure CIS for sustainable integration

and maintenance of clinical guidance – based on Alberta experience

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KNOWLEDGE AND CIS INTEGRATION

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SCN’s, Clinical Programs, Consensus Committees, DIMR CLINICAL INFORMATICS HEALTH INFORMATION MANAGEMENT Health Information System Content Clinical Knowledge Knowledge development Evidence-informed Reporting and analytics Performance measurement Variation analysis New Knowledge from research publications CDS design and build (paper) Clinical documentation build Order set design and build Care path (protocol) build Data structuring for reporting and CDS functions Health system encounters Transactional care Patient derived information (support patient care plans) Historical records

Health Information, Knowledge and Content Model

• Dr. A. Pattullo, 2012, AHS

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Decision Making: Applying EBM

Clinical state & circumstances Research evidence Patients’ preferences and actions Clinical expertise

Haynes B. Evid. Based Med. 2002;7;36-38

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Example: Patient Journey across the Continuum of Care for Acute Stroke

High-Level Patient Journey Map

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Clinical Capabilities (People, Process, Function, Resource) Clinical Support Capability Families (People, Process, Function, Resource) Personal Health Management Clinical Documentation (Minimum, Common Core, Unique Core) Medication Management Result Management Clinical Decision Support Order Management

Communication Education Personal Health Portal/Record Events Assessments/ Health Issues Care Plan Interventions Free Text Template Structured/ Coded

Natural Language Processing Closed Loop Medication Admin Bar Coded Medication Admin eMAR (administration) Cross Continuum Medication Rec Facility Medication Reconciliation Service Medication Rec Home Medication Management Evidence Based Order Sets

General Order Sets CPOE Computerized Order Entry Result Reporting Notification Media Alerts Reminders Real Time Surveillance Worklists Pathways Clnical Trending

Clinical Operations Support Health Information Management Corporate Administration Information Technology Health Information Exchange Population Health Management , Research & Analytics

Case Management Encounter Management Health Service Scheduling Intake & Screening Terminology & Taxonomies Provider Service Client Accounts Receivables Activity Case Costing

Inventory Supply Management

User Experience Device Management Access Management

Enabler

Safety Quality KPIs Surveillance Outbreak Population Mobility Referral Management Legal Record of Care Identity Management (Patient & Provider) Research Biomedical Clinical Science

Health Services/ Systems Social Determinants

Descriptive Predictive Prescriptive Emergency Disaster Bed / Capacity Management Health Records Management Media Information Life Cycle Location Accounts Payable Application Portfolio Management Clinical Financial Management

Asset Management

Corporate Admin Workforce Management Master Data Mangement Clinical Content and Knowledge Reporting Method Performance Analytics Transitions Monitoring/ Manage Process Immunization Allergies Conditions Advanced Directives Interventions Medications Continuity of Care Record Data Elements History Vitals/ Physiological Summary/ Reports Prevention & Promotion

Understand the CIS Architecture

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THE CKCM PROGRAM

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CMIO Organization

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CKCM Organization

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Five CKCM Program Components

• 1. Learning

Culture

Engagement Collaboration Change Adoption Continuous Loop

• 2. Program

Services

Skilled Informatics Professionals Skilled Clinicians in EBM/EBP

• 3. Information

Architecture

Knowledge Lifecycle

Development Approval Storage Dissemination Publication

• 4. Health Care

Technology

Tools to support the work

Collaboration Knowledge Repository Clinical Portal Interoperability to CISs

• 5. Governance - Decision Making Structures

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CKCM Goals

• development, adjudication, maintenance and

dissemination of evidence-informed and best practice knowledge and standards Facilitate Facilitate

• storage, access, modelling and management of

clinical knowledge Frame work Frame work

• enabling better decision-making and knowledge
• ptimization through data

Analytics Analytics

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CKCM Guiding Principles

Focus on Patient & Family Centred Care Clinician Driven: by clinicians for clinicians Based on clinical best practice, evidence, and outcomes Develop SAFE system agnostic clinical guidance Leverage work already done across the organization Learn by doing - a continual improvement process Provincially developed and governed

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CKCM Iterative Process – Learn by Doing!

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Lifecycle: Capabilities & Systems

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Analytics Framework

Data & Measurement Logical Model

Define data requirements Business Value Definitions

Describe the need & Identify the desired change, Understand method of measurement & Build analytic questions

Create clinical knowledge artifacts

Supporting Master Data * Patient Record Clinical Data

Define measurement rules

(How we use the information we have, to build the measurement we need, to support the Business Value defined) Care Timeline Data Patient Demographic Master Data

Generate new information Use new information

Compliance to Standards Appropriateness Patient Outcomes Cost Outcomes Therapy Effectiveness Foundational Knowledge Clinical Documentation Clinical Knowledge Topics Clinical Decision Support Evaluation of Standards Evaluation of CKT

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Clinical Knowledge & Content Management

Foundational Knowledge

Example: Lab/DI catalogue

Clinical Documentation

Example: Scoring Tools

Care of Diseases, Conditions

Example: Guideline, Clinical Pathway, Order Set

Three Areas of Work

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CKCM Resources

• We currently have 24 Clinical Informatics Leads, 1

informatics analyst, 2 BAs, 3 OCMs, 2 PM staff, and 4 leaders for a total of 36 FTEs.

• Expect us to be at 40 FTEs by year end as we currently

have a few outstanding vacancies and will be growing the team.

• We have 22 physicians on salary, ranging from 0.1 to

0.3 FTE.

• We also have engaged with 350 physicians and nearly

900 clinicians on working groups in the past quarter.

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SUPPORTING A LEARNING ORGANIZATION

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Recap

• AHS major initiative a Provincial Service for Clinical

Content Design (CKCM)

• Clinician & Informatics teams building CIS content using

“Open Standards”

– Orders content (catalogues, order items, order sets) : – Clincial Documentation – Knowledge Topics (training, decision support). – Care Pathways

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Why do this?

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Healthcare systems in the future must deliver improved care for less cost. Without good informatics capabilities, we cannot fully realize CIS benefits and risk re-implementing “paper based” thinking. Without our clinicians at the center our work, we risk creating many barriers to adoption and deliver changes that don’t demonstrate value at the front-line of care. We will build our evidence-based informatics capabilities that will serve our healthcare system for many years.

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Provincial CIS Content Repository Collaborative Authoring & Review Clinical Systems & Clinical Portals

Clinical Subject Matter Experts Informatics Experts Clinician Users & CIS Configuration Teams

Learning & Renewal [analytics, research etc.]

CKCM Guidance & Standards Cycle

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• Source of truth for Provincial CIS content
• Reusable content and decision support components
• Clinicians review & contribute via non-technical tools.
• Governed by Clinicians as a Strategic Asset.

OpenEHR based tools

Provincial CIS Content Repository

A Vendor Neutral Knowledge Repository

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INTRO TO CLINICAL MODELLING

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Template 1 Template 2 Common Concepts

Designing using common concepts

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Example Detailed Clinical Model

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Adverse Reaction Example

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Apgar Example

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If Blood Pressure was a building block

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Including Terminologies & Coding

[SNOMED-CT(2003)::163030003]

Systolic

[SNOMED-CT(2003)::163031004]

Diastolic

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Blood Pressure Standard Pain Score Standard Step 1 Select the relevant knowledge part(s) from the standard Step 2 Include in form for use in ICU. B.P. Pain Apgar Score Standard Knowledge Building Blocks A nice screen that I can use ;-)

Building an ICU Assessment (simplified example)

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Step 1 Select the relevant knowledge part(s) from the standard Step 2 Include in form for use in Neonatal workflow. B.P. Pain Apgar Knowledge Building Blocks A nice screen that I can use ;-) Blood Pressure Standard Pain Score Standard Apgar Score Standard

Building a Neonatal Assessment (simplified example)

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Screen designs meet the specific requirements of the groups that will use them, but use consistent data standards.

Neonatal Assessment ICU Assessment

Meeting Clinician needs, keeping standards

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Dashboard / Report / Extract / Summary / Message

Content Standards drive Information Reuse

Standards in the “building blocks” allow information to be shared and reused appropriately, regardless of who recorded it.

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Modular Content built in open standards using a collaborative tool.

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Takeaways

Closing the Quality Loop: A tools & services model connecting clinician leadership to CIS design, implementation and analytics. Appropriate Standards: evidence and consensus based, structured for reuse, with “just enough” detail and coding to support low-burden workflow, data sharing, analysis & measurement. Strategic Resource: an open repository of clinical decision support material, modelled using a vendor-agnostic formalism. Open Platform: an opportunity to elevate this collaboration to a national level

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Wrap Up

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Demo / Discussion

• http://openehr.org/ckm/
• http://ahsckm.ca

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https://www.youtube.com/watch?v=h3-8EFcDJo0

Standard Data Models & Services – Dr Stan Huff.

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…the need for the clinical models is dictated by what we want to accomplish as providers of health care. The best clinical care requires the use of computerized clinical decision support and automated data analysis. Clinical decision support and automated data analysis can only function against standard structured coded

• data. Therefore, DCM provides the standard data structure and

terminology needed for clinical decision support and automated data analysis.

Stan Huff, MD Chief Medical Informatics Officer, Intermountain Healthcare

The role of Detailed Clinical Models

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Building with Re-useable Blocks

Information adapted from Ocean Informatics

Fixed

OpenEHR “Reference Model” Basic Types

Stable

“Archetypes” AHS Clinical Concepts

Flexible

“Templates” AHS Implementable Designs

• Screens
• Forms
• Messages
• Orders
• Documents
• Catalogues
• Care Pathways

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Provincial Resources Provincial Resources Provincial CIS Content Repository

Information adapted from Ocean Informatics

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Modelling tools

Please be advised that we are currently in a controlled vendor environment for the One Person One Record project. Please refrain from questions or discussion related to the One Person One Record project.

Informatics…

utilizes health information and health care technology to enable patients to receive best treatment and best outcome possible.

Clinical Informatics…

is the application of informatics and information technology to deliver health care.

• AMIA. (2017, January 13). Retrieved from https://www.amia.org/applications-

infomatics/clinical-informatics

Conflict of Interest Declaration

• I do not have an affiliation (financial or otherwise) with a

pharmaceutical, medical device, health care informatics

• rganization, or other for-profit funder of this program.
• (Speakers who have no involvement with industry should

inform the audience that they cannot identify any conflict of interest.)

• I have/had an affiliation (financial or otherwise) with a

pharmaceutical, medical device, or communications

• rganization, or other for-profit funder of this program.

The Let’s Talk Informatics series meet the criteria outlined in the Manipro+ Certification guide for 1 credit by providing content aimed at improving computer skills as applied to learning and access to information. A certificate of attendance will be sent to you to personalize, along with the link for the evaluation. Thank you for attending today’s event.

This Group Learning program has been certified by the College of Family Physicians of Canada and the Nova Scotia Chapter for 1 Mainpro+ credit.