Overview:

This is a 14-week introductory course to the Basic Nursing Informatics Concepts and Applications for Nursing graduates.

Objectives:

• To provide all participants of the course with the necessary knowledge, skills and experience in the fundamentals of Nursing Informatics;
• To provide all participants opportunity to apply knowledge and skills in clinical systems analysis and software development and design;
• To prepare the trainees on how to work professionally in a corporate environment; and,
• To align the trainees to the corporate mission and vision of the hospital.

Target Participants or Trainees:

• Graduate of Nursing;
• Preferably a Registered Nurse (RN);
• At least with two (2) years of clinical experience;
• With basic computer knowledge and skills (Windows and MS Office); and,
• Must own laptop/notebook for use during training and practicum.

Methodology:

• Lectures;
• One-on-one coaching and mentoring sessions;
• On-the-Job-Training; and,
• Practicum Work (Special Projects).

Major Topics:

• Introduction (TMC and IT);
• Concepts in Healthcare Informatics and Nursing Informatics;
• Computer Applications in Healthcare and Nursing;
• Principles of Healthcare Interoperability and Integration;
• Effective Software Development and IT Project Management; and,
• Systems Analysis, Design and Implementation for Clinical Applications.

Practicum Work:

Participants will be working with the TMC-IT Special Projects team. Special projects may include:

• Electronic Medical Record (Clinical Documentation);
• Clinical Data Repository;
• HL7 Integration;
• Telemedicine;
• Electronic Medication Administration Record with Barcode;
• e-KARDEX Planning and Design;
• Hospital Information System Planning and Design; and,
• Outpatient Clinic Management System.

Other Details:

• Training is free. There is NO fee.
• Only a maximum of 3 participants will be accepted.
• Target start date is on March 1, 2012. All three slots should be filled up.
• Participants will be interviewed for fit into program and interest in Health IT.
• Program Duration is a minimum of 336 hours (8 hours per day, 3 days a week, 14 weeks)
• Certificate of Attendance shall be given to the trainees who have satisfied all the requirements in the Practicum.

Procedures:

• Interested and qualified participants should submit the necessary documents to the TMC Training and OD (TOD) Department and pass the initial interview:
• Letter of Interest specifying the participant’s intention to be exposed and be immersed in the Nursing Informatics Practicum and Training Program that is being provided by the Information and Technology (IT) Department,
• Updated copy of their resume with 1×1 or 2×2 size picture,
• Nursing Diploma or Nursing License.
• Shortlisted applicants will be forwarded to the IT Department for their final interview. If the participant passed the final interview, the IT Department shall forward its recommendation to the TOD Department for creation of a Memorandum of Agreement (MOA) between TMC and the participant to cover the training program.

—

Interested applicants may also send their application requirements to mbmuin(at)medicalcity.com.ph. I can forward the application to HR for initial screening before final interview with me and IT Department.

Questions, comments and suggestions are welcome.

Last January 27, 2012, the IT Department underwent extensive training in deploying, setting up and implementing all the acquired equipment. The next day, January 28, 2012, a small group of doctors and nurses were trained in the use of the equipment and software.

Why is The Medical City exploring telemedicine?

• To improve delivery of healthcare services within the whole TMC network of clinics and hospitals
• To expand service offerings beyond what is available in each local site
• To be the leader in delivering quality patient care services that goes beyond geographical boundaries

Pilot implementations of the telemedicine project will most likely include TMC Iloilo and TMC Angeles.

Telemedicine

We are looking at improving and expanding the healthcare services of The Medical City including the satellite clinics and provincial hospitals (TMC Iloilo and TMC Angeles).

MID OMRI

OMRI is the document management system for our medical records. This is were scanned images of previous patient charts are stored and managed by the Medical Information Department (MID). We plan to improve the interface, features and security of the program to allow access into the system from the various nursing units and clinical areas.

ICARUS Medication Management

The ICARUS system is our medication management system that uses barcode technology. It is deployed in all nursing units. Full compliance is a bit challenging. Poor Wi-fi coverage for the handheld units also need to be addressed. This year, ICARUS will have to be "re-implemented" to get more units to adopt the system and increase compliance.

Once ICARUS is "re-implemented", we can work with NSO for more IT projects that improve nursing workflows.

Laboratory Information System

Plans for this year include fully implementing the Microbio, Blood Bank and Histo-Cyto modules. We may need to look into building another system for Blood Bank to handle donor management.

HL7 integration of the system with SHAMAN (ADT and OMG) and PRIME (ORU) is also planned for this year.

PRIME Phase 1 Roll out

PRIME stands for Patient Records and Integrated Medical Exchange. It is our clinical data repository and electronic medical records platform. We just finished development December 2011 and we plan to roll this out in the ambulatory units within the year. First pilot implementation is at Wellness. Wellness should be working with the system by February 2012.

Roll out of the clinical documentation feature to the other ambulatory units should commence by mid-Feb or March 2012.

PRIME Phase 2 Development

There is still more to be done with PRIME. We have just touched the surface for what we need in clinical documentation and electronic medical records. Phase 2 will incorporate the clinical research agenda of the hospital.

PRIME Results Integration

We need to integrate the following systems with each other: SHAMAN, MUSE (ECG System), Laboratory Information System (LIS), OMRI, ICARUS Medication Management and PRIME.

—

This blog post is to help disseminate information among doctors and clinicians of TMC.

As always, I welcome comments, suggestions and questions. I also encourage active participation of clinical units in our efforts.

Thanks!

Text4baby receives high grades

Surveyed participants in text4baby, a health information text messaging service for pregnant women and mothers of newborn infants, reported high levels of user satisfaction, according to researchers from the University of California San Diego (UCSD) and the National Latino Research Center (NLRC).

…

Additionally, 63 percent of respondents reported that text4baby reminded them of an appointment or the need for an immunization; 75 percent reported that text4baby informed them of medical warning signs that they’d been unaware of; and 71 percent reported speaking to a physician about a topic they learned of through text4baby.

This is great use of texting for consumer health IT purposes. The text4baby site is here.

However…

Joint Commission- Doc ordering via text is unacceptable

Here’s the original post at the Joint Commission site.

Is it acceptable for physicians and licensed independent practitioners (and other practitioners allowed to write orders) to text orders for patients to the hospital or other healthcare setting?

No it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.

I know this practice is somewhat common here in the Philippines.

What do you think?

Making national policies on the Health IT tools and frameworks without identifying the target results and objectives is a mistake.

This mistake of a centralized level/policy of mandating technology is evident in recent news articles shared with the FB group. Here are quotes:

From Dismantling the NHS National Programme for IT | Media Centre (bold emphasis mine):

In a modernised NHS, which puts patients and clinicians in the driving seat for achieving health outcomes amongst the best in the world, it is no longer appropriate for a centralised authority to make decisions on behalf of local organisations.  We will continue to work with our existing suppliers to determine the best way to deliver the services upon which the NHS depends in a way which allows the local NHS to exercise choice while delivering best value for money.

The Department of Health said:

“The exchange of information between patients and clinicians and across the NHS is a fundamental part of how we are centring care on patients and making sure innovation and choice are fully supported.  The NPfIT achieved much in terms of infrastructure and this will be maintained, along with national applications, such as the Summary Care Record and Electronic Prescriptions Service, which are crucial to improving patient safety and efficiency.  But we need to move on from a top down approach and instead provide information systems driven by local decision-making.  This is the only way to make sure we get value for money and that the modern NHS meets the needs of patients.”

Sir David Nicholson, Chief Executive of the NHS, said:

“A modernised NHS needs information systems that are driven by what patients and clinicians want.  The NPfIT has provided us with a foundation but we now need to move on if we are going to achieve the efficiency and effectiveness required in today’s health service.  Restoring local control over decision-making and enabling greater choice for NHS organisations is key as we continue to use the secure exchange of information to drive up quality and safety.”

The Managing Director for Informatics at the Department of Health, Katie Davis, said:

“There are two important things we must achieve – the development of a vibrant marketplace for healthcare IT and clarity that we no longer manage delivery centrally unless there is a single, clear requirement across the NHS.  We have a great opportunity to build a new way of working which helps patients and clinicians gain the best value for public money.  I am instituting a full review of all Department of Health informatics applications and services to ensure that everything we do is compatible with these aims.  Later this autumn, I will announce what work will continue, alongside a framework for providing IT support to the NHS as it modernises.”

From Government to scrap NPfIT NHS IT programme today – ComputerworldUK.com (bold emphasis mine):

Health Secretary Andrew Lansley put the blame on the previous government. “Labour’s IT programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs.

…

“We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernised NHS.’

I’m sure many of you are starting to see the point I am making: Having a clear set of results is MORE IMPORTANT than a clear set of tools. A centralized policy on goals and objectives that allow CHOICES in implementation tools is better than a centralized policy on tools and standards without clear goals.

But what about the HIT Standards Committee in the US? Why do they have that?

Well, the point of a policy is to create a call to action.

When government creates policies for target results and goals, what is the call to action? It is to stimulate problem-solving towards a common objective. It is about EFFECTIVENESS.

When government mandates processes, e.g. standards, technology and terminology, what is the call to action? It is to control proliferation of many solutions. It is about EFFICIENCY. When it comes to interoperability, the US is at this point for their HIEs.

So, what kind of policies does the country need most right now? Problem-solving or control?

Better yet, let’s go through our sample Health IT continuum (from Part 1) as a thinking exercise:

• What does a Health IT project for a single MD practice need? Problem-solving or control?
• What does a Health IT project for a group practice need? Problem-solving or control?
• What does a Health IT project for a small hospital with disparate systems need? Problem-solving or control?

How about a network of hospitals? A chain of ambulatory clinics? A network of government hospitals? A national EHR implementation? What do these Health IT projects need in the Philippine context? Problem-solving or control?

Go through each level and think:

• Have we identified common goals and results for each?
• Do we have the right information to start mandating a specific set of standards for each level of implementation?
• If we do have a National Set of HIT Standards or Framework, is this applicable for all levels of implementation?
• Finally, do we have a clear set of goals and results identified at the national level so that a National Standard or Framework makes sense?

I don’t think so.

Mandating the tools without first identifying the project objectives is like ordering a carpenter to bring only a hammer without first allowing him to ask, "What is it that you want to build? What do you want to achieve?"

Always, always, always use the right tools for the job. But show me the job first before I start gathering my tools.

Premise:
Some members of the group proposed that a National Health IT Framework with official standards, technology and IT systems design would improve the Healthcare IT situation of the Philippines. They compared how US HIT is in a mess because it did not have these national frameworks when they started working on their Health IT systems.

My short version reply:
The US situation statement is an oversimplification. And a source of wrong thinking. Everyone needs to get out of that thinking that IT-specific policies will ‘correct’ what’s wrong with the state of Health IT in the Philippines.

My long version reply:

Health IT implementations come in different sizes but should still reside in a continuum of complexity. Small scale implementations can start from 1-user EMRs to small hospital settings. Large scale implementations can go from hospital networks to national implementations.

The “IT Perspective” would be to look at the technology needs (frameworks, standards, etc.) that each level of implementation requires. But the “Management Perspective” knows that the critical factor is to identify the different goals, objectives and desired results for each level.

Here’s a good mental exercise at this point. What would be the goals and desired results of:

• a single doctor EMR system?
• an LIS-HIS integration project?
• a Cancer Center EMR?
• a clinical data repository for a network of hospitals and clinics?
• a National EHR implementation similar to Singapore?

Each one would have different goals, priorities and objectives as compared to the others.

My short version reply was about common misconceptions of the role of policies in Health IT. We compared the PH scenario with US scenario. And this is where most get it wrong.

Many advocated the creation of national level “IT Perspective” policies, e.g. what standards we should follow, what format, what technology, what system etc. But the US national policies did NOT start like that. They were crafted from a “Management Perspective”. They identified and mandated a set of results and goals. Here are over-simplified samples:

• Medicare required better clinical documentation. EFFECT –> This lead to boom in EMR and medical transcription. (Did they say how hospitals should implement it? Not really.)
• Health insurance required more accurate diagnosis codes. EFFECT –> This lead to adoption of DRGs, ICD9-CM, CPT. Will need software to manage.
• Joint Commission identified goals for different areas. EFFECT –> Different implementations possible to achieve results. Some use IT. Some do not. Using IT proved easier.
• HIPAA mandated security and privacy goals. EFFECT –> Mostly achieved by EMR software. (There is no HIPAA-compliant software, only HIPAA-compliant organizations. Organizations looked into IT to comply with regulations.)
• ARRA/Meaningful Use/HITECH defined goals—and incentives!—in use and adoption (NOT the technology or interoperability standards). EFFECT –> Increased rate of EMR adoption.

There are plenty more stories and samples from the history of Health IT in US and other countries that drive the point. Basically, they FIRST identified the RESULTS they wanted to achieve at the level they wanted to implement. The did not go and create a policy for standards and technology without first identifying the need for it.

Let me emphasize: Having a clear set of results is MORE IMPORTANT than a clear set of tools.

(Please proceed to Part 2 Conclusion.)

My life as a CIO has been very busy. The past few weeks much more so. Some of my recent activities (I’ll write about them soon) include:

• Continuing development and design of TMC PRIME—the EMR platform we are developing.
• TMC Quality Fair Week where we had a booth that featured TMC PRIME.
• Implementation of Google Apps—Yes, TMC is now on GMail!
• Initial wrap-up of 2011 projects for Year-To-Date IT accomplishments (in preparation for budget planning).
• Initial project planning for next year’s budget.
• Initial brainstorming for restructuring of IT Department.

The last one has been in my mind for several months now—probably since I started work as CIO. I found our IT organizational structure to be rigid and unwieldy. I had a hard time responding to critical IT requirements and situations. Projects were not managed or monitored well. Some projects slip through the cracks of proper implementation.

Then it dawned on me. For several years, the main IT project was the hospital information system (SHAMAN). This system started out small but has since become the workhorse of hospital operations. And the IT department was almost exclusively organized around this application—to the detriment of other IT projects.

I shared this with my IT managers:

We have an IT department that is structured to support a single software.

That can’t be. We need to change that. We have other IT projects aside from SHAMAN, like:

• HL7 Integration Platform
• Clinical Data Repository Platform
• Clinical Documentation Platform
• Business Intelligence
• Document Management Systems

Our users also have other IT plans like:

• Improved charge capturing using mobile devices
• Improved medication management
• Online surveys and patient feedback forms
• Research and patient registries

So, I pose this challenge to my IT management team.

Let’s build an IT organization that supports the whole organization including the network of clinics and hospitals we serve.

It will not be easy. Our initial thoughts focus on the following areas:

• Strengthen the IT management team with focus on strategic planning, initiatives and relationship-building.
• Build project management and systems analysis core competencies among the staff.
• Build technical core competencies for the core technologies used.
• If possible, outsource some IT services, e.g. technical support, specialized programming.

Let’s hope we succeed.

Next year will be an exciting year!

• Achieve adoption and information exchange through meaningful use of health IT
• Improve care, population health and reduce healthcare costs through the use of health IT
• Inspire confidence and trust in health IT
• Empower individuals with health IT to improve their health and the healthcare system
• Achieve rapid learning and technological advancement

These goals are definitely something we can use in the Philippines. I think the ICT4Health efforts have similar goals.

The best next step is to formulate an action plan for each goal.

On a more personal note, these goals are not "confined" to the national level. With their broad practical application, even hospitals and other organizations can adopt these goals.

Seems like my 5-year strategic Health IT plan for The Medical City is off to a good start.

After the managers of the different sections of the department—development, SQA, support and technical—shared their activities and accomplishments, I presented possible projects and activities for next year. I also expressed the need to be more focused and proactive to ensure successful implementations.

I also wanted to end the meeting with an inspiring message. So I shared the Serenity Prayer:

Grant us the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference.

I highlighted the three concepts—serenity, courage and wisdom—and then told them that the prayer was wrong.

First off, the prayer got the order of the 3 concepts wrong. Starting with “accepting things we cannot change” is not serenity—it is surrender.

Second, it’s misleading to call it the Serenity prayer when what we need to change the world is courage. It should be the Courage prayer. I wanted my IT Department to have balls!

Lastly, the wisdom part assumed it was easy to know the difference. It is not.

So, how do we know which ones we can change and which ones we cannot?

The answer: We don’t know—and won’t know—until we try.

Therein lies the true wisdom: Going through life with the conviction to MAKE a difference is the only way to KNOW the difference.

So, I rewrote the prayer for our IT Department. I rewrote it matching the order of things we need to continually support the operations of the hospital, contribute towards better patient care and forge the way into the future.

Here it is:

Grant us the wisdom to make a difference, the courage to change the things we can change and the serenity to accept the things we cannot.

Our work in Health IT is not easy. We should first be wise enough and brave enough to challenge the status quo. Serenity should be our last resort.

Amen?

Amen.

• Australian state forms e-Health agency
• Health minister highlights Taiwan’s e-health services
• Sri Lankan govt to computerise patient information
• First phase of Singapore National EHR goes live
• NZ creates national health IT plan

But the Philippines also has its initiatives. I just hope it’s on a more national scale.

• The Philippines to deliver rural e-health services
• Philippine city automates health centres