Beyond Medical Informatics

The IT Department of The Medical City, in coordination with the HR Training Department, will be starting a Nursing Informatics Training Program (NITP).

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.

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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.

For 2012, these are SOME the things we will be working on here at The Medical City:

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.

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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!

In his Life as a Healthcare CIO blog, Dr. John Halamka shares his HIT lessons and experiences from his recent trip to Scotland. I found it interesting that the same challenges (and lessons) can be found here in the Philippines.

I recommend you read the whole article but let me highlight what I found most interesting for Philippine settings.

• There is a national healthcare identifier in Scotland. It would be great to have this one here in PH.
• EMRs and Data Exchange are document-centric. This is easier to implement than data element exchange where mapping becomes a big concern.

We need to learn from other countries when it comes to National HIT implementations. At this point where HIT best practices are yet to be set, the successes of different groups, hospitals and countries become important resources for our own projects.

Here’s a great idea we can use in healthcare applications:

Advanced sign-in security for your Google account

… we’ve developed an advanced opt-in security feature called 2-step verification that makes your Google Account significantly more secure by helping to verify that you’re the real owner of your account. Now it’s time to offer the same advanced protection to all of our users.

2-step verification requires two independent factors for authentication, much like you might see on your banking website: your password, plus a code obtained using your phone.

Imagine using security methods like these for clinical applications over the Web, e.g. PHRs and hospital EMRs. Patients can feel secure about their access to their Personal Health Records (PHR). Doctors can work with the hospital EMR from home.

Another good use would be for hospitals or patients giving access to other doctors.

I think this should be easy to emulate here in the Philippines with our advanced SMS technology.

Wow, I almost missed this one!

One of the original designers of the US Department of Veterans Affairs VistA system, Tom Munnecke shares his lessons learned from working with Vista (via http://www.fiercegovernmentit.com).

Here’s my quick summary:

• Build the system in a series of small steps. He calls this “Evolutionary development”
• Start with “good enough” and work fast to improve the system from there.
• Health information systems often have totally different requirements from other complex IT systems. (He proceeds to discuss the EAV model, although it was not directly named as such.)
• MUMPS may be old but it has proven itself in the field of medical informatics.

Definitely a great read!

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What do you think? Can you relate with the lessons? Are they true for you?

Let me share some good news: I am now the Chief Information Officer (CIO) for The Medical City (TMC) and its network of hospitals and clinics.

I started just over a month ago—and I really have my work cut out for me.

TMC is not unique in its healthcare IT challenges. Integration is still a major goal. The hospital information system needs enhancements and optimization. Correct alignment of IT projects with business strategy is a constant effort.

My immediate to-do list includes:

• draft an integration and EMR roadmap
• propose an effective clinical IT governance process
• build a professional IT organization
• transform IT infrastructure and services to support the TMC network

Sounds easy, right?

The road will be challenging but I welcome the adventure.

Wish me luck!

Early adopters of EMR and other Healthcare IT applications are keys in promoting EMR adoption. This is what an article calls the ‘social contagion’ theory.

Here’s the article: Doctors tech adoption influenced by social circle – American Medical News.

Hospitals will find this part useful:

The Management Science study ran statistical models and mathematical equations involving 3,989 hospitals to determine which would be the influencers and which would be influenced. One conclusion was that smaller hospitals’ use of EMRs was more likely to influence bigger hospitals’ use, rather than the other way around.

Much of the issue came down to resources. A smaller hospital might hear of a larger hospital’s success with an EMR system, but it might not have the resources to purchase one. However, researchers said a larger hospital has the financial resources to act if a smaller hospital had paved the way.

This concept might work for the Philippines. Sometimes, smaller hospitals in provinces are more aggressive for Healthcare IT growth. Their successes should be documented and broadcast to influence bigger hospitals.

Even HIT adoption among individual physicians is not immune to the ‘social contagion’:

The authors surveyed the physicians and residents to determine what social factors influenced use of the EMR, looking at the effect of professional relationships, "a friendship network based on personal intimacy," and "a perceived influence network" based on doctors’ perceptions of how other people affected their decision to adopt.

The study’s finding that personal relationships were the biggest influence on EMR adoption echoed the results of past studies on physician adoption of other technology. This was one reason researchers said they were confident in their results despite a small sample size.

I will have to consider the ‘social contagion’ concept during HIS implementations. The EMR project teams should identify physician champions not only for their ability to appreciate the use of technology but also for their ability to influence peers and colleagues.

I found a great online resource: IT Execs Release Guidebook on E-Health Records Implementation – CIO.com.

The College of Healthcare Information Management Executives released a guidebook for CIOs and other IT managers with tips and first-hand experiences in implementing electronic health records in order to meet government “meaningful use” standards.

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The publication, The CIO’s Guide to Implementing EHRs in the HITECH Era, includes best practices and steps health-care organizations should take to successfully implement EMRs, from the initial planning through the final documentation of results.

The guidebook is free for the public and can be downloaded here.

Here’s the first bit of news:

Electronic medical orders may save lives

Doctors at a California children’s hospital have found the first evidence that using an electronic system to communicate their orders may save lives.

After the system was introduced in 2007, the hospital witnessed a 20-percent drop in mortality rate, the equivalent of 36 fewer deaths over a year and a half.

CPOE implementations are challenging projects–and are prone to failure. But this shows the risk is worth taking.

About Telehealth:

Telehealth takes off as evidence grows that it can improve care, save money – FierceHealthIT

Telehealth is helping to expand the reach of dermatologists, neurologists, radiologists, critical care physicians and mental health professionals, among other specialties, and to reduce the need to transport the sickest of patients.

This news bit refers to an InformationWeek Article, which expounds on the points made about the activities and benefits of Telemedicine.

In the Philippines, the gap between what is and what should be when it comes to the delivery of basic health services is still wide. Undoubtedly, telemedicine plays an important role in bridging that gap. News like these can help in the cause.

I recently stumbled upon good news about CHITS:

First Region-wide CHITS-EMR Conference a Success

CHITS stands for Community Health Information Tracking System. More info about it here.