Beyond Medical Informatics

This is a guest post submitted by one of the NITP trainees: Sheryl Cu-Pineda. I changed some names and items for privacy and accuracy. Some observations and events may have changed since this was last submitted. – Dr. Mike Muin

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I turn off the alarm clock and start preparing to go to “work”. “Work”—that’s what I call it and that’s what it feels like. But its really a training program.

The Medical City, under its CIO Dr. Mike Muin, initiated a training program called NITP which stands for Nurse Informatics Training Program. And this is what’s been keeping me busy for the past two months now.

I and my two other trainee-mates are helping the Clinical Applications team create the Nursing Module that will be incorporated into the Health Information System. We’re currently working on digitizing the Medication Treatment Record, I and O sheet and the Vital signs monitoring sheet.

Going back to my story, on my way to work I think of the things that I need to accomplish for the day.
Yesterday it was about the MTR or the Medication Treatment Record for TMC PRIME. TMC PRIME (Patient Records and Integrated Medical Exchange) is TMC’s Health Information System.

• Project Overview Statement—Done
• Process workflow—Done
• User Stories—Done
• Presentation—Done

Everything has been emailed to our supervisor who uploaded it to Asana, a project tracking tool. We also had a meeting with our outsourced development team. It’s one of the weekly meetings we have regarding project updates. Later in the day I had to log onto Google Docs and answer some clarification questions from the developers about MTR. I’m happy be exposed to the wonderful world of Google’s tools: Google Calendar, Google docs, Gmail.

Today, we will be meeting with NSO personnel and gather requirements that needs to be incorporated into the Nursing Module of TMC PRIME. It’s important that we consult with them so that they actually get a system that they would want to use!

Coordination is key. It’s our role to get user requirements and to relay them accurately to the development team. Hence the documents, presentations and meetings. Not that I’m complaining. It’s really just the way things are.

For next week, I hope that we’ll get to work on the Laboratory Information System (LIS). We get exposed to the different systems hospitals use, and the main goal is to integrate all of these into one Healthcare Information System—TMC PRIME!

It’s so cool and exciting. With LIS, we get exposed to the process of choosing vendors/suppliers and dealing with maintenance agreements—and of course HL7 compatibility. For LIS, there’s the migration and version upgrade. We’re sort of late on this project.

Doc Mike also gave us lectures about Electronic Medical Records and Project Management. But the most interesting lecture was about HL7.  The concept is just so simple and yet it can accomplish so much data sharing among different systems. Let’s just not get into the technical part. My poor brain just won’t be able to take how it’s all coded!

Of course, it’s not just us nurse trainees doing all the work with regards to Nursing Module, LIS, e-Kardex data migration and other projects. We work under project managers who guide us and who can address our questions. Its a really nice experience all in all.

If someone would ask me if I’d recommend NITP to others, I’d say YES. The exposure that you’ll get here can’t be found anywhere else. The exposure to the Health IT world is fascinating. Its just so valuable because as I see it, health IT is just beginning to grow in the Philippines and the NITP is a good push to get that head start in this growing industry.

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Comments welcome! – Dr. Mike Muin

This is a guest post submitted by one of the NITP trainees: Tereska S. Quisao. I changed some names and items for privacy and accuracy. Some observations and events may have changed since this was last submitted. – Dr. Mike Muin

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It’s already been a month since I became part of the Nursing Informatics Training Program (NITP) under the IT Department of The Medical City. The work environment is very dynamic and there are a multitude of projects going on at the same time. It’s just as busy as a nursing unit, and I have to say that I’m enjoying myself. Working in IT is very different from what I’m used to since my background is purely bedside nursing. The information coming in can be technical and a little overwhelming, but I see that as a challenge.

Right now, I am working with the Clinical IT team on the Cathlab results and Tumor Registry automation. For the Cathlab, TMC PRIME will become a platform in which physicians can enter the results of different procedures with a uniform format and more speed and accessibility. We have met with the Cathlab staff and they seemed enthusiastic about the project and have been very accommodating. We made a Project Overview Statement (POS) and process flow diagrams. One of the senior nurses familiar with the workflow at the Cathlab has already seen and approved both documents. I have also written a separate POS for the migration of existing Cathlab results. Our concern right now is that we do not have any input from the doctors who will be the end-users for this project. We plan to meet with them to present what we have accomplished, gather feedback, and find a possible physician champion for the project.

We are also working on the Tumor Registry for Cancer Research. There is a lot of statistical data to be dealt with and an improved automation of its registry seems necessary. I was present at a meeting with one of the doctors of the center wherein the forms to be used were discussed. I have also talked to the staff several times regarding their workflow process. We made a POS and a process flow diagram and sent a copy of the POS to the doctor who said that it looks aligned with their goals. (However, we need more specific input with regards to the success criteria.)

After the workflow was laid out into a diagram, it became obvious that data collection was taking up a large amount of time which could be allotted for other tasks (such as the actual input of data into their existing registry). This made me realize how much more effective work would be with the use of technology.  It would help to automate many parts of their workflow but it might not be cost-effective. Another obstacle that we identified is the lack of manpower, as only two people make up the staff for cancer research.

What I am very excited about right now is the possibility of electronic nursing documentation. It gave me a lot of ideas. Nurses need to fill out more and more forms as hospitals continue to seek improvement in care by better documentation, legal protection, and compliance with JCI requirements. I used to dream of having one big Trodat stamp with a template of what is commonly written down in nurses’ notes. This is probably the closest thing to it.

Charting can be very time-consuming and anything that will make it quicker and easier will help, especially since it must be done for each patient. Small things (such as calculating your patients’ BMI, manually filling up patient’s name and PIN number on headings of each page, or computing their 24-hour input and output) can accumulate and take a big bite out of our time—and time is very important for a nurse. Imagine how much weight would be lifted off our shoulders if we had a nursing documentation system when we go on duty for 2 straight shifts with 8 patients assigned to you.

If done correctly, computerization of nurses’ notes can lighten our workload and allow us to allot more time for accomplishing other tasks. TMC can serve as the pioneer in electronic nursing documentation and as a model for other hospitals. I think it would make a good impact on the nursing community here in the Philippines not only because it will be the first of its kind in the country, but because there are so many advantages to be had with its implementation.

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More notes to come (I hope!) from the other 2 trainees. Comments welcome. Thanks! – Dr. Mike Muin

Three articles piqued my interest this week:

1. Do’s and Dont’s of Telemedicine

We are currently exploring Telemedicine for The Medical City and this article provides good insights for our implementation. I especially liked his practical tips in using common Web meeting technologies to improve telemedicine programs.

1. Why adoption of EHRs is a transformational event for physicians

This article explores why role-reversal in the hierarchy of medicine might help boost EHR adoption.

1. Why EMR is a dirty word to most physicians

I especially liked this article. It is a personal discourse on the kinds of challenges that HIT professionals like me will face as we advocate and promote EMR adoption.

QUICK UPDATE (Feb-08-2012): Due to the number of submissions, we will stop accepting applications by 5pm tomorrow, Feb-09-2012. This will give us time to sort through all CVs for interview schedules. Thanks!

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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.