Informatics and Evidence-based Practice

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Informatics andEvidence-based Practice

• M8120
• Fall 2001
• Suzanne Bakken, RN, DNSc, FAAN
• School of Nursing Department of Medical
  Informatics
• Columbia University

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Whats the Problem in Practice?

• Avoidable errors
• Under-utilization of services
• Overuse of services
• Variation in services
• Gap between best practice and actual practice

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Ways of Knowing for Practice

• Tradition
• Authority
• Personal experience
• Trial and error
• Intuition
• Logical reasoning inductive or deductive
• Systematic inquiry

4
What is Evidence-Based Practice?

• Evidence-based medicine is the practice of making
  medical decisions through the judicious
  identification, evaluation, and application of
  the most relevant information (Friedland, 1998)

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What is Evidence-Based Practice?

• Traditional conceptualizations
• Research utilization
• Clinical trials-based
• Clinical practice guidelines
• Application of domain knowledge to patient care
• Evidence as a continuum

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What Data Do We Need for Evidence-Based Practice?

• Information about the patient
• Domain information and knowledge (the evidence)
  from systematic inquiry and other sources

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Informatics Supports

• Building the evidence
• Retrieving the evidence
• Analyzing the evidence
• Applying the evidence

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Foundation for Evidence-based Practice

• Standardized terminologies
• Digital sources of evidence
• Standards that facilitate health care data
  exchange
• Informatics competencies
• Informatics processes that support the
  acquisition and application of evidence to a
  specific clinical situation

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Standardized Terminologies

• Capture patient care data in a standardized
  fashion
• Facilitate data re-use and aggregation
• Index information resources
• Facilitate information retrieval

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Standardized Terminologies
System Problem/Dx Interventions
Outcomes NANDA Taxonomy 1 x Current
Procedural Terminology x Nursing
Interventions Classification x Omaha
System x x x Home Health Care
Classification x x x International
Classification of Diseases x SNOMED
International x x x Nursing Outcomes
Classification x National Health Service
Clinical Terms (Read) x x x Medcin x x x
First Data Bank Pharmacy KB x x
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Outcomes of Interest

• Traditional
• Mortality
• Morbidity
• Health services utilization
• Clinical phenomena (e.g., pain, decubitus ulcers)
• Patient health status
• Knowledge
• Caregiver
• Family
• Community

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M8120

• Strengths and weaknesses of existing
  terminologies
• National and international standardization
  efforts related to representing concepts in
  computer-based
• Unified Medical Language System

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Foundation for Evidence-based Practice

• Standardized terminologies
• Digital sources of evidence
• Standards that facilitate health care data
  exchange
• Informatics competencies
• Informatics processes that support the
  acquisition and application of evidence to a
  specific clinical situation

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Types and Sources of Digital Evidence

• Bibliographic
• Primary literature
• Synthesized
• Practice parameters
• Standards of care
• Practice guidelines
• Disease management plans
• Comparative databases
• Knowledge bases
• Diagnostic decision support systems
• Pharmacy

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M8120

• Bibliographic sources
• Primary
• Cochrane Collaboration
• Diagnostic decision support systems
• Clinical practice guidelines

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Foundation for Evidence-based Practice

• Standardized terminologies
• Digital sources of evidence
• Standards that facilitate health care data
  exchange
• Informatics competencies
• Informatics processes that support the
  acquisition and application of evidence to a
  specific clinical situation

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Standards for Healthcare Data Exchange for EBP

• Data and knowledge representation
• Messaging
• Privacy, confidentiality, and security
• Digital library

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M8120

• Data and knowledge representation
• Messaging
• Privacy, confidentiality, and security

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Foundation for Evidence-based Practice

• Standardized terminologies
• Digital sources of evidence
• Standards that facilitate health care data
  exchange
• Informatics competencies
• Informatics processes that support the
  acquisition and application of evidence to a
  specific clinical situation

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Informatics Competencies

• Acquire various types of data, information, and
  knowledge
• Organize data, information, and knowledge
• Critically analyze and synthesize data,
  information, and knowledge
• Apply data, information, and knowledge in the
  clinical decision making and care provision
  process
• Use informatics-based approaches and information
  technologies in clinical decision making and care
  provision process

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Basic Computer Literacy Skills Required for M8120
Assignments

• Access and download documents from WWW
• E-mail and e-mail attachments
• Word-processing
• Power point slide presentation
• These will not be taught in M8120! Classes
  available on campus.

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M8120 Informatics Competencies

• Acquire various types of data, information, and
  knowledge
• Retrieve EBP literature from a variety of sources
  (Medline, CINAHL, CliniWeb, Cochrane
  Collaboration)
• Organize data, information, and knowledge
• Organize literature retrieved using a systematic
  approach (e.g., EndNote)

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M8120 Informatics Competencies

• Critically analyze and synthesize data,
  information, and knowledge
• Prognosis
• Diagnosis
• Clinical practice guideline
• Therapy
• Apply data, information, and knowledge in the
  clinical decision making and care provision
  process
• Evidence-based practice synthesis
• Assessment of practice relevance in critiques
• Expected value decision making
• DXplain

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Foundation for Evidence-based Practice

• Standardized terminologies
• Digital sources of evidence
• Standards that facilitate health care data
  exchange
• Informatics competencies
• Informatics processes that support the
  acquisition and application of evidence to a
  specific clinical situation

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Informatics-based Approaches

• Patient care systems
• Integration of disparate sources
• MedWeaver
• Skolar and Skolar RN
• Task-specific information retrieval
• Infobuttons
• Alerts and reminders related to practice
  guidelines
• Tailored delivery of informational and
  educational interventions
• PatCIS
• MI Heart
• Elicitation of client preferences
• Expected value decision making (decision analysis)

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Patient Care Systems

• Electronic health records
• Care management (e.g., care plans, critical
  pathways)
• Ancillary systems
• Laboratory
• Radiology
• Pharmacy

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Integration of Disparate Sources
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Task-Specific Information Retrieval
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Tailored Delivery of Informational and
Educational Interventions
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Elicitation and Incorporation of Client
Preferences
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Standard gamble
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Expected Value Decision Making
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A Simple Decision Tree
No cure
U2
Disease present
p.90
No cure
U2
Do not operate
Survive
p.10
p.10
p.10 p.90
U20
Cure
Try for the cure
p.90 p.10
p.90

U20


Cure
Disease absent
Disease present
Operative death U0 Operative death U0
p.10
Cure
p.02 p.98
U20
Palliate
p.10 p.90
Operative death
Operate
Survive
U0
U2
p.01 p.99
p.90
No Cure
Disease absent
U20
Survive
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M8120

• Electronic health records
• Dxplain
• Alerts and reminders
• Expected value decision making (Data 3.5)
• Interactive health communication