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 organization, 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 organization, 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.
Clinical Knowledge and Content Management (CKCM) A Program’s Journey Presenters: Debbie Pinter Executive Director, CKCM Chief Medical Information Office (CMIO) Jon Beeby Enterprise Architect Chief Medical Information Office (CMIO) ahs.ca
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 ahs.ca
SETTING THE CONTEXT ahs.ca
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 ahs.ca
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 ahs.ca
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 ahs.ca
Alberta’s Clinical Information Systems (CIS) • Cross continuum electronic health record in South, Meditech North and Central zones Allscripts • Calgary Zone – urban sites ( SCM ) Epic • Edmonton Zone ambulatory ( eClinician ) Provincial CIS • Cross continuum provincial EHR (TBD) Other • Lab, Pharmacy, Diagnostic Imaging, etc. ahs.ca
CLINICAL KNOWLEDGE VISION ahs.ca
Why a Provincial CKCM Program? Actionable evidence at the Provincial CIS solution point of care Zone CIS initiatives Recruit = clinical “street Strategic Clinical Networks smarts” about what works Key to reduced variability is effective engagement Manage core clinical Standardize data & meta data knowledge centrally Define positive & negative Build consensus deviance Conserve intellectual Compare practice patterns resources Continuous clinical Adjudicate provincially improvement ahs.ca
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. ahs.ca
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 ahs.ca
KNOWLEDGE AND CIS INTEGRATION ahs.ca
Health Information, CDS design and build (paper) Knowledge and Content Model Clinical documentation build Order set design and build Care path (protocol) build Health system encounters Data structuring for reporting Transactional care and CDS functions Patient derived information System (support patient care plans) Content CLINICAL Historical records INFORMATICS HEALTH SCN’s, Clinical INFORMATION Clinical Health Programs, Consensus MANAGEMENT Knowledge Information Committees, DIMR Knowledge development Evidence-informed Reporting and analytics Performance measurement New Knowledge Variation analysis from research publications Dr. A. Pattullo, 2012, AHS ahs.ca
Decision Making: Applying EBM Clinical state & circumstances Clinical expertise Patients ’ Research preferences evidence and actions Haynes B . Evid. Based Med. 2002;7;36-38 ahs.ca
Example: Patient Journey across the Continuum of Care for Acute Stroke High-Level Patient Journey Map 11 ahs.ca
Understand the CIS Architecture Order Result Clinical Decision (People, Process, Function, Resource) Clinical Documentation Personal Health Medication Management Management Management Support (Minimum, Common Core, Unique Core) Management Clinical Capabilities Evidence Based Closed Loop Cross Continuum Prevention & Result Reporting Alerts Free Text Immunization History Communication Order Sets Continuity of Care Record Data Elements Medication Admin Medication Rec Promotion General Order Summary/ Assessments/ Bar Coded Facility Medication Reminders Notification Template Allergies Education Sets Reports Medication Admin Reconciliation Health Issues Method Real Time Structured/ Personal Health eMAR Service Medication CPOE Media Conditions Vitals/ Care Plan Surveillance Coded Portal/Record Process (administration) Rec Physiological Computerized Advanced Natural Language Home Medication Worklists Events Interventions Order Entry Processing Directives Management Pathways Media Interventions Transitions Monitoring/ Clnical Trending Medications Manage Population Health Management , Research & Clinical Operations Support Health Information Corporate Analytics Health Information Enabler Management Administration (People, Process, Function, Resource) Exchange Clinical Support Capability Families Identity Management (Patient & Provider) Biomedical Descriptive Surveillance Health Records Accounts Provider Master Data Mangement Clinical Financial Population Bed / Capacity Information Analytics Management Receivables Clinical Management Management Predictive Technology Outbreak Research Science Clinical Content Activity Case Service Referral and Knowledge Costing Emergency Health Services/ Management Prescriptive Disaster Systems Information Life User Experience Client Accounts Workforce Cycle Payable Management Social Safety Determinants Device Management Location Legal Record of Encounter Care Corporate Admin Performance Management Quality Application Portfolio Inventory Supply Terminology & Management Management Health Service Taxonomies Scheduling KPIs Asset Mobility Management Intake & Screening Reporting Access Management Case Management ahs.ca
THE CKCM PROGRAM ahs.ca
CMIO Organization ahs.ca
CKCM Organization ahs.ca
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