2012 02 11 - Informatics Competencies in PT Education

Informatics Competencies in Physical Therapy Education:

A Proposed Framework

Assistant Research Professor, Indiana University School of Medicine Research Scientist, Regenstrief Institute, Inc

CSM 2012 – Chicago, IL

02.11.2012 © 2012

Daniel J. Vreeman, PT, DPT, MSc

St Luke's-Elks Rehab Idaho State University

Steven G. Wilkinson, PT, PhD

Overview

1.  Informatics in Physical Therapy education core documents

2.  Informatics competencies in other disciplines

3.  A framework and proposed informatics competencies

photo via Vernio77

Objectives for Today By the end of the session, you’ll be able to: 1.  Describe the current state of health

informatics in physical therapist education 2.  Appreciate informatics competencies

prevalent in other healthcare disciplines 3.  Discuss the informatics competencies

necessary for clinicians to be effective in the emerging electronic age

Entering the era of “big data”

Wilkinson SG, Chevan J, Vreeman DJ. Establishing the centrality of health informatics in physical therapist education: if not now, when? J Phys Ther Educ. 2010;24(3):10-15

Adoption of health information technology has become a top national priority... Failing to prepare clinicians with the appropriate competencies in information and knowledge management will hamper progress towards our profession’s goals of fully availing ourselves of technologies that can facilitate more effective and efficient care.

Informatics in PT education core documents Already established concepts that are part of the "eld

Core Documents • Evaluative Criteria for Accreditation of Education Programs for the Preparation of Physical Therapists [Evaluative Criteria] • Guide to Physical Therapist Practice • A Normative Model of Physical Therapist Professional Education:  Version 2004 • Minimum Required Skills of Physical Therapist Graduates at Entry-Level • Vision 2020 • RC 6-08 “Support of Electronic Health Records in Physical Therapy”

Minimum Required Skills of Physical Therapist Graduates at Entry-Level

http://www.dailymail.co.uk/news/article-1381464/Bunny-rabbits-compete-jumping-course-Dressage-set-world-storm.html

Normative Model Expectation Content Currently Included

Professional Duty Recognizes and values multiple methods to acquire knowledge and skills in support of lifelong learning and professional development…

Clinical Reasoning

Use simple heuristics in improving decision-making under uncertainty Use current technology resources to gather information about health personnel supply and demand, models of health care delivery, and efficacy of practice

Evidence-based Practice

Consistently use information technology to access sources of information to support clinical decisions Manages knowledge and information using online databases, disease registries, electronic medical records, and other information technology systems to facilitate the delivery of health care (informatics)

Normative Model (cont’d) Expectation Content Currently Included

Professional Duty Devote time, energy, and resources to advancing the profession

Accountability Understands security protections such as access control, data security, and data encryption related to the use of information technology in practice Directly addresses ethical and legal issues related to the use of information technology in practice

Communication Uses information technology such as word processing, presentation, data analysis software, e-mail, and electronic records to improve clarity and efficiency of communications.

Education Develop expertise in the use of technology available for patient/client or clinical staff education and consultation

Informatics competencies in other disciplines Calls for informatics competencies for health professionals

Core Competency: effective and appropriate use of communication and information technology.

Core Competencies for All Clinicians: provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and utilize informatics.

Recognizes that there are different educational needs for clinicians who use technology in their everyday practice than for the specialists who make up the domain.

Top priority for all health professionals: Efficient information processing and effective use of information and communication technologies.

Although most health professionals use IT daily in their work, few know how to adapt their roles and work processes to incorporate IT for the greatest benefit.

Stead WW, Searle JR, Fessler HE, Smith JW, Shortliffe EH. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34. PMID: 20711055

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Informatics education in nursing Always pushing the envelope

1977

First undergraduate course on applying computers in nursing.

Ronald JS. Computers and undergraduate nursing education: a report on an experimental introductory course. J Nurs Educ. 1979;18:4-9.

1980

The term “Nursing informatics” is coined.

Scholes M, Barber B, Bryant Y. The Impact of Computers on Nursing: An International Review. North Holland, Amsterdam: North-Holland; 1983.

Ball MJ, Hannah KH. Using Computers in Nursing. Reston, VA: Reston Publishing; 1984.

1984

First textbook published on using computers in nursing.

American Nurses Association Database Steering Committee. Nursing Data Systems: The Emerging Framework. Washington, DC: American Nurses Publishing; 1995.

1992

ANA approves nursing informatics as a new specialty.

Ronald JS. Evolution of nursing informatics education. http://www2.amia.org/history/presentations/EvolutionOfInformatics.pdf. Accessed March 27, 2009.

1998

School of Nursing Accrediting Agencies, American Association of Colleges of Nursing, and National League for Nursing Accrediting Commission identify essential informatics competencies and required their inclusion in curricula.

Technology Informatics Guiding Education reform. The TIGER initiative: evidence and informatics transforming nursing: 3-year action step toward a 10-year vision. http://www.aacn.nche.edu/Education/pdf/TIGER.pdf. Accessed March 27, 2009.

A comprehensive vision for informatics in nursing education and practice. Identi!ed competencies needed in: basic computing, clinical information management, and information literacy

2007

Informatics education in medicine From medical school to fellowship, board certi"cation, and everywhere in between

40+ years of training opportunities for informatics specialists

Gardner RM et al; AMIA Board of Directors. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc. 2009 Mar-Apr;16(2):153-7. Epub 2008 Dec 11. PMID: 19074296

Safran C et al; AMIA Board of Directors. Program requirements for fellowship education in the subspecialty of clinical informatics. J Am Med Inform Assoc. 2009 Mar-Apr;16(2):158-66. Epub 2008 Dec 11. Erratum in: J Am Med Inform Assoc. 2009 Jul-Aug;16(4):605. PMID: 19074295

In 1980s, early calls for physician informatics competencies. In 1999, AAMC recognized med school curricular changes needed.

Made recommendations across 5 informatics-roles: lifelong learner, clinician, educator, researcher, manager

Triola MM, Friedman E, Cimino C, Geyer EM, Wiederhorn J, Mainiero C. Health information technology and the medical school curriculum. Am J Manag Care. 2010 Dec;16(12 Suppl HIT):SP54-6. PubMed PMID: 21314222

Stead WW et al. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34. PubMed PMID: 20711055.

Silverman H, Cohen T, Fridsma D. The evolution of a novel biomedical informatics curriculum for medical students. Acad Med. 2012 Jan;87(1):84-90. PubMed PMID: 22104049

Incorporating Biomedical Informatics in PT education A framework to “capture the sky”

Academic Medicine, Vol. 87, No. 1 / January 2012

Thanks for your email and your interest and efforts in this area - truly BMI is an interdisciplinary sport and I am excited to hear of your efforts to introduce this into your PT programs. --Howard Silverman

A considerable number of technologies the students have a far better grasp than the instructors from their usage in previous course work or in their personal lives. Many items in question 4 are already known by all graduate students. We may refer them elsewhere for learning about technologies not used due to their lack of knowledge. Students must have a BS or BA degree before they are admitted into our program. Therefore, they all have had experiences in most of the above technology prior to coming to our program.

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This seems like a funny thing to study. My students all drive cars, but I don't teach them about internal combustion engines. Technology is a tool and when used, it is expected that students will gain the expertise. We offer a PT degree rather than an informational technology degree.

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Framing Thoughts

Informatics underpins other competency domains:

patient-centered care working in interdisciplinary teams employ EBP applying quality improvement

Stead WW et al. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34. PubMed PMID: 20711055.

We recommend viewing informatics as a longitudinal theme across all curricular elements.

A journey. Not a destination.

photo via Justin Ornellas

Proposed Competencies in Informatics

Role of Life-long Learner Professional Practice Expectation 5: Professional Duty

Support of life-long learning with biomedical informatics requires more than computer literacy. We need cognizance of the broad range of medical information resources, devices, and technologies available and their relative value for particular needs, the know-how to use them, and the motivation to use them routinely.

“ Connection to Vision 2020:

While fully availing themselves of new technologies, as well as basic and clinical research, physical therapists will…

Role of Life-long Learner Professional Practice Expectation 5: Professional Duty

Current Content Examples •  Recognizes and values multiple methods to acquire

knowledge and skills in support of lifelong learning and professional development

•  Maintains continued competence in clinical practice through a variety of lifelong learning strategies

Additional Competency Examples •  Recognize how to develop information habits to maintain

currency in emerging technologies and biomedical devices.

Core Informatics Competency Understanding the domain fundamentals enough to adapt their roles and work processes to incorporate HIT for the greatest bene"t.

Competency Examples •  De"ne and describe the evolution of Biomedical Informatics •  List and de"ne the four major application areas of Biomedical Informatics

•  cite examples of the common theoretical foundations of these four areas •  Describe why process redesign is important to care quality improvement

•  Explain effective approaches to the review and redesign of clinical processes •  Explain socio-technical and other barriers to effective use of process redesign

•  Review ontologies and data standards, explain how they are used and why are they important

Clinical Reasoning Current Content Examples •  Use current technology resources to gather information

about health, personnel, supply and demand, models of health care delivery, and efficacy of practice.

Additional Competency Examples •  Make critical use of decision support

•  Demonstrate knowledge of the available sources of decision support, which range from diagnostic expert systems to advisories issued from an EHR

•  Describe probabilistic clinical reasoning and its advantages and disadvantages

•  Discuss common heuristics that are employed in making judgments under uncertainty which lead to systematic and predictable errors.

Evidence-based Practice Professional Practice Expectation 9

Current Content Examples •  Consistently use information technology to access

sources of information to support clinical decisions. •  Manages knowledge and information using online

databases, disease registries, electronic medical records, and other information technology systems to facilitate the delivery of health care (informatics).

We recommend establishing Electronic Health Record (EHR) literacy as a separate expectation.

Healthcare is an information business. The quality, effectiveness, and efficiency of care depend on our ability to manage information. You just can't do it without EHRs.

Bill Tierney, AMIA 2011 Keynote

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Electronic Health Record Literacy Clinicians must acquire information about the patient, make clinical decisions based on available information, and document and communicate "ndings.

Additional Competency Examples •  Review the maturational history and functional evolution of EHRs •  Demonstrate $uency with EHRs for patient-speci"c:

•  Retrieval of subsets of information •  Documenting all aspects of patient/client management •  Sharing information with other providers

•  Explain how EHRs can be used to develop, implement, and monitor compliance with patient care protocols and other best practices

•  Make critical use of decision support •  Describe Personal Health Records (PHRs) and their pros/cons

We recommend establishing use of HIT as a knowledge management tool for advancing the science of physical therapy.

We recognize that formal “research” activities are performed by a relatively small proportion of physical therapists.

But, physical therapists need analytic skills to leverage the tools for retrieval and analysis of aggregate data for quality reporting, practice improvement, and benchmarking.

HIT for Advancing the Science of PT

Additional Competency Examples •  Determine what data exist relative to a clinical question or

formal hypothesis, demonstrating the following: •  The ability to use information resources to locate existing data sources.

•  local and external (e.g. national registry) •  Develop a plan for data collection and analysis, including:

•  Selecting an appropriate database for collecting and organizing data •  Represent data in a form that is useful and supports computer-based

analysis •  Analyze, interpret and report "ndings, demonstrating the

ability to: •  Select an appropriate software tool for analysis of data and perform simple

statistical analysis and portray the results graphically •  Interpret the reports of statistical software analysis

Accountability Professional Practice Expectation 1

Current Content Examples •  Understands security protections such as access control,

data security, and data encryption related to the use of information technology in practice

•  Directly addresses ethical and legal issues related to the use of information technology in practice

Additional Competency Examples •  Respect patient con"dentiality and data security

demonstrating the ability to use security-directed features of an electronic health record system

  Communication Professional Practice Expectation 6

Current Content Examples •  Uses information technology such as word processing, presentation,

data analysis software, e-mail, and electronic records to improve clarity and efficiency of communications

Additional Competency Examples •  Demonstrate pro"ciency with information and telemedicine technologies for

•  virtual teamwork •  remote diagnostic / intervention techniques •  clinician-patient communication

•  Effectively employ written, electronic, and oral communication: •  Use software to create visual materials that effectively support oral presentations •  Create a handout that includes simple graphics and tables for use in teaching or

patient education •  Collaborate across multiple sites using electronic mail, discussion lists,

teleconferencing, and related communication technologies

Education Professional Practice Expectation 10

Current Content Examples •  Develop expertise in the use of technology available for

patient/client or clinical staff education and consultation.

Additional Competency Examples •  Select and use information resources for professional and

patient education, demonstrating: •  Practical knowledge of instructional technologies and resources

available via the Internet, video teleconferencing, and other media. •  The ability to effectively leverage various computer-based

instructional tools, including electronic tutorials and patient simulations.

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danielvreeman.net/speaking