Title: Informatics and Evidence-based Practice
1Informatics andEvidence-based Practice
- M8120
- Fall 2001
- Suzanne Bakken, RN, DNSc, FAAN
- School of Nursing Department of Medical
Informatics - Columbia University
2Whats the Problem in Practice?
- Avoidable errors
- Under-utilization of services
- Overuse of services
- Variation in services
- Gap between best practice and actual practice
3Ways of Knowing for Practice
- Tradition
- Authority
- Personal experience
- Trial and error
- Intuition
- Logical reasoning inductive or deductive
- Systematic inquiry
4What 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)
5What 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
6What Data Do We Need for Evidence-Based Practice?
- Information about the patient
- Domain information and knowledge (the evidence)
from systematic inquiry and other sources
7Informatics Supports
- Building the evidence
- Retrieving the evidence
- Analyzing the evidence
- Applying the evidence
8Foundation 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
9Standardized Terminologies
- Capture patient care data in a standardized
fashion - Facilitate data re-use and aggregation
- Index information resources
- Facilitate information retrieval
10Standardized 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
11Outcomes 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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- Strengths and weaknesses of existing
terminologies - National and international standardization
efforts related to representing concepts in
computer-based - Unified Medical Language System
13Foundation 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
14Types 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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- Bibliographic sources
- Primary
- Cochrane Collaboration
- Diagnostic decision support systems
- Clinical practice guidelines
16Foundation 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
17Standards for Healthcare Data Exchange for EBP
- Data and knowledge representation
- Messaging
- Privacy, confidentiality, and security
- Digital library
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- Data and knowledge representation
- Messaging
- Privacy, confidentiality, and security
19Foundation 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
20Informatics 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
21Basic 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.
22M8120 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)
23M8120 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
24Foundation 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
25Informatics-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)
26Patient Care Systems
- Electronic health records
- Care management (e.g., care plans, critical
pathways) - Ancillary systems
- Laboratory
- Radiology
- Pharmacy
27Integration of Disparate Sources
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31Task-Specific Information Retrieval
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33Tailored Delivery of Informational and
Educational Interventions
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35Elicitation and Incorporation of Client
Preferences
36Standard gamble
37Expected Value Decision Making
38A 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
39M8120
- Electronic health records
- Dxplain
- Alerts and reminders
- Expected value decision making (Data 3.5)
- Interactive health communication