Clinical Informatics – What Is It?
from Practice Update, Winter 2006
Clinical informatics is an applied science that focuses on communication amongst clinical care teams, patients and their families – getting the right information to the right person at the right time to achieve the best possible outcome in the most efficient manner. That’s a lot of adjectives but it captures how clinical informatics perceives the connection between improved information availability and better medical care. Although much of clinical informatics research focuses on how to exploit the growing presence of clinical information systems and electronic medical records, many informatics projects use paper forms or reports to bring clinically-relevant, patient-specific, context sensitive information together to facilitate rapid decision-making. By nature, clinical informatics projects are multidisciplinary, bringing together experts in evidence-based practice, outcomes measurement, and clinical domain knowledge. The role of the clinical informatics expert is to design methods (computer-based or paper-based) that can “operationalize” the evidence-based practice in a manner that works well within the office or hospital workflow while also generating outcome measures. In the best-case scenario, a clinical informatics project will just “slip into” regular practice, making it easy to follow evidence-based practice yet not prevent the decision-maker from making important modifications when deemed clinically appropriate. Capturing relevant outcome measures in the same seamless manner during regular workflow is important to know if the intervention, in fact, achieved its intended objective. In the “real world,” implementing evidence-based practices is never entirely seamless. Including outcomes measurement from the start is critical as one should never assume that all change results in improvement.
Clinical informatics has been around for over 20 years but has risen in visibility due to the recent unrelenting focus on adverse events, low adherence to broadly accepted clinical practices, and the push for an ever growing set of quality metrics that very soon could be linked to reimbursement (the “Pay for Performance” movement). Numerous studies have demonstrated that the root cause of many adverse events and low compliance to recognized clinical practices are due to the convoluted, complex and time-pressured workflows that exist in most office and hospital environments. Study after study point to the success of a broad systems approach which focuses on information sharing, more streamlined workflows and integrated decision-support that improve the overall working environment than passive didactic lectures or unsolicited “Did you know?” mailings.
Clinical decision support is a phrase that, for some, conjures up negative images of cookbook or computer-dictated medicine. As someone who has spent his entire career creating so-called expert systems, I find these concerns to be very far removed from what these systems actually can do. Rather than a “disembodied expert” dictating care, I see decision-support as a means for reminding me to think about something that I already know but may have forgotten to apply given the rush of competing demands for my attention. Even when I decide to not follow a recommendation, I make that decision actively by design rather than passively by distraction. When I know that the system will look after the “small stuff ” (because that is all they can really do), I have more time to focus on more important diagnostic, therapeutic and psycho-social issues that fully engage my intellectual and problem-solving skills.
At The Children’s Hospital, a substantial investment in a new comprehensive clinical information systems environment for both ambulatory and hospital care is nearing completion. In three “whole house” steps during 2006, all pharmacy orders, all clinical documentation and all provider orders will be moved from paper to a comprehensive electronic medical record (EMR). For all health-care providers, the EMR will represent a substantial change in reviewing patient data, ordering diagnostic tests and therapeutic procedures and documenting the clinical encounter. Marked improvements in clear unambiguous communications between the care team and the primary care provider will be a major benefit of this change. With appropriate permissions, care providers can access the complete medical record from any location within the hospital and, via secure networking, from the office or home, ending the days of not knowing what is happening or has happened to the child during a hospital stay.
With the comprehensive electronic record in place, the opportunities to embed evidence based practices into regular clinical workflow, to objectively measure what works and what doesn’t work, and to keep only those practices that demonstrate objective positive impact are just beginning. A “learning organization” seeks ways to improve itself by constantly poking, prodding, exploring, challenging and testing. By combining the new clinical information systems and clinical informatics to implement evidence based practices and outcomes measurement, The Children’s Hospital is at the threshold of completely redefining itself as a continuous clinical care innovator.
For more information on clinical informatics, contact Michael Kahn at kahn.michael@tchden.org
Dr. Kahn is a board-certified Internist with a PhD in Medical Computer Science. Over the past 20 years, Dr. Kahn has been responsible for the development and deployment of advanced clinical systems, hospital-based adverse event detection systems, and infection control systems at BJC Health Systems in St. Louis, national quality indicator benchmarking systems at Rodeer Systems, the development of an intelligent protocol model and authoring system for regulatory clinical trials at Fast Track Systems and the strategic design of the next-generation enterprise clinical platform at GE Healthcare.
Dr. Kahn has served as a member of the board of directors of the American Medical Informatics Association, the Board of Scientific Counselors of the National Library of Medicine and the editorial boards of the Journal of the American Medical Informatics Association and the International Journal of Medical Informatics. Dr. Kahn has published extensively in the clinical informatics and pharmaceutical informatics literature.
