What is Clinical Informatics?

in this video I'm going to be going over a brief overview of what clinical informatics is this video is really directed towards medical students who might be possibly interested in the field but really could be watched by anybody who wants a basic idea of what clinical informatics is so clinical informatics combining technology and medicine in the digital era what is clinical informatics clinical informatics is basically asking how can we use all the information systems that we have at our fingertips now and technology in order to improve healthcare to put it another way how can we integrate technology in our medical system better in order to achieve things like lower cost greater efficiency and better clinical decisions ultimately this will all lead to the most important thing which is improved patient outcomes so here graphically we can see how can we take our brain add technology to it and get super brain technology mode so what the heck is an information system I mentioned it before well EMRs are a type of information system and I'm sure we've all worked with an electronic medical record at this point they've really changed the landscape of how we practice medicine now we have so much data and information at our fingertips we can access every single little detail about a patient with just a few clicks at the same time however EMRs have been associated with a lot of growing pains and there's been an adjustment period especially for people to figure out how to use them effectively so the EMR is not hindering their efficiency but rather enhancing their abilities to provide the best care possible so what are some problems with EMRs I think one big one that you hear all the time is that EMRs are extremely time consuming especially for people I mean there's people who are very fast with DMR's but there's also people who aren't as fast but the goal of clinical informatics is to make it so it's easy for everyone to save time with EMRs we don't want to have people get to take home tons of notes that they had to finish and we want to make sure that things are user-friendly and have great interfaces that are easy to understand so that everybody can be increasing their efficiency with EMRs another thing is that there can sometimes be documentation errors I think we've all seen those patients that have had a UTI for 10 years for example or we've seen those funny transcription errors when people are transcribing their notes you can google them actually I've found a lot of really funny ones but it's not so funny when it actually impacts you know a patient's care it can be very serious actually copy pasting notes is also very common and a lot of times you get old information that's no longer valid so we need to find ways to make sure documentation errors don't happen as frequently with the EMRs and finally I found this nice graphic that says I went into medicine to work with people and not to be a data entry clerk and that's how some people feel like EMRs have made them at this point they feel like it really has caused an interruption of the doctor-patient relationship we've all learned how you know people are facing their screens not more and not really looking at the patient and this is really causing problems in terms of the doctor-patient relationship so how can we make it so EMRs don't cause this kind of interference with the pop doctor-patient relationship well is it a bird is it a plane no it's clinical informatics so clinical informatics is here to save the day and so some of the things that clinical informatics can do are I just listed a few examples here but we can auto populate notes that'll speed up everybody's ability to finish their notes on time we can reduce alert fatigue and I'm going to go into this in a lot more detail but there's a lot of alerts that can happen and sometimes people just get fatigued and annoyed with them and stop paying attention to them we got to figure out how to optimize that we can create user friendly interfaces like I said before and we can reduce the total number of clicks so it might not seem like a lot but say you're clicking times to do a certain order set but with optimizations you can only click two times and you could do it and that'll add up over time and you could save a lot of time by making an interface where person does not have to click as much in order to accomplish the things they need to get done all of these changes as I mentioned before will increase efficiency and reduce excessive use of time it will decrease medical documentation errors and there also allow for more direct doctor and patient interaction because you're not spending as much time interacting with your EMR but what about paper charting I like paper charting it was so good well no we're not gonna go back to paper charting go home Nick Cage you crazy person so why is this exciting so say we had Billy here he's a stellar third-year medical student he's got all honours and all of his classes and he wants to go into his practice so he goes into his practice and he's got his little EMR is little computer right in front of him he's providing excellent care there's also tons of other excellent providers and they're all treating patients to the best of their ability as well well Sally here Sally was like hey I think I want to try clinical informatics I feel like I want to help a lot of people be able to help more patients basically by going into clinical informatics she feels like she can help a ton of patients indirectly and she can help all the providers as well so she works in clinical informatics she does a fellowship and she comes up with a bunch of improvements to the EMR is that these people are using and it gets sent out to all of their epics and oh look all their computers are happy now and look all of them got boosts to their efficiency plus thirty five percent plus twenty percent plus twenty five percent so indirectly Sally one person going into clinical informatics has indirectly helped hundreds if not thousands of patients as well as hundreds of thousands of medical providers as well so that's why clinical informatics I think is so exciting is because you can make some technology changes that can really impact a ton of people so let me just go into this one thing I wanted to talk about alerts as I mentioned earlier so I think you guys have all seen sometimes when people put in an order you get this alert right here and it's like warning do you sure you want to order this medication do you want to order this Qt prolonging medication when your patient has a long QT interval blah blah blah so these are called best practice advisories and they provide clinical decision support they also protect against medical mistakes so they're very important we need these alerts because you don't want to order the wrong type of medication that could potentially harm your patient or you don't want to do something that could harm a patient basically the problem is sometimes there's too many alerts and they can become fatiguing a lot of times when I've seen people looking at the alerts they kind of just ignore it they're just like oh likes warning or override or a warning cancel like they just basically ignore it because there's too many and they don't feel like they're useful so the goal of clinical informatics here is to minimize the alerts and minimize the interference of people's workflow but maximize usability because again these are important alerts if you can design them to be important and useful to the clinician so here was an example that I saw there was an organization that tracked the alerts that they had they had 76,000 BPA's in a single day 73% of them were ignored and only 27% of them caused the clinician to really do anything so this is telling you like this is not an effective alert system 73 percent being ignored means there's a ton of useless not useful alerts and maybe there's some important alerts actually being ignored because there's just so many alerts so they made a lot of changes and they tried to reduce the number of alerts in order to make it so only the really important alerts would get through so you can see 80,000 80,000 and they made some big changes in January in order to get it down to 20,000 and hopefully those are all the high yield alerts that are most important and here's a lot of the things they did to change it and is all within the realm of clinical informatics so before if somebody had a contrast allergy this is what the alert looked like and this is how they redesigned it so some of the things that they talked about about this first alert not being good is that it's just a bunch of text it's not very eye-catching and it doesn't have anything for the provider to do it's just a bunch of text and then there's no actions that could be taken in the after one they've really added you know some big graphics in order to kind of catch your eye and they've added different colors of the text to make it more to make it stand out more to the provider and also they've given you actionable things that you can do in order to address this alert and this is a way that it becomes more useful to the clinician and not more of a burden burning some pop-up where they just exit out of it right away because they don't want to deal with it so another thing they did is they added a feedback section and this was huge because now if they get feedback from all these people they can figure out the best ways to make the alerts work for the providers rather than work against them one of my favorite ones that I read here is you cannot have you cannot have this pop up in the middle of appointments with patients it's paperwork BS and does not help me with my job and stops clinical flow in its tracks stop doing this so this is a great way that they can figure out how they can improve their alerts so again here's some statistics total bpa firings per month there was like millions of alerts and over time clinical informatics was able to reduce the number of alerts to like yeah sixty-four percent decrease since September 2016 and what they noticed was the efficiency and effectiveness of these alerts which was in the single digits before was now like five or six times higher or even more so it's like 22 percent efficient and 43 percent effective and it got even higher through March so clinical informatics was really a stepwise optimization of these alerts to make it useful for these providers and not a burden so there's also a lot of other kinds of health informatics out there as well there's bioinformatics so we have all these people's genetic data now people are doing 23andme they're doing all these genetic testing sites how can we look at this their genes and find optimal therapies for these people based on informatics being able to look at all this data so one idea that I had was with SSRIs it takes like six weeks to know if this SSL SSRI is really going to be useful for someone's depression but what if you could like look at everybody's genes and kind of find genes that make certain SSRIs more effective in some people versus in other people and then you could really have targeted therapy for these people and they're like that's just my thing that I thought of but like obviously the big thing here with everyone is its cancer as they're looking into how they can find targeted cancer therapies based on people's genetics you have imaging informatics so the goal is not to take over the radiologists job but to augment their ability to really identify certain things to make things easier for the radiologist public health informatics so we have so much data from all these patients now we can stratify certain populations that might be at higher risk for certain things like here we have lead poisoning risk analysis so maybe we could target a specific screening test for patients that are coming from a certain zip code or something like that with public health informatics and for me what I think is most exciting is research informatics so you could basically do a full chart review by doing some queries in your information system the electronic medical record and find tons of things so you could search all patients who were treated with X drug in the past year and had Y result and you could study which ones of them had a good result or a bad result or whatever so you could do a ton of research with clinical informatics and the key to all of these is Big Data there is now an abundance of information our disposal is just waiting for us to use clinical informatics to unlock that data for us to be able to interpret so clinical informatics recently became a medical subspecialty in October of 2011 the American Board of Medical Specialties announced it as a new specialty it's a two-year fellowship program and and in October 2013 the first wart exam was held and I think it's very interesting it's still a very flexible field if you go into this you could really use in clinical informatics as however you choose to so for example my mentor who I was talking about talking with in preparation for this talk does four days of clinical informatics and one day of seeing patients but you could do the exact opposite if you wanted you could do four days of seeing patients and just one day of clinical informatics you could tailor it however you would like to because it's still such a new and growing field it's very exciting and also physicians are very valued on these teams there's tons of different specialties and different professions that go into clinical informatics pharmacists nurse like engineer is everything and you don't have to be someone who knows how to code or whatever in order to go into clinical informatics really just having the perspective of a physician is huge so the conclusion medicine is becoming increasingly digital there are still many growing pains but clinical informatics is here its role is to optimize our ability to use this technology in order to decrease costs increase efficiency improve decisions and ultimately patient outcomes there is a new medical subspecialty for clinical informatics and there are other branches to pursue as well bioinformatics research informatics the public health informatics etc and clinical informatics is truly exciting because it's a way that you can help thousands of patients and providers at once so I'd like to just take a moment to thank my mentor dr. Donald Klingon he is the chief medical information officer at mainline health and really helped introduce me to clinical informatics I basically came into contact with him because I mentioned that I was interested in technology and I was interested in how technology can be used in medicine and they linked me up with dr. Klingon who is basically the head of clinical informatics at all of mainline health and I thought that was like a really nice matching because I I got exposed to this field that I didn't know anything about before and now I feel like I've learned so much about it and it's really cool to know and I feel like more people should learn about it as well and I hope you guys learn something so thanks again for listening and see you guys next time

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