The Learning Healthcare System Workshop Summary (2007) / Chapter Skim
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7 Training the Learning Health Professional
7 Training the Learning Health Professional
Pages 267-288
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7 Training the Learning Health Professional OVERVIEW In a system that increasingly learns from data collected at the point of care and applies the lessons for patient care improvement, healthcare professionals will continue to be the linchpin of the front lines, assessing the needs, directing the approaches, ensuring the integrity of the tracking and the quality of the outcomes, and leading innovation. However, what these practitioners will need to know and how they learn will dramatically change.
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Vanderbilt Uniersity The electronic health record is one key to a shift to systems approaches to evidence-based care that is nonetheless individualized. EHRs enable
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Yet let us consider nine ways the EHR and clinical informatics tools could potentially be used to generate and apply evidence: using billing data to identify variability in practice; EHR data to direct care; EHR data to relate outcomes back to practice; EHR data to monitor openloop processes; decision support systems for alerts and reminders within clinical workflow; decision support systems for patient-specific alerts to change in practice; decision support systems for links to evidence within clinical workflow; de-identified EHR data to detect unexpected events; and de-identified EHR and Biobank data for phenotype-genotype hypothesis generation. Illustrative examples will be drawn from how Vanderbilt uses informatics, coupled with electronic health records, to support learning in clinical workflow and population management.
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This new resource would be much more than the personal health records emerging today. It would be a pre-computed intelligent integration of the individual's health information, together with the subset of biomedical evidence relevant to that individual, presented in a way that lets the clinician and the patient -- with very different learning levels and learning styles -- make the right decisions.
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The learn cycle begins by assembling a targeted curriculum using tools such as the Vanderbilt University School of Medicine's KnowledgeMap (Denny et al.
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In many cases, we took out BOX 7-1 A Splitters View of EHR Data and Tools to Support Learning Billing Data 1. Data to identify variability in practice Electronic Health Records 2.
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Baseline data were captured for each patient admitted with cardiovascular disease, the results of their studies and procedures were entered, and a research team added outcome data with long-term follow-up. The Databank led to early ambulation post-myocardial infarction.
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2 THE LEARNING HEALTHCARE SYSTEM For example, the clinician is alerted to an allergy to a drug being ordered or reminded to order levels of aminoglycosides. Patient-specific alerts to information about a recommended change in practice can take the next step by supporting learning at a "teachable moment." For example, the pharmacy and therapeutics committee at Vanderbilt recommends use of cephepime instead of ceftazidime for antipseudomonal treatment.
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2 TRAINING THE LEARNING HEALTH PROFESSIONAL and so forth. However, these informatics challenges are not the major ratelimiting steps at this juncture.
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2 THE LEARNING HEALTHCARE SYSTEM FIGURE 7-4 Medline searches. SOURCE: NLM: www.nlm.nih.gov/bsd/medline_growth.html.
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students using personal digital assistants. Doctoral research studies based on questions arising from faculty clinical practices include such topics as adult liver donation; testing acupressure for relief of AIDS-related nausea and vomiting; development of a fall and injury risk assessment instrument; diabetes treatment in the Hispanic population; and breast cancer screening practices.
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In medicine, evidence-based practice is incorporated into the curricula of three intensive courses that span one month in the fourth year of training. In this one month, students are introduced to the clinician scientist role, the practicing physician role, and biomedical informatics.
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2 TRAINING THE LEARNING HEALTH PROFESSIONAL in faculty research publications, but it has not yet found its way into the curricula as a very specific way to train students. Education lags somewhat behind academic practice, and this may be true nationally as well.
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20 THE LEARNING HEALTHCARE SYSTEM for nurses, and a hierarchy that negates the nurse's decision making are all factors contributing to a broken system. In the 1970s, models with nursing accountability, M.D.
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. Each year, thousands of clinical trials are added to the already voluminous research literature in hundreds of journals.
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Demands from patients, insurers, and regulatory agencies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Centers for Medicare and Medicaid Services (CMS)
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and providing tools or toolkits to facilitate such changes, best evidence can be delivered where it is needed. The Society of Hospital Medicine, the medical society for hospitalists, now promotes the use of such tools on its web site (http://www.
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. Fortunately, multiple quality improvement strategies, including some with robust research supporting their efficacy (e.g., audit and feedback)
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REFERENCES AHRQ (Agency for Healthcare Research and Quality)
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Journal of the American Medical Informatics Association 10(4)
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2007. Rethinking electronic health records to better achieve quality and safety goals.
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