Clinical informatics inspires change

Plays increasingly critical role in care
By John Andrews
12:00 AM
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The growth and maturity of clinical informatics over the past decade has been a prime catalyst in positioning the healthcare industry for the changes posed by reform measures. By understanding the process of analytics, clinical informatics specialists say healthcare providers have the insight necessary to make the process adjustments in the future.

"Clinical informatics will serve as the foundation for all aspects of successful healthcare reform initiatives as they are instituted," said Greg Chittim, director of analytics and performance improvement for Burlington, Mass.-based Arcadia Solutions. "As the baby boomer generation continues to age and move away from commercial insurance to CMS and Medicare Advantage programs, clinical informatics will ensure that seniors are cared for and transitioned consistently across the landscape of their primary care physicians, hospitals, long-term care facilities, and hospice centers."

As the Affordable Care Act implements new aspects of reform, clinical informatics will be required to measure quality and compliance, Chittim said. What's more, as the Medicare Shared Savings Program and Accountable Care Organizations are implemented, clinical informatics "will allow organizations to understand their risk and cost profiles while ensuring the best care for patients."

To be sure, Dan Riskin, MD, surgeon and CEO of Palo Alto, Calif.-based Health Fidelity sees clinical informatics as "absolutely sparking a change." Information technology, combined with analytics deployment is fostering a greater understanding of how the health system should operate, he said.

"All of healthcare is the challenge of classification and intervention - by assessing and deploying quality measures, everyone is trying to classify and intervene," Riskin said. Health Fidelity works in classification and says there are problems that constantly keep reoccurring with billing codes, quality codes, readmission codes and auditable events.

"This is a really tough nut to crack and it can't be done with small data," he said. "All the old models need to be thrown out."
Clinical informatics represents a significant growth area for companies that provide health services, such as Rochester, N.Y.-based Creative Computing Solutions. According to a study by Frost and Sullivan, clinical informatics is expected to be worth an estimated $6.5 billion by 2013 - a major increase from the estimate in 2009 of $973 million.

"Clinical informatics is still in its infancy," said Timothy Hays, senior director for customer health solutions at CCSi. "It is a tool that when properly implemented can increase options for treatments, reduce risks, improve processes, help with financial management, and ultimately improve patient care. It requires having the people, data, technologies and processes necessary to mine and act upon the information."
Clinical informatics can be used across the broad spectrum of healthcare and is not limited to decision support functions, he said, adding "It is a very broad field, but it is also a very complex field."

New careers
Since the advent of the HITECH and Affordable Care Act, there has been a substantial increase in the number of clinical informatics specialists inside hospitals, known as informaticists.

"These aren't Ph.D.-level researchers, but people with practical experience," says Jonathan Teich, MD, chief medical informatics officer for Elsevier's Health Sciences Division in Philadelphia. The CMIO is one of the fastest-growing titles in the "C suite," as techno-savvy physicians guide the medical aspect of EHR implementation and usage, Teich said. "They are teaching the doctors," he said. "This is someone who is clearly an expert in informatics - someone who serves in the role of champion, who takes the time to be part of the design meetings and planning meetings before it is socialized to the rest of the team."
Teich estimates that 80 percent of healthcare providers are in an EHR environment now compared to five years ago, which has facilitated the need for informaticists.

"Having these people around can help lessen the fear and anxiety, speak for your interests and speak for the system's interests in your language," Teich said. "These people are communicators who can translate your instructions into what the computer system can do."

Focus on ontology

Clinical informatics goes beyond content and into dissemination of data to the care team, adds Mike Cummens, MD, chief medical officer for Sandy, Utah-based Remedy Informatics. As a result, its importance is in how it interacts with care team workflow and how it is shared, whether as text, checkboxes or forms.
"Our focus is on the need to be able to exchange the data and reuse it for multiple purposes and unanticipated purposes," he said. "With providers assuming more risk, it is vital to control that risk by monitoring the decisions being made."

If informatics is the confluence of computer science and medicine, ontology represents the relationships formed at this intersection.
Cummens points to medical ontology as being "the logical structure of information and the relationship between pieces of information, such as diseases and treatment procedures."

The purpose of clinical informatics should be to make these relationships clear, explicit and valid, he said. "This is real world ontology," Cummens said. "The point of our work is to describe in great detail the reality - the presence of disease, real findings of physical exams and even the absence of disease."

'Pushing data around'

Digitizing data has been a gradual and arduous process in the imaging realm as radiology labs, surgery centers and physician clinics wean themselves off film and into electronic archives. It is now becoming a matter of "making the transition to adoption and wrapping it together to provide efficiency for the patient," notes Steve Deaton, vice president of Garner, N.C.- based Viztek. Most important is the delivery and communication of images and supporting documents, which Deaton says amounts to "pushing data around" in a systemic manner.

The process goes beyond mere logistics, however, he said. Imaging documents are memory-intensive files that need to be compressed for smooth transfer while ensuring patient privacy.

"We're putting a lot of effort into managing efficiencies, turnaround times, commitment levels and access," Deaton said. "It is also important to have a patient portal where patients can access their radiology reports and images so they can look for a second opinion or to show to the specialist who is managing their care plan."