Information Technology Essentials for Behavioral Health Clinicians

218 Pages·2011·1.71 MB·English

by  Naakesh A. Dewan, Nancy M. Lorenzi, John S. Lou (auth.), Naakesh Dewan, John Luo, Nancy M. Lorenzi (eds.)

Health Informatics
Naakesh A. Dewan • John S. Luo • Nancy M. Lorenzi
(Editors)
Kathryn J. Hannah • Marion J. Ball
(Series Editors)
Information Technology
Essentials for Behavioral
Health Clinicians
Editors Series Editors
Naakesh A. Dewan Kathryn J. Hannah
Advanced Psychiatry Department of Biomedical Informatics
2519 N. McMullen Booth Rd. School of Medicine
Suite 510-255 University of Utah
Clearwater, Florida 33761 Utah
USA USA
and
John S. Luo HECS Inc.
UCLA Semel Institute for Neuroscience Calgary
and Human Behavior Alberta
Department of Psychiatry Canada
760 Westwood Plaza
Los Angeles, California 90024 Marion J. Ball
USA Healthcare and life Sciences Institute
IBM Research
Nancy M. Lorenzi Johns Hopkins University
Vanderbilt University Medical Center Baltimore Maryland
The Informatics Center USA
428 Eskind Biomedical Library
2209 Garland Ave
Nashville, Tennessee 37232-8340
USA
ISBN 978-1-84996-343-5 e-ISBN 978-1-84996-344-2
DOI 10.1007/978-1-84996-344-2
Springer London Dordrecht Heidelberg New York
A catalogue record for this book is available from the British Library
Library of Congress Control Number: 2010937961
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I would like to dedicate this book to my wife, Devaki, who inspires
and supports me every single day.
Naakesh A. Dewan, M.D.
I would like to dedicate this book to my wife Karen and
daughter Kristen for their support, patience, and understanding
while this book was being written. My love and thanks to them
always and forever.
John S. Luo, M.D.
Dedicated to the people who work hard to keep our society
balanced! I hope that the informatics-based concepts and
systems outlined in this book support you in your efforts.
Nancy M. Lorenzi, Ph.D.
Foreword
On March 8, 2010, the Division of Clinical Informatics (formerly the Center for Clinical
Computing or CCC) now led by Charles Safran, celebrated 40 years of innovation and
excellence in application of the computing tool in clinical care, teaching, and research. The
story began even earlier. Warner Slack and colleagues at the University of Wisconsin con-
ducted the first direct patient–computer interview1 and began to use computers routinely in
the clinical laboratory.2 In Boston, Howard Bleich’s computer program systematically
evaluated acid–base disorders (happily sparing physicians the task of solving the requisite
quadratic equations)3 and soon added guidance for correcting them,4 creating sophisticated
computer consultation for a complex clinical problem. Howard and Warner joined together
to form the Center for Clinical Computing at Beth Israel Hospital in 1970. Cultural differ-
ences required Warner to change the last of five Wisconsin Progressive patient response
options from “None of your damn business,” to Boston Brahmin acceptable, “Skip it.”
“Yes, No, Don’t know, and Don’t understand” had been acceptable in both cultures
and other amusing differences were readily overcome as productivity of the CCC
sky-rocketed.
In short order CCC produced the Miniature Information Storage and Retrieval (MISAR)
data base system,5 hospital-wide email, an early word processor, Paper Chase6 which was
a direct forerunner of Pub Med. By 1977, fifteen of the papers describing CCC’s work
appeared in the New England Journal of Medicine, a measure of the programs’ quality.
CCC not only created and proved these programs’ value, they shared them! Paper
Chase in various versions has been used since 1974 in the Madison Institute of Medicines’
Bipolar and OCD Information Centers7,8 now holding more than 65,000 citations to those
disorders and their treatments. MISAR, much modified, was an important element in EPIC
System’s first Electronic Medical Record (EMR).
The Beth Israel Hospital had arguably the first effective hospital-wide EMR9 – competi-
tion with Massachusetts General Hospital was keen and constructive. The Beth Israel’s
EMR was built not from the top down, but bottom up, from clinical department to depart-
ment with integral involvement of those using the system. “Hotel” administrative and
financial programming trailed clinical programming, and the immediate use and accep-
tance of the program by clinicians led to a second EMR evolution at Peter Bent Brigham
Hospital where it was found that institutional differences could be as great within Boston
as between Wisconsin and Boston. The successful development and continued use of these
EMRs has been a proof of the concept and value of EMR in clinical care and a stimulus for
their extension across clinical practice.
vii
viii Foreword
The future these pioneers forecast with their early programs is arriving at a rapidly
increasing pace. Most of their principles remain remarkably vibrant: direct patient–computer
interviews give time and structure for patients to be interviewed as clinicians would inter-
view when we are on our best form – never tired, hurried, cross, forgetful or out of our
areas of mastery; direct patient–computer self-help programs provide outbound interactive
education, advice, information, and many treatments that are available when patients have
time to care for themselves and without having to commute to the clinic for guidance;
computers speed routine functions (laboratory, x-ray, finding records, etc.) that often slow
and impede quality care; they make possible new standards of care, providing tireless
systems that surpass humankind’s persistence and endurance; when found faulty, com-
puter programs have no ego distress as the faults are identified and corrected and the cor-
rections are lasting, in contrast with predictable slippage of humans sent to do a computers
work; the computers speed in consulting vast databases splints our memories, consistently
checking for possible drug interactions as but one obvious example. Simply put, well-
designed clinical computer programs developed at CCC permit clinicians to practice better
medicine.
Consonant with work at the CCC, Information Technology Essentials for Behavioral
Health Clinicians brings us up to date on the important achievements since it’s a seminal
predecessor volume and addresses foreseeable remaining issues in the applications of
clinical computing in behavioral health.
Certain tensions remain constant across the decades: all medicine, as politics, is at some
level local. Balancing the benefits of standardization possible only by using computers
with the benefits of individual clinician experience and hands-on contact with patients
remains a challenge. Acceptance is growing as programs prove their worth and continue to
be improved. Fundamental truths are reified: a clinical computing program should not get
patients or clinicians home later for dinner; many current computer programs work well
enough to be implemented – discerning how to implement them is a larger immediate
problem and may require nonclinical professional skills as well as deep knowledge of local
clinical practices and politics.
The authors of this second edition are to be commended for their thorough and consci-
entious review, summarization, and forecasts for the future. I look forward to their third
edition.
John Greist
References
1. Slack WV, Hicks GP, Reed CE, Van Cura LJ. A computer-based medical-history system.
N Engl J Med 1966;274(4):194–198.
2. Hicks GP, Gieschen MM, Slack WV, Larson FC. Routine use of a small digital computer in
the clinical laboratory. JAMA 1966;196(11):973–978.
3. Bleich HL. Computer evaluation of acid-base disorders. Trans Assoc Am Phys 1968;81:
184–189.
4. Bleich HL. The computer as a consultant. N Engl J Med 1971;284(3):141–147.
Foreword ix
5. Karpinski RH, Bleich HL. MISAR: a miniature information storage and retrieval system.
Comput Biomed Res 1971;4(6):655–660.
6. Beckley RF, Bleich HL. Paper chase: a computer-based reprint storage and retrieval system.
Comput Biomed Res 1977;10(4):423–430.
7. Greist JH, Jefferson JW, Combs AM, Schou M, Thomas A. The lithium librarian: an interna-
tional index. Arch Gen Psychiatry 1977;34(4):456–459.
8. Carroll JA, Greist JH, Jefferson JW, Baudhuin MG, Hartley BL, Erdman HP, Ackerman DL.
Lithium Information Center. One model of a computer-based, psychiatric information service.
Arch Gen Psychiatry 1986;43(5):483–485.
9. Bleich HL, Beckley RF, Horowitz GL, et al. Clinical computing in a teaching hospital. N Engl
J Med 1985;312(12):756–764.
Preface
Information Technology is only beginning to innovate and transform the practice and per-
formance of clinicians in behavioral healthcare. Minimal investments in information tech-
nology research and development are fundamentally altering the lives of millions
worldwide. This promise and future of behavioral informatics is outlined in the chapters
that follow.
The book is divided into parts that can serve as “modules” for the reader. Parts cover
broad conceptual issues, clinical practice, patient and client-centric issues, and finally
organizational efforts. The authors are physicians, psychologists, informatics executives,
researchers, social workers, engineers, and sociologists. This diversity of perspectives
brings richness to the book and will keep the reader interested and focused.
In the first part, the authors offer an overview of the entire landscape of behavioral
informatics, which includes practical technologies and discussions regarding privacy and
security. The next part focuses on the clinician; their knowledge, care, and technology
developments and tools. The next part is dedicated to technologies driven by the recipient
of care. Clients, patients, and consumers are the really drivers for change. The final part
focuses on the organization and leaderships issues involved in transforming a behavioral
health care organization into modern technology-supported systems of care.
In this book, Naakesh A. Dewan, M.D., an international leader and pioneer in quality
improvement, consumer empowerment, and behavioral informatics, joins with John S. Luo,
M.D., an academic innovator and teacher of technology, and Nancy Lorenzi, Ph.D., a
world renowned champion of technology and the field of organizational issues in health
information technology. The editors have crafted a book in collaboration with nationally
recognized experts in the field in order to fill the discipline’s tremendous void.
This book is essential for students and faculty in departments of psychiatry, psychology,
social work, other human service disciplines, and informatics departments. It is for clini-
cians, administrators, IT executives, and consumers who wish to know what is possible
today and what lies ahead as both technology and behavioral health care converge.
We hope this book will be considered a “must read” in the field of health informatics,
and feel that it is a necessary reference book for any educational, public, or personal
library.
Naakesh A. Dewan
John S. Luo
Nancy M. Lorenzi
xi
Series Preface
This series is directed to healthcare professionals leading the transformation of healthcare
by using information and knowledge. For over 20 years, Health Informatics has offered a
broad range of titles: some address specific professions such as nursing, medicine, and
health administration; others cover special areas of practice such as trauma and radiology;
still other books in the series focus on interdisciplinary issues, such as the computer-based
patient record, electronic health records, and networked healthcare systems. Editors and
authors, eminent experts in their fields, offer their accounts of innovations in health infor-
matics. Increasingly, these accounts go beyond hardware and software to address the role
of information in influencing the transformation of healthcare delivery systems around the
world. The series also increasingly focuses on the users of the information and systems:
the organizational, behavioral, and societal changes that accompany the diffusion of
information technology in health services environments.
Developments in healthcare delivery are constant; in recent years, bioinformatics has
emerged as a new field in health informatics to support emerging and ongoing develop-
ments in molecular biology. At the same time, further evolution of the field of health
informatics is reflected in the introduction of concepts at the macro or health systems
delivery level with major national initiatives related to electronic health records (EHR),
data standards, and public health informatics.
These changes will continue to shape health services in the twenty-first century. By
making full and creative use of the technology to tame data and to transform information,
Health Informatics will foster the development and use of new knowledge in healthcare.
Kathryn J. Hannah
Marion J. Ball
xiii