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JMU Prepares Students to Use Informatics

PHOTO: Computer circuit bank

There’s no doubt about it. Informatics is transforming health care.

That’s why Carolyn Schubert, Health Sciences and Nursing Librarian, has been teaching a class about it each spring, starting two years ago. Informatics, says Schubert, is another word for information science or computer science, the study of information processing.

“The class is about how informatics impacts and improves life,” Schubert says. “It’s about how computers, mobile applications and the cloud, and electronic health records (EHRs) can improve health care.”

Introduction to Informatics for Health Care Professionals looks at multiple aspects of health care and technology, including economics, the role of government, health policy challenges, and how informatics affects health care professionals and patients. The class has drawn undergraduate students who plan to be nurses, physician assistants, dentists, nurse practitioners and physical therapists.

Informatics at work

“The information technology can work,” says Schubert. “The variable is people. What motivates them to change their workflow pattern?” Effective documentation can help avoid errors as well as save time. It enables specialists to work together more seamlessly and provides patients with access to their own records.

“If you have 30 years of health records in various health care settings, how can you get all that information to a doctor?” she asks. Having all medical records in one place helps specialists work together. This is especially helpful when it comes to medications they prescribe.

“If a dietitian says a patient should eat grapefruit every day but it cancels out the effectiveness of a medication, is there something else they can eat?” Schubert says. “It all ties back together.”

Guest lecturers in the class bring expertise from different disciples. David Cockley, associate professor of health sciences, comes from an administrative point of view, addressing how technology makes more efficient use of time. For instance, a woman with a high-risk pregnancy who lives in Harrisonburg may have to travel every week to the UVA Medical Center for prenatal care. “It can be time-consuming, expensive and stressful,” Schubert says. Having a Skype-like link between her doctor’s office in Harrisonburg and her doctor’s office in Charlottesville can save her the two-hour trip. “It maximizes resources and improves care.”

William Grant, associate professor in the College of Business, talks about the economics of health care. He discusses how to understand the impact of the Affordable Care Act, how much of what patients pay goes to their care, to malpractice and to the insurance companies. Health care costs often go up because of a lack of competition. For instance, why does a box of gauze that costs $5 at the drugstore cost $50 at the hospital?

Some of these disparities result from duplication of documentation, says Schubert. Informatics can help to eliminate that, thus making the billing process more transparent.

Informatics is already starting to have an impact on epidemiology. Schubert gives the example of the “Google flu trend.” Technology experts can see how many people searched for information about the flu during a certain time period. “We can see the patterns of the seasons, the locations and predominance of the flu there,” she says. Because of similarities of symptoms between the flu, mononucleosis and pneumonia, having the data can help doctors make the correct diagnosis.

Within hospital systems, health professionals can look at how many people during the previous season got flu shots and how many people got the flu. They can send an alert to area doctors to remind their patients to get the shot.

Students get it

James Gwinn, a biology student in the pre-dental program, took the Informatics class last spring. He thought he needed to know how technology is used in health care settings.

“Technology in health care is way behind everyday technology,” says Gwinn, who graduated in May. “It has a lot of catching up to do.” For instance, he says, many doctor’s offices still use pen and paper for information. Patients must bring their medical histories with them rather than having it available digitally. He says, “It’s very old-school.”

The course emphasizes critical thinking components in sociology and psychology, especially when it comes to how to engage populations. Schubert assigns her students to make a pitch about why a medical practice should adopt an EHR system. She’s been impressed with what her students have pulled together. For instance, one student said an EHR wouldn’t work in rural locations where the Cloud is not the best way to communicate.

Another student made a connection on the basis of a family member in California receiving medical treatment. She realized that if she had access to her mother’s medical records, she could check to see if her mother had visited the doctor and what had happened during the visit. This would enable the young woman to engage more helpfully with her mother’s medical care. “It’s nice to see the students bringing it together,” says Schubert.

Interprofessional care

The informatics class is an Interprofessional Education (IPE) course implemented and funded through IIHHS. Rhonda Zingraff, IIHHS director and associate dean of the College of Health and Behavioral Studies, says faculty from multiple academic departments were concerned about adequately preparing students for the impact of informatics on their future roles in health care.

“The topic is inherently interprofessional,” Zingraff says. “Medicine, physical therapy, pharmacy, dentistry—informatics crosses all professions.” The course actively seeks to enroll students who represent a variety of health care interests. This reflects the movement in the health care field toward interprofessional care.

“By bringing these different students from different majors together, they begin to experience the interprofessional workplace they will be entering in the next few years,” Schubert says.

At the beginning of the course, Schubert polls her students. She has found they recognize their need for more exposure to informatics. Starting in 2015, the MCAT exam will ask questions about informatics.

Preparing for change

Informatics big picture—a nationwide network of electronic health records—starts with many small pictures, which involves health care providers keeping EHRs of their patients. The federal government provided incentives to providers to do so through the HITECH (Health Information Technology for Economic and Clinical Health) Act in 2009. To qualify for the monetary incentives, providers must also use the EHRs efficiently, thus meeting the Meaningful Use criteria. Phase 1 of the HITECH Act encourages providers to enter their patients’ information into specific fields, rather than free text fields, to make it easier to report information.

“For example, EHRs should record the smoking status or immunization records of individuals in their appropriate areas, so administrators can run office or hospital-wide reports,” Schubert says.

Phase 2, also underway, aims to bridge the systems together for larger, universal reporting. “We aren't there yet,” she says, “but the goal is to have interoperable health systems that will communicate between health care facilities, as well as larger public health organizations like the CDC.” Goals for Phase 3 are still under development but the contours of a very different health system are obviously taking shape and students at JMU will be shaping that future.