Transforming Health Care Through Information Case Studies
(Health Informatics)
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Laura Einbinder • Nancy M. Lorenzi
Joan S. Ash • Cynthia S. Gadd
Jonathan Einbinder
Editors
Transforming Health
Care Through Information:
Case Studies
Third Edition
Editors
Laura Einbinder Nancy M. Lorenzi
Partners Health Care Vanderbilt University Medical Center
Center for Clinical Informatics Department of Biomedical Informatics
Research and Development Eskind Biomedical Library 4th floor
Research Applications Group 2209 Garland Avenue
Boston, MA, Nashville, TN 37232-8340
USA USA
Joan S. Ash Cynthia S. Gadd
Oregon Health Science University Vanderbilt University Medical Center
Department of Medical Informatics Department of Biomedical Informatics
& Clinical Epidemiology Eskind Biomedical Library 4th floor
3181 SW Sam Jackson Park Road 2209 Garland Avenue
Mailcode: BICC Nashville, TN 37232–8340
Portland, OR 97239–3098 USA
Jonathan Einbinder
Partners Health Care
Center for Clinical Informatics
Research and Development
Research Applications Group
Boston, MA
USA
ISBN 978-1-4419-0268-9 e-ISBN 978-1-4419-0269-6
DOI 10.1007/978-1-4419-0269-6
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2009931684
© Springer Science+Business Media, LLC 2010
All rights reserved. This work may not be translated or copied in whole or in part without the written
permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York,
NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in
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The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are
not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject
to proprietary rights.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
My dedication is to Robert T. Riley,
the managing editor of the first edition
of Transforming Health Care through
Information: Case Studies. In that role he
edited all the cases and ensured that they
were more readable and had a sense
of balance and humor. Bob was nationally and
internationally acclaimed for his presentations,
his management developmental seminars,
and his consulting skills. He authored
several books and numerous articles on
management and on managing technological
change. Bob was known for his humor, his
constant quest for new knowledge, his ability
to understand and solve problems, his ability to
make friends, and his ability to teach
others. By publishing yet another edition in
this series, we continue to remember and
honor his memory.
Foreword
By any measure, our field of clinical informatics is poised for rapid growth and
expansion. A confluence of forces and trends, including pressure to contain health
care costs and simultaneously expand access and coverage, a desire to reduce medi-
cal error and health care disparities, the need to better understand and optimize our
clinical interventions and delivery systems, the need to translate new knowledge
into practice quickly and effectively, and the need to demonstrate the value of our
services, all call for the application of the methods and techniques of our field –
some of which are well honed with experience, and some of which are still in the
process of being discovered. Clinical informatics is not the only solution to what
ails health care, but it is a critical component of the solution.
Our methods and techniques are similar in many ways to the knowledge base
of any interdisciplinary field: some are informed by experience, the trials and
tribulations of figuring out what works through real world implementation, some
are informed by controlled experimentation in randomized controlled trials and
related studies, some are informed by critical observation and analysis, and some
are developed through laboratory evaluation rather than field trials. As we develop
both the basic science, as well as the applied science, of our field, there is a criti-
cal role for learning from others by way of case reports and stories. These reports
of work in progress contribute in significant ways to the growing understanding
of what works, and what does not, in practice. They play a key role in helping to
develop and evolve a framework of understanding, on which we may hang a variety
of evidence to substantiate, or to reform our principles and theory, and with which
we may identify the key questions that are yet to be assessed.
The following text is a collection of case reports and stories, some more formal
than others, but all contributing to this evolving framework of understanding, and
all of which will help any practitioner in the field of clinical informatics increase his
or her understanding, and become better able to pursue their own trials and tribula-
tions with any clinical informatics project, and contribute their own experiences
to the framework. The text is organized around four major areas or domains of
clinical informatics – Managing Change, Patient Safety, Organizational Impact and
Evaluation, and Integration – and focuses on the people and organizational process
of applied informatics, as well as evaluation, across a wide range of topics. The
authors are all deeply involved in their projects and they bring an intimate under-
standing of the problems at hand. The editors are all expert leaders in the field, who
vii
viii Foreword
have brought these authors together and created this rich collection. These stories
will inform, entertain, surprise, and console the reader – we have much to offer in
our field, but we may be humbled by the scope of the challenge, and we will surely
benefit from sharing our stories and insights.
Read and enjoy this book – and learn from it more about what works, and what
may not work in practice, and apply it to your own efforts. Your own understanding
will be much improved, and you will be more likely to succeed. And, in any case,
you will add your own experience to the framework of understanding. Be sure to
write your story, too.
Partners Healthcare System Blackford Middleton, MD, MPH, MSc
Wellesley, MA
Series Preface
This series is directed to Health care professionals who are leading the transfor-
mation of health care by using information and knowledge. Historically the series
was launched in 1988 as Computers in Health Care, to offer a broad range of
titles: some addressed to specific professions such as nursing, medicine, and health
administration; others to special areas of practice such as trauma and radiology;
still other books in the series focused on interdisciplinary issues, such as the com-
puter based patient record, electronic health records, and networked Health care
systems. Renamed Health Informatics in 1998 to reflect the rapid evolution in the
discipline known as health Informatics, the series continued to add titles that con-
tribute to the evolution of the field. In the series, eminent experts, serving as editors
or authors, offer their accounts of innovations in health Informatics. Increasingly,
these accounts go beyond hardware and software to address the role of information
in influencing the transformation of Health care delivery systems around the world.
The series also increasingly focused 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 health care delivery are constant; most recently developments
in proteomics and genomics are increasingly becoming relevant to clinical deci-
sion making and emerging standards of care. The data resources emerging from
molecular biology are beyond the capacity of the human brain to integrate and
beyond the scope of paper based decision trees. Thus, bioinformatics has emerged
as a new field in health informatics to support emerging and ongoing developments
in molecular biology. Translational informatics supports acceleration, from bench
to bedside, i.e. the appropriate use of molecular biology research findings and bio-
informatics in clinical care of patients.
At the same time, further continual 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 such as the Health care Information
Technology Standards Panel (HITSP) in the United States, Canada Health Infoway,
NHS Connecting for Health in the UK.
We have consciously retained the series title Health Informatics as the single
umbrella term that encompasses both the microscopic elements of bioinformatics
and the macroscopic aspects of large national health information systems. Ongoing
ix
x Series Preface
changes to both the micro and macro perspectives on health informatics will con-
tinue 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 health care. As coeditors,
we pledge to support our professional colleagues and the series readers as they
share advances in the emerging and exciting field of Health Informatics.
Kathryn J. Hannah
Marion J. Ball
Acknowledgments
To students in my class who investigated the people and organizational issues side
of informatics.
Nancy M. Lorenzi
xi
Contents
Section I Managing Change
Nancy M. Lorenzi
1 Back Breaking Work: Implementing
a Spine Registry in an Orthopedic Clinic................................................. 7
Brian C. Drolet
2 A RHIO Struggling to Form: Will it Get Off the Ground?.................... 15
Paul Zlotnik, Denny Lee, Mike Minear, and Prashila Dullabh
3 A Rough Ride at the Theodore Roosevelt Cancer Center....................... 29
Karen Albert, Nitika Gupta, Teresa Mason, and Purvi Mehta
4 Implementation of an Electronic Prescription Writer
in Ambulatory Care.................................................................................... 47
Minhui Xie and Kevin B. Johnson
5 Online Health Care: A Classic Clash of Technology,
People and Processes................................................................................... 57
John Butler, Dan Dalan, Brian McCourt, John Norris,
and Randall Stewart
Section II Patient Safety
Joan S. Ash
6 A Dungeon of Dangerous Practices........................................................... 73
Andrew Amata, Allen Flynn, Michelle Morgan,
Teresa Smith, and Mary Tengdin
7 Different Sides of the Story........................................................................ 83
Allison B. McCoy
xiii
xiv Contents
8 Barcode Medication Administration Implementation
in the FIAT Health System....................................................................... 85
Linda Chan, William Greeley, Don Klingen,
Brian Machado, Michael Padula, John Sum, and Angela Vacca
9 H.I.T. or Miss............................................................................................. 97
James McCormack, Bimal R. Desai, Jennifer Garvin,
Randal Hamric, Kirk Lalwani, Andi Lushaj, Alexey Panchenko,
Deborah Quitmeyer, and JoAnna M. Vanderhoef
Section III Organizational Impact and Evaluation
Cynthia S. Gadd
10 The Implementation of Secure Messaging.............................................. 107
Zhou Yan
11 Who Moved My Clinic? Donnelly University
Pediatric Rehabilitation: The Wheelchair Clinic................................... 115
Fredrick Hilliard
12 OncoOrders: The Early Years.................................................................. 127
Chris Raggio and Judith W. Dexheimer
13 Implementing a Computerized Triage System
in the Emergency Department................................................................. 135
Scott R. Levin, Daniel J. France, and Dominik Aronsky
14 Medication Barcode Scanning: Code “Moo”: Dead COW................... 155
Laurie L. Novak and Kathy S. Moss
Section IV Integration
Jonathan S. Einbinder
15 Project NEED: New Efficiency
in an Emergency Department.................................................................. 167
Barry Little, Denise Johnson, Jennifer Tingle,
Mary Stanfill, and Michael Roy
16 Digital Radiology Divide at McKinly...................................................... 179
Neal Goldstein, David Ross, Ken Christensen,
Jayashree Kalpathy-Cramer, Aseem Kumar,
and Marilyn Schroeder
Index................................................................................................................... 191
Contributors
Karen Albert
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Andrew Amata
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Dominik Aronsky
Eskind Biomedical Library, Departments of Biomedical Informatics and
Emergency Medicine, Vanderbilt University Medical Center, Nashville,
TN 37232-8340, USA
Joan S. Ash
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
John Butler
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Linda Chan
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Ken Christensen
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Dan Dalan
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Bimal R. Desai
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
xv
xvi Contributors
Judith W. Dexheimer
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Brian C. Drolet
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Prashila Dullabh
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Jonathan S. Einbinder
Research Applications Group, Center for Clinical Informatics Research and
Development, Partners Health Care, Boston, MA, USA
Laura Einbinder
Research Applications Group, Center for Clinical Informatics Research and
Development, Partners Health Care, Boston, MA, USA
Allen Flynn
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Daniel J. France
Eskind Biomedical Library, Departments of Biomedical Engineering and
Anesthesia, Vanderbilt University Medical Center, Nashville, TN 37232-8340,
USA
Cynthia S. Gadd
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Jennifer Garvin
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Neal Goldstein
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
William Greeley
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Nitika Gupta
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Contributors xvii
Randal Hamric
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Fredrick Hilliard
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Denise Johnson
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Kevin B. Johnson
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Jayashree Kalpathy-Cramer
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Don Klingen
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Aseem Kumar
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Kirk Lalwani
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Denny Lee
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Scott R. Levin
Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD,
21287 USA
Barry Little
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Nancy M. Lorenzi
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Andi Lushaj
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
xviii Contributors
Brian Machado
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Teresa Mason
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
James McCormack
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Brian McCourt
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Allison B. McCoy
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Purvi Mehta
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Mike Minear
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Michelle Morgan
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Kathy S. Moss
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
John Norris
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Laurie L. Novak
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Michael Padula
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Alexey Panchenko
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Contributors xix
Deborah Quitmeyer
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Chris Raggio
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
David Ross
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Michael Roy
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Marilyn Schroeder
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Teresa Smith
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Mary Stanfill
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Randall Stewart
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
John Sum
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Mary Tengdin
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Jennifer Tingle
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
Angela Vacca
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
JoAnna M. Vanderhoef
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
xx Contributors
Minhui Xie
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
Zhou Yan
Eskind Biomedical Library, Department of Biomedical Informatics, Vanderbilt
University Medical Center, Nashville, TN 37232-8340, USA
P.J. Zlotnik
Department of Medical Informatics & Clinical Epidemiology, Oregon Health
Science University, Portland, OR 97239-3098, USA
