Clinical Informatics subspecialty in PT

[Daniel Vreeman]

Some of my physician colleagues are starting to sit for their Clinical Informatics subspecialty board certification. It took about 5 years from the commitment of AMIA to launch the initiative to getting it approved by ABMS. Given that a lot of the core content definition work has been done, but that so few in physical therapy are tuned in to informatics and that there are no non-clinical subspecialties approved by ABPTS, when do you think we might see informatics subspecialty certification in PT?

10 years, 20 years?, never?

Just curious what others think.

Thanks,
__

Daniel J. Vreeman, PT, DPT, MSc
Assistant Research Professor, Indiana University School of Medicine
Research Scientist, Regenstrief Institute, Inc

[Alan Lee]

Hello Dan,
It is good to hear from you and updates from Medicine. Boy, there are many layers to unpack here so excuse my email for lack of details. First, I wonder if we should focus on the importance of partnerships/collaborations on informatics instead of when it will occur for the PT profession. Some of our IT vendors tell me ICD-10 has about 60% orthopedics compared to other disciplines in medicine. Ortho Docs do not want to deal with primary care informatics and they fight against it. However, subspecialty like this will improve HIT and health information exchange programs in the future. A common core standard and uniformity is always the first to pack into the IT suitcase. National Boards' support as well as federal funding for incentives for IT with association advocacy are few layers I would like to pack into the suitcase as well.
Next, I believe PTs have a role to play in this. However, the profession needs to figure out what is our role (value proposition) in informatics post-ACA. Can ABMS envision PTs sitting for the exam instead of ABPTS? Or, is ABPTS the best option. I don't know but I do know from the wound management specialty like CWS from ABWM includes MD, DO, PT, RN, etc.; it takes a village to heal a wound. And now ABPTS is investigating a wound certification in support of section on Clin.Electro/wound management. Thus, both avenues should be investigated. And, I think your leadership and others in our tech SIG could think about other collaborations within the sections of APTA.
Back to your question of when? Never is not the answer since technology is here to stay. And, health information exchange and practitioner competence on informatics will be critical for best practice in the digital age. Please let me know how I can assist you and champion this in our profession. Alan L.

Alan Chong W. Lee, PT, PhD, DPT, CWS, GCS
Associate Professor
Mount St. Mary's College
Doctor of Physical Therapy Program
10 Chester Place
Los Angeles, CA 90007

213-477-2981 office
213-477-2609 fax
al...@msmc.la.edu
________________________________________
From: aptat...@googlegroups.com [aptat...@googlegroups.com] On Behalf Of Daniel Vreeman [dvre...@gmail.com]
Sent: Wednesday, October 16, 2013 9:05 AM
To: APTA Tech SIG
Subject: [aptatechsig] Clinical Informatics subspecialty in PT

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[Daniel Vreeman]

Hi Gail -

No, the SIG encompasses everything related to Tech. We haven't really had enough of a critical mass to form an official subgroup in any particular area, though at different times various focus areas have emerged - mostly due to the participant's interest area. But, if you've read the recent HPA Resource article about Catalyst Groups (more info at http://www.aptahpa.org/displaycommon.cfm?an=1&subarticlenbr=109f), one could imagine using that kind of mechanism to launch something like this too.

I'm just interested in hearing what other people think about how far/fast we'd need to come as profession to have it be an official subspecialty.

Thanks,
__

Daniel J. Vreeman, PT, DPT, MSc
Assistant Research Professor, Indiana University School of Medicine
Research Scientist, Regenstrief Institute, Inc

On Oct 16, 2013, at 12:17 PM, Gail Altekruse <Gail.Al...@parkview.com> wrote:

> Good question.
>
> Do we have a subgroup for the Tech SIG in informatics?
>
> Gail Altekruse, PT,MBA
>
> Implementation Analyst
> Certified Inpatient ClinDoc
>
> Certified Reporting Workbench
> Link: Make a Report Request - Team.Parkview
>
> (w) 260 373-8861
>
> Nothing is less productive than to make more efficient what should not be done at all. - Peter Drucker

>
> -----Original Message-----
> From: aptat...@googlegroups.com [mailto:aptat...@googlegroups.com] On Behalf Of Daniel Vreeman
> Sent: Wednesday, October 16, 2013 12:05 PM
> To: APTA Tech SIG
> Subject: [aptatechsig] Clinical Informatics subspecialty in PT
>

[Christopher Peterson]

Thank you Dan and Alan for initiating a discussion about informatics as it pertains to our profession. Because I know that many of us are busy and may not be entirely up to date with the abbreviations used in these posts, I put together a quick reference list with links to helpful resources, please see below.

As far as how far our profession needs to come to embrace informatics. From my vantage point, a long way. We still seem to be in a phase of technology adoration slowly moving towards a focus of how to utilize the technology we already possess in a meaningful way.
It seems to me that we will need to answer some important questions such as:

What informatics are important to physical therapy?

How can informatics help physical therapists improve the quality of the service they provide?

How can physical therapists apply informatics to contribute successfully to ACOs (accountable Care organizations)?


References and definitions to support Dan and Alan's posts:
ABMS: The American Board of Medical Specialties
Link to the informatics specialty announcement
http://www.abms.org/News_and_Events/news_archive/release_Announcing_TwoNewSubspecialties_10312011.aspx

ABPTS: American Board of Physical Therapy Specialties
Link to the home page (note searches for "technology" and "informatics" yielded no results)
http://www.abpts.org/home.aspx

ACA: Accountable Care Act

Link to the wikipage
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

ABWM: American Board of Wound Management
Link to the ABWM home page
http://www.aawm.org/

CWS: Clinical Wound specialist

Link to an ABWM web page on CWS certification

[Kathleen Blair]

Hi Dan,

Nurses are already moving into Clinical Informatics Roles. I'd love to see us do it as well. Your point regarding non-clinical subspecialties is definite food for thought....

Katie Blair PT

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[beth]

Perhaps something in the fellowship realm similiar to what Jody Frost has done with the Leadership program.

Beth 

 

 

Beth Ennis, PT, EdD, PCS, ATP
All About Families, PLLC
Louisville, KY
502-296-2430

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[Gail Altekruse]

Regarding clinical informatics and how it relates to our profession, it would be great to increase the knowledge base for our colleagues.  To that end, I would like to see if anyone else is interested in a Catalyst group of members who have been a part of an EMR implementation/ upgrade that required new build and training of end users.

 

Let me preface my comments with the premise that I am only dealing with the experience of one health system.  My fear is that I am not alone.

 

The health system where I am working recently implemented Epic after many years on a different product.  I am a member of the build/implementation team for Clinical Documentation, and the Reporting application coordinator for the ClinDoc team.  The IP and OP rehabilitation therapies were one of the groups who were assigned to me as a group of users.

 

My dilemma:  The foundation system product was a good start, but was far from complete for the therapies.  I have had 3 major difficulties: 1) Prior to implementation, many of the workflow processes for therapies were (and still are) filled with redundancies and waste (from a LEAN perspective), both IP and OP, 2) Therapists have difficulty with documenting in “real” time, and 3) Many of the therapists do not understand the power of discreet data, and the impact on reporting->outcomes measurement-> compliance with evidence based practice.  Consequently, they have a tendency to continue to document in a narrative style in notes.  All of these issues have major downstream effects in a health system, and impact how therapists are viewed regarding their contributions to the healthcare team.

 

I’m not even sure where to start…Can we connect the dots for our colleagues and communicate the power of the EMR?  Being valued for your knowledge/expertise/contribution to the patient’s experience comes from validating it with outcome data from the documentation…and gathering the data in a reportable format means having that data as a discreet field…which means the end users need to USE those fields consistently…which means the users in the workgroup need to come to a consensus on what to measure and where that occurs in the workflow, and having that incorporated in the build of the EMR…and then training the users to use it correctly...

 

Can we continue the discussion at CSM, perhaps come up with process recommendations for implementations/ upgrades?

 

Gail Altekruse, PT,MBA

Implementation Analyst

Certified Inpatient ClinDoc

 

Certified Reporting Workbench

Link:  Make a Report Request -  Team.Parkview

 

(w) 260 373-8861

 

Nothing is less productive than to make more efficient what should not be done at all. – Peter Drucker

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[Kathleen Figetakis]

Hi, Daniel,

 

Can you elaborate more about the definition of informatics?  Nursing has a specialty of Informatics available, but it sometimes seems that "Informatics" does not have a standard definition across all medical professions and applications.   

 

Are you asking when it is envisioned that PT would have a specialty of Informatics that is an exact equivalent to the nursing specialty of Informatics? 

 

Thanks,

Kathleen

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[Daniel Vreeman]

Interesting thoughts everyone.

Well, as I mentioned the good news is that "core content" of clinical informatics has been pretty well defined (at least from the medical field) in these documents:

Core Content for the Subspecialty of Clinical Informatics:

http://jamia.bmj.com/content/16/2/153.full.pdf+html

Program Requirements for Fellowship Education in the Subspecialty of Clinical Informatics

http://jamia.bmj.com/content/16/2/158.full.pdf+html

Kathleen is right that nursing has been working on this for a while too, and has very similar documents. So yes, my question is how long till a PT can sit for a board exam via ABPTS (or some other APTA-recognized organization) and become a certified specialist in informatics. There are of course prerequisites that must be in place before such a certification would be approved (including sufficient number of PTs, fellowship training opportunities, approval by the House of Delegates, etc).

In my de-briefings with colleagues who sat for the CI medical subspecialty exam, they said there was very little physician-specific content. A few questions about ordering meds, but if you've worked on or been reading the literature about computer-generated reminders (decision support systems) you'd get them. So, if/when we decide as a profession that this an area we need more PTs in, the good news is that much of the work has been done…just need to adapt it for our unique role.

That being said, as a graduate of one of the fellowships originally designed for physicians (because they were they main group interested in this space), I can say that the core competencies needed for all clinicians are basically the same. We just need to apply them in different (i.e. rehab/PT) settings.

I also agree with Gail who expressed a sentiment I've heard from lots of different folks in conversations about this. I'd love to continue the conversation within the SIG about what we can do to increase that awareness. CSM is a great opportunity for that, but I'd also suggest that we don't necessarily have to wait till then to start generating some ideas on how to move the field forward. I think the newly launched SIG blog is one opportunity. Maybe Gail you'd be interested in writing about your experience, thoughts, and recommendations? 

When the SIG members help create the APTA EHR Toolkit (http://www.apta.org/EHR) we focused more on the pre-implementation side than the post-implementation side, because that was where most people were. Might be time now to create some recommendations/best practices/tips, etc for how to get the most out of it?

Thanks,

__

 

Daniel J. Vreeman, PT, DPT, MSc

Assistant Research Professor, Indiana University School of Medicine

Research Scientist, Regenstrief Institute, Inc 

[Beth]

I wonder if a fellowship outside of medicine might not be appropriate.  

B

Beth Ennis, PT, EdD, PCS, ATP

Sent from my iPad

[Beth]

Sorry for the multiple sends.  IPad issues at panera.  :)

Beth Ennis, PT, EdD, PCS, ATP

Sent from my iPad

[Robert Latz]

Hello All,

In following on a topic that Gail touched upon (in quotes below), we have a major sense of urgency upon us now. Basically, if we do not identify our discreet data elements within the next year, they will be identified for our profession. In other words, in my opinion, we do not have time to wait for a clinical informatics sub specialty within PT to be in place and recognized.

Please note, I do think the sub specialty is a good idea. And, I do think the time to begin this development is now. However, I believe we need to act on this initial piece ASAP and here is why...

Recently, at the AHCA/NASL conference, on day one an MD and Pharmacist gave a presentation and talked about the need for a 'core set of therapy specific data elements that was site site agnostic and could be shared across the continuum of care'. Later the same day, during a presentation about CMS's auditing process, the discussion again diverted to the need for a set of therapy specific data elements that can be compared over time and which would demonstrate the value of therapy services. (This presenter was not present during the discussion from earlier in the day).

Early the next morning, during a presentation about the status of the CARE Tool, we learned that some organizations are pushing to have this tool be the core set of data elements for therapy (again, this presenter was not present for either of the discussions the day before).

Later, on this second day, I was in a room with representatives from ~20 of the largest post acute software vendors in the US market. For a good portion of this meeting, the topic centered around the need for a Core Set of Therapy Specific Data Elements that could be shared in a Therapy Specific CCD (Continuity of Care Document). In the end, the group agreed that this would be a key goal to complete during 2014. Of interest, two of the vendors shared that 'data is cheap' and 'sharing data is easy'. There is little cost to them to actually develop the script to 'hold' or to 'share' the data elements. The challenge is that the data set must be developed and if representatives from therapy were not willing or able to come up with the universe of data elements--and then identify within this 'universe' the most commonly used elements, then it was only a matter of time when someone else did this for them.

Bottom line, we have an opportunity now. We need to create a spreadsheet with the universe of all data elements within Rehab Therapy. On this spreadsheet, we can 'tag' what we might identify as the 'core' data set. The software companies can then write the script for these items...to collect, store, and share. Does anyone have a 'starter' set of data elements related to therapy services? One thought is a spreadsheet format with columns identifying the data elements, another column (or multiple columns) identifying where the data element is from and what 'standardized tests' include the noted data element. 

For example, Turn 360 degrees is one example of (what I think of) as a data element. This can be measured within the Berg or the Tinetti--or it can be measured in other tests or independent of any standardized test. Within the clinical setting, we still complete whatever standardized test we choose to use...and we then have the opportunity to share the data element across settings. Over time, we will begin to identify the 'most commonly documented (not necessarily used)' data elements in therapy in different settings.

Your thoughts?

Thank you.

Bob

Robert "Bob" Latz, PT, DPT, CHCIO

Robert "Bob" Latz, PT, DPT, CHCIO

cell: 859.802.7274

email: Rober...@gmail.com

[Tim Richardson]

Bob,

100% agree.  I've often called for a clear-cut set of metrics that could be used to define the skilled therapy note.  Obviously, Functional Reporting has gone a long ways towards getting rank-and-file therapists to think this way, too.

Any centralized 'core set' will probably encounter the same criticism that Functional Reporting is encountering.  But, we still need to define a core set or, as you point out, one will be defined for us.

But, is a consensus approach the best way to solicit items for the core set?  Doesn't that risk too many favorite 'special tests' being tossed in the mix?

What about a task force to review the literature, identify evidence-based items (there won't be many) that predict the outcome of therapy and start with those?

Then, any secondary items can be added.

By the way, could this conversation be put on the Tech SIG blog?  If you're not comfortable with that what about an edited version for the blog?

Thanks,

TIm

Tim Richardson, PT

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[beth]

Here is my challenge with this, (and with meaningful use, for that matter) -- Often what is chosen is appropriate for the adult patient with mskel issues (that is all PTs work with, correct?) and doesn't address the wide range of ages, diagnoses, and movement disorders that we address.

 

So my challenge is -- can we come up with something that addresses the human condition across the board, and how do we quantify progress meaningfully in a variety of ways?  

 

eg.  I cannot use the tinetti with a 6 month old, and the pedi berg (for ages 7 and up) is very different form the adult berg.

 

Just thoughts.

[Robert Latz]

Hello.

Good comments and one clarification as I understand....the tinetti, pedi berg, and functional items are all assessments which are all made up from several data elements....many cells of data, is another way to think of this. 

When using data elements, each clinic can still use their chosen test (hopefully more than one when appropriate). Even so, we can measure changes over time within any data elements that are measured over time.

Bob

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