Neurology Health Services & Informatics
Neurology Health Informatics
Health informatics represents the crossroads of technology, the use of data to improve specificity and quality, data-driven decision-making, and critical support for interprofessional collaboration and communication. Specifically, the discipline of health informatics (HI) involves the collecting, storing, retrieving, and analyzing of health-related data to improve healthcare outcomes and patient care. The lexicon of informatics disciplines can be quite confusing. For instance, health informatics, medical informatics and even biomedical informatics are often used synonymously, but have subtle differences, as defined by the Board of the American Medical Informatics Association (AMIA). Conversely, bioinformatics and health informatics are diverging as distinct fields, with the latter being more patient-facing.
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The two informatics fields pertinent to neurologists are neuroinformatics and neurology health informatics (NHI) [Figure 1]. Neuroinformatics, a subset of bioinformatics, combines neuroscience and informatics research to develop innovative tools for organization of large-volume, high-dimensional neuroscience data. It also applies computational models to integrate and analyze these data to eventually understand brain structure and function.
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Neurology health informatics, on the other hand, focuses on the application of information technology to acquire, process, and analyze neurobiological data for the purpose of improved neurology care systems and patient outcomes. A subspecialty of health informatics, neurology health informatics draws from quality improvement, program management, and information technology theory and methodology. Clinical guidelines, best practices, and models of delivering care are evolving as rapidly as information technology systems. Health care providers, health informaticists, and IT specialists must work in conjunction to create information systems that meet specific needs, maintain interoperability between various design systems, and minimize information waste.
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Neurology Health Informaticist as a Profession
Neurology health informaticists use their knowledge of neurology-related patient care combined with their understanding of informatics concepts, methods, and tools to evaluate clinical processes. Furthermore, their evaluation and analyses lead the design and implementation of data-driven solutions to refine clinical decision support systems, improve clinical information systems, and, in turn, improve patient care. For instance, advancements in neurological diagnostic tools create opportunities for raw data to be processed into information and utilized in different modalities of interest. A neurology health Informaticist facilitates this process by asking some questions, such as:
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How a neurodiagnostic tool will be incorporated into practice
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How best to capture, process, and utilize its data
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How to design a data storage system and integrate into EHR
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Which data analysis tool is best suited for the data set
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The skillset needed for a neuro-Informaticist is different than the skillset of neurology health informaticist. Neurology health informaticists are proficient in quality improvement methodologies, such as Lean Six Sigma, as well as database organization. In contrast, neurology informaticists are focused on analysis of neurobiological data and have a mastery of respective analytic tools. Both specialists have a strong knowledge of modern web applications (HTML5, CSS3, JavaScript, Java), coding languages (Python, R, Perl, SAS), database development and tools (SQL, Oracle, Data Warehousing), and a strong understanding of electronic healthcare record based quantitative research. Educational and training programs are primarily available outside of traditional neurology residency programs.
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Training opportunities
As more healthcare providers transition to federally mandated electronic medical records, the demand for health informatics professionals and training opportunities are growing. Physicians, including neurologists, may become board certified in clinical informatics.
AMIA also offers a Clinical Informatics Board Review Course to provide a comprehensive review of the core content for Clinical Informatics. Physicians with primary certification from an American Board of Medical Specialties (ABMS) member board are now eligible to become board certified in clinical informatics through an exam offered by the American Board of Preventive Medicine and the American Board of Pathology. Neurologists who are actively engaged in health informatics can sit for the clinical informatics boards examinations until 2022. Beginning in 2023, physicians must complete an ACGME-accredited Clinical Informatics Fellowship Program to be eligible for the board exam.
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Conclusion
Big data, deep learning, and other technological advancements are fueling the health informatics boom and improving care for patients. Through neurology health informatics, neurologists can leverage digital-age information systems to develop insights and solutions that lead to better patient care. The demand for talented neurology health informaticists outpaces the supply of qualified applicants. For rising neurologists trained in health informatics, opportunities for interprofessional collaboration, research, and career advancement are abundant.
Current Projects
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Reduction of Seizures Through Education and Support (ROSES) Study
The Yale ROSES study aims to develop a neurology health informatics tool to improve the performance of epilepsy care. A Seizure Action Plan (SAP), developed by the Epilepsy Foundation, will be modified into a template to help facilitate communication and understanding between patients and caregivers with their healthcare providers. As a clinical decision support tool, the SAP template will serve to help maintain clinical standards of epilepsy care. The impact of SAP availability and its formal implementation on patients who experience seizure clusters have not yet been determined. This study includes the assessment of the patient/caregiver experience and quality of life via validated questionnaires and focus groups.
Specifically, the Yale ROSES mixed-method study is designed to assess the following:
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Clinical quality intervention (clinic workflow, completion of seizure action plans (SAPs), effectiveness of SAPs as perceived by healthcare providers and patients/caregivers)
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Review of rescue medication possession and attitudes of prescribers and patients/ caregivers about their use.
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Impact of rescue medications on health outcomes, total pharmacy use, and healthcare resource utilization (HCRU)
VA National Neurology Dashboard
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In partnership with AMCMS, members of the Altalib Lab are providing support to develop and evaluate a national neurology dashboard to evaluate coordination of community care for Veterans with neurological conditions.
Past Projects
Measuring coordination of epilepsy care: A mixed methods evaluation of social network analysis versus relational coordination
In a parallel mixed methods approach, we compared coordination of care of VA providers who formally engage the Epilepsy Centers of Excellence (ECOE) system to VA providers outside the ECOE system using SNA and RC. This study examines the value of Social Network Analysis (SNA) and Relational Coordination (RC) in measuring coordination of care. SNA quantifies and visualizes coordination of care, generated through administrative data, and can be applied to large healthcare systems. RC requires collection of surveys from stakeholders and is best applied in small clinical settings. For quality improvement and research purposes, SNA and RC can be used to measure coordination of neurological care data at a local as well as population level.
Social network physician maps of five VA facilities. Nodes are color coded by physician specialty: blue, neurology; turquoise, internal medicine; yellow, primary care; and red, psychiatry.
Collaborations
