Integrating informatics and interprofessional education and practice to drive healthcare transformation

Introduction

Over the past two decades, there have been numerous calls worldwide for healthcare transformation and systems reform in order to meet objectives, such as the provision of collaborative, safe, patient centered care (Health Council of Canada, 2013; IOM 2012). One bold initiative to address these objectives emphasized the key function of evidenced-based/evidence-supported care, team-based care and the essential infrastructure of informatics in supporting knowledge discovery and dissemination to foster health system transformation. Committed to objective assessment and strategy development of the United States (U.S.), the Institute of Medicine (IOM) published the seminal piece The Learning Healthcare System which outlined four key characteristics of the learning healthcare system. These essential characteristics include the following: (a) science and informatics for real-time access to knowledge and digital capture of the care experience, (b) patient–clinician partnerships with engaged, empowered patients, (c) incentives aligned for value and full transparency, and (d) a leadership-instilled culture of learning and supportive system competencies (IOM, 2006; IOM, 2012). In this editorial, we discuss the need for integration between informatics and interprofessional practice and interprofessional education (IPP/IPE) as a lead in to a themed issue on the topic. We also introduce a series of papers that comprise this themed issue.

The need for interprofessional practice and education

A key part of healthcare transformation is the need for healthcare systems to transform into a system that supports IPP/IPE. While there is an abundance of studies and reports advocating the need for increased collaborative care delivery (AAMC, 2011; IOM, 2001), putting the recommendations in practice has shown to be challenging. Numerous interventions have been proposed to improve IPP including education and the use of technologies, such as electronic health records (Collins, Bakken, Vawdrey, Coiera & Currie, 2011). However, these macrolevel interventions have not transpired into improved outcomes, and studies highlight that collaboration remains a cause of adverse events, such as communication issues and medical errors (Kuziemsky & Varpio, 2011; Leonard, Graham, & Bonacum, 2004).

A point that needs to be emphasized is that the transformation to a collaborative system is a longitudinal process that requires the development of rules of engagement for how such a system should work (Reid, Compton, Grossman, & Fanjiang, 2005). There is also a fundamental need to understand the challenges associated with transforming a complex system, such as the healthcare system. Complex systems are defined by not only the number of concepts inherent in the system, but also by the degree of interrelations between the concepts (Kannampallil, Schauer, Cohen, & Patel, 2011). Changing the nature of complex processes, such as collaboration without understanding the impact of the changes will lead to, for example, unintended consequences and further fragmentation (Ellis & Hebert, 2011).

IPP/IPE is complex and comprises members from different functional and clinical backgrounds who must be integrated in order to execute healthcare tasks in a collaborative manner (West & Lyubovnikova, 2013). IPP/IPE can be looked at as having a structure that is represented by a set of behaviors. While we have made some good progress in determining how IPP/IPE should be structured, there is a need for research on their behavioral aspects. In fact, it has been highlighted that our focus on improving collaboration and teamwork needs to be on the behavioral aspects such as group processes and dynamics (Courtney, Nancarrow, & Dawson, 2013). Moreover, improving collaborative care necessitates having the data and evidence to support the scholarship of IPP/IPE.

Interprofessional informatics

Informatics tools and methods can provide the means of providing the structure and data to support evidence based/evidence supported IPP/IPE. Yet, broad-brush approaches of putting technology into healthcare organizations will not work because of the degree of complexity of healthcare delivery. Most specific is the need to understand the rules of engagement for how informatics tools should be developed and used to support IPE/IPP. Key aspects include the digital infrastructure to improve the capacity to capture clinical, delivery process, and financial data for better care, system improvement and creating new knowledge. Moreover, informatics can provide solutions to address data utility that would promote the capture of clinical data and analysis to generate knowledge.

The science of informatics “drives innovation that is defining future approaches to information and knowledge management in biomedical research, clinical care, and public health,” including the breadth of IPE/IPP (AMIA, 2015). Inherently, interdisciplinary, health informatics work is motivated by the need to create new solutions, using information technology, that enhance biomedical and health science, the health of the populace and the quality and safety of care. This discipline addresses translational science, clinical research, clinical care, consumer health and public health. The breadth and depth of IPE/IPP relies on this continuum of informatics expertise to assure quality, safety and system transformation.

While the field of informatics is well established, the evidence base for integration and application of this science to IPE/IPP is in its infancy. The biggest challenge that we face in developing informatics solutions to support collaboration is the need to integrate people, processes and context. At times, the study of IPP/IPE and fields, such as biomedical health informatics, has worked in a parallel manner. The IPP/IPE field has produced models that represent micro and macroperspectives of IPP/IPE, while fields, such as health informatics and computer-supported cooperative work, have provided insight on how to design tools to support collaboration.

In this section

The state of the field of interprofessional informatics is nascent, though expanding, as demonstrated by the nature of the papers published in this special section of the issue. In the following section, we summarize each of these scholarly contributions.

Isabelle Brault et al. recognize that the rising prevalence of chronic diseases and population aging have stimulated increased collaboration among healthcare professionals to respond better to patient and family needs. While they acknowledge that many universities have developed IPE programs consisting mainly of courses or clinical simulation experiences where students share professional expertise and learn collaborative skills in academic settings, they highlight that few attempts have been made to pursue IPE in healthcare clinical settings, where students and professionals work together to provide healthcare services and develop core collaboration competencies, and further little to no knowledge supports how information and communication technology (ICT) can support interprofessional development. Their reported pilot work addresses interprofessional learning activities implemented during multiple professional disciplinary practicums actual and potential use of informatics.

Acknowledging that fragmented care contributes to adverse events, medical errors and poor patient outcomes, Jennifer Titzer and colleagues provide a comprehensive review of the literature related to interprofessional collaboration to decrease medical errors, increase quality patient care and establish healthcare delivery models as well as literature-based evidence of the fundamental challenge that healthcare systems are not designed for the integration of people, processes and information, informatics competencies are not required and healthcare professionals often graduates with little knowledge regarding informatics or adapting to the new technology to improve outcomes. Vernon Curran et al. report the results of a review of evaluation outcomes of IPE initiatives delivered using ICT and further note the need for more rigorous evaluation of outcomes in ICT-mediated IPE.

Beth Elias et al. address the centrality of informatics to the interprofessional team and propose a model enabled by healthcare information technology and defined by information flow, workflow and communication needs and interagency free clinic setting. While Elias et al. propose a model related to the interprofessional team being enabled by healthcare information technology, Sripriya Rajamani et al. present a case study of an academic–practice partnership which focuses on both interprofessionalism and informatics, collaborative curriculum development, teaching and research, practicums to promote competencies, complemented by service to advance biomedical health informatics and collaborative environments to facilitate a learning health system. Jeffrey Gold et al. describe the adoption and integration of an electronic health record (HER) into a high-fidelity, interprofessional intensive care unit simulation and the errors induced. This work begins to address one of the fundamental challenges of lack of a standardized environment for testing the EHR in contextually appropriate exercises.

Amy Gilbert and Stephen Downs describe a medical legal partnership model and the interprofessional team that was used to design, launch and evaluate an informatics approach to implement the model to address social determinants of health that may adversely impact child health outcomes. The paper by Timothy Aungst and Paul Belliveau focuses on a particular mobile device to facilitate interprofessional education (IPE) in health professions education programs, while Sunmoo Yoon et al. focus on the development and refinement of the Self-Assessment of Nursing Informatics Competencies Scale and discuss its relevance for IPE and IPP.

Judith Pechacek et al. focus on enabling the scholarship of IPE/IPP and relationship of interprofessional education and collaborative practice (IPECP) on patient outcomes from a national perspective. The development and adoption of the National Center Data Repository (NCDR) as well as support and collaboration to assure the NCDR is designed to capture data related to IPECP processes and outcomes to support analyses of the effect of IPECP on the Triple Aim. Similarly, Barbara Brandt et al. represent a national initiative, the US public–private partnership initiative, the National Center for Interprofessional Practice and Education (NC). The National Center provides leadership, scholarship, evidence, coordination and national visibility to advance interprofessional education and practice (IPECP) as a viable and efficient health care delivery model. While the fundamental building blocks of informatics (data, information and knowledge) have been poorly represented in the field of IPECP, the center uses an informatics approach that focuses on collaborative processes and works to address data definition and access, information management and processing and communications. Brandt et al. go on to summarize the National Center’s multiple informatics informed platforms – informatics education, a resource exchange, communication strategy, an intervention research network, national data repository and learning system.

Common themes arise from the papers in this issue. Several papers detail emerging work of the field of interprofessional informatics, some outline the methodological challenges due to the infancy of the field such as the need for data. Most papers report on small case studies or pilot work. Collectively, these papers help to show that there is a clear need to build upon this work to advance the science on IPP/IPE and informatics, to move to new and advanced methods, supported by more empirical studies, with a transition from small to more rigorous large-scale studies.

Concluding comments

This journal has recognized an urgent need to expand the awareness of the state of the science of interprofessional informatics. The interprofessional issues highlighted in this collection of papers need to be used to inform the design and evaluation of informatics tools that support IPP and IPE, as well as the scholarship of integrative biomedical health informatics. Moreover, while substantial progress at “technical interoperability” has occurred (i.e. the ability to connect two or more computer systems), standards for systems design and education to support teamwork and collaboration, are lacking. The solutions to address collaborative interoperability must come from blending of the two fields, informatics and IPE/IPP. We believe the papers in this themed issue provide some useful initial insights to help guide us in our pursuit of collaborative interoperability.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the writing and content of this article.