2012 10 09 - Maybe is Not a Wary Word

8/13/2019 2012 10 09 - Maybe is Not a Wary Word

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[email protected]

INAPTA Central District Meeting
mailto:[email protected]:[email protected]:[email protected]


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photo via Sadie Hernandez
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If you care for your patients, dont you

want to know whether your interventionsreally work? The only way we can know isthrough clinical trials with controls. In avery real sense, we, like other health careprofessionals, abuse the trust of ourpatients when we give the impression ofknowing more than we do.

- Jules M Rothstein, PT, PhD, FAPTA32nd Mary McMillan Lecture


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photo via jdhancock
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Physical therapy, by 2020, will be provided by physical therapists who aredoctors of physical therapy and who may be board-certified specialists.Consumers will have direct access to physical therapists in allenvironments for patient/client management, prevention, and wellness

services. Physical therapists will be practitioners of choice in patients'/clients' health networks and will hold all privileges of autonomous practice.Physical therapists may be assisted by physical therapist assistants who areeducated and licensed to provide physical therapist directed andsupervised components of interventions.

Guided by integrity, life-long learning, and a commitment tocomprehensive and accessible health programs for all people, physicaltherapists and physical therapist assistants will render evidence-basedservices throughout the continuum of care and improve quality of life forsociety. They will provide culturally sensitive care distinguished by trust,respect, and an appreciation for individual differences.

While fully availing themselves of new technologies, as well as basic andclinical research, physical therapists will continue to provide directpatient/client care. They will maintain active responsibility for the growthof the physical therapy profession and the health of the people it serves.

Vision 2020


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Looking forward, I am profoundly

uninspiredby such a narrow, inwardlydirected vision for our future as aprofession. Today, Vision 2020 isneither bold nor visionary, and asDuncan stated in her 2002 McMillanLecture, it sounds self-promotingand self-aggrandizing.

- Alan M. Jette, PT, PhD, FAPTA43rd Mary McMillan Lecture


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We need to shift dramatically

our focus from optimizingparts to focusing on our role inthe changing systems and

society in which we practice.

- Alan M. Jette, PT, PhD, FAPTA43rd Mary McMillan Lecture


11/119photo via JD Hancock
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PASSreframed our traditional

focus on the physical therapistand the patient/client to one in

which physical therapists are anintegral part of a collaborative,

multidisciplinaryhealth careteam with the health careconsumer as its focus.


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First, therapists must become interested in

data.Second, they must become skilled inthe ability to devise solutions for the

system problems that data and experienceuncover. Third, the physical therapyprofession must develop the ability toimplement at scale - the ability to get

therapists along the entire chain of care

unctioning in concert, in collaboration.

- Alan M. Jette, PT, PhD, FAPTA

43rd Mary McMillan Lecture


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Frances WestleyBrenda Zimmerman

Michael Patton


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Michael Patton


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Michael Patton

Maybe comes with no

guarantees, only a chance.

But maybe has always beenthe best odds the world hasoffered to those who set out

to alter its course...


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Michael Patton

Maybe is not a cautiousword. It is a defiant

claim of possibilityin theface of a status quo we

are unwilling to accept.


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22/119photo via komunews
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photo via martinak15
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Complete,

longitudinalinformation that

follows the consumer


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Care that is

value-basedandcoordinated

across settings

photos via meddygarnetand brykmantra
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Health decisions madewith information tools thatassist and guide

Have youconsidered


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Results

Fewer errors, waste, variationsConsumer-centered care

Lower spending


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Healthcare is an informationbusiness. The quality,

effectiveness, and efficiencyof care depend on our abilityto manage information. You

ust can't do it without EHRs.

Bill Tierney, AMIA 2011 Keynote


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To do this, well need

information systems that are

WAY more than justelectronic documentation.


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Meanwhile,back on planet Earth


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Fundamental challenge:

local systems have idiosyncraticways of identifying the same

concepts


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Patients move

fasterand furtherthan their healthinformation


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photo via pfarrell95
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What does this look

like in the wild?

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photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.JAMA. 1998;280(15):1325-1329.


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photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.JAMA. 1998;280(15):1325-1329.

The rain forest canopy is aseamless web through which

arboreal creatures efficientlymove to reach the edible

fruits without any attentionto the individual trees.


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41%of ED visits are for patients with

data at another institution

Finnell JT, Overhage JM, Grannis SJ. All Health Care is Not Local: An Evaluation of the Distribution of Emergency Department Care Delivered in Indiana. AMIA Annu Symp Proc. 2011;:409-416.

Connectedness among IN EDs


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Connectedness among IN EDs

Finnell JT, Overhage JM, Grannis SJ. All Health Care is Not Local: An Evaluation of the Distribution of Emergency Department Care Delivered in Indiana. AMIA Annu Symp Proc. 2011;:409-416.


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Similar name, different meaning


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Similar name, different meaning

meerkat meerkat mere cat meerkat

photo via Caption Time
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MEASUREMENTS

US

R

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photo via Ed Yourdon
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ICF: walking short distances


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Walking speed: 1 m/s

6 min walk distance: 600m

Fall risk: Mod



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Fall risk: Mod



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Fall risk: Mod



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2 Key Ways EHRs can Help

Accelerate that VisionSeamless web of data

Decision support

photo via OiMax
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photo via liber
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1968!


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1968!


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Do PTs today

really use EHRs?good question...

APTA 2010 Member Survey


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28%

33%

38%

1%

Yes, all electronicYes, paper and electronicNo

Dont know

Got EMR?

APTA 2010 Member Survey


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Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

0 10 20 30 40 50 60

EHR Satisfaction


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Most common

complaint?anecdotal


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A journey.

Not a destination.


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photo via Justin Ornellas
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Adopt interoperable

Electronic Health Records,but be mindful of the

complexity.


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apta.org/EHR


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apta.org/EHR


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Physical therapisteducation programs

should incorporate coreinformatics competencies

into their curricula.


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Although most health


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Although most health

professionals use IT dailyin their work,fewknow

how to adapt their rolesand work processes to

incorporate IT for thegreatest benefit.Stead WW, Searle JR, Fessler HE, Smith JW, Shortliffe EH. Biomedical informatics: changing what physicians need to know and how they learn.Acad Med. 2011 Apr;86(4):429-34. PMID: 20711055

We have frequently heard the


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Silverman H, Cohen T, Fridsma D. The evolution of a novel biomedical informatics curriculum for medical students. Acad Med. 2012 Jan;87(1):84-90. PubMed PMID: 22104049

q yopinion from both faculty and

students that medical studentsalready possess all the basic skillsnecessary to function effectively in

an information-rich environment.

We have frequently heard the


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Silverman H, Cohen T, Fridsma D. The evolution of a novel biomedical informatics curriculum for medical students. Acad Med. 2012 Jan;87(1):84-90. PubMed PMID: 22104049

q yopinion from both faculty and

students that medical studentsalready possess all the basic skillsnecessary to function effectively in

an information-rich environment.This is similar to assuming that a

student proficient in the use of aword processing program knows how

to write an award-winning novel.


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photo via JOPHIELsmiles

Physical therapist education

programs should partner withhealth informatics professionals

in evaluating the efficacy ofinformatics interventions in

physical therapist practice,education, and research.
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photo via JOPHIELsmiles
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photo via IMLS DCC
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Human

+Computer

Human


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I didnt see it then, but it turned out that


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I didn t see it then, but it turned out thatgetting fired from Apple was the best

thing that could have ever happened tome. The heaviness of being successfulwas replaced by the lightness of being a

beginner again, less sure abouteverything. It freed me to enter one ofthe most creative periods of my life.

- Steve JobsStanford Commencement Speech 2005


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photo via scragz

Though Wooten's basses
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photo via scragz

Though Wooten s basses

receive much attention, hismost frequent and consistentresponse when asked by hisfans about his equipment isthat "the instrument doesn't

make the music ...you do".


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photo via scragz


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2012 10 09 - Maybe is Not a Wary Word