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NI2009 workshop on PHRs, Health 2.0, virtual worlds June 30, 2009

Posted by peterjmurray in conference, Europe, krew, NI2009, nursing informatics.
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Scott Erdley, Peter Murray and Heather Strachan are leading a workshop titled ‘Personal health records (PHR), Health 2.0, Virtual Worlds (and more!)’. The workshop aims to exxplore increasingly patient-driven, as opposed to provider-driven PHRs, and to explore issues and ideas around the implications of Web 2.0/Health 2.0, and also of virtual worlds such as Second Life.

We will be making our slides available later on Slideshare.

Peter gave an overview of some models of PHR that exist; he covered AHIMA, HIMSS and Markle Foundation views, as well as covering issues around Google Health etc.

Heather Strachan presented on eHealth in Scotland – about 2.5% of NHS Scotland budget spent on ehealth. Scotland has some of worst health problems in Europe, and has many inequalities. There are issues in devolved government and having a different political party running Scottish government as opposed to UK ruling party. Vision for ehealth is around expoiting the power of electronic information – also aim to improve health literacy so as to support individuals maintaining their own health status. Scotland not creating one single large database due to security/privacy issues – so architectural vision is based around a virtual electronic record gathering data from different sources. ‘Windows’ into services and communications systems and single sign-in system; also use unique patient identifiers. Patients and providers contribute to content of the health record, and there is inter-relationship between patient and clinical portals. Patients want self-management tools for long-term conditions, decision support to manage health as well as health information.

Heather presented examples, inc. www.clinicaldecisions.scot.nhs.uk, the Babylink special care baby unit portal in Edinburgh, ‘my diabetes my way’, renal patient view, NHS 24 (telephone triage system), etc.

Peter then covered descriptions of Web 2.0 and Health 2.0.

Scott presented some uses of Second Life for health. He gave an overview of what Second Life (SL) is, and some other virtual world tools. He gave examples of ways in which people see themselves differently in SL, its use for health conditions, and repositories of information and links.

After the presentations, there was a a very good, dynamic discussion, with interactions from many of those attending the workshop.


Twittering from NI2009 June 30, 2009

Posted by peterjmurray in conference, Europe, NI2009, nursing informatics.
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We have added a number of krew members’ Twitter streams to the blog (see right hand column). A number of other colleagues here have signed up with Twitter and are providing tweets about the sessions they are attending. They include @pattifbrennan, @NewRNPhD (thanks, Jane, for participating in the discussion in the session we were in), @SusanPhDRN.

You can follow the Twitter stream @ni2009 (www.twitter.com/ni2009) or search Twitter for #ni2009

OP224 Strategies and methods for HIT Training 06.30.09 June 30, 2009

Posted by Scott Erdley in conference, education, nursing informatics, speaker.
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James Turley, first speaker, speaking about moving to a science from a discipline. See his paper on CD for background or 1st part of this talk. Outlines advantages and disadvantages of ‘discipline’. Questions: Have we moved past the notion of biomedical informatics as a discipline, and, if so, have we begun to see the outline of a science develop?

What is knowledge? See Kuhn’s definition involving knowledge & theory. Knowledge as a core of science is raised next as in different types (declarative, et al) as well as also formal, completed, and so forth. Basic assumptions are data/information/knowledge/wisdom; praxis and nature of science and, role of theory. Within praxis, core issues have to do with methods / mechanisms of communication, mediated communications (p2p, p2media, media2p). P2P same level, different level, different assumptions about context & knowledge.

Ellis (1968) – theory is critical practices discipline (theory IN, Theory OF and theory FOR). Definition -> computation knowledge modeling IN, OF, and FOR health including healthcare.  Role of HI: develop models. Set of Axioms for discussion:

  1. Axiom 1 [sorry, missed this one]
  2. Axiom 2 [see Axiom 1 apology]
  3. Axiom 2a representations interact with KNOWLEDGE to alter the meaning
  4. The PURPOSE and CONTEXT for the use of knowledge changes frequently and rapidly
  5. computational knowledge is technology dependent (tech should not limit vision but application; connot do what is NOT tech feasible even if we envision it)
  6. socio-tech model of use (avail, accept & access)
  7. Axiom 6 – healthcare is modeled both in knowledge and in workflow (outcome measures tend to reflect workflow and not necessarily knowledge)
  8. Axiom 7 – if communication fails, informatics, fails, regardless of the technology (tech is NEVER the use; it is an enabling issue)

Need to create a knowledge landscape where knowledge can interact; deal with problem of shifting purpose and shifting perspective. Reviewing theory indicates problems of purpose & perspecitve (OF), structure of knowledge moedl & landscape (IN) and computer science structures (FOR). Challenges in clude refining biomed inf theory (IN, OF, FOR) and scope of domains.

Second is S. Narita titled “Training program for counsellors in contraception and the prevention of STI and a website-based support system (in Japan). Interesting presentation about a topic and concern within this country; nice use of technology.

Third is S. Stewart and D. Pope titled “Using Second Life to enhance ACCEL an online accelerated nursing BSN Program (in the US). Demonstration includes a number of video clips of SecondLife (SL).  Purchased four islands in ’08 and built various buildings (alumni, facult offices, library, and so forth, similar to real life) as well as patient avatars and self avatars. Theory supporting this modality include constructionist (Piaget & Papert, 2005), social learning theory (Bandura) and so forth. Nicely done and interesting use of this technology. This is kind of a nuts & bolts of SL and education presentation. Nicely done. Of note – use patient avatar for initial patient assessment by student; avatar is ‘run’ by faculty. I’m off on a short break now. ‘Til later…scott

Keynote Lecture Tuesday 06.30.09 (0830 – 0915) June 30, 2009

Posted by Scott Erdley in conference, education, health informatics, Keynote, NI2009, nursing informatics, speaker.
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Dr. Helena Leino-Kilpi, PhD, RN, titled “Ethics & nursing informatics – a multilevel perspective”. I am also trying to twitter the keynote concurrent with entries to this blog.

Nursing is human action (stress importance of values). Reviewed importance / current status of ethics in many health areas (health policies, patient rights, advances in tech solutions, public discussion as well as research results in nursing). Levels range of value base of individual nurse to value base of nursing to organization(s) to society (levels I – IV). Ethical problem defined as a value-based problem, no single solution, longstanding & need to separate from other problems (clinical, organizational, financial, and so forth). Importance of individual / professional nurse as individual in ethics of nurse & technologies / informatics. How do I use technology, how do I communicate, as well as attitude / approach to technology / informatics. Levels of ethical problems within all of these areas / questions. Leino-Kilpi’s review of literature lead her to note there is not definition of ethics or ethics competencies documented in NI literature. These are in all Level I.

Nursing as profession, Level II, ethical codes are somewhat present in the attitude, approach to technology/informatics but not in the other 2 areas (use of technology/informatics and communication about technology/informatics). Technology improves the realizaation of ethical principles of nursing care.  Level III organization level (administrator level), re: communication about, involves administration, leadership & management (Curtin L 2005. Ethics in informatics: The intersection of nursing, ethics and information technoology. Nursing Administration – didn’t get rest of cite). Technology impvoes the realization of ethical decision-making. She continues here review of all levels and details related to ethics in this arena.

Ethics & Health Technology Assessment (HTA); since 1970’s (Banta 2004); no clear focus (vander Wilt et al 2000); and more explicity in geeral technology assessment (TA, Hennen 2004). HTA definition from HTA Glosary 2006 is used by Leino-Kilpi in this presentation. HTA & ethics – importance -> implementation of HT may have moral consequenses, carries values & may challenge prevalent moral principles of society & HTA enterprise is value-laden. Ethcial questions in HTA/issues r/t define concepts, diagnostic procedures, preventive strategies, resesarch & resource allocation; all are ethical questions.

Two types of ethical anaylsis using HTA: ethics OF HTA and ethics IN HTA. Future research in this field is importance of ethical analysis and technology itself does not have any values, users / designers, though, do (citation: Bakken, S. (2008). A nursing informatics research agenda for 2008 – 2028: Contextual influences and key componentts. Nursing outlook, 55, 5, 206-214.).

Interesting presentation.

“Combining Science and Wisdom: Bringing Evidence-Based Practice into Nursing Education” June 29, 2009

Posted by maggie2hansen in conference, education, nursing informatics, speaker.
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“Combining Science and Wisdom: Bringing Evidence-Based Practice into Nursing Education” by “Jim Cato, Patti Abbott, and Laura Taylor presented how to use technology to incorporate evidence and wisdom to support practice. How do we translate new information and knowledge (evidence) into plans of care (practice). Johns Hopkins Univ. School of Nursing JHUSON) has created a model that improves students’ readiness. In 2005, a new paradigm of nursing education was created within JHUSON. Jim Cato works for Eclipsys, a worldwide technology company, and he met with Patti Abbott in 2004 and came up with a public private partnership (a unique academic partnership) to re-engineer nursing curriculum with clinical information technology. The goals of the partnership was to increase healthcare information technology competence of nursing graduates and to design new methods of delivering the curriculum. Patti Abbott spoke about the JHUSON program goals that include: To develop and test educational interventions for students and faculty to successfully navigate today’s technology driven healthcare. As other schools of nursing, students at JHUSON have to learn the HIS before they are able to document at the hospital as a student nurse. How are the students going to learn the technology? Of course they wanted to adhere to JHUSON’s mission statement. Students, faculty and health care technology are the building blocks. The long-term outcomes of the Eclipsys-JHUSON joint EHR programs for research, education, and patient care are: innovative research, education and patient/family care with a multi-disciplinary, multi-professional team approach. And, provision of global health care solutions that demonstrate comparative effectiveness in outcomes… Laura Taylor spoke about the four sample classes at JHUSON: principles and applications of nursing; health assessment; pediatric simulation assessment; pathophysiology and pharmacology in the Junior year. They are classes from simple to complex. The HER are used in all of these classes. The student logs in to the class on the computer and fill in the flowsheets. Faculty champions were noted by Laura too!

Session OP143 – Teaching Methodology 1 (1400 – 1530) HALL 102 June 29, 2009

Posted by Scott Erdley in conference, education, NI2009, nursing informatics, speaker.
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Late start due to close finish of opening afternoon plenary. Plus the opening speaker at this session, Patricia Dykes, has a 2nd presentation right after her opening survey in this session. Her session “Validation of the Impact of Health Informaiton Technology (I-HIT) Scale: An international collaborative” reports on moving the HIMSS impact of HIT scale into the international community. I-HIT 29 item scale with 4 subscales. Overview of international validation process provided by Dykes. It is troubling to me we (nursing informatics), as a profession, still conducting survey research of attitudes. We (aka NI) began research of / in NI using survey research of attitudes and perceptions. Now we use the web versus using hardcopy snail collection format but otherwise still pretty much the same (sigh). Time marches on . . .Patty now leaving and will return for Q&A at end of this session.

Amy Barton next, presentation titled ‘Informatics Curriculum integration for quality and safety education for nurses’ as part of the QSEN initiative, a national US effort. It is funded by RWJ / Robert Wood Johnson foundation. 6 competencies outlined of patient-centered care to teamwork & collabration through informatics. Additional initiatives include TIGER, revised AACN Essentials of Baccalaurate of Nursing Education, and NLN position statement. Colorado trying to insert a curricular thread for nursing education; make it relevant to all involved (AD, BS, etc.) programs. KSA are three sub-content related to all 6 competencies (knowledge, skills and attitudes). She continues to outline distinct, for each, KSA’s at different levels of education at beginning and intermediate phases. There are no ‘advanced’ phase or phases, though. Implications of findings include informatics content learned largely via course assignments & readings (partnered with McKesson for system to be used in lab), creation of new learning activities (see QSEN website) and creation of instructor toolkit. Created professional learning lab (wear clinical scrubs, cis for use, etc.) for students throughout their education. Q&As at this point to Amy & Diane Skiba.

Shwu-Fen Chiu and colleagues titled “Development of an Incident Event reporting System for Nursing students” is next up at this session. Begins with review of current practice – aka oral and or paper reporting processes. Both forms tend to encourage under-reporting of incidents. A web-based system for reporting incidents was employed in this study. Results indicate students seem to like the system. There is also a distinct faculty review view of the student system; faculty can annotate and comments automatically linked or entered into student academic record. Assessed on 4 items of number of events, time faculty rec’d notice, time of report by student, and when the entire process was completed. I suspect the marked improvement of reporting of incidents by students is due to the ability to enter incident without immediate retribution by staff and or faculty person. Not sure if my ‘hunch’ is correct, though – ymmv.

Last presenter is Diane Skiba titled “Using social software to transform informatics education”. Background informatin of UCD program provided by Diane. Of note is it is entirely online having begun in 1997. Also houses the i-Collaboratory, which now uses webinars, wikis, and so forth. Students need to use these tools (social networks) as patients become more adept and comfortable with using these tools themselves. They use Ning to create a social network (healthcareinformatics.ning.com). Ran through a large number of screen shots of their ‘Ning’ site at this point. Other tools of social bookmarking include bookmarking of URLS and such (via twine, CiteUlike, del.icio.us, etc.). Nicely done!

Afternoon plenary speaker – Dr. Charles Friedman 06.29.09 1315 – 1400 June 29, 2009

Posted by Scott Erdley in conference, health informatics, NI2009, Plenary, speaker.
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Topic is ‘The National eHealth Initiative in the United States’ for Dr. Friedman today. He was pushed up to this status due to the illness of the opening speaker. He is a US government employee but is on holiday and so none of his talk is official US policy and such. Made this disclaimer to open his speech. Opening salvo by ‘Chuck’ is a review of US health system to provide a backdrop for the rest of the presentation.

Part two of the presentation is a review of HIT, on a national health level, from 2004 – 2008 (development of the Office of National Coordinator / ONC and so forth). The process of adoption, viewed in 2004 and still viewed, needs to move through the ‘tipping point’ (whatever this is) of technology adoption to facilitate health care IT adoption. Adoption in hosptials of HIT (Jha et al. NEJM, 2009) statistics are cited illustrating little adoption of HIT in hospitals as aggregate perspective. Looking at specific applications, though, raises the rate significantly (lab/rad reporting and medication lists for example). Graphic depicting what is called ‘The Nationwide Health Information Network’ to show what this is and what is coming in the near future.

Chuck then moved to current status and support of President Obama and appointment of Dr. David Blumenthal as the National Coordinator for Health IT (author of ‘The Federal Role in Promoting Health Information Technology, Commonwealth Fund, 2009’). Outlined next is the Recovery Act and its sub-act of HITECH, which supports with increased funding of health IT adoption. This support via dollars in the US was a major change in health care. HITECH highlights are permanent ONC for national coordination, payment incentives to providers & hospitals, 6 supportive grant programs, and enhanced privacy & security provisions (aka ‘enhanced trust’). He postulates these ‘hopefully’ will enable acceleration of the HIT in the US.

Final comments by Chuck include addressing the definition of the concept ‘meaningful use’ and the process underway to define this concept. Such definition is needed as financial support is tied to this concept. He had to squeeze through, due to time, and so did discuss in-depth additional points raised during the entire presentation.

On to afternoon sessions!

Session OP124 – Patient Preferences (0945 – 1145) Monday 06.29.09 June 29, 2009

Posted by Scott Erdley in conference, education, health informatics, patient safety, speaker.
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I’m blogging this session because Margaret Hansen, good friend and colleague, is the last presenter in this session. Also I am interested in this topic to a degree. I hope to attend other sessions later in the day and blog these as the opportunity presents.

The opening presenter (R. Helleso) discusses the work of her and her colleagues in Norway, titled “Severity of illness – implication for information management by patients”. Patients in this study are chronic heart insufficiency NYHA 3 or 4 classification requiring post-hospital care after d/c home. A qualitative approach was used in this study. Sub-themes of system of information were how information given, when and what information the patient received. Process of information had two categories are as follows: what patient did with information (who got/received ‘it’) and patient comprehension of information (dependent on personal attributes such as recall, memory function, and so forth). Patient information management process had sub-themes of different strategies (why wanted information) and role of the next of kin (helped patient manage information such as script filling, as well as how much the kin would do with information). Summation thoughts included information not sufficient, timely or appropriate for patients; ‘fuzzy’ role of nurses in the information process role; patient compensates for lack of information exchange between providers (interesting conclusion). There is a need for customizing information, involving next of kin in a systematic fashion, balance information strategy & need for autonomy and bridge info gap in health care.

Second speaker is J. Bichel-Findlay and colleagues from Australia presenting “Health information systems and imrpoved patient outcomes: Do nurses see the connection?” Another research study presented to the audience. Focused on emergency department (ED, ER, etc.) environment. Nurses needs in this environment include lack of agreement and std’d language and diverse needs of information management. Describes environment in NWS health (location in Australia where study took place) – many many patients, large number of EDs, and so forth. No metrics regarding documentation and so forth. Used tool to measure how EDIS as tool is better or worse (pro’s and con’s) via opposite phrased statements in survey. Significant results highest level of education, most positive, were postgraduates in several areas as experience (middle range of 5-8 years). Appears to be a shift in nurses views of technology from negative to tolerance (from literature review). Conclusions include perception of EDIS and organizational performance of staffing rtion increasing and work resturing, but no perception of data ownership, data value impact on patient outcomes nor the bigger picture of EDIS in technology and health. Most postive respondents were 20-34 with 5-8 yrs and post-graduate and 35 order and such were not. Author’s contact email is jenbic@tpg.com.au.

Third presenter is S. Tsuru and colleagues from Japan, titled “Structuring clinical nursing knowledge using PCAPS: patient condition adaptive path system”. PCAPS is a tool to visualize clinical/nursing information / knowledge. Very graphical / quantified sort of model involving high level of graphics to depict flow and so forth. Very much a systems approach to visualize and structure clinical processes. Currently addresses over 19 topics and 113 areas. Ischemeic heard disease visualized via root cause analysis as well as other examples of colon cancer and such. Very technical and or complex approach to a complex problem.

Next is V. Barnoy and colleagues from Israel, titled “Nurses attitudes towards the informed patient”. Focus of research is on patient and not nurse as previous presenters offered during this session. Previous research in this area on providers (physicians and nurses) and so study wanted to look at the ‘power shift’ to patients. Most of shift related to, at least anecdotally, the growth of the web. Study wanted to know nurses attitudes towards savvy-patients (knowledgeable patients). Factors possibly impacting attitude of nurses might include professional esteem, prior exposure to patients preferring net available med information as well as ‘net self-efficacy’ of the nurses. Only presenting on these 3 items here. Scales used to ‘measure’ attitudes of study participants. Prior exposure connected to more positive attitudes towards the internet; the number of encounters made no difference on this, indicating quality of experience (aka ‘1st experience’) importance. Professional exteem & attitudes does not seem to intimidate the nurse regarding such patients. More use of internet associated with more positive use and less intimidation perceived by nurses using the ‘net. Age negatively correlated, which might be expected. Conclusions include the 1st impression of the patient with the nurse had consequences and or long-range retention by the nurse about the patient. Published in Nursing Outlook, 56:31, 2008, too. Q&A with audience for about 5 minutes followed the presentation.

Closing out the list is M. Hansen and colleagues from the US, titles “The potential of 3-D virtual worlds in professional nursing education”. I admit a vested interest in this study as I am one of the co-authors. She’s providing a ‘brief’ overview of the use of virtual worlds in nursing education. Not sure of this but think the presentation is also available on SlideShare (http://www.slideshare.com) and search on ‘Margaret Hansen’. Examples include work of John Miller at Tacoma, Washington, US, Juliana Brixey at Kansas University (KUMC Center for Healthcare Informatics), SecondLife project at University of Wisconsin Oshkosh College of Nursing. She also includes numerous site examples. Theoretical frameworks used by Margaret include Roger’s Diffusion of Innovations and Siemens’ Connectivism Learning (not what you know but who). Q&A followed. Great presentations by all! Lunch time ;’)

Papers on ‘human computer interaction’ June 29, 2009

Posted by peterjmurray in conference, Europe, future, NI2009, nursing informatics.
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Kathy Dallest, from Scotland spoke on ‘The online managed knowledge network that shares knowledge for ehealth in NHS Scotland’ – http://www.nmahp.scot.nhs.uk

Nurses, midwives and allied health professions are 72% of clinical workforce in Scotland – largest group who will use electronic systems to support delivery of healthcare and information management. She described the portal that has been developed to provide a managed knowledge network; the model builds on the idea of communities of practice, with communities operating across disciplinary boundaries. The project found a large diversity of roles among the staff working in ehealth; they often felt isolated, with a need/desire to share information.

The nmahp site uses topic rooms and expert searches on subject areas. Kathy also mentioned the ‘using information’ website, and international collaboration – http://www.usinginfo.org and the clinical ehealth toolkit. The MKN site is open to anyone to join.

Elina Kontio from University of Turku in Finland spoke on ‘Key elements of successful care process of patients with heart symptoms in an emergency care – would an ERP system help?’ She says healthcare has been slow to use process-oriented systems for decision making. The research she described has looked at identifying the key elements of care processes of patients with acute heart problems; used a critical incident technique to collect data on the nurses’ roles and interactions with patients, with a sample of 50 nurses across 3 hospitals in southern Finland. The study developed recommendations on development and use of enterprise planning systems to provide alerts, decision support etc. in care continuum.

Debra Wolf presented on ‘Nurses using futuristic technology in today’s healthcare setting’. She talked about voice-assisted technology to do point of care documentation in a community hospital in USA. The system is wireless and used for charting, reminders and prioritising tasks. The system comprises a wearable computer and headset, speech recognition engine and software to send and receive patient orders and to do real-time documentation using speech-to-text. The system has reduced documentation time (by up to75% – but also found little diffrence in completeness of the documentation) and to provide proactive reminders about issues (such as fall risk) pertinent to individual patients. It has improved adherenece to policies and so enhanced quality of care. The pilot study found there was reduction in potential for infection, as nurses only touch one device once a day, as opposed to mutliple touches with other computer systems (eg mouse, keyboard, etc).


Opening keynote 06.29.09 morning session – Dr. David Bates June 29, 2009

Posted by Scott Erdley in conference, health informatics, NI2009, nursing informatics, patient safety, Plenary, Uncategorized.
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Keynotes today are shifted due to severe health problems of the original speaker. So, David Bates, scheduled for later today, is the opening speaker. Dr. Charles Friedman will be the opening afternoon speaker.

David Bates’ talk is about IT & patient safety (“Improving safety & quality using HIT: Keys for nursing”). Talk will range from background to using HIT for safety, in various settings, then crossing issues and final thoughts / issues. He cites the IOM report “To Err is Human” as a primary compelling force behind current interest in patient safety & HIT. Provides a list of 10 top priorities for patient safety research in developing countries (see very recent BMJ article). Nurses impact adverse events from pressure ulcers to adverse drug events, too. He describes the US efforts and considers US to be near ‘tipping point’. LL Weed cited as to use of external aids to promote change in health care; patients could participate in decision-making (their own). Ways IT to improve safet include error prevention / adverse events to more rapid resonse after adverse event to tracking & feedback of adverse events.

Bates then outlines 7 main strategies for preventing errors & adverse events, via HIT, including improving communication to accessible knowledge to providing key information, calculation assistance, real-time ‘checks’ to monitoring assistance and finally decision support. He then cites specific examples such as CPOE to smart pumps / monitoring and so forth. A specific example / research project is titled ‘NEPHROS’, which looked at renal insufficiency patients (Chertow et al, JAMA 2001). Another specific area of patient safety is medication administration, in particular, several US major adverse events surrounding use of heparin. Some ‘easy’ solutions are BMA (bar code administration) as well smart pumps (Rothschild et al, Crit Care med 2005). Most of Bates’ discussion centered on inpatient / acute care environment. He also, though, did discuss outpatient environment, which may be termed ‘medical home’. Nice use of a Dilber cartoon to state where he believes health care is today. Future areas for NI include personal health records as well as decision support (e.g.: computer ‘think along’ with provider), interoperability, and so forth. Quality from IT and its transforming ability from ehr (poc decision support, registry tools & ‘team’ care) and measure performance; safety need to increase processes reliability (e.g. check lists, new CPOE approaches). IS helps with communication, cost holding, quality accessible, and such.

Keys for NI include tools to track risk, digital documentation (vital signs), computerized handovers / report, nursing decision support, multidisciplinary communcation, and key roles in medical home patients / outpatient settings. Sytems future possibilities range from ‘better provider cockpit’ to communcation to quality measurement and NI needs higher profile in most organizations, all leading to safer care with use of IT. Ended with Yogi Berra quote “I don’t want to make the wrong mistake.” Nice ending and nice talk. Time for Q&A at this point. One question justly asked had to do with public health disease / pandemic condition tracking and monitoring (infections, H1N1, and so forth).

Personal thought – not sure if talk content is anything startlingly new but may instead be a reminder of what NI persons can or should do regarding patient safety. Scott Erdley