Rutgers 30th Conference – Final Round-up, Part 1

These final blog posts from the Rutgers College of Nursing’s Thirtieth Annual International Interprofessional Technology Conference, in New Brunswick, New Jersey, USA  are a belated round-up of the final two days of the event. Among the various presenters:

Sarah Farrell spoke on “Teaching nurses in remote clinics to access information”. She began from the premise that still talking about the IOM 2002 report, 10 years on, around the need for  patient-centred care, interdisciplinary teams and evidence-based practice – and we still have along way to go. She promoted the  use of GIS etc for visualising data on maps and other graphical representations, and gave examples based in the use of materials from the website http://phpartners.org/health_stats.html She has been encouraging students to create surveys online, use Evernote and similar for creating tagged notes, and encouraging nurses’ use of WordPress and similar tools for developing team-writing skills. In the second part of her talk, “Use of portable and connected devices to increase access to health information in remote global settings”, she explored community participatory action research.

Diane Skiba explored several studies into the use of social media content for health purposes – including Orizio et al 2010 studies on the use of social networks; Weitzman et al 2011; noted several studies on Twitter relating to health issues; Greene et al 2010, who found clinically inaccurate recommendations were infrequent, but were usually associated with promotion of a specific product or services; and Ahmed et al (2010) on peer-to-peer interaction as a key aspect, with rich information being shared.

Jacqueline Norrell explored “Cloud based computing and the EHR” – she began with an overview of “revenge effects: why things bite back – technology and the revenge of unintended consequences” and noted that, while it may be good to have many things automated, there may be unexpected or unintended consequences that may result in problems. She explored definition/descriptions of cloud computing, discussing  the use of networked or remote servers, their access through the internet for storage, management and processing of data, and that they are typically sold ‘on demand’ – so offering software/platform/infrastructure as a service. She noted the existence of different types of cloud – public, rivet, virtual private, hybrid, federation, etc., and raised several issues for discussion, including that of how does one connect to cloud if there is power outage??

The opening panel session on Tuesday morning was titled “Where Are We In The United States in Implementing HIE?” and featured four speakers providing a range of perspectives. Gil Kuperman began by providing national level perspectives on health information exchange (HIE) before covering some issues specific to his experience in New York issues, and addressing how to use HIE to support coordinated models of care. He began by noting that while EHRs are applications, HIE is a capability not an application, that different HIE scenarios and organisational models exist and that one size won’t fit all. He gave a brief overview of how federal policy has evolved in relation to HIE: in the period 2004-08, there were RHIOs at the start, with not a great deal of funding – about 200 RHIOs by 2010. From 2009, the HITECH Act and Meaningful Use were a shift of policy, with more focus on EHRs rather than HIE. In the current landscape, there is a transition period, with competing/conflicting approaches, no single model, some legacy HIE organisations inc RHIOs, some vendor-based HIEs (‘family and friends’), State HIE cooperative programe, and the Nationwide Health Information Network (NwHIN). Among questions he raised where “Will HIE enable innovative care models?”

In outlining the ONC HIE Strategy, Gil noted that it encompassed setting goals, leading development of standards, and keeping a focus on patient care. ONC sees roles at state level in building/maintaining infrastructure, engaging stakeholders and supporting rural and low resource settings. In relation to New York State: HEAL-NY, he noted that they NY had been an early supporter of HIE, with an advanced RHIO model and support for EHRs, including public funds to support “21st century health information infrastructure”.

Helen Connors provided “the Kansas HIE Initiatives overview”, noting that Kansas is a very rural state, so has different needs to some other areas, but that this has brought stakeholders together from across the state to develop strategy and plan. She discussed, in particular, privacy law harmonisation as an important area of work. Colleen Woods gave an overview of issues in New Jersey, in particular the challenges of EHR-HIE interoperability across state boundaries (NJ-NY), and noted that an interoperability WG set up to address standards issues. Rainu Kaushal, the final panelist, addressed “The value of HIE” and covered issues of value including cost and quality, noting there existed limited data on HIE and quality, although some studies (eg the Frisse et al 2011 JAMIA study) found evidence of costs savings, but from perspective of patients rather than that of provider. She noted the need for data on patient outcomes.

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