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Rutgers 30th Conference – Day 2 Summary April 17, 2012

Posted by peterjmurray in conference, education, future, Keynote, nursing informatics.
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I think I am losing my ‘blogging touch’; I find it increasingly difficult to do the live blogging ‘on the fly’ of conference sessions that I have done in the past. maybe it is simply lack of practice, due to doing more tweeting from events. So, this post is a summary of Monday’s presentations and activity. My tweets can be found on @peterjmurray, or searching for hashtag #Rutgers30

The first full day of the conference began with a keynote from Michelle Troseth (@CPMRCmichelle on Twitter). Michelle is Chief Professional Practice Officer at Elsevier CPM Resource Center, and her talk was titled “Bridging the gap between interprofessional education and evidence-based practice: leveraging technology”. She began by noting the many problems of system integration in healthcare services, and that evidence-based care will be critical to the future, so there is a need to think about team-based care and interprofessional care-planning. She asked whether computer nowadays are getting in the way of interprofessional relationships, and discussed the need to design patient-centric systems.

She introduced the TIGER Initiative (http://www.thetigerinitiative.org/)  and TIGER recommendations around being interdisciplinary and evidence-based, as well as covering a number of reports that over the years have advocated the need for transformation of practice and modes of working, including:

  • Carnegie Foundation – Preparation of the Professions – studies call for radical transformation on how we teach and prepare nurses and clinicians for future of care.
  • IOM report on future of nursing – “nurses should be full partners with physicians and other health professions in redesigning care”

Michelle was also awarded the 15th Annual Award for the advancement of technology in healthcare that is traditionally presented at this event.

Other speakers during the day (I was only able attend one of each parallel session, most of which I was chairing/moderating):

Darlene Scott (Saskatchewan, Canada): Connecting the dots: using Web 2.0 tools for interprofessional education –  explored the development of a core IPE (interprofessional education) curriculum to embed in nursing and science and health programmes. It was designed to prepare collaborative, practice-ready care givers.

The conference continues today (Tuesday), beginning with a panel session and followed by individual presentations and keynotes. The conference website is at http://nursing.rutgers.edu/conferences/30th-annual-international-interprofessional-technology-conference


Rutgers 30th Conference – Day 1, Kulikowski Keynote April 16, 2012

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The Rutgers College of Nursing’s Thirtieth Annual International Interprofessional Technology Conference, in New Brunswick, New Jersey, USA  formally started on 15 April, 2012. Held at the Hyatt Regency New Brunswick, the fact that this year sees the 30th offering of this event makes it probably the longest-running annual event of its kind within nursing informatics within the USA. At least two of this year’s speakers, Casimir Kulikowski and Diane Skiba spoke at the second event, in 1984.

After pre-conference workshops, the opening keynote was given by Prof. Casimir Kulikowski, Board of Governors Professor of Computer Science at Rutgers University. Cas is also, among other post, a Vice president of the International Medical Informatics Association (IMIA – www.imia.org) and a co-editor of the IMIA Yearbook of Medical Informatics. He spoke on “How technology helps to improve healthcare globally”, although many of the points raised in his presentation pointed to areas in which technology does not always work at its best to improve health, but has other impacts.

Cas noted that, while we continue to see major advances in computer-information sciences, and advances around increasingly distributed, ubiquitous and mobile technologies, their impacts vary due to the contrasting challenges of developed and developing countries in applying information and computer technologies to health. The application of current technologies to the challenges of the burdens of chronic disease in the ageing in developed countries is still immature, and technologies are not readily available in many parts of the developing world where younger populations still face burdens of infectious disease. He noted the increasing economic challenges of radical shifts in the population support ratio, and also noted that wide disparities exist in terms of gender differences in the incidence of many diseases.

Among the questions he raised was whether it is better to invest spending (especially in terms of health spending) in breakthrough technologies that might have major impact, or to incremental improvements in systems. He noted that incremental changes often result in changes to systems and processes, and do not necessarily benefit people, or work in the best interests of patients.  They often occur in a system of legal constraints, and are responses to needs to reduce costs rather than improve care. He suggested the need to look at technologies that stimulate best care practices, and outlined examples of health-enabling technologies, smart homes/environments and social computing, to provide patient empowerment, self-care and preventive healthcare. He cited the work of colleagues such as Patti Brennan in Wisconsin, George Demiris and colleagues in Washington state, and Haux and Marschollek in Germany who are researching many of these areas, although noted that such work is still in early stages and many of the technologies remain immature.

Cas raised the idea that technology should not at the centre, but be part of a movement towards changing how people interact with technology in the home. There is, he suggests, a need for pervasive, personalised technologies to provide support (ambient assisted living), and that there are demonstrable cost savings if older persons can be supported in homes as opposed to being in hospital.  He introduced Demiris’ work on resistance to care if it is obtrusive, and noted that while smart home technology has the potential to support independence etc.,  using technology can also promote dependency.

Monday sees the first full day of presentations. The conference website is at http://nursing.rutgers.edu/conferences/30th-annual-international-interprofessional-technology-conference

SINI2009 – final keynote, Suzanne Bakken July 25, 2009

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Suzanne Bakken’s closing keynote address is titled “Reducing health disparities through informatics”. She began by describing the range of health disparities, including racial or ethnic differences in the quality of healthcare, differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions among specific population groups, and differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation. She asked whether informatics will be part of the solution to the problems, or whether it will result in increased disparities (eg in rural areas, if they do not get enough IT funding to meet specific needs).

Suzanne sees the digital divide in 2009 being due to access issues, although racial and ethnic differences are decreasing, but rural versus urban differences remain along with age-related differences (“senior divide”).

She sees issues of use and understanding of systems, eg around computer literacy, functional literacy, numerac and health literacy, as remaining important. She described a number of projects within her institution, aimed at addressing some of the disparities, including self-management of hypertension in diabetes, and self-assessment via a PHR.

One project she described is “Facebook PPALS” – Promoting Physical Activity Among Adolescent Latinos – addressing overweight immigrant teenagers and trying to promote physical activity.

Last day of SINI2009 – Saturday 07.25.09 Morning Keynote July 25, 2009

Posted by Scott Erdley in conference, education, Keynote, nursing informatics, SINI2009.
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This is my last entry for the conference, readers. Had a great time. I have to catch a flight back to home base (Buffalo, NY) and with the weather such as it is these past few days (traditional Baltimore – h3 (hzy, hot & humid)) as well as in Buffalo (humid & stormy) there’s a chance I’ll be parked at BWI for a while. There’s also a chance I won’t. Either way, given transit time to the airport via the Lightrail, I will be departing for BWI at 10am local (end of opening presentation, too).

Introduction is provided by local STTI chapter president because this chapter, in honor of 50 years of service, is sponsoring Dr. Staggers’ presentation. Opening keynote is Nancy Staggers, PhD, RN, FAAN, Professor & Director for Nursing Informatics, University of Utah College of Nursing. Title of her presentation is “Optimizing the usability of clinical systems: Past work and future directions”. Start time is a little behind normal most likely due to this being the last day of the conference and participants are a bit tardy arriving for the morning food before the session. Nothing unusual here with this, to be honest. Good attendance in spite of the last day of the conference. Discussion will cover usability, synthesis of usability research, future directions and then example (from her research).

Usability deals with solutions, context/environment, and specific goals. Related to human facotrs, ergonomics, HCI and usability (demonstrated via a modified Venn-type diagram. Talks about usability and cpoe in health care practice (Leapfrog Group cited). Reviews systems penetration due to ARRA $’s and Brailler’s (09) talk about need for specialist. DaVinci surgical system cited as tech example. Continuum of info & tech in nursing practice is depicted related to Essentials of Baccalaurate Education (AACN). Need for usability of phr’s, too, reviewed. Also provides a review of past usability research with her doctoral student, Greg Alexander. Search was extensive with exclusion criteria outlined. The process is described in detail from beginning to end. Bottom line, out of more than 11,000 citations, only 34 relevant articles (with 50 studies). Organized into effectiveness, efficiency and satisfaction. A lot to do with information searching, potential error with device designs (e.g.: IV pumps), and so forth. Satisfaction results indicate users want knowledge worth of mention (dense screens, graphic designs, etc.), heuristic evals of devices, remedy the no apparent rationale for selecting products to evaluate. Future directions include expansion of types of devices to study (Only 2 IV pums, PCAs and 1 EHR studied), settings & participants, integrated displays and the type of study outcome variables. Need to examine cognitive burden workflows, need for national db for study results, and, EHR comparative studies re: usability. Additional future directions include administration, education & research areas, look at actual clinical settings (vs. simulated labs), and study interdisciplinary teams. Now she launches into her work on change-of-shift report as example of the issues encountered during this literature review. Employed a variety of methods of research (observation, audio-taped with qualitative analysis after transcription). Results of this study are part of this example discussion. 4 themes are ‘the dance of report (largest percentage), just the facts, professional nursing practice and lightening the load’. Professional practice involved actions, reasoned judgments, care decisions, problem-solving, and such. Context of report issues included noise level, interruptions, patient loads, and report from 2-3 separate nurses. Overall discussion includes issues of ‘speed bumps’, high level of jargon, no report structure and ehr not any part of shift report.  Nicely done.

Friday Opening Keynote Session SINI 2009 07.24.09 July 24, 2009

Posted by Scott Erdley in conference, education, Keynote, nursing informatics, patient safety, SINI2009, speaker.
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Paut Tang, MD, Palo Alto Medical Foundation, titled “Personalizing Health Care: Creating a Patient’s Health Home”. For missing pieces of this blog please consult Peter Murray (@peterjmurray) and or Margaret Hansen (@m2hansen) tweets. Interactive presenter with good audience appeal. Not medical home but health home. Defining health via proverbs and personal anecdotes. Outline of presentation is traditional health care, a definition of phr, personalizing and then creating a patient’s ‘health home’. Draws from ION 2001 ‘Chasm’ report for definition of health. Jim Collins, “Good to Great” book referenced, needs to focus on ‘who, then what?’ ’cause ‘who’ will take ‘you’ to ‘what’. How to support patient & family? So, turn to patients first. Derive a phr definition based on patient perspectives is next goal. Draws from his past research using patient focus groups as well as newer work / studies by organizations such as the Markle Foundation. Privacy is a very common and strong concern by those who participated in research studies. Utilizes example, which is included in his work flow, of patient & provider communication and information exchange. Neat part is captured into medical record, shared, of all communications between these 2 parties. Online survey yearly of patients and their use of this systems (PAMF – forgot what is stands for – sorry). Self efficacy is big point (test charts help visualize; lab results graphic; ‘score card’ is in front, and so forth). It is a report card for the patient, which changes lives. Online reminders enhance adherence to health maintenance guidelines (4-fold increase in breast mammography testing due to such reminders).

Paul Tang presenting at SINI2009

Paul Tang presenting at SINI2009

Traditional disease management is protocol driven (aka – you got the disease, we got the treatment [and sometimes the same for all, too]). Asked patients, in this study, about support structure perceived by the patients / study participants. Describes chronic care model as also indicative of health care overall. To be patient centered start with (my) risk profile, then (my) disease condition and finally (my) agenda. In this diabetic study report, they created diabetes dashboard for patients. Diabetes, for example, becomes much more self management versus traditional paper-based with time disadvantage. Online allows more timely review and behavioral changes by patient and provider along with eliminating paper (also provides longitudinal view / trending to help communicate and or change behavior). A follow-up clinical trial is now planned for 400 diabetic patients (200 intervention & 200 control). Conclusions include phr/ehr integration as optimal approach. Very very personable speaker and very well received by audience. Q&A session followed.

Opening session SINI 2009 Wednesday 07.22.09 July 22, 2009

Posted by Scott Erdley in conference, Keynote, Plenary, SINI2009, speaker, Uncategorized, USA.
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Photo by Heather Sobko.

Official welcome and introductions by Patricia Morton (Professor & Associate Dean for Academic Affairs, UM School of Nursing), Judy Ozbolt, Program Chair, SINI 2009, Professor & Program Director of Nursing Informatics, UM School of Nursing, and Amar Kapadia, Director of Acute Care, AccuNurse by Vocollect Inc. Overall casual scanning of the attendees at the opening indicates a good number in attendance. However, number of in-person attendees given by Judy Ozbolt indicates a fair decrease from previous years (this year quoted as 350 in-person attendees). Judy also announced her retirement at the end of this year. New co-chairs for next year include Marietta Mills & Marisa Wilson along with Judy until her retirement on December 31, 2009.


Photo by Heather Sobko.

Keynote speaker is James J. Cimino, MD, titled “Informatics as a Bridge to Knowledge at the Bedside”. He is Chief, Laboratory for Informatics Development, NIH, Clinical Center Senior Scientist, Lister Hill National Center for Biomedical Communication, NLM.

He further divides the topic into 3 sub-topics: bedside environment, knowledge to support care and informatics as the bridge of these two. He reviews informatics research issues associated with bridging ‘problem’ as a 7 step process (information needs of users). Very personable with his presentation style; well received by the audience. Findings of observational studies are information needs occur often, often unresolved and computer-based resources are under used.

James includes a fair number of screen shots to support statements and assertions made in presentation. Patient information is not easily available to providers at bedside. Health knowledge (such as Pubmed, textbooks, and so forth) has multiple sources; needs to be included for use at bedside / concurrent with patient information access / use. Third point is procedural knowledge. All of these are under the heading of Informatics, delivering knowledge. Procedural includes or requires perhaps refreshing what one already knows, BMI calculator, and so forth.

Informatics: Integration is the bridge. One issue is workflow. One way to ascertain workflow is observational studies. Another area is in expert systems and how integrated into workflow. third area is ‘intelligent retrieval’. Infobutton and Infobutton-like systems somewhat answer this last topic of intelligent retrieval. Examples include Vanderbilt’s PC-POETS, LDS HELP system, Partner’s Healthlink, and Columbia’s Infobutton Manager (speaker’s research project). Describes, now, this project with supporting screen shots (examples include laboratory tests, drugs, organism cultures, and so forth). Information is linked to term or item. Minimal number of clicks is something strived for (2-3 clicks to get answer). 5 year use history of infobutton use shows topics (lab manual, Micromedex, Pubmed, up-to-date, Harrisons, national guidelines, patient instructions. User analysis indicate nurses are major users of patient instruction topic.

Summary of presentation findings at this point. 1st – knowledge to support care (1/3 each for patient, wellness & disease, practice). 2nd – bedside environment (patient, clinician and technology). 3rd point – informatics as bridge; understanding knowledge needs (clinician & patient); delivery of patient information health knowledge, procedural knowledge; finally about integration of workflow, expert systems and intelligent retrieval). Conclusions: (1) putting patient, nurse & tech in same room is not sufficient; (2) informatics is needed to understand the info needs and provide the resources and integrate ‘them’ into the workflow; (3) big topics – cognition, terminology & knowledge representation provide the bridges.

Q&A session, since session completed early (3:45pm with schedule to complete 4:30pm), will be ‘extended’.

Well done opening talk. There is a meet the keynote speaker session from 4:30p – 5:30p (east coast time) with James J. Cimino following this keynote opening talk. More information at http://www.infobuttons.org

Morning Keynote NI2009 07.01.09 (0800-0845) July 1, 2009

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Evelyn Hovenga titled “Milestones of the IMIA-NI History and Future”. As this is closing day, as well as the session moved up 1/2 hour, the number of attendees is a bit sparse. Evelyn’s presenting style is to expound on the slide content. Opening setting reviewed is ‘having a vision’ begun in 1987 in Stockholm – nursing competencies. Key activities cited include reference term model, with ICN, begun in ’99 among others. Key facets of ’09 vision of IMIA-NI include EHR (using & informing nursing knowledge), clinical data standards dev’t, decision support & ebc options among others. Reviewed what IMIA-NI promotes (I’m guessing what she showed is from the website (http://www.imiani.org/). She discusses a national e-health record using a graphic (spoke-wheel design) with phr as the hub. Next up is discussion of integrated ehr (see ISO TR 20514:2002 Health Informatics – EHR Scope, Definition and Practice). EHR needs to be perceived as foundation of sustainable health system infrastructure, therefore requiring adoption of a set of HI standards along with comprehensive governance infrastructure. A description of ehr architecture is drawn from the open ehr foundation’s content. The bottom line is discrepancy between model (nicely structured) and proprietary systems with different reference models. Graphic of ehr structure is available at open ehr website (http://www.openehr.org/home.html). Clinical knowledge manager is next up and again seems to be also a component of the open ehr website (see ckm (clinical knowledge maanger) at site in previously mentioned link). Clinical content models, and the need for such, outlined at this point and the need for said models to relate to the structure (then dictates how data is used). Clarity is necessary for functionality – key point stressed by Evelyn.

Clinical knowledge repositories discussed with national examples cited (Singapore & Sweden with federated approach); need for repository hierarchy versus ‘flat set’ (need for interoperable for sharing via silo without sharing).  Terminology needs to be in context and should have national governance.  Future directions of IMIA-NI includes leadership for dev’t of standards of nursing clinical content knowledge. Collaboration with ICN needed to move forward with mindmaps of content, documentation of nursing processes, clinical templates (see Derek Hoy’s work in Scotland) and global nursing knowledge governance infrastructure. Other items needed to move forward range from national mtgs, recruitment of expert nurses and sharing / participating via technology and in-person. That’s all for now.

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.

NI’09 Opening Ceremony June 28, 2009

Posted by Scott Erdley in conference, Keynote, NI2009, nursing informatics.
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Opening ceremony & speeches under way promptly at 17:00 in the grand hall with a scheduled conclusion of 19:00 and spectacular weather outside. Attendance is not overwhelming but about what one would expect for the beginning of the conference as I look out over the audience from my back section advantage. Peter is twittering this session at @ni2009 on Twitter.

Initial speech provided by ‘stand-in’ (my apology for not including names as I missed hearing the names nor am I very good at spelling using the Finnish language) for Health Minister (who, a nurse, is out on sick leave). Speech focuses on current status of nursing in Finland as well as hopes and or anticipated future direction. ePortfolio for nurses discussed as success story for nurses throughout Finland. Various tools provided to nurses to manage career and or academic information and is used for employment advancement. eHealth in Finland is next topic. Facilitation of ehealth is via standard ‘items’ in documentation regardless of format (paper or electronic). The public is very trusting of electronic documentation, too. Central data storage is the direction of the future helps with centralizing government health services. While promising there are hurdles Finland needs to overcome (overlapping IT initiatives, control costs, electronic signatures, etc.).

Robyn Carr, current IMIA-NI president, next speaker. Various committees recognized by audience. This is her final conference in the role as president and will pass on the ‘baton’ to the incoming president. The next item, at least common to the NIs I’ve attended in the past, is performance of native music / culture, in this case Finnish folk song and dance from, I think the Sibelius group (not sure). Had I practiced with this interface I would have recorded and included the performance in this entry. Nicely performed, too, I might add – wonderful.

The next speaker is the Scientific Committee chair person, Kaija Saranto. She describes the process of the committee as well as those involved with this evaluative process along with the themes. A history of this conference provided by Kaija. She introduced the keynote speakers, Dr. Reinhold Haux & Dr. Michael Marschollek, both from Germany. The title of their speech is “Sensor-enhanced health information systems for ambient assisted living: New opportunities for nursing informatics?” Flow is outlined as demographic change, health-enabling technologies (HET), new ways of living and care and then include examples with a closing of new opportunities for nursing informatics. Dr. Haux also provides a shameless plug for Medinfo2010 to be held at Cape Town, South Africa. His point regarding demographic change is the ‘aging population’ with reservations of the term ‘aging’. Several nice graphics illustrate the rise of aging and decline in the care givers (health & non-health care persons). Next topic is health-enabling technologies (p-health). Primarily reference is sensors, their use, and ability to interact with health systems within a home environment. Several considerations of use outlined included cost of the technology to the user, specifically in Germany. Opportunities for such HET include increasing life expectancy as well as quality of life (these points sound very similar to points raised during a post-conference meeting after NI2006). He stresses also the need for interdisciplinary research involving all providers and caregivers. A nice reference list, for their work, is provided in the presentation. I believe if one is interested in this list Dr. Haux would be more than willing to email the list to those who contact him about it.

The graphic titled ‘double circle’ is provided as depicted in Informatics for Health and Social Care (2008); 33, pp. 77 – 89. I can’t do justice to this graphic so feel free to look it up. He uses this to depict new opportunities for health care. Next is examples provided by his colleague, Dr. Michael Marschollek. His sensor he includes real-time display of his ecg with triaxial accelerometer (motion sensor) under real-life conditions, recording daily physiological stresses. Very interesting project and results presented. A search of Google Scholar on Dr. Michael Marschollek provided additional published results of this research. Dr. Marschollek then moved into the ‘smart home’ concept and use of this technology in this sort of environment. One use is to help detect and or prevent falls. Another possibility is patient feedback with sensors to help patients’ manage their own health. Dr. Haux provides the concluding comments of the presentation including opportunities for ni. NI should be a leader in this sort of research and efforts; knowledge shared via many ways including conferences; ni education should include HET. He closed with shameless plug for Medinfo2010.

Dr. Anneli Ensio provided some housekeeping announcements. Keynote for tomorrow morning has changed, d/t health issue, to Dr. David Bates followed by Dr. Charles Friedman in the afternoon. Rosemary Kennedy final speaker, duly noted to be listed by Healthcare Management as one of the 25 most influential women in health care in the USA. Now off to the Wintergarten Room for the opening reception. Done for now!