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OP331 NI2009 Teaching methodology 2 (1030-1215) July 1, 2009

Posted by Scott Erdley in conference, education, health informatics, NI2009, speaker.
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Sorry, folks, late arrival from panel presentation with Peter. Only arrived late for 2nd presentation (obviously missed first one). 3rd presentation is “Educating a Health Terminologist” by J. Warren. She demonstrates terminology tools educators can use; basic session to inform participants and update them so ‘they’ may have a basic understanding of the role of health terminologist, responsibilities and then help educate others about this role. Some very nice graphic slides to help understanding available in her presentation.

4th presenter – T. Indergaard (Finland) “Counseling of problem-based learning (PBL) groups through videoconferencing”. Discusses project and advice for those pursuing videoconferencing solutions.

Final presenter is J. Brixey “Creating experiential learning activities using Web 2.0 tools and technologies: a case study.” Stressing the social need of connecting with others (see Siemen’s principles of connectivism). Making such connections possible with Web 2.0 tools / platform; ‘at/ap/ac’ if-you-will (anytime/anyplace/anywhere) – aka ‘cloud computing’. Describes project at Kansas University of using 2.0 tools / technologies for facilitation of learning experiences (such as conference attending and so forth). Nice list of social software toolkit application inclusion criteria on her slide (easy to dl/install to easy navigation to user interaction encouragement; about 10 items in all). Use of MSN Live Messenger dictated by desire for concurrent communication between students and faculty. Wide range of 2.0 tools used including SL. Activities within SL range from ppt evaluations to interactive socializations. Nicely done! Off to lunch then perhaps one of the 3 final sessions (start at 1315 through 1415). Final ceremony is from 1415 – 1600. I will not be blogging the closing ceremony because one of the closing speakers requires the use of my Mac computer for her presentation. Later!


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

Posted by Scott Erdley in conference, health informatics, IMIA, Keynote, NI2009, nursing informatics, speaker.
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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.

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

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.

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

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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!

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

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!