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SINI2010 – day 2 July 22, 2010

Posted by peterjmurray in conference, education, nursing informatics, SINI2010.
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Thursday is day 2 of SINI2010; the first speaker is Patti Brennan, who will be starting to talk soon.

The heat and humidity doesn’t seem too bad at 7am in Baltimore – but is due to get up to over 95F later today. Thanks to the jetlag, I’ve been up since 5am. Had very nice dinner with Chris Lehmann and George Kim last night – discussing ACI Journal (www.aci-journal.org), and breakfast with Ted Shortliffe from AMIA. More meetings to come over the next few days, but will try to report on various sessions over the next few days.

At 08:30 am, we have a full auditorium for the first speaker. Patti Brennan’s talk is titled ‘Let’s Make Sure That “Meaningful Users” Includes PATIENTS!” – her key message is to ensure that patients are meaningful users if investment in IT is going to be of real benefit and support patient-centred care. She said that the original ideas around ‘meaningful use’ did not take account of PHRs (personal health records), as concepts, rather than products.

Patient-centred care, Patti says, is where the patient is, not where the provider is – so, it is everywhere. She began by showing a video about the My-medi-health project (http://www.projecthealthdesign.org/projects/overview-2006_2008/405594), which shows ways in which mobile communications tools can support self-care. People, Patti says, manage their health every day, not from clinical episode to episode, and so ‘observations in daily living’ (ODLs), selected and reported by patients arising from their daily life,  are important feature of PHRs and need to be available to clinicians.

Patti described how groups are looking at innovative technologies and the ways in which ODLs can expand the very nature of health data (eg mobile devices, wireless sensors and bio-monitors), and explore integration into clinical workflow, and so testing what will come to be relevant in stage 3 of meaningful use (ie, thinking forward to what will be needed in 2015). Among projects are PHRS for adults with asthma and depression/anxiety, and using mobile platforms (eg iTouch) with youths with obesity and depression.

Patti went on to say that making sure that patients are also “Meaningful Users”, then health information and policies are needed that that enable the integration of patient‐defined and
patient‐generated information into clinical care; the health information needs to be accessible to patients in a computable form, and health information for patients needs to be actionable. Among the legal/regulatory challenges that still need to be addressed are:

  • Ensuring patient authorization that satisfies HIPAA
  • Minimize (realistically) the security risks associated with devices
  • Proper verification of identity
  • Secure transmission
  • Compliance with mandatory reporting and other obligations on the part of clinicians

Patti closed by summarising questions that remain, including:

  • Should data obtained in the home or created by the patient be noted as such?
  • In order of priority, which ODLS should be included in the clinical record?
  • What is needed to extend the benefits of meaningful use to others, like the VNA, social health providers, and community drug therapies

More information on projects that Patti is involved with is at www.projecthealthdesign.org and on Twitter at @PrjHealthDesign

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Welcome to SINI2010 – day 1 July 21, 2010

Posted by peterjmurray in conference, education, nursing informatics.
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I have finally arrived here in a hot and humid Baltimore (hon) – from a hot and humid Washington DC – for the 20th anniversary SINI – http://nursing.umaryland.edu/sini/ At 2.30pm, the auditorium is filling up and we are nearly ready for the opening session.

I will be attempting to blog and tweet (hashtag #sini2010) from the event over the next few days.

Janet Allan, Dean of the School of Nursing, gave the opening welcome remarks. She noted that the School had started its first nursing informatics programme 22 years ago, and since has graduated over 500 nurses from informatics programmes. The theme of SINI2010 is ‘Nursing informatics: from first use to meaningful use’, and there are over 400 participants in the event.

Mary Etta Mills, conference co-chair followed and gave welcoming remarks to those attending in person and on webcast.

Dr Connie White Delaney (Professor and Dean, School of Nursing, University of Minnesota) is the opening keynote speaker, talking on “Nursing Informatics Empowering Meaningful Use: People, Processes, and Policy”. She began by noting that informatics is her ‘key addiction’ and noted the collegiality that exists in the nursing informatics community. She also noted that nurses have always been involved in person-centred care and the ‘meaningful use’ of data to support care.

Connie says that it is important that nurses’ voices be heard in the electronic health records, as well as the voices of people and families. She gave an overview of the funding opportunities that are expected, and are being granted, towards the development of initiatives in the area of health IT – eg, the funding of research to move beyond the barriers to IT adoption, and to support the development of national interoperability work. The focus, she notes, needs to be on the achievement of quality healthcare for all, through the use of health IT – but that we need to acknowledge the inter-professional and international aspects that have to be addressed.

Connie noted that the outcomes and discussions of many of the meetings of the HIT Policy Committee and HIT Standards Committee, and other related work, are available through the HealthIT website – via http://healthit.hhs.gov/portal/server.pt

Privacy and security, she says, are foundational to achieving meaningful use for health IT, and for developing electronic health information exchange; they are critical to building a foundation of trust to enable/support meaningful use by providers, hospitals, consumers and patients.

Connie notes that health information exchange is currently very patchy, and much work needs yet to be done.

After Connie finishes, we will move on to the traditional Exhibitor Evening and Dinner, held at the University.

Covering SINI2010, Baltimore July 17, 2010

Posted by peterjmurray in conference, education, nursing informatics, USA.
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SINI is here again – where does the time go?

SINI2010 is the 20th (Anniversary) Annual Summer Institute in Nursing Informatics, organised by and delivered at the University of Maryland School of Nursing – Baltimore. This year’s theme is “Nursing Informatics: From First Use to Meaningful Use”, and the main conference is July 21-24, with pre-conference tutorials on July 19-21. Full information is at http://nursing.umaryland.edu/sini/ with the schedule at http://nursing.umaryland.edu/sini/schedule/index.htm

The traditional CARING dinner (or ANIA-CARING dinner as it is now) will be taking place (http://www.ania-caring.org) at  Chiapparelli’s Restaurant, and there will be other social events.

Twitter stream from @peterjmurray will cover the event (use hashtag #sini2010 to search Twitter). If anyone else will be blogging or tweeting, please let us know.

AMIA2009 – Nursing Informatics Special Event November 15, 2009

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Sunday morning, early, and AMIA2009 activities are already in full swing. Peter is attending the the Nursing Informatics Working Group (NIWG) Special Event. The first part of the event was an overview by Charlotte Weaver, talking about current activities and goals etc for the group. A number of international participants are the event, including Polun Chang from Taiwan and Kaija Saranto from Finland. About 60 people are attending the event at present.

The second part of the event is Diane Skiba, introducing work on the TIGER initiative, covering the development of the project so far and future plans. Next, Sue Newbold introduced the nursing informatics history project; she introduced the origins of the project, and the pioneering work of people such as Harriet Weley and Virginia Saba. Sue says the project aims to reaearch and document the history, including the stories of the pioneers through video interviews. The history project webpages are at https://www.amia.org/niwg-history-page The common themes from interviews etc have been extracted (http://coursedocs.umaryland.edu/Projects/amia/interviews.htm)

The third session was lead by Kaija Saranto and Patti Brennan, who introduced the work and outputs of the NI2009 post-conference. The book has been produced rapidly though a collaborative effort. The books is available as “Personal Health Info management: tools and strategies for citizens’ engagement” at http://www.uku.fi/vaitokset/2009/isbn978-951-27-1321-9.pdf (Book Info: Kaija Saranto, PF Brennan, Anne Casey, eds “Personal Health Info management: tools and strategies for citizens’ engagement” (University of Kuopio) ISBN 978-951-27-1321-9.

SINI2009 is over – on to SINI2010 July 25, 2009

Posted by peterjmurray in conference, nursing informatics, SINI2009, USA.
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SINI2009 is now closing, with the final raffle.

SINI2010 will take place in the usual venue (University of Maryland School of Nursing, Baltimore MD, USA) on July 21-24, 2010 (with pre-conference tutorials on 19-21 July). The theme for what will be the 20th SINI, is “Nursing informatics: from first use to meaningful use”. We hope to be there to blog and tweet the event, and play with whatever new tools may come along between now and then.

SINI2009 – final keynote, Suzanne Bakken July 25, 2009

Posted by peterjmurray in conference, Keynote, nursing informatics, SINI2009.
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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.

SINI2009 – TIGER usability panel July 25, 2009

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The TIGER (http://www.tigersummit.com/) usability collaborative is presenting a panel of recommendations on ‘Creating usable systems for nurses’. The four speakers are Greg Alexander, Cheryl Parker, Nancy Staggers and Denise Tyler. Nancy Staggers outlined the work of the TIGER initiative, and the nine collaborative teams working on various areas – the usability and clinical application design collaborative was the one that attracted most interest from nurses wanting to be involved in activities.

Greg Alexander outlined the problem addressed as being that current information systems do not always meet the workflow and information needs of nurses working in clinical areas. He said that systems should be patient-centric, and evidence-based, and take account of the interdisciplinary collaboration at the point of care. Aspects of usability include efficiency/productivity (how time-efficient is the application? ), how well does the product help end users avoid errors that impact their efficiency? how quickly can a person learn to use the application?, effectiveness (how well the system matches the way users think and work? how well the system supports patient safety, preventing critical error?

Denise Tyler described a number of case studies of implementation to look at usability issues. The successful case studies had end users (multidisciplinary) involved in all processes, from system selection, to design, through testing and education, and starting with selection to ongoing system optimization. Among lessons learned were that usability is the fit between system users, their work and environments, and imperatives included engaging end users early and often, understanding users, their tasks and their environments, and conducting usability testing and redesigning before implementation (to avoid problems during implementation).

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.

SINI2009 – videos and photos July 24, 2009

Posted by peterjmurray in conference, education, krew, nursing informatics, SINI2009.
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Some video clips, courtesy of Eric Rivedal’s new iPhone:

1. second Jim Turley clip

2.Kathleen Charters clip

3. vendor evening clip

They can all be viewed at http://drpeter.posterous.com/

Some photos are at http://picasaweb.google.com/peterjmurray/SINI2009Baltimore

If anyone else has photos or video clips they want us to link to, please let us know.

Presentation SINI2009 07.24.09 Session 5A July 24, 2009

Posted by Scott Erdley in conference, health informatics, nursing informatics, SINI2009, speaker.
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Presentation is recipient of practice award from SINI (see @m2hansen for tweets of this session). About 50 attendees in the main lecture hall, which also means this is webcast. Title is “Leveraging technology for nursing handoffs” presenters are from Northwestern Memorial Hospital. Authors are Stephanie Kitt, MSN, RN, Marilyn Szekendi, PhD, RN, and Kathleen Linn BSN, RN. Northwestern Memorial is a magnet hospital with over 900 beds total. Organization is reported to be about 99% digital / emr throughout. Provides background information regarding the need for nursing handoffs and impact on patient care and safety (aka ‘communication’). Effective handoff elements include f2f verbal with verbal report + hardcopy summary; current/up-to-date info, predictable / stable presentation format, minimal interruptions of report & unambiguous transfer of responsibility (cited from Patterson ES et al 2004 study; difficult to read so more not included). Cites 2 studies of handoff failures (Arora V. et al (2005) and McCann, L. et al (2007). Primary cause of failure was communication. Overall key factors of failure outlined (failure of communication primary).

NMH uses SBAR format (paper-based). Second presenter reviews what SBAR is and the actual paper-based form used by the organization. Stands for Situation-Background-Assessment-Recommendation. Deployment was piloted in medicine, surgery, oncology to one unit in each of these areas for 6 months. Implemented in med/surg and oncology units; training consisted of job aide document; train the trainer & coaching support available at change of shift. Described the deployment of this during the workflow process, which also includes prioritization of ‘next-to-go’ areas. During these processes the organization also underwent a model of care change (this tool reported to facilitate / aid the care change). These presenters did follow-up research of this implementation. Overall the shift report decreased to a 5-15 minute timeframe versus longer reports (still individualized based on patient and nurse). Suggestions by nurses to improve the report process included more specificity but at the same time more freespace; more accurate information (get rid of old information); viewable online to eliminate use of dead trees, and, get all units onboard with SBAR. Lessons learned is e-report format is preferable but not a panacea; stakeholder lead is imperative and nurse involvement is key! Nice presentation. Completed early so long time for Q&A session (about 15 minutes).