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Post-conference posting: CARING Friday Evening Dinner (07.24.09) July 26, 2009

Posted by Scott Erdley in SINI2009, social activities.
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I was not in attendance for this annual social event but there were more than a few in attendance. Here are some pictures of this very popular event held every year during SINI in Little Italy of Baltimore’s Inner Harbor (specifically Chiapparelli’s >>>. Enjoy!
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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

Posted by peterjmurray in conference, education, nursing informatics, SINI2009.
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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 – social outings July 25, 2009

Posted by peterjmurray in conference, SINI2009, social activities.
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An important part of any conference is the social activities; and they generally mainly happen on a Friday night at SINI. A small group of us (Peter, Scott, Margaret and Eric) ventured out to Max’s Taphouse at Fell’s Point (http://www.maxs.com/). We went over by water taxi (I’m not keen on the new split route with transfers), and then a short walk up Broadway on Fells Point. We tried a wide selection of excellent beers, including Christmas ales, IPAs, stouts, and Belgian beers. The food was absolutely excellent, with very generous portions – we had a selection including steamed shrimps, garlic mussels (with lots of chopped garlic), hummus, foot-long chili dogs, and cajun quesadillas (crab and Andouille). After a trip back on the water taxi, the evening was rounded off by a tipple of very nice Glenfiddich.

The traditional CARING dinner – organised once again by Sue Newbold – also took place last night (Friday) at Chiapparelli’s (http://www.chiapparellis.com/) in Little Italy. By all accounts, it was a good evening, with close to 80 people attending.

SINI2009 – Margaret Hansen on use of video iPods July 24, 2009

Posted by peterjmurray in conference, krew, SINI2009.
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Margaret started by describing how she began podcasting lectures; positive anecdotal feedback on the experience as students can listen anytime. Then started to think about using video iPods for teaching clinical skills. Received grant to conduct a small study in school of nursing.

Was involved in a study in Auckland, New Zealand in teaching medical students skills in urinary catheterisation; Margaret’s study was essentially a replication study. Would student’s competency level in the skill and in self-confidence be increased? – would it be of benefit to the patient? – would it decrease the learning time for students to reach particular levels of skills? Margaret also has interest in using mobile devices for patient education.

Study was a randomised controlled intervention study with nursing students at a university in California. Skills teaching involved the use of short videos of the skills, followed by demonstrations of skills on mannequins; students had the opportunity to practice the skills and be assessed by the nurse who had done the teaching. Students were then randomly assigned to groups, with some having video iPods and some not. Students were then re-assessed on the skills after two weeks; during this period, students were in clinical settings and would be expected to perform the skills for real.

The study results (just out) showed little significance between the two groups in the study; but did the experimental group take less time to achieve the same levels of competence and confidence levels? Data is slow in coming back from the students, so it is difficult to know the answers at present.

School is now going to continue using the video iPods for skills learning, and a series of approx. 30 videos will be created and loaded to the devices.

Session 6F ‘Virtual Reality’ SINI09 07.24.09 Friday July 24, 2009

Posted by Scott Erdley in conference, education, future, health informatics, SINI2009, speaker.
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John Miller, MN, RN and Cathy Walker, titled “Nursing Education in 3D: Leveraging Virtual Worlds and Immersive Learning Simulations”. Using 2 screens and projectors to demo SecondLife (SL). Slides at MUVers.org and at Slideshare.com as well as SINI site for this conference as well. IMG_0157 Well attended with some 25 or so people in attendance. To emphasize and show better on screen the session is run with room lights off. They have created an ‘OS’ so medical equipment interacts within SL, records to off-world website, and so forth. Presentation is very verbal and demo-like to show how used and what it is all about.

Some events are scripted or the instructor can adjust as needed during the scenario. Also able to see thought / decision-making processes of student, instructor, or both if this is something desired. Interesting environment for students to experience such as monitor, drugs (administration), reading physician orders, IV pumps, and so forth. There is also a bit of ‘selling’ here by the presenters about their corporation and services for hospital institutions. Question about research but there is no research ’cause they have no time (she is part of 3 companies; he is involved with full-time teaching along with collaborating other companies). A person recommended is Stephanie Stewart (formerly of UofW, Oshkosh). Otherwise very interactive with rolling ‘Q&A’ between audience and presenters. Nicely done. See YouTube clip, too, for a demonstration >>>

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).