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Rutgers 30th Conference – Final Round-up, Part 1 May 7, 2012

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

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

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

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

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

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

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


SINI2010 over – on to 2011 July 25, 2010

Posted by peterjmurray in conference, nursing informatics, SINI2010, Uncategorized, USA.
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A successful SINI2010 is over. Once again, over 400 nurse informaticians gathered to learn, discuss and network, exploring the important issues of the day. As ever, the event was well organised by the local team and SPC – and the newly opened Southern Management Corporation Campus Center (SMC), linked to the School of Nursing building, is definitely a bonus in terms of space and facilities.

Next year will see the 21st SINI – SINI2011. It will be held on July 20-23, 2011, with pre-conferences on July 18-20. Keep an eye on nursing.umaryland.edu/sini for more information.

Poster Session 07.24.09 SINI2009 July 24, 2009

Posted by Scott Erdley in Uncategorized.
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SINI09 Poster Session

SINI09 Poster Session

Poster Session SINI09

The winning posters

Some pictures of the well attended poster session at SINI2009! Very engaging!

Social Networking 07.22.09 SINI2009 July 23, 2009

Posted by Scott Erdley in conference, nursing informatics, SINI2009, Uncategorized, USA.
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Wednesday evening this annual conference event was held School of Nursing, University of Maryland, the host of SINI this year. With apology for ‘back entry’ of this event by me, of course. It was from 5:30pm – 7:30pm. I’ve included just a few of many pictures of this event (without comments at this point) to provide a flavor of the atmosphere!

UPDATE: some more photos from Peter at >>>

Having fun

Having fun

Personal networking

Personal networking

More networking

More networking



Smile v2!

Smile v2!



Thursday 07.23.09 Full Day July 23, 2009

Posted by Scott Erdley in conference, education, nursing informatics, SINI2009, speaker, Uncategorized, USA.
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Recap of yesterday. Good start to conference. Well-received keynote by James Cimino. Intimate networking session during early evening. Today is first full day of conference. Day starting with planning committee meeting (of which I & Peter are members). A little early to be sure, too. And, post composition, good thing as the rain is really coming down by 0830! Pics from last evening will be posted under separate heading.

Opening distinguished lecturer is Marcelline Harris, PhD, RN, Senior Associate Consultant, Departments of Nursing & Health Sciences Research, Division of Biomedical Informatics, Mayo Clinic. Title of her presentation is ‘Pathways to Translational Informatics for Nursing’. Introduction supplied by Judy Ozbolt. Marcelline provided a bit of background about her place of employment – Mayo Clinic.

Initial talk begins with definition of translational informatics – what is it as a concept. Shift to applied aspect in ’07. Earlier demonstrated with grants for use of IT to help with or optimize utility and or use of information. National efforts, currently, now looks at it as linking with practice of informatics. Uses CTSA abbreviation – missed what this stands for. ’08 was first summit for translational bioinformatics – heavily genetic focus. Shared include translating research into practice / application. Informatics is the engine for translation (data, information, knowledge).

Asks is informatics a discipline and science providing support (sorry, missed her reasons) for postulating it is both. She then describes commonalities of different definitions of informatics. One is both science & discipline; focus on modeling of data, information, knowledge. Need to exchange data as a requisite concern or focus. Illustrates with Shortliffe’s graphic of scope of biomedical informatics, basic research to applied research. Also indicates informatics folks are vertical people & shows adaptation of C. Lehmann’s work on this (focus on modeling data, information & knowledge across layers).  Circular process of clinical practice and integration of information, data, knowledge at Mayo depicted as graphic of circle; scientific research similarly depicted. Stresses need to pull both together for translational with informatics as the middle / engine. Marcelline uses a lot of graphics to demonstrate or visualize for the audience. Sorry but not taking pics to post. Will be accessible later via link from Marcelline. Competencies outlined; informatic roles trying to promote / identify at Mayo include academic research (easy one); applied / professional roles (primary fxn is operational informatics), liason roles (nurses, MDs, in practice, delivery system & technology experts), and translational roles (primary fxn bridging from research science to applied). Nursing issues / priorities for cis’s include technology & usability, data retrieval / analysis and terminology uses.

Problems for nurses re: tech & usability issues. Reports of such include ’07 (Klas Report), ’08 (Advisory Board Reports) and ’09 (AAN study). Common theme is systems don’t support work of nurses (instead introduces complexity and such things do not coordinate, but fracture, care). She also depictes tne ’07 EMR Adoption Model (no translational concepts as well as no nursing visible). Shows 8 stages (0-7). Included as a follow-up is Gartner’s Hype Cycle (may be able to locate with a net search). Huges, AHRQ, 2008, report / book about nursing & technology an integrative review (free 3 volume book). Findings show chaos of implementation among others impacting nurse practice and perceptions. Data analysis / retrieval issues include unmet expectations, inspite of storage unable to find information and or generation of new knowledge. Touch briefly on the ‘meaningful use’ definition work. Policy priorities recently published on 07.17.09. Content issues include nursing terminology systems; maybe refocus on translational requirements and or meaningful use issues. Offers a slide showing, based on HIE work, offering the idea of content representation enabling translational informatics. Data/information/knowledge life cycle (Chute & Harris) is proffered as her understanding of what nurses may actually want as related to translational informatics. Offers examples of Mayo Clinic is doing in this overall area of translational informatics. Organizational culture of Mayo plays a big role in ‘what’ the clinic is. Mayo has an integrated medical dossier where ‘everything’ is related (diseases, medications, tests, life habits, and so forth). Current state is a big genetics initiative by Mayo; clinic keeps / stores a lot of stuff (included is clinical data as well as tissue ‘data’). Mayo has 100 years worth of all of this data. Very detailed graphic demonstrating the individualized medical record / care provided by / at Mayo. A highly ‘committee’ized’ organization with another graphic depicting this; chartless for about 5 years now (as a clinic). Practice convergence pathway depicted, too, demonstrating tech & practice integration. Modeling May Knowledge is underway. Various endorsed models depicted (concept, knowledge, etc.). All are available to all staff on their organizational website. Unified nursing assessment model depicted, too. Building own vocabulary and then mapping to other systems (ICNP, SNOMED, etc.). LexGrid as core model. Very detailed enterprise model of pain illustrated. Have an enterprise data trust in place. Closes with key lessons regarding vocabulary (use one that works); structured documents are not helpful (typicall organized from user perspective, not standardized), and so on. Does translational informatics work? Yes with standardized models of nursing knowledge guide retrievals / analytics somewhat independent of constraints in source information. Nurses are well prepared for translational informatics. If interested email speaker (harris.marcelline@mayo.clinic) for additional information.

Off to break and then session reports blogging!

UPDATE: Link to video clip courtesy of Eric Rivedal (recorded on iPhone): >>>

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

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

NI2009 tutorial blog January 22, 2009

Posted by peterjmurray in Uncategorized.
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We will be offering a tutorial as part of NI2009, titled ‘How to Weave Web 2.0 Applications for Nursing Informatics and Healthcare Professional Education’.  Among the subjects that will be explored from a hands-on, as well as theoretical, perspective, will be:

•   the basic format, function, and use of blogs.
•   the potential use of blogs in education, professional development, and virtual conference participation.
•   readily available Free/Libre/Open-Source Software (FLOSS).
•   creating RSS feeds by using a source, such as Feedburner.
•   the basic set-up, purpose, and use of podcasts.
•   using podcasts in education, professional development, personal use, and virtual conference participation.
•   creating a YouTube video for your professional use.
•   creating a “team NI2009 conference” wiki.
•   using the “peer-to-peer” Skype application.
•   exploring “mash-ups” and “widgets” are and how they may be used online.
•   discuss ideas about how to access core web-based systems via mobile devices (eg, iPhones)

– and probably lots more. Watch the NI2009 website for tutorial information and how to sign up if you want to participate.

The tutorial blog will be used by participants – http://ni2009tutorial.wordpress.com/

We will be at NI2009 January 2, 2009

Posted by peterjmurray in Uncategorized.
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Some of us will be at NI2009 in person (www.ni2009.org – the 10th International Congress on Nursing Informatics in Helsinki, Finland on 28 June – 1 July 2009). We hope we can bring others in virtually to present and participate, but that depends on the technology available at the event.

We know of at least 4 submissions that we have been successful in having accepted for presentation:

1. a paper on 3D virtual worlds in professional nursing education, lead by Margaret;

2. a panel on Web 2.0 for nursing informatics and professional development, lead by Peter;

3. a workshop on personal health records (PHR), lead by Scott; and

4. a tutorial, again lead by Margaret, titled ‘How to Weave Web 2.0 Applications for Nursing Informatics and Healthcare Professional Education’.

More news in coming months on our plans for Helsinki – come and join us!

Welcome to Buenos Aires October 27, 2008

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By way of an introductory post – I am attending the IMIA Education Working Group conference at Hospital Italiano in Buenos Aires, Argentina. I will be blogging the event over the next two days, but the first pst may be later in the day, as I am giving one of the opening keynotes shortly.

I have been here in Buenos Aires for the past week, just doing the tourist bit – but now have to pay the price and get down to the business end of the trip.

More to follow. I will try to upload my slides to Slideshare later. The hospital wireless network seems to be working fine here.