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Rutgers 30th Conference – Final Round-up, Part 2 May 7, 2012

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Among presentations at the final day and a half of the Rutgers College of Nursing’s Thirtieth Annual International Interprofessional Technology Conference, in New Brunswick, New Jersey:

Debra Wolf explored the role of the informatics nurse, while Bonnie Anton built on her overview and noted that the role is becoming increasingly patient-focused, with new competencies needed in supporting the delivery of health information for consumers; these include issues of information literacy and health literacy. Bonnie also addressed the role of social media, as communications tools, for user-generated, collaboration activities, and enabling patients and others to find ‘people like me’, although raised issues of “is it safe?” She raised the need to include the patient as an active member of the healthcare team, and aspects of Health 2.0 and educational guidelines re:social media use were introduced.

Dennis Crain explored the proliferation of private data on the internet (‘digital exhaust’) that can be collected, mined, and used for personalised targeting of products. Greg Alexander focused on ageing populations, and how advances in science, medicine etc have lead to reductions in mortality, leading into an exploration of monitoring devices and systems for home care. Bernie Garrett (University of British Columbia) explored “Using Web 2.0 tools to globalise the curriculum”, and discussed the International Science Education Partnerships Project (Canada-UK links), a pilot project to establish the potential of freely available social networking tools to support educational international partnerships. The project generated discussion on the value of philosophical perspectives, and evaluated the potential of using tools
(more information at http://www.plymouth.ac.uk/staff/rcutting). Evaluation of the project was done with surveys/questionnaires and online focus groups (plus Google Analytics).

In the closing keynote, Marion Ball explored a wide range of issues around using smarter technology to improve health globally. Among here messages, she raised questions of “are we asking the right questions?” and whether the workload for clinicians has been increased through use of IT, rather than reducing it. She covered a wide range of topics including TIGER, IBM’s Watson, and other developments.


Rutgers 30th Annual International Interprofessional Technology Conference April 12, 2012

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Peter will be attending and presenting at the Rutgers College of Nursing’s Thirtieth Annual International Interprofessional Technology Conference, in New Brunswick, New Jersey, USA – from 14-18 April, 2012. The conference website is at http://nursing.rutgers.edu/conferences/30th-annual-international-interprofessional-technology-conference  There should also be tweets via @peterjmurray with hashtag #Rutgers30 – and information will be added here about any other bloggers, tweeters, etc at the event.

SINI2010 over – on to 2011 July 25, 2010

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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.

SINI2010 – final morning sessions July 24, 2010

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The first distinguished lecture this morning is from Marilyn Chow, Vice President, Patient Care Services at Kaiser Permanente, and Murielle S. Beene, Chief Nursing Informatics Officer at Department of Veterans Affairs, and titled “Where’s the Quality in EHRs? A Collaborative Model to Promote Data Sharing and Quality Reporting”. Their talk will aim to describe how nursing leaders can have a transformative role in influencing EHR-related decisions that improve clinical effectiveness, efficiency, patient safety, and the delivery of quality-based patient care; define an emerging information model related to pressure ulcer risk that standardizes and informs nursing practice and reflects real-time clinical decision-making; and demonstrate the usefulness of common information models and reference terminologies to achieve semantic interoperability across different technology platforms.

Marilyn began by talking about her vision of being able to exchange information between the Kaiser Permanente (KP) and VA systems. KP is the US’s largest no-profit health plan, with 8.7 million members and over 40,000 nurses, while VA covers 7.8 million enrollees and 70,000 nurses. VistA, the VA system has been recognised as a world-leader for over 20 years.

The speakers summarise ‘meaningful use’ as being about financial incentives and penalties designed to support the adoption of EHRs, with the goal of linking healthcare resource use to patient outcomes. The vision is to derive quality measures directly from EHRs, improve care coordination with electronic exchange of health information, share baseline patient data across settings, and enhance clinical decision making. They went on to explore the implications of meaningful use for nurses, which include:

  • identify structures and content that would meet U. S. meaningful use criteria for a quality measure;
  • facilitate data portability between software applications and between organizations;
  • improve the ability to aggregate outcome data for research, comparison, quality and process improvement; and
  • promote nursing participation in standards development.

Currently, they say, valuable patient information is “locked” within an organization’s EHR, and data is often tightly bound to proprietary data models, which causes current and future potential problems.

The collaborative goals of work between KP and VA include defining a common Information Model driven by nursing practice that enables data capture, data re-use, and data sharing within and outside organizations. Also, they aim to facilitate the measurement and extraction of data for meaningful EHR use specific to the delivery of nursing care to support quality, safety, efficiency and clinical decision support. Nursing documentation represents a large part of the content of EHRs and therefore there is a need for nurse-lead initiatives.

They described a ‘replicable process’ for the development of the information model and data sets, and the use case scenarios, and determining the meaningful data capture, though:

1. Evaluate the Evidence
2. Leverage Clinical Expertise
3. Develop Optimum Data Sets
4. Information Harmonization – Identify the Gaps
5. Map to Reference Terminologies
6. Develop Practice-driven Information Models
7. Validate the Models

The presentation concluded by reporting that, although the work was just beginning, already made some significant progress had been made through a collaboration between the largest public and the largest private healthcare organizations on developing a nursing information model. They hope that the work promises to have an direct impact on both patient care activities and the future direction of nursing informatics within KP and the VA. They closed with a ‘call for action’ to demand the inclusion of nurse sensitive measures in the 2013 Meaningful Use criteria, and claim that the project demonstrates that the data for nursing sensitive measures can be “unlocked” from the EHR and used directly for quality reporting.

SINI2010 – Gil Kuperman July 23, 2010

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It’s Friday morning in Baltimore; temperatures are supposed to get up to near 100F today. Attendance at the Orioles game didn’t look too great last night (my hotel room overlooks Camden Yards).

The distinguished lecture this morning is from Gil Kuperman, from NewYork-Presbyterian Hospital and Columbia Biomedical Informatics in New York, NY. His talk is titled “Health Information Exchange: Why Are We Doing It and What Are We Doing?” His premise for his talk is that we are at an inflection point in respect of interoperability, and that some of the responses to ‘meaningful use’ are altering the landscape for interoperability. He outlined the role of clinical data in giving a more accurate picture of the patient’s needs, but also noted the wider uses of such data, for public health and research. He referred back to the 2001 report and recommendations on ‘A strategy for building the national health information infrastructure’, which had three components, including health care provider, personal health and population health dimensions.

Gil then went on to review the 2004 origins of ONC within a four-part strategy which had little funding for real implementation. It did highlight, however, the importance of health information exchange for EHR adoption, and some encouraging signs for interoperability. He noted the origins of the first prototype National Health Information Network (NHIN) project in 2004, and the growth of the “NHIN1” model as a ‘network of networks’. NHIN2 in 2007 aimed to demonstrate interoperable and secure health information exchange, with specific use cases.

After an exploration of other phases/stages of NHIN, Gil moved on the NHIN Direct (www.nhindirect.org), which aims to support stage 1 meaningful use. It aims to push data to a known recipient and automate health information exchange that is currently being undertaken by other modes.

He highlighted a number of challenges and questions that still exist, including:

  • Is it really easier? – need an address book (central authority) – need authorization scheme – need auditing
  • How much of the problem does it solve? – “Push” vs. “pull” – Important use cases left out
  • Need agreed upon security standards – Need governance to create policies – Need compliance to assure policies followed
  • How well does it work for large organizations? – Putting an incoming lab result in the right chart

The NHINDirect model is not seen by many as an end in itself, but is seen as complementary to other aspects, and may or may not address some of the use cases identified within NHIN2.

Gil ended by noting that many questions are raised by the contrasting models, ie “Sending messages” vs. “Information Retrieval”, does it enable innovative care models, how will it affect RHIOs in the future, and will it allow migration to more sophisticated health information exchange?

Some interesting ideas were raised, and it is useful to compare with the situation and questions raised 5 years ago in the UK with the development of the NHS Spine model.

Covering SINI2010, Baltimore July 17, 2010

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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.

AMIA 2009 – global health informatics November 16, 2009

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“Experiences and challenges of global health informatics” – a panel on global ehealth initiatives, presenting the experiences of practitioners from various parts of the world. The first presenter, Neil Advani, explored the distinction between global and international in terms of health. He says that ‘international health’ is based in tropical medicine, as a distinct speciality, and based in a foreign aid paradigm, while global health is based in global health threats that potentially affect all countries, and a paradigm of elf-sustainable development. International health sees innovation only in ‘developed nations’, while global health sees innovation required in, and occurring in the ‘global south’. International health is based in adapting high-tech solutions to resource constrained areas, while global health sees innovation and exchange occurring in both directions between developed and developing areas.

The first presenter is Muzna Mirza (on behalf of Scott McNab), on Saudi Arabian National Guard Electronic Disease Surveillance System. The system vision is around an integrated surveillance and information system designed for appropriate actions to prevent and control illness.

The second presentation is from Andrew Kanter, on “The Millennium Global Village Network”, a network of 10 countries in sub-Saharan Africa. MVP (Millennium Villages Project) is a partnership between UNDP, national governments, and Earth Institue at Columbia University; it is integrated project, not just focusing on health, but on other aspects of everyday life that influence health and disease.  The project covers about 500,000 people, at a cost of around $120 per person per year. The project is based around primary care clinic registers The project covers about 500,000 people, at a cost of around $120 per person per year. The project is based around primary care clinic registers, but wants to move to comparable and timely data, electronically stored. The project uses OpenMRS as a core to collect structured data from different facilities; information is aggregated, used locally, sent from district information systems to meet the needs of regional and national health ministry levels. The project wants to also find what works and what doesn’t work in different areas, and common themes.

The system needs to be population based, not just based in health clinics. A system built on Open Rosa uses a cellphone based data collection system to then send data to Open MRS and generate reports based in local communities. Challenges include human capacity, reliable electricity (often solar power based), clinician engagement, reliable connectivity (via 3G networks) and government policies. Conclusions include that open robust systems are an important part of these developments.

T Kass-Hout talked about disease surveillance through novel tools in InSTEDD, and the final speaker was Charles Safran, talking about diabetes management in Dubai, United Arab Emirates. About 30% of Emirati seem to develop diabetes later in life (versus a smaller percentage of around 7% in USA). Charles discussed population management of diabetes, and doing so from a distance. He discussed some of the cultural issues around people admitting to having diabetes, and aspects of care. Charles discussed some research into how IT available today can provide better healthcare in Dubai; the results found that people already made everyday use of IT (especially cellphones), but often are not trained in utilising them to their full potential. They found that ‘culture trumps everything’ – Charles suggests a need for ‘cultural informatics’ and a supporting research framework for comparative cultural explorations.

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.

AMIA 2009, San Francisco November 15, 2009

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Peter is at the AMIA 2009 conference in San Francisco (http://symposium2009.amia.org/). I will be trying to blog some of the action from here – but may end up with most of my reportage being on Twitter – look for #amia2009sf

As of Saturday, 5:30 pm – Registration is now open – after a minor hiccough – and there are lots of people queuing to get their badges etc. A nice sunset over San Francisco at the moment, as viewed from the 35th floor of the hotel. I have been here for two days – done some of the usual tourist bits – some photos are uploaded at http://www.facebook.com/peterjmurray and I’ll try to add more in due course.

Any other tweeters or bloggers, let me know and I’ll add you a link/mention here. I know Kevin Clauson is on Twitter (@kevinclauson), as is Chris Paton (@DrChrisPaton). AMIA is now on twitter at http://twitter.com/AMIAinformatix

SINI2009 is over – on to SINI2010 July 25, 2009

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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.