jump to navigation

Afternoon session 07.23.09 July 23, 2009

Posted by Scott Erdley in conference, education, health informatics, SINI2009, speaker, USA.
Tags: , , ,
add a comment

Concurrent session 2, Jim Turley, titled “The impact of genomics on nursing care”. In the nether region of the School of Nursing (7th floor). Good attendance despite weather (very rainy – pouring more like it) and immediately post-lunch (about 17 so far). This is listed in the program as being at the ‘expert’ level. It is a session to generate questions and create discussion more than inform. Future and research involve genomics in health, individuals and society. Health & lifestyle facts indicate controllable variables versus genomics. So, the question, what to focus on? We understand behavior but not how to do it ‘well’ regarding behavior. How much can we txt via genomics and what might be ‘leftover’ or influenced by environment? Fair use is the discriminating question de jour.Presentation

Genomics & new conceptualization of health & illness; genomics -> study of all the genes in human genome together. . . health & disease no longer defined in terms of function (nursing assist with functional ‘things’ of patients); predictive models of intervention before loss of function; need for targeted care; blur boundary of health & chronic illness. One impact is redefinition of nursing role. Carol Bickford offered comment of nursing as a profession that’s ‘a bit conservative’ (to paraphrase). Knowledge of ‘risk state’: a non0symptomatic state after an individual or family is aware of their genetic risk. Treatments (individual, family), communication (other healthcare providers, other family members, and others). Agreement of baseline issues logically leads to traumatic re-definition of roles (for example nurses and informatics specialists) and therefore responsibilities (for example, informaticists and mathematical models of information delivery). Describes history of genetics, therapeutics and nursing. Discussion of examples include simple and not-so-simple genetic disorders. CF is an example of not-so-simple genetic disorder.

Suggests finding a gene on a chromosome map (see NCBI website). Core data site for computational genomics. SNPs is single nucleotide polymorphisms (individual A, T, G, or C). Humans are 99% identical at the level of genetic sequence. Diversity of remaining 1% variation is mostly due to SNPs. Common examploe is apoE and Alzheimer’s incidence. Also is BRCA1 & BRCA2 & breast cancer incidence and or chance thereof. SNPs we can know women at risk for breast cancer & heart disease, risk for PCN allergy, and kids with ASA trigger for asthma. Question – at what point, or when, does this sort of testing become cost effective? How does all of this impact nursing practice? Bedside technology now includes micro-array testing at POC. Given now able to own genetic testing some of the companies currently doing this are listed as examples by Jim. Questions arise, then. Intention and or quality of science, for example. 23andme (https://www.23andme.com/) and decode genetics (http://www.decode.com/) are examples. 23andme also purchased genetic code of Iceland (entire country), which are linked to the emr of Iceland, too.

Some side effects of all of this testing include the Human Genome Project Information site covering a lot of different issues as well as various articles talking about state regulation of this sort of testing (see Wired magazine) to the UK and regulation of genetic testing. Sharing will become more common (between those who can) so eventually a fair amount will be in the public domain. Postulated questions by Jim include the following:

  • How to display a genome?
  • Include in an EHR?
  • What does it MEAN?
  • What do you do while KNOWLEDGE is evolving?
  • Do companies have the right to ‘buy’ the genomic data of a country?
  • Should genomic data be available without a healthcare referral?
  • Does it, genomic data, covered by HIPAA?
  • Should genomic data be PUBLIC? (does social good out weigh privacy?)
  • Should patients be required to ‘share’ genomic data with their clinicians? (family members, insurance companies, employers/potential or actual)
  • Are we ready for a new paradigm of research (where consumers pay and companies reap)?
  • Is it truly a generational problem? (next generation & privacy)

Understanding the human genome project dvd is a nice information resource on many of these issues. See site >>> Excellent presentation and good Q&A with audience at end of session.

UPDATE – a video from Eric Rivedal >>>

Advertisements

Social Networking 07.22.09 SINI2009 July 23, 2009

Posted by Scott Erdley in conference, nursing informatics, SINI2009, Uncategorized, USA.
Tags: ,
add a comment

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!

Smile!

Smile v2!

Smile v2!

Volunteers

Volunteers

Thursday 07.23.09 Full Day July 23, 2009

Posted by Scott Erdley in conference, education, nursing informatics, SINI2009, speaker, Uncategorized, USA.
Tags: , , ,
add a comment

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.
Tags: , , , ,
add a comment
IMG_0044

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.

IMG_0046

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

Covering SINI2009 July 9, 2009

Posted by peterjmurray in conference, nursing informatics, USA.
Tags: , ,
add a comment

Several of us will be attending, speaking at, and covering through blogs and tweets, the SINI2009 event in Baltimore, Maryland, USA, from approx. 21-25 July, 2009.

SINI2009 is the 19th Annual Summer Institute in Nursing Informatics, organised by and delivered at the University of Maryland School of Nursing – Baltimore. This year’s theme is “Informatics at the Point of Care: A Barrier or a Bridge?”, and the main conference is July 22-25, with pre-conference tutorials on July 20-22. Keynote and featured presenters include James J. Cimino, Paul Tang, Nancy Staggers and Suzanne Bakken.

The traditional CARING dinner will be taking place (http://www.caringonline.org/) , and there will be other social events.

Twitter streams from @peterjmurray, @m2hansen, @scotterdley will cover the event (use hashtag #sini2009 to search Twitter). If anyone else will be blogging or tweeting, please let us know.