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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.

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SINI2010 – final morning sessions July 24, 2010

Posted by peterjmurray in conference, education, nursing informatics, SINI2010, USA.
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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 – social catch-up July 24, 2010

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It’s Saturday already; the last day of SINI2010. It’s still hot (31C, 88F) already at 8:00am, and predicted to get up to 100F later today.

Still, the heat did not stop the annual Friday evening pilgrimage down to Chiapperelli’s in Little Italy, Baltimore for the ANIA-CARING networking dinner. The event was organised efficiently, as ever, by Sue Newbold and colleagues, and attracted over 70 people. Another part of the annual ritual, for a few of us, was a stop-off for liquid refreshment and cooling down at the Pratt Street Ale House (http://www.prattstreetalehouse.com), on the walk down to Chiapparelli’s.

Many thanks, this year as last, to Eric Rivedal for his extensive ‘guest blogging’ of many of the SINI2010 sessions.

Final day participants are gathering for breakfast and coffee – more blogging later when the sessions start.

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.

TIGER, TIGER, burning bright July 22, 2010

Posted by peterjmurray in conference, education, future, nursing informatics, SINI2010.
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The parallel afternoon sessions are due to start. I am attending a very well-attended session, “The TIGER Initiative: Adoption of Health IT and Meaningful Use for Nurses and Other Disciplines”, a panel presentation and discussion with Patricia Hinton Walker, Vice President for Nursing Policy & Professor of Nursing at Uniformed Services University of the Health Sciences; Diane J. Skiba, Professor & Health Care Informatics Coordinator, University of Colorado College of Nursing; and Brian Gugerty, Gugerty Consulting, LLC. The session covers reports on TIGER Phases II and III ; specifically, outcomes of the Competencies Collaborative with implications for Education, Faculty Development, and Staff Development, along with progress on the emerging TIGER III, Virtual Learning Environment.

TIGER, for the uninitiated, is “Technology Informatics Guiding Educational Reform” (http://www.tigersummit.com). The TIGER vision is to allow informatics tools, principles, theories and practices to be used by nurses to make healthcare safer, effective, efficient, patient-centered, timely and equitable; and interweave enabling technologies transparently into nursing practice and education, making information technology the stethoscope for the 21st century.

Patricia started the session by giving an overview of the history of TIGER, especially phases I and II – reports are available at http://www.tigersummit.com/Downloads.html TIGER phase III will focus on implementation, integrating the TIGER recommendations into the nursing community along with colleagues from all disciplines across the continuum of care. These activities are focused on creating a Virtual Learning Center and developing another invitational summit.

Brian Gugerty next gave an overview of the work of nine collaboratives, focusing on the informatics competencies work (http://www.tigersummit.com/Competencies_New_B949.html). Informatics competencies for nurses were seen to be at two levels, ie all practicing and graduating nursing students; and nursing leaders. Existing work in the literature on basic computer competencies and information literacy/management was explored, from an international perspective. Work related to this is available at http://tigercompetencies.pbworks.com/

Diane Skiba talked about the education and faculty development collaborative work – http://www.tigersummit.com/Education_New.html She explored how to engage faculty to move the agenda forward, although noted the difficulties of making changes in higher education. She identified the challenge as that of preparing nurses to practice in a technology-rich world, and addressing areas of both teaching about technology and teaching with technology.

Patricia concluded the presentations by introducing TIGER phase III, which is about dissemination of the results to date of the initiatives and collaboratives, and the development of the virtual learning environment (VLE), as one of several potential solutions to addressing the problems. The VLE work is also beginning to address a wider interdisciplinary audience, including patients and ‘cosnumers’, and not just to nurses.

SINI2010 – day 2 July 22, 2010

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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

Welcome to SINI2010 – day 1 July 21, 2010

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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

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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.

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!
IMG_0096 IMG_0106 IMG_0108

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.