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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

Posted by peterjmurray in conference, education, nursing informatics, USA.
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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.

OpenHealth, Belfast – morning keynotes January 21, 2010

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The first keynote talk of the morning session is from Joseph dal Molin, on “Open and connected health: a North American perspective – it’s time for the new paradigm”. Joseph is President of e-cology corporation and Director of WorldVista (http://www.worldvista.org/); he is also adviser to the Jordanian government on EHR implementation using Vista. Joseph began by saying that an open and connected health model is a patient-centric ecosystem; there is a great deal of complexity that must be taken into account; holistic perspective is needed, and all domains affecting care must be taken into account. A simple industrial model does not work; much of current health system is based in silos of information etc.

Joseph says that the US VA ecosystem delivers high quality care, and is very cost-effective; number of veterans treated from 1996 to 2003 rose by 75% (with increasing complexity of care), but the budget only rose by 32% in total over that period. Barcode medication administration has virtually eliminated medication errors in their system, and there have been many other high standards in quality indicator achievement. In most other places, legacy software industry models (based in proprietary systems) have failed to deliver, he says – reinventing the wheel is a pandemic.

Joseph outlined a summary of the open source development model, and likened it to the cycle of evidence-based medicine leading to exploration and improvement of the software. Among open source applications used in health in North America are VistA, OSCAR as EHR solutions; Indivo and MyOSCAR as personally controlled health records; NHIN CONNECT Gateway in USA is an open source project, sponsored by US Health and Human Services Department; Open Health Tools (http://www.openhealthtools.org/). But, he says, open isn’t enough, and semantic interoperability is needed, and is essential for comparability of data. Costs are often a barrier here at present, but there are open source terminology projects seeking to address the issues.

Challenges for open connected health include governments not knowing how to accept free software, not invented here syndromes, procurement processes being based in expensive proprietary software and being hindrances to innovation.

The second keynote presentation of the morning is from Gerald Hurl, from the Health Services Executive (HSE) in the Republic of Ireland, and chair of Health Informatics Society of Ireland (HISI) talking on ‘Delivering connected health in a national context’. Gerald began with an overview of the changes in delivery of health and social care in Ireland, and intentions to move from episodic to holistic care, with the implications for where health service staff may work in the shift from institutional to community-based health and social care services. This has implications for ICT, if services are integrated around the patient, and requires a focus on connectivity and connected health. The new ICT strategy reflects this new model/paradigm of care. But a key challenge will be the lack of ICT staff with the domain knowledge and expertise to support the delivery of the necessary ICT.

AMIA 2009 – opening session November 16, 2009

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There was no reliable wifi for the opening session, so this blog post was written during the session and uploaded afterwards. Ted Shortliffe, AMIA CEO and President gave the opening and welcoming remarks. Attendance is on target for this year, with 1,900 so far, with expectation of over 2,000 due to on-site registrations to come. Lucila Ohn–Machado, SPC programme chair followed Ted; she reported that there are 360 posters, some panels and late-breaking sessions, and a number of other innovations. The SPC includes representatives from training programmes and journal editors or representatives. There is also a journal-eligible programme, with 7 journals (including JAMIA, IJMI). Lucila gave an overview of a number of highlights to be presented during the next few days.

Following this, there was an overview of the student paper competition from David Krusch; of 80 submissions, 52 were selected as short-listed finalists, then narrowed down to 8, from which the final three winners were selected. Winners will receive cheques and certificates – third place winner, from Carnegie-Mellon is Christopher Harley; second place from Columbia University is Chintan Patel; first place winner of student paper competition is John D Duke, from Indiana University and Regenstrief Institute.

David Bates, Chair of AMIA Board, was the next speaker, giving an overview of other award winners presented at the AMIA Leadership Dinner on Saturday evening. Joyce Mitchell, president of ACMI, then presented the Morris Collen Award (AMIA’s highest award, for lifetime achievement), given to Betsy Humphries, Deputy Director of the US National Library of Medicine, together with new inductees into the College (founded in 1984 with over 300 Fellows). The award was presented by Morris (currently 96 years old and living in the San Francisco bay area).

The opening keynote presentation was given by Mark D. Smith, President and CEO of California HealthCare Foundation. Mark says he is not in informatics, and is not a technologist, but is passionate about the use of IT in healthcare. He began by talking about ‘hope’ – he says the “stars are aligned” for delivering on the promises around using technology to change healthcare. Why can you put a piece of plastic in a hole in the wall anywhere in the world and get money from your bank account – but go to the hospital you were born in and they don’t know the most basic things about you? – a paraphrase of a question Mark asked. He gave a couple of examples of kiosk-based information and symptom checking.

Mark then moved on to the “hype”; starting with Gartner Hype Cycle – suggests we are at peak of inflated expectations in use of technology/IT in healthcare. He says there has been hype, and we have been having the same debates, for nearly 40 years, with predications/hype of change for that long. Avoiding the ‘road to hell’ – he suggests need to pay attention to policy, pay attention to key technology issues, and address the forces of inertia. A lot of scientific studies costing many millions of dollars have produced ‘nothing but tenure’ – but have had no effect on healthcare delivery systems – this has got to change, he says. The only thing we do more or less same as 20 years ago is healthcare – basic structures have changes, despite a few new gadgets etc – but technology has changed many other areas of everyday life. He gave the example of opentable.com as a way of booking a reservation for dinner; are integral to restaurant reservation systems. By implication, he asks – why cannot we do the same in healthcare? “The restaurant owner did not have to come to a conference to get 10×10 certified to be able to use the system to get more customers into his restaurant”.

Critical technology areas – embrace affordability (we know what we can afford, what can we get for it?) – need a priority in bringing down the costs of healthcare while maintaining quality etc. Need to focus on the consumer – technology needs to be simple and elegant if people are going to use them. We also need to “avoid analogue limbo” – we have fast cheap machines linked by slow, dumb humans; there is no end-to-end digital movement and manipulation of data. So pressing task is to eliminate the trapping of data in analogue limbo.

His final admonition – aimed at students, and the younger generation – this is the chance to fundamentally transform the system – so “don’t screw it up”.

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

Medicine 2.0’09 Toronto September 18, 2009

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Peter is at Medicine 2.0’09 in Toronto; a great conference and as interesting and dynamic as last year’s inaugural event. He will be blogging mostly on the official conference blog at http://medicine20congress.blogspot.com/ – there are several other bloggers, most of them students of Gunther Eysenbach.

The best way to follow the event ‘live’ is through Twitter – search for #med2

MIE2009 is over – onwards to Toronto September 3, 2009

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MIE2009 is now finished, and people will be returning home from Sarajevo today, if they have not already done so.

Peter will be blogging from the Medicine 2.0’09 event in Toronto, Canada on 17-18 September (http://www.medicine20congress.com). There will also be an official blog for the event this year – http://medicine20congress.blogspot.com/

In addition, he hopes to be able to cover the Healthcamp Toronto (http://healthcamp.ca/) – I have not been to a Healthcamp yet, so I am looking forward to learning.

MIE2009 – final day September 2, 2009

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Today is the last day of MIE2009. I won’t be reporting much, as my flight home is at lunchtime. Last night was the gala dinner, held in a restored beerhall near Sarajevo town centre. A good time was had by all; Izet sang and ended up losing his voice, he told me this morning. I will upload some photos later, if any have come out OK.

The final keynote speaker is Silvia Miksch from Danube University Krems, Austria, talking on “Computer-Based Medical Guidelines and Protocols: Current Trends”. She is a computer scientist, and is addressing the issues from this perspective. She outlined the problem areas from a user perspective, of information overload, transfer of information and knowledge, and assessment of the quality of care. She notes that there are many different definitions of clinical guidelines and protocols, with varying views in different countries. The guidelines tend to be free text, flowcharts or algorithms – they are used with the aim of improving quality of care and consistency of care, as well as cutting down on costs.

My final bit of MIE2009 is Luis Fernandez-Luque’s presentation on “Challenges and Opportunities of Using Recommender Systems for Personalized Health Education” – related to the work he is doing for his PhD. Tailoring health information is an important aspect of medical informatics. Health education has to do with aptitudes and knowledge relating to improving health – can tailor information to the needs of the individual. Traditionally, tailored health information has been in related to specific diseases or health issues – have been 3 parts, ie gathering information on the users, knowledge of the health information available, and then giving the tailored information to the user, often via rule-based systems. Much web-based work in this area, is still based on the traditional methods. One problem now is the plethora of resources available – and it can be difficult to find good quality content.

Now moving into area of information retrieval tools – search engines or recommender systems. Three types of recommender systems – collaborative (based on gathering knowledge for similar users), content (based additionally on items as well as user information) and hybrid. Some examples of health-related systems – HealthyHarlem (community of patients who tag resources); Cancer Sites Recommender (University of Toronto); MyHealthEducator. Such systems do not rely on experts (although some input from them can help), but derive information from the users. Many recommender systems rely just on popularity of items/resources, and may be skewed due to interests of heavy users. Are no ethical guidelines governing development and use of recommender systems, and the sorts of profiling they are doing on users. Recommender systems have potential for use in health – cannot rely just of popularity as a guide, and quality control is needed. Audience question – what is the role of ‘reputation’?