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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.


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

Session 6F ‘Virtual Reality’ SINI09 07.24.09 Friday July 24, 2009

Posted by Scott Erdley in conference, education, future, health informatics, SINI2009, speaker.
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John Miller, MN, RN and Cathy Walker, titled “Nursing Education in 3D: Leveraging Virtual Worlds and Immersive Learning Simulations”. Using 2 screens and projectors to demo SecondLife (SL). Slides at MUVers.org and at Slideshare.com as well as SINI site for this conference as well. IMG_0157 Well attended with some 25 or so people in attendance. To emphasize and show better on screen the session is run with room lights off. They have created an ‘OS’ so medical equipment interacts within SL, records to off-world website, and so forth. Presentation is very verbal and demo-like to show how used and what it is all about.

Some events are scripted or the instructor can adjust as needed during the scenario. Also able to see thought / decision-making processes of student, instructor, or both if this is something desired. Interesting environment for students to experience such as monitor, drugs (administration), reading physician orders, IV pumps, and so forth. There is also a bit of ‘selling’ here by the presenters about their corporation and services for hospital institutions. Question about research but there is no research ’cause they have no time (she is part of 3 companies; he is involved with full-time teaching along with collaborating other companies). A person recommended is Stephanie Stewart (formerly of UofW, Oshkosh). Otherwise very interactive with rolling ‘Q&A’ between audience and presenters. Nicely done. See YouTube clip, too, for a demonstration >>>

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

OP331 NI2009 Teaching methodology 2 (1030-1215) July 1, 2009

Posted by Scott Erdley in conference, education, health informatics, NI2009, speaker.
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Sorry, folks, late arrival from panel presentation with Peter. Only arrived late for 2nd presentation (obviously missed first one). 3rd presentation is “Educating a Health Terminologist” by J. Warren. She demonstrates terminology tools educators can use; basic session to inform participants and update them so ‘they’ may have a basic understanding of the role of health terminologist, responsibilities and then help educate others about this role. Some very nice graphic slides to help understanding available in her presentation.

4th presenter – T. Indergaard (Finland) “Counseling of problem-based learning (PBL) groups through videoconferencing”. Discusses project and advice for those pursuing videoconferencing solutions.

Final presenter is J. Brixey “Creating experiential learning activities using Web 2.0 tools and technologies: a case study.” Stressing the social need of connecting with others (see Siemen’s principles of connectivism). Making such connections possible with Web 2.0 tools / platform; ‘at/ap/ac’ if-you-will (anytime/anyplace/anywhere) – aka ‘cloud computing’. Describes project at Kansas University of using 2.0 tools / technologies for facilitation of learning experiences (such as conference attending and so forth). Nice list of social software toolkit application inclusion criteria on her slide (easy to dl/install to easy navigation to user interaction encouragement; about 10 items in all). Use of MSN Live Messenger dictated by desire for concurrent communication between students and faculty. Wide range of 2.0 tools used including SL. Activities within SL range from ppt evaluations to interactive socializations. Nicely done! Off to lunch then perhaps one of the 3 final sessions (start at 1315 through 1415). Final ceremony is from 1415 – 1600. I will not be blogging the closing ceremony because one of the closing speakers requires the use of my Mac computer for her presentation. Later!

Keynote Lecture Tuesday 06.30.09 (0830 – 0915) June 30, 2009

Posted by Scott Erdley in conference, education, health informatics, Keynote, NI2009, nursing informatics, speaker.
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Dr. Helena Leino-Kilpi, PhD, RN, titled “Ethics & nursing informatics – a multilevel perspective”. I am also trying to twitter the keynote concurrent with entries to this blog.

Nursing is human action (stress importance of values). Reviewed importance / current status of ethics in many health areas (health policies, patient rights, advances in tech solutions, public discussion as well as research results in nursing). Levels range of value base of individual nurse to value base of nursing to organization(s) to society (levels I – IV). Ethical problem defined as a value-based problem, no single solution, longstanding & need to separate from other problems (clinical, organizational, financial, and so forth). Importance of individual / professional nurse as individual in ethics of nurse & technologies / informatics. How do I use technology, how do I communicate, as well as attitude / approach to technology / informatics. Levels of ethical problems within all of these areas / questions. Leino-Kilpi’s review of literature lead her to note there is not definition of ethics or ethics competencies documented in NI literature. These are in all Level I.

Nursing as profession, Level II, ethical codes are somewhat present in the attitude, approach to technology/informatics but not in the other 2 areas (use of technology/informatics and communication about technology/informatics). Technology improves the realizaation of ethical principles of nursing care.  Level III organization level (administrator level), re: communication about, involves administration, leadership & management (Curtin L 2005. Ethics in informatics: The intersection of nursing, ethics and information technoology. Nursing Administration – didn’t get rest of cite). Technology impvoes the realization of ethical decision-making. She continues here review of all levels and details related to ethics in this arena.

Ethics & Health Technology Assessment (HTA); since 1970’s (Banta 2004); no clear focus (vander Wilt et al 2000); and more explicity in geeral technology assessment (TA, Hennen 2004). HTA definition from HTA Glosary 2006 is used by Leino-Kilpi in this presentation. HTA & ethics – importance -> implementation of HT may have moral consequenses, carries values & may challenge prevalent moral principles of society & HTA enterprise is value-laden. Ethcial questions in HTA/issues r/t define concepts, diagnostic procedures, preventive strategies, resesarch & resource allocation; all are ethical questions.

Two types of ethical anaylsis using HTA: ethics OF HTA and ethics IN HTA. Future research in this field is importance of ethical analysis and technology itself does not have any values, users / designers, though, do (citation: Bakken, S. (2008). A nursing informatics research agenda for 2008 – 2028: Contextual influences and key componentts. Nursing outlook, 55, 5, 206-214.).

Interesting presentation.

Session OP143 – Teaching Methodology 1 (1400 – 1530) HALL 102 June 29, 2009

Posted by Scott Erdley in conference, education, NI2009, nursing informatics, speaker.
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Late start due to close finish of opening afternoon plenary. Plus the opening speaker at this session, Patricia Dykes, has a 2nd presentation right after her opening survey in this session. Her session “Validation of the Impact of Health Informaiton Technology (I-HIT) Scale: An international collaborative” reports on moving the HIMSS impact of HIT scale into the international community. I-HIT 29 item scale with 4 subscales. Overview of international validation process provided by Dykes. It is troubling to me we (nursing informatics), as a profession, still conducting survey research of attitudes. We (aka NI) began research of / in NI using survey research of attitudes and perceptions. Now we use the web versus using hardcopy snail collection format but otherwise still pretty much the same (sigh). Time marches on . . .Patty now leaving and will return for Q&A at end of this session.

Amy Barton next, presentation titled ‘Informatics Curriculum integration for quality and safety education for nurses’ as part of the QSEN initiative, a national US effort. It is funded by RWJ / Robert Wood Johnson foundation. 6 competencies outlined of patient-centered care to teamwork & collabration through informatics. Additional initiatives include TIGER, revised AACN Essentials of Baccalaurate of Nursing Education, and NLN position statement. Colorado trying to insert a curricular thread for nursing education; make it relevant to all involved (AD, BS, etc.) programs. KSA are three sub-content related to all 6 competencies (knowledge, skills and attitudes). She continues to outline distinct, for each, KSA’s at different levels of education at beginning and intermediate phases. There are no ‘advanced’ phase or phases, though. Implications of findings include informatics content learned largely via course assignments & readings (partnered with McKesson for system to be used in lab), creation of new learning activities (see QSEN website) and creation of instructor toolkit. Created professional learning lab (wear clinical scrubs, cis for use, etc.) for students throughout their education. Q&As at this point to Amy & Diane Skiba.

Shwu-Fen Chiu and colleagues titled “Development of an Incident Event reporting System for Nursing students” is next up at this session. Begins with review of current practice – aka oral and or paper reporting processes. Both forms tend to encourage under-reporting of incidents. A web-based system for reporting incidents was employed in this study. Results indicate students seem to like the system. There is also a distinct faculty review view of the student system; faculty can annotate and comments automatically linked or entered into student academic record. Assessed on 4 items of number of events, time faculty rec’d notice, time of report by student, and when the entire process was completed. I suspect the marked improvement of reporting of incidents by students is due to the ability to enter incident without immediate retribution by staff and or faculty person. Not sure if my ‘hunch’ is correct, though – ymmv.

Last presenter is Diane Skiba titled “Using social software to transform informatics education”. Background informatin of UCD program provided by Diane. Of note is it is entirely online having begun in 1997. Also houses the i-Collaboratory, which now uses webinars, wikis, and so forth. Students need to use these tools (social networks) as patients become more adept and comfortable with using these tools themselves. They use Ning to create a social network (healthcareinformatics.ning.com). Ran through a large number of screen shots of their ‘Ning’ site at this point. Other tools of social bookmarking include bookmarking of URLS and such (via twine, CiteUlike, del.icio.us, etc.). Nicely done!

Session OP124 – Patient Preferences (0945 – 1145) Monday 06.29.09 June 29, 2009

Posted by Scott Erdley in conference, education, health informatics, patient safety, speaker.
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I’m blogging this session because Margaret Hansen, good friend and colleague, is the last presenter in this session. Also I am interested in this topic to a degree. I hope to attend other sessions later in the day and blog these as the opportunity presents.

The opening presenter (R. Helleso) discusses the work of her and her colleagues in Norway, titled “Severity of illness – implication for information management by patients”. Patients in this study are chronic heart insufficiency NYHA 3 or 4 classification requiring post-hospital care after d/c home. A qualitative approach was used in this study. Sub-themes of system of information were how information given, when and what information the patient received. Process of information had two categories are as follows: what patient did with information (who got/received ‘it’) and patient comprehension of information (dependent on personal attributes such as recall, memory function, and so forth). Patient information management process had sub-themes of different strategies (why wanted information) and role of the next of kin (helped patient manage information such as script filling, as well as how much the kin would do with information). Summation thoughts included information not sufficient, timely or appropriate for patients; ‘fuzzy’ role of nurses in the information process role; patient compensates for lack of information exchange between providers (interesting conclusion). There is a need for customizing information, involving next of kin in a systematic fashion, balance information strategy & need for autonomy and bridge info gap in health care.

Second speaker is J. Bichel-Findlay and colleagues from Australia presenting “Health information systems and imrpoved patient outcomes: Do nurses see the connection?” Another research study presented to the audience. Focused on emergency department (ED, ER, etc.) environment. Nurses needs in this environment include lack of agreement and std’d language and diverse needs of information management. Describes environment in NWS health (location in Australia where study took place) – many many patients, large number of EDs, and so forth. No metrics regarding documentation and so forth. Used tool to measure how EDIS as tool is better or worse (pro’s and con’s) via opposite phrased statements in survey. Significant results highest level of education, most positive, were postgraduates in several areas as experience (middle range of 5-8 years). Appears to be a shift in nurses views of technology from negative to tolerance (from literature review). Conclusions include perception of EDIS and organizational performance of staffing rtion increasing and work resturing, but no perception of data ownership, data value impact on patient outcomes nor the bigger picture of EDIS in technology and health. Most postive respondents were 20-34 with 5-8 yrs and post-graduate and 35 order and such were not. Author’s contact email is jenbic@tpg.com.au.

Third presenter is S. Tsuru and colleagues from Japan, titled “Structuring clinical nursing knowledge using PCAPS: patient condition adaptive path system”. PCAPS is a tool to visualize clinical/nursing information / knowledge. Very graphical / quantified sort of model involving high level of graphics to depict flow and so forth. Very much a systems approach to visualize and structure clinical processes. Currently addresses over 19 topics and 113 areas. Ischemeic heard disease visualized via root cause analysis as well as other examples of colon cancer and such. Very technical and or complex approach to a complex problem.

Next is V. Barnoy and colleagues from Israel, titled “Nurses attitudes towards the informed patient”. Focus of research is on patient and not nurse as previous presenters offered during this session. Previous research in this area on providers (physicians and nurses) and so study wanted to look at the ‘power shift’ to patients. Most of shift related to, at least anecdotally, the growth of the web. Study wanted to know nurses attitudes towards savvy-patients (knowledgeable patients). Factors possibly impacting attitude of nurses might include professional esteem, prior exposure to patients preferring net available med information as well as ‘net self-efficacy’ of the nurses. Only presenting on these 3 items here. Scales used to ‘measure’ attitudes of study participants. Prior exposure connected to more positive attitudes towards the internet; the number of encounters made no difference on this, indicating quality of experience (aka ‘1st experience’) importance. Professional exteem & attitudes does not seem to intimidate the nurse regarding such patients. More use of internet associated with more positive use and less intimidation perceived by nurses using the ‘net. Age negatively correlated, which might be expected. Conclusions include the 1st impression of the patient with the nurse had consequences and or long-range retention by the nurse about the patient. Published in Nursing Outlook, 56:31, 2008, too. Q&A with audience for about 5 minutes followed the presentation.

Closing out the list is M. Hansen and colleagues from the US, titles “The potential of 3-D virtual worlds in professional nursing education”. I admit a vested interest in this study as I am one of the co-authors. She’s providing a ‘brief’ overview of the use of virtual worlds in nursing education. Not sure of this but think the presentation is also available on SlideShare (http://www.slideshare.com) and search on ‘Margaret Hansen’. Examples include work of John Miller at Tacoma, Washington, US, Juliana Brixey at Kansas University (KUMC Center for Healthcare Informatics), SecondLife project at University of Wisconsin Oshkosh College of Nursing. She also includes numerous site examples. Theoretical frameworks used by Margaret include Roger’s Diffusion of Innovations and Siemens’ Connectivism Learning (not what you know but who). Q&A followed. Great presentations by all! Lunch time ;’)

Papers on ‘human computer interaction’ June 29, 2009

Posted by peterjmurray in conference, Europe, future, NI2009, nursing informatics.
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Kathy Dallest, from Scotland spoke on ‘The online managed knowledge network that shares knowledge for ehealth in NHS Scotland’ – http://www.nmahp.scot.nhs.uk

Nurses, midwives and allied health professions are 72% of clinical workforce in Scotland – largest group who will use electronic systems to support delivery of healthcare and information management. She described the portal that has been developed to provide a managed knowledge network; the model builds on the idea of communities of practice, with communities operating across disciplinary boundaries. The project found a large diversity of roles among the staff working in ehealth; they often felt isolated, with a need/desire to share information.

The nmahp site uses topic rooms and expert searches on subject areas. Kathy also mentioned the ‘using information’ website, and international collaboration – http://www.usinginfo.org and the clinical ehealth toolkit. The MKN site is open to anyone to join.

Elina Kontio from University of Turku in Finland spoke on ‘Key elements of successful care process of patients with heart symptoms in an emergency care – would an ERP system help?’ She says healthcare has been slow to use process-oriented systems for decision making. The research she described has looked at identifying the key elements of care processes of patients with acute heart problems; used a critical incident technique to collect data on the nurses’ roles and interactions with patients, with a sample of 50 nurses across 3 hospitals in southern Finland. The study developed recommendations on development and use of enterprise planning systems to provide alerts, decision support etc. in care continuum.

Debra Wolf presented on ‘Nurses using futuristic technology in today’s healthcare setting’. She talked about voice-assisted technology to do point of care documentation in a community hospital in USA. The system is wireless and used for charting, reminders and prioritising tasks. The system comprises a wearable computer and headset, speech recognition engine and software to send and receive patient orders and to do real-time documentation using speech-to-text. The system has reduced documentation time (by up to75% – but also found little diffrence in completeness of the documentation) and to provide proactive reminders about issues (such as fall risk) pertinent to individual patients. It has improved adherenece to policies and so enhanced quality of care. The pilot study found there was reduction in potential for infection, as nurses only touch one device once a day, as opposed to mutliple touches with other computer systems (eg mouse, keyboard, etc).


IMIA Education WG – updating IMIA recommendations October 30, 2008

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In the final session, John Mantas from Greece, Co-chair of the IMIA Education WG, presented ‘New Recommendations of the International Medical Informatics Association (IMIA) on Education in Health and Medical Informatics’. He reported to results of the work that the IMIA taskforce has been undertaking over the past year to revise and update the IMIA recommendations, which were first published in 1999. He explained that as a result of development of a new knowledge core, and the development of new domains, environments and requirements, it has been necessary to update the recommendations. The revised document will shortly be sent out to WG members and to IMIA Academic members to invite comment.

John says that, despite the documented benefits of heath informatics, there is still a need for education, and there remain many issues over the precise name and description of the domain, the nature of the boundaries with other disciplines, and issues around certification, and recognition of the profession, among others. The revision of the recommendations is also needed due to the development of the IMIA Strategic Plan, and the focus it has on education and knowledge. The revised recommendations, as the previous version, are intended to act as framework and guide to the development of health and medical informatics education programmes, courses etc at various levels of education and for a variety of professionals, including health informatics specialists and healthcare professionals who need varying levels of skills and knowledge in informatics.