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Presentation SINI2009 07.24.09 Session 5A July 24, 2009

Posted by Scott Erdley in conference, health informatics, nursing informatics, SINI2009, speaker.
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Presentation is recipient of practice award from SINI (see @m2hansen for tweets of this session). About 50 attendees in the main lecture hall, which also means this is webcast. Title is “Leveraging technology for nursing handoffs” presenters are from Northwestern Memorial Hospital. Authors are Stephanie Kitt, MSN, RN, Marilyn Szekendi, PhD, RN, and Kathleen Linn BSN, RN. Northwestern Memorial is a magnet hospital with over 900 beds total. Organization is reported to be about 99% digital / emr throughout. Provides background information regarding the need for nursing handoffs and impact on patient care and safety (aka ‘communication’). Effective handoff elements include f2f verbal with verbal report + hardcopy summary; current/up-to-date info, predictable / stable presentation format, minimal interruptions of report & unambiguous transfer of responsibility (cited from Patterson ES et al 2004 study; difficult to read so more not included). Cites 2 studies of handoff failures (Arora V. et al (2005) and McCann, L. et al (2007). Primary cause of failure was communication. Overall key factors of failure outlined (failure of communication primary).

NMH uses SBAR format (paper-based). Second presenter reviews what SBAR is and the actual paper-based form used by the organization. Stands for Situation-Background-Assessment-Recommendation. Deployment was piloted in medicine, surgery, oncology to one unit in each of these areas for 6 months. Implemented in med/surg and oncology units; training consisted of job aide document; train the trainer & coaching support available at change of shift. Described the deployment of this during the workflow process, which also includes prioritization of ‘next-to-go’ areas. During these processes the organization also underwent a model of care change (this tool reported to facilitate / aid the care change). These presenters did follow-up research of this implementation. Overall the shift report decreased to a 5-15 minute timeframe versus longer reports (still individualized based on patient and nurse). Suggestions by nurses to improve the report process included more specificity but at the same time more freespace; more accurate information (get rid of old information); viewable online to eliminate use of dead trees, and, get all units onboard with SBAR. Lessons learned is e-report format is preferable but not a panacea; stakeholder lead is imperative and nurse involvement is key! Nice presentation. Completed early so long time for Q&A session (about 15 minutes).


Friday Opening Keynote Session SINI 2009 07.24.09 July 24, 2009

Posted by Scott Erdley in conference, education, Keynote, nursing informatics, patient safety, SINI2009, speaker.
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Paut Tang, MD, Palo Alto Medical Foundation, titled “Personalizing Health Care: Creating a Patient’s Health Home”. For missing pieces of this blog please consult Peter Murray (@peterjmurray) and or Margaret Hansen (@m2hansen) tweets. Interactive presenter with good audience appeal. Not medical home but health home. Defining health via proverbs and personal anecdotes. Outline of presentation is traditional health care, a definition of phr, personalizing and then creating a patient’s ‘health home’. Draws from ION 2001 ‘Chasm’ report for definition of health. Jim Collins, “Good to Great” book referenced, needs to focus on ‘who, then what?’ ’cause ‘who’ will take ‘you’ to ‘what’. How to support patient & family? So, turn to patients first. Derive a phr definition based on patient perspectives is next goal. Draws from his past research using patient focus groups as well as newer work / studies by organizations such as the Markle Foundation. Privacy is a very common and strong concern by those who participated in research studies. Utilizes example, which is included in his work flow, of patient & provider communication and information exchange. Neat part is captured into medical record, shared, of all communications between these 2 parties. Online survey yearly of patients and their use of this systems (PAMF – forgot what is stands for – sorry). Self efficacy is big point (test charts help visualize; lab results graphic; ‘score card’ is in front, and so forth). It is a report card for the patient, which changes lives. Online reminders enhance adherence to health maintenance guidelines (4-fold increase in breast mammography testing due to such reminders).

Paul Tang presenting at SINI2009

Paul Tang presenting at SINI2009

Traditional disease management is protocol driven (aka – you got the disease, we got the treatment [and sometimes the same for all, too]). Asked patients, in this study, about support structure perceived by the patients / study participants. Describes chronic care model as also indicative of health care overall. To be patient centered start with (my) risk profile, then (my) disease condition and finally (my) agenda. In this diabetic study report, they created diabetes dashboard for patients. Diabetes, for example, becomes much more self management versus traditional paper-based with time disadvantage. Online allows more timely review and behavioral changes by patient and provider along with eliminating paper (also provides longitudinal view / trending to help communicate and or change behavior). A follow-up clinical trial is now planned for 400 diabetic patients (200 intervention & 200 control). Conclusions include phr/ehr integration as optimal approach. Very very personable speaker and very well received by audience. Q&A session followed.

Morning Keynote NI2009 07.01.09 (0800-0845) July 1, 2009

Posted by Scott Erdley in conference, health informatics, IMIA, Keynote, NI2009, nursing informatics, speaker.
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Evelyn Hovenga titled “Milestones of the IMIA-NI History and Future”. As this is closing day, as well as the session moved up 1/2 hour, the number of attendees is a bit sparse. Evelyn’s presenting style is to expound on the slide content. Opening setting reviewed is ‘having a vision’ begun in 1987 in Stockholm – nursing competencies. Key activities cited include reference term model, with ICN, begun in ’99 among others. Key facets of ’09 vision of IMIA-NI include EHR (using & informing nursing knowledge), clinical data standards dev’t, decision support & ebc options among others. Reviewed what IMIA-NI promotes (I’m guessing what she showed is from the website (http://www.imiani.org/). She discusses a national e-health record using a graphic (spoke-wheel design) with phr as the hub. Next up is discussion of integrated ehr (see ISO TR 20514:2002 Health Informatics – EHR Scope, Definition and Practice). EHR needs to be perceived as foundation of sustainable health system infrastructure, therefore requiring adoption of a set of HI standards along with comprehensive governance infrastructure. A description of ehr architecture is drawn from the open ehr foundation’s content. The bottom line is discrepancy between model (nicely structured) and proprietary systems with different reference models. Graphic of ehr structure is available at open ehr website (http://www.openehr.org/home.html). Clinical knowledge manager is next up and again seems to be also a component of the open ehr website (see ckm (clinical knowledge maanger) at site in previously mentioned link). Clinical content models, and the need for such, outlined at this point and the need for said models to relate to the structure (then dictates how data is used). Clarity is necessary for functionality – key point stressed by Evelyn.

Clinical knowledge repositories discussed with national examples cited (Singapore & Sweden with federated approach); need for repository hierarchy versus ‘flat set’ (need for interoperable for sharing via silo without sharing).  Terminology needs to be in context and should have national governance.  Future directions of IMIA-NI includes leadership for dev’t of standards of nursing clinical content knowledge. Collaboration with ICN needed to move forward with mindmaps of content, documentation of nursing processes, clinical templates (see Derek Hoy’s work in Scotland) and global nursing knowledge governance infrastructure. Other items needed to move forward range from national mtgs, recruitment of expert nurses and sharing / participating via technology and in-person. That’s all for now.

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 ;’)

Opening keynote 06.29.09 morning session – Dr. David Bates June 29, 2009

Posted by Scott Erdley in conference, health informatics, NI2009, nursing informatics, patient safety, Plenary, Uncategorized.
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Keynotes today are shifted due to severe health problems of the original speaker. So, David Bates, scheduled for later today, is the opening speaker. Dr. Charles Friedman will be the opening afternoon speaker.

David Bates’ talk is about IT & patient safety (“Improving safety & quality using HIT: Keys for nursing”). Talk will range from background to using HIT for safety, in various settings, then crossing issues and final thoughts / issues. He cites the IOM report “To Err is Human” as a primary compelling force behind current interest in patient safety & HIT. Provides a list of 10 top priorities for patient safety research in developing countries (see very recent BMJ article). Nurses impact adverse events from pressure ulcers to adverse drug events, too. He describes the US efforts and considers US to be near ‘tipping point’. LL Weed cited as to use of external aids to promote change in health care; patients could participate in decision-making (their own). Ways IT to improve safet include error prevention / adverse events to more rapid resonse after adverse event to tracking & feedback of adverse events.

Bates then outlines 7 main strategies for preventing errors & adverse events, via HIT, including improving communication to accessible knowledge to providing key information, calculation assistance, real-time ‘checks’ to monitoring assistance and finally decision support. He then cites specific examples such as CPOE to smart pumps / monitoring and so forth. A specific example / research project is titled ‘NEPHROS’, which looked at renal insufficiency patients (Chertow et al, JAMA 2001). Another specific area of patient safety is medication administration, in particular, several US major adverse events surrounding use of heparin. Some ‘easy’ solutions are BMA (bar code administration) as well smart pumps (Rothschild et al, Crit Care med 2005). Most of Bates’ discussion centered on inpatient / acute care environment. He also, though, did discuss outpatient environment, which may be termed ‘medical home’. Nice use of a Dilber cartoon to state where he believes health care is today. Future areas for NI include personal health records as well as decision support (e.g.: computer ‘think along’ with provider), interoperability, and so forth. Quality from IT and its transforming ability from ehr (poc decision support, registry tools & ‘team’ care) and measure performance; safety need to increase processes reliability (e.g. check lists, new CPOE approaches). IS helps with communication, cost holding, quality accessible, and such.

Keys for NI include tools to track risk, digital documentation (vital signs), computerized handovers / report, nursing decision support, multidisciplinary communcation, and key roles in medical home patients / outpatient settings. Sytems future possibilities range from ‘better provider cockpit’ to communcation to quality measurement and NI needs higher profile in most organizations, all leading to safer care with use of IT. Ended with Yogi Berra quote “I don’t want to make the wrong mistake.” Nice ending and nice talk. Time for Q&A at this point. One question justly asked had to do with public health disease / pandemic condition tracking and monitoring (infections, H1N1, and so forth).

Personal thought – not sure if talk content is anything startlingly new but may instead be a reminder of what NI persons can or should do regarding patient safety. Scott Erdley

Looking towards “Web 4.0” in health and nursing June 26, 2009

Posted by peterjmurray in future, krew.
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Members of the krew (Margaret, Scott, Peter, Ulrich) have had a pleasant morning strolling around Helsinki Zoo. We have been bouncing ideas around, in part due to planning for the Web 2.0 panel that Scott and I are doing later in the week, and started thinking about what might be the next stage beyond Web 2.0 and Web 3.0. Web 2.0 is already with us, and people are starting to discuss seriously what Web 3.0 might be – many people see it as the true ‘semantic web’ – but what comes after that – and what might it mean for nursing and health?

We have just done a quick Google search for Web 4.0, especially relating to health and nursing, and no-one seems to have started talking about it yet. Nova Spivack wrote an article considering the move beyonf Web 3.0 to be towards the ‘WebOS’ (but are we already seeing that with the development  of cloud computing and some of the moves within Web 2.0/3.0?); he also talked about ‘intelligent personal agents’ (http://blogs.zdnet.com/BTL/?p=4499). Is direct brain-computer interface (invasive or non-invasive) part of what Web 4.0 will be about? Is Web 4.0 related to increasingly blurred lines between ‘SL-worlds’ and the ‘real world’?

We will be batting around these ideas over the next few weeks as we work on developing a discussion/ideas paper on these issues.

Blogging HINZ from Rotorua October 15, 2008

Posted by peterjmurray in krew, New Zealand, Uncategorized.
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Chris Paton is blogging the HINZ (Health Informatics New Zealand) conference this week, from Rotorua. His posts are on the NIHI (National Institute for Health Innovation, The University of Auckland) website, and you can subscribe to the RSS feed.

The HINZ conference website contains the full programme, and Chris has links and posts from his ‘Health Informatics blog‘.