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NI2009 wrap-up July 4, 2009

Posted by peterjmurray in conference, education, nursing informatics.
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NI2009 is now over; and the post-conference has just finished. We have tried a mix of blogging and twittering to cover the main event and the activities around it. We will be interested to hear from anyone about the experiences of using these tools.

While the next major international nursing informatics event will be NI2012 in Montreal, Canada (http://www.ni2012.org/) (from which we will be blogging, twittering, and experimenting with whatever other new tools have come along by then), we will be blogging from many other events before then. The next major event will be SINI2009 in Baltimore, Maryland, USA.

SINI2009 (http://nursing.umaryland.edu/sini/) takes place on July 22-25; Margaret, Peter and Scott will be attending. If you are on Twitter, you can search for the #sini2009 hashtag.


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.

“Combining Science and Wisdom: Bringing Evidence-Based Practice into Nursing Education” June 29, 2009

Posted by Maggie Hansen in conference, education, nursing informatics, speaker.
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“Combining Science and Wisdom: Bringing Evidence-Based Practice into Nursing Education” by “Jim Cato, Patti Abbott, and Laura Taylor presented how to use technology to incorporate evidence and wisdom to support practice. How do we translate new information and knowledge (evidence) into plans of care (practice). Johns Hopkins Univ. School of Nursing JHUSON) has created a model that improves students’ readiness. In 2005, a new paradigm of nursing education was created within JHUSON. Jim Cato works for Eclipsys, a worldwide technology company, and he met with Patti Abbott in 2004 and came up with a public private partnership (a unique academic partnership) to re-engineer nursing curriculum with clinical information technology. The goals of the partnership was to increase healthcare information technology competence of nursing graduates and to design new methods of delivering the curriculum. Patti Abbott spoke about the JHUSON program goals that include: To develop and test educational interventions for students and faculty to successfully navigate today’s technology driven healthcare. As other schools of nursing, students at JHUSON have to learn the HIS before they are able to document at the hospital as a student nurse. How are the students going to learn the technology? Of course they wanted to adhere to JHUSON’s mission statement. Students, faculty and health care technology are the building blocks. The long-term outcomes of the Eclipsys-JHUSON joint EHR programs for research, education, and patient care are: innovative research, education and patient/family care with a multi-disciplinary, multi-professional team approach. And, provision of global health care solutions that demonstrate comparative effectiveness in outcomes… Laura Taylor spoke about the four sample classes at JHUSON: principles and applications of nursing; health assessment; pediatric simulation assessment; pathophysiology and pharmacology in the Junior year. They are classes from simple to complex. The HER are used in all of these classes. The student logs in to the class on the computer and fill in the flowsheets. Faculty champions were noted by Laura too!

Afternoon plenary speaker – Dr. Charles Friedman 06.29.09 1315 – 1400 June 29, 2009

Posted by Scott Erdley in conference, health informatics, NI2009, Plenary, speaker.
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Topic is ‘The National eHealth Initiative in the United States’ for Dr. Friedman today. He was pushed up to this status due to the illness of the opening speaker. He is a US government employee but is on holiday and so none of his talk is official US policy and such. Made this disclaimer to open his speech. Opening salvo by ‘Chuck’ is a review of US health system to provide a backdrop for the rest of the presentation.

Part two of the presentation is a review of HIT, on a national health level, from 2004 – 2008 (development of the Office of National Coordinator / ONC and so forth). The process of adoption, viewed in 2004 and still viewed, needs to move through the ‘tipping point’ (whatever this is) of technology adoption to facilitate health care IT adoption. Adoption in hosptials of HIT (Jha et al. NEJM, 2009) statistics are cited illustrating little adoption of HIT in hospitals as aggregate perspective. Looking at specific applications, though, raises the rate significantly (lab/rad reporting and medication lists for example). Graphic depicting what is called ‘The Nationwide Health Information Network’ to show what this is and what is coming in the near future.

Chuck then moved to current status and support of President Obama and appointment of Dr. David Blumenthal as the National Coordinator for Health IT (author of ‘The Federal Role in Promoting Health Information Technology, Commonwealth Fund, 2009’). Outlined next is the Recovery Act and its sub-act of HITECH, which supports with increased funding of health IT adoption. This support via dollars in the US was a major change in health care. HITECH highlights are permanent ONC for national coordination, payment incentives to providers & hospitals, 6 supportive grant programs, and enhanced privacy & security provisions (aka ‘enhanced trust’). He postulates these ‘hopefully’ will enable acceleration of the HIT in the US.

Final comments by Chuck include addressing the definition of the concept ‘meaningful use’ and the process underway to define this concept. Such definition is needed as financial support is tied to this concept. He had to squeeze through, due to time, and so did discuss in-depth additional points raised during the entire presentation.

On to afternoon sessions!

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

NI’09 Opening Ceremony June 28, 2009

Posted by Scott Erdley in conference, Keynote, NI2009, nursing informatics.
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Opening ceremony & speeches under way promptly at 17:00 in the grand hall with a scheduled conclusion of 19:00 and spectacular weather outside. Attendance is not overwhelming but about what one would expect for the beginning of the conference as I look out over the audience from my back section advantage. Peter is twittering this session at @ni2009 on Twitter.

Initial speech provided by ‘stand-in’ (my apology for not including names as I missed hearing the names nor am I very good at spelling using the Finnish language) for Health Minister (who, a nurse, is out on sick leave). Speech focuses on current status of nursing in Finland as well as hopes and or anticipated future direction. ePortfolio for nurses discussed as success story for nurses throughout Finland. Various tools provided to nurses to manage career and or academic information and is used for employment advancement. eHealth in Finland is next topic. Facilitation of ehealth is via standard ‘items’ in documentation regardless of format (paper or electronic). The public is very trusting of electronic documentation, too. Central data storage is the direction of the future helps with centralizing government health services. While promising there are hurdles Finland needs to overcome (overlapping IT initiatives, control costs, electronic signatures, etc.).

Robyn Carr, current IMIA-NI president, next speaker. Various committees recognized by audience. This is her final conference in the role as president and will pass on the ‘baton’ to the incoming president. The next item, at least common to the NIs I’ve attended in the past, is performance of native music / culture, in this case Finnish folk song and dance from, I think the Sibelius group (not sure). Had I practiced with this interface I would have recorded and included the performance in this entry. Nicely performed, too, I might add – wonderful.

The next speaker is the Scientific Committee chair person, Kaija Saranto. She describes the process of the committee as well as those involved with this evaluative process along with the themes. A history of this conference provided by Kaija. She introduced the keynote speakers, Dr. Reinhold Haux & Dr. Michael Marschollek, both from Germany. The title of their speech is “Sensor-enhanced health information systems for ambient assisted living: New opportunities for nursing informatics?” Flow is outlined as demographic change, health-enabling technologies (HET), new ways of living and care and then include examples with a closing of new opportunities for nursing informatics. Dr. Haux also provides a shameless plug for Medinfo2010 to be held at Cape Town, South Africa. His point regarding demographic change is the ‘aging population’ with reservations of the term ‘aging’. Several nice graphics illustrate the rise of aging and decline in the care givers (health & non-health care persons). Next topic is health-enabling technologies (p-health). Primarily reference is sensors, their use, and ability to interact with health systems within a home environment. Several considerations of use outlined included cost of the technology to the user, specifically in Germany. Opportunities for such HET include increasing life expectancy as well as quality of life (these points sound very similar to points raised during a post-conference meeting after NI2006). He stresses also the need for interdisciplinary research involving all providers and caregivers. A nice reference list, for their work, is provided in the presentation. I believe if one is interested in this list Dr. Haux would be more than willing to email the list to those who contact him about it.

The graphic titled ‘double circle’ is provided as depicted in Informatics for Health and Social Care (2008); 33, pp. 77 – 89. I can’t do justice to this graphic so feel free to look it up. He uses this to depict new opportunities for health care. Next is examples provided by his colleague, Dr. Michael Marschollek. His sensor he includes real-time display of his ecg with triaxial accelerometer (motion sensor) under real-life conditions, recording daily physiological stresses. Very interesting project and results presented. A search of Google Scholar on Dr. Michael Marschollek provided additional published results of this research. Dr. Marschollek then moved into the ‘smart home’ concept and use of this technology in this sort of environment. One use is to help detect and or prevent falls. Another possibility is patient feedback with sensors to help patients’ manage their own health. Dr. Haux provides the concluding comments of the presentation including opportunities for ni. NI should be a leader in this sort of research and efforts; knowledge shared via many ways including conferences; ni education should include HET. He closed with shameless plug for Medinfo2010.

Dr. Anneli Ensio provided some housekeeping announcements. Keynote for tomorrow morning has changed, d/t health issue, to Dr. David Bates followed by Dr. Charles Friedman in the afternoon. Rosemary Kennedy final speaker, duly noted to be listed by Healthcare Management as one of the 25 most influential women in health care in the USA. Now off to the Wintergarten Room for the opening reception. Done for now!

From Helsinki; 25 June June 25, 2009

Posted by peterjmurray in conference, Europe, NI2009, nursing informatics.
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I arrived in Helsinki for NI2009 (www.ni2009.org) yesterday. As we had to cancel our Friday tutorial due to ow numbers regsitered for it, have a little more free time than anticipated. I decided to do some of the touristy bit this morning; so, after wandering down from my hotel, past the city centre, to the south harbour, I did the 1.5 hour cruise round the harbour and islands. A very nice morning, sunny weather, lots to see. My first set of photos (some still to be captioned) are at http://picasaweb.google.com/peterjmurray/HelsinkiJune2009

Blogging NI2009 June 11, 2009

Posted by peterjmurray in conference, IMIA, krew, nursing informatics.
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We will be blogging the NI2009 nursing informatics congress, to be held in Helsinki, Finland on 28 – 01 July, 2009 (www.ni2009.org). This 10th International Congress in Nursing Informatics is hosted by the Finnish Nurses Association and is organised under the auspices of IMIA-NI, the Special Interest Group on Nursing Informatics of the International Medical Informatics Association (www.imiani.org).

Karl, Margaret, Peter and Scott will all be in Helsinki, as will our colleague Ulrich. We hope to provide plenty of posts about the event. You can also follow on Twitter – either the @ni2009 feed, or search Twitter for hashtag #ni2009 in tweets from @peterjmurray, @ulrichs, @m2hansen and others.

For those unable to attend, there is also a Facebook event where you can follow the event if people find time to add materials there. We will add links to other people who are providing reports and opportunities to interact if you let us know – email hi.blogs[at]gmail.com