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Rutgers 30th Conference – Final Round-up, Part 2 May 7, 2012

Posted by peterjmurray in conference, education, nursing informatics, USA.
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Among presentations at the final day and a half of the Rutgers College of Nursing’s Thirtieth Annual International Interprofessional Technology Conference, in New Brunswick, New Jersey:

Debra Wolf explored the role of the informatics nurse, while Bonnie Anton built on her overview and noted that the role is becoming increasingly patient-focused, with new competencies needed in supporting the delivery of health information for consumers; these include issues of information literacy and health literacy. Bonnie also addressed the role of social media, as communications tools, for user-generated, collaboration activities, and enabling patients and others to find ‘people like me’, although raised issues of “is it safe?” She raised the need to include the patient as an active member of the healthcare team, and aspects of Health 2.0 and educational guidelines re:social media use were introduced.

Dennis Crain explored the proliferation of private data on the internet (‘digital exhaust’) that can be collected, mined, and used for personalised targeting of products. Greg Alexander focused on ageing populations, and how advances in science, medicine etc have lead to reductions in mortality, leading into an exploration of monitoring devices and systems for home care. Bernie Garrett (University of British Columbia) explored “Using Web 2.0 tools to globalise the curriculum”, and discussed the International Science Education Partnerships Project (Canada-UK links), a pilot project to establish the potential of freely available social networking tools to support educational international partnerships. The project generated discussion on the value of philosophical perspectives, and evaluated the potential of using tools
(more information at http://www.plymouth.ac.uk/staff/rcutting). Evaluation of the project was done with surveys/questionnaires and online focus groups (plus Google Analytics).

In the closing keynote, Marion Ball explored a wide range of issues around using smarter technology to improve health globally. Among here messages, she raised questions of “are we asking the right questions?” and whether the workload for clinicians has been increased through use of IT, rather than reducing it. She covered a wide range of topics including TIGER, IBM’s Watson, and other developments.

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Looking for the MIE2011 Blog? August 10, 2011

Posted by peterjmurray in conference, EFMI, Europe.
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UPDATED, 23 August 2011:

For the MIE2011 blog, please go to http://mie2011blog.wordpress.com – Thanks to Karl Oyri for setting up this blog for the MIE2011 conference and related activities.

SINI2010 over – on to 2011 July 25, 2010

Posted by peterjmurray in conference, nursing informatics, SINI2010, Uncategorized, USA.
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A successful SINI2010 is over. Once again, over 400 nurse informaticians gathered to learn, discuss and network, exploring the important issues of the day. As ever, the event was well organised by the local team and SPC – and the newly opened Southern Management Corporation Campus Center (SMC), linked to the School of Nursing building, is definitely a bonus in terms of space and facilities.

Next year will see the 21st SINI – SINI2011. It will be held on July 20-23, 2011, with pre-conferences on July 18-20. Keep an eye on nursing.umaryland.edu/sini for more information.

SINI2010 – final morning sessions July 24, 2010

Posted by peterjmurray in conference, education, nursing informatics, SINI2010, USA.
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The first distinguished lecture this morning is from Marilyn Chow, Vice President, Patient Care Services at Kaiser Permanente, and Murielle S. Beene, Chief Nursing Informatics Officer at Department of Veterans Affairs, and titled “Where’s the Quality in EHRs? A Collaborative Model to Promote Data Sharing and Quality Reporting”. Their talk will aim to describe how nursing leaders can have a transformative role in influencing EHR-related decisions that improve clinical effectiveness, efficiency, patient safety, and the delivery of quality-based patient care; define an emerging information model related to pressure ulcer risk that standardizes and informs nursing practice and reflects real-time clinical decision-making; and demonstrate the usefulness of common information models and reference terminologies to achieve semantic interoperability across different technology platforms.

Marilyn began by talking about her vision of being able to exchange information between the Kaiser Permanente (KP) and VA systems. KP is the US’s largest no-profit health plan, with 8.7 million members and over 40,000 nurses, while VA covers 7.8 million enrollees and 70,000 nurses. VistA, the VA system has been recognised as a world-leader for over 20 years.

The speakers summarise ‘meaningful use’ as being about financial incentives and penalties designed to support the adoption of EHRs, with the goal of linking healthcare resource use to patient outcomes. The vision is to derive quality measures directly from EHRs, improve care coordination with electronic exchange of health information, share baseline patient data across settings, and enhance clinical decision making. They went on to explore the implications of meaningful use for nurses, which include:

  • identify structures and content that would meet U. S. meaningful use criteria for a quality measure;
  • facilitate data portability between software applications and between organizations;
  • improve the ability to aggregate outcome data for research, comparison, quality and process improvement; and
  • promote nursing participation in standards development.

Currently, they say, valuable patient information is “locked” within an organization’s EHR, and data is often tightly bound to proprietary data models, which causes current and future potential problems.

The collaborative goals of work between KP and VA include defining a common Information Model driven by nursing practice that enables data capture, data re-use, and data sharing within and outside organizations. Also, they aim to facilitate the measurement and extraction of data for meaningful EHR use specific to the delivery of nursing care to support quality, safety, efficiency and clinical decision support. Nursing documentation represents a large part of the content of EHRs and therefore there is a need for nurse-lead initiatives.

They described a ‘replicable process’ for the development of the information model and data sets, and the use case scenarios, and determining the meaningful data capture, though:

1. Evaluate the Evidence
2. Leverage Clinical Expertise
3. Develop Optimum Data Sets
4. Information Harmonization – Identify the Gaps
5. Map to Reference Terminologies
6. Develop Practice-driven Information Models
7. Validate the Models

The presentation concluded by reporting that, although the work was just beginning, already made some significant progress had been made through a collaboration between the largest public and the largest private healthcare organizations on developing a nursing information model. They hope that the work promises to have an direct impact on both patient care activities and the future direction of nursing informatics within KP and the VA. They closed with a ‘call for action’ to demand the inclusion of nurse sensitive measures in the 2013 Meaningful Use criteria, and claim that the project demonstrates that the data for nursing sensitive measures can be “unlocked” from the EHR and used directly for quality reporting.

SINI2010 – social catch-up July 24, 2010

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

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

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

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

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.

Covering SINI2010, Baltimore July 17, 2010

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SINI is here again – where does the time go?

SINI2010 is the 20th (Anniversary) Annual Summer Institute in Nursing Informatics, organised by and delivered at the University of Maryland School of Nursing – Baltimore. This year’s theme is “Nursing Informatics: From First Use to Meaningful Use”, and the main conference is July 21-24, with pre-conference tutorials on July 19-21. Full information is at http://nursing.umaryland.edu/sini/ with the schedule at http://nursing.umaryland.edu/sini/schedule/index.htm

The traditional CARING dinner (or ANIA-CARING dinner as it is now) will be taking place (http://www.ania-caring.org) at  Chiapparelli’s Restaurant, and there will be other social events.

Twitter stream from @peterjmurray will cover the event (use hashtag #sini2010 to search Twitter). If anyone else will be blogging or tweeting, please let us know.

MIE2009, Sarajevo – arrivals August 29, 2009

Posted by peterjmurray in conference, EFMI, Europe, health informatics.
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Well, here I am, safely ensconced in the Holiday Inn, Sarajevo in Bosnia and Herzegovina for the MIE2009 (www.mie2009.org) conference. It looks like being another hot and humid day here. After a long day of travel yesterday, including a 5 hours wait between planes at Munich airport, finally got here last night. The pick-up arrangements were excellent (many thanks to Promo Tours for their excellent work – http://www.promotours.ba/), and so it was a quick trip from Sarajevo airport to the hotel.

The EFMI (www.efmi.org) Council meets all day today (after the EFMI Board meeting yesterday) – those of us here already and not involved will be taking the opportunity for tourism today and tomorrow. I have never been to Sarajevo before, so I am looking forward to seeing some of it – will post photos later.

Various other people will be reporting from MIE2009 (mainly tweeting, I think) – so, watch out for @CiscoGIII, @luisluque, @omowizard – or search Twitter with #MIE09

OK, enough sitting in the hotel over a laptop – off to see the sights.

UPDATE, 17:15hrs – after a wander round the old town, lunch (cevapi with onions – http://en.wikipedia.org/wiki/%C4%86evap%C4%8Di%C4%87i), turkish coffee and lemonade, and conference registration, we had a beer and chat with Ed Hammond at the conference hotel.

Some photos area at http://picasaweb.google.com/peterjmurray/MIE2009Sarajevo where more will be added later. Now the hard choices – where to have dinner; there seem to be plenty of choices.

Last day of SINI2009 – Saturday 07.25.09 Morning Keynote July 25, 2009

Posted by Scott Erdley in conference, education, Keynote, nursing informatics, SINI2009.
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This is my last entry for the conference, readers. Had a great time. I have to catch a flight back to home base (Buffalo, NY) and with the weather such as it is these past few days (traditional Baltimore – h3 (hzy, hot & humid)) as well as in Buffalo (humid & stormy) there’s a chance I’ll be parked at BWI for a while. There’s also a chance I won’t. Either way, given transit time to the airport via the Lightrail, I will be departing for BWI at 10am local (end of opening presentation, too).

Introduction is provided by local STTI chapter president because this chapter, in honor of 50 years of service, is sponsoring Dr. Staggers’ presentation. Opening keynote is Nancy Staggers, PhD, RN, FAAN, Professor & Director for Nursing Informatics, University of Utah College of Nursing. Title of her presentation is “Optimizing the usability of clinical systems: Past work and future directions”. Start time is a little behind normal most likely due to this being the last day of the conference and participants are a bit tardy arriving for the morning food before the session. Nothing unusual here with this, to be honest. Good attendance in spite of the last day of the conference. Discussion will cover usability, synthesis of usability research, future directions and then example (from her research).

Usability deals with solutions, context/environment, and specific goals. Related to human facotrs, ergonomics, HCI and usability (demonstrated via a modified Venn-type diagram. Talks about usability and cpoe in health care practice (Leapfrog Group cited). Reviews systems penetration due to ARRA $’s and Brailler’s (09) talk about need for specialist. DaVinci surgical system cited as tech example. Continuum of info & tech in nursing practice is depicted related to Essentials of Baccalaurate Education (AACN). Need for usability of phr’s, too, reviewed. Also provides a review of past usability research with her doctoral student, Greg Alexander. Search was extensive with exclusion criteria outlined. The process is described in detail from beginning to end. Bottom line, out of more than 11,000 citations, only 34 relevant articles (with 50 studies). Organized into effectiveness, efficiency and satisfaction. A lot to do with information searching, potential error with device designs (e.g.: IV pumps), and so forth. Satisfaction results indicate users want knowledge worth of mention (dense screens, graphic designs, etc.), heuristic evals of devices, remedy the no apparent rationale for selecting products to evaluate. Future directions include expansion of types of devices to study (Only 2 IV pums, PCAs and 1 EHR studied), settings & participants, integrated displays and the type of study outcome variables. Need to examine cognitive burden workflows, need for national db for study results, and, EHR comparative studies re: usability. Additional future directions include administration, education & research areas, look at actual clinical settings (vs. simulated labs), and study interdisciplinary teams. Now she launches into her work on change-of-shift report as example of the issues encountered during this literature review. Employed a variety of methods of research (observation, audio-taped with qualitative analysis after transcription). Results of this study are part of this example discussion. 4 themes are ‘the dance of report (largest percentage), just the facts, professional nursing practice and lightening the load’. Professional practice involved actions, reasoned judgments, care decisions, problem-solving, and such. Context of report issues included noise level, interruptions, patient loads, and report from 2-3 separate nurses. Overall discussion includes issues of ‘speed bumps’, high level of jargon, no report structure and ehr not any part of shift report.  Nicely done.

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).