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Afternoon session 07.23.09 July 23, 2009

Posted by Scott Erdley in conference, education, health informatics, SINI2009, speaker, USA.
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Concurrent session 2, Jim Turley, titled “The impact of genomics on nursing care”. In the nether region of the School of Nursing (7th floor). Good attendance despite weather (very rainy – pouring more like it) and immediately post-lunch (about 17 so far). This is listed in the program as being at the ‘expert’ level. It is a session to generate questions and create discussion more than inform. Future and research involve genomics in health, individuals and society. Health & lifestyle facts indicate controllable variables versus genomics. So, the question, what to focus on? We understand behavior but not how to do it ‘well’ regarding behavior. How much can we txt via genomics and what might be ‘leftover’ or influenced by environment? Fair use is the discriminating question de jour.Presentation

Genomics & new conceptualization of health & illness; genomics -> study of all the genes in human genome together. . . health & disease no longer defined in terms of function (nursing assist with functional ‘things’ of patients); predictive models of intervention before loss of function; need for targeted care; blur boundary of health & chronic illness. One impact is redefinition of nursing role. Carol Bickford offered comment of nursing as a profession that’s ‘a bit conservative’ (to paraphrase). Knowledge of ‘risk state’: a non0symptomatic state after an individual or family is aware of their genetic risk. Treatments (individual, family), communication (other healthcare providers, other family members, and others). Agreement of baseline issues logically leads to traumatic re-definition of roles (for example nurses and informatics specialists) and therefore responsibilities (for example, informaticists and mathematical models of information delivery). Describes history of genetics, therapeutics and nursing. Discussion of examples include simple and not-so-simple genetic disorders. CF is an example of not-so-simple genetic disorder.

Suggests finding a gene on a chromosome map (see NCBI website). Core data site for computational genomics. SNPs is single nucleotide polymorphisms (individual A, T, G, or C). Humans are 99% identical at the level of genetic sequence. Diversity of remaining 1% variation is mostly due to SNPs. Common examploe is apoE and Alzheimer’s incidence. Also is BRCA1 & BRCA2 & breast cancer incidence and or chance thereof. SNPs we can know women at risk for breast cancer & heart disease, risk for PCN allergy, and kids with ASA trigger for asthma. Question – at what point, or when, does this sort of testing become cost effective? How does all of this impact nursing practice? Bedside technology now includes micro-array testing at POC. Given now able to own genetic testing some of the companies currently doing this are listed as examples by Jim. Questions arise, then. Intention and or quality of science, for example. 23andme (https://www.23andme.com/) and decode genetics (http://www.decode.com/) are examples. 23andme also purchased genetic code of Iceland (entire country), which are linked to the emr of Iceland, too.

Some side effects of all of this testing include the Human Genome Project Information site covering a lot of different issues as well as various articles talking about state regulation of this sort of testing (see Wired magazine) to the UK and regulation of genetic testing. Sharing will become more common (between those who can) so eventually a fair amount will be in the public domain. Postulated questions by Jim include the following:

  • How to display a genome?
  • Include in an EHR?
  • What does it MEAN?
  • What do you do while KNOWLEDGE is evolving?
  • Do companies have the right to ‘buy’ the genomic data of a country?
  • Should genomic data be available without a healthcare referral?
  • Does it, genomic data, covered by HIPAA?
  • Should genomic data be PUBLIC? (does social good out weigh privacy?)
  • Should patients be required to ‘share’ genomic data with their clinicians? (family members, insurance companies, employers/potential or actual)
  • Are we ready for a new paradigm of research (where consumers pay and companies reap)?
  • Is it truly a generational problem? (next generation & privacy)

Understanding the human genome project dvd is a nice information resource on many of these issues. See site >>> Excellent presentation and good Q&A with audience at end of session.

UPDATE – a video from Eric Rivedal >>>


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

Covering SINI2009 July 9, 2009

Posted by peterjmurray in conference, nursing informatics, USA.
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Several of us will be attending, speaking at, and covering through blogs and tweets, the SINI2009 event in Baltimore, Maryland, USA, from approx. 21-25 July, 2009.

SINI2009 is the 19th Annual Summer Institute in Nursing Informatics, organised by and delivered at the University of Maryland School of Nursing – Baltimore. This year’s theme is “Informatics at the Point of Care: A Barrier or a Bridge?”, and the main conference is July 22-25, with pre-conference tutorials on July 20-22. Keynote and featured presenters include James J. Cimino, Paul Tang, Nancy Staggers and Suzanne Bakken.

The traditional CARING dinner will be taking place (http://www.caringonline.org/) , and there will be other social events.

Twitter streams from @peterjmurray, @m2hansen, @scotterdley will cover the event (use hashtag #sini2009 to search Twitter). If anyone else will be blogging or tweeting, please let us know.

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.

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!

IMIA-NI General Assembly meeting June 28, 2009

Posted by peterjmurray in IMIA, NI2009, nursing informatics.
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The IMIA-NI SIG (Special Interest Group on Nursing Informatics – www.imiani.org) General Assembly meeting is taking place on Sunday morning (28 June) at the NI2009 conference venue in Helsinki. Over 40 members are present comprising many country representatives, working group chairs, honorary members, etc. from many countries, including Slovenia, USA, Finland, UK, Japan, Canada, Germany, Norway, Australia, Switzerland, Taiwan, Sweden, Ireland, Korea, New Zealand, Brazil and The Netherlands.

Anneli Ensio, from the NI2009 Organising Committee, reported that there had been 400 submissions to the conference, and attendance is expected to be over 540 participants from 40 countries.

Patti Abbott from the NI2012 Organising Committee reported that the event will take place in Montreal, on June 23-27, 2012 (www.ni2012.org).

Robyn Carr explained a number of revisions to the IMIA-NI Strategic Plan to help focus the activities of IMIA-NI and its constituent groups over the next few years.

This is the last meeting to be chaired by Robyn Carr (New Zealand), the current chair; Heimar Marin (Brazil) takes over as chair of IMIA-NI at the end of NI2009. Elections took place for the new vice chair positions; William Goossen becomes the vice chair for working groups, Patrick Weber becomes the vice chair for communications, Hyeoun-Ae Park becomes vice chair for membership and Lucy Westbrook becomes vice chair for administration and finance.

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