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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.

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SINI2010 – day 2 July 22, 2010

Posted by peterjmurray in conference, education, nursing informatics, SINI2010.
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Thursday is day 2 of SINI2010; the first speaker is Patti Brennan, who will be starting to talk soon.

The heat and humidity doesn’t seem too bad at 7am in Baltimore – but is due to get up to over 95F later today. Thanks to the jetlag, I’ve been up since 5am. Had very nice dinner with Chris Lehmann and George Kim last night – discussing ACI Journal (www.aci-journal.org), and breakfast with Ted Shortliffe from AMIA. More meetings to come over the next few days, but will try to report on various sessions over the next few days.

At 08:30 am, we have a full auditorium for the first speaker. Patti Brennan’s talk is titled ‘Let’s Make Sure That “Meaningful Users” Includes PATIENTS!” – her key message is to ensure that patients are meaningful users if investment in IT is going to be of real benefit and support patient-centred care. She said that the original ideas around ‘meaningful use’ did not take account of PHRs (personal health records), as concepts, rather than products.

Patient-centred care, Patti says, is where the patient is, not where the provider is – so, it is everywhere. She began by showing a video about the My-medi-health project (http://www.projecthealthdesign.org/projects/overview-2006_2008/405594), which shows ways in which mobile communications tools can support self-care. People, Patti says, manage their health every day, not from clinical episode to episode, and so ‘observations in daily living’ (ODLs), selected and reported by patients arising from their daily life,  are important feature of PHRs and need to be available to clinicians.

Patti described how groups are looking at innovative technologies and the ways in which ODLs can expand the very nature of health data (eg mobile devices, wireless sensors and bio-monitors), and explore integration into clinical workflow, and so testing what will come to be relevant in stage 3 of meaningful use (ie, thinking forward to what will be needed in 2015). Among projects are PHRS for adults with asthma and depression/anxiety, and using mobile platforms (eg iTouch) with youths with obesity and depression.

Patti went on to say that making sure that patients are also “Meaningful Users”, then health information and policies are needed that that enable the integration of patient‐defined and
patient‐generated information into clinical care; the health information needs to be accessible to patients in a computable form, and health information for patients needs to be actionable. Among the legal/regulatory challenges that still need to be addressed are:

  • Ensuring patient authorization that satisfies HIPAA
  • Minimize (realistically) the security risks associated with devices
  • Proper verification of identity
  • Secure transmission
  • Compliance with mandatory reporting and other obligations on the part of clinicians

Patti closed by summarising questions that remain, including:

  • Should data obtained in the home or created by the patient be noted as such?
  • In order of priority, which ODLS should be included in the clinical record?
  • What is needed to extend the benefits of meaningful use to others, like the VNA, social health providers, and community drug therapies

More information on projects that Patti is involved with is at www.projecthealthdesign.org and on Twitter at @PrjHealthDesign

Post-conference posting: CARING Friday Evening Dinner (07.24.09) July 26, 2009

Posted by Scott Erdley in SINI2009, social activities.
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I was not in attendance for this annual social event but there were more than a few in attendance. Here are some pictures of this very popular event held every year during SINI in Little Italy of Baltimore’s Inner Harbor (specifically Chiapparelli’s >>>. Enjoy!
IMG_0096 IMG_0106 IMG_0108

SINI2009 is over – on to SINI2010 July 25, 2009

Posted by peterjmurray in conference, nursing informatics, SINI2009, USA.
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SINI2009 is now closing, with the final raffle.

SINI2010 will take place in the usual venue (University of Maryland School of Nursing, Baltimore MD, USA) on July 21-24, 2010 (with pre-conference tutorials on 19-21 July). The theme for what will be the 20th SINI, is “Nursing informatics: from first use to meaningful use”. We hope to be there to blog and tweet the event, and play with whatever new tools may come along between now and then.

SINI2009 – final keynote, Suzanne Bakken July 25, 2009

Posted by peterjmurray in conference, Keynote, nursing informatics, SINI2009.
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Suzanne Bakken’s closing keynote address is titled “Reducing health disparities through informatics”. She began by describing the range of health disparities, including racial or ethnic differences in the quality of healthcare, differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions among specific population groups, and differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation. She asked whether informatics will be part of the solution to the problems, or whether it will result in increased disparities (eg in rural areas, if they do not get enough IT funding to meet specific needs).

Suzanne sees the digital divide in 2009 being due to access issues, although racial and ethnic differences are decreasing, but rural versus urban differences remain along with age-related differences (“senior divide”).

She sees issues of use and understanding of systems, eg around computer literacy, functional literacy, numerac and health literacy, as remaining important. She described a number of projects within her institution, aimed at addressing some of the disparities, including self-management of hypertension in diabetes, and self-assessment via a PHR.

One project she described is “Facebook PPALS” – Promoting Physical Activity Among Adolescent Latinos – addressing overweight immigrant teenagers and trying to promote physical activity.

SINI2009 – TIGER usability panel July 25, 2009

Posted by peterjmurray in conference, education, nursing informatics, SINI2009.
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The TIGER (http://www.tigersummit.com/) usability collaborative is presenting a panel of recommendations on ‘Creating usable systems for nurses’. The four speakers are Greg Alexander, Cheryl Parker, Nancy Staggers and Denise Tyler. Nancy Staggers outlined the work of the TIGER initiative, and the nine collaborative teams working on various areas – the usability and clinical application design collaborative was the one that attracted most interest from nurses wanting to be involved in activities.

Greg Alexander outlined the problem addressed as being that current information systems do not always meet the workflow and information needs of nurses working in clinical areas. He said that systems should be patient-centric, and evidence-based, and take account of the interdisciplinary collaboration at the point of care. Aspects of usability include efficiency/productivity (how time-efficient is the application? ), how well does the product help end users avoid errors that impact their efficiency? how quickly can a person learn to use the application?, effectiveness (how well the system matches the way users think and work? how well the system supports patient safety, preventing critical error?

Denise Tyler described a number of case studies of implementation to look at usability issues. The successful case studies had end users (multidisciplinary) involved in all processes, from system selection, to design, through testing and education, and starting with selection to ongoing system optimization. Among lessons learned were that usability is the fit between system users, their work and environments, and imperatives included engaging end users early and often, understanding users, their tasks and their environments, and conducting usability testing and redesigning before implementation (to avoid problems during implementation).

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.

SINI2009 – social outings July 25, 2009

Posted by peterjmurray in conference, SINI2009, social activities.
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An important part of any conference is the social activities; and they generally mainly happen on a Friday night at SINI. A small group of us (Peter, Scott, Margaret and Eric) ventured out to Max’s Taphouse at Fell’s Point (http://www.maxs.com/). We went over by water taxi (I’m not keen on the new split route with transfers), and then a short walk up Broadway on Fells Point. We tried a wide selection of excellent beers, including Christmas ales, IPAs, stouts, and Belgian beers. The food was absolutely excellent, with very generous portions – we had a selection including steamed shrimps, garlic mussels (with lots of chopped garlic), hummus, foot-long chili dogs, and cajun quesadillas (crab and Andouille). After a trip back on the water taxi, the evening was rounded off by a tipple of very nice Glenfiddich.

The traditional CARING dinner – organised once again by Sue Newbold – also took place last night (Friday) at Chiapparelli’s (http://www.chiapparellis.com/) in Little Italy. By all accounts, it was a good evening, with close to 80 people attending.

SINI2009 – Margaret Hansen on use of video iPods July 24, 2009

Posted by peterjmurray in conference, krew, SINI2009.
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Margaret started by describing how she began podcasting lectures; positive anecdotal feedback on the experience as students can listen anytime. Then started to think about using video iPods for teaching clinical skills. Received grant to conduct a small study in school of nursing.

Was involved in a study in Auckland, New Zealand in teaching medical students skills in urinary catheterisation; Margaret’s study was essentially a replication study. Would student’s competency level in the skill and in self-confidence be increased? – would it be of benefit to the patient? – would it decrease the learning time for students to reach particular levels of skills? Margaret also has interest in using mobile devices for patient education.

Study was a randomised controlled intervention study with nursing students at a university in California. Skills teaching involved the use of short videos of the skills, followed by demonstrations of skills on mannequins; students had the opportunity to practice the skills and be assessed by the nurse who had done the teaching. Students were then randomly assigned to groups, with some having video iPods and some not. Students were then re-assessed on the skills after two weeks; during this period, students were in clinical settings and would be expected to perform the skills for real.

The study results (just out) showed little significance between the two groups in the study; but did the experimental group take less time to achieve the same levels of competence and confidence levels? Data is slow in coming back from the students, so it is difficult to know the answers at present.

School is now going to continue using the video iPods for skills learning, and a series of approx. 30 videos will be created and loaded to the devices.

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 >>>