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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.

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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.

SINI2010 – Gil Kuperman July 23, 2010

Posted by peterjmurray in conference, education, nursing informatics, SINI2010, USA.
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It’s Friday morning in Baltimore; temperatures are supposed to get up to near 100F today. Attendance at the Orioles game didn’t look too great last night (my hotel room overlooks Camden Yards).

The distinguished lecture this morning is from Gil Kuperman, from NewYork-Presbyterian Hospital and Columbia Biomedical Informatics in New York, NY. His talk is titled “Health Information Exchange: Why Are We Doing It and What Are We Doing?” His premise for his talk is that we are at an inflection point in respect of interoperability, and that some of the responses to ‘meaningful use’ are altering the landscape for interoperability. He outlined the role of clinical data in giving a more accurate picture of the patient’s needs, but also noted the wider uses of such data, for public health and research. He referred back to the 2001 report and recommendations on ‘A strategy for building the national health information infrastructure’, which had three components, including health care provider, personal health and population health dimensions.

Gil then went on to review the 2004 origins of ONC within a four-part strategy which had little funding for real implementation. It did highlight, however, the importance of health information exchange for EHR adoption, and some encouraging signs for interoperability. He noted the origins of the first prototype National Health Information Network (NHIN) project in 2004, and the growth of the “NHIN1” model as a ‘network of networks’. NHIN2 in 2007 aimed to demonstrate interoperable and secure health information exchange, with specific use cases.

After an exploration of other phases/stages of NHIN, Gil moved on the NHIN Direct (www.nhindirect.org), which aims to support stage 1 meaningful use. It aims to push data to a known recipient and automate health information exchange that is currently being undertaken by other modes.

He highlighted a number of challenges and questions that still exist, including:

  • Is it really easier? – need an address book (central authority) – need authorization scheme – need auditing
  • How much of the problem does it solve? – “Push” vs. “pull” – Important use cases left out
  • Need agreed upon security standards – Need governance to create policies – Need compliance to assure policies followed
  • How well does it work for large organizations? – Putting an incoming lab result in the right chart

The NHINDirect model is not seen by many as an end in itself, but is seen as complementary to other aspects, and may or may not address some of the use cases identified within NHIN2.

Gil ended by noting that many questions are raised by the contrasting models, ie “Sending messages” vs. “Information Retrieval”, does it enable innovative care models, how will it affect RHIOs in the future, and will it allow migration to more sophisticated health information exchange?

Some interesting ideas were raised, and it is useful to compare with the situation and questions raised 5 years ago in the UK with the development of the NHS Spine model.

Covering SINI2010, Baltimore July 17, 2010

Posted by peterjmurray in conference, education, nursing informatics, USA.
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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.