Present and Future Trends In Nursing Informatics

1. Present and Future Trends In Nursing Informatics Bonnie L. Westra, RN, PhD Assistant Professor University of Minnesota, School of Nursing Goal is to build on previous session in 2006 �Nursing Role in Informatics� class. As part of this, I will build on basics and also stretch your imagination.Goal is to build on previous session in 2006 �Nursing Role in Informatics� class. As part of this, I will build on basics and also stretch your imagination.

2. Objectives Relationship between nursing science and computer science Technology use to manage and communicate data Present and future trends in nursing informatics Professional organizations that support nursing informatics Role of the nurse informaticist in transforming patient care

3. Nursing Informatics Art � is the system designed to help manage, process, and communicate information?Art � is the system designed to help manage, process, and communicate information?

6. Informatics Science

7. What is the Focus of Nursing?

8. Not as easy to learn as a computer game from Best Buy, but a computer game can�t help you run your business. What does easy to use/learn mean? Truly flows like your day to day agency workflow. There is a great deal of software to help you structure your business processes & we provide experts to train you on the applications and help to implement best practices. As Bonnie goes through the system, watch how quickly & efficiently it flows. You�ll notice how the mouse pointer hardly ever seems to move. That�s because we�ve incorporated the standard Windows functionality of arrows and hot keys making it virtually a mouse-less system. Not as easy to learn as a computer game from Best Buy, but a computer game can�t help you run your business. What does easy to use/learn mean? Truly flows like your day to day agency workflow. There is a great deal of software to help you structure your business processes & we provide experts to train you on the applications and help to implement best practices. As Bonnie goes through the system, watch how quickly & efficiently it flows. You�ll notice how the mouse pointer hardly ever seems to move. That�s because we�ve incorporated the standard Windows functionality of arrows and hot keys making it virtually a mouse-less system.

9. ANA Recognized Terminologies & Data Element Sets

10. ANA Recognized Terminologies & Data Element Sets

11. Example Care Plan A HANDS �short story/synopsis� consists of a series of care plans stored as episodes of care (admission to discharge on a unit). At every handoff the nurse updates the care plan from the previous shift and this becomes the �latest care plan� and is owned by the nurse who entered the Update (or admission plan if this is the 1st for the episode. HANDS includes reports that display the entire history of the patient for each episode including: 1) All NANDA diagnoses followed during the episode and the current or discharge status 2) All NOC outcomes followed during the episode and the current or discharge status 3) Expected and current (or discharge) ratings for each NOC outcome followed 4) Trend of all NOC outcomes ratings across the entire episode 5) All NIC intervention provided and the cumulative current/discharge total for the entire episode. A HANDS �short story/synopsis� consists of a series of care plans stored as episodes of care (admission to discharge on a unit). At every handoff the nurse updates the care plan from the previous shift and this becomes the �latest care plan� and is owned by the nurse who entered the Update (or admission plan if this is the 1st for the episode. HANDS includes reports that display the entire history of the patient for each episode including: 1) All NANDA diagnoses followed during the episode and the current or discharge status 2) All NOC outcomes followed during the episode and the current or discharge status 3) Expected and current (or discharge) ratings for each NOC outcome followed 4) Trend of all NOC outcomes ratings across the entire episode 5) All NIC intervention provided and the cumulative current/discharge total for the entire episode.

12. Information Processes

13. Processing Requirements

14. Information Processing

15. Technology to Manage Data What does technology mean? How has it changed? What do we want to see happen next?What does technology mean? How has it changed? What do we want to see happen next?

16. Newer Technologies Methods of data entry Handwriting recognition Bar coding RFID Voice recognition Thought recognition CEBIT - Scientists show thought-controlled computer An Austrian company is showing a brain-computer interface at Cebit that 'reads' thoughts to operate a computer. Forget speech-recognition software: How about typing a letter just by thinking it? In a quiet corner of the Cebit trade show a small Austrian company is showing a "brain-computer interface," a technology that could one day transform how we use computers, play video games and even talk to each other. It sounds like science fiction but is a clever application of science and technology. The system does not really read thoughts; rather, it measures fluctuations in electrical voltage in the brain and translates them into commands on a computer screen. The system consists of a cap that fits over the user's head, with a few dozen holes through which electrodes are attached so they rest on the scalp. The electrodes are connected via thin cables to a "biosignal amplifier," which transmits the signals from the brain to a computer. Different parts of the brain are used to process different types of thoughts. Vertical and horizontal hand movements are handled in an area called the sensory motor cortex, for example, said Christoph Guger, CEO of g.tec, which built the BCI system shown at Cebit. James Niccolai (IDG News Service) 28/03/2007 14:14:50 http://www.computerworld.com.au/index.php/id;361485560;fp;16;fpid;1CEBIT - Scientists show thought-controlled computer An Austrian company is showing a brain-computer interface at Cebit that 'reads' thoughts to operate a computer. Forget speech-recognition software: How about typing a letter just by thinking it? In a quiet corner of the Cebit trade show a small Austrian company is showing a "brain-computer interface," a technology that could one day transform how we use computers, play video games and even talk to each other. It sounds like science fiction but is a clever application of science and technology. The system does not really read thoughts; rather, it measures fluctuations in electrical voltage in the brain and translates them into commands on a computer screen. The system consists of a cap that fits over the user's head, with a few dozen holes through which electrodes are attached so they rest on the scalp. The electrodes are connected via thin cables to a "biosignal amplifier," which transmits the signals from the brain to a computer. Different parts of the brain are used to process different types of thoughts. Vertical and horizontal hand movements are handled in an area called the sensory motor cortex, for example, said Christoph Guger, CEO of g.tec, which built the BCI system shown at Cebit. James Niccolai (IDG News Service) 28/03/2007 14:14:50 http://www.computerworld.com.au/index.php/id;361485560;fp;16;fpid;1

17. Data Storage

18. Data Warehouse and Retrieval Environment Patient identifier Admission/ discharge dates 01 Unit/Service Unique Identifier 03 Patient/ client population Nursing resources Staff providing care Financial resources Patient payor Billing vs reimbursement Environment Patient identifier Admission/ discharge dates 01 Unit/Service Unique Identifier 03 Patient/ client population Nursing resources Staff providing care Financial resources Patient payor Billing vs reimbursement

19. Knowledge Discovery in Databases Knowledge discovery in databases Automated (not automatic!) identification of patterns in databases Data mining The application of specialized software tools and cognitive processes to aid in discovering knowledge

20. Standardized EHR Data OASIS Data Clinical Record Items Demographics & Patient History Living Arrangements/ Supportive Assistance Health Status Functional Status Emergent Care Use/ Discharge Omaha System Data Problems � Environmental, Psychosocial, Physiological, Other Health Related Problems Problem Rating Scale � Knowledge, Behavior, Status Interventions

21. Integration of Technology

22. Technology in Service of Nursing Think like a nurse Ease of use Do the right thing Enter data once Improve competency

23. Present and Future Trends Consumer-driven care/ patients as partners Evidence-based practice Clinical decision support Integrated/ interoperable electronic health records Tiger Initiative

25. Consumer Websites

26. Evidence Based Practice (EBP) Aim - to deliver the most appropriate care to patients with the use of an integration of current research evidence, clinical expertise, and an understanding of patient values and expectations (Craig & Smyth, 2002). Aim - to deliver the most appropriate care to patients with the use of an integration of current research evidence, clinical expertise, and an understanding of patient values and expectations (Craig & Smyth, 2002).

27. EBP Resources

28. What is CDS? Giving clinicians, patients, and others relevant information in context, that helps them make better decisions, prevent errors, and improve care quality and outcomes CDS interventions include guidelines, alerts, order sets, tools to interpret patient data Studies show value: guideline adherence, fewer medication errors/adverse events

29. AMIA and Clinical Decision Support

31. The above slide describes the Picis integration methodologies as implemented at the Palo Alto and San Francisco VAs (VISN 21). VistA and CPRS integration with Picis and CareVue are similar. VistA & CPRS access and verify codes are used for CIS therefore separate Access and Verify Codes are not necessary. Laboratory results automatically download from VistA to CIS record. Progress Notes, bedside monitor and ventilator data integrate with VistA/CPRS. Patient demographic information from the VistA admission/discharge/transfer files automatically populate CIS fields. The current IV pumps are not compatible with CIS. New pumps are funded for purchase this fiscal year and integration will be a consideration in the procurement process. Summary of integration status: VistA Access/Verify Codes - yes Labs from VistA - Yes Flow Sheets to CPRS � VistA imaging capable Progress Notes to CPRS - Yes ADT from VistA - yes Bedside Monitor Data - yes Ventilator Data - yes IV Pump data � not yet The above slide describes the Picis integration methodologies as implemented at the Palo Alto and San Francisco VAs (VISN 21). VistA and CPRS integration with Picis and CareVue are similar. VistA & CPRS access and verify codes are used for CIS therefore separate Access and Verify Codes are not necessary. Laboratory results automatically download from VistA to CIS record. Progress Notes, bedside monitor and ventilator data integrate with VistA/CPRS. Patient demographic information from the VistA admission/discharge/transfer files automatically populate CIS fields. The current IV pumps are not compatible with CIS. New pumps are funded for purchase this fiscal year and integration will be a consideration in the procurement process. Summary of integration status: VistA Access/Verify Codes - yes Labs from VistA - Yes Flow Sheets to CPRS � VistA imaging capable Progress Notes to CPRS - Yes ADT from VistA - yes Bedside Monitor Data - yes Ventilator Data - yes IV Pump data � not yet

32. 1. Fully Engage in the Health Information Technology (HIT) Standards and Interoperability Development Health Information Technology standards and interoperability initiatives have taken on increasing importance and urgency as we work towards converting our nation to an electronic health record. Nursing, which represents more than 55% of the healthcare workforce, has been significantly underrepresented in these efforts. In addition, many of the efforts to designate standards in the nursing domain have been done in a specialty niche market. With the TIGER Initiative, we have the opportunity to bring in these specialty representatives to ensure that the standards represent all of healthcare, specifically nursing. 2. Fully Engage in the National Healthcare IT Agenda A National Healthcare IT agenda was established in 2004 with the Office of the National Coordinator. The TIGER Initiative is in a position to bring a strong and unified voice for nursing to this agenda, maintaining close contact to the policy makers that are establishing and refining this agenda. 3. Comprehensive Informatics Competencies for All Areas of Nursing Excellent efforts have been made in circumscribed areas within nursing to develop informatics competencies for nurses. Work still needs to be done in harmonizing existing competencies and setting competencies for areas of nursing where competencies do not yet exist. 4. Educational Curriculum, Faculty and Program Development The TIGER Initiative vision includes using the most effective information technology at every stage of a nurse's development, and using the informatics competencies, theories, research and practice examples throughout nursing curriculums. 5. Innovative and Effective Staff Development/Continuing Education Programs Establish educational resources and affordable programs within the practice setting that foster IT innovation and adoption, and are based upon the informatics competencies. 6. Improve Usability of Clinical Applications to Support the Workflow and the Role of the Nurse in the Delivery of Patient Care Although an increasing number of nurses and nurse informatics specialists work in companies that develop, sell, implement and maintain information systems, there remains much opportunity for improvement and involvement by many more nurses in the systems development process. This collaborative must be comprised of a mix of industry partners; including nursing professional organizations, healthcare organizations, health information and librarian professionals, and academic representatives. 7. Create a Virtual Demonstration Gallery/Center to Showcase Best Nursing Practices through the effective use of IT One strategy to improve nursing adoption of IT is to provide access and visibility to the vision of IT-enabled nursing practice and education. The intent of this project is to demonstrate the breadth and depth of IT resources in use by nurses to enhance their practice and educational environments by using examples from different practice environments that can demonstrate best practices, results of research, case studies and lessons learned by partnering with nursing professional organizations. Most importantly, we want to demonstrate how integrated IT systems impact nurses and the quality and safety of patient care. 8. Engage and Support Nursing Leadership A relatively small investment of the TIGER Initiative effort with nursing leaders will be multiplied many times due to the leaders' power and influence in their organizations and the profession. This initiative strives to develop programs for nurse executives that stress the value of information technology and empower them to use IT knowledgeably, giving the leaders of the profession a strong and identifiable voice. This program will also facilitate nursing leadership to understand, promote, own, and measure the success of IT projects. 9. Engage and Support Healthcare Consumers Consumers are becoming more empowered healthcare participants. Informatics can mediate consumers drive for improved health and healthcare as well as broker the relationship between nurse and client. This program will work with Personal Health Record (PHR) advocates and developers to optimize PHRs as they relate to nursing. 1. Fully Engage in the Health Information Technology (HIT) Standards and Interoperability Development Health Information Technology standards and interoperability initiatives have taken on increasing importance and urgency as we work towards converting our nation to an electronic health record. Nursing, which represents more than 55% of the healthcare workforce, has been significantly underrepresented in these efforts. In addition, many of the efforts to designate standards in the nursing domain have been done in a specialty niche market. With the TIGER Initiative, we have the opportunity to bring in these specialty representatives to ensure that the standards represent all of healthcare, specifically nursing. 2. Fully Engage in the National Healthcare IT Agenda A National Healthcare IT agenda was established in 2004 with the Office of the National Coordinator. The TIGER Initiative is in a position to bring a strong and unified voice for nursing to this agenda, maintaining close contact to the policy makers that are establishing and refining this agenda. 3. Comprehensive Informatics Competencies for All Areas of Nursing Excellent efforts have been made in circumscribed areas within nursing to develop informatics competencies for nurses. Work still needs to be done in harmonizing existing competencies and setting competencies for areas of nursing where competencies do not yet exist. 4. Educational Curriculum, Faculty and Program Development The TIGER Initiative vision includes using the most effective information technology at every stage of a nurse's development, and using the informatics competencies, theories, research and practice examples throughout nursing curriculums. 5. Innovative and Effective Staff Development/Continuing Education Programs Establish educational resources and affordable programs within the practice setting that foster IT innovation and adoption, and are based upon the informatics competencies. 6. Improve Usability of Clinical Applications to Support the Workflow and the Role of the Nurse in the Delivery of Patient Care Although an increasing number of nurses and nurse informatics specialists work in companies that develop, sell, implement and maintain information systems, there remains much opportunity for improvement and involvement by many more nurses in the systems development process. This collaborative must be comprised of a mix of industry partners; including nursing professional organizations, healthcare organizations, health information and librarian professionals, and academic representatives. 7. Create a Virtual Demonstration Gallery/Center to Showcase Best Nursing Practices through the effective use of IT One strategy to improve nursing adoption of IT is to provide access and visibility to the vision of IT-enabled nursing practice and education. The intent of this project is to demonstrate the breadth and depth of IT resources in use by nurses to enhance their practice and educational environments by using examples from different practice environments that can demonstrate best practices, results of research, case studies and lessons learned by partnering with nursing professional organizations. Most importantly, we want to demonstrate how integrated IT systems impact nurses and the quality and safety of patient care. 8. Engage and Support Nursing Leadership A relatively small investment of the TIGER Initiative effort with nursing leaders will be multiplied many times due to the leaders' power and influence in their organizations and the profession. This initiative strives to develop programs for nurse executives that stress the value of information technology and empower them to use IT knowledgeably, giving the leaders of the profession a strong and identifiable voice. This program will also facilitate nursing leadership to understand, promote, own, and measure the success of IT projects. 9. Engage and Support Healthcare Consumers Consumers are becoming more empowered healthcare participants. Informatics can mediate consumers drive for improved health and healthcare as well as broker the relationship between nurse and client. This program will work with Personal Health Record (PHR) advocates and developers to optimize PHRs as they relate to nursing.

33. Professional Organizations - AMIA

34. HIMSS

35. Caring

36. Educational Programs Formal Programs - Examples Colombia University School of Nursing Duke University School of Nursing NYU Nursing Informatics University of Maryland School of Nursing University of Minnesota School of Nursing Continuing Educational Programs http://www.amia.org/10x10/ http://nursing.umaryland.edu/informatics/ http://www.amia.org/meetings/f07/ http://www.himssconference.org/ http://www.allianceni.org/

37. Educational Programs

38. Transforming Care Safe and Reliable Care Vitality and Teamwork Patient-Centered Care� Value-Added Care Processes

39. Nurse Informaticist Roles in Transforming Care Systems Analyst Project Manager Super User Trainer/Educator Informatics Coordinator Chief Nursing Informatics Officer Information Technology Nursing Advocate There are several key components of successful implementation of the replacement CIS product. It is important consider current workflow of areas currently using CIS and the all new departments first implementing CIS (de Mul et al (2004), Shabot (2004), Fraenkel et al (2003)). This must be balanced with the need to improve and redesign processes when implementing CIS software (deLima et al 1988). The staff education process, particularly physicians and nurses, and use of superusers among those groups will positively impact the transition to CIS.There are several key components of successful implementation of the replacement CIS product. It is important consider current workflow of areas currently using CIS and the all new departments first implementing CIS (de Mul et al (2004), Shabot (2004), Fraenkel et al (2003)). This must be balanced with the need to improve and redesign processes when implementing CIS software (deLima et al 1988). The staff education process, particularly physicians and nurses, and use of superusers among those groups will positively impact the transition to CIS.