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CHIMSS NIC Roundtable May 9, 2006


... documented ( 30% decrease in code blue) ... The NIC book is in its 4th edition. It includes linkages with NANDA. There are ... Jane Kelley, Southeast ... – PowerPoint PPT presentation

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Title: CHIMSS NIC Roundtable May 9, 2006

CHIMSS NIC RoundtableMay 9, 2006
  • Industry Conference Update

Technology Informatics Guiding Educational
Reform The TIGER Initiative
TIGER Executive Council
  • Marion Ball, Ed.D
  • Connie Delaney, PhD, RN, FAAN, FACMI (Co-Chair.
  • Donna DuLong, RN
  • Brian Gugerty, DNS, RN (Chair, Fund-Raising
  • Angela Barron McBride
  • Joyce Sensmeier MS, RN, BC, CPHIMS, FHIMSS
    (Co-Chair, ANI)
  • Diane J. Skiba, Ph.D., FAAN, FACMI
  • Michelle Troseth, RN, MSN (Chair, Program
  • Charlotte Weaver, Ph.D.

  • July 2005 National Coordinator Announcement
  • January 2005 Johns Hopkins Meeting
  • Summer 2005 IOM Submission
  • November 2005 IOM Approval
  • January 2006 Release from IOM
  • October 30-November 1, 2006 TIGER Summit

TIGER Vision
  • Allow informatics tools, principles, theories and
    practices to be used by nurses to make healthcare
    safer, effective, efficient, patient-centered,
    timely and equitable
  • Interweave enabling technologies transparently
    into nursing practice and education, making
    information technology the stethoscope for the
    21st century

TIGER Stakeholders
  • Alliance for Nursing Informatics
  • Nursing Organizations
  • ANA, AONE, AACN, AORN, etc
  • Government Agencies
  • Military-Chief Nurses
  • Vendor Community
  • Academic Institutions

Tiger Summit
  • Invitational Conferences
  • 120 Participants
  • Uniformed Services University of Health Sciences
  • Bethesda, MD
  • Keynote Panel Presentations
  • Exemplars Clinical and Academic
  • Gallery Walk

SUMMIT Outcomes
  • Publish a report, including Summit findings and
    exemplars of excellence
  • Establish guidelines for organizations to follow
    as they integrate informatics into academic and
    practice settings and
  • Set an agenda whereby the nursing organizations
    specify what they plan to do to bridge the
    quality chasm via IT strategies.

Actionable Plans
  • Individual nursing organization will develop
    collaborative action plans to increase the
    knowledge and skills of nurses to practice in an
    informatics rich and consumer centric health care
  • Identify organizations or partnerships that can
    help them accomplish their action plans
  • Agree to commit a point person who will respond
    to evaluation surveys and reporting mechanisms

Actionable Plans
  • Agree to accomplish at least 85 of their
    established short-term (first year) goals, and
  • Agree to accomplish 100 of long term goals
    within the three year time span.
  • Evaluation
  • Goal Attainment
  • Diffusion Index

TIGER Summit
  • Evidence and Informatics Transforming Nursing
  • October 30-November 1, 2006
  • Uniformed Services University of the Health
  • Bethesda, Maryland

HIMSS Annual Conference and Nursing Informatics
  • Michele Norton MS RN
  • Terri Barylak-Roge BSN RN

HIMSS NI Symposium
  • Dr. Carol Romano CNO US Public Health Service
  • The role of informatics in improving the health
    of all people in our country
  • Caring for public health begins with caring for
    individuals and linking information so that it
    can be used to improve the care and outcomes
  • Federal initiatives- ONC, CMS, VA health e vet
  • Technology- systems to assist Public Health,
    biosurveillance and health promotion
  • HIMSS NI Taskforce and Partners Survey- Impact of
    HIT on interdisciplinary communication
  • Respondents agree that HIT support the role of
    nurses and communication
  • Key areas where we need to focus our work
    interoperability, promoting care efficiency and
    usability- global deployments
  • Barriers to Effective Comm dual processes,
    information silos, HIT tools not optimized
  • .

HIMSS NI Symposium
  • UKs National Health Service Connecting for
    Health-Barbara Stuttle
  • Nurses function as information repositories
  • A key challenge-nurses and informaticists to take
    a transformational approach to design and
    implementation of IS
  • Develop competencies to support transformation
    from a paper to electronic world
  • design technology so it is viewed as an enabler,
    not a barrier to transformation

HIMSS NI Symposium
  • The evolving role of informatics nurses- Leslie
  • link of past and future roles- nursing-nursing
  • Nursing Informatics education and roles
  • HIMSS NI Survey
  • MA Regional Data Exchange initiatives- Cindy Spur
  • RHIOs for information sharing through the MA
    Share project.
  • Steps to share information, link care in MA
  • Nursing/Interdisciplinary communication missing
    from RHIOs

HIMSS NI Symposium
  • David Cornwall described the benefits of
    informatics, technology and telehealth in an
    integrated HC delivery system including care
    coordination, clinical outcomes, decreased costs
    and improved satisfaction.
  • Rosemary Kennedy and Susan Matney talked about
    strategies for success and the value associated
    with integrating structured terminology within
    the electronic health record to improve the
    processes and outcomes of care.

HIMSS NI Symposium
  • Using Benchmarking to Quantify Benefits in HIT
    Implementation- Judy Murphy
  • Diagnostics- use benchmarks to determine area of
    focus and goals
  • Assess baseline measures
  • Design and Implement IT
  • Remeasure
  • Disseminat improvements or action plan

HIMSS NI Symposium
  • Nancy Lorenzi presented the Success Factor
  • A practice guideline for selecting an
    implementation site to improve the probability of
    system acceptance and success.
  • Reasons for project failure
  • Communication
  • Culture
  • Underestimation of complexity
  • Scope creep
  • Organizational issues
  • Technology
  • Training
  • Leadership
  • Strategies for Success
  • Understand IT and users
  • Demonstrate value
  • Engage clinicians early and continuously
  • Reach and teach
  • Leverage knowledge and experience

HIMSS NI Symposium
  • Leah Curtin- The Future Moving from
    Impossibility to Probability
  • When the unthinkable becomes thinkable, it
    moves from the realm of impossibility to
  • Genomics
  • Designer drugs
  • Teleportation
  • Biometrics
  • Implanted electrodes in brain- run smart room

HIMSS Conference Themes
  • Interoperability
  • Focus on HIE, vendor showcase, EHR Standards
  • RHIO Research Launched-federal gov will begin
    research effort to support the evolution and
    maturation of regional health information
  • HIMSS RHIO Federation
  • Evolution toward consumer centered care
  • State initiatives funding/organization/support of
    RHIO initiatives- Tennessee

HIMSS Conference Themes
  • Reducing Error/Improving Care
  • Reduce Variances by
  • CPOE order sets, vocabularies, knowledge
  • Programming tools
  • Alerts dynamically fed by the database
  • Paging, faxing, clip boards
  • Decrease medication turn around time
  • Accurate and timely data
  • Evidence based clinical decision support
  • Clinical systems with embedded clinical decision

HIMSS Conference Themes
  • Integration of EBP into HIT improving quality of
  • Pay for performance- Quality incentives
  • Successful implementations- CPOE
  • Transforming Healthcare
  • The Katrina Story-

AONE April 2006
  • Teresa McCasky, MBA, RN,BC
  • Chief Nursing Strategist

  • Introduction to AONE
  • The American Organization of Nurse Executives
  • AONE is designed for Nursing Executives and Nurse
  • CNO and Nursing Managers
  • Annual Meeting
  • 6000 attendees in 2006
  • Next year in Washington DC

  • 2006 KEYNOTE Presentation with Dr. Mae
    JemisonHealth Care Technology Powering
    Nursings Future

AONERescue Me  The Value of Empowering Nurses
to Initiate Rapid Response Teams
  • RRT is part of the IHI 100,000 lives campaign
  • UPMC presented
  • RRT usually mean no physician on the team
  • MET (medical emergency team) typically has a
    physician on the team
  • Finding great results, improved outcomes,
    empowered nurses
  • How to start?
  • For small hospitals, hard to justify budget
  • Start with what you have, current code blue team
  • New term new miss code blues
  • Many pt saves being documented ( 30 decrease in
    code blue)
  • Good web link
  • Family RRT teams ( helps with pt satisfaction)

  • PLENARY SESSION with Dr. John IzzoReawakening
    the Soul--Renewing Joy Wonder at Work
  • REMEMBER why you got into nursing
  • Remember why you do this work, write it down
  • What nurses do, does matter, patients do care
  • Books
  • Radical Loving Care
  • Enlighten Leaders
  • Video on patients perspective of care

  • Wharton Lecture with Dr. Roch Parayre How Blue
    is Your Ocean? 
  • What does your organization want to be known as?
  • Patient experience of care ( is it personalized?)
  • How do you make nursing indispensable?
  • Role changes, shortage?
  • What will nursing be like in the future?
  • If your value straddles competition, its a red
  • Reinvent your core value curve
  • How do you change the game to make competition
  • Cirque du Soleil

  • Multi-Site Study of How Medical-Surgical Nurses
    Spend Their Time
  • Ann Hendrich, MS, RN, FAAN, Robert Wood Johnson
    Fellow Vice President of Clinical Excellence,
    Ascension Health, St. Louis, MO and Marilyn
    Chow, RN, DNSc, FAAN, Vice President, Patient
    Care Services, Kaiser Permanente, Oakland, CA.
  • 4 methods of workflow analysis used, try to
    understand what nurses spend their time on
  • Results
  • Spend 10 seconds in one spot
  • Walk on average 6 miles per shift
  • Understand the physical impact on nursing
    workload and stress
  • Need to understand work environment before you
    can change it
  • Impact direct patient care

  • Common Themes of Conference
  • Leveraging Energy and Dreams The Power for
    Nursings Future
  • Unionization
  • What will happen to the workforce
  • AONE would like to enhance the workforce
  • 9 elements of care, defined by NOA
  • Patient Safety, key focus
  • Requires collaborative communication
  • Empowering nursing and nursing
  • CNOs big worry, lack of recognition and
    acknowledgement of the work nurses do ( C suite
    and pts)
  • TCAB ( transforming care at the bedside)

  • AONE Institute Annual Lecture with Dr. Mary
    BlegenPatient Safety Process and Outcomes Nurse
    Staffing and Work Environment
  • Key finding research does not support the
    premise that bar coding medications decreases
  • Hard to do pre and post studies when technology
    in place ( error reporting poor in manual world)

  • Nursing intensity billing for hospitals
  • John Welton, PhD, RN, Professor of Nursing and
    Mary Fischer, RN, MSN Medical University of
    South Carolina, Charleston, SC.
  • CMS bill 1488P
  • Debasing DRG model
  • More focus on med/surg and not surgical
  • Control cost
  • Payment based on cost of care, not charges
  • ?? Move nurse charges to charges based on
    service, not room/bed charge

  • Dr. Phyllis KritekCelebrating the Legacy of
    Nursing Leadership Writing the Story of the
  • First time 4 generations are in the workforce at
    same time
  • Classics
  • Boomers
  • Gen X
  • Gen Y


ANIAAutomated Patient Care Innovations in
Nursing Informatics April 2006
  • Michele Norton MS, RN, INS

  • Writing for Publication in Nursing Workshop-
  • A workshop walking attendees through the writing
    process, resources, tips, targeting journals,
    letters to the editors etc

  • Keynote- Carol Romano CNO US Dept PH
  • Nursing as translators of information,
    information literacy- Public Health
  • Priorities for Health- prevention, preparedness,
    health literacy
  • Public Health globalization- telenursing,
  • PHR
  • IT- Culture/technology and innovations

  • Innovations Beyond the Lab
  • Emerging Practice/academic partners
  • IOM Workforce challenge-preparing nurses for the
  • Johns Hopkins/Eclipsys
  • Nursing education/next generation

  • Establishing a Foundation for Innovation Dont
    Fall to pieces over pt. safety
  • Importance of dialogue techniques
  • Have meaningful conversations about patient
  • Healthy culture

  • Going from good to great- A sustainable approach
    to meeting regulatory compliance
  • Key Clinical Initiatives-core measures, falls,
    med rec, hand offs etc
  • ? focus on clinical pathways/processes
  • Develop technology and systems that support
    quality outcomes
  • Role of nursing with quality measures
  • EBP
  • Compliance tools-continuous evaluation

  • Pay for Performance
  • Quality initiatives
  • Under treatment of pt
  • Financial incentives
  • Variability leads to safety issues
  • Clinical Focus
  • Both patient and aggregate clinical data
  • Efficacious care optimizing quality and cost
    --not under treating or over treating
  • Outcomes (associated with cost merging clinical
    and financial data)
  • Achieving practice standards that are evidence
    and research based

  • High Touch/High Tech Nursing
  • Importance of Emotional Intelligence skills in
    nursing leadership and change management
  • Adoption of technology

The NANDA, NIC, NOC AllianceMarch 2006
  • Kathleen Kimmel RN, MHA, CHE

  • Background
  • The North American Nursing Diagnosis Association
    (NANDA) began in 1973 and was officially founded
    in 1982. In cooperation with the University of
    Iowa, NANDA has developed a nursing practice
    taxonomy and structure. NANDA accommodates
    interventions and outcomes from the Nursing
    Interventions Classification (NIC) and Nursing
    Outcomes Classification (NOC).

  • EHRs Optimizing e-Nursing Data - Nancy Staggers,
    Intermountain Healthcare
  • The 1st EMR was at El Camino hospital in
    California in 1968, (Technicon, TDS). Technology
    has been around for 38 years, but the incentives
    have not been there to move the adoption and the
    technology forward
  • US economic incentives have not helped stimulate
  • Stressed the importance of user-centered product
  • Called for predictive modeling for EHR
  • RHIOs will have interoperability challenges that
    stem from not having standards

  • Nursing Intervention Classification (NIC) Update
    Gloria Bulechek, Univ of Iowa
  • NIC is a standard language that names and
    describes the treatments that nurses perform.
  • NIC interventions are both physiological and
  • The NIC book is in its 4th edition. It includes
    linkages with NANDA
  • There are 514 interventions
  • Licensed for inclusion into SNOMED in 2002
  • Translated into nine foreign languages

  • Nursing Outcomes Classification (NOC) Update Sue
    Moorehead, Univ of Iowa
  • NOC is beneficial for evaluating care over time
    and across settings of care.
  • Believes older nurses have a more difficult time
    thinking about outcomes and goals
  • The rating score has changed. It now includes 1)
    positive (rating increased) 2) negative (rating
    decreased) 3) rating stayed the same
  • Includes time frames frequent and non-frequent
    outcomes. For example, quality of life is
    unlikely to change frequently. However, pain
    status might change frequently
  • Also in nine languages
  • Linked with NANDA and Gordons Functional Health
  • Moving away from using the terms, terminology
    and languages to calling it effectiveness

  • Using the Omaha System to Describe what is inside
    the Black Box
  • Kathryn Bowles, Univ of Pennsylvania Background
  • The Omaha System is a research-based,
    comprehensive and standardized taxonomy designed
    to enhance practice, documentation, and
    information management.
  • Consists of three components the Problem
    Classification Scheme, the Intervention Scheme,
    and the Problem Rating Scale for Outcomes.
  • Work on the Omaha system began in 1970 through
    the efforts of the Omaha Visiting Nurses
  • Presentation discussed the Advanced Practice
    Nurse (APN) program at the Univ of Pennsylvania.
  • Focus on an interdisciplinary program to improve
    outcomes and reduce costs for high risk elderly
    using APNs.
  • Most of the data on this research project has
    been collected manually
  • They are partnering with two Aetna plans and one
    Kaiser plan to determine if their model of
    translating research to practice is feasible in
    the real world.
  • The patients they treat have an average of 8
    active problems at one time.
  • High interest in determining the relationship
    between patient knowledge and behavior change.

  • Computerized Cross-Mapping with Linguistic
    Optimal Mapping Technique Implications for the
    Standardization of International Nursing Practice
    Marge Simon Colier, Univ of Connecticut
  • Presentation focused on the ability to cross map
    Axis 1 nursing concepts/diagnoses of NANDA
    taxonomy II with those of the International
    Classification of Nursing Practice (ICNP)
  • In order to adapt their optimality theory, they
    created an optimal mapping technique (OMT). How
    it works for each NANDA input there is a set of
    possible ICNP outputs that are generated
  • Universal constraints and violable constraints
    are used in the mapping process

NANDA/NIC/NOCUsing Nursing Outcomes to Define
the Role of the Clinical Nurse Leader Sally
Decker RN PhD
  • The role of the clinical nurse leader (CNL) was
    defined as overseeing the care coordination of
    group of patients.
  • A CNL evaluates patient outcomes, assesses
    cohort risk and has decision making authority to
    change care plans when necessary. The CLN serves
    in the role of an Outcomes Manager
  • Five common outcomes were identified
  • Patient satisfaction
  • Symptom reduction
  • Compliance/adherence
  • Knowledge of patient/family
  • Quality of Life
  • The CNL is also interested in care delivery
    processes and collaboration between healthcare
    providers (i.e., how accurately did the provider
    meet the needs of the patient
  • Recently new psychosocial outcomes were added,
    such as perception of being well cared for and
    trust in your provider

Meeting Magnets Research Criteria with Studies
of NANDA, NIC and NOC Christa Minthorn,
Hackettstown Regional Medical Center
  • The use of NANDA, NIC and NOC (NNN) to meet the
    research criteria for Magnet status.
  • There are 14 Forces of Magnetism, which form the
    framework for accreditation. Force number 6,
    Quality of Care, includes a component that
    refers to research and evidence-based practice.
  • Research tips for non-academic organizations are
  • Educate nurse leaders and obtain executive
    buy-in. The education should include an
    introduction to research methods
  • Use and operate through existing structures, such
    as shared governance councils, practice and
    quality councils
  • Mentor and coach staff nurses
  • Hire a nurse researcher consultant if needed
  • Pay attention to privacy and research protection
  • Establish budget
  • Collaborate with NNN and local colleges
  • Select the patient population(s)

Organization Nursing Diagnosis for a Taxonomy of
Nursing Practice Administrative Domain Jane
Kelley, Southeast Missouri State University
  • The purpose of this session was to develop
    nursing languages to meet administrative/
    organizational management requirements. Some of
    the organizational nursing problem terms are
  • Nursing recruitment inadequate
  • Nurse-patient ratio unbalanced
  • Patient morbidity increased, related to
    unbalanced nurse-patient ratio and staff mix
  • Budget variance related to increased use of
    disposable supplies
  • Capital budget misaligned with strategic terms

  • Use of Standardized Nursing Language for Outcomes
    Effectiveness Research Marita Titler, University
    of Iowa Hospitals and Clinics
  • This session address the topic of outcomes
    effectiveness research.
  • There are three key areas 1) effectiveness 2)
    efficacy and 3) appropriateness.
  • The importance of using the standardized nursing
    language in electronic documentation systems was
    emphasized with respect to articulating nursing
    contributions to patient outcomes across care

  • The Nursing Appointment as a Component of the
    Patients Electronic Records Miram de Abreu
    almeida, Elenara Franzen, Szana Zachia, Vera
    Lucia Dias
  • This session addressed
  • The usefulness of electronic appointments
  • Recording of nursing actions in an outpatient
    health clinic in Brazil.
  • Espoused the value of demographic information to
    track the patient longitudinally, and recording
    of nursing teaching and treatments in a primary
    care setting.

  • Care Planning with Electronic Problem List and
    Care Set Functions Jane Brokel, Cindy Nicholson,
    Trinity Health, Novi, Michigan
  • The purpose of this session was to identify the
    attributing factors from admission interview and
    assessments that guide nurses to select core
    patient problems/nursing diagnoses for adults
    select nursing outcomes and interventions from a
    care set to plan the care of patients in an
    electronic health record and, to evaluate
    nurses care planning using NNN
  • Most common problems in literature coincided with
    findings across 6 facilities
  • Knowledge Deficit
  • Self-care Deficit
  • Confusion, acute
  • Impaired mobility
  • Acute Pain
  • Nutrition, less than requirements
  • Risk of Injury
  • Impaired Skin Integrity
  • Impaired Tissue Integrity
  • Impaired Gas Exchange
  • Ineffective Breathing Pattern
  • Fluid Volume Deficit
  • Fluid Volume Excess
  • Conclusions 1) approach patient situations in
    terms of outcomes and eliminate the list of
    problems 2) integrate clinical decision making
    into the workflow 3) use standardized language

  • Nursing outcomes Classification (NOC) in SNOMED
    CT A Cross-mapping Validation Debra Konicek
    Connie Delaney
  • Purpose of the study was to validate a
    back-mapping of NOC into SNOMED-CT, with NOC as
    the source system and SNOMED-CT as the target
  • Researchers used a knowledge representation
    comparison between source and target systems.
  • Findings Only 4.8 of cross-mapped NOC concepts
    were mis-assigned in SNOMED-CT. SNOMED-CT is a
    good reference terminology model

  • Economic Evaluations and Usefulness of
    Standardized Nursing Terminologies Patricia Stone
  • Objectives of this session were to demonstrate
    why we should care about the money review
    different types of economic analyses commonly
    found in healthcare literature discuss the
    potential roles of standardized terminologies in
    providing cost and outcome data useful in
    economic evaluations. Presenter described types
    of economic evaluations
  • Cost Minimization used when health outcomes are
    equivalent. Goal is to find the least costly
  • Cost Consequences no attempt to aggregate costs
    and effects into one outcome measure. An array
    of consequences is usually presented.
  • Cost Effectiveness (cost utility) effects
    expressed in their natural units. Cost
    effectiveness important not to look at average
    cost effectiveness. Cost Utility analysis look
    at per quality of life year gained. Use the
    QUALY summation of TU. T time in health
    state, U utility of health state
  • Cost Benefit both cost and consequences valued
    in monetary terms requires placing a dollar
    value on health outcomes
  • Presenter challenged the NNN group to utilize
    standard terminologies to conduct economic

  • The Importance of Perspective and Primary Focus
    in Choosing and Measuring Outcomes Sue Moorehead,
    University of Iowa
  • Focus of this session was to consider whose
    perspective should be considered when selecting
    NOC outcomes for measurement, i.e. patient,
    family, caregiver, nurse, members of the
    community, etc.
  • Key Points
  • More work needed in NOC to better represent
  • Education of staff nurses needs to include a
    discussion on the importance of perspective on
    outcome selection
  • Definitions are a useful tool to determining the
    focus of an outcome
  • Measurement of pain level in NOC is not the same
    thing as using a ten point pain scale
  • When measuring outcomes of care nurses must
    carefully select sources of information to
    measure an outcome to not violate the focus of
    the outcomes being measured
  • Most NOC outcomes are evaluated from the
    perspective of the nurse as expert
  • Adding outcomes that include the patient
    perspective is an important criteria for
    evaluating care provided by nurses
  • Without the patient perspective it is difficult
    to evaluate the human responses to illness

  • A Secondary Analysis of Selected Patient Factors
    Associated with the Status of Nursing-Sensitive
    Patient Outcomes Peg Kerr, University of Iowa
  • Research sought to assess the ability of specific
    patient characteristics (age, gender, primary
    medical diagnosis, comorbid medical diagnoses,
    and socioeconomic status) to explain variation in
    change in each of four selected NOC outcomes
  • Implications for practice
  • Awareness of those at risk for poor outcomes
  • Development of profiles of risk to incorporate
    into electronic health records risk alerts
  • Development of risk adjustment methods to
    meaningfully interpret institutional-level
    reporting of outcomes

Upcoming Events
  • May 20-24 Toward Electronic Patient Records
  • June 11-14 NI 2006- 9th Annual International
    Nursing Informatics Conference- Seoul
  • July 19-22 SINI- Summer Institute of NI-
  • October TIGER Summit
  • November 11th AMIA NI Symposium RHIOs Nursing
    at the Center of Care
  • http//
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