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Applying Strategy to Practice Making Solutions Become Reality

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Title: Applying Strategy to Practice Making Solutions Become Reality


1
Applying Strategy to Practice Making Solutions
Become Reality
  • Kathleen A. McCormick, Ph.D.,R.N.
  • HIMSS Nursing Informatics Symposium 2004
  • Orlando, Florida
  • February 22, 2004

2
Futures
  • For over 30 years I have been invited to look
    into crystal balls to describe where we are,
    where we have been, and where we might be going

3
Began in1971
  • Graduate Education at the Univ. of Wisconsin in
    Computer Science instead of a classic language,
    e.g. Spanish, French
  • Learned to speak Fortran and Cobol and work on
    the Graduate School computer simulation lab
  • Later in 1978.
  • Evaluated Nursing input and the use of nursing
    terminology (Diagnosis) into the NIH Technicon
    Hospital Information System (Eclypsis)
  • Developed a position paper in response to a
    request from Medical Management to get rid of
    nursing on the medical record
  • Responded that if you get rid of nursing
    information on the computerized medical record
    you wont have a hospital.so lets work on
    improving it

4
In the 1980s
  • We all taught a lot about what is a computer
  • What can a computer do
  • What could we put on them for nursing content
  • Why do we need a structured vocabulary
  • What data could be retrieved if we had it

5
Academic Endeavors
  • Incorporating Hannah and Ball, Saba and McCormick
    into school curricula- now additional textbooks
  • NLN - in 1985 the National League for Nursing
    created the National Forum on Computers in
    Nursing and Health Care
  • NLN in 1991 passed a resolution at the
    convention recommending that computer technology
    be included in nursing curricula and that it
    become part of the accreditation criteria
  • Many nurses taking first masters preparation in
    informatics

6
Graduate Courses in Nursing Informatics
  • University of Maryland
  • University of Utah
  • New York University
  • University of Texas Hunter-Bellevue School of
    Nursing
  • University of Medicine Dentistry of New Jersey
    - College of Nursing, Rutgers
  • Case Western Reserve University
  • State University of New York Buffalo
  • Columbia University School of Nursing
  • University of San Francisco School of Nursing
  • University of Colorado Health Sciences Center
    School of Nursing
  • North Park University School of Nursing
  • University of Iowa College of Nursing
  • University of Kansas School of Nursing
  • Central Missouri State University Department of
    Nursing
  • Pace University Westchester Campus
  • Duke University School of Nursing
  • University of Pennsylvania School of Nursing
  • University of Pittsburgh School of Nursing
  • Others..

7
1990s focus
  • Preparing a critical mass of informed nurses on
    what computers can do, and what nursing
    informatics supports
  • Nurses developed key positions in Government
    (HRSA, AHRQ, CMS, NLM, NINR, VA, NIH), Industry
    (McKeeson, Cerner, Eclypsis, Siemens, Aurora
    Health, , Academia (Colorado, Maryland, Utah,
    San Francisco, Iowa, NYU), Managed Care (Kaiser
    Permanente) and Organizations (HIMSS, ANIA,
    Caring, AMIA, JCAHO)
  • Furthered work on vocabulary standards
  • Integrated nursing standards into health standards

8
1990s
  • ANA recognized Nursing Informatics as a specialty
    (1992)
  • Nursing Informatics Certification (1995)
  • ANA dedicating Working Group to Database needs
  • AMIA Special Interest Group in Nursing Established

9
1990s
  • First nurses prepared in Nursing Informatics
  • Research priorities defined (1993 US PHS Report
    on Nursing Information)
  • Formalization of nursing vocabularies
  • Design and management of databases for nursing
    information
  • Development of technologies to support nursing
    practice
  • Use of telecommunications technology in nursing
  • Patient use of information technology
  • Identification of nurses information needs
  • Systems modeling and evaluation

10
By the end of the 1990s
  • Innovative Curriculum Models for Nursing
    Informatics responsive to the World Wide Web,
    e-mail, international standards movement,
    inexpensive and powerful personal computers,
    user-friendly software, changes in the Health
    Care System, health care financing, evidence
    based practice, and assuring cost-effectiveness
    in health care
  • Since 1998 the American Association of Colleges
    of Nursing have identified core competencies
    related to the use of Information Technology for
    promoting professional knowledge and documenting
    and evaluating patient care, and teaching
    patients about information technology
  • The National League for Nursing Accrediting
    Commission (NLNAC) has informatics related core
    competencies in their accreditation criteria
  • Source Murphy, Abbott, Brennan, Gassert (AMIA,
    1997)

11
Nursing Informatics Education Model (Riley and
Saba in Saba and McCormick, 1996)
  • The Nursing Informatics Education Model (NIEM)
    identified four steps
  • Basic Computer Skills
  • Application of computers to document and access
    health information
  • Advanced concepts to utilize information systems
    in clinical agencies and to implement patient
    care simulated case studies
  • Integrate computer technology into nursing care
    including evaluation, quality improvement,
    interdisciplinary collaboration and utilization
    of available resources

12
Multiple Nursing Informatics Organizational
Structures
  • AMIA American Medical Informatics Association
    Nursing Informatics Working Group
  • ANIA American Nursing Informatics Association
  • HIMSS Healthcare Information and Management
    Systems Society and regional nursing informatics
    chapters
  • CARING Capital Area Roundtable on Informatics
    in Nursing
  • PSNI - Puget Sound Nursing Informatics Group
  • NISCNE - Nursing Information Systems Council of
    New England
  • SCINN South Carolina Informatics Nursing
    Network
  • BANIC Boston Areas Nursing Informatics
    Consortium
  • DVNCN Delaware Valley Nursing Computer Network
  • MANI Midwest Alliance for Nursing Informatics
  • UNIN Utah Nursing Informatics Network..and
    they all have web-sites and excellent leaders
  • OTHERS..

13
Classifications Integrated into Major Clinical
and Management Information Systems
  • ?Eclypsis
  • ?Cerner
  • ?Siemens
  • ?ERGO
  • ?McKesson Horizon Clinicals
  • ?Nurses Aide
  • ?Aurora Health
  • ?OTHERS

14
Nursing Vocabularies and Classifications
integrated into Health Information Standards
  • UMLS
  • SNOMED
  • HL7

15
Developed International ISO Reference Terminology
Model
  • International effort to develop framework for
    reference terminology model

16
Nurses Have Risen to the Challenge
  • We have a critical mass of faculty
  • We have a critical mass of students
  • We have nurses in high positions doing
    outstanding Models of Nursing practice
  • We have nurses in high positions developing
    innovation research findings
  • BUT have WE supported our funders of training and
    research?
  • ------Who are the champions for Nursing
    Informatics on Capital Hill?
  • -------Who can inform society of this
    entrepreneurial group of nurses?
  • ? BUT have WE supported our nurses who represent
    us on the standards groups?
  • ? Do WE have the data on who is in this group?
  • ? BUT have WE supported our executive nurse
    leaders in Industry?
  • ? BUT have WE supported our senior policy level
    nurses in Government/DoD?
  • BUT have WE supported our senior executive
    managers in getting sufficient resources to
    support nursing partnerships?
  • BUT have WE provided a forum to

17
25 YEARS
  • A quarter century of growth, innovation,
    transformation in nursing informatics

18
Today
  • "By computerizing health records, we can avoid
    dangerous medical mistakes, reduce costs, and
    improve care." George W. Bush - State of the
    Union Address - Jan 20, 2004

19
US has a Critical Mass of Nurses in Informatics
  • CARING estimates 5000 nurses in informatics
  • Academia
  • Industry
  • Government
  • Consulting Companies
  • Professional Organizations

20
Today - Investments in Information Technology are
Increasing
  • Recent American Hospital Association, and Cap
    Gemini forecasts confirms top issues and health
    care and hospitals are increasingly investing in
    information technology as a means to deal with
  • Rising costs and Limited access to capital
  • Scare Labor
  • Patient care and safety
  • Medical-report complexities, and
  • Public Health emergencies
  • Competition eroding profits
  • More Demanding Consumers

21
Trends in Health Care - 2020
  • Demographic Trends the graying of America
  • Growth in chronic diseases
  • Emerging Infectious Disease threats
  • Changes in Health Seeking Behavior on the
    Internet
  • Focus on Quality Focus on Informatics
  • Security and Biodefense
  • Genetic revolution

22
Change in Population Growth 2000-2020Source
Maddy Dychtwald.,Cycles How we will Live, Work
and Buy, 2003
23
Aging Centric versus Youth Centric
  • Demographics indicate a shift from youth centric
    to an aging centric society

24
Types of Chronic Diseases-2020
  • Ischemic Heart Disease
  • Unipolar Major Depression
  • Road Traffic Accidents
  • Cerebrovascular Disease
  • Chronic Obstructive Pulmonary Disease
  • Lower Respiratory Infections
  • Tuberculosis
  • War
  • Diarrheal diseases
  • HIV
  • Source Murray and Lopez, 1996

25
Why children die?
  • Mixed causes 33
  • Unintentional Injuries 22
  • Congenital Anomalies 12
  • Homicide and Suicide 8
  • Short Gestation 8
  • SIDS 5
  • Cancer 4
  • Respiratory Distress 2
  • Heart Disease 2
  • Placental Cord Membranes 2
  • Complications of Pregnancy 2
  • Source When Children Die, 2003, p4.

26
Emerging Infectious Diseases
  • Respiratory infections
  • HIV/AIDS
  • Diarrheal diseases
  • Tuberculosis
  • Malaria
  • Measles
  • Pertussis
  • Tetanus
  • Meningitis
  • Syphilis
  • Source WHO, 2002

27
Health Seekers have moved to the Internet
  • Internet 55
  • TV 44
  • Health Magazines 37
  • TV ads 18
  • Pharmacy Sites 18
  • Source Exploring Challenges, Progress and New
    Models for Engaging the Public in the Clinical
    Research Enterprise, 2003, p38

28
Improving Quality
  • Employing Evidence-Based Practice
  • Applying Quality Improvement Methods
  • Utilizing Informatics
  • Source Health Professions Education A Bridge to
    Quality, 2003, p46

29
Health Diversity by 2050
  • White 50
  • Hispanic 25
  • Black 14
  • Asian/Pacific Islander 10
  • American Indian 1

30
Security and BiodefenseProtect-Mitigate-Respond-R
ecover
  • Surveillance
  • Preparedness Planning and Readiness
  • Control and Prevent Disease
  • Assure Vaccine and Drug Delivery
  • Assure Communication and Dissemination of
    Information
  • Emergency Response
  • Quarantine
  • Mobilization
  • Field reporting via wireless
  • Education and Training

31
Security and Biodefense
  • Real-time Decision Support
  • Database Integration and Interoperability
  • Assure Service Delivery
  • Sustain and Improve Delivery
  • Monitor Safety and Side Effects
  • User Registration
  • Data Standards
  • Information Security
  • Policies and Practices

32
Types of Threats
  • Biologic result in disease
  • Chemical result in burns, disease
  • High Explosive result in trauma, disease
  • Radiological and Nuclear result in trauma,
    disease

33
Critical Infrastructure Protection
  • Food, water, agriculture, public health,
    emergency services, government, defense,
    information and communication, energy,
    transportation, finance and banking, chemical and
    hazardous materials, postal and shipping, and
    national monuments

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What makes us different?
  • 99.9 identical
  • Single nucleotide polymorphisms (SNPs) these are
    individual point changes. Although 99.9
    identical, the 3 million SNPs that occur about
    once every thousand bases account for the
    remaining 0.1 that makes us unique
  • 1.3 million SNPS currently in the consortium
    database

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Francis Collins (2003), Director, NHGRI
says.........
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The Vision for Clinical Functional Genomics
Systems
  • A general purpose, programmable clinical
    laboratory on a chip
  • Disease-specific gene expression signatures for
    diagnosis and therapy planning
  • Personal Genomics

54
Trends in IT
  • Mobile Computing/Technology
  • Bioinformatics/Laboratory Information Management
    Systems
  • Claims Processing
  • Identify Management Smart Cards
  • Electronic Health Record Clinical Information
    Systems Computer-Based Patient Records-
    Hospital Healthcare Information Systems
  • Data Warehousing
  • Decision Support
  • Disease Management/Outcomes
  • HIPAA Compliance

55
TRENDS in IT Continued
  • Medication Error Prevention/Patient Safety
  • Telecommunications/Telehealth/Telemedicine
  • Outsourcing Services
  • Point of Care Computing
  • Prescription Management
  • Practice Management
  • Scheduling
  • Security
  • Speech Recognition
  • Standards
  • Supply Ordering/Management
  • Vocabulary Integration/Interface
  • Web Portals

56
Our Nurse Managers are facing.
  • Newer levels of business rigor in technology
    investments
  • Transformations in clinical care with improved
    technology (bar coding, electronic records,
    e-prescriptions, consumers on the web)
  • Redesigning core business processes
  • Outsourcing non-core functions
  • Complying with HIPAA and other standards
    regulations
  • Collaboration between payers and providers
  • New benefit models for employees
  • Redirections in medical management efforts
  • Emphasis on organizational ethics and
    institutional governance
  • Community approaches to biological threats
  • Source Cap Gemini Ernst Young Forecast

57
Nurse Informaticians Role
  • Understand what is coming
  • Develop SOLUTIONS
  • Predict new laboratory and clinical assessments
  • Develop new analysis tools, decision supports,
    mobile linkages
  • Educate others - health providers, consumers,
    informatics professionals
  • Know the tools available to integrate into IT
    systems e.g., NCHPEG Genetic Core Curriculum

58
After the Standards, What?.
  • Need a core group of experts to develop
    implementation guidelines
  • Use case scenarios
  • Practice applications of reference terminology
    models
  • Comparative studies of different terminologies
  • Administrative utilization of reference
    terminologies
  • Education models for teaching reference
    terminologies
  • Integration of reference terminologies into
    evidence based practice models

59
Demonstrated Research
  • Links nursing informatics to knowledge that has
    significant benefit to patient care, outcomes,
    public health, home care, etc.
  • Meta-Analysis of Research findings in Nursing IT
    since the 1993 recommendations

60
Need Additional Support for
  • Infrastructure Human, material, financial in
    education and clinical settings for nursing
    informatics in education, practice, government,
    policy, standards, biodefense, public health,
    home health care, research and consulting industry

61
Who will nurture our champions?
  • On CAPITAL HILL
  • At the National Institutes of Health
  • In the Division of Nursing
  • In the NLN
  • In the AACN
  • In the Government Research Communities
  • In the Foundations

62
Partnerships are Needed
  • Within Settings
  • Across Settings
  • With the Private Sector

63
Recommendations
  • A comprehensive National Nursing Informatics
    Strategy in Education
  • An update of the comprehensive research Strategy
    for Nursing Informatics

64
Follow-up Contacts
Kathleen McCormick, Ph.D.(Senior Principal) SRA
International, Inc. 11300 Rockville Pike, Suite
501 Rockville, MD 20852 (240) 221-2023 (240)
221-2009 (301) 670-0282 Home (202) 550-7211
Cell kathleen_mccormick_at_sra.com
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