Applying Strategy to Practice – Making Solutions Become Reality

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Applying Strategy to Practice – Making Solutions Become Reality

  1. 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. 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. 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 won’t have a hospital….so let’s work on improving it
  4. 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. 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. 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. 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. 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. 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. 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. 11. Nursing Informatics Education Model (Riley and Saba in Saba and McCormick, 1996) The Nursing Informatics Education Model (NIEM) identified four steps: 1) Basic Computer Skills 2) Application of computers to document and access health information 3) Advanced concepts to utilize information systems in clinical agencies and to implement patient care – simulated case studies 4) Integrate computer technology into nursing care including evaluation, quality improvement, interdisciplinary collaboration and utilization of available resources
  12. 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. 13. Classifications Integrated into Major Clinical and Management Information Systems Eclypsis Cerner Siemens ERGO McKesson Horizon Clinicals Nurse’s Aide Aurora Health OTHERS……
  14. 14. Nursing Vocabularies and Classifications integrated into Health Information Standards • UMLS • SNOMED • HL7
  15. 15. Developed International ISO Reference Terminology Model • International effort to develop framework for reference terminology model
  16. 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. 17. 25 YEARS • A quarter century of growth, innovation, transformation in nursing informatics
  18. 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. 19. US has a Critical Mass of Nurses in Informatics • CARING estimates 5000 nurses in informatics – Academia – Industry – Government – Consulting Companies – Professional Organizations
  20. 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. 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. 22. Change in Population Growth 2000-2020 Source: Maddy Dychtwald.,Cycles: How we will Live, Work and Buy, 2003 -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% Under 14 15-24 25-34 35-44 45-54 55-65 65+
  23. 23. Aging Centric versus Youth Centric • Demographics indicate a shift from youth centric to an aging centric society
  24. 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. 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. 26. Emerging Infectious Diseases • Respiratory infections • HIV/AIDS • Diarrheal diseases • Tuberculosis • Malaria • Measles • Pertussis • Tetanus • Meningitis • Syphilis • Source: WHO, 2002
  27. 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. 28. Improving Quality • Employing Evidence-Based Practice • Applying Quality Improvement Methods • Utilizing Informatics • Source: Health Professions Education: A Bridge to Quality, 2003, p46
  29. 29. Health Diversity by 2050 • White – 50% • Hispanic – 25% • Black – 14% • Asian/Pacific Islander – 10% • American Indian – 1%
  30. 30. Security and Biodefense Protect-Mitigate-Respond-Recover • 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. 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. 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. 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
  34. 34. 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
  35. 35. Francis Collins (2003), Director, NHGRI says.........
  36. 36. 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”
  37. 37. 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
  38. 38. 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
  39. 39. 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
  40. 40. Nurse Informatician’s 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
  41. 41. 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
  42. 42. 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
  43. 43. 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
  44. 44. 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
  45. 45. Partnerships are Needed • Within Settings • Across Settings • With the Private Sector
  46. 46. Recommendations • A comprehensive National Nursing Informatics Strategy in Education • An update of the comprehensive research Strategy for Nursing Informatics
  47. 47. 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@sra.com

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