Health Informatics Penetrating Nurse Education– An examination of the Aims Overall Health Informatics Education Through Planning, Implementation, Evaluation and Administration of Information Resources in Health Sector PIRKKO KOURI PhD, PHN, RN Principal Lecturer in Healthcare Technology, Savonia University of Applied Sciences, Finland Member of eHealth Strategic Group at the ICN Member of ICN Telenursing Advisory Board Member of IMIA-NI Education working group Secretary of Finnish Society of Telemedicine and eHealth Board CONFERENCE : HINZ, Health Informatics into Clinical Practice TIME: November 7th – 9th 2012, PLACE : Energy Events Centre, Rotorua, NZ
Contents• Concepts around Health Informatics and e-Health• eHealth phase – brief national viewpoint from Finland• Health Informatics Education – Standarised nursing language – ICT – eHealth - Educational change – Three examples of HI-related education projects• ICN eHealth programme• Learning today and future
Health Informatics 1/2• Health Informatics is a scientific field• e-Health is a domain of practice• Both are about the use of information and information -and communication technologies for improved healthcare services and thus indirectly for better health
Health Informatics 2/2• Health Informatics is a scientific field – E.g., ‘mixture’ of technology, particularly artificial intelligence, computer science, and informational science relates to the health care field. -> field of study is applied to nursing, clinical care, public health, and biomedical research, for instance Jobs in Health Informatics field: • Nursing information officer • Chief information officer • Medical informatics specialist/Health informatics specialist • Certified health information specialist • Informatics consultant • Information systems manager • Clinical informaticist • Project manager in health information • Healthcare administrator • Medical and health services manager
WHO: eHealth• eHealth is the use of information and communication technologies (ICT) for health.• Examples include treating patients, conducting research, educating the health workforce, tracking diseases and monitoring public health. – EPR, Telehealth and telecare, Decision making support systems and online knowledge sources, Web-based patient information and PHRs, Social networking groups, etc… http://www.who.int/topics/ehealth/en/
Public Health and ICT Policy - European UnionTelehealth was first….eHealth, the integration of telehealth technologies withthe Internet..eHealth means1. the use of modern information and communication technologies (ICT) in support of health and health-related fields, and2. to meet needs of citizens, patients, healthcare professionals, healthcare providers as well as policy makers.3. eHealth covers the interaction between citizens/patients and health-service providers, institution-to-institution transmission of data, or peer-to-peer communication between citizens/patients and/or health professionals.
Health care education - Telecommunication• (Tele)phoning• Videoconferencing• Using Simulation laboratories• Social media, Moodle, Adobe connect pro, Skype, SL
eHealth use by GPs• Storage of administrative patient data• Storage of medical patient data• Use of a computer during consultation• Use of a Decision Support System• Transfer of administrative patient data to reimburses or other carers• Transfer of lab results from the laboratory• Transfer of medical patient data to other carers• e-PrescribingSource: empirica, Pilot on eHealth Indicators, 2007.
Facts about Finland• Population 5 400 000• People under 15 years constitute about 18 % of the total population• People over 65 years some 15 %. The population is aging.• Life expectancy was 83.2 years for women and 76,7 years for men in 2010.• Home of Nokia, Linux and Santa Claus• The proportional ratio of mobile phones and internet connections is very high
Finnish Telehealth/eHealth policy development• 1996: Strategy for Utilising Information and Communication Technology in the field of Social Welfare and Healthcare (citizen-centred, seamless service-chain, horizontal integration of social and health services)• 1998: Update of the strategy, placing emphasis on several issues, e.g. digital patients records, nationwide interoperability or privacy protection• 2002: Decision-in-Principle by the Council of State for the introduction of nationwide patient records• 2007, and 2009: “eHealth Roadmap for Finland” is published by the Ministry of Social Affairs and Health eHealth strategy 2010
Legal acts - Telehealth/eHealth development1999 Personal Data Act2000 Act on Experiments with Seamless Service Chains in Social Welfare and Care Services2001 Decree on the Storing of Patient Data2007 Regulation on the Use of Electronic Social and Healthcare Client and Patient Information from, also called the “Client Data Act”2007 Legislation on the Use of ePrescription2011 1st of May New Health Care Act
Finnish eHealth development• Nationwide archive system (KanTa), connected to e- prescribing and personal health records (on process – pilots) – Within the KanTa the internet-based eView service for citizens is being developed.• Early political commitment to e-health issues, making it well-prepared for e-health products and services.
Data stored in the national eArchive:First phase- Administrative/ demographics- Electronic medication record- GP record/ summary- Medical record- Referral and discharge letters- Laboratory results Challenges: in the areas of interoperability and the decentralisation of the healthcare system.- Radiology reports- Summary of nursing information- Emergency care data- Log informationNext steps- Radiology, endoscopy etc images- Medical statements- Dental healthcare- Biosignals PKo 2012
Nursing documentation – an integral part of development
Nursing Information Reference Model L a ye r 5 S tru c tu re in te rn a tio n a l N M D Sc h a ra c te ris tic s : L a ye r 4 : s e rv ic e ite m s NMDS: e n v iro n m e n t n a tio n a l P o lic y d e c isio n s c o n te xt p u rp o s e s L a ye r 3 : U s e o f N u rs in g M in im u m D a ta S e t N M D S o n In s titu tio n a l le v e l M anagem ent d e c is io n s U n ifie d L a ye r 2 : d o c u m e n ta tio n o f: n u rs in g N u rs in g d ia g n o se s te rm in o lo g y N u rs in g in te rv e n tio n s fo r c o m p a ra b le O u tc o m e s o f n u rs in g c a re d a ta : IC N P ® L a ye r 1 : F a c ts : C lin ic a l d e cisio n s - D e m o g ra p h ic a l d a ta - O b s e rv a tio n s : s ig n s & s ym p to m s - A e tio lo g y: fa c ts c a u s a l re la tio n s / d a ta o th e r d is cip lin e s e tc . Epping & Goossen 1997
The Use Of Nursing Data In Patient Care ManagementTurku University Hospital /Orthopedics
Use of structured nursing data MULTIDISCIPLINARY INFORMATION RETRIEVAL SUMMARIES INFORMATION ABOUTSYSTEMATIC DOCUMENTATION HEALTH STATUS AND PROGRESS OF NURSING CARE OF NURSING CARE NURSING STATISTICSNurses care 80% for the patients AND REPORTS By David Benton CEO in ICN eARCHIEVE
Moving more toward communities --- personalised care --- eHealth
Tools for Citizens – challenge for NursesMobile phone uHealth Digi-TV tools … or using printers Computer/PC Writing notes Tarja Meristö 25.3.2010
How to linkages Consumers/Citizens and Healthcare Personnel?
People/community-centred approach in health care• Legislation supports• Increase of patient/client/consumer/community independence• At the same time, patients themselves create, access, process and exchange information about their health situation
Using health information to• Promote healthy living (personal, community)• Empower individuals and community about e.g. drugs• Provide resources for the health of the people• Enlighten patients on self-care• Educate on diseases and conditions• Make decision regarding products and services• Keep health care professionals updated about client’s conditionSource: Retha de la Harpe, CPUT/SA, presentation 2012
Health information ICN eHealth programmePatients
Future Citizen participating in his/her health care path• Self care & Following – at home • Result documentation • Sending/receiving results e.g portable monitoring systems/ on-line feedback• eView • (Patient) health records • Laboratory results• Appointments - online booking• Information share - reporting • Q/A • Health history forms • Electronic interviews• Locating services• Controlling/Managing payment orders• Information search, health information networks and health literacySlide by Pekka Muukkonen 25.3.2010
Health Informatics –Three Educational Projects
INDEHELA-ICI curriculum development briefly Pirkko Kouri, senior advisor www.uef.fi/indehela/ici
Summary• the INDEHELA-ICI (Institutional Collaboration Instrument for Informatics Development for Health in Africa) project, is funded by the Finnish Ministry for Foreign Affairs (MFA) within the new Higher Education Institutions Institutional Collaboration Instrument (HEI ICI) programme.• The project focuses on developing the capacities of three African HEIs in HI and e-health education.
PartnersThe African partners:• Obafemi Awolowo University (OAU), Department of Computer Science andEngineering (CScE), Ile-Ife, Nigeria• Eduardo Mondlane University (UEM), Department of Mathematics and Informatics(DMI), Maputo, Mozambique• Cape Peninsula University of Technology (CPUT), IT Department (ITD), Cape Town,South AfricaThe Finnish partners:• University of Eastern Finland (UEF), School of Computing (coordinator) andDepartment of Social and Health Management, Kuopio, Finland• Savonia University of Applied Sciences, Unit of Health Care, Kuopio, Finland
ObjectivesThe three specific objective are:• Staff development; The core groups of 6-10 junior and 3-5 senior staff• Educational capacity development; Each African has the curriculum and a timed plan for implementing its Masters and/or certificate programme• Administrative capacity development
Basis of Curriculum work – widely accepted modelRecommendations of the International Medical Informatics Association(IMIA) on Education in Biomedical and Health Informatics. Methods inInf Med 2. by Mantas, J., Ammenwerth, E.Demiris, G., Hasman, A., Haux, R., Hersh, W., Hovenga, E.Lun, K.C., Marin, H., Martin-Sanchez, F. and Wrigth, G. 2010.Source: http://www.schattauer.de/en/magazine/subject-areas/journals-a-z/methods/contents/archive/issue/1053/manuscript/12538.html
Sub-disciplines within HI Dimension of IT History, Tech. Info. Software Comp. Comp. Math & Adapted from: Saranto K, Korpela M, eds. Tietotekniikka ja philosophy assessm Systems Eng. Eng. Science physics tiedonhallinta sosiaali- ja terveydenhuollossa, WSOY 1999 ent Dimension of wellness services Health Paradigm of Paradigm of Paradigm of promotion organisational Engineering Natural Self-help by and work Sciences citizens sciences Healthcare delivery system Healthcare Health IS management Social services & sciences Nursing work Nursing & science Informatics Clinical medicine Medical Informatics Biomedical research Other6 Feb 2012 biosciences Mikko Korpela 36
Information systems for healthcare delivery Information system for inter-organizational Information system forKorpela et al., HELINA’2003: Preconditions for sustainable … networking in citizen-to-healthcare healthcare = ”IOHIS” linkages = ”eHealth” H e a lth c e n tre s T e a c h in g h o s p ita l G e n e ra l h o s p ita l M a na ge me nt M a na ge me nt M a na ge me nt Contr ol, C lin ic s , c oor dination, Inf or mation r es our c es s p e c ia ltie s H e a lth S u p p o rt H e a lth H e a lth C a re re co rd s C a re re co rd s C a re C itiz e n s , re co rd s se rvi ce s p ro vi sio n p ro vi sio n p ro vi sio n c o m m u n itie s Ser v ic es Ser v ic es Health s er v ic es Inf or mation Data Needs Needs Health needs S o c ia l s e rv ic e s Information system for clinical healthcare Information system for delivery = CIS regional integration of P riv a te c lin ic s e tc . L e g e n d: healthcare and social For mal or ganiz ation services = ”RHSIS” N G O s , tra d it io n a l Ac tiv ity h e a le rs , e tc . Need/s er v ic e r elations hip
Information systems for healthcare management N a tio n a l h e a lth a d m in is tra t io n Information system for district Information system S ta te / p ro v in c e health management = DHMIS Contr ol,Korpela et al., HELINA’2003: Preconditions for sustainable … c oor dination, h e a lth a d m in is t ra tio n L o c a l g o v e rn m e n t for national Inf or mation r es our c es D is tric t h e a lth Contr ol, healthcare Inf or mation c oor dination, r es our c es a d m in is tra t io n management = Contr ol, c oor dinatio n, NHMIS Inf or mation r es our c es H e a lth c e n tre s T e a c h in g h o s p ita l G e n e ra l h o s p ita l M a na ge me nt M a na ge me nt M a na ge me nt Contr ol, C lin ic s , c oor dination, Inf or mation r es our c es s p e c ia ltie s H e a lth S u p p o rt H e a lth H e a lth C a re re co rd s C a re re co rd s C a re C itiz e n s , re co rd s se rvi ce s p ro vi sio n p ro vi sio n p ro vi sio n c o m m u n itie s Ser v ic es Ser v ic es Health s er v ic es Inf or mation Data Needs Needs Health needs S o c ia l s e rv ic e s Information system for healthcare facility management = ”HFMIS” P riv a te c lin ic s e tc . L e g e n d: For mal or ganiz ation N G O s , tra d it io n a l Ac tiv ity h e a le rs , e tc . Need/s er v ic e r elations hip
FUNDAMENTALS OF HEALTH INFORMATICS EDUCATION developed during INDEHELA-ICI Workshop 3, 6-10 Feb 2011, AOU, Ile Ife, Nigeria1. Basic terms and concepts in Health Informatics2. Health care systems3. Information recording in healthcare4. Using information for healthcare professional5. Using Health Information for patients and communities6. Information systems in healthcare7. Using information technologies in Healthcare8. Socio-technical issues in healthcare9. Integration of service, work and information flows in practice10. Legal and ethical issues11. Principles of project management
Basic terms and concepts in Health Informatics 2/2Learning outcomes (tentative):At the end the learner should be able to:1.1 Explain the difference between data, information andknowledge,1.2 Describe the manifestation of health informatics as adiscipline and e-health as a practice.1.3 Describe health informatics related concepts in relation tohealth informatics and e-healthAssessment (tentative)
Learning methods Independent learning Home work Identifying own learning needs Learning activities Independent practice eLearning Interviewing Problem solving Evaluation of Reading Acquiring and evaluating learning Observing Group work knowledge Reflecting Study groups Writing Inde Learning Face-to-face Group works and sessions Practice periods discussions Simulations Skill tests Study visits Exams Evaluation –giving and receiving Face-to-face learning 41
Sexual Health Centre‘Ayvot’ projectProject funded by European Social Fund
Partners Finnish On-line University of Applied Sciences (coordinator), Hiv support centre, Sexpo Foundation, Helsinki Deaconess Institute, Lahti University of Applied Sciences (LAMK), Jyväskylä University ofApplied Sciences (JAMK), Centria University of Applied Sciences, Turku University of Applied Sciences, Häme University of Applied Sciences (HAMK) and Laurea University of Applied Sciences.
The project creates• Aims of the learning environment: – offer modern tools for interaction between the teachers and the learners, especially youngsters – enhance learning – increase motivation for information acquisition
Sexual health centre•Open and authentic learning environment forsexual health : Seksuaaliterveysasema.fi•Sexual health centre can be used in –education for social services and health care –further education –independent information acquisition –teacher education, when applicable•The learning environment acknowledges the vastscope of sexual health, diversity and the course of aperson’s life
Image 1. Front page of the sexual health centre. At this point the contents are only in Finnish.
Contents of the sexual health centreThe topics include: –safe sex and sexually transmitted disease –sexual rights –relationships –sexual violence –sexual dysfunction –safety on-lineLearning at the centre is made more interesting by e.g.: – videos – discussions – authentic customer cases
Travelling & Sexual HealthImage 2. Course at the sexual health centre. The course contents will be published in early 2013.
Project Whole Name Funding Objectives A Virtual ideal home for 2010-2013 To renew the teaching and learningHIMA Senior Citizens as a learning processes and methods with(Finnish and development regard to the care of old peopleslang for the environment and gerontological teaching byword Home) developing a virtual ideal home for Senior Citizens in the Second Life virtual world. To develop a learning game for theoretical studies. On top of the virtual studies a practical training among Senior Citizens is included.
The IDEAL HOME• Second Life is an online virtual world in Internet where users can socialize, connect and create using free voice and text chat• Interaction with each other happens through avatars, a digital ‘person’, that a student can create and customize.• Aim is provide elderly people’s home and environment as unimpeded and safe as possible
The IDEAL HOME IN SECOND LIFE• Learning material for elderly care studies• Information and networking forum for the companies and associations• Updating education environment to social and health care professionals• Pilot is ongoing, at the moment our students are practising and app. 400 senior citizens involved
The BUILDING in IDEAL HOMEBuilding includes information about security, accessibility, domestic lighting...Companies and associations are using this building as an exhibition area, today28 companies and 13 associations present their products in the Ideal home
LEARNING MATERIAL in IDEAL HOME• Exercises, for example: – Life stories – Ethical issues – Older people´s ability to function – Different appliances – Social and health care services – Nutrition – Medication• Multiprofessional learning environment – Practical nurses, nurses, midwifes, public health nurses, social workers etc.
VIVA GAME as part of HIMA project• Virtual home visits - > different home environments – Three different clients – Three different life stories – > Students can practice there e.g. How to behave at client´s home, Interaction skills, Home modifications, Medication, for instance
VIVA GAME: clientsIltaleena, 77- years old woman, who has memory disease. She is living with her husband.Viljo, 67 years old single man. He has problems with his circulation.Viivi, 63 years old woman, who has problems with alcohol. She is living alone.Memory disease, circulation problems and alcohol problems are very common within older people.
VIVA- GAME – Iltaleena`s homeThis is Iltaleena´s home outside. Before student can start playing the game theymust notice a task: they must sweep snow off from the outdoor stairs. After that it ispossible to go inside and continue playing.
Iltaleena`s home insideDuring practice period students meet real older people. (senior citizen`s home or other placeshaving a laptop with her/him). They play together Viva-game
Collaboration with Different EnterpisesIdeal home - enterprises Ideal home – private health care providers
Collaboration with othersIdeal home – voluntary associations, parishes The Association of Finnish Pensioners The Finnish Parkinson Association Finnish Rheumatism Association Carers Association The Alzheimer Society of Finland (in local level) Local Cancer Association The Association for Stroke Patients Orthodox Church
eHealth ProgrammeInternational Council of Nurses
Leading thought If we cannot name it, we cannot control it, finance it, research it, teach itor put it into public policy. (Clark & Lang 1992) 64
eHealth Strategic Advisory Group at the ICN, Oct 2012, GenevaChair prof Nicholas Hardiker
ICN eHealth programme• Transforming nursing through the visionary application of information and communication technology• Over 20 years of making• Announced at the ICN conference in Malta, 2011 ICN – Advansing Nursing and Health Worldwide
ICN eHealth Programme Goals• Transforming nursing through the visionary application of information and communication technology• To be recognised as an authority on eHealth (professional)• To be positioned centrally in the eHealth community (business) http://www.icn.ch/pillarsprograms/ehealth ICN – Advansing Nursing and Health Worldwide
Why ICN eHealth?• ICN informs, supports and advocates for nursing and its members• Worldwide proliferation of ICT• ICT in health care provides new opportunities, not least equity and improved access• eHealth threads through ICN processes and products ICN – Advansing Nursing and Health Worldwide
International Classification for Nursing Practice (ICNP®)• ICN has supported ICNP® since 1989• A standardised terminology used to represent nursing diagnoses, interventions and outcomes• Available in 15 languages• A formal infrastructure that facilitates cross-mapping and allows output in multiple formats• A related classification in the WHO Family of International Classifications• Harmonisation agreement in place with IHTSDO* (SNOMED-CT)• Collaborative agreements with other nursing terminologies* International Health Terminology Standards Development Organisation
ICN Accredited Centres for ICNP® Research & Development• Australia – Canberra – ICNP® and evidence-based practice• Australia – Flinders – ICNP® and disaster nursing• Brazil – Development and use of ICNP®• Chile – ICNP® and family nursing• German-speaking countries – 3 NNAs and 3 national user groups – Translation - Development and use of ICNP®• Iran – Translation - Development and use of ICNP®• Korea – Translation - Development and use of ICNP®• Poland – Translation - Development and use of ICNP®• Portugal – Improve quality of care through Nursing Information Systems and ICNP®• USA – ICNP® and minimum data sets
..Connecting nurses..• A forum for expert healthcare professionals from around the world to share their ideas, advice and innovations• Learning from each others• A contest that highlights nursing innovations and helps to put them into practice http://www.information-shareapy.com/
FUTURE…Learning is changing.. Challenging education
Today --- Fast Forward 25-30 Years…• Right care - right patient - right medication - right time…right documented (literate)-------------------- ICT/eHealth --------------------• “Anyone can now learn anything from anyone at any time.” (also illiterate)
Education 2022: Improve ICT skills of users (citizens, patients, health professionals)1. Learner-Driven – > patient driven –> community driven2. Openly Accessible3. Personalized4. Social (MOOC = Massive open online course )5. Ubiquitous6. Holistic7. Teaching Redefined -> nurse counselling, teaching methods8. Policy Redefined9. Industry Engaged10. Achievement RedefinedSource: Lecture Education 2022: A 360 Degree View Ten predictions of 2022by Curtis J. Bonk, Professor, Indiana University,http://trainingshare.com/pdfs/I_am_Not_content_Deakin.pdf
We-all-learn: Ten Forces that Opened the Learning World eHealth era 1. Web Searching in the World of e-Books 2. eLearning and Blended Learning 3. Availability of Open Source and Free Software 4. Leveraged Resources and OpenCourseWare 5. Learning Object Repositories and Portals 6. Learner Participation in Open Info Communities 7. Electronic Collaboration and Interaction 8. Alternate Reality Learning (e.g., MMOG*, Second Life) 9. Real-Time Mobility and Portability (e.g., iPhone) 10. Networks of Personalized Learning (e.g., Blogs) * MMOG = massively multiplayer online game Source: Lecture Education 2022: A 360 Degree View Ten predictions of 2022 by Curtis J. Bonk, Professor, Indiana University, http://trainingshare.com/pdfs/I_am_Not_content_Deakin.pdf
Issues Timeline…. How to Can you trust handleCan we trust Can you non-visit health information the trust care? on the Internet? Internet? personal health records? 1998 1999 2000 How to handle Should patients patients with How to say see their health Internet health “I don’t Know”? information? information? Lab Reports? C. P Waegemann’s presentation 2008 in Stakes