Applying Strategy to Practice Making Solutions Become Reality

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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

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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

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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

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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

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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

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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..

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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

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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

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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

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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)

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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

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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..

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Classifications Integrated into Major Clinical
and Management Information Systems

• ?Eclypsis
• ?Cerner
• ?Siemens
• ?ERGO
• ?McKesson Horizon Clinicals
• ?Nurses Aide
• ?Aurora Health
• ?OTHERS

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Nursing Vocabularies and Classifications
integrated into Health Information Standards

• UMLS
• SNOMED
• HL7

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Developed International ISO Reference Terminology
Model

• International effort to develop framework for
  reference terminology model

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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

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25 YEARS

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

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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

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US has a Critical Mass of Nurses in Informatics

• CARING estimates 5000 nurses in informatics
• Academia
• Industry
• Government
• Consulting Companies
• Professional Organizations

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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

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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

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Change in Population Growth 2000-2020Source
Maddy Dychtwald.,Cycles How we will Live, Work
and Buy, 2003
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Aging Centric versus Youth Centric

• Demographics indicate a shift from youth centric
  to an aging centric society

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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

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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.

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Emerging Infectious Diseases

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

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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

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Improving Quality

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

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Health Diversity by 2050

• White 50
• Hispanic 25
• Black 14
• Asian/Pacific Islander 10
• American Indian 1

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Partnerships are Needed

• Within Settings
• Across Settings
• With the Private Sector

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Recommendations

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

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Follow-up Contacts
Kathleen McCormick, Ph.D.(Senior Principal) SRA
International, Inc. 11300 Rockville Pike, Suite
501 Rockville, MD 20852 [phone] (240)
221-2009 [phone] Home [phone]
Cell kathleen_mccormick_at_sra.com