Nursing, Professional Curiosity and Big Data CoCreating eHealth.

This paper describes work that has taken place over the past three years in the form of an annual deep dive study track within a national conference setting. The work explores the changing influence that big data, and in particular population and social determinants of health data, makes upon the generation of co-created eHealth within a nursing domain. Working with delegates, many of whom returned year after year, the paper reports the discussion themes and ideas that evolved over time. The paper is presented as an example of connected reasoning and personal development by all those involved and is offered as a distributed think tank for further discussion and debate.

Population health: a nursing action plan.

The passage of the Affordable Care Act shifted the focus of health care from individual, patient specific, episodic care, towards health management of groups of people with an emphasis on primary and preventive care. Population health management assists to attain and maintain health while improving quality and lowering costs. The recent Catalyst for Change report creates an urgent call for harnessing the power of nurses-in our communities, schools, businesses, homes and hospitals-to build capacity for population health. Informatics Nurse Specialists are prepared to bridge roles across practice, research, education, and policy to support this call. Each year, the AMIA Nursing Informatics Working Group convenes an expert panel to reflect on the "hot topics" of interest to nursing. Not surprisingly, the 2017 topic was on the current state and challenges of population health. The following summary reflects the panel's perspectives and recommendations for action.

Evaluation of a Postdischarge Call System Using the Logic Model.

This mixed-method study was conducted to evaluate a postdischarge call program for congestive heart failure patients at a major teaching hospital in the southeastern United States. The program was implemented based on the premise that it would improve patient outcomes and overall quality of life, but it had never been evaluated for effectiveness. The Logic Model was used to evaluate the input of key staff members to determine whether the outputs and results of the program matched the expectations of the organization. Interviews, online surveys, reviews of existing patient outcome data, and reviews of publicly available program marketing materials were used to ascertain current program output. After analyzing both qualitative and quantitative data from the evaluation, recommendations were made to the organization to improve the effectiveness of the program.

Using Clinical Decision Support and Dashboard Technology to Improve Heart Team Efficiency and Accuracy in a Transcatheter Aortic Valve Implantation (TAVI) Program.

Heart Team meetings are becoming the model of care for patients undergoing transcatheter aortic valve implantations (TAVI) worldwide. While Heart Teams have potential to improve the quality of patient care, the volume of patient data processed during the meeting is large, variable, and comes from different sources. Thus, consolidation is difficult. Also, meetings impose substantial time constraints on the members and financial pressure on the institution. We describe a clinical decision support system (CDSS) designed to assist the experts in treatment selection decisions in the Heart Team. Development of the algorithms and visualization strategy required a multifaceted approach and end-user involvement. An innovative feature is its ability to utilize algorithms to consolidate data and provide clinically useful information to inform the treatment decision. The data are integrated using algorithms and rule-based alert systems to improve efficiency, accuracy, and usability. Future research should focus on determining if this CDSS improves patient selection and patient outcomes.

Using Dashboard Technology and Clinical Decision Support Systems to Improve Heart Team Efficiency and Accuracy: Review of the Literature.

AIM: This review aimed to provide a comprehensive overview of the current state of evidence for the use of clinical dashboards and clinical decision support systems (CDSS) in multidisciplinary teams. METHODS: A literature search was performed for the dates 2004-2014 on CINAHL, Medline, Embase, and Cochrane Library. A citation search and a hand search of relevant papers were also conducted. RESULTS: (One hundred and twelve full text papers were retrieved of which 22 were included in the review.) There was considerable heterogeneity in setting, users, and indicators utilized. Information on usability and human-computer interaction was thoroughly reviewed. There was evidence that dashboards were associated with improved care processes when end-user input was incorporated and information was concurrent, pertinent and intuitive. CONCLUSION: There is some evidence that implementing clinical dashboards and/or CDSS that provide immediate access to current patient information for clinicians can improve processes and patient outcomes.

Nursing and eHealth: Are We Preparing Our Future Nurses as Automatons or Informaticians?

The Education Working Group of IMIA NI present this thought provoking panel where the changing and challenging role of nursing will be explored within the information intensive eHealth arena. The session will be of interest to any nurse as the discussion will be driven by the objective of trying to understand how best to prepare nurses to be actively engaged in information and communication technology (ICT) developments that enhance care assessment, delivery, evaluation and audit. As a balance, the discussion will consider the increasing emergence of 'nursing by numbers' where risk assessment tools are used in an automatic way leaving little room for individual evidenced based care.

Exploring Community Planning Thinking as a Model for Use Case Development.

There are many vetted technical and semantic standards promulgated within the United States and the United Kingdom to operationalize eHealth interoperability in order to improve care outcomes, manage population health, and provide efficient information exchange between providers, services, patients and consumers. However, consideration must be given to the complex real world use cases in which the data and information will be exchanged between a wide variety of interested parties, including the consumer or patient. In many instances, community based use cases need development in order to serve as the model. These use cases can only be accurately described and created by using a wide lens viewpoint such as community-planning engages, which requires that all interested parties be actively involved. This poster will introduce models of community planning that can be developed and led by the Nurse Informatician.

Electronic Personal Health Record Use Among Nurses in the Nursing Informatics Community.

An electronic personal health record is a patient-centric tool that enables patients to securely access, manage, and share their health information with healthcare providers. It is presumed the nursing informatics community would be early adopters of electronic personal health record, yet no studies have been identified that examine the personal adoption of electronic personal health record's for their own healthcare. For this study, we sampled nurse members of the American Medical Informatics Association and the Healthcare Information and Management Systems Society with 183 responding. Multiple logistic regression analysis was used to identify those factors associated with electronic personal health record use. Overall, 72% were electronic personal health record users. Users tended to be older (aged >50 years), be more highly educated (72% master's or doctoral degrees), and hold positions as clinical informatics specialists or chief nursing informatics officers. Those whose healthcare providers used electronic health records were significantly more likely to use electronic personal health records (odds ratio, 5.99; 95% confidence interval, 1.40-25.61). Electronic personal health record users were significantly less concerned about privacy of health information online than nonusers (odds ratio, 0.32; 95% confidence interval, 0.14-0.70) adjusted for ethnicity, race, and practice region. Informatics nurses, with their patient-centered view of technology, are in prime position to influence development of electronic personal health records. Our findings can inform policy efforts to encourage informatics and other professional nursing groups to become leaders and users of electronic personal health record; such use could help them endorse and engage patients to use electronic personal health records. Having champions with expertise in and enthusiasm for the new technology can promote the adoptionof electronic personal health records among healthcare providers as well as their patients.

Electronic personal health record use among registered nurses.

INTRODUCTION: Nurses promote self-care and active participation of individuals in managing their health care, yet little is known about their own use of electronic personal health records (ePHRs). The purpose of this study was to examine factors associated with ePHR use by nurses for their own health management. METHODS: A total of 664 registered nurses working in 12 hospitals in the Maryland and Washington DC area participated in an online survey from December 2013 to January 2014. Multiple logistic regression models identified factors associated with ePHR use. RESULTS: More than a third (41%; 95% confidence interval [CI], 0.37-0.44) of the respondents were ePHR users. There was no variation between ePHR users and nonusers by demographic or job-related information. However, ePHR users were more likely to be active health care consumers (i.e., have a chronic medical condition and take prescribed medications; odds ratio [OR] = 1.64; 95% CI, 1.06-2.53) and have health care providers who used electronic health records for care (OR = 3.62; 95% CI, 2.45-5.36). CONCLUSIONS: Nurses were proactive in managing their chronic medical conditions and prescribed medication use with ePHRs. ePHR use by nurses can be facilitated by increasing use of electronic health records.

Second Life simulation as a strategy to enhance decision-making in diabetes care: a case study.

AIMS AND OBJECTIVES: The case study evaluated the Second Life perceived usability and the decision-making of insulin administration via situational awareness at two different simulation freezes during Second Life simulation. BACKGROUND: Due to safety issues stemming from nursing knowledge deficits of insulin administration, the use of simulation via practice in a virtual immersive environment, Second Life was evaluated in a case study of practicing nurses. DESIGN: This case study used a single convenience group, post-test design. METHODS: Perceived usability was evaluated using the System Usability Scale. Evaluation of decision-making was evaluated via Situational Awareness Score at two simulation freezes in the Second Life simulation with practicing nurses (n = 12). RESULTS: Nurses with more years of practice reported difficulty in using Second Life. As age increased, the total Situational Awareness Score decreased. Day shift nurses were more likely to obtain a High Situational Awareness Score. CONCLUSIONS: Although usability was nearly obtained, virtual immersive environments for nurses has promise to provide practice in aiding clinical decision-making. RELEVANCE TO CLINICAL PRACTICE: Finding a new platform to allow all nurses to practice difficult clinical decisions is key. A virtual immersive environment, like Second Life, can provide simulation for nurses to practice making such difficult decisions.

Data analytics: making the most of input with strategic output.

In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the authors will describe data analytics and explore the potential for data analytics in meaningful use implementation to enhance executive decision making.

Medication reconciliation across the continuum of care: a meaningful use mandate.

In this department, the authors highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, Drs Wilson, Murphy, and Newhouse discuss use of information technology to support the process of medication reconciliation as mandated by Meaningful Use Stage 2 and The Joint Commission.

Improving care transitions through meaningful use stage 2: continuity of care document.

In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demon strate innovative approaches to organizational problems. In this article, the authors describe the elements of continuity of care documentation, how sharing information can improve the quality and safety of care transitions and the implications for nurse executives.

Patients' access to their health information: a meaningful-use mandate.

This department highlights topics in nursing outcomes, research, and evidence-based practice relevant to nurse administrators. In this article, the authors describe patient access to personal health information as it relates to the meaningful-use requirement, technologies that have been used to enhance patient engagement, and the nursing leadership implications.

Meaningful use: intersections with evidence-based practice and outcomes.

In this department, Drs Newhouse and Wilson highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the authors describe the implications of meaningful use implementation to evidence-based practice and outcome measurement and discuss issues facing nurse executives in planning for these changes.

Terminology use in electronic health records: basic principles.

Electronic health records (EHRs) are a cost-saving and environmentally friendly means for documenting patient care and improving patient safety, quality, and evidence-based practice. Standardized clinical classification systems and terminologies are essential ingredients of the EHR. Their selection must be driven by a clear understanding of requirements for their use and application. This article describes the principle uses of clinical information and motives for consistency in practice, and provides a distinction between classification systems and reference terminologies for clinical settings.