Nursing Informatics' Contribution to One Health.

OBJECTIVES: To summarise contemporary knowledge in nursing informatics related to education, practice, governance and research in advancing One Health. METHODS: This descriptive study combined a theoretical and an empirical approach. Published literature on recent advancements and areas of interest in nursing informatics was explored. In addition, empirical data from International Medical Informatics Association (IMIA) Nursing Informatics (NI) society reports were extracted and categorised into key areas regarding needs, established activities, issues under development and items not current. RESULTS: A total of 1,772 references were identified through bibliographic database searches. After screening and assessment for eligibility, 146 articles were included in the review. Three topics were identified for each key area: 1) education: "building basic nursing informatics competence", "interdisciplinary and interprofessional competence" and "supporting educators competence"; 2) practice: "digital nursing and patient care", "evidence for timely issues in practice" and "patient-centred safe care"; 3) governance: "information systems in healthcare", "standardised documentation in clinical context" and "concepts and interoperability", and 4) research: "informatics literacy and competence", "leadership and management", and "electronic documentation of care". 17 reports from society members were included. The data showed overlap with the literature, but also highlighted needs for further work, including more strategies, methods and competence in nursing informatics to support One Health. CONCLUSIONS: Considering the results of this study, from the literature nursing informatics would appear to have a significant contribution to make to One Health across settings. Future work is needed for international guidelines on roles and policies as well as knowledge sharing.

Representing knowledge, data and concepts for EHRS using DCM.

With the move towards next generations of Electronic Health Record Systems (EHRS), the focus changes from administrative and data retrieval and data entry system capabilities towards clinical functions. The representation of the clinical knowledge and evidence base into EHRS becomes an important asset for health care, with its own challenges. Clinician's do want EHRS support but do not want to standardize care, they do want unified terminology and structured data entry but also free text. In addition, information modelers challenge each other for the best solution, and care pathways and other workflows seem to differ for each situation. Such diverging approaches add complexity to the already difficult situation around Information Technology in health care, the EHRS in particular. This paper argues that a change is necessary to adopt Detailed Clinical Modeling as a method to organize clinical knowledge, represent concepts and define data in such a manner that it allows for semantics to be exchanged without being trapped in a specific technology. DCM help to fulfill the requirements for the enter data once, reuse multiple times paradigm for EHRS.

Bridging the HL7 template - 13606 archetype gap with detailed clinical models.

The idea of two level modeling has been taken up in healthcare information systems development. There is ongoing debate which approach should be taken. From the premise that there is a lack of clinician's time available, and the need for semantic interoperability, harmonization efforts are important. The question this paper addresses is whether Detailed Clinical Models (DCM) can bridge the gap between existing approaches. As methodology, a bottom up approach in multilevel comparison of existing content and modeling is used. Results indicate that it is feasible to compare and reuse DCM with clinical content from one approach to the other, when specific limitations are taken into account and precise analysis of each data-item is carried out. In particular the HL7 templates, the ISO/CEN 13606 and OpenEHR archetypes reveal more commonalties than differences. The linkage of DCM to terminologies suggests that data-items can be linked to concepts present in multiple terminologies. This work concludes that it is feasible to model a multitude of precise items of clinical information in the format of DCM and that transformations between different approaches are possible without loss of meaning. However, a set of single or combined clinical items and assessment scales have been tested. Larger groupings of clinical information might bring up more challenges.

Semantic Cross-Mapping Execution of Data in the Perinatal Registry of the Netherlands.

INTRODUCTION: The electronically submitted data from midwives and hospitals to the Netherlands perinatal registry vary significantly in their data definitions, and electronic message versions. The purpose of this article is to describe the semantic cross-mapping tool and execution procedure to prepare the data for statistical analysis. METHODS: requirements analysis, design, development and testing. RESULTS: The tool for governance of versions of datasets, CIMs, data, and value sets is designed, developed, and tested. The test is based on the data-mart of version PRN 1.3 based data from 2019. Data are semantically cross mapped to current version perinatology data 2.2. CONCLUSION: The cross-mapping of PRN 1.3 data to perinatology 2.2 data are defined in the tool, testing revealed this mapping is successful.

Sending electronic nursing discharge messages using the HL7 v3 Care Provision standard.

There is a growing need to exchange nursing related information electronically from one health care professional to another, crossing institutional, time and language boarders. Both continuity of care, care for populations, decision support and secondary use of patient data are valid uses of nursing information. Achieving electronic exchange of nursing information requires information analysis, modeling, standardization and deployment in electronic health systems. The HL7 working group 'Patient Care' has developed a set of HL7 v3 messages that allows nursing content to be specified and exchanged between electronic patient record systems, or systems deployed for secondary data use. This contribution discusses the dynamics of the process and the use of electronic messages for continuity of care. Also, the use of nursing terminology and assessment scales within HL7 v3 messages is illustrated. The Care Provision message is useful for sending structured nursing information between health care facilities.

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group.

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

Using detailed clinical models to bridge the gap between clinicians and HIT.

Two level object modelling has been introduced in recent health care IT standards, such as Health Level 7 version 3, CEN/ISO 13606 and OpenEHR. Generic functions of electronic health records and electronic messages can be developed in such a way that they become independent of the clinical data, but allow its data management. Clinical data are elicited from clinicians and modelled in the form of clinical statements or archetypes. Such clinical statements or archetypes can be standardized and inserted into the technology upon choice of clinicians. This allows flexibility in development using collections of standardized models. Detailed clinical models (DCM) thus make clinical data explicit, allowing its use in multiple standards and multiple technologies. This paper presents an overview of work for DCM including a workshop in Brisbane in 2007 and project proposals for HL7, CEN and ISO joint standardization work.

ROC van Twente: nursing education in care and technology.

The ROC van Twente offers nursing education at the diploma level (MBO), and is innovating the program to include a major/minor structure for education about care and technology. In order to achieve this, a new position was created: the Master Docent, Care and Technology. The task of the master docent includes development of education for nursing about technology, multidisciplinary cooperation, and service to health care institutions among others. The first development concerns a module about electronic patient records, standards, and semantic interoperability for continuity of care. The module is delivered to nursing students and to students from the information technology department, who work jointly in 'development teams'. This paper describes the background, the development of the educational material and program, and the core content of the module. The core content are the care information models that link clinical materials with health care information standards. The program has started end November 2006. At the Medinfo 2007 conference the results of the course for the first group of about 40 students will be presented.

Architecture for Variable Data Entry into a National Registry.

INTRODUCTION: The Dutch perinatal registry required a new architecture due to the large variability of the submitted data from midwives and hospitals. The purpose of this article is to describe the healthcare information architecture for the Dutch perinatal registry. METHODS: requirements analysis, design, development and testing. RESULTS: The architecture is depicted for its components and preliminary test results. CONCLUSION: The data entry and storage work well, the Data Marts are under preparation.

Informatics Competencies in Connected Health: Annotated Bibliography.

In this book it is of course impossible to be complete on all competencies publications, or all relevant subjects. For that reason the Post Conference Team decided to have some pages of the book reserved for annotations. An annotation is seen as a short reference to another topic or publication, not included in this book, and a brief motivation from one of us, why this might be of interest to the readers.

Introduction: Forecasting Informatics Competencies for Nurses in the Future of Connected Health.

This introduction to the book discusses how the topic of competencies for nurses in a world of connected health needs to be addressed at the curriculum level to achieve the specific competencies for various roles, including practicing nurse, nurse teacher, nurse leader, and nursing informatics specialists. It looks back at milestone publications from the international Nursing Informatics post conferences that still serve a purpose for inspiring developments today and looks forward to the way nurses can use connected health to improve the health and health care for their patients. Specific emerging topics in health information technology are addressed as well, such as semantics, genetics, big data, eHealth and social media.

Information Architecture for Perinatal Registration in the Netherlands.

In the Netherlands, the perinatal registry has undergone significant changes in the past decades. The purpose of this article is to describe the current health care information architecture for the national perinatal registry, including how the national data set is arranged and how electronic messages are used to submit data. We provide implications for women's health care providers based on the creation and implementation of the Dutch perinatal registry system.

Intelligent semantic interoperability: Integrating knowledge, terminology and information models to support stroke care.

INTRODUCTION: Electronic patient record (EPR) systems for the continuity of care for stroke patient are under development. These systems are based on standards such as for clinical practice, vocabularies, and the HL7 information model. PROBLEM STATEMENT: In order to achieve intelligent semantic interoperability, knowledge about evidence based patient care, vocabulary and information models need to be integrated. METHODOLOGY: A format was developed in which the clinical knowledge, clinical terminology, and standard information models are integrated as specification for the technical implementation of electronic health systems and electronic messages. This format is verified by clinicians and technicians. RESULTS: The document structure consists of meta-information such as version control and changes, purpose of the clinical content, evidence from the literature, variables and values, terminology used, guidelines for application and interpretation, HL7 message models, coding, and technical data specification. Further, XML message excerpts, archetypes and screen designs are developed from these documents to facilitate implementation. CONCLUSION: The combination of these aspects in one document creates valuable content for intelligent semantic interoperability by means of development of messages and systems.

Evaluation of documents that integrate knowledge, terminology and information models.

Healthcare depends on evidence for practice and for electronic exchange of clinical patient information. To standardize the information that is being exchanged we created a format for describing care related information: a care information model. This model integrates knowledge, terminology and an information model. During a meeting between experts on nursing, standards and electronic patient records we evaluated the format of the care information model by use of an evaluation form and a group discussion. In general, the experts were enthusiastic about the format of the care information model. However they missed specific information about the purpose of the documents, and clarity on copyright issues. In addition, detailed comments on the existing structure and suggestions for additional categories were given. Also, experts suggested representing the integration in both HL7 message model format and in OpenEHR archetype format to allow different implementations of the same intelligence. From this we can conclude that the combination of these aspects in one document creates a valuable content for development of messages and systems. However, some adjustments are needed.

Using SNOMED CT codes for coding information in electronic health records for stroke patients.

For a project on development of an Electronic Health Record (EHR) for stroke patients, medical information was organised in care information models (templates). All (medical) concepts in these templates need a unique code to make electronic information exchange between different EHR systems possible. When no unique code could be found in an existing coding system, a code was made up. In the study presented in this article we describe our search for unique codes in SNOMED CT to replace the self made codes. This to enhance interoperability by using standardized codes. We wanted to know for how many of the (self made) codes we could find a SNOMED CT code. Next to that we were interested in a possible difference between templates with individual concepts and concepts being part of (scientific) scales. Results of this study were that we could find a SNOMED CT code for 58% of the concepts. When we look at the concepts with a self made code, 54.9% of these codes could be replaced with a SNOMED CT code. A difference could be detected between templates with individual concepts and templates that represent a scientific scale or measurement instrument. For 68% of the individual concepts a SNOMED CT could be found. However, for the scientific scales only 26% of the concepts could get a SNOMED CT code. Although the percentage of SNOMED CT codes found is lower than expected, we still think SNOMED CT could be a useful coding system for the concepts necessary for the continuity of care for stroke patients, and the inclusion in Electronic Health Records. Partly this is due to the fact that SNOMED CT has the option to request unique codes for new concepts, and is currently working on scale representation.

Cross-mapping between three terminologies with the international standard nursing reference terminology model.

PURPOSE: The International Standards Organization's (ISO) International Standard IS 18104 should assist the nursing profession to integrate their terminologies into computer systems and healthcare reference terminologies. The purpose of this study is to cross-map between different terminologies; that is, to determine if concepts in one terminology are similar to concepts in another terminology. METHODS: The ISO standard was used to test the degree to which three terminologies could be cross-mapped to each other. Concepts and terms were selected, their equivalence determined by experts, and the specific concepts were dissected or broken down to their constituent parts. RESULTS: Based on experts' selections from the three classifications, equivalent concepts were identified. Those concepts deemed equivalent were dissected, thus revealing whether the components of the nursing diagnostic concepts such as focus, judgment, and other attributes of the ISO standard matched. Based on the dissection of each diagnosis, the decision was made whether mapping was possible or not. CONCLUSIONS: The dissection revealed that several nursing diagnostic concepts can easily be interchanged, while others cannot or can be mapped only for specific purposes (e.g., clinical or aggregate use). This implies that for some concepts it does not matter which terminology is used, and in other cases it does because of different meanings.

Strategic Deployment of Clinical Models.

The selection, implementation, and certification of electronic health records (EHR) could benefit from the required use of one of the established clinical model approaches. For the lifelong record of data about individuals, issues arise about the permanence and preservation of data during or even beyond a lifetime. Current EHR do not fully adhere to pertinent standards for clinical data, where it is known for some 20 plus years that standardization of health data is a cornerstone for patient safety, interoperability, data retrieval for various purposes and the lifelong preservation of such data. This paper briefly introduces the issues and gives a brief recommendation for future work in this area.

Checking the Quality of Detailed Clinical Models: Instrument Application.

BACKGROUND: The exchange of clinical data between electronic health records is a challenge and need flexible models that adapt to clinical needs. Detailed Clinical Models (DCM) are used for this purpose, however, what is their quality? This paper's objective is to report on the application of an existing instrument to determine DCM quality. METHODS: A selection of 9 DCMs about oncology care was tested using the 'Quality Metrics for DCM'. RESULTS: The instrument revealed scores per DCM varying from 16 to 26, rendering one DCM insufficient and five requiring upgrading. CONCLUSION: The instrument proved practical in its administration and revealed useful feedback for DCM improvement. A core part of a DCM, the actual specification of data elements, is not included in the instrument and is suggested to be added.

Strategies for Leveraging Interoperable Health Information Exchange Systems Among Healthcare Communities.

The panel will share international Health Information Exchange (HIE) projects to improve quality and lower costs in healthcare communities (i.e. hospitals, clinician practices, and aged care facilities). HIE allows healthcare professionals and patients to appropriately access and securely share a patient's vital medical information electronically within and across organizations. Intended audience: Researchers, consumers, practitioners, vendors, care providers, and policy makers with interests in technology design, development, implementation, and management, particularly focused on HIE.

Linking nursing care to medical diagnoses: heterogeneity of patient groups.

AIM: The new budget system for Dutch hospitals makes use of patient groups that are highly homogeneous in terms of diagnosis and treatment combinations (diagnose behandeling combinaties (DBC)). These DBCs are the Dutch DRG variants. The DBC mainly concerns medical care; nursing care is almost regarded as a constant factor. In this study the DBC is linked to the nursing minimum data set for The Netherlands (NMDSN), to explore the degree of homogeneity in terms of nursing care for patient groups that are homogeneous in terms of the DBC. METHOD: In nine Dutch hospitals, patient information was collected by means of the NMDSN. To answer the question, we performed a secondary data analysis on the NMDSN. First, groups were formed in terms of medical diagnoses as defined in the DBC. Next, explorative statistical analyses were used to form homogeneous groups in terms of nursing diagnoses. These groups were compared in terms of the nursing care interventions and in terms of medical diagnoses. FINDING: Some medical diagnoses seem to be homogeneous, others more heterogeneous in terms of nursing care. DISCUSSION AND CONCLUSION: Limitations in the study design hinder a firm conclusion. However, the results discourage the use of the medical DBC for nursing care.