Representing Nursing Practice in EMR/EHRs.

OBJECTIVE: Review of the ISO 18104 technical standard for a Nursing Categorial structure to best represent nursing practice in EMR/EHRs and digital health ecosystems. METHODS: Application of ISO standard review guidelines in consultation with ISO member stakeholders. RESULTS: Comprehensive views of the nursing practice knowledge domain are presented as mindmaps. Groups of patients can now be identified using the 'type of subject of care' category. The collaborative role of nurses is now recognized. This high level structured information model recognises nursing diagnosis, nursing actions and nurse sensitive outcomes relative to other categories and sub-categories known to influence nursing actions and nurse sensitive outcomes. DISCUSSION: This nursing practice framework reflects the nursing process. It supports conceptual and logical analysis of patient journey related nursing practice. CONCLUSION: This updated categorial structure is a good fit with today's information technologies. Its adoption enables the value of nursing services provided to be demonstrated.

Integrating a Categorial Structure for Clinical Practice into EHRs.

A continuing global desire to be using clinical systems within a digital health ecosystem, able to facilitate data flows and information exchange as required to support person-centred, predictive, preventative, participatory and precision (5p) health and medical care can best be supported through the use of the standard categorial structure able to represent not only the clinical nursing practice domain but also other clinical disciplines by the generic labelling of some high-level categories. It is hypothesised that adoption of this generic clinical categorial structure within any electronic health/medical record within a well connected digital health ecosystem, supported by a cloud based openEHR platform, will enable the 5p support to be realized. This presentation provides the results of the latest update of this technical standard based on the 20+ year nursing practice categorial structure development process adopted to achieve this aim and a summary about linking this categorial structure to standard terminologies and to standard EHR/EMR system architectures.

Exploring the Knowledge and Use of Standardised Nursing Terminology Across Australia.

Standardised nursing terminologies (SNTs) support the visibility of nursing work and documentation, enabling data sharing and comparison. An online survey assessed the knowledge and use of SNTs and revealed barriers and enablers to their use by Australian nurses. Just over half of the respondents were familiar with SNTs before the survey, a quarter reported a reasonable understanding of SNTs, just under half reported previous use of a SNT, and less than 14% indicated a current use of a SNT in their workplace. Perceived benefits to SNTs identified by respondents included a reduction in variation and the ability to evaluate the effectiveness of nursing care by measuring outcomes. Both barriers and enablers to the use of SNTs included education and training, standardisation and contextualisation across Australia, and integration into any electronic medical record system. Nurses are poorly informed on what SNTs are and how they can be leveraged to support their work and documentation. There is a need for an Australia-wide strategic approach to ensure the future of nurses' work is visible, and SNTs are purposefully and correctly implemented across the country.

Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics: Second Revision.

BACKGROUND: The purpose of educational recommendations is to assist in establishing courses and programs in a discipline, to further develop existing educational activities in the various nations, and to support international initiatives for collaboration and sharing of courseware. The International Medical Informatics Association (IMIA) has published two versions of its international recommendations in biomedical and health informatics (BMHI) education, initially in 2000 and revised in 2010. Given the recent changes to the science, technology, the needs of the healthcare systems, and the workforce of BMHI, a revision of the recommendations is necessary. OBJECTIVE: The aim of these updated recommendations is to support educators in developing BMHI curricula at different education levels, to identify essential skills and competencies for certification of healthcare professionals and those working in the field of BMHI, to provide a tool for evaluators of academic BMHI programs to compare and accredit the quality of delivered programs, and to motivate universities, organizations, and health authorities to recognize the need for establishing and further developing BMHI educational programs. METHOD: An IMIA taskforce, established in 2017, updated the recommendations. The taskforce included representatives from all IMIA regions, with several having been involved in the development of the previous version. Workshops were held at different IMIA conferences, and an international Delphi study was performed to collect expert input on new and revised competencies. RESULTS: Recommendations are provided for courses/course tracks in BMHI as part of educational programs in biomedical and health sciences, health information management, and informatics/computer science, as well as for dedicated programs in BMHI (leading to bachelor's, master's, or doctoral degree). The educational needs are described for the roles of BMHI user, BMHI generalist, and BMHI specialist across six domain areas - BMHI core principles; health sciences and services; computer, data and information sciences; social and behavioral sciences; management science; and BMHI specialization. Furthermore, recommendations are provided for dedicated educational programs in BMHI at the level of bachelor's, master's, and doctoral degrees. These are the mainstream academic programs in BMHI. In addition, recommendations for continuing education, certification, and accreditation procedures are provided. CONCLUSION: The IMIA recommendations reflect societal changes related to globalization, digitalization, and digital transformation in general and in healthcare specifically, and center on educational needs for the healthcare workforce, computer scientists, and decision makers to acquire BMHI knowledge and skills at various levels. To support education in BMHI, IMIA offers accreditation of quality BMHI education programs. It supports information exchange on programs and courses in BMHI through its Working Group on Health and Medical Informatics Education.

Nursing Informatics Integration into Mainstream Health Informatics.

Nursing Informatics emerged in Australia during the early 1980s and drove the Professional development and acceptance of Health Informatics. Milestones achieved include the development of a national journal, the establishment of the Health Informatics Society of Australia and the Australasian College of Health Informatics (now collectively the Australasian Institute of Digital Health), nursing participation in Health Informatics standards development activities, adoption of the HL7 messaging standard, the delivery of numerous workshops, an annual national health informatics conference since 1993, hosting international conferences, the development and delivery of Health Informatics post graduate programs and establishing a research centre where the first prototype for an archetype repository was developed. This became the openEHR Clinical Knowledge Manager. The most recent milestone was the establishment of a private company that became a Registered Training Organisation. Continuing challenges include workforce capacity building to address the poor understanding of the need for improved data and IT governance at every level, the need to comply with proven scientific and technical principles and a need to transform national and international traditional infrastructures no longer fit for purpose to enable adequately support for global sustainable digital health ecosystems. Desired personal and aggregate data supply chains must be taken seriously and be supported by the best available technologies. Our collective biggest challenge is to improve multidisciplinary and intersectoral collaboration, semantic interoperability and optimum digital support to maintain global public health.

Health informatics competencies - underpinning e-health.

There is a widespread consensus that we have an urgent need to improve our workforce capacity in all aspects associated with the skills and knowledge required for successful e-health and health informatics developments, associated change management and systems implementation strategies. Such activities aim to support various health reform policy initiatives. This paper considers the work being undertaken by many researchers around the globe to define the range of skills and knowledge requirements to suit this purpose. A number of requirements and areas of specialisation are detailed. This is followed by descriptions for competencies in general and more specifically descriptions of a set of high level agreed Health Informatics competencies. Collectively these competencies provide a suitable framework useful for the formal recognition of Health Informatics, including e-health, as a nationally recognised study discipline. Nationally agreed competencies for this discipline enables all education and training efforts to be consistently implemented and to fit with the Australian Qualifications Framework covering both the Vocational Education and Training (VET) and Higher Education sectors.

Applying the Nursing Ecosystem Concept to Developing Strategic Innovation and Entrepreneurial Leadership for Valued Patient Care.

Research confirms entrepreneurial leadership encourages entrepreneurial behaviour and an entrepreneurial culture supports the development of 'entrepreneurial mindset'. Nurses implementing and optimizing information technology need to work with numerous stakeholders that collectively make up their ecosystem. Indeed, nurses with an entrepreneurial mindset increase their ability to sense opportunities and mobilize the resources and knowledge required to seek' informatics' opportunities to deliver patient centred care across the whole ecosystem.

Health care services, information systems & sustainability.

This chapter gives an educational overview of: * many competing characteristics within national health systems * national primary information and knowledge flows between health care entities * the role of information technologies in assisting health organizations become sustainable enterprises * the business of maintaining healthy populations for any nation * desirable e-health strategy objectives.

National standards in health informatics.

This chapter gives an educational overview of: * The relationship between standards and a national e-health strategy * National and international standards development processes * The Development of a national HI standards roadmap * The benefits of standards adoption.

Resource, quality and safety management.

This chapter gives an educational overview of: * Resource management relative to sustainability and the use casemix systems * Types of resources and their information system needs to support their optimal management * Quality, performance measurement options and associated information needs * Casemix systems' characteristics, usage and need for enterprise systems.

Foundations for a nursing services reference model.

The Nursing Services Reference Model (NSRM) is presented as a theoretical position and discussion paper. The aims are to describe the components of the NSRM concept, to explain why such a model needs to be developed and to explore methodological issues in the development of a NSRM. The concept is important to address as it may illuminate a most pressing problem faced by the Australian health care industry where the content and activity of nursing practice is not embedded as computer processable data in health information system structures. Digital documentation of nursing content and activity is urgently needed to enable reliable electronic processing of nursing services. However, it is necessary, prior to this, to develop a reference model that describes the range of nursing services in an unambiguous manner.

E-health records and future healthcare.

This chapter gives an educational overview of: * Data collected, stored in health records and used for multiple purposes * Electronic health records and how these are likely to influence our future * Personal health records * Clinical systems and their relationship to national data collections * Potential future use of new technologies.

Sustainable clinical knowledge management: an archetype development life cycle.

This chapter gives an educational overview of: 1. The significance of having a formal ontology of health care data 2. How openEHR has used an ontological approach to designing an electronic health record 3. The phases of archetype development and key steps in the process 4. The openEHR architecture and integrated development environment.

Health informatics - an introduction.

This chapter gives an educational overview of: * the scope of the health informatics discipline * health informatics and e-health definitions * health informatics professional networks * potential benefits of applying health informatics technologies.

Milestones of the IMIA-NI history and future directions.

IMIA-NI's past achievements are reflected upon in the context of its current strategic directions. Two key historical milestones are described in some detail, the ISO Reference terminology model for nursing and the International Nursing Minimum Data Set development project, as this work is continuing to influence future directions in health and nursing informatics. Current features of our health care environment are explored noting the current desire of most nations to implement electronic health records (EHRs) and its relationship with IMIA-NI's strategic directions. Nurses can play their part by working collaboratively, converting their knowledge into computer processable formats, establishing the necessary professional knowledge governance infrastructure and lobbying key decision makers to establish national infrastructures that will enable the adoption and optimum use of EHRs.

Operationalising the National Nursing Informatics Position Statement.

The need for nurses and midwives to drive the digital transformation of care has been recognised as an important factor in future health care innovation. An Australian Chief Nursing Informatics Officers collaboration is leading the way. They were supported by the three professional organisations who collaboratively developed a National Nursing Informatics position statement. This paper describes the development and use of the elements described in the statement in operationalising Nursing informatics within individual healthcare organisations and for driving national digital transformation initiatives.

Technology Informatics Guiding Education Reform - TIGER.

BACKGROUND: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework. OBJECTIVES: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings. METHODS: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics. RESULTS: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains "data, information, knowledge", "information exchange and information sharing", "ethical and legal issues", "systems life cycle management", "management" and "biostatistics and medical technology", all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas. CONCLUSIONS: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.

Towards semantic interoperability for electronic health records.

OBJECTIVES: In the field of open electronic health records (EHRs), openEHR as an archetype-based approach is being increasingly recognised. It is the objective of this paper to shortly describe this approach, and to analyse how openEHR archetypes impact on health professionals and semantic interoperability. METHODS: Analysis of current approaches to EHR systems, terminology and standards developments. In addition to literature reviews, we organised face-to-face and additional telephone interviews and tele-conferences with members of relevant organisations and committees. RESULTS: The openEHR archetypes approach enables syntactic interoperability and semantic interpretability -- both important prerequisites for semantic interoperability. Archetypes enable the formal definition of clinical content by clinicians. To enable comprehensive semantic interoperability, the development and maintenance of archetypes needs to be coordinated internationally and across health professions. Domain knowledge governance comprises a set of processes that enable the creation, development, organisation, sharing, dissemination, use and continuous maintenance of archetypes. It needs to be supported by information technology. CONCLUSIONS: To enable EHRs, semantic interoperability is essential. The openEHR archetypes approach enables syntactic interoperability and semantic interpretability. However, without coordinated archetype development and maintenance, 'rank growth' of archetypes would jeopardize semantic interoperability. We therefore believe that openEHR archetypes and domain knowledge governance together create the knowledge environment required to adopt EHRs.

Healthcare in the year 2020--practice and policy.

Among the key issues facing the nursing profession as we moves towards the year 2020 are politics, policy and practice. This paper addresses these areas, as well as considering legal challenges and the question of whether nursing will exist as we currently know it. Moves away from hospital-based care towards more community-based and preventative care are considered, together with various scenarios describing possible futures.

Towards sustainability of health information systems: how can we define, measure and achieve it?

Health information systems (HIS) in their current form are rarely sustainable. In order to sustain our health information systems and with it our health systems, we need to focus on defining and maintaining sustainable Health Information System building blocks or components. These components need to be easily updatable when clinical knowledge (or anything else) changes, easily adaptable when business requirements or processes change, and easily exchangeable when technology advances. One major prerequisite for this is that we need to be able to define and measure sustainability, so that it can become one of the major business drivers in HIS development. Therefore, this paper analyses general definitions and indicators for sustainability, and analyses their applicability to HIS. We find that general 'Emergy analysis' is one possibility to measure sustainability for HIS. Based on this, we investigate major enablers and inhibitors to sustainability in a highlevel framework consisting of four pillars: clinical, technical, socio-technical, and political/business.