Automatically detecting activities of daily living from in-home sensors as indicators of routine behaviour in an older population.

Objective: The NEX project has developed an integrated Internet of Things (IoT) system coupled with data analytics to offer unobtrusive health and wellness monitoring supporting older adults living independently at home. Monitoring involves visualising a set of automatically detected activities of daily living (ADLs) for each participant. ADL detection allows the incorporation of additional participants whose ADLs are detected without system re-training. Methods: Following a user needs and requirements study involving 426 participants, a pilot trial and a friendly trial of the deployment, an action research cycle (ARC) trial was completed. This involved 23 participants over a 10-week period each with ∼20 IoT sensors in their homes. During the ARC trial, participants took part in two data-informed briefings which presented visualisations of their own in-home activities. The briefings also gathered training data on the accuracy of detected activities. Association rule mining was used on the combination of data from sensors and participant feedback to improve the automatic ADL detection. Results: Association rule mining was used to detect a range of ADLs for each participant independently of others and then used to detect ADLs across participants using a single set of rules for each ADL. This allows additional participants to be added without the necessity of them providing training data. Conclusions: Additional participants can be added to the NEX system without the necessity to re-train the system for automatic detection of their ADLs.

HL7-FHIR-Based ContSys Formal Ontology for Enabling Continuity of Care Data Interoperability.

The rapid advancement of digital technologies and recent global pandemic-like scenarios have pressed our society to reform and adapt health and social care toward personalizing the home care setting. This transformation assists in avoiding treatment in crowded secondary health care facilities and improves the experience and impact on both healthcare professionals and service users alike. The interoperability challenge through standards-based roadmaps is the lynchpin toward enabling the efficient interconnection between health and social care services. Hence, facilitating safe and trustworthy data workflow from one healthcare system to another is a crucial aspect of the communication process. In this paper, we showcase a methodology as to how we can extract, transform and load data in a semi-automated process using a common semantic standardized data model (CSSDM) to generate a personalized healthcare knowledge graph (KG). CSSDM is based on a formal ontology of ISO 13940:2015 ContSys for conceptual grounding and FHIR-based specification to accommodate structural attributes to generate KG. The goal of CSSDM is to offer an alternative pathway to discuss interoperability by supporting a unique collaboration between a company creating a health information system and a cloud-enabled health service. The resulting pathway of communication provides access to multiple stakeholders for sharing high-quality data and information.

Developing a standardized national undergraduate curriculum for future healthcare professionals on self-management support for chronic conditions.

This is a report on the development of the second part of a national undergraduate interprofessional standardized curriculum in chronic disease prevention for healthcare professionals in the Republic of Ireland; National Undergraduate Curriculum for Chronic Disease Prevention and Management Part 2: Self-management Support for Chronic Conditions. The development processes involved in Part 1, Making Every Contact Count for Health Behavior Change, were described earlier. This report presents an overview of the development of a national self-management support curriculum and barriers and enablers encountered. The curriculum was developed by a National Working Group, with interprofessional representation from each of the Higher Education Institutions (HEIs) in Ireland and the national health service, i.e. the Health Service Executive (HSE). All phases of the project were overseen by a Steering Group and supported in each HEI by a local working group. The aim of the curriculum is to introduce standardized self-management support education across all undergraduate and graduate entry healthcare programmes nationally to prepare future healthcare professionals with knowledge, skills and attitudes to support individuals to self-manage their chronic conditions.

FHIR Based ContSys Ontology to Enable Continuity of Care Data Interoperability.

In the midst of a global pandemic, perspectives on how digital can enhance healthcare service delivery and workflow to address the global crisis is underway. Action plans collating existing digital transformation programs are being scrutinized to set in place core infrastructure and foundations for sustainable healthcare solutions. Reforming health and social care to personalize the home care setting can for example assist in avoiding treatment in a crowed acute hospital setting and improve the experience and impact on both health care professionals and service users alike. In this information intensive domain addressing the interoperability challenge through standards based roadmaps is the lynchpin to enable health and social care services to connect effectively. Thus facilitating safe and trustworthy data workflow from one healthcare systems provider to another. In this paper we showcase a methodology on how we can extract, transform and load data in a semi-automated process using a Common Semantic Standardized Data Model (CSSDM) to generate personalized healthcare knowledge graph (KG). CSSDM is based on formal ontology of ISO 13940:2015 ContSys for conceptual grounding and FHIR based specification to accommodate structural attributes to generate KG. CSSDM we suggest enables data harmonization and data linking. The goal of CSSDM is to offer an alternative pathway to speak about interoperability by supporting a different kind of collaboration between a company creating a health information system and a cloud enabled health service. This pathway of communication provides access to multiple stakeholders for sharing high quality data and information.

Development of an Internet of Things Technology Platform (the NEX System) to Support Older Adults to Live Independently: Protocol for a Development and Usability Study.

BACKGROUND: In a rapidly aging population, new and efficient ways of providing health and social support to older adults are required that not only preserve independence but also maintain quality of life and safety. OBJECTIVE: The NEX project aims to develop an integrated Internet of Things system coupled with artificial intelligence to offer unobtrusive health and wellness monitoring to support older adults living independently in their home environment. The primary objective of this study is to develop and evaluate the technical performance and user acceptability of the NEX system. The secondary objective is to apply machine learning algorithms to the data collected via the NEX system to identify and eventually predict changes in the routines of older adults in their own home environment. METHODS: The NEX project commenced in December 2019 and is expected to be completed by August 2022. Mixed methods research (web-based surveys and focus groups) was conducted with 426 participants, including older adults (aged ≥60 years), family caregivers, health care professionals, and home care workers, to inform the development of the NEX system (phase 1). The primary outcome will be evaluated in 2 successive trials (the Friendly trial [phase 2] and the Action Research Cycle trial [phase 3]). The secondary objective will be explored in the Action Research Cycle trial (phase 3). For the Friendly trial, 7 older adult participants aged ≥60 years and living alone in their own homes for a 10-week period were enrolled. A total of 30 older adult participants aged ≥60 years and living alone in their own homes will be recruited for a 10-week data collection period (phase 3). RESULTS: Phase 1 of the project (n=426) was completed in December 2020, and phase 2 (n=7 participants for a 10-week pilot study) was completed in September 2021. The expected completion date for the third project phase (30 participants for the 10-week usability study) is June 2022. CONCLUSIONS: The NEX project has considered the specific everyday needs of older adults and other stakeholders, which have contributed to the design of the integrated system. The innovation of the NEX system lies in the use of Internet of Things technologies and artificial intelligence to identify and predict changes in the routines of older adults. The findings of this project will contribute to the eHealth research agenda, focusing on the improvement of health care provision and patient support in home and community environments. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35277.

ContSOnto: A Formal Ontology for Continuity of Care.

The global pandemic over the past two years has reset societal agendas by identifying both strengths and weaknesses across all sectors. Focusing in particular on global health delivery, the ability of health care facilities to scale requirements and to meet service demands has detected the need for some national services and organisations to modernise their organisational processes and infrastructures. Core to requirements for modernisation is infrastructure to share information, specifically structural standardised approaches for both operational procedures and terminology services. Problems of data sharing (aka interoperability) is a main obstacle when patients are moving across healthcare facilities or travelling across border countries in cases where emergency treatment is needed. Experts in healthcare service delivery suggest that the best possible way to manage individual care is at home, using remote patient monitoring which ultimately reduces cost burden both for the citizen and service provider. Core to this practice will be advancing digitalisation of health care underpinned with safe integration and access to relevant and timely information. To tackle the data interoperability issue and provide a quality driven continuous flow of information from different health care information systems semantic terminology needs to be provided intact. In this paper we propose and present ContSonto a formal ontology for continuity of care based on ISO 13940:2015 ContSy and W3C Semantic Web Standards Language OWL (Web Ontology Language). ContSonto has several benefits including semantic interoperability, data harmonization and data linking. It can be use as a base model for data integration for different healthcare information models to generate knowledge graph to support shared care and decision making.

A Knowledge Graph to Understand Nursing Big Data: Case Example for Guidance.

PURPOSE: To provide a summary of research on ontology development in the Centre of eIntegrated Care at Dublin City University, Ireland. DESIGN: Design science methods using Open Innovation 2.0. METHODS: This was a co-participatory study focusing on adoption of health informatics standards and translation of nursing knowledge to advance nursing theory through a nursing knowledge graph (NKG). In this article we outline groundwork research conducted through a focused analysis to advance structural interoperability and to inform integrated care in Ireland. We provide illustrated details on a simple example of initial research available through open access. FINDINGS: For this phase of development, the initial completed research is presented and discussed. CONCLUSIONS: We conclude by promoting the use of knowledge graphs for visualization of diverse knowledge translation, which can be used as a primer to gain valuable insights into nursing interventions to inform big data science in the future. CLINICAL RELEVANCE: In line with stated global policy, the uptake and use of health informatics standards in design science within the profession of nursing is a priority. Nursing leaders should initially focus on health informatics standards relating to structural interoperability to inform development of NKGs. This will provide a robust foundation to gain valuable insights into articulating the nursing contribution in relation to the design of digital health and progress the nursing contribution to targeted data sources for the advancement of United Nations Sustainable Development Goal Three.

A micro credential for interoperability.

In the midst of a global pandemic the need for health and social care providers to commit to, and deliver on, integrated patient-centered care services has been accelerated. Globally, health and social care programme administrators are turning to digital devices and applications to provide supporting infrastructure which can offer safe access to health information at the point of care. Digitalisation is increasingly considered a key requirement to support diagnostics and therapeutic care services in health care delivery. The open source community are responding to this need to advance integrated care and digital services by providing targeted resources to address the interoperability challenge. Addressing interoperability in health systems is a core part of achieving sustainable enterprise wide integrated care. Using Open Innovation 2.0 methods for advancing knowledge on interoperability, this paper describes the development of a micro credential for knowledge transfer on interoperability created by the Centre for eIntegrated Care (CeIC). Designed and developed to signpost interested stakeholders to targeted material and build understanding and capacity on the topic. The design approach and initial resource content are explained through the lens of a specific research project funded by an Elite S Fellowship to advance leadership and standardisation for Information and Communications Technology (ICT) in Europe.

The practice doctorate approach to assessing advanced nursing practice in Ireland.

AIM: To describe the practice doctorate scholarly approach to assess advanced nursing practice in Ireland to address healthcare and nursing policy initiatives. BACKGROUND: A global team from Ireland and the United States collaborated with stakeholders, using a practice doctorate approach to identify geographic healthcare needs, the current state of the education and the evolving roles of advanced nursing practice. In Ireland, current policy initiatives call for expanding the capacity for advanced nurse practitioners to meet healthcare needs in community settings. SOURCES OF EVIDENCE: Further assessment data were required from stakeholders to inform graduate nursing education to prepare advanced practice nurses to fulfil increasingly complex healthcare needs. The practice doctorate approach included review of literature, current policy and assessment with interviews, dialogue and the development of working relationships with policymakers, academics and practitioners. DISCUSSION: The current state and future vision of graduate nursing education are evolving. A force field analysis identified promoting and restraining factors to the desired state of development of the primary care advanced practice role. Relationship building with stakeholders and sharing of expertise was key to engage academia and policymakers to address identified restraining forces. Short-term outcomes included development of collaborative relationships between practice, academia and policymakers, curricular development for the primary care nurse practitioner and intentionally shared dissemination to promote community graduate nursing education. IMPLICATIONS FOR NURSING PRACTICE: This innovative practice scholarship approach was used to assess and promote advanced nursing practice impact and promote the nursing profession globally. IMPLICATIONS FOR POLICY: Successful collaboration between two global partners was achieved to promote policy objectives for both nursing and health care, with the ultimate goal of improving health outcomes and population health.

From Entry to Practice to Advanced Nurse Practitioner - The Progression of Competencies and How They Assist in Delivery of eHealth Programs for Healthy Ageing.

Most of the health issues encountered in persons of older age are the result of one or more chronic diseases. The evidence base reports that chronic diseases can be prevented or delayed by engaging in healthy behaviors. Education provides a cost effective intervention on both economic grounds in addition to delivery of optimal patient outcomes. Information and Communication Technology (ICT) increasingly is viewed as a critical utility in eHealth delivery, providing scope for expanding online education facilities for older persons. Developing nursing competencies in the delivery of eHealth solutions to deliver user education programs therefore makes sense. This chapter discusses nursing competencies on the development of targeted eHealth programs for healthy ageing. The role of Advanced Nurse Practitioner in Ireland and its associated competency set identifies how a strong action learning model can be designed to deliver eHealth educational programs for effective delivery of healthy ageing in place.

Using Education Technology as a Proactive Approach to Healthy Ageing.

Bone Health in the Park was created in Ireland and is an online health promotion education resource focussing on bone health, healthy ageing and falls prevention. The programme was designed by an Advanced Nurse Practitioner in collaboration with an Education Technologist and primarily uses storytelling to promote education specifically on bone health and falls risk prevention for health care professionals, clients, families and informal carers. This paper reports on core deliverables from this programme from 2010 to 2015, and provides insight into their development, in addition to details on its clinical effectiveness by using technology enhanced learning to underpin health promotion initiatives.

Transition to blended learning: experiences from the first year of our blended learning Bachelor of Nursing Studies programme.

BACKGROUND: The School of Nursing at Dublin City University offered a new blended learning Bachelor of Nursing Studies programme in the academic year 2011. AIM: To document the experiences of the academic team making the transition from a face-to-face classroom-delivered programme to the new blended learning format. METHOD: Academics who delivered the programme were asked to describe their experiences of developing the new programme via two focus groups. RESULTS: Five dominant themes were identified: Staff Readiness; Student Readiness; Programme Delivery and Student Engagement; Assessment of Module Learning Outcomes and Feedback; and Reflecting on the First Year and Thinking of the Future. Face-to-face tutorials were identified as very important to both academics and students. Reservations about whether migrating the programme to an online format encouraged students to engage in additional practices of plagiarism were expressed by some. Student ability/readiness to engage with technology-enhanced learning was an important determinant of their own success academically. DISCUSSION: In the field of nursing blended learning is a relatively new and emerging field which will require huge cultural shifts for staff and students alike.

OC17 - Merging the person and the illness: the lived experience of emerging adults with childhood onset chronic illness.

Theme: Transition of care.

Instantiating informatics in nursing practice for integrated patient centred holistic models of care: a discussion paper.

AIM: A discussion on how informatics knowledge and competencies can enable nursing to instantiate transition to integrated models of care. BACKGROUND: Costs of traditional models of care are no longer sustainable consequent to the spiralling incidence and costs of chronic illness. The international community looks towards technology-enabled solutions to support a shift towards integrated patient-centred models of care. DESIGN: Discussion paper. DATA SOURCES: A search of the literature was performed dating from 2000-2015 and a purposeful data sample based on relevance to building the discussion was included. DISCUSSION: The holistic perspective of nursing knowledge can support and advance integrated healthcare models. Informatics skills are key for the profession to play a leadership role in design, implementation and operation of next generation health care. However, evidence suggests that nursing engagement with informatics strategic development for healthcare provision is currently variable. IMPLICATIONS FOR NURSING: A statistically significant need exists to progress health care towards integrated models of care. Strategic and tactical plans that are robustly pragmatic with nursing insights and expertise are an essential component to achieve effective healthcare provision. To avoid exclusion in the discourse dominated by management and technology experts, nursing leaders must develop and actively promote the advancement of nursing informatics skills. For knowledge in nursing practice to flourish in contemporary health care, nurse leaders will need to incorporate informatics for optimal translation and interpretation. CONCLUSION: Defined nursing leadership roles informed by informatics are essential to generate concrete solutions sustaining nursing practice in integrated care models.