NENIC Year in Review€¦ · (2016). Nurses' perceptions, acceptance, and use of a novel in-room...
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NENIC Year in Review Spring 2016 – Winter 2017 May 12, 2017 Kathleen Donaher-Keough Andrew Phillips
Transcript of NENIC Year in Review€¦ · (2016). Nurses' perceptions, acceptance, and use of a novel in-room...
NENICYearinReviewSpring2016– Winter2017
May12,2017KathleenDonaher-Keough
AndrewPhillips
ConflictofInterest
KathleenDonaher-Keough andAndrewPhillipsHavenorealorapparentconflictsofinteresttoreport.
LearningObjectives
• Evaluatethemesthatimpactnursinginformatics.• Identifygapsinnursinginformaticsresearch.• Generatelogicalnextstepsinadvancingnursinginformaticsresearch.
Methods– ScopingStudy
• Arksey andO’Malley1• Step1– IdentifytheResearchQuestion• Step2– IdentifyRelevantStudies• Step3– StudySelection(Iterativeprocesswhichcanchangeovertime)• Step4– ChartingtheData• Step5– Collating,summarizing,andreportingtheresults• Step6– Consultation– Thisisyouguys
1Arksey,H.,&O'Malley,L.(2005).Scopingstudies:towardsamethodologicalframework.Internationaljournalofsocialresearchmethodology,8(1),19-32.
Step1:ResearchQuestion
• Whattrendsandthemesemergefromasurveyofthepublishedliteratureintheareaofnursinginformaticsduringthepastyear• Makemeaningofcurrentandpastthemes–historicalcontext.
Step2:IdentifyRelevantStudies
• SearchStrategy• Databases:PubMedandCINAHL• Searchterms
• ((“nurse”or“nursing”)AND“informatics”)OR“nursinginformatics”
• PublicationDates3/1/2016– 2/28/2017• Newissue– ”roamingpublicationdates”duetopublicationprocess(acceptedpublicationsbasedondatenotedinsearch)
Step3:StudySelection
InclusionandExclusionCriteria• Inclusioncriteria:Research,contributestonursinginformaticsknowledgebase,prototypedevelopmentandtesting,clinicalcaredeliveryfocus;informatics• Exclusions:Articlesthatfocusedoninformaticseducationprograms,nursingeducation,nursingstudents,competencies,simulation
Re-evaluateforfuture?
SearchResults(flowchart)
Newmethodologyadopted
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81
129
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60
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2012-2013 2013-2014 2014- 2015 2015- 2016 2016- 2017
ArticlesIncludedinEvaluation
NENICPublications
• Showofhands??
8%10%
16%
11%25%
15%
15%
ResearchbySetting(%)2016-2017
Ambulatory
Community/PublicHealth
ContinuumofCare
HealthProfessional/ExpertPanel
Hospital
LongTermCare
Other(Theory/Design/Standards)
3%0%
3%0%
58%
0%
16%20%20%
5%
13%
48%
7% 7%6%
12%
73%
3%6%
15% 16%
23%
4%
41%
1%
8% 10%
16%
11%
25%
15% 15%
0
0.1
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0.3
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ResearchSetting(%)ByYear
2012-2013 2013-2014 2014- 2015 2015- 2016 2016- 2017
Breadthofsettingandpotentiallinktoconsumerfocusfromsettingfocus
Categoriesbecominghardertodistinguish
Systemshavebecomesettings
Trendtowardnon-HITECHsettings
65%6%
5%
3%3%
3%3%
3% 2%2%
7%
ByCountry (%)2016-2017
USA UK Sweden Korea Iran China Canada Brazil Tiawan Australia Other
Note:Whilefirstauthorcountryisnotedhere,manyoftheUSauthoredstudieswereperformedinothercountries.
Step5– Collating,summarizing,andreportingtheresults
ThemesIdentified
1. Potentialfordirectconsumerinvolvementandengagement
2. Process/Workflow/Outcomes/QI(DeepStructure)
Patient/consumerinvolvement/empowerment
3. PublicHealthandReporting(learninghealthsystem)
4. TransitionsofCare5. BigDatacontinues(patient as
population)DataMiningPublicandPopulationHealthPrecisionnursing
6. Costeffectiveness,identification
ofvalue,QI(Patient ascustomer)7. CulturalSensitivity(patient)8. TechnologyAcceptance,usability
(patient/consumer),competencies9. CareCoordination,
Interprofessional Care,Collaboration,SharedDecisionMaking(patient/consumer nowincluded)
10. Movementtonewsettingsofcare– LTC,SkilledNursing,HomeHealth,SchoolHealth,SmartHome(patient)
11. ReevaluationofExistingIT
HighlightedPublicationsSpring2016– Winter2017
Changingthe“deepstructure”ofthedeliverysystemtocapturethepatient/personsstory,supportengagement,andcoordinatecare.
Policyframeworkwasevidentintheliterature…
…evidenceofneedfordeepstructuralchangeandconsumerinvolvement.
Phillips,A.B.,&Merrill,J.A.(2015).Innovativeuseoftheintegrativereviewtoevaluateevidenceoftechnologytransformationinhealthcare.Journalofbiomedicalinformatics,58,114-121.
Khokhar,A.,Lodhi,M.K.,Yao,Y.,Ansari,R.,Keenan,G.,&Wilkie,D.J.(2017).Frameworkforminingandanalysisofstandardizednursingcareplandata.WesternJournalofNursingResearch,39(1),20-41.
Topic:Structuralchangetocapturethestory,supportengagement,andcoordinatecare.Purpose:Demonstrateknowledgediscoverywithbroadapplicability- forpatients,cliniciansandinstitutions– needforcommonframeworkforuseandre-useofexistingEHRdata.Methods:Applies“bigdataanalytics”toadatarepositoryofhospitalgeneratednursingcareplans(>300,000careplansfromHANDSdatasetfor~35,000patients)usingKnowledgeDiscoveryFrameworkFindings:Confirmsbenefitsofstandardsinknowledgediscoveryfrommultipleperspectives.Consumerchoice;nursingcan“see”linkbetweeninterventionandimprovedoutcomesovertime.Implications:Capturingamultidimensionalstorytoaffectoutcomes.
Matney,S.A.,Dolin,G.,Buhl,L.,&Sheide,A.(2016).Communicatingnursingcareusingthehealthlevelsevenconsolidatedclinicaldocumentarchitecturerelease2careplan.Computers,Informatics,Nursing:CIN,34(3),128-136.
Topic:Structuralchangetocapturethestory,supportengagement,andcoordinatecare.Purpose:CanweuseexistingdatastandardssupportedbyONCandotherstoeffectivelycommunicatenursingcareplansacrosssystemsandsettingsaspartofthe“patientstory.”Methods:Examinationofexistingmethodologieswitha“usecase”Findings:DemonstratesthesuccessfulmappingofthenursingprocesstoSNOMEDandLOINCusingHL7C-CDA-interoperabilityImplications:Capturingpatientstoryisnoteasy,butitispossibleusingexistingstandardontologies
Perri-Moore,S.,Kapsandoy,S.,Doyon,K.,Hill,B.,Archer,M.,Shane-McWhorter,L.,etal.(2016).Automatedalertsandreminderstargetingpatients:Areviewoftheliterature. PatientEducationandCounseling,99(6),953-959.
Topic:Structuralchangetocapturethestory,supportengagement,andcoordinatecare.Purpose:InvestigationintoefficacyofalertsandreminderstoconsumertosupportPatientSelf-ManagementMethods:ReviewoftheliteratureFindings:Automatedreminderswereshownto“work”includingappointment,adherenceandbehavioralreminders.Evidencesupportedby23outof51studieswereRCTsImplications:Economicevaluationlimitedacrossstudies;environmentinfluencessuccess,butsuccessgoesacrossgender,age,andsocioeconomicstatus.EconomicValuemustbedemonstratedtoinformpublicpolicy.
Samal,L.,Dykes,P.C.,Greenberg,J.O.,Hasan,O.,Venkatesh,A.K.,Volk,L.A.,etal.(2016).Carecoordinationgapsduetolackofinteroperabilityintheunitedstates:Aqualitativestudyandliteraturereview. BMCHealthServicesResearch,16,143-016-1373-y.
Topic:Structuralchangetocapturethestory,supportengagement,andcoordinatecare.
Purpose:ToevaluatetheextentHITis“involvedwhentransitioningpatientsbetweenemergencydepartments,acutecarehospitals,skillednursingfacilities,andhomehealthagenciesinsettings”
Methods:ExpertPanelandLiteratureReview
Findings:Identifiedgapsfromalackofinteroperabilityandlinktocommunityresources
Implications:UnrealizedPotentialofHITincoordinationofcare,butalsofoundthatnotallcareprocessesshouldbeautomated
Technologyacceptanceandinclusionofpatientandfamily
Holden,R.J.,Asan,O.,Wozniak,E.M.,Flynn,K.E.,&Scanlon,M.C.(2016).Nurses'perceptions,acceptance,anduseofanovelin-roompediatricICUtechnology:Testinganexpandedtechnologyacceptancemodel. BMCMedicalInformaticsandDecisionMaking,16(1),145.
Topic– Technologyacceptancebynursing.Adaptionofexistingacceptancemodelstonursing.Purpose– TestsanadaptedTAMwhichincludeslearnability,usefulnessforpatient/familyengagement,andsocialinfluencefrominstitution,patientsandfamiliesandothers.Methods– CrosssectionalsurveywithinaPediatricICU(newEPICSystembasedInteractiveMonitor)andstepwiselinearregressionformodelfit.Findings– Perceivedusefulnessforpatientcaringstrongestpredictorofintentiontouseandsatisfaction.Perceivedusefulnessforpatient/familyinvolvementalsofoundtobesignificantandsocialinfluence,whileweek,alsosignificant.Implications– technologyacceptancemodelswithgreaterhealthcarefocusneeded(patientcaring)androleofpatientandfamilyinsatisfactionandintentiontouse.
ProcessImprovementandQualityImprovement
Kricke,G.S.,Carson,M.B.,Lee,Y.J.,Benacka,C.,Mutharasan,R.K.,Ahmad,F.S.,etal.(2016).Leveragingelectronichealthrecorddocumentationforfailuremodeandeffectsanalysisteamidentification. JournaloftheAmericanMedicalInformaticsAssociation:JAMIA,
Topic– ProcessImprovement,QualityImprovement,CareCoordinationPurpose– CanthesecondaryuseofEHRdatabeusedtoenhanceaccuracyorprocessunderstandingusingFailureModeEffectsAnalysis(FMEA)methodandguidequalityimprovement.Methods– UsingFMEApractices/protocols,hand-drawnprocessmapsweredevelopedbyinterdisciplinaryteamofexpertclinicians.Mapincludedactivitieswhocompletedthem.Findings– 35%ofactivitieswerecompletedbyunexpectedprovidersincludingprovidersnotpartofthedocumentedworkflowImplications– AccesstogreaterdataprovidedbyEHRandotherelectronicsourceshastheabilitytogreatlyimproveprocessdocumentationaccuracy– firststepforimprovingquality.Alsohighlightedthetrueinterdisciplinarynatureofpatientcare.
WildCard– Reevaluationof“Old”Technology– Thepager
Kummerow Broman,K.,Kensinger,C.,Phillips,C.,Fesseha,B.,Fill,M.M.,Borges,N.,etal.(2016).Characterizingtheclamor:Anin-depthanalysisofinpatientpagingcommunication. AcademicMedicine:JournaloftheAssociationofAmericanMedicalColleges,91(7),1015-1021.
Topic:WildCarePurpose:Whatisthequalityofpagingdataanddoesitcontributetocommunicationfailures.Methods:RetrospectiveanalysisofpagingdataatlargeUShealthsystemFindings:Largenumberofnon-criticalmessaging“clamor”(estimated2–8pagesperhour/physician)Implications:Toughtomoveawayfromoldtechnologieswhichrequirereevaluationaspartofprocess.Createsasignificantamountofduplicativeinformation.
Step6– Consultation
FeedbackandProfessionalInput…
