Ebook: ICNP in Europe: TELENURSE

Maintenance care and palliative care are major challenges to the European society. Care for the elderly, disabled and chronically ill relies mainly on nurses who account for close to 50% of salaries in hospital charges. But no systematised standardised data are available to describe and compare nursing care activity, quality and cost effectiveness in hospitals. TELENURSE will as an accompanying measure of the Telematics Application Programme in the health care sector start to fill up this gap by promoting the use of the emerging ICNP and an associated clinical nursing minimum data set (NMDS) in electronic patient care records.

The features of a new generation of terminological systems are introduced: they are computerbased, multihierarchical, extensible, mappable. This performance is achieved by a compositional approach: each phrase of a reference nomenclature is represented systematically by predefined descriptors from a thesaurus, according to a “categorial structure” (a model of semantic categories and their relations).

A new terminological system is therefore made of four interrelate components: i) categorial structure, ii) thesaurus (system of descriptors), iii) a family of system of phrases (reference nomenclature, reference classifications, taxonomies) and iv) a knwoledge base with the systematic representation of phrases according to the structure.

The role of the European standardization body (CEN) to support the development of such terminological systems (of second generation) is outlined; the synergy with traditional systems (first generation) and with formal models (third generation) is discussed.

The above perspective is applied to the alpha version of the International Classification for Nursing Practice (ICNP), and potential steps to complete its evolution into a fully effective second-generation system are outlined; an initial hypothesis about the content of a CEN standard on categorial structures for nursing phenomena and nursing interventions is provided.

The TELENURSE project is an accompanying measure to the EU Telematics Application Programme. Its primary aim is to promote consensus among nurses around the use of the International Classification of Nursing Practice (ICNP) in order to lay the foundations for comparing nursing practice across different parts of Europe. This article describes how, as part of TELENURSE, the Medical Informatics Group is applying the GALEN (Generalised Architecture for Languages, Encyclopaedias and Nomenclatures in Medicine) approach to clinical terminology to represent ICNP in a usable and useful form.

Patient record is the repository of data describing the patient care process. It is the center of many diverging aims such as monitoring the care delivery process for a given patient to the recycling of care data for health statistics, accounting and billing. The nursing care process, as an example of the problem solving paradigm applied to health care plays a key role in the nursing activity. Its architecture is apparently quite compatible with emerging European standards for Electronic Healthcare Records (EHCR). A detailed study of nursing modules implemented in various existing or recently developed patient information systems will give critical indications for the integration of nursing data in a standardized architecture of electronic healthcare records.

This paper is a presentation of the Synapses project for the First TELENURSE conference. The presentation gives an overview of the project, expected outcome and approach to achieve the objectives and outcome. Synapses sets out to solve problems of sharing record information between autonomous information systems consistently, simply, comprehensibly and securely. The results of the Synapses will be in the public domain in the form of a set of specifications and guidelines for electronic record information exchange between autonomous systems. This presentation also gives an example of one of the declared verifications; the nursing summary where also ICNP can be included when desired.

The α version of ICNP has been translated into french. It has also been loaded into a computer based patient record designed as a support to the nursing care process. The initial structure of ICNP is found to be a sound basis for future refinements of an International Classification for Nursing Practice. The number of level and the coding schema should be improved when ICNP will reach a more mature state. The lack of operational definitions on top of the hierarchical ones is also evidenced.

The objective of TELENURSE is to implement ICNP (“The $\underbar{I}$nternational $\underbar{C}$lassification for $\underbar{N}$ursing $\underbar{P}$ractice”) electronically in nursing modules of electronic patient records. In Denmark, we will implement a prototype of an electronic nursing care record which will focus on the application of ICNP for documentation of nursing activities. This prototype will be verified in three different hospital wards in Denmark. The ideas and concepts behind the design of the prototype are the subject of this article.

The Telenurse project, financed by the European Union, aims to show the effectiveness of the application of the International Classification of Nursing Practice (ICNP) in practice. To this aim, the ICNP will be applied in three test sites in Europe. In the Netherlands, a pilot application of the ICNP is carried out at the VU Hospital in Amsterdam. The target of this pilot is to gain insight into the patient-related care activities of nurses, with the primary aim to provide the hospital management adequate information for managing nursing care. To this aim a subset of the ICNP is selected (the NMDS). The starting point is that data collection should not require an extra effort of nurses. The ICNP-based NMDS will therefore be collected by the nursing information system that is used by the hospital: the VISION system. VISION is a nursing information system which is integrated in the HISCOM Hospital Information System.

The main scope of this paper is to describe the Portuguese Hospital Information System, developed by IGIF, and how his connection with ICNP will be made.

It was only with the introduction of telematics in healthcare that an urgent need was revealed for organised standardisation activities and for a common use of standards in healthcare informatics.

The objective of CEN/TC 251/WG 2 is the semantic organisation of information and knowledge so as to make it of practical use in the domains of healthcare informatics and telematics. Its Work Items are focusing on the interrelationships of concepts and on structures for concepts systems. The production of detailed coding schemes and selection of the best existing coding schemes are actually outside the scope of WG 2.

So far Working Group 2 has proved very productive and successful.

In the area of nursing, national and international clinical databases are practically non-existing, The lack of common nomenclatures and classifications is the main reason for this unsound situation, in nursing as in many other areas. Additionally, the limited use of clinical nursing record systems by nurses in their daily work makes the provision of structured and standardised nursing data almost impossible. Consequently, the definition of a commonly approved set of indicators on nursing activities has not yet been formulated. However, the TELENURSE project will address the need for structured information about clinical nursing practice, and it will among others develop a clinical nursing database in which to store the clinical data collected from operational nursing record systems. The ideas and concepts behind the design of the clinical nursing database are the subject of this article.

It is a very long process to go from describing nursing care in a standardised way, over data collection, over data analysis and presentation to the final goal of starting to use this information for describing, comparing, interpreting, discussing and finally and hopefully deciding. In this paper, the focus is on the description of six presentation tools for nursing data, developed in the Nursing Minimum Data Set project in Belgium since the start in 1985.

Feed-back is the essential element in any information system. Electronic feed-back of nursing care data relates to the type of questions that are essential in managing patient care : questions about effectiveness and efficiency regarding the total care path, in which nursing is one of the contributing services. Illustrations are ginven based on the Nursing Minimum Data Set in Belgium.