Ebook: Nursing Informatics 2014

Taiwan's Nursing Informatics community and sponsoring academic and organizational partners are very pleased to be able to welcome this Twelfth International Congress on Nursing Informatics, titled: East Meets West eSMART+. The Ni2014 Congress is being held in Taipei, Taiwan as an inaugural event for the nursing informatics communities in our Asia Pacific geographic region. The growing maturity of nursing informatics within our Asia Pacific region is reflected in the broad representation of presenters from across Asia and the breadth of subjects being reported. The Scientific Program has over 300 presentations as submitted papers, panel presentations, student papers, and poster sessions. The richness and expertise reflected in this program and these conference proceedings brings together the foremost international experts in our field, as well as a large number of student papers. The aim of this congress is to provide a single, high-profile, internationally renowned forum for research in the theory and practice of nursing informatics. Oh behalf of myself and the Congress Co-Chairs, Rung-Chuang Feng and Da-Wei Wang, we commend this congress to you with the goal that it follow in the footsteps of the eleven congresses that proceeded it. Historically, these congresses have been instrumental in the advancement of nursing informatics by providing an international forum for sharing of the latest research, methodologies, and technologies, and most importantly, the development of collaborations, study exchanges, and networks. We look forward to extending all of these important benefits into our nursing informatics communities across our Asia Pacific region, as well as our international members.

Both the NI2009 Congress hosted by Finland and Canada's NI2012 event successfully attracted over 600 participants. This year, the NI2014 in Taipei will also present the most up-to-dated scientific evidence through our comprehensive scientific program that focuses on mobile and web technologies with healthcare delivery applications, as well as core topics to our times that include: patient safety and quality, big data, information management, usability, meaningful use and educating for competencies. The topics addressed in these conference proceedings as well as the panels and Posters all fit the “eSmart+” theme of the 12th NI Congress:

• “e” stands for eHealth

• “S” implies simplicity

• “m” represents mobility

• “a” denotes advanced leadership

• “r” indicates revolution

• “t” means translational technologies

• “+” symbolizes People Leading uCare Safely.

The eSmart+ acronym is also used to convey the idea of adopting smart technology to help health providers deliver higher quality care.

All together, the NI2014 Congress consists of two keynote lectures, two plenary lectures, and more than 280 papers contributed by more than 300 delegates from over 30 countries. Special thanks are due at this stage to all the delegates, the members and referees of the Scientific Program committee, chaired by Nick Hardiker and Heimar Marin. The supports given by the members of the Organizing Committee chaired and Congress Committee are gratefully acknowledged. We would also like to acknowledge the Local Committees who worked behind the scenes to do all the detail work that made our Congress possible. The Chairs of these local committees are: Yen-Chiao Lu, Hui-Chu Yu, Ching-Chiu Kao and Hsien-Mei Yu. Thanks are also due to those individuals and organizations that have supported and assisted either financially or in other ways. To all of these supporters and teams, we say “Thank You” because you made a successful NI2014 possible.

Polun Chang

Congress and Organizing Committee Chair

Aging of population is an inevitable process by which the number of elderly people is increasing. Rapid development of information and communication technology (ICT) is changing basic needs of elderly people; therefore society should ensure opportunities for elderly to learn and use ICT in a way to manage their daily life activities and in this way enable them participation in the information and knowledge society. The purpose of the study was to find out whether elderly are acquainted with the advanced technology and to what extent they use it or they desire to use it. Within the single point study we interviewed 100 randomly selected elderly people from different geographical regions in Slovenia. Results showed the differences in the use of advanced technology by Slovenian regions; therefore in the future activities should be focused on organizing promotional and demonstrational activities including ICT courses to increase elderly's motivation for ICT interaction.

A cornerstone of ‘meaningful use’ of health information is engaging consumers and their families. Yet for consumers to be engaged requires an informed population and therefore focus on consumer's health information needs. Reports indicated consumers want health information, yet little was known about their internet use or perception of electronic health information. This New Zealand study surveyed consumers to gain an understanding of their health information requirements. Some 1783 questionnaires were available for descriptive statistical analyses. The internet was the third most preferred source of health information. Two thirds of participants had used the internet to access health information, because of the speed of access and to find information before going to the doctor. There was little awareness or use of existing New Zealand-based online health resources. Study implications include promoting existing resources and increasing the use of electronic communication between consumers and healthcare providers as these are currently underutilized.

Consumer involvement in healthcare is critical to support continuity of care for consumers to manage their health while transitioning from one care setting to another. Validation of evidence-based practice (EBP) guideline by consumers is essential to achieving consumer health goals over time that is consistent with their needs and preferences. The purpose of this study was to compare an Omaha System EBP guideline for community dwelling older adults with consumer-derived evidence of their ongoing needs, resources, and strategies after home care discharge. All identified problems were relevant for all patients except for Neglect and Substance use. Ten additional problems were identified from the interviews, five of which affected at least 10% of the participants. Consumer derived evidence both validated and expanded EBP guidelines; thus further emphasizing the importance of consumer involvement in the delivery of home healthcare.

This paper outlines an emerging typology of older users of information and communication technology (ICT) to facilitate active aging. Through inductive data analysis from focus groups, iterative workshops, and personal interviews, we suggest three types of technology users. These types are “the Excluded,” “the Entertained,” and “the Networker.” Clearly, ICT offers several benefits to those who are enthusiastic and frequent users, exemplified as the Entertained and the Networker. Hence, our findings support the notion of technology as a tool to maintain or increase an older person's engagement and activity level. Conversely, for those reluctant, uninterested, or incapable of using ICT, such potentials are limited and imply fewer opportunities for participation in activities.

The author investigated attitudes of nursing students enrolled in e-Learning towards academic dishonesty. The descriptive-exploratory design was used in the conduct of the study. Respondents were randomly selected 36 junior and senior nursing students. It revealed that nursing students perceived as neutral (mean = 2.77, mean = 3.17) in taking responsibility for promoting academic integrity in e-learning. The paraphrasing a sentence from internet source without referencing it (38.89%) got the most form of cheating. Female and level four (4) nursing students revealed as the most cheaters. The reasons not to cheat, nursing students considered punishment, and education or learning (91.67%) got the highest in ranks, and simply wrong (75%) got the lowest rank. Hence, there is a need to look on how to maintain academic honesty among nursing students in and out of the university with respect to e-learning as a means of teaching-learning method.

The purpose of this study was to investigate the relationship between learning effects of the self-learning tool for nursing students and types of teaching materials. Ten nursing students were asked to perform transfer a patient from bed to wheelchair after watching the demo video and practicing 20 minutes. The students' performance was evaluated before and after practicing. The students were also asked to choose teaching materials that would be developed in the future. Out of nine teaching materials, the students chose seven of them. Correspondence analysis was conducted between the results of the evaluation of students' transfer technique and their preference of teaching materials. The results indicated that there was no relationship between the preference of teaching materials and the scores of transfer techniques. The authors concluded that the self-learning was not affected by the preference of teaching materials.

There is a need to develop cost effective ways to bring hands-on education about essential information technologies, such as electronic health record (EHR) systems to nursing students, nursing faculty and practitioners. This is especially the case as worldwide there is an increased deployment of these systems and they are transforming the practice of healthcare. However, due to technical, financial and knowledge limitations, many nursing schools and programs do not have an adequate way to bring such technology into their classes and curricula. In this paper we describe an approach to developing Web-based EHR education that allows students from any Web-accessible location to access and work with real EHR systems remotely over the Internet for learning purposes. In this paper we describe our work in moving this approach to a cloud-based solution to allow access to EHRs for educational purposes from any location with Web access and to do so in a way that is both educationally sound and cost effective.

The iTEAM goal is to prepare advanced practice nurses, physicians and pharmacists with the interprofessional (IP) core competencies (informatics, patient centric, quality-focused, evidence based care) to provide technology enhanced collaborative care by: offering technology enhanced learning opportunities through a required informatics course, advanced practice courses (team based experiences with both standardized and virtual patients) and team based clinical experiences including e-health experiences. The innovative features of iTEAM project will be achieved through use of social media strategies, a web accessible Electronic Health Records (EHRs) system, a Virtual Clinic/Hospital in Second Life, various e-health applications including traditional telehealth tools and consumer oriented tools such as patient portals, social media consumer groups and mobile health (m-health) applications for health and wellness functions. It builds upon the schools' rich history of IP education and includes clinical partners, such as the VA and other clinical sites focused on care for underserved patient populations.

The objective of this study is to propose a Cloud Computing based platform for sleep behavior and chronic disease collaborative research. The platform consists of two main components: (1) a sensing bed sheet with textile sensors to automatically record patient's sleep behaviors and vital signs, and (2) a service-oriented cloud computing architecture (SOCCA) that provides a data repository and allows for sharing and analysis of collected data. Also, we describe our systematic approach to implementing the SOCCA. We believe that the new cloud-based platform can provide nurse and other health professional researchers located in differing geographic locations with a cost effective, flexible, secure and privacy-preserved research environment.

The purposes of this methodological paper are: 1) to describe data mining methods for building a classification model for a chronic disease using a U.S. behavior risk factor data set, and 2) to illustrate application of the methods using a case study of depressive disorder. Methods described include: 1) six steps of data mining to build a disease model using classification techniques, 2) an innovative approach to analyzing high-dimensionality data, and 3) a visualization strategy to communicate with clinicians who are unfamiliar with advanced statistics. Our application of data mining strategies identified childhood experience living with mentally ill and sexual abuse, and limited usual activity as the strongest correlates of depression among hundreds variables. The methods that we applied may be useful to others wishing to build a classification model from complex, large volume datasets for other health conditions.

The purpose of the project was to capture nursing data and knowledge, represent it for use and re-use by retrieval from a data warehouse, which contains both clinical and financial hospital data. Today nurses at LUH use standardized nursing terminologies to document information related to patients and the nursing care in the EHR at all times. Pre-defined order sets for nursing care have been developed using best practice where available and tacit nursing knowledge has been captured and coded with standardized nursing terminologies and made explicit for dissemination in the EHR. All patient-nursing data is permanently stored in a data repository. Core nursing data elements have been selected for transfer and storage in the data warehouse and patient-nursing data are now captured, stored, can be related to other data elements from the warehouse and be retrieved for use and re-use.

Observing the pattern changes of inpatient fall and validating the Fall Prevention Tool Kit (FPTK) are essential for developing fall prevention strategies. However, the work requires the collection, calculation, and comparison of large amount of data. The information is often scattered in diverse information systems and lack of integration, which makes the work difficult and often neglected. This study demonstrates the development of an Interactive Data Repository System (IDRS) and uses it in the analysis of the pattern changes of inpatient fall within the institute, and validates efficiency of the FPTK across time. This study collected the incident data of year 2011 and compared it with the previous analysis in 2001. The result shows that reasons for patient fall had turned from physical disability to impaired conscious or cognition. The scoring result may be too sensitive in identifying patient falls. Patients with high scores needed to reinforce in functional strength.

This study was undertaken in the planning phase for the introduction of a comprehensive computer based nursing documentation system at Erlangen University Hospital. There, we expect a wide range of difficult organizational changes, because the nurses currently neither used computer based nursing documentation nor did they follow strongly the nursing process model within paper based documentation. Thus we were eager to recognize potential pitfalls early and to identify potential barriers for digital nursing documentation. In a questionnaire study we surveyed all German university hospitals for their experience with the implementation of computer based nursing documentation implementation. We received answers from 11 of the 23 hospitals. Furthermore we performed a questionnaire study about expectations and fears among the nurses of four pilot wards of our hospital. Most respondents stated a positive attitude towards the nursing process documentation, but many respondents note technical (e.g. bad performance of the software) and organizational barriers (e.g. lack of time).

This observational study was conducted before and after implementing an electronic medical record (EMR) system to evaluate the change in outpatient workflow by implementation of EMR and the effectiveness of clinical documentation improvement (CDI). The number of hours for patient care increased by 89.2% (p < .05) and the hours for writing medical records after consulting decreased after implementation of EMR by 27.3% (p < .01). Implementation of EMR reduced nurses' workload to handle medical records by 78.8 (p < .05) but not changed for physicians. The necessary change in the information management process occurred after using the CDI indicator. We recommend that the “working hours of health professionals” and “handling hours for information resources” should be used widely as CDI indicators to improve workflow when implementing EMR.

The Ministry of Health (MOH) of Israel has overall responsibility for the healthcare system. In recent years the MOH has developed strong capabilities in the areas of technology assessment and prioritization of new technologies. Israel completed the transition to computerized medical records a decade ago in most care settings; however, the processes in Israel was spontaneous, without government control and standards settings, therefore large variations among systems and among organizations were created. Currently, the main challenge is to convert the information scattered in different systems, to organized, visible information and to make it available to various levels in health management. The MOH's solution is of implementing a selected information system from a specific vendor, at all the hospitals and all HMO's clinics, in order to achieve interoperability. The sys-tem will enable access to the patient's medical record history from any location.

This study collects and critically reviews the published literature to synthesize the risk factors for client safety in residential aged care and the potential contributions of electronic health records to reducing these risks. Three major types of risk factors for client safety were identified: risk factors related to the person's health; those related to the health and aged care system serving the person and those related to human error. Multiple strategies at all levels of an aged care organization are needed to reduce risks and improve client safety. Electronic health records can be one of the effective organizational mechanisms because it improves access to better information and integrates intelligent functions to support point-of-care decision making.

Health self-management is important in the care of patients with chronic kidney disease. It is possible to improve the efficiency of patient self-management through the use of mobile technology and related software. This study is divided into three stages: 1. analysis of need: through observation, interview and content analysis of the chronic kidney disease health management manual; 2. design of system prototype: establish interface and system function; 3. prototype evaluation: evaluate whether the prototype designed by this study meets user needs. The system prototype includes: daily record, laboratory examination results, trend graphs, information search, sharing, communications and settings. Prototyping is done with Pencil Project for interface design and linking. The prototype is then exported in PDF format for mock-up simulation. Evaluation results: overall score was 4.01±0.60 leaning towards “agree”, the highest score was ease of use (4.25±0.6), followed by easy to learn (4.15±0.68), acceptance (4.01±0.61), reliability (3.87±0.6) and functionality (3.83±0.49). The results show positive attitude towards the system.

Eliciting user requirements from HIV-positive gay men who smoke can be challenging. This is because of the complex relationship between social stigma and gender identities (e.g., gay, masculine, HIV+, and smoking status). Inspired to engage HIV-positive gay men in the development of a web-assisted tobacco intervention, we used personas as a main communication tool in our participatory design sessions. Personas are characters created by users that embody part of their own behaviours, thoughts, and motivations. In an apparent paradox, this article is a description of how the use of personas to ensure less realistic self-representation provided an impetus for more self-disclosure. Findings and feedbacks from this study reveal that personas are an effective design tool to engage users in sensitive topics. Implications for future work are also discussed.

While the provision of medical care incorporating safety measures, etc. that can earn the trust of the people, patients in particular, is required, the content of instruction is diverse, complex and rapidly increasing in volume along with the sophistication and specialization of medical care. However, until now, the development of electronic instruction systems has lagged behind in the development of HIS. All instructions must be linked to orders and the input of the implementation of instructions in the electronic instruction system incorporated into medical accounting. The system must aim at integrating physician and nursing records and be of a specification that can ensure reliability and efficiency. We report on the efforts at Kagoshima University Hospital to systematize instruction in order to promote multidisciplinary teams.

Access to personal health information assists efforts to improve health outcomes and creates a population of active and informed health consumers. Understanding this significance, Healthy People 2020 retained, as a Focus Area, the need for improved interactive Health Communication and HIT. Attainment of this goal includes increasing the use of Internet-based electronic personal health management tools (EPHMT). Health information management, essential for favorable health outcomes, can be problematic in low income, special needs populations with complex chronic illnesses such as HIV/AIDS. Furthermore, barriers to the adoption and acceptance of an EPHMT in such populations have not been well explored. The current study seeks to explore the usability of an EPHMT entitled MyHealthProfile and to identify perceived health information needs in a vulnerable population of people living with HIV and AIDS (PLWH) that have access to an EPHMT through their Medicaid Special Needs Plan.

Patient controlled analgesia (PCA) and Patient-controlled epidural analgesia (PCEA) pumps are methods of pain control with complex smart infusion devices and are widely used in hospitals. Smart PCA/PCEA pumps can be programmed with the dose and rate of medications within pre-set ranges. However, adverse effects have been reported associated with these pumps' use. In this paper, we describe a prevalence observational study where observers used an electronic data collection tool to record pump settings and medications with PCA pumps, corresponding medication orders to identify errors. The results showed that there were many labeling and tubing change tag errors, which were a violation of hospital policy. A few potential harmful medication errors were identified but no critical errors. Study results suggest the importance of a standard process of PCA pump use. Next steps include implementing a safety bundle for improving PCA practice to support safe and effective pain management.

This paper discusses suggested evaluation frameworks' appropriateness for a study introducing Ambient Assisted Living (AAL) interventions. Specifically, we look at how well proposals cover these dimensions: impact on society, impact on professionals, and impact on patients. We discuss three widely used approaches for such assessments: RE-AIM, MAST, and UTAUT. Our assessment showed careful selection of elements from all three models seems needed to sufficiently cover the dimensions. RE-AIM provides a broad framework; MAST adds aspects of transferability and ethics, and UTAUT adds perception of technology and future use. All these approaches lack pivotal aspects concerning inclusion of patients' or citizens' point of view in a study's planning phase. To ensure rigor and include meaningful use from citizens' perspective, we added these aspects to our study.

Handovers need a common ground on the clinical cases between the members of the successive shifts to establish continuity of care. Conventional electronic patient record systems (EHR) proved to be only insufficiently suitable for supporting the grounding process. Against this background we proposed a basic concept for a handover EHR that extends general EHRs in particular openEHR based systems. The resulting handover information model was implemented in a database and evaluated based on 120 clinical cases. The information items of these cases could be mapped successfully to the model, however, the new class “anticipatory guidance” needed to be introduced. The evaluation also demonstrated the importance of highly aggregated information on the clinical case, opinions and meta-information such as the relevance of an item during handovers. Based on these findings, in particular the handover database, handover EHR applications are currently developed to support the grounding process.

In this paper, we present an overview of activities and results from a regional development project in Finland. The aim in this project was to analyze how healthcare providers produce and receive information on a patient's medication, and to identify opportunities to improve the quality, effectiveness, availability and collaboration of social and healthcare services in relation to medication information. The project focused on the most important points in patients' medication management such as home care and care transitions. In a regional development project, data was gathered by interviews and a multi professional workshop. The study revealed that medication information reached only some professionals and lay caregivers despite electronic patient record (EPR) systems and tools. Differences in work processes related to medication reconciliation and information management were discussed in the group meeting and were regarded as a considerable risk for patient safety.