Ebook: Nursing Informatics 2016

On behalf of the Scientific Program Committee, I extend a warm welcome to the IMIA-NI members, students, practitioners, informatics researchers, industry partners, and others interested in health and nursing informatics who have come to attend the NI 2016, 13th International Congress on Nursing Informatics.

NI 2016 is a biennial conference of the IMIA-NI and the leading scientific meeting for health and nursing informatics research and practice. NI 2016 presents work not only from the discipline of nursing but also from many other disciplines and specialties including both basic and applied informatics.

The theme of NI 2016 is eHealth for all: Every level collaboration – From project to realization. The theme reflects the major challenges we face in healthcare today, that is, the need to collaborate at every level to achieve our goal of Health For All. NI 2016 offers a variety of topics on the conference theme.

The mission of the Scientific Program Committee is to solicit for, evaluate and schedule NI 2016 conference program to be consistent with the goal of the IMIA-NI. We received 445 submissions for papers, posters, short communications, panels, workshops, demonstrations, student competitions and tutorials from more than 40 countries. Each submission was reviewed by three reviewers selected from a panel of more than 963 experts. Reviewers' feedback was provided to the authors and every effort was made to ensure the best submissions given the constraints of the conference timetable. In the end, a total of 332 submissions were selected.

The result of the Scientific Program Committee's activity is reflected in the Conference Program and Proceedings. The proceedings contain OA full papers, indexed in MEDLINE, and also workshops, panels and posters summaries.

The Scientific Program Committee has prepared a wonderful program. We have six keynote speakers addressing the state-of-the-art for health and nursing informatics ranging from data, to healthcare delivery to the policy level. There are 24 paper sessions, 20 poster sessions, 23 panel discussions, 14 workshops, 1 demonstration, 8 tutorials and 6 student competitions to attend. The exhibit hall will provide attendees with the opportunity to learn about the latest products and services in health and nursing information and information technology. The NI 2016 is adding two new features, a Wearable Fashion Show and an Interoperability Showcase. The Wearable Fashion Show will present how technology and fashion can be merged for healthcare. The Interoperability Showcase will present how EHR Applications, Devices and Apps communicate patient data electronically using HL7 standards and IHE profiles. This showcase is jointly organized by the HL7 Nurses Work Group with HL7 PCWG EHRWG, CICWG and Associations such as IMIA-NI, ICN, HIMSS and IHE. I hope that all participants have the opportunity to learn from and network with others through tutorials, keynotes, paper sessions, poster sessions, panel discussions, and workshops and find new and exciting ideas to inspire them.

I am very grateful to the contributors for their contributions and the reviewers for providing expert reviews. I am especially grateful to Patrick Weber, Chair of the NI 2016 Local Organizing Committee, and Maria Muller-Staub and Margie Kennedy, Co-chairs of the Scientific Program Committee, for their leadership and strong support.

We are in Geneva, Switzerland and I hope you find some time before or after the conference to enjoy this beautiful city and country.

Hyeoun-Ae Park, PhD, RN, FAAN Chair, Scientific Program Committee, Professor in College of Nursing and Systems Biomedical Informatics Research Center, Seoul National University

The Oulu University Hospital's staffing management project sought information on the number of nursing staff in relation to treatment days and visits, using existing indicators to describe the activities involved. The retrospective data obtained was compared to human resources and the personnel structure. On this basis an optimal number of staff was determined for the units, taking account of a range of explanatory indicator data. The project made use of the computational model for nurse staffing and the World Health Organisation's (WHO) Workload Indicators of Staffing Need (WISN) method. The project provided extensive information on human resources issues within the units. Its results indicated the differences between wards with respect to the number and structure of resources. In addition, the nurse administrators lacked skills in gathering and using data from administrative datasets. This information will provide support for the further development of nursing operations and nursing management decision-making.

Objectives: The aims of this study were to develop a nursing information system (NIS), enhance the visibility of patient risk, and identify challenges and facilitators to adoption of the NIS risk assessment system for nurse leaders.

Methods: This article describes the function of a nursing risk assessment information system, and the results of a survey on the risk assessment system.

Results: The results suggested that quality of information processing in nursing significantly improved patient safety. Nurses surveyed demonstrated a high degree of satisfaction, with saving time and improving safety.

Conclusions: The nursing document information system described was introduced to improve patient safety and decrease risk. The application of the system has greatly enhanced the efficiency of nursing work, and guides the nurses to make an accurate, comprehensive and objective assessment of patient information, contributing significantly to further improvement in care standards and care decisions.

An innovative nursing documentation project conducted at Bumrungrad International Hospital in Bangkok, Thailand demonstrated patient care continuity between nursing patient assessments and nursing Plans of Care using the Clinical Care Classification System (CCC). The project developed a new generation of interactive nursing Plans of Care using the six steps of the American Nurses Association (ANA) Nursing process and the MEDCIN^® clinical knowledgebase to present CCC coded concepts as a natural by-product of a nurse's documentation process. The MEDCIN^® clinical knowledgebase is a standardized point-of-care terminology intended for use in electronic health record systems. The CCC is an ANA recognized nursing terminology.

In 2014, a group of diverse informatics leaders from practice, academia, and the software industry formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. This presentation reports the recommendations from this Working Group geared towards a 2020 framework. The recommendations propose redesign to optimize nurses' documentation efficiency while contributing to knowledge generation and attaining a balance that ensures the capture of nursing's impact on safety, quality, yet minimizes “death by data entry.”

We used a valid questionnaire to survey Iranian nurses' seeking information behavior and their confidence on different information sources. The frequently used sources were Internet" and “personal experiences” (54.8% and 48.2% respectively). “English medical journals” (61.9%) and “English textbooks” (41.3%) were the least frequently used sources. Nurses felt high confidence in sources such as “International instructions/guidelines” (58.6%) and “English medical textbooks” (50.4%). The main reasons for selecting sources were easy accessibility, being up to date and reliability. Google, Pubmed and Up to Date were the most used electronic sources. In addition, there were differences in terms of using some of these resources and nurse' age and gender. In developing information sources for nurses, factors such as reliability level, availability, and updatedness of resources should be more emphasized.

The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, non-nursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intra-team communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow.

Online bibliographic databases constitute the access to information supporting evidence-based practice. The purpose of the present survey is to evaluate the awareness, the use and the impact that online evidences have in clinical practice. An online survey was conducted using a 25 item questionnaire which was completed by 263 healthcare practitioners (nurses and doctors). Chi-square analysis and t-tests were used and comparisons between both groups were made. Multiple logistic regression to predict databases use was employed. Ninety-three percent (n = 206) of participants had heard about the online bibliographic databases; 5.7% of participant sample have heard about online databases but they do not use them. 18.3% was the total sample of non-users (n = 48). The main reason of using was filling a knowledge gap (50.7%), and the main reasons of not using were both that they use another information source and they don't need them to do their job. Both nurses and doctors believe that the use of online databases improves patient care it is a part of their legitimate clinical role. They need more training to improve their searching skills, enhancing them in everyday clinical place.

The design and implementation of health information technology (HIT) is challenging, particularly when it is being introduced into complex settings. While complex adaptive system (CASs) can be a valuable means of understanding relationships between users, HIT and tasks, much of the existing work using CASs is descriptive in nature. This paper addresses that issue by integrating a model for analyzing task complexity with approaches for HIT evaluation and systems analysis. The resulting framework classifies HIT-user tasks and issues as simple, complicated or complex, and provides insight on how to study them.

The Association of periOperative Registered Nurses (AORN) approached the Nursing Informatics Research Team (NIRT) with a request to collaborate and conduct a competency assessment for their organization. An online tool was developed to determine current technology in perioperative settings. This presentation shares the process used to conduct research that led to a method for assessing perioperative nurses' competencies skills in their practice as well as identified gaps in curricula that faculty could address. Both successes and areas for improvement are detailed. The outcome of the process demonstrated a need to understand what skills are being assessed as AORN did not know what technology existed or how existing equipment was being used.

The purpose of this project was to reveal the status quo of mHealth application in clinical settings in China, especially in reducing patient falls and pressure ulcers and discuss how patient safety could be enhanced in the context of global collaboration on patient safety. The literature search resulted in a total of 290 articles. A steady increase is witnessed in the field of mHealth, especially after the year 2010. Personal digital assistant and electronic cart are the two main devices used in mobile nursing workstation. mHealth was mainly focused on two clinical areas, nursing practice (60.69%) and nursing management (25.86%). mHealth has begun to change the way of nursing process in prevention of adverse nurse events with an encouraging results in reducing the rate of pressure ulcer and falls. Healthcare educators should fully recognize the characteristics of mHealth and enhance a clinical informatics component in the curricula.

This paper describes the evaluation of a computerized clinical decision support system (CCDSS) for Emergency Department (ED) triage. The CCDSS for triage was developed as a means to improve ED quality and safety. Whilst there is significant research on the role of CCDSS in health care, their role in EDs remains under-investigated. In this study, a CCDSS for ED triage was developed and evaluated using a quasi-experimental interrupted time-series design. Data was collected at four time points before and after the introduction of the CCDSS to assess key aspects of quality and safety within the ED. The results demonstrated a statistically significant improvement in triage prioritization (p < 0.001), pain scoring (p < 0.001) and pain management (p < 0.001). This study clearly identifies the positive clinical impact that a CCDSS can have on quality and safety for ED patients and provides a unique contribution to the current knowledge base.

We developed a tool that allows a medical facility to offer efficient nursing care with limited human resources by optimizing the distribution of hospital ward nursing tasks. The use of information and communications technology to visualize daily workloads and make use of quantified workload data is important for identifying management elements that allow the efficient allocation of personnel and tasks. The goal of this study was to utilize data from the ward management tool that we developed to consider workflow processes for nursing staff and the relationships between the nursing competence of the nursing staff and the patients' conditions and how these impact on workloads. We found a correlation between workload and staff competence. With respect to the teamwork index and patient condition, structural equation modeling analysis using the intensity of nursing care needs and degree of independent daily living showed that patient condition had a meaningful effect on workload.

We report the findings of a big data nursing value expert group made up of 14 members of the nursing informatics, leadership, academic and research communities within the United States tasked with 1. Defining nursing value, 2. Developing a common data model and metrics for nursing care value, and 3. Developing nursing business intelligence tools using the nursing value data set. This work is a component of the Big Data and Nursing Knowledge Development conference series sponsored by the University Of Minnesota School Of Nursing. The panel met by conference calls for fourteen 1.5 hour sessions for a total of 21 total hours of interaction from August 2014 through May 2015. Primary deliverables from the bit data expert group were: development and publication of definitions and metrics for nursing value; construction of a common data model to extract key data from electronic health records; and measures of nursing costs and finance to provide a basis for developing nursing business intelligence and analysis systems.

Although biometric attendance management is available, large healthcare organizations have difficulty in big data analysis for optimization of work processes. The aim of this project was to assess the implementation of a biometric attendance system and its utility following big data analysis. In this prospective study the implementation of biometric system was evaluated over 3 month period at our institution. Software integration with other existing systems for data analysis was also evaluated. Implementation of the biometric system could be successfully done over a two month period with enrollment of 10,000 employees into the system. However generating reports and taking action this large number of staff was a challenge. For this purpose software was made for capturing the duty roster of each employee and integrating it with the biometric system and adding an SMS gateway. This helped in automating the process of sending SMSs to each employee who had not signed in. Standalone biometric systems have limited functionality in large organizations unless it is meshed with employee duty roster.

Medicine management is at the core of hospital care and digitalization of prescribing and administration of medicines is often the focus of attention of health IT programs. This may be conveyed to the public in terms of the elimination of paper-based drug charts and increased readability of doctors' prescriptions. Based on analysis of documents about hospital medicines supply and use (including systems' implementation) in the UK, in this conceptual paper electronic prescribing and administration are repositioned as only one aspect of an important wider transformation in medicine management in hospital settings, involving, for example, procurement, dispensing, auditing, waste management, research and safety vigilance. Approaching digitalization from a systemic perspective has the potential to uncover the wider implications of this transformation for patients, the organization and the wider health care system.

This study aims at evaluating hospital information systems (HIS) acceptance factors among nurses, in order to provide suggestions for successful HIS implementation. The study used mainly quantitative survey methods to collect data directly from nurses through a questionnaire. The availability of computers in the hospital was one of the most influential factors, with a special emphasis on the unavailability of laptop computers and computers on wheels to facilitate immediate data entry and retrieval when nurses are at the point of care. Nurses believed that HIS might frequently slow down the process of care delivery and increase the time spent by patients inside the hospital especially during slow performance and responsiveness phases. Recommendations were classified into three main areas; improving system performance and availability of computers in the hospital, increasing organizational support in the form of providing training and protected time for nurses' to learn and enhancing users' feedback by listening to their complaints and considering their suggestions.

With the increasing adoption of interactive systems in healthcare, there is a need to ensure that the benefits of such systems are formally evaluated. Traditionally quantitative research approaches have been used to gather evidence on measurable outcomes of health technology. Qualitative approaches have also been used to analyze how or why particular interventions did or did not work in specific healthcare contexts. Mixed methods research provides a framework for carrying out both quantitative and qualitative approaches within a single research study. In this paper an international group of four informatics scholars illustrate some of the benefits and challenges of using mixed methods in evaluation. The diversity of the research experience provides a broad overview of approaches in combining robust analysis of outcome data with qualitative methods that provide an understanding of the processes through which, and the contexts in which, those outcomes are achieved. This paper discussed the benefits that mixed methods brought to each study.

With the advent of wide scale adoption and use of clinical information systems and other technologies to support the delivery of healthcare services, the inclusion of iterative evaluation is an often overlooked but important component of project management. In this paper, it is proffered that the evaluation process should be an imperative and initiated at the outset of the design and implementation of clinical information systems including any single component of hardware or software. Ideally, methods of evaluation should be multi-faceted, include formative and summative evaluation approaches and include a range of metrics that will provide organizations with insight to process and technology efficiency and effectiveness as well as human and financial impacts.

Regarding the user-centered design (UCD) practices carried out at Hospital Italiano of Buenos Aires, nursing e-chart user interface was redesigned in order to improve records' quality of nursing process based on an adapted Virginia Henderson theoretical model and patient safety standards to fulfil Joint Commission accreditation requirements. UCD practices were applied as standardized and recommended for electronic medical records usability evaluation. Implementation of these practices yielded a series of prototypes in 5 iterative cycles of incremental improvements to achieve goals of usability which were used and perceived as satisfactory by general care nurses. Nurses' involvement allowed balance between their needs and institution requirements.

Heart Team meetings are becoming the model of care for patients undergoing transcatheter aortic valve implantations (TAVI) worldwide. While Heart Teams have potential to improve the quality of patient care, the volume of patient data processed during the meeting is large, variable, and comes from different sources. Thus, consolidation is difficult. Also, meetings impose substantial time constraints on the members and financial pressure on the institution. We describe a clinical decision support system (CDSS) designed to assist the experts in treatment selection decisions in the Heart Team. Development of the algorithms and visualization strategy required a multifaceted approach and end-user involvement. An innovative feature is its ability to utilize algorithms to consolidate data and provide clinically useful information to inform the treatment decision. The data are integrated using algorithms and rule-based alert systems to improve efficiency, accuracy, and usability. Future research should focus on determining if this CDSS improves patient selection and patient outcomes.

To enhance patient safety from falls, many hospital information systems have been implemented to collect clinical data from the bedside and have used the information to improve fall prevention care. However, most of them use administrative data not clinical nursing data. This necessitated the development of a web-based Nursing Practice and Research Information Management System (NPRIMS) that processes clinical nursing data to measure nurses' delivery of fall prevention care and its impact on patient outcomes. This pilot study developed computer algorithms based on a falls prevention protocol and programmed the prototype NPRIMS. It successfully measured the performance of nursing care delivered and its impact on patient outcomes using clinical nursing data from the study site. Results of the study revealed that NPRIMS has the potential to pinpoint components of nursing processes that are in need of improvement for preventing patient from falls.

Long-term care is more efficient and effective when it involves the active participation of the empowered patient and informal caregivers. To achieve this, it is necessary to guide the patient and informal caregivers through the systematic process of self-care. Well-documented observations and assessments are fundamental to plan further interventions of the interdisciplinary team.

A systematic literature review revealed that the self-care process and the support of information technology are focused on just one chronic disease. Defined self-care process has a positive impact on the functionality and satisfaction of patients with comorbidity and on their caregivers. The model of the patient's self-care process should be an integral part of the long-term care.

There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone.

Aims and Objectives: The aim of this study was to evaluate the effectiveness of tele-consultation by nurses using an integrated call centre.

Materials and Methods: This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. Patients called the call centre and the specially trained call centre staff answered the calls who handled their simple queries, if they were unable to respond, the call was directed to the nurse informatics specialist on duty responded to their queries with the help of senior residents who were posted in emergency department. The nurse informatics specialist documents a tele-consult note in CPRS (Computerized Patient Record System).

Results: Of the total 150 calls, 64 calls were diverted to the nurse informatics specialist (NIS). Of the 64 calls received by the NIS 55 (85%) were rectified by the nurses at their level and 9 calls (14%) were further discussed with the concerned doctors.

Conclusions: As shown by our case study, call centers can be used for tele consultation with the help of nurse informatics specialist.