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Nursing and Informatics What could a future be? Alain Junger CHUV PhD St Patrick Weber EFMI President A. Junger,, P. Weber 1 Nursing & Informatics Environment Profession Technology
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Nursing and Informatics What could a future be? Alain Junger CHUV PhD St Patrick Weber EFMI President A. Junger,, P. Weber 1 Nursing & Informatics Environment Profession Technology A. Junger,, P. Weber 2 Current situation Many of the C suites (CEO, CIO, CFO, ) are not well informed about what should be done and how. Nurses are not taking or having the lead to drive IT implementations A. Junger,, P. Weber 3 Health care financing systrem Many counties have adopted DRG based reimbursement system. Does DRG include nursing activity Some says YES Some says NO A. Junger,, P. Weber 4 APDRG 112 & LEP APDRG Type MDC Label LOS LTP HTP_Inf HTP_Sup CWH 112 P 5 Percutanious cardiovascular procedures W/O CC Inliers: 202 Average age: 62.8 Mean Median Length of stay Caring duration (LEP min) Average duration /day ( LEP min) A. Junger,, P. Weber 5 APDRG 112 & accounting Nursing 17.2% Labs 1.2% Physiotherapy 0.2% Implants/material 33.1% Occupation therapy 0.0% Other treatments 0.1% Medications 0.8% Xray 17.3% Other 4.3% Medical costs 7.0% Operation room 18.9% A. Junger,, P. Weber 6 APDRG 112 & LEP % % 32 Hygene / Dressing 41 Documentation / Administration 45 Security 45 29% A. Junger,, P. Weber 7 APDRG 112 LEP measures by day Minutes of care Days A. Junger, P. Weber 8 APDRG 112 Minutes of care LEP Cumulative care duration Length of stay A. Junger, P. Weber 9 APDRG 112 LEP Cumulative care duration Minutes of care Patient age A. Junger, P. Weber 10 APDRG 541 & LEP APDRG Type MDC Label LOS LTP HTP_Inf HTP_Sup CWH 541 M 4 Symptoms of pneumonia and other respiration diseases excepts bronchitis asthma with major complications Inliers: 110 Average age: 75.3 Mean Median Length of stay Caring duration (LEP min) Average duration /day (LEP min) A. Junger, P. Weber 11 APDRG 541 & accounting Other 12% Medications 4% Implants/material 1% Medical costs 10% Operation room 3% Xray 5% Other treatments 0% Nursing 54% Physiotherapy 4% Labs 7% A. Junger, P. Weber 12 APDRG 541 & LEP % Mobility 54 11% 32 14% 32 Hygiene / dressing 42 Communication 45 13% % Security 53 Medication A. Junger, P. Weber 13 APDRG 541 LEP measures by day Minutes of care Day A. Junger, P. Weber 14 APDRG 541 Minutes of care LEP Cumulative care duration Length of stay A. Junger, P. Weber 15 APDRG 541 LEP Cumulative care duration Minutes of care Patients age A. Junger, P. Weber 16 Chronic disease costs 70% J. Hofdijk 2010 Barcelona A. Junger, P. Weber 17 Definition Nursing Informatics is the integration of nursing, its information, and knowledge management with information and communication technology to support improvement in the health of people, families and communities world wide. It supports nursing research, education, management and practice in order to enable the delivery of quality healthcare that is patient centered, safe, effective, efficient, equitable and timely. IMIA NI Helsinki A. Junger, P. Weber 18 Cyber Teamwork team A. Junger, P. Weber 19 Cyber nurse A. Junger, P. Weber 20 Cyber nursing A. Junger, P. Weber 21 Cyber doctor A. Junger, P. Weber 22 Microsoft future in health Vidéo: care A. Junger, P. Weber 23 Nurse s s roles Nurses play an important role in leveraging health information technology to improve patient safety, quality and efficiency of care delivery. An important area of expertise of nursing informatics is workflow Nursing informatics: Designing the healthcare of the future, Sensmeier, Joyce E. MS, RN-BC, CPHIMS, FHIMSS A. Junger, P. Weber 24 Hardware Electronic resources will multiply significantly: mobile devices becoming increasingly powerful.. variety of devices will increase to meet the diverse needs of the domains of practice. Helen Edwards Nursing Informatics Past, Present and Future A. Junger, P. Weber 25 Brainware Clinical decision support software will become increasingly sophisticated, recognizing abnormal results, prompting automatic communication to the nurse or physician. Increasingly life-like like simulation and the use of virtual reality for educating students and staff. Helen Edwards Nursing Informatics Past, Present and Future A. Junger, P. Weber 26 Efficency Smart cards that authenticate the user s s identity will simplify a quick access to the electronic resources. Developments in telecommunications and telehealth will allow for more sophisticated distance patient visits. Bioinformatics. Speech recognition and other technologies will improve the interface efficiency Helen Edwards Nursing Informatics Past, Present and Future A. Junger, P. Weber 27 Consumers of health care will demand more online health care services: personal health records, schedule their own appointments, retrieve test results with some associated analysis, communicate with their health care practitioner without having to leave the house, participate in social network forums that provide a supportive element. (Ball, 2000; McCormick, 2006, Sensmeier, 2006) A. Junger, P. Weber 28 Guideposts to the future Areas that will require nursing informatics research involvement: 1. secondary use of clinical data; 2. security including the use of biometrics, signatures, encryption, and Public Key Infrastructure (PKI); 3. aggregation of patient data without use of identifiers; 4. promoting the use and development of standards; 5. population health; 6. privacy and confidentiality; 7. a focus on an NHIN (Nationwide Health Information Network). Guideposts to the Future An Agenda for Nursing Informatics, 2006, Jamia, Kathleen A McCormick, Connie J Delaney, Patricia Flatley Brennan, Judith A Effken, Kathie Kendrick, Judy Murphy, Diane J Skiba, Judith J Warren, Charlotte A Weaver, Betsy Weiner, Bonnie L Westra A. Junger, P. Weber 29 The future of nursing: «Advanced practice nursing» «Clinical Nurse Specialist» «Nurse Practitioner» A. Junger, P. Weber 30 Delamaire, M.L. & Lafortune, G. (2010). Nurses in advanced roles: a description and evaluation of experiences in 12 developed countries. Paris: OECD Health Working Paper N p. Advanced Practice Nursing The term advanced practice nurse refers to registered nurses who have gained advanced preparation for expanded clinical practice by earning a master's degree in nursing. Their specific training and skills make them different than other registered nurses A. Junger, P. Weber 31 Roles continuum Advanced practice nursing Integrated roles Professionnal improvement Organizational framing Research Education Extended clinical functions Clinical practice role Bryant Lukosius, 2004 / 2008: The continuum of advanced practice nursing roles, in Di Censo & Bryant Lukosius, 2010: Clinical Nurse Specialists and Nurse Practicioners in Canada A. Junger, P. Weber 32 Promoted role in advanced practice Direct clinical practice Clinical evaluation, health education, EBP, safety, quality Consulting, Coaching, Guidance With patients, families, teams, networks, Students mentoring. Leadership and Collaboration Protocols, policies, clinical pathways, innovative designs, etc A. Junger, P. Weber 33 Promoted role in advanced Research practice Integration, coordination and evaluation, links researchers and nurses, disciplinary or interdisciplinary research projects Ethics conflict prevention, clinical decision model, teaching Medical practice (NP only!) Nursing cares + Med., Orders : exams, treatments, medication A. Junger, P. Weber 34 Evidence on added value on the APN 4RCT recent systematic review ( ) Studies Interventions Effects Albers-H. et al. (2012) Neederland Primary care Arts et al. (2011) Neederland Vermeire (2005) Revue Cochrane Diabetis Team with ANP Vs. MD Team with ANP Vs. MD Perceived Health state Win 16K /patient Hospitalization Side effect Rx Cost Glynn et al. (2010) Revue Cochrane Hypertension (1) Selfmanagement (2) education (3) accessibility (4) recall (5) medication AHT A. Junger, P. Weber 35 Evidence on added value on the APN 4RCT recent ( ) including effect and et cost analysis Studies Interventions Effects Hopkins et al. (2011) Canada Renal failure Kroese et al. (2011) Neederland Fibromyalgia Morse Synthesis revue Schizophrenia Wong et al. (2011) Cochrane revue Chronic obstructive Team with nephro nurse specialist Vs. current care Team with ANP Vs. current care Team with ANP and ANP Cost linked to the LOS Satisfaction Costs 1298 Vs ) Medication and other treatment compliance Social implication A. Junger, P. Weber 36 pulmonary disease (COPD) (1) Selfcare support (2) education (3) clinical monitoring (4) coordination Respiratory function & quality of life Ø no mortality due to medical act Managers and technology Four specific knowledge worker skills: Data gatherer, information user, knowledge user, knowledge builder Sharyn Conrad, Dennis Sherrod, 2011, Nursing managers as knowledge workers, Nursing Management, Feb 2011, p A. Junger, P. Weber 37 Managers and technology Successful healthcare organizations must engage nurse managers who are: Knowledge workers, Technology role models, Change agents for quality improvement, Critical communicators. Sharyn Conrad, Dennis Sherrod, 2011, Nursing managers as knowledge workers, Nursing Management, Feb 2011, p A. Junger, P. Weber 38 A. Junger, P. Weber 39 Stakeholders people who have something to gain by the message Patients/Consumers Practitioners Clinical Care, Quality, Risk, Decision Support, Utilization Management, Infection Control, Privacy Funders and Policymakers Educators Researchers Professional Associations and Regulatory Bodies NI2012 post conference not yet published A. Junger, P. Weber 40 Challenges - 1 Shaping the political dynamics, creating the culture and an enabling environment Being realistic in the face of financial constraints Creating short-term term goals within the context of a long-term vision Ensuring good project management Defining clear accountability for project tasks and deliverables Identifying knowledge gaps and finding resources to fill NI2012 post conference not yet published A. Junger, P. Weber 41 Challenges - 2 Limited view of ICT as clinical tool need to see it as means to an end not an end in and of itself Transitional variable state of ICT deployment Lack of valuing of clinical perspective in ICT initiatives (e.g., secondments, transformers, super users) Training versus education Adoption of clinical practice change needs to be the priority for the education, and not use of the technology Benefits realization (quantitative vs. qualitative) and cost avoidance NI2012 post conference not yet published A. Junger, P. Weber 42 Best Practice Recommendations Clear, consistent, articulated Vision Visible and explicit leadership support Project ownership by business leaders Communication strategies Multi-media IT Governance creating the right structures Include Subject Matter Experts from Business, Nursing, Medicine, Finance, IT Framing the work in a way that resonates with each leader in terms their frame of reference NI2012 post conference not yet published A. Junger, P. Weber 43 Why Only 32% of IT projects completed on time, on budget, and with required features and functions (Standish Group, 2009) EU total cost of IT project failure estimated to be 142 billion (McManus & Wood-Harper, 2007) People-related soft skills at least as important if not more important than technical expertise in supporting effective project management NI2012 post conference Lynn Naggle not yet published A. Junger, P. Weber 44 8 Step Change Model Create a sense of urgency Create a powerful guiding coalition Create a vision Communicate the vision Empower others to act Plan and create short-term term wins Consolidate improvements Institutionalize new approaches Kotter, 2007 NI2012 post conference Lynn Naggle not yet published A. Junger, P. Weber 45 Change Leadership or Change Management or? NI2012 post conference Lynn Naggle not yet published A. Junger, P. Weber Frank, Martineau & Pascal, New Clinical System Design Flow NI2012 post conference Lynn Naggle not yet published A. Junger, P. Weber 47 Clinical Adoption Evaluation Framework (Lau et al., 2009) NI2012 post conference Lynn Naggle not yet published People Organization IMPLEMENTATION System Quality Information Quality Service Quality Use User Satisfaction Net Benefits Quality Access Productivity Legislation, Policy, Societal, Political, Healthcare Standards Funding, Incentives Governance A. Junger, P. Weber Economic Trends 48 NI2012 post conference Lynn Naggle not yet published EHR Investment Change Investment Relationship of EHR/Change Investment to Adoption Time Rate of Adoption A. Junger, P. Weber 49 Nagle & Catford 2008 Nurses roles Caring and conducting prevention Coordinating across the health care provider team Doing patient and family education Conducting research Contributing to evidence based A. Junger, P. Weber 50 Data and Knowledge for Medical Decision Support August Conducting medical informatics by Converging technologies, Conveying sciences and Connecting people 40 th anniversary of EFMI A. Junger, P. Weber 51 Thank you A. Junger, P. Weber 52
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