nenic year in review€¦ · (2016). nurses' perceptions, acceptance, and use of a novel...

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

3548

33

81

129

0

20

40

60

80

100

120

140

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

0.2

0.3

0.4

0.5

0.6

0.7

0.8

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…