31 Aug 2016

The Opportunity for Nursing Informaticists in the Face of Technological Disruption

By Ian Chaves, RN, BScN, MACT
*Written for NIAA's N-Form Newsletter, May 2016 edition.
I had the fortune of attending the National Institute for Nursing Informatics at the Bloomberg Faculty of Nursing, University of Toronto, in February 2016 (NINI 2016).
It was an exciting opportunity to learn from some of the most innovative and brightest minds leading Nursing Informatics (NI) in Canada, and to connect with nursing contemporaries eager to participate in the wave of change which comes with technological disruption. 
I expected to be captivated with the real-life stories of successful NI projects: projects illuminating the standardization of nursing terminologies and their significance in uncovering the value of nurses; projects demonstrating the application of telehealth to empower patients and providers to stay healthy within their communities; and projects demonstrating how the use of mobile devices and apps allow nurses to reach greater potential as knowledge workers at point-of-care. The narratives shared about these topics during NINI 2016 did not disappoint.
However, I wasn’t prepared for a brilliant and thought-provoking call to action by Dr. Richard Booth, Assistant Professor at the Faculty of Nursing, Western University.   Dr. Booth began his session with a role call of various technologies that fall within our cursory stream of consciousness — technological feats we acknowledge, but likely don’t spend enough time marvelling at because of the ubiquitousness of information and communication technologies (ICTs) and the seemingly light speed pace of technological change and product life-cycles.
For example:
  • You ever use the self-check out at Safeway? In some US grocery chains, you will not find a human grocery store clerk at all.
  • Curious about your genetic code? You can go to 23andMe, a personal genomics biotechnology company, to order a kit you use to submit a saliva sample. They test for a range of DNA types, like your predispositions to having fast-twitch muscles, consuming caffeine, and growing a unibrow. 
  • Do you text while your drive? If you do, you should really stop — but will it really matter when Google’s self-driving car begins to chauffeur us around? 
  • After carrying a Japanese communication satellite in space, Elon Musk’s SpaceX (a venture seeking to create reliable reusable rockets), landed on an offshore self-positioning ‘droneship' in the Atlantic Ocean. 
Meanwhile, I’m still learning how to change the toner at my office. 
I can’t fathom the out-of-the-box-paradigm-shifting type of thinking necessary to engineer some of these feats. Regardless of my own shortcomings, it's not just me -- the pervsaviness of paternalistic in-the-box-paradigm-saving types of  thinking in some healthcare systems is also of influence.
When Dr. Booth surveyed his second year BScN students about whether patients/consumers should be given access to their electronic health information, 65% answered “yes”. However, when asked whether patients/consumers should be allowed to edit or add content to their electronic record health record, 93% of them answered “no”.
Emerging healthcare ICTs functions are intended to open up communications, but a paternalistic view of patient engagement by providers cancels that out -- and if we close this corridor, other ones open (or already exist) for patients.
New consumers technologies are allowing health consumers to create new forms of health data. Are you currently wearing a Fibit? How many steps did you take today? Multiply that by 6.7 million users, and now Fitbit has a rich database of health data — valuable data that is OUTSIDE of the traditional healthcare system. 
Okay, so if the healthcare system no longer monopolizes health data, surely the healthcare system continues to stake its claim on ‘healthcare intelligence’? You still need experts to make sense of the data, do you not?
Let’s take a sobering look at what’s happening with Watson OncologyWatson, IBM’s cloud-based cognitive "super" computing system, is being used at various Cancer Centers in the US and Canada to analyze the DNA fingerprints of patients’ tumours. It will sift through thousands of mutations to identify what drives a patient’s tumour, and cross-reference these findings to best-practice data from thousands of research articles, to identify a personalized treatment plan. What would take oncologists years to perform, now takes IBM’s Watson a matter of minutes (Also, Watson will beat you quite handily at Jeopardy).
Wait, what? Technology is even creeping into our space of healthcare intelligence?
With the emergence of Watson Oncology, one begins to appreciate the idea of the technological singularity — the hypothetical event where artificial general intelligence would be capable of recursive self-improvement, or of autonomously building ever smarter and more powerful machines than itself. What is the likelihood that cognitive computing, a precursor to artificial intelligence, will soon obsolesce health care knowledge workers?


Let's assume that computers will be performing certain functions and tasks with greater speed and accuracy than their human counterparts. Where does that leave nurses (and for that matter, other health knowledge workers)?  
Before you go out to gather pallets of water and rations of SPAM in anticipation of a dystopic future where we're ruled by cybernetic machines, Dr. Booth provides a voice of reason. Dr. Booth argues that rather than conceding passively to technological determinism, nurses must see this as THE opportunity to redefine their value and contributions to the health of patients, families, and communities. It’s time to reconsider our paradigms within nursing in the face of technological disruption. Health(care) is no longer just the domain of health care organizations and providers. Patients, machines, and new industries are now active participants in healthcare, because of the new ways we transfer,share, and interpret information, ideas, and data.

Dr. Booth uncovers that, all around us, disruption is ALREADY occurring -- the ways we act and see the world are changing. Using a quote from Smythe (2014), Dr Booth asserts, “The problem is that unless we are willing to re-evaluate the actual processes of care (such as who or what delivers the actual care, where care is delivered, and what level of care is delivered to whom, etc.), the changes we are seeking will not occur.”
One of the key messages I found most important from Dr. Booth's session is that healthcare leaders must begin to be aware of the nature of this disruption and begin to take lead to redefine processes in a health system that tends to work at glacial speeds. Classic models of nursing and nursing informatics should be adaptive, and must be re-evaluated and re-designed as technologies emerge and evolve.

Dr. Booth asserts, “Technology itself is not important. The changes technology enables is the variable we should be exploring. We have focused almost exclusively on ‘shiny objects’.”
The other key message? What an exciting time this is for nursing, especially for those involved in the health ICT space. This is a momentous opportunity for nurse informaticists to shape the future of healthcare delivery and authour in new narratives of how healthcare providers and patients approach health.
Dr. Booth references Annette Wollowick who prognosticated (astounding in the 1970s) that because of increasing computerized care and shifts in the division of labour, roles of necessity will change in healthcare. For the nursing profession, this will result in the opportunity to provide new dimensions of patient care:
"If nursing accepts the latter (this) opportunity, a new concept of nursing will merge: one that will require a redefinition and revision of how nurses are to be prepared and how they are to practice in the future.”
During National Nursing Week, lets divert attention from these shiny new objects. Instead, lets acknowledge, celebrate, and inspire the talented nursing professionals who explore the applications of health care ICTs, how these technologies enable better patient care, and how these technologies create new dimensions for the profession of Nursing. 
To all of you working in Nursing Informatics — as technology continues to disrupt, your talent and foresight is what will help healthcare and Nursing not only sustain an important role in our society, but also discover new role niches and dimensions in care. In doing so, you are agents for change, not just in the sense of supporting the implementation of shiny new objects and helping providers use them for classical processes, but in terms of your importance to empowering Nursing to be future-facing and ready — to discover and embrace emerging processes and skills that new technology makes possible or society now requires.
As Nurse Informaticists, you are accepting an opportunity to lead Nursing with the crucial steps forward towards an unwritten, but exciting future. Perhaps the Fitbit will let you count these steps. Otherwise, Google's car will drive you there. 

19 Aug 2016

Nursing on the Frontier of Potential

By Dawn Vellenoweth, RN, BScN, BA

*Reprinted from the May 2016 Issue of N-Form

Nursing Informatics exists in an ever-changing and adaptive environment with the potential for a tremendous amount of growth and change.  Whether you’re in a traditional nursing role or a non-traditional one, this is an interesting time of transformation in healthcare and information technology.  Each and every nurse plays an important role in the transformations that are currently taking place. ​ 

As information technology has evolved over the years, it has impacted health care in a number of ways.  Nursing practice influences technology as technology influences practice, and each contributes to an evolution in health care that continues to progress.  The rapid momentum of this evolution will continue into the future and can be seen spanning many disciplines and decades in healthcare.   Nurses are known for their capacity to recognize value, opportunity and significance as well as their ability to identify concerns before they become problems.  Their aptitude to support, manage and enhance the process of change throughout the development and implementation of new technologies helped pave the way for the evolution of both modern healthcare practices and modern information access.  Nursing Informatics have come a long way since Florence Nightingale began compiling and sharing her statistical data. Today, the vital support of nurses leads to improved continuity of care and increasing access to a variety of data.  This, ultimately, contributes to better clinical practices and leads to improved patient care.

Today, technology has reached a point where it can effectively support the needs of patient care and facilitate the transition to improved methods of healthcare delivery and management.  With increasingly useful applications available for patient and staff use, communication methods allowing for care provision in isolated locations, and an increasing ability to provide improved continuity of care across disciplines, locations and time, we are moving into a new age of healthcare.  As nurses, we will be making significant contributions to the future of healthcare.

As technology evolves to encompass an increasing amount of information, allowing for faster access to more accurate statistics and research, better access to care for many, and more effective follow-up care and continuity of care, our roles are evolving to enrich the services we provide.  Communication technologies are encouraging patients to play a key role in their care teams, which is providing a venue for improved service as well as improved care and outcomes.  This multi-disciplinary, multifaceted approach to patient care, combined with easy access to information for both the patient and the care team, is bringing us into a future of new possibilities. 

17 Aug 2016

The Technology-enabled Nurse: Engaging the 'One Constant' with Patient Portals 


*Reprinted from the May 2016 edition of NIAA's N-Form Newsletter

By Ian Chaves, RN, BScN, MACT
Edmonton, AB. Karla Vermeer, Registered Nurse, sees the significance of patient portals in how they will change the way patients engage with their health and health care providers.
“The one constant in a ‘patient’s medical record of care’ is the patient. Until now, that one constant did not have ease of access to their own health information,” Karla says.
Karla has had extensive experience in the use of EMRs and EHRs. Her previous projects have included the development, pilot implementation, and subsequent role out of Netcare and EClinician. Currently, she is working in a Primary Care Clinic doing Diabetes and complex patient care as a Chronic Disease Management Nurse. In her collective experiences, she observed the importance of patients being engaged in their care. 

Karla remarks, “As nurses we say that chronic diseases are best managed when the patient is involved, but many patients are not or don’t have a way to really be involved. How can a patient really be part of the plan when they don’t have access to their own health information?”   Her work has now brought her to an opportunity to use technology in as a way to engage patients with their own health information – the introduction of patient portals. A patient portal provides a secure tool for patients to access their own health information, track their medication lists, medical history, labs, and diagnostic imaging. Karla has been involved in a couple patient portal projects over the past five years. In her first patient portal foray, she helped develop the provincial untethered Patient Health Portal, which is now the Public Health website myhealthalberta.ca.

In describing this project, Karla states, “An untethered portal is one where a patient has secure access to their health information, but is not necessarily able to communicate directly with their health care provider.”
While lacking a two-way communicative function, it does offer value with a selected view of the patient’s health information. This untethered patient portal laid the groundwork for other new ways for patients to engage, and it would be a matter of time before Karla became involved in the next iteration – the tethered patient portal.

In this past year, Karla has been working with the Edmonton Zone eClinician EMR which hosts a tethered patient portal. Initially piloted in December 2015, it offered patients access to view their own diagnostic imaging and lab results dating back to 2008 and allowed them to access their medical history as recorded within the eClinician EMR.  In addition to all this, it also gave patients the opportunity to send messages to their direct healthcare teams and offered them the option to book appointments online.  

“Our patients are getting timely advice from their health care providers… It can save having to book a clinic visit or save a patient from having to go to Emergency.”  Karla adds, “When it comes to scheduling, we are able to give real-time support to our patients. If it’s a weekend and the clinic is closed, a patient can schedule an appointment online for Monday, for example, and not have to wait for the 9 a.m. Monday phone lines to open to try to get an appointment.”

Further to finding appointments, tethered patient portals also address another issue with appointment scheduling – last moment patient cancellations.

“A patient can cancel their appointment online, freeing up an appointment spot which someone may benefit from, and by the time Monday morning arrives, we don’t have a lost appointment spot or a no show,” Karla says.

In contrast to paper-based systems, patient portals optimize access to digital health information and also begin to link patients to providers in new ways. When you change the way patients communicate with their own health information and health care providers, you change the way patients engage.

Karla remarks, “Nurses may be concerned with a patient that is overdue for a health intervention, or think that a patient does not understand the importance of timely health interventions. When we consider general health management, there are timely clinical indicators and health targets (e.g. screening or risk indicators). But how is a patient to know if he is meeting his own personal health targets or timelines of care if he can’t access his own information? We would not expect this in business or banking or other life management activities.”

A patient portal is a key shift in the paradigm of care, where patients are now partners in their care – a model providing them with their own information and fuelling their engagement. But in doing so, does this change what nurses need to do and how nurses need to engage?

Karla believes it does.

“Nurses need to leverage ways to communicate securely and in a timely fashion with our patients,” Karla says,  “we need to step into the new workflows of including our patients into the plan of care, digitally, so we can support our patients better.”

As a result, nurses find themselves involved in new ways to advocate for patient safety and represent the provider’s voice for safe and efficient workflows when using a patient portal. Karla asserts that this new connection will require new thinking.

“It takes flexibility on behalf of caregivers to think outside the box and integrate new ways to communicate with patients, check their in basket messages, monitoring a health indicator at home (i.e. Home glucose Or INR testing or blood pressure reads, and even sending comments about result notes directly to the patient to help clarify and lab value reading.”

While a patient portal may change how nurses approach providing care in a virtual space, the essence of nursing, how can we best support the care of this patient, continues to underpin it all.

“Nurses and clinicians have been waiting for this long overdue ability to securely communicate with their patients,” Karla adds, “It is an absolute JOY to have a secure way to message our patients”. ​

18 Apr 2016

Southern Charm: Public Health Informatics Conference 2016

August 21 -24, 2016, Atlanta, Georgia

The goal of the Public Health Informatics Conference is to provide a forum for public health, healthcare, and information technology professionals to exchange experiences, ideas, and strategies about public health informatics that are paramount to the advancement of public health practice and health equity.

This year's theme, "Access, Analysis, Action", explores how to procure technology and best obtain data for the end-users; connect attendees with tools and support available to understand the meaning of data; and drive attendees to apply lessons learned about the application of data win their own profession and community.

For more information and to register, visit phiconference.org

16 Mar 2016

Contribute to SNOMED/ICD-11: A Call to Clinicians!

The International Health Terminology Standards Development Organization (IHTSDO) determines global standards for health terms. They are committed to ensure that SNOMED CT, their world-leading product, is accepted as the global common language for health terms.

IHTSDO is now looking for practicing clinicians in a variety of specialties to review the proposed changes to SNOWMED CT to ensure clinical relevance for international usage. 

Clinicians will benefit by gaining more knowledge of SNOWMED CT and its application for their specialty. For more information about this call, please visit IHTSDO's site.

12 Jan 2016

Viva Las Vegas: The HIMSS 2016 Conference & Exhibition


February 29 - Mar, 2016 | Las Vegas, USA | Venetian - Palazzo - Sands Expo Center

The 2016 HIMSS (Healthcare Information & Management Systems Society) Annual Conference & Exibition brings together 40,000+ health IT professionals, clinicians, executives and vendors from around the world. Exceptional education, world-class speakers, cutting-edge health IT products and powerful networking are hallmarks of this industry-leading conference. More than 300 education programs feature keynotes, thought leader sessions, roundtable discussions and e-sessions, plus preconference symposia and workshops. For more information, visit the official HIMSS 16 Conference site.

11 Dec 2015

A San Francisco Treat: The American Nursing Informatics Association (ANIA) 2016 Annual Conference is approaching


Visit the City by the Bay from April 21-23, 2016 to engage with informatics colleagues and learn the newest trends in nursing Informatics.



Let the 2016 ANIA Conference be your "Golden Gate" ticket to network with informatics colleagues, increase your knowledge of current trends and best practices; interact with leading service and product vendors; and explore the history and excitement of the "City by the Bay" while learning about innovations in the informatics field. See more details at the official ANIA 2016 Annual Conference site.

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