NATIONAL NURSING INFORMATICS DEEP DIVE PRE CONFERENCE PROGRAM

Transcription

1 NATIONAL NURSING INFORMATICS DEEP DIVE PRE CONFERENCE PROGRAM PARTICIPANT BINDER November 19, 2014 Renaissance Bal more Harborplace Bal more, MD This program is generously funded by the Gordon and Be y Moore Founda on

2 National Nursing Informatics Deep Dive Program Background In today s complex healthcare environment nurse educators are continuously challenged to stay abreast of the rapidly expanding field of nursing informatics. From electronic health records, social media, consumer informatics, mobile-health, smart phones, and other applications, the expectations on nurse educators to prepare students for a data, information, and technology intensive healthcare environment are high. Compounding these challenges are the expectations of digital natives or students who have grown up in the information age and already possess advanced computer skills. Information technology is an enabling tool that links data, information, knowledge and wisdom and facilitates problem solving and decision making. However, incorporating information technology in ways that educate students on these important concepts remains a challenge for many educators and is the focus of this program. Purpose The National Nursing Informatics Deep Dive Program addresses the opportunity to enhance the competencies of prelicensure students, specifically in the area of nursing informatics. The goal of this free, daylong workshop is to provide nursing faculty with resources to teach nursing informatics to prelicensure students. The workshop is funded through the generous support of the Gordon and Betty Moore Foundation and in partnership with The University of Minnesota School of Nursing and AACN. This workshop is a national extension of the original Nursing Informatics Deep Dive Workshop held October 2 and 3, 2012 in San Francisco, CA. Recognizing the growing impact of information technology on the delivery of care, professional nursing organizations have established standards for nursing informatics to assist faculty integrate them into program curriculums. These standards include The AACN Essentials of Baccalaureate Education for Professional Nursing Practice Information Management and Application of Patient Care Technology, The TIGER Informatics Competencies for Every Practicing Nurse and The QSEN Knowledge, Skills and Attitudes for Informatics. The program will align these standards with a recommended curriculum and suggested methods, tools, and learning resources to teach them. The specific objectives of this workshop are to: 1. Discuss methods of integrating professional standards for nursing informatics into program curricula aimed at prelicensure nursing students. 2. Explore various methods used to teach nursing informatics to prelicensure students. 3. Provide nursing informatics resources and tools that can be easily incorporated into existing prelicensure program curricula. 1

3 National Nursing Informatics Deep Dive Program Wednesday, November 19, :30-8:30 a.m. Registration and Light Continental Breakfast 8:30 9 am (30 minutes) Welcome and Opening Program Session What is Nursing Informatics and Why is it Important? Preparing nursing students to benefit from the rapidly expanding role of information technology in care delivery is increasingly challenging for nurse educators. From electronic health records, social media, consumer informatics, mobile-health, smart phones, and other applications, the expectations to prepare students for a technology intensive healthcare environment are high. Dean Connie Delaney White, a pioneer in nursing informatics, will discuss this growing field and why it is so important to nurse educators today. Presenter: Connie Delaney White, PhD, RN, FAAN, FACMI Professor and Dean, School of Nursing and Director CTSI-BMI, Acting Director of the Institute for Health Informatics (IHI) BMI/CTSI-BMI, University of Minnesota, Minneapolis, MN 9:00-10:00 a.m. (1 hour) Program Session Integrating AACN Essentials, QSEN KSA and TIGER Competencies for Nursing Informatics This session will provide an introduction and crosswalk between the AACN Essentials, QSEN KSA s (knowledge, skills and attitudes) and TIGER Competencies for Practicing Nurses that can be used for developing a nursing informatics curriculum aimed at prelicensure students. The session will also discuss key nursing informatics concepts as well as faculty expectations of students regarding basic computer competencies and methods to teach and evaluate them. Presenter: Thomas R. Clancy, MBA, PhD, RN, FAAN, Clinical Professor and Assistant Dean, Faculty Practices, Partnerships and Professional Development, School of Nursing, University of Minnesota, Minneapolis, MN 10:00-10:30 a.m. Break 10:30 a.m.-12:00 p.m. (1.5 hours) Program Session Tools for Managing Information through Technology Managing the volume, variety and velocity of data in today s healthcare environment is an ongoing challenge for clinical nurses. This session will discuss various methods to educate students on patient care technologies, and information systems that support safe nursing practice. This includes navigating the electronic health record, planning patient care and documenting interventions related to achieving nurse sensitive outcomes. The session will also 2

4 discuss information literacy and various tools and strategies for evaluating nursing practice and outcomes and the benefits of standardization of nursing terminologies. Presenter: Jehad Adwan, PhD, RN, Assistant Professor, School of Nursing, University of Minnesota, Minneapolis, MN 12:00-1:30 p.m. Lunch on your own 1:30-3:00 p.m. (1.5 hours) Program Session Designing Effective Safeguards and Decision Making Support Providing safe care to patients begins with designing effective information systems. This session will describe how the design of technology and information management systems can improve the quality and safety of patient care through clinical decision support (CDS). The session will focus on the nurses role in workflow design and the selection, implementation, and evaluation of information technologies to support patient care. This includes discussing reliable and effective tools such as alerts, reminders and other forms of CDS for error prevention and care coordination. Presenter: Marisa Wilson, DNSc, MHSc, CPHIMS, RN-BC, Assistant Professor, Department of Acute and Chronic Care, School of Nursing, The Johns Hopkins University, Baltimore, MD 3:00-3:30 p.m. Break 3:30-5:00 p.m. (1.5 hours) Program Session Patient Engagement, Communication Technologies and Information Security This session will contrast benefits and limitations of different communication technologies and their impact on safety and quality. The session will discuss various patient engagement strategies including consumer health literacy, personal health records, emobile health, telehealth and virtual care delivery. The session will also include a discussion of ethics, information security, and protected health information as they relate to regulatory requirements, confidentiality, and clients right to privacy. Presenter: Dorcas Kunkel, DNP, RN, APHN-BC, Clinical Assistant Professor, School of Nursing, University of Minnesota, Minneapolis, MN 3

5 National Nursing Informatics Deep Dive Program Preconference November 19, 2014 Presenter Bio-sketches Presenter: Connie White Delaney, PhD, RN, FAAN, FACMI Professor & Dean, School of Nursing and Director CTSI-BMI Acting Director of the Institute for Health Informatics (IHI) BMI/CTSI-BMI, University of Minnesota, Minneapolis, MN Connie White Delaney is Professor and Dean, School of Nursing, University of Minnesota. She also serves as Associate Director of the CTSI-BMI in the Academic Health Center. Dr. Delaney is the first Fellow in the College of Medical Informatics to serve as a Dean of Nursing and was an inaugural appointee to the Health Information Technology Policy Committee. She is an active researcher and writer in the areas of national standards development for essential nursing care and outcomes/safety data. Dr. Delaney holds a BSN with majors in nursing and mathematics, MA in Nursing Adult Health, Ph.D. Educational Administration and Computer Applications, and completed postdoctoral study in nursing & medical informatics at the University of Utah. Presenter: Thomas R. Clancy, MBA, PhD, RN, FAAN, Clinical Professor and Assistant Dean, Faculty Practices, Partnerships and Professional Development, School of Nursing, University of Minnesota, Minneapolis, MN Dr. Clancy is project director for the National Nursing Informatics Deep Dive Program funded by the Gordon and Betty Moore foundation. He is a clinical professor and assistant dean at the University Of Minnesota School Of Nursing where he teaches, conducts research and consults on nursing informatics. Dr. Clancy, specializes in the integration of information technology into the clinical workflow of nurses. He currently serves as the co-chair for the expert panel on Informatics and Technology for the American Academy of Nursing. Prior to his appointment at the University Of Minnesota School Of Nursing, Dr. Clancy spent over 30 years in health system leadership roles in a variety of settings including acute, outpatient, long term and home care. Dr. Clancy has published numerous articles and chapters and presented on the benefits of information technology in complex healthcare systems. Presenter: Jehad Adwan, PhD, RN, Assistant Professor, School of Nursing, University of Minnesota, Minneapolis, MN Dr. Adwan is a clinical assistant professor at the University Of Minnesota(UM) School Of Nursing and is certified in Health Informatics Leadership through the UM School of Nursing and Institute for Health Informatics. Known as an exceptional teacher, Dr. Adwan specializes in teaching prelicensure students the fundamentals of nursing informatics in both the classroom and clinical setting. Dr. Adwan has extensive knowledge of various tools and methods to teach nursing informatics and has co-developed several on-line health informatics courses including a recent MOOC (Massive On-line Open Course) with over 15,000 participants. 4

6 Presenter: Marisa Wilson, DNSc, MHSc, CPHIMS, RN-BC, Assistant Professor, Department of Acute and Chronic Care, School of Nursing, The Johns Hopkins University, Baltimore, MD Marisa L Wilson, DNSc, MHSc CPHIMS, RN-BC, is an assistant professor at the Johns Hopkins University School of Nursing in the Department of Acute and Chronic Care. She is responsible for coursework in informatics, leadership, evidence based practice, and translation. Dr. Wilson teaches at the BSN, Masters, and Doctor of Nursing Practice levels. She is a Board Certified Nursing Informatician with an interest in understanding how we can maximize the impact that design and implementation of health care technology can have on the operations, efficiencies, and outcomes at the point of care. She has developed computational terminology, analyzed integration of disparate systems, implemented disruptive technologies, and proposed new leadership models. She has more than 30 years of experience designing and implementing clinical and reporting systems in the public health and acute care environments, the development of critical thinking and clinical reasoning using virtual immersive environments, and the changing needs of clinicians with the uptake of technology. She is on the Public Policy Board for the Maryland HIE, the Board of Directors for TIGER, and MD HIMSS. Dr. Wilson is the chair for both the Summer Institute in Nursing Informatics (SINI) and the TIGER Virtual Learning Environment Committee. She has published peer reviewed journal articles and has authored multiple book chapters. Presenter: Dorcas Kunkel, DNP, RN, APHN-BC, Clinical Assistant Professor, School of Nursing, University of Minnesota, Minneapolis, MN Dr. Kunkel is a clinical assistant professor at the University of Minnesota, School of Nursing and has a Doctor of Nursing Practice (DNP) degree and certificate in Health Informatics Leadership through the UM School of Nursing and the Institute for Health Informatics. Dr. Kunkel currently provides didactic and clinical instruction to undergraduate nursing students and is a faculty member of the Veteran s Administration (VA), Nurse Academic Partnership (VANAP) at the Minneapolis Veteran s Health Care System (MVAHCS). She has extensive knowledge of the VA s electronic health record (EHR) and telehealth applications and brings valuable teaching methods that can be used in the clinical environment. 5

7 National Nursing Informatics Deep Dive Program What is Nursing Informatics and Why is it Important? Connie White Delaney, PhD, RN, FAAN, FACMI Dean and Professor, School of Nursing Director, Clinical and Translational Science Institute Biomedical Informatics Acting Director, Institute for Health Informatics November 19,

8 National Nursing Informatics Deep Dive Program What is Nursing Informatics and Why is it Important? Connie White Delaney, PhD, RN, FAAN, FACMI Dean and Professor, School of Nursing Director, Clinical and Translational Science Institute Biomedical Informatics Acting Director, Institute for Health Informatics November 19, Disclosure I have no relevant financial interest to disclose nor am I endorsing any commercial products identified in this presentation. 2 Objectives Discuss why informatics? Examine national transformation initiatives, including the Triple Aim, Learning Health System, knowledge generating infrastructure, & interprofessional initiatives. Describe what is informatics and integration with nursing s mission. 3 7

9 Why does today matter? 4 8 Recommendations Supporting 4 Key Messages Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and information infrastructure. 5 TRIPLE AIM ning_and_integration/approach_to_health_system_improvement/triple%20aim%20triang le%20with%20bullseye.png 8

10 TRIPLE AIM The Vision Continuous Learning, Best Care, Lower Cost 8 Sept 2012 iom.edu/bestcare 7 Characteristics of continuously Learning Healthcare System Science and informatics 1. Real-time access to knowledge. The system continuously and reliably captures, curates and delivers the best available evidence to guide and improve clinical decision-making and healthcare safety and quality. 2. Digital capture of the care experience. The system captures the care experience on digital platforms for real-time generation and application of knowledge for care improvement. Patient-clinician relationships 3. Engaged, empowered patients. The system focuses on patient needs and perspectives and promotes the inclusion of patients, families and other caregivers as vital members of the continuously learning care team. 9 9

11 7 Characteristics of continuously Learning Healthcare System Incentives 4. Incentives aligned for value. The system actively aligns incentives to encourage continuous improvement, identify and reduce waste and reward high-value care. 5. Full transparency. The system systematically monitors the safety, quality, processes, prices, costs and outcomes of care, and makes information available for care improvement and informed choices and decision-making by clinicians, patients and their families. Culture 6. Leadership-instilled culture of learning. The system has leadership committed to a culture of teamwork, collaboration and adaptability in support of continuous learning as a core aim. 7. Supportive system competencies. The system constantly refines complex care operations and processes through ongoing team training and skill building; systems analysis and information development; and creation of the feedback loops for continuous learning and system improvement. 10 Federal Health IT Strategic Plan coordinated strategy between the public and private sector to improve the quality, efficiency, safety and patient-centeredness of health care through use of information and technology. 11 Federal Health IT Strategic Plan Pre-decisional Draft Do Not Disclose 11 Meaningful Use of Meaningful Use Utilize technology Access to information Care coordination Data utilized to improve delivery and outcomes Patient self management Care coordination Transform health care Improved population health Enhanced access and continuity Data utilized to improve delivery and outcomes Patient engaged, community resources Patient centered care coordination Patient informed Evidenced based medicine Team based care, case management Basic EHR functionality, structured data Structured data utilized Registries for disease management Registries to manage patient populations Privacy & security protections Privacy & security protections Privacy & security protections Privacy & security protections 12 Stage 1 MU Stage 2 MU PCMH 3-Part Aim ACO s Stage 3 MU 10

12 Evidence & Knowledge Generating Infrastructure NIH transformation 13 Knowledge Generating Infrastructure Clinical and Translational Science Awards (CTSAs) Program creates a definable academic home for clinical and translational research. CTSA institutions work to transform the local, regional, and national environment to increase the efficiency and speed of clinical and translational research across the country 14 Layers of Context (AHRQ Clinical Community Relations Measures Atlas, 3/2012) 15 11

13 16 The Nexus Regents of the University of Minnesota, All Rights Reserved Synergy of: Triple Aim Learning Health System Knowledge generating infrastructure Interprofessional initiatives 18 12

14 Biomedical Informatics AMIA.org Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health. 19 Biomedical Informatics: Corollaries to the Definition 1. BMI develops, studies and applies theories, methods and processes for the generation, storage, retrieval, use, and sharing of biomedical data, information, and knowledge. 2. BMI builds on computing, communication and information sciences and technologies and their application in biomedicine. 20 Biomedical Informatics: Corollaries to the Definition 3. BMI investigates and supports reasoning, modeling, simulation, experimentation and translation across the spectrum from molecules to populations, dealing with a variety of biological systems, bridging basic and clinical research and practice, and the healthcare enterprise. 4. BMI, recognizing that people are the ultimate users of biomedical information, draws upon the social and behavioral sciences to inform the design and evaluation of technical solutions and the evolution of complex economic, ethical, social, educational, and organizational systems

15 Biomedical Informatics in Perspective Basic Research Biomedical Informatics Methods, Techniques, and Theories Biomedical Informatics Bioinformatics Applied Research And Practice Bioinformatics Imaging Informatics Clinical Informatics Public Health Informatics 22 Interdisciplinary Nature of Biomedical Informatics Computer Science (hardware) Computer Science (software) Cognitive Science & Decision Making Management Sciences Biomedical Informatics Bioengineering Epidemiology And Statistics Clinical Sciences Basic Biomedical Sciences 23 Biomedical Informatics in Perspective Basic Research Biomedical Informatics Methods, Techniques, and Theories Biomedical Informatics Health Informatics Health Informatics Applied Research And Practice Bioinformatics Molecular and Cellular Processes Imaging Informatics Tissues and Organs Clinical Informatics Individuals (Patients) Public Health Informatics Populations And Society 24 14

16 An Envisioned Cycle That Ties Patient Care with Knowledge Creation and Dissemination Providers Caring for Patients Electronic Health Records Information, Decision-Support, and Order-Entry Systems Creation of Protocols, Guidelines, and Educational Materials Regional and National Public Health and Disease Registries Standards for Prevention and Treatment Biomedical and Clinical Research A Learning Healthcare System 25 LIFE in the year 2100 [THE WEEK, April , Vol 11, Issue 509; Physics of the Future by Michio Kaku] 1900 life expectancy 40, farmers (no internet, airplanes, TV, computer) Methods Interviews of 300 top world scientists Findings: Internet in your contact lenses No computers, cell phones, clocks, watches, MP3s Cars driver-less, use GPS, cushion of magnetism Grow spare parts for organs as they wear out Aging slowed down, expanded human life span Molecular smart bombs circulating to kill cancer cells Toilets & BR mirrors contain DNA sensors to detect Ca cells, clothes with sensors Growth of robots Tourism into outer space Advanced dangers of biological warfare, global warming (computer chip industry cease) 26 Higher Education Challenges of the 21 st Century Improve internal democracy (ethics, autonomy, responsibility, anticipation) Changes in knowledge creation (interdisciplinary & transdisciplinary Changes in the educational model (more active, connected to real life, designed with students and their unique qualities in mind) Tapping the potential of information and communication technologies in the creation and dissemination of knowledge (digital wisdom) Changes for social responsibility and knowledge transfer

17 Future Work Skills Sense-making 2 Social intelligence 3 Novel & adaptive thinking 4 Cross -cultural competency 5 Computational thinking Definition: ability to translate vast amounts of data into abstract concepts and to understand data-based reasoning 2020 Workforce Skills 28 Future Work Skills New-media literacy Definition: ability to critically assess and develop content that uses new media forms, and to leverage these media for persuasive communication 7 Transdisciplinarity Definition: literacy in and ability to understand concepts across multiple disciplines 8 Design mindset Definition: ability to represent and develop tasks and work processes for desired outcomes 29 Future Work Skills Cognitive load management Definition: ability to discriminate and filter information for importance, and to understand how to maximize cognitive functioning using a variety of tools and techniques 10 Virtual collaboration Definition: ability to work productively, drive engagement, and demonstrate presence as a member of a virtual team

18 Society s Call for Nursing s Leadership Transform our health care system Extraordinary possibilities for nursing Era of big data, massive databases of health information electronic health records systems health repositories genomics resources mobile computing social media archives Power of predictive and visualization analytics to: ascertain patterns & trends provide evidence that will guide patient care & care management, risk management, patient satisfaction, and decision support Support solutions for practice, scholarship, and management Effective stewardship and socially responsible engagement Context of polarity and partnerships. 31 National Nursing Informatics Deep Dive Program What is Nursing Informatics and Why is it Important? Connie White Delaney, PhD, RN, FAAN, FACMI Dean and Professor, School of Nursing Director, Clinical and Translational Science Institute Biomedical Informatics Acting Director, Institute for Health Informatics November 19,

19 National Nursing Informatics Deep Dive Program Integrating AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Clinical Professor and Assistant Dean Faculty Practices, Partnerships and Professional Development November 19,

20 National Nursing Informatics Deep Dive Program Integrating AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Clinical Professor and Assistant Dean Faculty Practices, Partnerships and Professional Development November 19, Disclosure I have no relevant financial interest to disclose nor am I endorsing any commercial products identified in this presentation. 2 Workshop Objectives Discuss methods of integrating professional standards for nursing informatics into program curricula aimed at prelicensure nursing students. Explore various methods used to teach nursing informatics to prelicensure students. Provide nursing informatics resources and tools that can be easily incorporated into existing prelicensure program curricula. 3 19

21 Presentation Objectives Discuss the Knowledge Complexity Framework as it relates to curriculum development for nursing informatics. Review the integration of The AACN Essentials for Information Management, The TIGER Competencies for Practicing Nurses and the QSEN knowledge, skills and attitudes for nursing informatics into a nursing informatics curriculum. 4 Knowledge Work Data statistics, financial data, metrics procedures, standards, user guides, Information specifications, regulations, audits, (Procedural) filing and classification, order processing workflow planning, priorities, graphs, Knowledge engineering, historical data, tracking, (Functional) database design & management business plans, goals, objectives, budgets, Meaning resources, roles, culture, managing variables, (Managing) developing projects Philosophy strategic planning, systemic mapping, (Systems) competitive analysis, market forecasts Wisdom values, vision, future trends (Renewing) Union social, environmental & global issues, activism, ecological values work 2002 Verna Allee, used with permission 5 Knowledge Complexity Curriculum Framework Sample Crosswalk Between AACN BSN Essentials/ Knowledge Framework/Semester Key DATA (Instinctual INFORMATION (Single KNOWLEDGE MEANING PHILOSOPHY WISDOM UNION 1. Classroom Activities Learning) Loop learning). (Double Loop (Communal (Duetero learning) (Generative (Synergistic) 2. Simulation Activities Sensing Action without learning) learning) Self-organizing learning) Connection 3. Clinical Activities reflection Self-conscious Understanding Value driven 4. Syllabus reflection. context, 5. Readings 6. Assignments relationships & trends. FALL FRESHMAN YEAR ICL, 1,5,6 ICL, 1,5,6 SPRING FRESHMAN YEAR ICL, 1,5,6 ICL, 1,5,6 FALL SOPHOMORE YEAR ICL, PCT, CIS, CD, ICL, PCT, CIS, CD, CDS, CDS, SNT, SNT, 1,2,4,5,6 1,2,4,5,6 SPRING SOPHOMORE YEAR ICL, PCT, CIS, CD, ICL, PCT, CIS, CD, CDS, ICL, 1,2,4,5,6 CDS, SNT, SNT, 1,2,4,5,6 1,2,4,5,6 FALL JUNIOR YEAR ICL, PCT, CIS, CD, ICL, PCT, CIS, CD, CDS, ICL, PCT, CIS, CD, CDS, SNT, CL, SNT, CL, HIPAA, CI CDS, SNT, HIPAA, CI 1,2,3,4,5,6 1,2,3,4,5,6 1,2,3,4,5,6 ICL 1,2,3,4,5,6 SPRING JUNIOR YEAR ICL, PCT, CIS, CD, ICL, PCT, CIS, CD, CDS, ICL, PCT, CIS, CD, ICL, PCT, CIS, CD, CDS, SNT, CL,CI, SNT, CL, HIPAA, CI CDS, SNT, CL, CI, CDS, SNT, HIPAA 1,2,3,4,5,6 1,2,3,4,5,6 HIPAA, 1,2,3,4,5,6 1,2,3,4,5,6 FALL SENIOR YEAR ICL, PCT, CIS, CD, ICL, PCT, CIS, CD, CDS, ICL, PCT, CIS, CD, CDS, SNT, CL, SNT, CL, HIPAA, WA CDS, SNT, CL, HIPAA, WA, 1,3,4,5,6 HIPAA, WA, 1,3,4,5,6 1,3,4,5,6 ICL, PCT, CIS, CD, ICL, PCT, CIS, CD, CDS, CDS,, SNT, SNT,,1,3,4,5,6 CL,HIPAA, WA,, 1,3,4,5,6 SPRING SENIOR YEAR ICL, PCT, CIS, CD, ICL, PCT, CIS, CD, CDS, ICL, PCT, CIS, CD, CDS, SNT, CL, SNT, CL, HIPAA, WA, CDS, SNT, CL, HIPAA, 1,3,4,5,6 HIPAA, WA,1,3,4,5,6 WA1,3,4,5,6 ICL, PCT, CIS, CD, CDS, SNT, CL, HIPAA, WA 1,3,4,5,6 ICL, PCT, CIS, CD, CDS, SNT, CL, HIPAA, WA 1,3,4,5,6 6 20

22 Standards and Guidelines AACN Essentials for Information Management And Patient Care Technologies Quality, Safety & Education for Nurses Knowledge, Skills and Attitudes Technology Informatics Guiding Education Reform Competencies for Practicing Nurses 7 AACN Essentials for Baccalaureate Education For Professional Nursing Practice Information Management and Application of Patient Care Technology AACN Essentials I. Liberal Education for Baccalaureate Generalist Nursing Practice II. Basic Organizational and Systems Leadership for Quality Care and Patient Safety III. Scholarship for Evidence Based Practice IV. Information Management and Application of Patient Care Technology V. Healthcare Policy, Finance, and Regulatory Environments VI. Inter-professional Communication and Collaboration for Improving Patient Health Outcomes VII. Clinical Prevention and Population Health VIII. Professionalism and Professional Values IX. Baccalaureate Generalist Nursing Practice 8 Course by AACN Essential Sample Crosswalk Between AACN BSN Essentials for Information Management and Patient Care Technologies and Curriculum Key 1.0 Demonstrate skills 2.0 Understand the use of 3.0 Advocate for the use 4.0 Use 1. Classroom Activities in using patient care CIS (clinical information of new patient care telecommunication 2. Simulation Activities technologies, systems) to document technologies for safe, technologies to assist in 3. Clinical Activities 4. Syllabus information systems, interventions related to quality care effective 5. Readings and communication achieving nurse sensitive communication in a 6. Assignments devices that support outcomes. variety of healthcare safe nursing practice. settings. FALL SOPHOMORE YEAR NURS 3703 Assessment and Basic Nursing (lab I) NURS 3801PCC Adults/Older Adults I or NURS 3802 Nursing Care of Families I (1/2 Class in each) 1,2,4,5,6 1,2,4,5,6 1,5 1,5 1,5 1,5 NURS 3806 Professional 1,5 1,5 1,5 1,5 Nursing NURS 5010 Foundations of 1,2,4,5,6 1,2,4,5,6 1,5 1,2,4,5,6 Interprofessional Communication/Collaboratio n 9 21

23 AACN Essentials For Information Management and Application For Patient Care Technology 1.Demonstrate skills in using: patient care technologies, information systems and communication devices that support safe nursing practice. 10 AACN Patient Care Technologies Patient Care Technologies Computers, printers IV smart pumps, Bar coded medication management systems, Pulse oximeters, Automated blood pressure and pulse Monitoring equipment (ECG, arterial blood pressure, respirations) Automated temperature Defibrillators AACN Sample Content Use of patient care technologies 11 AACN Communication Devices Communication Devices Smart phones, Hands free mobile communication devices (Vocera), Tablets (ipads) Quantified Self 12 22

24 AACN Information Systems Operations Support Basic computer hardware and software Software (spread sheets, , word processing, databases) Core Systems Admission, discharge, transfer Financial systems Order entry system Ancillary systems (lab, pharmacy, radiology) Results reporting systems Documentation systems Administrative systems (scheduling) Sample AACN Content Computer skills that may include basic software, spreadsheet, and healthcare databases. 13 QSEN Attitudes Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills Knowledge Explain why information and technology skills are essential for safe patient care Skills Seek education about how information is managed in care settings before providing care. 14 Technology Informatics Guiding Education Reform (TIGER) Informatics Competencies for Every Practicing Nurse: TIGER Competencies European Computer Driving License Basic Computer Competencies 1.1 Hardware 1.2 Software 1.3 Networks 1.4 Information/communication tech. 2.1 Operating systems 2.2 File Mgt 2.3 Utilities 2.4 Print Mgt 3.1 Using the Application 7.1 The Intranet 7.2 Using the browser 7.3 Using the Web 7.4 Web outputs 15 23

25 AACN Essentials For Information Management and Application For Patient Care Technology 2. Understand the use of CIS (clinical information systems) to document interventions related to achieving nurse sensitive outcomes. Small, D. (2011). Patients First! Engaging the hearts and minds of nurses with a patient-centered practice model American Nurses Association On-line Journal of Issues in Nursing: Vol AACN Clinical Information Systems Clinical Information Systems Electronic health records in: Acute care Ambulatory care Skilled nursing care Home, public and community health systems Applications to manage care. Provider order entry Clinical documentation (assessment, care planning, other) Results reporting Bar coded medication administration (BCMA) Electronic medication administration record (emar) Ancillary systems (pharmacy, lab, radiology) AACN Sample Content Electronic health records/physician order entry. 17 QSEN Attitudes Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills Knowledge Explain why information and technology skills are essential for safe patient care. Skills Document and plan patient care in an electronic health record. Navigate the electronic health record

26 Technology Informatics Guiding Education Reform (TIGER) Informatics Competencies for Every Practicing Nurse: TIGER Competencies European Computer Driving License Information Management 1.0 Demographic 2.0 Consents 3.0 Medication Mgt 4.0 Planning care 5.0 Order results 6.0 Care documentation 19 AACN Essentials For Information Management and Application For Patient Care Technology 3. Advocate for the use of new patient care technologies for safe, quality care 20 Emobile Health Telehealth Patient Engagement/Personal Health Records Social Media Predictive analytics and Big Data Robotics Nano-technology and 3D computing 3D Printing Wearable Technology Science Roll, The Journey of a Geek Medical Futurist accessed Sept. 2, 2014: The Future is Here! Google Glasses 21 25

27 AACN Essential 4. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings. Telecommunications Technologies: AACN Sample Content Technology for virtual care delivery and monitoring. Interstate practice regulations (e.g., licensure, telehealth). Information literacy 22 Telehealth Patient monitoring technologies (virtual assessments, ICU s) Home sensing devices (weight scale, BP monitor, bed chair, glucose meter, implant monitors, baby monitors, spirometer, medication monitoring, pedometer) Patient engagement Personal health records Health literacy Social networking AACN Essentials Telehealth Communication Technologies 23 QSEN Attitudes Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills Knowledge Contrast benefits and limitations of different communication technologies and their impact on safety and quality Skills Employ communication technologies to coordinate care for patients

28 Technology Informatics Guiding Education Reform (TIGER) Informatics Competencies for Every Practicing Nurse: TIGER Competencies European Computer Driving License Communication Technologies Basic Computer Competencies Electronic Communication 7.6 Using management Information Mgt Competencies 9.0 Facilitating Communications 25 AACN Essentials For Information Management and Application For Patient Care Technology 5. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers. 26 Safeguards and Decision Making Support Medication dosing support (medication pick lists, dosing calculators) Order facilitators (order sets for specific conditions based on evidence based guidelines: pneumonia, adult prosthetic hip replacement, myocardial infraction) Point of care alerts (drug to drug interactions, duplicate therapy, drug allergies, contraindications to specific conditions) Point of care reminders (immunizations, cancer screenings, fall prevention, pain management). Information displays (dashboards of relevant data) Courtesy of icare AACN Sample Content Use of technology and information systems for clinical decision-making. Technology and information systems safeguards 27 27

29 QSEN Attitudes Value technologies that support clinical decision-making, error prevention, and care coordination Knowledge Describe examples of how technology and information management are related to the quality and safety of patient care Skills Respond appropriately to clinical decision-making supports and alerts. Apply technology and information management tools to support safe processes of care. 28 TIGER Competencies Decision Support 7.1 Standard Assessments 7.2 Patient Context- Driven assessments 7.3 Identification of Potential Problems and Trends 7.4 Patient and Family Preferences 7.5 Standard Care Plans, Guidelines, and Protocols 7.6 Context-Sensitive Care Plans, Guidelines, and Protocols 7.7 Consistent Healthcare 7.8 Patient Groups or Populations 7.9 Research Protocols Relative to Individual Patient Care 7.10 Self-Care 7.11 Medication and Immunization Ordering 7.12 Drug Interaction Checking 7.13 Patient Specific Dosing and Warnings 7.14 Medication Recommendations 7.15 Medication and Immunization Administration 7.16 Non-Medication Ordering 7.17 Support for Result Interpretation 7.18 Referral Process 7.19 Referral Recommendations 7.20 Safe Blood Administration 7.21 Accurate Specimen Collection 29 AACN Essentials For Information Management and Application For Patient Care Technology 6. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment. Big Data 30 28

30 Information Technology and Improving Patient Outcomes Benefits of Big Data Population management Cost benefit/effectiveness Best practices & EBG s Health analytics Descriptive Predictive Clinical research Comparative analysis Nurse sensitive quality outcomes Dashboards 31 AACN Essentials For Information Management and Application For Patient Care Technology 7. Use standardized terminology in a care environment that reflects nursing s unique contribution to patient outcomes. 32 Standardized Terminologies Multidisciplinary terminologies (SNOMED-CT, LOINC) Nursing terminologies (CCC, ICNP, NANDA, NIC, NOC, OS, PNDS) AACN Content Sample: Information management for patient safety

31 QSEN Attitudes Value technologies that support clinical decision-making, error prevention, and care coordination Knowledge Identify essential information that must be available in a common database to support patient care Skills Use information management tools to monitor outcomes of care processes 34 Technology Informatics Guiding Education Reform (TIGER) Informatics Competencies for Every Practicing Nurse: TIGER Competencies European Computer Driving License Standardized Nursing Terminology Information Literacy 2.9 Understand how to use classification systems and their rationale. 35 AACN Essentials For Information Management and Application For Patient Care Technology 8. Evaluate data from all relevant sources, including technology, to inform the delivery of care

32 Relevant Sources, Including Technology AACN Sample Content Retrieval from information systems, including access, evaluation of data, and application of relevant data to patient care. On-line literature searches Technological resources for evidence based practice 37 QSEN Attitudes Value technologies that support clinical decision-making, error prevention, and care coordination Knowledge Identify essential information that must be available in a common database to support patient care Skills Use high quality electronic sources of healthcare information. 38 Technology Informatics Guiding Education Reform (TIGER) Informatics Competencies for Every Practicing Nurse: TIGER Competencies European Computer Driving License Information Literacy Competencies 1. Knowledge 2. Access 3. Evaluate Information 4. Application of information 5. Evaluate Outcomes 39 31

33 AACN Essentials For Information Management and Application For Patient Care Technology 9. Apply patient-care technologies as appropriate to address the needs of a diverse patient population. Institute for Family Health Early adopter of the patient portal, introducing the Epic MyChart, MyHealth in 2007 and the Spanishlanguage version, MiRecord, MiSalud, in Diverse Patient Populations The Institute implemented a robust patient portal that patients can use to: Send and receive secure messages Access and review clinical summaries Access and review their health information (medications, health history, allergies, current medication, lab and other test results) Download their medical record Create a wallet card that lists their medications Access MedlinePlus patient education resources, schedule appointments Request medication refills Specific programs to address health care needs in these communities: including education and support for people with HIV, a comprehensive diabetes program, school-based clinics, and clinics for the homeless. 41 AACN Essentials For Information Management and Application For Patient Care Technology 10. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice

34 AACN Essentials For Information Management and Application For Patient Care Technology 11. Participate in evaluation of information systems in practice settings through policy and procedure development. 43 QSEN Attitudes Value nurses involvement in design, selection, implementation, and evaluation of information technologies to support patient care. Knowledge Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care 44 AACN Essentials For Information Management and Application For Patient Care Technology 12. Uphold ethical standards related to data security, regulatory requirements, confidentiality, and clients right to privacy. AACN Sample Ethical and legal issues related to the use of information technology, including copyright, privacy, and confidentiality issues 45 33

35 Technology Informatics Guiding Education Reform (TIGER) Informatics Competencies for Every Practicing Nurse: TIGER Competencies European Computer Driving License Basic Computer Competencies 1.10 Security 1.11 Law 46 QSEN Attitudes Protect confidentiality of protected health information in electronic health records 47 Information Management Systems as Enablers of BSN Essentials III. Scholarship for Evidence Based Practice The baccalaureate program prepares the graduate to evaluate the credibility of sources of information, including but not limited to databases and Internet resources. locating and evaluating sources of evidence electronic database search strategies (e.g., CINAHL, PubMed, the Cochrane Database of Systematic Reviews) IV. Information Management and Application of Patient Care Technology Baccalaureate graduates must have competence in the use of information technology systems, including decision support systems, to gather evidence to guide practice. Improvement of cost effectiveness and safety depend on evidence based practice, outcomes research, interprofessional care coordination, and electronic health records, all of which involve information management and technology (McNeil et al., 2006)

36 Questions? 49 35

37 Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN # AACN Definitions AACN Sample Content 1 Demonstrate Computer skills skills in using that may include patient care basic software, technologies, spreadsheet, and information healthcare systems, and databases. communication devices that support safe nursing practice. 2 Understand the use of CIS (clinical information systems) to document interventions related to achieving nurse sensitive outcomes. Patient Care Technologies Computers, printers IV smart pumps, Bar coded medication management systems, Pulse oximeters, Automated blood pressure and pulse Monitoring equipment (ECG, arterial blood pressure, respirations) Automated temperature Defibrillators Communication Devices Smart phones, hands free mobile communication devices (Vocera), tablets (ipads) Clinical Information Systems Electronic health records in: Acute care Ambulatory care Skilled nursing care Home and community health systems Public health systems Applications to manage care. Provider order entry Clinical documentation (assessment, care planning, other) Results reporting Bar coded medication administration (BCMA) Electronic medication administration record (emar) Ancillary systems (pharmacy, lab, radiology) Use of patient care technologies (e.g., monitors, pumps, computerassisted devices. Electronic health records/physician order entry. TIGER Competencies Basic Computer Competencies. 1.1 Hardware 1.2 Software 1.3 Networks 1.4 Information and communication technology 2.1 Oper. systems 2.2 File Mgt 2.3 Utilities 2.4 Print Mgt 3.1 Applications 7.1 The Intranet 7.2 Browser 7.3 Using the Web 7.4 Web outputs Information Mgt Competencies 1.0 Demographic 2.0 Consents 3.0 Med Mgt 4.0 Planning care 5.0 Order results 6.0 Care doc. QSEN Knowledge Explain why information and technology skills are essential for safe patient care QSEN Skills QSEN Attitudes Seek education about how information is managed in care settings before providing care Document and plan patient care in an electronic health record. Navigate the electronic health record. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills 36

38 Value technologies that support clinical decision-making, error prevention, and care coordination Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN 3 Advocate for the use of new patient care technologies for safe, quality care 4 Use telecommunicati on technologies to assist in effective communication in a variety of healthcare settings. New Patient Technologies Emobile Health Telehealth Patient Engagement/Personal Health Records Social Media Predictive analytics and Big Data Robotics Nano-technology and 3D computing 3D Printing Wearable Technology Telecommunications technologies: , Telehealth Patient monitoring technologies (virtual assessments, ICU s) Home sensing devices (weight scale, BP monitor, bed chair, glucose meter, implant monitors, baby monitors, spirometer, medication monitoring, pedometer) Patient engagement Personal health records Health literacy websites Social networking Technology for virtual care delivery and monitoring. Information literacy Interstate practice regulations (e.g., licensure, telehealth). Basic Computer Competencies 1.9 Information and Communication Technology. 7.5 Electronic Communication 7.6 Using mgt Information Mgt Competencies 9.0 Facilitating Communications Contrast benefits and limitations of different communicat ion technologies and their impact on safety and quality Employ communicatio n technologies to coordinate care for patients Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare Safeguards and decision making support (Information Systems) Medication dosing support (medication pick lists, dosing calculators) Order facilitators (order sets for specific conditions based on evidence based guidelines: pneumonia, adult prosthetic hip replacement, myocardial infraction) Point of care alerts (drug to drug interactions, duplicate therapy, drug allergies, contraindications to specific Use of technology and information systems for clinical decisionmaking. Technology and information systems safeguards (e.g., patient monitoring, Information Mgt Competencies 1.0 Decision Support 2.0 Notifications Describe examples of how technology and information management are related to the quality and safety of patient care Respond appropriately to clinical decisionmaking supports and alerts. Apply technology and information

39 Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN 6 workers. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment. conditions) Point of care reminders (immunizations, cancer screenings, fall prevention, pain management). Information displays (dashboards of relevant data) equipment, patient identifications systems, drug alerts, IV systems, and bar-coding. management tools to support safe processes of care. 7 Use standardized terminology in a care environment that reflects nursing s unique contribution to patient outcomes. Standardized terminologies Multidisciplinary terminologies (SNOMED-CT, LOINC) Nursing terminologies (CCC, ICNP, NANDA, NIC, NOC, OS, PNDS Information management for patient safety. Information Literacy 2.9 Understand how to use classification systems and their rationale. Identify essential information that must be available in a common database to support patient care Use information management tools to monitor outcomes of care processes 8 Evaluate data from all relevant sources, including technology, to inform the delivery of care. Relevant sources Literature search methods to access, evaluate information, apply to practice and evaluate outcomes Retrieval information systems, including access, evaluation of data, and application of relevant data to patient care. On-line literature searches Information Literacy Competencies 1.Knowledge 2.Access 3. Evaluate info. 4.Application 5.Evaluate Outcomes Use high quality electronic sources of healthcare information Technological resources for evidence based practice 38 Web-based learning and

40 Value nurses involvement in design, selection, implementation, and evaluation of information technologies to support patient care Protect confidentiality of protected health information in electronic health records Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN 9 Apply patient-care technologies as appropriate to address the needs of a diverse patient population. 10 Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice. 11 Participate in evaluation of information systems in practice settings through policy and procedure development. 12 Uphold ethical standards related to data security, regulatory requirements, confidentiality, and clients right to privacy. Diverse patient population Ethnic/racial Gender Cultural Uninsured/under-insured/homeless Sexual orientation Elderly/Adult/ Adolescent/pediatric Workflow and Care Processes SDLC Systems Design Life Cycle Human computer interaction Data Security, regulatory, confidentiality, right to privacy. HIPAA Copyright laws Ethical behavior online literature searches for self and patient use. Ethical and legal issues related to the use of information technology, including copyright, privacy, and confidentiality issues. Basic Computer Competency 1.10 Security 1.11 Law Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care 39

41 Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN 40 Sample Crosswalk Between AACN BSN Essentials for Information Management and Patient Care Technologies and Curriculum 1.0 Demonstrate skills 2.0 Understand the use of 3.0 Advocate for the use in using patient care CIS (clinical information of new patient care technologies, systems) to document technologies for safe, information systems, interventions related to quality care and communication achieving nurse sensitive devices that support outcomes. safe nursing practice. Key 1. Classroom Activities 2. Simulation Activities 3. Clinical Activities 4. Syllabus 5. Readings 6. Assignments FALL FRESHMAN YEAR Psych 1001 General Psychology Chem 1015 General Chemistry (add Chem 1017 to meet Liberal Ed req.) Electives or Liberal Ed. courses (2 courses) Seminar for Freshman Guarantee Students SPRING FRESHMAN YEAR Biol 1009 Biology Human Growth and Development (Lifespan) Nutrition English Composition Writing FALL SOPHOMORE YEAR NURS 3703 Assessment and Basic Nursing (lab I) NURS 3801PCC Adults/Older Adults I or NURS 3802 Nursing Care of Families I (1/2 Class in each) NURS 3806 Professional Nursing 1,2,4,5,6 1,2,4,5,6 1,5 1,5 1,5 1,5 1,5 1,5 1,5 1,5 4.0 Use telecommunication technologies to assist in effective communication in a variety of healthcare settings.

42 Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Key 1. Classroom Activities 2. Simulation Activities 3. Clinical Activities 4. Syllabus 5. Readings 6. Assignments NURS 5010 Foundations of Interprofessional Communication/Collaboration Phsl 3051 Physiology (Twin Cities Students only) Anat 3001 Anatomy (Twin Cities Students only) Writ 3562 Technical & Professional Writing; or Statistics (optional) SPRING SOPHOMORE YEAR NURS 3705 Nursing Interventions (Lab II) NURS 3801 PCC Adults/Older Adults I or NURS 3802 Nursing Care of Families I (1/2 Class in each) PHARM 3800 Pharmacotherapy for the Health Professions (online) VBS 2032 Microbiology with lab NURS 3803 Application of Genetics in Nursing (online) FALL JUNIOR YEAR 1.0 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice. 2.0 Understand the use of CIS (clinical information systems) to document interventions related to achieving nurse sensitive outcomes. 3.0 Advocate for the use of new patient care technologies for safe, quality care 1,2,4,5,6 1,2,4,5,6 1,5 1,2,4,5,6 1,2,4,5,6 1,2,4,5,6 1,5 1,2,4,5,6 1,5 1,4,5,6 1,4,5,6 1,5 1,5 4.0 Use telecommunication technologies to assist in effective communication in a variety of healthcare settings. 41

43 Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Key 1. Classroom Activities 2. Simulation Activities 3. Clinical Activities 4. Syllabus 5. Readings 6. Assignments NURS 4301PCC Adults/Older Adults II Practicum I: NURS 4303 PCC Adults in Acute Care I NURS 3115 Informatics (online) OR: NURS 4312 Nursing Care of Families II Practicum I: NURS 4305 Community-based Family Care-lifespan I NURS 4321 Public Health Nursing NURS 4106 Nurse as Collaborator (online, all students) NURS 4104 Ethical Sensitivity and Reasoning in Health Care (all students) NURS 3710 Stats for Clinical Research (or other approved statistics course) 1.0 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice. 2.0 Understand the use of CIS (clinical information systems) to document interventions related to achieving nurse sensitive outcomes. 3.0 Advocate for the use of new patient care technologies for safe, quality care 1,2,3,4,5,6 1,2,3,4,5,6 1,5 1,4, ,2,4,5,6 1,2,4,5,6 1,5 4.0 Use telecommunication technologies to assist in effective communication in a variety of healthcare settings. 42

44 Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN 43 Key 1. Classroom Activities 2. Simulation Activities 3. Clinical Activities 4. Syllabus 5. Readings 6. Assignments SPRING JUNIOR YEAR NURS 4301PCC Adults/Older Adults II Practicum II: NURS 4303 PCC Adults in Acute Care I NURS 3115 Informatics (online) NURS 4312 Nursing Care of Families II (1/2 Class in each) Practicum II: NURS 4305 Community-based Family Care-lifespan I NURS 4321 Public Health Nursing NURS 4205W Nursing Theory and Research (all students, stats required prior to or concurrently) Electives: NURS 4324 Transcultural Nursing or HMED course (if needed to meet LE reqs.) FALL SENIOR YEAR NURS 4777W Major Project: Thesis Practicum III: NURS 4703 Specialty-focused clinical I 1.0 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice. 2.0 Understand the use of CIS (clinical information systems) to document interventions related to achieving nurse sensitive outcomes. 1,2,3,4,5, 1,2,3,4,5,6 1, Advocate for the use of new patient care technologies for safe, quality care 4.0 Use telecommunication technologies to assist in effective communication in a variety of healthcare settings.

45 Integrative AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Key 1. Classroom Activities 2. Simulation Activities 3. Clinical Activities 4. Syllabus 5. Readings 6. Assignments Practicum III: NURS 4704 Continuum of Care Practicum NURS 4402 Taking Ethical Action Interprofessional Elective (e.g., immunization course) Elective(s) or Liberal Ed reqs as needed SPRING SENIOR YEAR NURS 4707 Nursing Leadership: Professional Practice in Complex Systems Practicum IV: NURS 4705 Specialty-focused clinical II Interprofessional Elective (e.g., immunization course) Elective(s) or Liberal Ed reqs as needed 1.0 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice Understand the use of CIS (clinical information systems) to document interventions related to achieving nurse sensitive outcomes. 3.0 Advocate for the use of new patient care technologies for safe, quality care 4.0 Use telecommunication technologies to assist in effective communication in a variety of healthcare settings. 44

46 Integrating AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Sample Outline for Prelicensure Course in Nursing Informatics Overall Course Objectives Demonstrate basic understanding and use of Computer Technologies and skills that support nursing knowledge work, health care delivery, and the advancement of nursing knowledge, learning, and service. Appreciate and value nursing knowledge work, informatics literacy, and the role of emerging technologies in the advancement of nursing science and the delivery of high quality safe nursing care within the context of a learning health care system. Explain the nurses role in supporting and engaging people in the adoption, use, and meaningful evaluation of technologies and resources that promote health and prevent disease. Describe and explain the evolution and development of nursing informatics to support care delivery across health care contexts. Understand the use of CIS (clinical information systems) and the EHR (electronic health care records) to support decisions and document nursing value in service of health care s triple aim: improved patient experience, improved health of populations, and health care cost reduction. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers. Discuss the influence of policy and ethics, in regard to patient engagement, clinical decision support and the delivery of safe, high quality care. Discuss future trends and issues related to nursing informatics that support and influence the science of nursing informatics and the advancement of practice, education and research. Passport Module - Digital Literacy: Mastering the Fundamentals of Computers and Technologies Demonstrate basic understanding and use of Computer Technologies and skills that support nursing knowledge work, health care delivery, and the advancement of nursing knowledge, learning, and service. Demonstrate knowledge about basic computer operation. Differentiate between different computer hardware parts. Identify a variety of software applications used for productivity and patient care applicability. List names of major operating systems. o Basic Computer Competencies. o Hardware o Software o Networks o Information and communication technology o Operating systems o File Management o o o o o o o o Utilities Print Management Using the Application The Intranet Using the browser Using the Web Web outputs management 45

47 Integrating AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Module 1 - Introduction and Overview: Knowledge Complexity, Informatics Literacy and Nursing Knowledge Work Appreciate and value nursing knowledge work, informatics literacy, and the role of emerging technologies in the advancement of nursing science and the delivery of high quality safe nursing care within the context of a learning health care system. Develop a systems thinking and quality improvement mindset that values innovation and the use of evidence in service of care. Explore definitions of knowledge, knowledge management, and knowledge complexity. Develop an understanding about the relationships between and among data, information, knowledge, learning, performance and meaning, philosophy, and wisdom derived from nursing informatics knowledge work. Appreciate the history, evolution and development of the science of informatics and nursing informatics as a means to support high quality, safe, efficient and effective health care. Module 2 Welcome to the World of Nursing Informatics Explain the nurses role in supporting and engaging people in the adoption, use, and meaningful evaluation of technologies and resources that promote health and prevent disease. Describe and explain the evolution and development of nursing informatics to support care delivery across health care contexts. Recognize the history of the evolution of nursing informatics. Identify major theories of nursing informatics. Identify key health informatics literacy terms and components. Explore current definitions, theories, and concepts in nursing informatics. Evaluate information from a web resource for professional education on a health topic. Module 3 - Making Nursing Knowledge Visible Through Clinical Information Systems Understand the use of CIS (clinical information systems) and the EHR (electronic health care records) to support decisions and document nursing value in service of health care s triple aim: improved patient experience, improved health of populations, and health care cost reduction. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care. Identify essential information that must be available in a common database to support patient care. Use standardized terminology in a care environment that reflects nursing s unique contribution to patient outcomes. Value nurses involvement in design, selection, implementation, and evaluation of information technologies to support patient care. o Systems thinking o Workflow and Care Processes o o SDLC Systems Design Life Cycle Human computer interaction 46

48 Integrating AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Value technologies that support clinical decision-making, error prevention, and care coordination. o Applications to manage care o Bar coded medication o Provider order entry administration (BCMA) o Clinical documentation (assessment, care planning, o Electronic medication administration record (emar) other) o Ancillary systems (pharmacy, o Results reporting lab, radiology) Module 4 - Using Technological Knowledge to Enhance Quality and Safety Across Care Settings Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice in service of health care triple aim goals. Explain why information and technology skills are essential for safe patient care. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice. Document and plan patient care in an electronic health record. Navigate the electronic health record. o Information and Knowledge Management Competencies o Demographic o Consents o Med Management o Planning care o o o Order results Notifications Care documentation Apply patient-care technologies as appropriate to address the needs of a diverse patient population. o Patient Care Technologies o Pulse oximeters, o Personal health records o Automated blood pressure and o Health Literacy pulse o Social Networks o Monitoring equipment (ECG, o Computers, printers arterial blood pressure, o IV smart pumps, respirations) o Bar coded medication o Automated temperature management systems, o Defibrillators Apply technology and information management tools to support person centered care and safe processes of care. o Safeguards and decision making support (Information Systems) o Medication dosing support (medication pick lists, dosing calculators) o Order facilitators (order sets for specific conditions based on evidence based guidelines: pneumonia, adult prosthetic hip replacement, myocardial infraction) 47

49 Integrating AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN o o o Point of care alerts (drug to drug interactions, duplicate therapy, drug allergies, contraindications to specific conditions) Point of care reminders (immunizations, cancer screenings, fall prevention, pain management). Information displays (dashboards of relevant data) Use telecommunication technologies to assist in effective communication in a variety of healthcare settings. o Communication Devices o Smart phones, hands free mobile communication devices ( Vocera), tablets (ipads) o Telecommunications technologies: o , o Telehealth o Patient monitoring technologies (virtual assessments, ICU s) o Home sensing devices (weight scale, BP monitor, bed chair, glucose meter, implant monitors, baby monitors, spirometer, medication monitoring, pedometer) Contrast benefits and limitations of different communication technologies and their impact on safety and quality Respond appropriately to clinical decision-making supports and alerts. Module 5 Policy and Ethics for Guiding Informatics Literacy and Nursing Care Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers. Discuss the influence of policy and ethics, in regard to patient engagement, clinical decision support and the delivery of safe, high quality care. Describe examples of how technology and information management are related to decision support and the quality and safety of patient care Protect confidentiality of protected health information in electronic health records Participate in evaluation of information systems in practice settings through policy and procedure development. o Data Security, regulatory, confidentiality, right to privacy. o HIPAA o Copyright laws o Ethical behavior Module 6 - Future Trends and Issues in Nursing Knowledge Work and Informatics Literacy Discuss future trends and issues related to nursing knowledge work and informatics literacy to support the advancement of practice, education and research. Advocate for the use of new patient care technologies for safe, quality care Appreciate the core competencies for interprofessional collaborative practice and education to support safe, effective, high quality care delivery. o Big data and Nursing Science 48

50 Integrating AACN Essentials, QSEN KSA s and TIGER Competencies for Nursing Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Module 7 - Faculty Teaching and Learning Resources Passport Module Digital Literacy: Mastering the Fundamentals of Computers and Technologies Module 1 Introduction and Overview: Knowledge Complexity, Informatics Literacy and Nursing Knowledge Work Module 2 Welcome to the World of Nursing Informatics Module 3 Making Nursing Knowledge Visible Through Clinical Information Systems Module 4 Using Technological Knowledge to Enhance Quality and Safety Across Care Settings Module 5 Policy and Ethics for Guiding Informatics Literacy and Nursing Care Module 6 Future Trends and Issues in Nursing Knowledge Work and Informatics Literacy Module 7 Faculty Teaching and Learning Resources 49

51 National Nursing Informatics Deep Dive Program Tools for Managing Information Through Technology Jehad Adwan, PhD, RN University of Minnesota School of Nursing November 19,

52 National Nursing Informatics Deep Dive Program Tools for Managing Information Through Technology Jehad Adwan, PhD, RN University of Minnesota School of Nursing November 19, Disclosure I have no relevant financial interest to disclose nor am I endorsing any commercial products identified in this presentation. 2 Objectives At the end of this session, you will: 1. Appreciate the value and challenge of nursing data. 2. Discuss importance of information literacy among pre-licensure nursing students. 3. Explore methods to educate students on patient care technologies. 4. Identify informatics tools used to support safe nursing care. 5. Demonstrate examples for navigating the electronic health record as a teaching tool. 6. Discuss role of informatics knowledge to achieving patient outcomes. 7. Identify tools and strategies connecting nursing informatics to knowledge and patient outcomes. 8. Describe the benefits of standardization of nursing terminologies. 3 51

53 Warm-Up with a Quick Poll Visit: Answer a few quick questions Take few minutes Let s see real-time results 4 5 Challenge of Nursing Data

54 Don t we all wish it were that simple? Today s data-intensive environment What should pre-licencure students be taught about nursing data? How do we connect nursing documentation with knowledge? Where do we start? 7 AACN Essentials: Jumping Forward to Basics What every student needs to know, and why? Knowledge work and knowledge management A framework for integrating knowledge into entering, understanding, analyzing nursing data 8 Essential IV: Information Management and Application of Patient Care Technology Rationale Knowledge and skills in information and patient care technology are critical in preparing baccalaureate nursing graduates to deliver quality patient care in a variety of healthcare settings baccalaureate graduates must have competence in the use of information technology systems, including decision support systems, to gather evidence to guide practice (p.17) AACN (2008)

55 Basic Knowledge How we can ensure RNs are ready for informatics-rich environment AACN essentials TIGER competencies QSEN s KSA 10 Before You Start Baseline assessments can be valuable Avoid generalized assumptions about what students already know You could either over or underestimate Assess broad skills set first Move to specifics 11 Building a Course for Undergrads Incorporating the curricular Crosswalk Discussed earlier by Dr. Clancy Based on AACN Essentials, Tiger Competencies, and QSEN s knowledge, skills, and Attitudes Incorporating knowledge work model Go beyond what we want students to know Why should they know it Why should they care? What it means to them 12 54

56 Assessing What Students Know Basic computer competencies Pre-test Post-test Available learning resources Fill in knowledge gaps Refresh current knowledge Why is this important? 13 How about computer skills? Miller et al. (2014) Ranking of % of new/novice nurse reporting they are highly or very-highly skilled by skill area (28 skills) % 2. Internet use and search 92% 3. Word processing 80% 4. Lab results look up 77% 10. Treatment documentation 68% 16. Patient education 62% 17. Care plan development and update 59% 21. Order entry 45% 14 What New Nurses Know Miller et al. (2014) Time it took nurses to become comfortable using an EHR 15 55

57 Pre-test Question Sample 16 Pop Quiz Test your computer hardware and software knowledge URL: 17 Post Test Same question pool Randomized questions/responses If passing score Go to next module If not good score Referred to online resources Reattempt post-test Watch basic computing videos 18 56

58 Basic Knowledge Understanding how things work Understanding why things work Is even more important Ties clinical knowledge to informatics knowledge Allows for reflection Drawing wisdom from data at hand Engaging the Learner Warming up exercises on everyday informatics usage Example: e-health Survey Sharing instant results allows for more interactive learning 21 57

59 Engaging the Learner(cont d) Highlighting the value of nursing informatics Teaching someone to be a clinician vs technician? It s somewhere in between A knowledgeable clinician Example: Hi-Tech Aging: (Alma s Story) 22 Challenges in Teaching Informatics 5 minute Discussion Please form small group with 2-4 persons in each Discuss the following: What are main challenges you have faced? How did you overcome these challenges? What was it like to teach this subject? Write notes on paper Or, go to and enter your responses 23 Engaging the Learners (cont d) Meaningful knowledge acquisition Individual informatics knowledge discovery Group project to put learning to use Find gaps Suggest solutions Self and peer evaluation tools to enhance group functioning Real-time instructor engagement/followup 24 58

60 25 Engaging the Learners (cont d) Interactive quizzes 26 Teaching the EHR Highly dependable on availability to your own institution At UMN: SimChart via Elsevier Other options: DocuCare Issues with embedding in a universal informatics course Proprietary materials 27 59

61 EHR Open-EMR hands-on activity 28 Knowledge Management Questions Reflective learning after exploring EHR Did the activity make sense? What caught your attention/liked the most? Why? How would you apply it as a future nurse Why do you care? Discuss with other students 29 Knowledge Work Data statistics, financial data, metrics procedures, standards, user guides, Information specifications, regulations, audits, (Procedural) filing and classification, order processing workflow planning, priorities, graphs, Knowledge engineering, historical data, tracking, (Functional) database design & management business plans, goals, objectives, budgets, Meaning resources, roles, culture, managing variables, (Managing) developing projects Philosophy strategic planning, systemic mapping, (Systems) competitive analysis, market forecasts Wisdom values, vision, future trends (Renewing) Union social, environmental & global issues, activism, ecological values work 2002 Verna Allee, used with permission 30 60

62 Evidence-Based Practice Competence Laibhen-Parkes (2014) Concept analysis and proposed definition: the ability to ask clinically relevant questions for the purposes of acquiring, appraising, applying, and assessing multiple sources of knowledge within the context of caring for a particular patient, group, or community. (p. 180) Fits well with the knowledge work model 31 Evidence-Based Nursing & the EHR Standardized Languages permeate all levels Data Information Knowledge Meaning and Philosophy Wisdom Union Nursing diagnoses: NANDA Raw numbers Observations interventions How the experience influences the nurse Lessons learned Global perspective Interventions: NIC Terms Vital Signs Future practice guidelines Nursing sensitive outcomes: NOC Meaningless without context 32 Standardized Languages Time and distance measurement Units to measure things in daily life 1 minute in USA = 1 minute in China Weight in Kilos or Pounds Financial transactions Electronic Health Record (EHR) Credit cards Demographic, billing information, ICD-10, LOINC, NIC 33 61

63 Standardized Languages International Classification of Disease Health Level Seven International Messaging (HIE) Problems, Interventions, & Outcomes Lab results ICD-9 HL7 Omaha System LOINC Nursing Diagnoses Nursing Interventions Classifications Nursing Outcomes Classifications NANDA NIC NOC 34 What a Teaching Strategy of Patient Case Should Include: Embed within the lesson plan Questions in each lesson/module Students discuss the new ideas, concepts, and skills they were exposed to After learning about something new, Students reflect on What they liked Why is it useful and how it could be applied Go beyond what will be on exams and quizzes Subject matter, does matter! But that is not all there is to it. 35 Molding the Learner Knowledge: Beyond Traditional Nursing Education Data Union Information Patient/ Population Wisdom Knowledge Meaning 36 62

64 Example: Child with diarrhea What are examples of the following? Data: Information: Knowledge: Meaning: Wisdom: Union: Technology Tools at the Bedside Measureable outcomes Data Input Monitors and probes Smart pumps VS equipment Barcode scanners Blood glucose monitors Patient input Nursing actions aligned with evidence Standardized terminologies Clinical Decision Support Evidence-based Practice 38 Clinical Decision Support (CDS) Evendriven alerts and reminders Real-time Alerts, Dashboard s Order sets, care plans, protocols Parameter guidance to Safe, Timely Nursing Practice 39 63

65 Clinical Example with Students Administering Gabapentin Medication dispensing Sys Nursing Knowledge Interventions Outcome: Meaning Philosophy Neurological Pain Scale 8/10 Drug interaction knowledge base Integration of Evidence Timely/Appropri ate Patient pain managed Lessons learned CDS pop-up Transforms into wisdom Initiate Fall Precaution Safety Future applicability Side Effect: Fall risk Patient Education re: safety Shaping of Future Practice SE Acknowledged 40 Questions! 41 References Laibhen-Parkes, N. (2014). Evidence-Based Practice Competence: A Concept Analysis. International Journal of Nursing Knowledge, 25(3), Miller, L., Stimely, M., Matheny, P., Pope, M., McAtee, R. & Miller, K. (2014). Novice Nurse Preparedness to Effectively Use Electronic Health Records in Acute Care Settings: Critical Informatics Knowledge and Skill Gaps. Journal of Nursing Informatics,18(2). Retrieved 11/2/2014:

66 Contact Information Jehad Adwan, PhD, RN

67 Tools for Managing Information Through Technology - Jehad Adwan, PhD, RN 66

68 67

69 Tools for Manaing Information Through Technology - Jehad Adwan, PhD, RN 68

70 Tools for Managing Information Through Technology Jehad Adwan, PhD, RN Challenges in Teaching Nursing Informatics Challenges: Strategies to overcome What was it like? 69

71 National Nursing Informatics Deep Dive Program Designing Effective Safeguards and Decision Making Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC November 19,

72 National Nursing Informatics Deep Dive Program Designing Effective Safeguards and Decision Making Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC November 19, Disclosure I have no relevant financial interest to disclose nor am I endorsing any commercial products identified in this presentation. 2 Objectives 1. Define and describe Clinical Decision Support (CDS). 2. Determine impact of CDS on safety and support. 3. Outline a process for integrating CDS at the point of care. 4. Provide information and exemplars for teaching content to prelicensure students. 3 71

73 Definition of CDS Is a tool that provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. (HealthIT.gov) CDS is a strategic tool. 4 Description of CDS CDS systems are active knowledge systems using patient specific data to generate case specific advice. CDS systems use evidence based practice findings and applies that to the patient. CDS systems also provide quality judgment based on economic and cultural values. CDS systems are implemented with stakeholders and are led by champions. 5 CDS Tools Computerized alerts Reminders to care providers and patients Clinical guidelines Condition specific order sets Focused data reports and summaries Documentation templates Diagnostic support Contextually relevant reference information 6 72

74 How does CDS Happen During data entry documentation, order sets, care plans During data review single patient summaries, multi patient displays, predictive analytics During assessment filtered reference material or knowledge resources Not During a Task alerts triggering asynchronously (ex: lab results) 7 What Are the Purposes? Assists in problem solving Supports but does not replace clinical judgment and reasoning Improved the decision making process 8 Why CDS? Increased quality of care Enhanced outcomes Avoidance of errors and adverse events Improved efficiency Cost effectiveness Provider and patient satisfaction 9 73

75 How Does CDS Work? CDS processes require: Actionable evidence Embedded and accurate person specific data Technical reasoning mechanisms that combine evidence based knowledge and data to form information that can be acted upon A method to filter and display information that supports workflows Enough information to allow for quick decision making 10 The CDS Five Rights Rights information Right person Right intervention Right channel Right point in the workflow 11 CDS Model 12 74

76 The Informatics Model Behind CDS 13 Alignment with Underpinnings of Informatics 14 Exercise Scenarios Case 1 - Reduction in falls Case 2 - Prevention of Pressure Ulcers Case 3 - Prevention of CAUTI You are the manager of a thirty two bed adult neurological unit. You have been tasked with building a CDS tool to assist nurses with these identified problems

77 How are CDS Systems Created? 16 Systems Development Life Cycle 17 Planning Tasks Aligning the mission, vision and values of the organization Defining the Problem Developing the Scope Review of the literature Determining feasibility (technical, schedule, financial) Producing a draft project plan Defining an initial team Present return on investment 18 76

78 Exercise 1 What is your unit mission? What is the problem? What is the scope of the solution you are seeking? What does the literature tell us? Is this CDS feasible? Do you have a team to develop this? What will be the return on the investment? 19 The Analysis Tasks Analyzing the existing system Synthesis of evidence Exploring the human factors Developing a workflow as is and to be Conducting Business Process Redesign Crafting Prototypes or a Use Case Drafting requirements Establishing requirements (including equipment) Develop evaluation strategy Review current Policies and Procedures 20 Exercise 2 What do you already have in place to address this issue? What does the evidence synthesis direct us to do? What human factors do we need to take into consideration? What is the workflow? What are the requirements of this CDS? Can you create a prototype? What will be the evaluation measures? 21 77

79 Tools Used in Analysis 22 A Workflow Diagram A graphical depiction of steps taken, time spent, distance traveled necessary to complete a required business process. 23 Workflow Diagram 24 78

80 Data Flow Diagram A data flow diagram (DFD) is a graphical representation of the "flow" of data through an information system. 25 Data Flow Diagram 26 A Use Case Diagram Use Case Diagrams graphically depict: -The actors that the system you are describing interacts, -The system itself, -The use cases, or services, that the system knows how to perform, -The lines that represent relationships between these elements

81 A Use Case Diagram 28 The Design Tasks Define the input requirements This includes standardized terminology, tools, and measures Define the output requirements Develop system controls Determine interface needs Create security protocols Draft downtime and disaster recovery processes 29 Exercise 3 Do you have validated tools to use? Do you have standardized terminology? What will the input look like? How will you control for data entry errors? Will there be a need for data coming from other systems or other parts of the current system? What does the output look like? How will this fit in your desired workflow? Who will do this and who will not? Who will get the CDS messages and who will not? 30 80

82 The Implementation Tasks Develop and begin training Prepare equipment Ensure that Policies and Procedures are up to date Review system s User Manuals Educate support and Help Desk 31 Exercise 4 What type of hardware will you use? How will this hardware be managed? How will you conduct training (face to face, on line, at the elbow)? Will there be a need to adjust Policies and Procedures? What will you do with this CDS process if the system goes down? 32 The Maintenance Tasks Determine evaluation outcomes Analyze processes for work arounds Activate strategy for ensuring the evidence driving the CDS action is up to date Develop process for change control 33 81

83 The Promise of CDS Improved healthcare quality, safety, and cost efficiency Achievement of unit goals Engagement of evidence Provision of best practice Prevention of adverse events Appropriate resource utilization 34 The Perils of CDS Poor acceptance and untoward consequences Poorly designed interventions that create distraction Overuse and reliance on CDS and lack of use of clinical judgment Inadequate planning, analysis and development leading to lack of use No quality management of the CDS 35 Resources What is Clinical Decision Support (CDS)? Clinical Decision Support Systems: State of the Art Types of Clinical Decision Support: Examples from HIMSS Davies Award Winners Clinical Decision Support

84 Designing Effective Safeguards and Decision Making Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC Workflow Diagram 83

85 Designing Effective Safeguards and Decision Making Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC A Use Case Diagram 84

86 National Nursing Informatics Deep Dive Program Patient Engagement, Communication Technologies, and Information Security Dorcas Kunkel, DNP, MS, BSN, APHN-BC University of Minnesota School of Nursing November 19,

87 National Nursing Informatics Deep Dive Program Patient Engagement, Communication Technologies, and Information Security Dorcas Kunkel, DNP, MS, BSN, APHN-BC University of Minnesota School of Nursing November 19, Disclosure I have no relevant financial interest to disclose nor am I endorsing any commercial products identified in this presentation. 2 Objectives Define patient engagement. Describe consumer health literacy, personal health records, emobile health, telehealth, and virtual care delivery. Discuss ethics related to information security and protected health information. Contrast benefits and limitations of different communication technologies and their impact on safety and quality. Examine teaching methods. 3 86

88 Patient Engagement Engaged patients: Seek information about their health and health care Make informed and shared decisions with their health care team Take steps to manage their health and health care Act as partners with their health care team Engaged caregivers also play a key role, especially when patients have limitations because of age, an illness, cognitive impairment, or other reasons. 4 "Patient activation" refers to a patient's knowledge, skills, ability, and willingness to manage his or her own health and care. "Patient engagement" is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly. James, J. (Feb. 14, 2013). Patient Engagement. Health Policy Briefs /Insulin_pump_with_infusion_set.jpg oadimage/010511/biggulp_ jpg 6 x%3e/quality/85/?url=%2fcmsmedia%2f18%2f c9d555144d85 588aaa3f%2F45572WideModern_DoctorandPatient_ jpg 87

89 Patient Engagement What Does This Mean? Patient Engagement, Interview with Jan Oldenburg, FHIMSS 7 8 "Health Policy Brief: Patient Engagement," Health Affairs, February 14, Patient Engagement Framework

90 Discussions at tables Review the two frameworks and think about how your curricula includes learning opportunities for students about patient engagement in both didactic and practice learning. Share several of these with a partner at the table. Identify if there are gaps in your curricula in what students are learning about patient engagement. How might you close those gaps? Use the two Patient Engagement Frameworks in your packets (5 minutes). 10 Patient Engagement Strategies Access Personal Health Records Emobile Health Health Information Consumer Health Literacy Exchange/Portals Telehealth and Virtual Care Delivery 11 ACCESS: Personal Health Records An electronic application managed by patients to maintain and manage their health information in a private, secure, and confidential environment. Includes information from a variety of sources, health care providers and patients. Properly designed and implemented, PHRs can help patients become full partners in the quest for good health

91 13 Student Learning Activity Example Describe activity I have junior level clinical groups register for a basic account and take the healtheliving assessment that is part of the VA s personal health record within Myhealthevet. Learning outcome This helps them get a feel for how to engage Veteran s and answer questions such as: How can the healtheliving assessment help me reach my goals? 14 ACCESS: Health Information Exchange Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient s vital medical information electronically improving the speed, quality, safety and cost of patient care

92 Three Key Forms of Health Information Exchange Directed Exchange ability to send and receive secure information electronically between care providers to support coordinated care Query-based Exchange ability for providers to find and/or request information on a patient from other providers, often used for unplanned care Consumer Mediated Exchange ability for patients to aggregate and control the use of their health information among providers 16 Health IT for You: Giving You Access to Your Medical Records When and Where They're Needed Office of the National Coordinator for Health IT 17 Student Learning Activity Example

93 ACCESS: Portals A portal simply allows patients to view provider information or communicate with providers and is distinct from a PHR Student Learning Activity Example

94 Emobile Health (mhealth) mhealth is the generation, aggregation, and dissemination of health information via mobile and wireless devices (HIMSS) Emobile Health Sensors_BlogImg.jpg Social Media: Facebook, YouTube and Twitter, etc Google Glass Vallurupalli, S., Paydak, H., Agarwal, S. K., Agrawal, M., & Assad- Kottner, C. (2013). Wearable technology to improve education and patient outcomes in a cardiology fellowship program - a feasibility study. Health and Technology, 3(4), pp Science Roll, The Journey of a Geek Medical Futurist accessed Sept. 2, 2014:

95 25 Quantified Self self-knowledge through self-tracking with technology. Quantified selfadvancement have allowed individuals to quantify biometrics that they never knew existed, as well as make data collection cheaper and more convenient. Quantified Self, Gary Wolf (5 min) The Apple Watch Credit: Apple livestream, screengrab 26 Global Surveillance Short Message Service (SMS) is a the text messaging service component of a mobile phone, the Web, or other mobile communication systems. Rapid detection of early stage disease outbreaks via mobile phones employing SIM cards. World Health Organization. (2011). mhealth: New horizons for health through mobile technologies. oe_mhealth_web.pdf 27 94

96 Smart Homes 28 Student Learning Activity Example 4 29 Telehealth and Virtual Care Delivery Definitions of Telehealth Nursing Telehealth nursing is the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing. (American Association of Ambulatory Nursing 2004) Telehealth nursing is the use of telecommunications technology in nursing to enhance patient care. It involved the use of electromagnetic channels (e.g., wire, radio, and optical) to transmit voice, data and video communications signals. It is defined as distance communication, using electrical or optical transmissions between humans and/or computers. (Skiba, D.J. & Barton, A.J.,2000) Telehealth nursing is the practice of nursing over distance using telecommunications technology. (National Council of State Boards of Nursing, 1997) 30 95

97 Use of Telehealth Home health care - monitoring, education, support Nursing home - specialty consultations Ambulatory care - specialty consultations Hospital consultations - stroke care Prison settings mental health services Mentoring i.e. wound care specialists ICU monitoring neonatal intensive care, cardiac care Health promotion obesity, exercise/ fitness 31 Role of Telehealth Nurse Nurse presenter ambulatory Nurse case manager i.e. diabetes care Public health nursing Text4babies, Text2Quit Health coach Tele-ICU nursing Clinical tele-health coordinator 32 Example Nurse Presenter Planning telehealth program i.e. specialty consultations in rural clinic/ hospital Coordinate scheduling patients Evaluating and preparing equipment Assessing patients Presenting patient Facilitating remote exam Documentation Follow up care 33 96

98 Telehealth Methods Real-time Telephone-based limited to education/ counseling Web-consults (two-way audio and video) With or without peripheral devices Store and forward images, audio, video Combination 34 Telehealth Equipment Phone lines/ internet Phone/ computer with or without camera/ microphone Cell phones Peripheral Devices Life line Blood pressure Sensor Technology Scales Peripheral devices Glucose monitoring EKG/ cardiac monitoring Dermascope Otoscopes Pedometers 35 Monitoring - eicu Care Baptist - eicu eight ICUs for a total of 142 beds 4 nurses/ shift average 19 years experience Real time vital signs and cardiac monitoring Entire electronic record Alerts if any change that could be a problem Activation of camera and speaker from eicu for visual assessment and communication with the floor staff or patient

99 Mr. Smith s House is Calling Caregiver Alerts Voice Prompts Floor Sensors Safety Features Smart Beds Video Monitors Vital Sign Monitoring Medical Condition Monitoring 37 Ethical/ Legal Issues Competent Care AAACN - Scope and Standards of Telehealth Nursing ATA Standards and Guidelines Devices Center for Telehealth and ehealth Law License to practice 38 Safety Issues Assess appropriateness of telehealth for the patients ability and status Know equipment Evaluate reliability and effective use of equipment Infection control Information safety Compliment with nurse judgment 39 98

100 Benefits and Challenges Benefits of Telehealth Health care access Financial return Coordination of care Quality of care Challenges of Telehealth Expansion of usage Technology infrastructure/interopera bility Financial investment Licensure and credentialing Reimbursement 40 Student Learning Activity Example 5 41 Consumer Health Literacy ehealth literacy is defined as the ability to seek, find, understand and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a problem

101 Consumer Health Literacy Type of Literacy Oral literacy Print/visual literacy Information literacy Numeracy Computer literacy Explanation Speaking and listening Writing and reading, understanding graphical and visual information Obtaining and applying relevant information The ability to calculate or reason with numbers Operating a computer or information device 43 Scope of Health Literacy Extent of problem About half (90 million) American Adults have difficulty processing and understanding complex text. 9 of 10 adults have difficulty with every day health information Implications: Challenges with common health information from insurance forms to medication labels. 44 Importance of Health Literacy Without clear information and an understanding of the information s importance, patients are more likely to: Have difficulty managing chronic diseases like diabetes or high blood pressure. Not engage in decisions Results: Higher utilization of health services Skip necessary medical tests Poor adherence to treatments End up in the emergency room more often Higher costs range from $106 billion to $238 billion annually Poorer outcomes

102 Consumer Health Literacy Dave de Bronkhart calls on all patients to talk with one another, know their own health data, and make health care better one e-patient at a time. 46 Student Learning Activity Example 6 47 Regulatory Requirements, Confidentiality, and Clients Right to Privacy Protected Health Information Ethics Information Security

103 Protected Health Information Personal health information (PHI), also referred to as protected health information: demographic information medical history test and laboratory results insurance information other data that is collected by a health care professional to identify an individual and determine appropriate care. Protecting Health Information 49 Information Security 1. Use a password or other user authentication 2. Install and enable encryption 3. Install and activate remote wiping and/or remote disabling 4. Disable and do not install or use file sharing applications 5. Install and enable a firewall 6. Install and enable security software 7. Keep your security software up to date 8. Research mobile applications (apps) before downloading 9. Maintain physical control 10. Use adequate security to send or receive health information over public Wi-Fi networks 11. Delete all stored health information before discarding or reusing the mobile device 50 Student Learning Activity Example

104 Discussion session 15 minutes Paper for participants to record observations and insights What are some of the current strategies you are using in you curricula for students to learn about the topics in this presentation? What new ideas do you have for learning activities? (1 min.) Generate ideas in pairs, building on ideas from self-reflection. (2 min.) Share and develop ideas from your pair in foursomes (notice similarities and differences). (4 min.) Each group shares one important idea with all (repeat cycle as needed). (5 min.) We would like to collect your thoughts and ideas, so please leave your completed papers at table center. Thank you! 52 Dorcas Kunkel, DNP, RN, APHN-BC Assistant Clinical Professor University of Minnesota, School of Nursing W kunk0041@umn.edu

105 Patient Engagement, Communication Technologies, and Information Security (Handout) "Health Policy Brief: Patient Engagement," Health Affairs, February 14,

106 Patient Engagement, Communication Technologies, and Information Security (Handout) 105