1 Michael Smith Foundation for Health Research Networking Program Phase II: Technology/Methodology Platforms Expression of Interest PROPOSED PLATFORM: NI-LEARN: Nursing Informatics Leadership, Education and Research Network March 1 st, 2006 Contact: June Kaminski, RN MSN PhD Candidate Phone: (604) 599-2085 VM 9179 (0ffice) (604) 984-0813 (home) June.Kaminski@kwantlen.ca
2 Michael Smith Foundation for Health Research Networking Program Phase II: Technology/Methodology Platforms Expression of Interest PROPOSED PLATFORM NI-LEARN: Nursing Informatics Leadership, Education and Research Network Area of Interest The NI-LEARN platform is being proposed to focus on nursing informatics professional development; curriculum and faculty development; CEU and specialty certification; and the formation of communities of practice for nursing informatics research in B.C. Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge to support patients, nurses and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology (Staggers & Bagley-Thompson, 2002, p. 262). Nurses are the largest group of health care providers in British Columbia (about 36,000) and in Canada (about 241,000), thus it is critical for the evolution of health-related informatics that nurses become competent and knowledgeable in both theory and practical informatics applications within the discipline and practice of nursing. In essence, due to sheer numbers as well as the amount of time patients spend in the care of nurses, nursing informatics must become a key focus in health informatics initiatives. The role of the nurse has intensified and diversified with the widespread integration of communication technology and information science into health care agencies. The professional nurse is now expected to function well within a technologically advanced health-care environment, carry out higher-level, complex activities, and are held responsible and accountable for the systematic planning of holistic and humanistic nursing care for clients and their families. This is expected to occur within a system challenged by a nursing shortage, heavy workloads and long shift-work hours, tight budgets, modest wages, rising chronic illness, and an increasingly ill hospital population. Nurses are expected to keep abreast of technological implementation within their work environment with little time for professional development activities or in-service attendance. Recent research suggests that competent application of nursing informatics ability can significantly reduce the amount of time nurses spend performing routine tasks such as documentation of data and information, deciphering care directives, providing patient education, and researching critical information to guide patient care. Health informatics is the general application and study of informatics within the health system. Nursing informatics is an important cornerstone of the more general science of health informatics. Health informatics, from its inception, has always been disciplinary...informatics applications that are targeted to the information needs of clinicians improve health care delivery and health outcomes. We need to prevent the collapse of health care as we know it through discipline-specific informatics initiatives that prepare specialists to engage in integration. (Masys, Brennan, Ozbolt, Corn & Shortliffe, 2000, p. 305). It is critical that registered nurses take their place in developing future knowledge, information and health care services delivery systems. (Canadian Nurses Association, 2000, p.8).
3 Nurses must become proficient in participating in the use of the emerging Canadian Health Infostructure, including the design and use of Electronic Health Records (EHRs), web-based and tele-health initiatives. As the transition to an electronic health record gains momentum, health-care delivery will need to dramatically reinvent the way it collects, processes, and uses health information. A workforce capable of innovating, implementing, and using health communications and information technology (ICT) will be critical to health-care's success, (AHIMA, 2006, p. 2). Two contingents are needed to address this critical need: specialists in health information management and competency development in the people who must use health information technology, such as the practicing nurse and other health care professionals. The NI_LEARN collaboration will develop a four pronged approach to nursing informatics competency in practicing nurses, nursing students, faculty and researchers. These four areas include: Continuing Education workshops that can be offered on weekends and in short course formats throughout British Columbia. These workshops will be similar to the Weekend Immersion in Nursing Informatics (WINI) offered by an American collaborative in both US and eastern mid-west Canadian cities. At the current time, education in nursing informatics is usually done in an informal, self-directed way, with little access to credited courses or accessible education. As well, e-learning short courses would augment these compact on-location courses, serving nurses in remote areas, and those unable to devote the time to attend in-person courses. These workshops would grant Continuing Education credit (CEUs) and provide convenient, accessible professional development for practicing nurses who lack the time and resources to pursue formal education in nursing informatics. These credits could be designed in a way that nurses could work toward eventual certification status in nursing informatics. A prototype curriculum for incorporating nursing informatics into undergraduate and graduate BC Schools of Nursing curriculum would be developed to foster nursing informatics competencies and knowledge in nursing students. Faculty development initiatives would also be required and planned. E-learning curriculum would augment the on-campus curriculum development to again serve students in remote areas, and those who wish to study using an on-line approach to learning. Although national organizations and initiatives have advocated for the integration of nursing informatics into basic nursing program curricula for several years, to date, nursing schools in BC and across Canada have not succeeded in achieving this to any great extent. Specialization development would be undertaken to determine and design a formal program of study to educate nurses to develop nurse informatician specialty skills and knowledge. The BC health system needs expert nurses who can make a valuable contribution to the development, implementation, monitoring and problem-solving involved with implementing the EHR (electronic health record), ensuring trouble free system implementation in health care systems, and training and supporting nurses working with electronic information and data. A community of practice for research would be the fourth focus of the NI-LEARN network. Both quantitative and qualitative research is needed to guide evidenced-based applications of nursing informatics theory and applications in the health care system: in hospitals, community health facilities, tele-nursing, and in education. Research is also needed to find ways to cultivate a positive information technology culture in nursing, and develop a cohesive and comprehensive nomenclature for nursing care that provides a
4 legal record of care that captures the nurse's expression of patient assessment, diagnosis, goals, plan of care, care delivered, the patient's responses to care, and the actual patient outcomes within a foundation of domain completeness. How this initiative is provincial in scope and value added There is a critical need for development of nursing informatics competencies in nursing students and practicing RNs across the entire province. National and provincial nursing governance organizations support this critical need and are taking steps to include informatics competencies within the expected standards of care by nurses (CRNBC, 2006). There is also an urgent drive to set formal standards and to develop comprehensive curriculum (both on site and e-learning) for inclusion in basic nursing education across the province. As well, a definite gap in nursing informatics research is evident. Since nurses are the largest health care provider group, these proposed research and education strategies would enhance health informatics in general, and facilitate a province-wide technologically competent nursing workforce. This initiative would place B.C. in the forefront of Canadian nursing informatics development and education. How it will enhance B.C.'s international competitiveness Nursing informatics initiatives have become a global trend: most nations across the planet are currently working on standards and plans for education and research development. Compared to many of these countries, (especially the USA, Britain, and Europe) Canada is far behind in our state of nursing informatics development and strategic planning for education and research. NI-LEARN could help BC become a leader in preparing a nursing workforce capable of making a meaningful contribution to the development of a cohesive national health care system and in sharing information and services across provincial and even national borders while still respecting unique needs of different national and international regions. BC and Canada are far behind other nations, in developing nursing informatics educational, certification, and research programs. NI-LEARN TEAM Co-Chairs June Kaminski, RN MSN PhD Candidate (BC) Val Cartmel, RN MSN Candidate (BC) Steering Committee Robin Carriere, RN MSN (Ontario) Dr. Lynn Nagle, RN (Ontario) Dr. Xing Liu (BC) Dr. Stephen Petrina (BC) Vivian Eliopoulos, RN, BSN, MA (BC) Dr. Heather Clarke, RN (BC) Bev Mitchell, RN MSN (BC) Alyse Capron, RN BSN (BC) Dr. Dianne Symonds, RN (BC)
5 DEVELOPMENT PROCESS Key stakeholders: These would include all B.C. Schools of Nursing including nursing students and faculty, all Health Authorities and their inclusive nursing workforce, the CRNBC, the B.C. Ministry of Health (including the Nursing Directorate and its strategic priorities), and ultimately, all BC residents would benefit from the initiatives proposed within this EOI. Process of Engagement: An inclusive and well-articulated strategic plan would be developed to facilitate collaboration and support with all BC Universities, University Colleges and Colleges that offer Nursing education. Provincial health authorities would be approached to plan continuing education workshops and specialization education for practicing nurses in a variety of care settings. A community of practice will be formed to further nursing research in both education and practice by collaborating with administrators, scholars, and clinicians from around the province. Key Success Factors include: there is national support for initiatives in nursing informatics competencies and knowledge base directives are being established by national bodies the national nursing shortage provides support to optimize the role of nurses the proposed Chairs and Steering Committee have well-established expertise in education and research in nursing informatics and/or information technologies this initiative will help prepare nurses to integrate nursing data into provincial and national databases and participate in the development of systems such as the International Classification for Nursing Practice (ICNP) which could translate data from various databases into a universal language A national standard for a clinical information system (SNOMED) is well on its way to being accepted for pilot testing with one of the recommendations being to work with other classification systems (including ICNP) to ensure comprehensiveness of clinical information in electronic health records Key Obstacles include: there is a lack of positive information technology culture in nursing heavy workloads and lack of time could inhibit nurse participation in initiatives providing the infrastructure, including the hardware, software, education necessary to support nurses to develop informatics competencies requires funding, resources and commitment BUDGET The initial budget would be mainly allotted to cover expenses related to: A thorough Environmental Scan, to collect data and dialogue with Provincial Health
6 Authorities' key spokespeople and the MOH Nursing Directorate, academic liaisons, national and provincial licensing bodies such as the CRNABC and CNA A carefully thought-out Plan of Action to organize the four proposed initiatives will be done including the articulation of the network's mission, goals, strategies, time-lines, and steps to take to confirm collaborative links with BC Schools of Nursing and Health Authorities.
7 APPENDIX References AHIMA. (2006). Building the workforce for health information transformation. Chicago, IL: Author. Canadian Nurses Association. (2000). Vision 2020 Workshop on Information and Communications Technologies in health care from the perspective of the nursing profession. Ottawa: Author. College of Registered Nurses of British Columbia. (2006). Entry-level Registered Nursing practice: Competencies and Context. Vancouver: Author. Masys, D., Brennan, P., Ozbolt, J., Corn, M., & Shortliffe, E. (2000). Are Medical Informatics and Nursing Informatics Distinct Disciplines? The 1999 ACMI Debate. Journal of the American Medical Informatics Association. 7(3), May-Jun, 304-312. Staggers, N., & Bagley Thompson, C. (2002). The evolution of definitions for nursing informatics: A critical analysis and revised definition. Journal of the American Medical Informatics Association, 9(3), 255 262. Backgrounds/Experiences of Chairs and Steering Committee Members Chairs June Kaminski, RN MSN PhD Candidate President-Elect of Canadian Nursing Informatics Association June Kaminski has been training practicing RNs and nursing students to use computers in both practice and education since 1987. June currently teaches third and fourth year BSN students at Kwantlen University College in the Collaborative Nursing Program. She is also completing PhD studies in the Faculty of Curriculum Studies and Technology Education at the University of British Columbia. Her doctoral dissertation focus will be related to The In/Visibility of Nurses in Cyberculture and looking at ways to cultivate a positive culture for information technology in nursing. June has developed and offered integrated curriculum related to Nursing Informatics for all BSN students at Kwantlen since the early 1990s using both paper based manuals and online delivery modes. This curriculum was also used by the nine former partners of the Collaborative Nursing Program of BC including the nursing programs at the University of Victoria, Camosun College, University College of the Cariboo, Malaspina University College, Selkirk College, Douglas College, Langara College, Okanagan University College, and North Island College. The web version of this work is viewable at http://www.nursing-informatics.com/kwantlen A presentation on the above curriculum, entitled "Nursing Informatics Integration in a Four-Year
8 BSN Program: The Experience of Participation in a Web-based Learning Environment" was presented at both the WRCAUSN and CNA Biennial Convention in Vancouver in 2000 and via web-cast in 2004. She is currently Editor-in-Charge of Virtual Nursing Practice and Culture for the Online Journal of Nursing Informatics http://www.eaa-knowledge.com/ojni/index.htm June has also developed a web environment to promote professional development in nursing informatics competency for practicing nurses, viewable at http://www.nursing-informatics.com This includes an Online Nursing Informatics Competencies Self-Assessment area where nurses can begin to examine their own competencies and create an action plan for self-development. This is viewable at: http://www.nursing-informatics.com/niassess/index.html Val Cartmel, RN BSN MS Candidate Val has been active in the Nursing Informatics world since the early 1980's and has been involved in many Informatics initiatives throughout her career as a Nursing Instructor at the BC Institute of Technology (BCIT), as a Nursing Manager, and as a Clinical Systems Coordinator, as well as her current role as the Regional Leader, Clinical Informatics for Vancouver Coastal Health (VCH). In her role she acts as a liaison between clinical areas and the IS department and provides nursing leadership for IS initiatives at VCH. She holds a BSN from UBC and is currently enrolled in the Master of Arts in Leadership and Training (MALT) at Royal Roads University in Victoria, BC. She is also the President Elect of the College of Registered Nurses of British Columbia (CRNBC). Steering Committee Robin Carriere, RN BSN (Ontario) President Canadian Nursing Informatics Association Robin is currently a Clinical Informatics Specialist at Mount Sinai Hospital in Toronto. He completed his Bachelor of Nursing at Laurentian University, in Sudbury, Ontario. Mr. Carriere has had a variety of experiences in nursing informatics and is currently involved in the design and implementation of a computerized provider order entry system (CPOE). His previous experiences include web and multimedia design, IT planning and assessment, database migration, nursing workload, and user training. Mr. Carriere is very involved in the informatics community, currently holding the position of promotions coordinator for the Ontario Nursing Informatics Group and as a member of the Open Nurse group. Mr. Carriere's clinical nursing experience includes pediatric emergency, neonatal intensive care and adult intensive care. Dr. Lynn Nagle, RN (Ontario) Past President of Canadian Nursing Informatics Association Dr. Nagle is the Chief Information Officer for Mount Sinai Hospital, Toronto, Ontario. With more than 25 years of healthcare experience, Dr. Nagle has worked in a wide variety of settings and roles. Her work as a clinician, educator, researcher, and administrator has provided her with a broad-based perspective of healthcare delivery and information needs. For the last decade, her work in informatics has focused on the identification and evaluation of appropriate information management solutions within MSH. In her current role, she has corporate responsibility for information and communication technologies, health records management, and performance measurement strategies to support daily operations and strategic planning.
9 Her research is focused on understanding the effects of technology in clinical practice settings - the human-technology interface. Specifically, she is interested in the study of information technology that supports and facilitates clinical care delivery. She is also an Assistant Professor at the Faculty of Nursing, University of Toronto and teaches a graduate course in Informatics. As current and founding President of the Canadian Nursing Informatics Association, she is also the Canadian representative for the International Medical Informatics Association, Nursing Interest Group. She has many publications and paper presentations to her credit and is internationally recognized for her expertise in health informatics. Dr. Xing Liu BSc MSc PhD (BC) Xing Liu, BSc(Hunan) MSc(Hunan) Ph.D(Wales), Member IEEE(Computer Society), Member ACM (Association of Computing Machinery), Member IEEE Industrial Electronics Education Committee. With teaching and research experiences in Canada, US, UK, Singapore and China. Have been teaching computing/it courses since 1996 in universities/colleges in Canada and US, as well as provided consulting services to several Canadian/US companies during the same period. Dr. Stephen Petrina (BC) Dr. Petrina is an Associate Professor in Curriculum Studies and Technology Education at the University of British Columbia. He supervises and teaches graduate students at the Masters and Doctoral levels. His research and publishing interests centre around cyber-culture, cultural studies, new media, science and technology studies, intellectual property rights, academic freedom, design, eco-design, educational technology, on-line education, critical theory, and critical pedagogy. He has published numerous papers, articles, book chapters and two books related to the above topics. Dr. Heather Clarke, RN (BC) Dr. Clarke is an Adjunct Professor for the School of Nursing at the University of British Columbia, as well as a self-employed professional working on national, provincial and local contracts, primarily related to policy (e.g. Nursing Directorate and Chief Nurse Executive positions, public health nursing and First Nations and Inuit health and nursing). She was the principal investigator for the Canadian Nursing Informatics Association and the Health Canada, Office of Health and the Information Highway research study, Educating Tomorrow s Nurses Where s Nursing Informatics? (2002-3). Bev Mitchell, RN BSN MSN (BC) Bev is a clinical analyst in corporate information technology for the Providence Heath-care Group in Vancouver, BC. She has completed research that examined the identification of requisite informatics competencies for entry-level nursing practice. Alyse Capron, RN MSN (BC) Director of Education of Canadian Nursing Informatics Association
10 Alyse is employed as a Clinical Informatics Specialist working as a member of the Vancouver Island Health Authority's (VIHA) Clinical Informatics team. Reporting directly to the Medical Director of Clinical Informatics and Telehealth, Alyse's role supports nursing and allied health practitioners involvement in both the design of VIHA clinical information systems as well as the development and integration of informatics competencies into practice. The past five years have brought concentrated involvement in both the development and implementation of a regionally integrated clinical information system, as well as ensuring the integration of new information and communication technologies into care. As a masters prepared nurse, Alyse views nursing's understanding of informatics and its related competencies as critical to the overall success of informatics' potential to inform and enhance practice. Working closely with her colleagues in the various Vancouver Island educational institutions, she works to support this understanding among nursing educators and students. Dr. Dianne Symonds, RN (BC) Dr. Symonds is the Director of the Institute for the Advancement of Personal and Community Health and Wellness at Kwantlen University College, as well as Coordinator of the Wellness Centre at KUC. Dianne has been involved in a variety of research initiatives in the Fraser Valley and Vancouver area, related to nursing, population health, and continuing competencies.