UPDATE 28 December 2006: this blog site has been moved to a new hosting provider – so some of the ‘bells and whistles’ we had may no longer work; we will try and find time to re-install them. But watch out for the SINI2007 blog and more opportunity to interact.

SINI2006 is over. As ever, it came and went all too fast for those who were there.

If you were at SINI2006 and have not yet had to chance to add you views on any of the activities, it is not too late to do so. You can add a comment to any existing post.

We would also welcome your views on the blog – again, please add comments to this post, or email me on peterjmurray[at]gmail.com

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Jeff Goldsmith (www.healthfutures.net/) is the final speaker, with a lecture titled ‘Informatics’ influence on the future of health care’. He compared US health spending against the whole of the Canadian economy, and that it is similar to the GDP of Germany.

Emerging technologies:
1. – genomics – will be a lot bigger deal than most people think. Many of the highest powered applications in healthcare are around gathering genetic data; will make a big difference in how we care for patients.
Clinical implications of genomics will include new business models for pharmaceutical companies. Metabolic information, especially around understanding the genetic contribution to adverse drug reactions, will be one of first uses of genetic information in patient records. There are also huge issues around access to the information gathered. Long term potential is for individualised therapies, antibodies, vaccines for specific illnesses in indivduals’ bodies.

2. – intelligent clinical care systems – will be a mature technology when it is cheaper and easier to use. The nature of the record (a historical record of what was done in the past) will change – interaction of existing and new elements, such as cellular information, metabolic pathology, interventions, anatomic detail, genetic information. We need a tool to locate where patient is right now and a navigational tool set for the whole care team (GPS navigation model).

Jeff describes evolution of EMR from passive documentation, (individual unit of care) through clinical navigation system (episode of illness), through to knowledge resource (clinician’s practice). He compared the remembering of previous visits to sites such as Amazon, and suggested that new EHR tools will include such systems.

Usability issues are an important aspect of reasons why healthcare IT tools are not as widely used and embraced by clinicians as they could and should be. Suggests there will be a digital divide in access to healthcare IT tools.

3. – remote patient monitoring – convergence of remote sensing with intelligent clinical software to maintain people in home, as well as monitoring of hospital patients. On the sensor horizon are things like the eNose (to smell infections), RFID-like sensors for clinical parameters, and integration of suites of sensors. Modalities will include smart clothes, smart homes, etc. Issues arise of who will access all the telemetric data, and how it will be used. Also – because we can do it, should we; and how can IT maximise scarce professional time in patient care activity, and so make a difference?

Among implications for nursing, Jeff suggests there is/should be no IT installation without work redesign – clinical transformation does not come out of a box. IT objectives should be about providing more nursing time for direct patient care.

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The middle session of the morning is a panel, chaired by Jeff Goldsmith, and involving myself, Joyce Sensemeier and Kathryn Hannah. I am going to try and blog it ‘live’ as we go along. I’m not sure what effect this will have on the Talkr podcast … but we’ll see. Mary Etta Mills has introduced the panel members to those still here at SINI, although numbers are starting to thin as people begin to leave for home.

Jeff first asked whether, because of the different health systems (US, Canada, UK) nurses spend more time in direct care in other countries. Kathryn suggested documentation is for different reasons – and there nay be a little less due to lack of need to gather financial data.
Discussion continued on whether increases in government funding has resulted in better nursing care in the UK; discussion moved on to the movement of nurses from Third World to first world countries.

Joyce discussed a question about nursing involvement in the US national information infrastructure – and sees evidence of real nursing involvement and the effects of their understanding of healthcare and patient needs.

Jeff referred back to Kathryn’s talk and sought to clarify Kathryn’s point about nursing information systems – Kathryn clarified her point and the need she for nursing content in patient systems.

Peter answered some questions on the UK situation. A further question asked about patient-centred-records; Kathryn mentioned the Canadian context and Peter talked about UK government rhetoric on patient-centred and personal health records.

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Kathryn suggested that, so far, there has been little use of informatics to support population care, self-care, etc. She went on to outline her vision of integrating information into work as care-givers – this includes defining the clinical information requirements, from which detailed clinical data can be captured and then compiled into historical data (EHR); this can be used to compile aggregate population data, from which plans, policy and decision making can be developed.

Kathryn went on to talk about how she sees modern nursing, and the importance of nursing care impacting patient outcomes.

From here, Kathryn provided an overview of the development of nursing informatics in the 1980s, including using photos from the first international nursing informatics conferences in London and Calgary.

In the Canadian system, health care is devolved to a provincial level, so there are, in effect, 13 health systems in Canada.

After an excursion around aspects of terminologies and languages, Kathryn moved on the an increasing emphasis on change management, and the need for it to be effective and sustainable.
Future trends that Kathryn sees as important are genomics and robotics; need to be able to understand gene sequence information in the clinical chart. There are important ethical considerations that are only now starting to be considered (eg prediction of disease before it occurs).

Kathryn sees the need to move from nursing information systems to \patient information systems, but with a nursing component.

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Saturday, and we are rapidly rushing towards the end of this year’s SINI. The opening session of the day is the Cerner Distinguished Lecture, given by Kathryn Hannah and with the title ‘Lighting the way for modern nurses with nursing informatics’.

As an interesting aside, while we sit here waiting for the start of the session – both Kathryn, and the closing keynote, Jeff Goldsmith, are using Apple Mac machines.

Kathryn was introduced by Charlotte Weaver, from Cerner Corporation. Kathryn revealed that her maiden name was Nightingale, and began her talk by talking about Florence Nightingale’s early work on statistics and hospital design and management.

She began by recapping some of the influences on health services delivery, from new diseases and treatments, rising drug costs, shifts to community-based care, demographic chnages and decreasing proportions of governemtn spending on healthcare. In addition, there are efficiency and effectiveness drivers. This all leads to a super-abundance of data with the growth of the medical literature, moves to lifelong electronic records, and rapidly rising amounts of genetic data.
She pointed out that, while data and information are essential to rational decision making, political decisions influencing health policy are not always rational.

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The now traditional CARING (www.caringonline.org) dinner was held on Friday night at Chiapparelli’s, in Baltimore’s Little Italy (www.chiapparellis.com/) on Friday evening.

Organised efficiently as ever by Sue Newbold, the event was sold out, with over 80 attendees. This year, most people registered – and paid – online through the CARING website.

I will upload a couple of photos – if anyone has any they wish to submit for the blog, please let me know.

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The final session of the day that I am attending (before going for some liquid refreshment and then to the CARING dinner) is titled ‘Informatics challenges for the impending patient information explosion’, and is being delivered by Jacqueline Moss of the University of Alabama, Birmingham.

Her presentation is based in a paper in JAMIA (Berner and Moss, JAMIA 12, 614-7, 2005).

She says that in the next 10 years, due to improved technology and access, there will be increasing ease to collect and disseminate information, with increased use of elcectronic health records and thus the amount of data. One question that arises is whether, with all this, we will be data rich and information poor.

Future information challenges will include the need for better information filtering, context sensitive decision support, clarification of legal and ethical obligations, assessing data accuracy, who has rights of access, and much more.

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For the first session of the afternoon, following lunch and the posters session, I thought I would sit on the presentation by Diane Skiba and Michele Norton titled ‘Creating partnerships to share intellectual and social capital’.
Among other activities, Diane is involved with the Informatics Collaboratory – see, for example, http://www.nursingworld.org/ojin/topic30/tpc30_4.htm

Michelle outlined some of the impetuses towards collaborative partnerships among, for example, hospitals, academic institutions, and vendors. These include various IOM reports, workforce shortages, and limited academic resources and funding. Benefits she sees include preparing clinicians for the future in terms of, for example, evidence-based practice and IT, in enhancing patient safety, in industry access to academic intellectual and social capital, research collaboration, and contributions to ongoing product design and innovation.

Among examples, Michelle cited some current academic-industry partnerships, including University of Kansas/Cerner (SEEDS project – Simulated E-hEalth Delivery System –http://www2.kumc.edu/son/abp.html), Johns Hopkins University/Eclipsys, and University of Colorado Denver HSC/McKesson, as wll as past examples such as the HBOC Nurse Scholar Program of the 1980’s/90’s.

In the second part of the presentation, Diane kicked off with an interactive exercise to get attendees to look at issues around developing proposals for partnerships. She asked people to think about organisational assets, goals for proposed partnerships, identification of existing intellectual and social capital, and what the next steps might be.

Among factors identified by Diane from her experience were barriers and issues/opportunities, including:
approaches to problem identification and prioritisation (whether there is agreement, prioritisation if there are multiple problems, formal structures and hierarchies, a focus on weaknesses rather than strengths);
values (eg different demands related to career advancement, suspicion and bias, styles of interactions);
work styles (socialisation of scholars as independent thinkers has effects, including uncertainty, ‘expert’ syndrome);
time demands (effective collaboration requires immersion, time to build trust);
approaches/mindsets to information, including ‘publish or perish’, intellectual property issues, and dissemination of information.

Among strategies for successful partnerships, Diane suggests partnering at the highest level, ensuring the right match, contractual areements (eg Memoranda of Understanding), commitment and accountability.

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Following the ‘purple perils’ of last year’s SINI, the student volunteers and others (who are doing a great job) are all dressed in orange shirts – and some with fetching orange trousers too. For a little light relief, here is a list of the ‘Top Ten Reasons SINI Volunteers Love Wearing Orange Shirts’; this was provided by an anonymous source among the orange shirt wearers:

10. Looking like a healthy fruit strengthens our self-esteem.

9. Getting mistaken for a street barricade makes it safe and easy to cross the street.

8. Imitating an Orange Julius employee allows us to give our friends free drinks.

7. Keeps us safe when hunting with Dick Cheney!

6. Being visible from space makes Google Earth into a fun “Where’s Waldo” type game!

5. No need to turn on the lights in a dark room.

4. Fill in for Rudolph if he gets sick.

3. Finally! I have a shirt to wear to with my orange pants.

2. Can guide planes in to the gate just by waving our arms.

1. Works like camouflage when hiding in an orange tree!

Thanks for this – we look forward to seeing what colour is chosen for next year ;-))

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Folks, must issue an apology to ya’ll. My intention was to conduct a few video inteviews with participants here at SINI. Unfortunately there were technical issue(s) (the mike I brought was dysfunctional with my Apple). Hopefully I can purchase a functional external mike for future use.
Scott

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