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Jul
04
Filed Under (Uncategorized) by Peter on 04-07-2008

The SINI2007 blog is now ‘frozen’ as an archive.
We will be blogging SINI2008 at:
http://www.differance-engine.net/krew/
rather than with its own separate blog.
See the SINI2008 website for full information about the event:
http://www.nursing.umaryland.edu/sini/

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Jul
22
Filed Under (Uncategorized) by Peter on 22-07-2007

As always, SINI rushes by far too fast. SINI2007 is over. The SINI website will, we are told, remain ‘live’ for some time.

Will will keep this blog online indefinitely – but will close it to posts and comments in a few weeks’ time, so take the chance now to post comments.

Everyone seemed to have a good time. Scott and I enjoyed the blogging and were kept busy – not necessarily out of trouble, but busy ;-)) As a consequence, we never got to do Lexington Market for the crab cakes or soft shell crabs this year (but I got my ‘fix’ in Eastport, near Annapolis, on Saturday evening).

SINI2008 (the 18th SINI) will take place on 16-19 July, 2008; the call for abstracts will close on 7 March, 2008; the theme will be ‘Building connections for patient-centered records’

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Jul
21
Filed Under (asides) by Peter on 21-07-2007

Posted by mobile phone:
And, oh yes, NEXT year I will finally make it to Lexington Market, too. Scott

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Jul
21
Filed Under (asides) by Peter on 21-07-2007

Posted by mobile phone:
Here I sit @ BWI waiting to lv for home, thinking, had a lot of fun AND learned, too. Can’t wait to see changes for next year!
Scott

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Jul
21
Filed Under (Saturday, Speakers) by scott on 21-07-2007

Dr. Kolodner is the closing speaker for the conference. Title is “Moving the NHI Technology agenda forward”. He is the National Coordinator of ONCHIT in the US. He begins with reviewing costs in the US and then moving on to nursing challenges, including nurse/MD ratio (3:1) as well as noting how nurse time is ‘budgeted’ (sorry, missed the specifics on that one). the drivers of Health IT adoption in clude rising helath care costs, substanial benefits for consumers / economy, clinical leadership, political leadership & industry leadership. Description of key health IT components follows this, which include EHR, PHR, public health information, standards (data, technical & security) & then interoperable HIE network. He provides his view on the future of health care r/t individuals (increased emphasis on prevention; eliminate barriers to care at multiple sites; telecare/telemonitoring increased prevalence, and so forth). Genomics is also a part of the future of health care as r/t individualized care (personalized medicine). A piece of this is linking to / with the EHR. Other future health concerns r/t IT include interoperability and so forth.

Dr. Kolodner offered up a review of ONC/Office of the National Coordinator (of Health IT). Included in this is what are perceived as cornerstones of value-driving health care (4 components). The framework for transformation, from 2004 – 2014, is outlined on his slide (graphic representation). How this transformation change occurs is via a tipping point. View is not at the tipping point but close to it according to Dr. Kolodner. But ‘we’re’ still not close to making it widely adopted after the tipping point. It’s about the training and support to support ‘doing this right’. EHR & transformation care will follow after the health IT is ‘tipped’. This is depicted in a graphical fashion – sorry, folks, I’m not good at capturing on the fly ;’). He describes the ‘levers’ available to facilitate the IT shift / change. One of these tools is AHIC (American Health Information Community). 17 members both public & private sectors, with 7 workgroups under it, of which 4 started meeting in 2005. See the for this office for additional details such as priorities & use case roadmap. Some of the IT initiatives are with other US agencies ranging from HRSA to CMS and so forth. He outlines additional collaborations by ONCHIT with such as CCHIT, HITSP and the NHIN, nationally, as well as state levels. (Feel free to search for the definition of these ‘letters’ as a homework assignment – just kidding, folks.) He presented the ‘infamous’ ‘tree’ slide (analogy used for Health and IT). Elements of success include governance, policy, technology & adoption activities. Continued to stress the need to ‘work together’ to achieve the goals & objectives.

Dr. Kolodner’s presentation was well attended and well received, a nice closing to a great conference!

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Jul
21
Filed Under (Saturday, Speakers) by scott on 21-07-2007

Speaker: Jim Jirjis, MD MBA. Title: “Patient web portals: Involving patients in their health care – connecting patients, their personal health information, and their providers”

This is the 2nd of 3 sessions this last day and appears to be as well attended, if not a bit more, than the first session. Dr. Jirjis offers a presentation style with a good mix of humor, anecdotes, and informality to engage the audience. He did a brief historical overview of ‘online’ services and health care. Question he poses: are ‘we’ ready for online? Example he used is what was done at his site regarding physician-patient messaging / communication(s). Physician perspective – patients can’t handle the truth (aka – lab results). He continues on with a brief review of different approaches (practice-based and so forth). Challenges with messaging include need of win/win/win situation (patient, MD, staff); information flow; responsive to patient (aka no dropped messages). Signing on includes ability to transition a large number of patients from email to this & easier to use and given ‘them’ more than ‘just’ email. So, what’s the matter with just using email? Why not a messaging system better than email? Too much email, printing, tracking, legibility, not save in record automatically, and so forth. Solution provided is portal – site is MyHealthatVanderbilt. Major areas included are messaging, lab/test results, appointments, billing and so forth (https://www.myhealthatvanderbilt.com). He then continued on describing the system via screenshots and relevant anecdotal & historical ‘stories’.

He then continued presenting and reviewed results of implementation and current system status. New ongoing costs include support/training & maintaining directory. A decision to audit the messaging system was then carried out. Lab result reporting required a piece initially missing – confirmation of the lab result. [quick side note – he is a presenter who knows how to work the audience and is good at it. Excellent speaker with a style resonating with most of the audience – end of quick side note]. 3 groups of results for patients to view: limite4d group of test with results having a high value for immediate patient viewing with low risk of untoward rx to the information; largest number of lab & x-ray result with labs having a 7 day delay and x-rays with 14 days, which allow provider to confirm the accuracy & communicate the result ot the patient; AND, the last group of labs & x-rays not released through MyHealthatVanderbilt (HIV, Ca pathology results, urine drug results, etc).

An excellent presentation – style, content and practicalness to / for attendees. Very well received.

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Jul
21
Filed Under (Saturday, Speakers) by Peter on 21-07-2007

Jim Jirjis, Chief Medical Information Officer from Vanderbilt University Medical Center (VUMC), is the middle speaker of the morning, addressing ‘Patient Web Portals: involving patients in their health care – connecting patients, their personal health information, and their providers’.

Historically, there was little interest in patient web portals, but with growing numbers of people using the Internet, being online is part of life through places like Amazon, Skype, Ebay, news sites, etc. – the world has changed.
Do patients want test results online etc, Jim asks? – yes, according to surveys – but many health professionals take the view ‘patients can’t handle the truth’. The infrastructure is in place with secure web and data transfer capabilities – the question is whether health professionals are ready.

The use of messaging between patients and health professionals has to be win-win-win for doctors, patients and staff if it is to work. Patients must be able to get responses or they will not use the systems. There are problems with using email, as opposed to messaging.
He talked about the MyHealthatVanderbilt portal (https://www.myhealthatvanderbilt.com/), which can be customisable for individual patients’ needs. With the messaging system, all patients have access to all their doctors. Jim explored some of the issues that has been faced in using the system, resistance issues from doctors, and how unanswered messages had been dealt with to reduce them.

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Jul
21
Filed Under (Uncategorized) by Peter on 21-07-2007

Christopher Silberholz, one of the students volunteers at SINI2007, writes:
A team of students from the Johns Hopkins University (Tia Gao), the University of Maryland (Christopher), and University of Virginia (Leo Selavo), (plus some high school students!!) have developed low-cost wireless vital sign monitors that operate on TinyOS and mote platforms. The sensor monitors are Temperature, Pulseox, and 1-lead EKG. These devices operate on a wireless ad-hoc mesh network, and can be used to triage and monitor casualties in the event of a disaster. The team is seeking clinical trial partners for additional pilots.

Photos from the disaster drill can be found at this site:
http://www.flickr.com/photos/aid-n/sets/72157594226526329

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Jul
21
Filed Under (Saturday, Speakers) by Peter on 21-07-2007

The opening distinguished lecturer is Angela McBride, from Indiana University School of Nursing (but originally from Baltimore), whose talk has the title ‘Informatics for all nurses’.

Angela began by talking about her time at Sigma Theta Tau International, during which time the Virginia Henderson (electronic) library was developed. Indiana University was the first university to have a School of Informatics, the Regenstrief Institute. Later, she spent a year as a scholar-in-residence at the Institute of Medicine, and went on to discuss what she had gained during that time.

Angela moved to talking about meeting foundational goals in relation to the use of technology in healthcare:
1. safety – expedites continuous monitoring, seamlessness at points of transition between care settings, and clinical decision making
2. effectiveness – facilitates dissemination of standards/policies and supports benchmarking
3. patient-centeredness – supports patients and providers in their decision making, mitigates social isolation and loneliness, and enables patients to avoid hospitalisations (eg through telecare)
4. timeliness – facilitates ‘just in time’ as opposed to ‘just in case’
5. efficiency – removes redundancies (eg lab tests) and makes possible ‘mass customisation’ and community outreach
6. equity – facilitates access
7. global connectiveness – permits a ‘no borders’ approach to health care.

Her take-away message is that nursing has long-held goals that are congruent with these seven foundational goals – but have not been fully achievable until the advent of 21st century information technology.

In discussing the politics of moving forward and confronting that all nurses need informatics, she talked about paradigm shifts in health care (from conventional to new rules) that are happening or need to happen include a move from process oriented to outcome oriented, a move from focus on provider-patient relationship to focus on work setting as a learning organisation, and move from ‘do no harm’ as an individual responsibility, to safety as a systems concern. She also talked about moves from care giving being place and time bound to not being so; from focus of care being patient compliance to focus being on best practices; from decision making based on training and experience to being evidence-based, and from organisation in professional silos to interdisciplinary collaboration being expected (as opposed to an option).

In her parting thoughts, Angela sees healthcare professionals’ relationship to IT is like their relationship once was to research – research once was only part of research courses, but now is a staple of all educational preparation. Faculty need to be engaged in transformations that are going on in clinical agencies. She sees ‘utilising informatics’ being a core IOM competency, but also being the ONE by which all the others will be achieved.

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Jul
21
Filed Under (asides) by scott on 21-07-2007

Hmm, closing session is not quite as full as the opening session of this past Wednesday afternoon. However, there continues to be a fair sized trickle as the session progresses. Scott

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