TIGER Making a Difference: Maximizing Local & Global Virtual Connections

Transcription

1 TIGER Making a Difference: Maximizing Local & Global Virtual Connections Michelle R. Troseth, MSN, RN, DPNAP, FAAN Chief Professional Practice Officer ELSEVIER Clinical Solutions Patricia Hinton Walker, PhD, RN, FAAN, PCC Vice President for Policy & Strategic Initiatives Uniformed Services University of the Health Sciences Bethesda, MD

2 Initial TIGER Vision & Phases Allow informatics tools, principles, theories and practices to be used by nurses, other interdisciplinary providers and consumers Interweave enabling technologies transparently into practice, education and research to improve outcomes, patient safety and reduce costs of healthcare Better preparing workforce to use technology and informatics for improvement of patient care TIGER Phase I Engaged practice, education, industry, organizational and federal stakeholders to create a common vision of Health IT in an Invitational Symposium in 2006 TIGER Phase II Facilitated collaboration to Develop Nine Collaborative Reports involving over 1500 nurses from all types of practice, education, research and policy. TIGER Phase III - Integrate interdisciplinary professionals and Consumers primarily through a Virtual Learning Environment to enhance widespread adoption of Health IT Today - The TIGER Initiative Foundation furthering TIGER I, II, III & Next Steps!

3 Current TIGER Vision To enable nurses and interprofessional colleagues to use informatics and emerging technologies to make healthcare safer, more effective, efficient, patientcentered, timely and equitable by interweaving evidence and technology seamlessly into practice, education and research fostering a learning healthcare system.

4 Today TIGER Wants to Take a Look in OUR Health IT REAR VIEW MIRROR In Year 2017, 2020! Where will you be in 2017? Where will you be in 2020? What are the changes in Health Care that will Drive your Decisionmaking? MOST IMPORTANT! What will we, as Nursing Informaticists have accomplished by 2017, 2020?

5 Office of the National Coordinator (ONC) Dr. David Blumenthal, former National Coordinator of HIT, brought Meaningful Use and indicated: HIT is the means, but not the end. Dr. Farzad Mostashari, current National Coordinator of HIT, emphasizes: Consumers are Meaningful Users, too! IT S NOT A TECHNOLOGY PROJECT, IT S A SOCIAL CHANGE PROJECT.

6 21 st Century Biomedicine: Requires Competency and Culture Change Personalized, Predictive, Preemptive, and Participatory Unifies discovery, clinical research, and clinical care (benchbedside-bench) into a seamless continuum Results in improved clinical outcomes for individuals and populations Accelerates the time from discovery to patient and consumer benefit Empowers consumers in managing their health over a lifetime Enables a Learning Health System with Providers using Justin-Time Evidence from CER and Patients and Consumers using Real-Time Information from PHRs and Mobile Health Devices Adapted from Presentation by Ken Buetow, Ph.D., Associate Director, Bioinformatics and Information Technology National Cancer Institute

7 Coaching: Use of Powerful Questions and Visioning Your Future And/or the Future of Your Organization! TIGER wants to use these strategies today to explore YOUR Next Steps in the context of one VISION of the future of Health Care!

8 Accountable Care Organizations Regardless of Model Requires New Roles WHAT WILL BE YOUR ROLE and How can TIGER help YOU GET THERE

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10 epatients and Their Contribution to Health Care Research Equipped Enabled Empowered Patient-generated research questions Patient-adapted protocols Engaged Educated Expert Electronic Patient-facilitated recruitment Patient participation and retention Patient-focused policy agenda Adapted from NLM Presentation by Donna R. Cryer, JD

11 PHRs and mhealth Devices Key to Healthcare Management and Cost Reduction! Important Contents also include: From Patient/Consumer Centered Mobile or Home Devices: - Health and Prevention data such as: - Diet and Nutrition - Exercise - Data re: Chronic-Care Management - Blood Sugar Monitoring - Blood Pressure Monitoring - Weight in context of fluid retention/diuretics - Heart rate and regularity - Other relevant indicators

12 Citizen science (also known as crowd science, crowd-sourced science, or networked science) is scientific research conducted, in whole or in part, by amateur or nonprofessional scientists, often by crowdsourcing. Formally, citizen science has been defined as "the systematic collection and analysis of data; development of technology; testing of natural phenomena; and the dissemination of these activities by researchers on a primarily avocational basis". Citizen science is sometimes called "public participation in scientific research." [ Citizen Science (wikipedia)

13 The Love Army of Women National Cancer Institute is partnering with the Love/Avon Army of Women to build a consumer-controlled online cohort of one million women, called the Health of Women (HOW) Study Adapted from: Ken Buetow, Ph.D. Associate Director, Bioinformatics and Information Technology National Cancer Institute

14 Three open questions: - What s the relationship between self tracking and citizen science? And between citizen science and laboratory science? - How does the quantified self interact with the internet of things, and a wider proliferation of sensors? - Is the quantified self broader than the quantified body? And what do we learn from quantifying other aspects of the self? CITIZEN SCIENTIST

15 What is a quantified self? There s lots of big data projects in the world, and not a lot of people are working on the self. The self is not a sideshow in the world of data it s the main thing, it s the center ring. Computing, historically, is designed to help scientists and engineers solve math problems. These days, this isn t how we think about computing they re about creativity, self expression, information. It s personal computing. And we got here through advanced users, who teach technologies to do new things. Advanced users are trying to solve problems that are important to everybody. Technology can connect us to people very different from us who are trying to make the same discoveries how to eat, how to sleep, how to learn, how to work. By discovering goals we share in common, there s the possibility that common ground on the quantified self leads us to empathy. The QUANTIFIED SELF

16 Extreme Quantified Self Gary Wolf The quantified self.wmv

17 The Extreme Quantified Self Individual and Organizational Incentives for Health and Health Behavior Change

18 Individual and Organizational Incentives for Health and Health Behavior Change The Extreme Quantified Self

19 Integrate Systems for both Client and Providers Slides from Presentation by: Victor Stretcher, PhD,MPH University of Michigan and Health Media

20 Data Metrics Provide timely, relevant data to link interventions and monitoring to outcomes Slides from Presentation by: Victor Stretcher, PhD University of Michigan and Health Media

21 The Biomedical Informatics Continuum: From Data to Knowledge Data Information Knowledge + Context + Application To Wisdom for Patients, Consumers and Providers 21 Phillip R. O. Payne, PhD OSU Center for Personalize Healthcare

22 CHALLENGE: Reducing The Distance Between Data & Knowledge, Then Realizing the Promise of HIT, Nursing & Biomedical Informatics Clinical Encounters EHR Data Generation Management, Integration, Delivery HIT + Biomedical &Nursing Informatics EDW Research Increasing Distance 22 Knowledge Generation

23 Health and Nursing Informatics consists of Information Technology Health care Research Education Fundamentals Data Collection Data Analytics Knowledge Management Decision support Clinical Information Management Communication 23

24 Data Collection Tools: Through reliable data collection instruments in a organized, systematic, and scientifically robust manner in person and then entered into databases, Online data collection (require computer literacy with access to a computer) Electronic Health Records (EHR Personal Health Records mhealth Apps Patient Portals to Large Health Care Systems Research Protocols Public Health Records Page 24

25 Key Terms Defined Relational databases - A collection of related records stored in a computer system using tables that can be related to one another and the data extracted in a variety of ways to gain needed information without. having to reorganize the tables Clinical Databases - A collection of related patient records stored in a computer system using software that permits a person or program to query the data in order to extract needed patient information.

26 Florence would be PROUD... We have returned to our roots... The basics of health care!!! I am fain to sum up with an urgent appeal for adopting this or some uniform system of publishing the statistical records of hospitals. If they could be obtained they would show subscribers how their money was being spent, what amount of good was really being done with it, or whether the money was doing mischief rather than good. Florence Nightingale, 1863

27 Health Coaching Vs. Traditional Approach of Patient Education Health Coaching is practice that: Enhances the well-being of individuals and Facilitates achievement of health-related goals. Motivates behavior change through a structured, partnership between person & coach DO NOT try to solve the problem or issues for the PERSON Validate perspectives and capacity (self-efficacy) Ask powerful questions for Person s own solutions and conclusions Empower patients, family, care force with support/guidance to make progress toward health-related goals and self-management.

28 Health Nurse Coaching & Chronic Condition Management Behavior Change Models Need to be in Lexicon such as: Learning Theories Health Belief Model Trans-theoretical Change Model Social Learning/Social Cognitive Theory Reasoned Action and Planned Behavior Change Social Support Self Efficacy Ecological Approaches

29 Many Headlines Tell the Story Geisinger s GMP: Interactive Voice Response (IVR) + Care Coordination cuts readmits by 44% Health Finance News 02/2012

30 Health IT + Health Coaching = Solutions to Cost Reduction, Quality, Access Business and Industry Target GE Walgreens Auto Industry Safeway: 100,000 lbs And MORE!!! Walmart

31 What are the STRATEGIES to Explore Relationships with Health IT, Data Analytics, Tracking Behavior change and HEALTH Nurse COACHING And how can TIGER help? Reference: NURSE COACH Document from ANA

32 Sharing with Others and with TIGER re: YOUR Emerging Vision? Positioning Yourself for TOMORROW! What possibilities are you thinking about and what are you interested in? TIGER is Interested in YOUR Vision for yourself and how we can help!

33 Technology Informatics Guiding Education Reform (TIGER) Initiative Foundation Future Directions! Background and Virtual Learning Environment and Strategic Future Directions

34 Insert Text Box Here If Want! With bullets If you Want TIGER roared and Successfully Navigated the STORMS of CHANGE for Health IT with application in Practice, Education and International Colleagues! In 2003: Potential Vision for TIGER Developed by TIGER Leaders!

35 TIGER launched an accessible, sustainable VIRTUAL LEARNING ENVIRONMENT Virtual Learning Environment Enhanced the ONC 70 Extension Centers Improved the knowledge and capabilities of nurses and other disciplines Technology and Informatics Enhanced Education at all levels of interdisciplinary health provider education The Digital Divide has shrunk for diverse future health workers Rural Communities are not longer disconnected they are in the flow!

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37 TIGER Impact Metrics from the TIGER VLE to highlight demographics of participants and history of content targeted for learning

38 TIGER VLE: Top 10 Presentations Downloaded

39 # Participants # States # International Participants 250 (Examples of Participant Roles) Director, Clinical Informatics Educator Marketing Director Graduate nursing faculty, RN Business Analyst System Coordinator RN CLINICAL INFORMATICS Clinical Informatics, Consultant Network Administrator, NP Practice Transformation Education Manager, Business Leader Director, National Healthcare Manager, Nursing Info Systems IS Site Manager, Assist Prof Health IT Advisor, President VP Clinical Informatics Director, Nursing Informatics Clinical Informatics Manager Nursing/Clinical Informatics Director, CIO, CNO, Dir. of Nursing Process, Workforce Development Co-Lead Visiting Lecturer, Executive Director Quality Coordinator Surgical CSU CNIO, Director, HIM and CPO Student mostly graduate Senior Director Acute Care Systems How They Heard about VLE? 40* 10+** Referrals from Colleagues & Instructors States Represented: *CA, CT, NY, RI, MO, CO, AZ, NE, Al, IL, IA, VA, KS, AL, FL, GA, HI, IN, KY, ME, MD, MA, MI, MN, MS, MT, NJ, NC, ND, OH, OK, OR, PA, SC, SD, TN, TX, UT, VT, WA, WI All states except: AK, AR, DE, ID, LA, NV, NH, NM, WV, WY (10) Countries Represented: Canada-Alberta, British Columbia and Ontario New Zealand Australia, Ireland Denmark, Brazil Taiwan, Puerto Rico More than one from our neighbor, Canada Through a professional association (primarily HIMSS) Conferences and presentations TIGER Website Membership in Organizations such as HIMSS, ANIA, AMIA, other Informatics Groups and Professional Organizations

40 Future Directions Advancing Practice with Informatics Informatics Competencies Interprofessional Education & Interprofessional Clinical Practice Polarity Thinking & Management

41 Consumer ehealth Pledge

42 Advancing Practice with Technology Technology must capture the tasks performed but not limit practice to the rituals and routines of traditional practice Tasks Technology must be designed to enhance scope of practice and evidence-based practice at the point of care Scope of Practice Technology is key to embrace and shape so practice is truly knowledge-driven Knowledge- Worker Wesorick, Troseth & Cato (2004) Intentionally Designed Automation. Healthcare Technology (vol. 2) McBride (2005) Nursing and the Informatics Revolution. Nursing Outlook.

43 TIGER Informatics Competencies Competency Basic Computer Competencies Information Literacy Resources European Computer Driving License Foundation (ECDL) ( CPPlacement (Official distributer of ECDL within the US) ( Healthcare Information Management System Society (HIMSS) ( American Library Association ( racycompetency Health Level Seven (HL7) ( Information Management European Computer Driving License Foundation (ECDL) (

44 Competencies: Ongoing Evolvement QSEN Informatics ANA Computer Literacy Information Literacy Professional Development and Leadership TIGER Basic Computer Information Literacy Information Management

45 TIGER Usability and Application Design Report TIGER Usability & Design Systems Thinking Evidence-Based Practice Scope of Practice Individual & Integrated Competency Knowledge Discovery Figure: Adapted from the CPM Resource Center with Permission

46 The Education Committee Chair: Diane Skiba, Ph.D., FAAN, FACMI Responsible for developing and overseeing the education program and related products (specifically the Virtual Learning Environment), The TIGER Institute at HIMSS s Conference, and other educational endeavors.

47 Output of the TIGER Education Committee

48 TIGER Vision for Leadership Revolutionary Leadership that drives, empowers, and executes the transformation of healthcare through the use of Health IT Leadership Report in Process of Being Updated Currently

49 Interdisciplinary & Community Engagement Chair: Carol Petersen RN, BSN, MAOM, CNOR Responsible for developing and engaging with new interprofessional partnerships, entities and organizations. Currently engaged in reaching out to interested parties in rekindling the TIGER relationships.

50 Interprofessional Education & Practice: A 40 year old New Trend Based on IOM Competencies Defined Principles Four Competency Domains 38 Competencies

51 Utilize Informatics IOM 5 Core Interprofessional Competencies, adapted to IP Education Competencies Work in Interprofessional Teams Core Competencies Employ Evidence- Based Practice Informatics Relevant to ALL Provide Patient- Centered Care Apply Quality Improvement

52 University of Minnesota to House New National Center for Interprofessional Education Health care delivered by well-functioning coordinated teams leads to better patient and family outcomes, more efficient health care services, and higher levels of satisfaction among health care providers. We all share the vision of a U.S. health care system that engages patients, families, and communities in collaborative, team-based care. This coordinating center will help us move forward to achieve that goal. Mary K. Wakefield, Ph.D., R.N. HRSA Administrator September 14,

53 Dentistry Medicine Nursing Optometry Osteopathic Medicine Pharmacy Podiatric Medicine Psychology Social Work Veterinary Medicine Speech Language Pathology Physical Therapy Occupational Therapy Associate Members The National Academies of Practice was founded in 1981 to advise governmental bodies on our health care system. It is the only interdisciplinary group of health care practitioners dedicated to these issues. Distinguished Practitioners, Scholars and Policy Fellows are elected by their peers.

54 Josiah Macy Foundation Conference Recommendations 1. Engage patients, families, and communities in the design, implementation, improvement, and evaluation of efforts to link interprofessional education and collaborative practice. 2. Accelerate the design, implementation, and evaluation of innovative models linking interprofessional education and collaborative practice. 3. Reform the education and life-long career development of health professionals to incorporate interprofessional learning and team-based care. 4. Revise professional regulatory standards and practices to permit and promote innovation in interprofessional education and collaborative practice. 5. Realign existing resources to establish and sustain the linkage between interprofessional education and collaborative practice. Transforming Patient Care: Aligning Interprofessional Education with Clinical Practice Redesign January 7-10, 2013 Atlanta, Georgia

55 Foundation Development Committee Chair: Roy Simpson DNP, RN, DPNAP, FAAN Responsible for the development and successful execution of all private and public fundraising activities. Current Strategies

56 Celebrating TIGER s New Tax Exempt Status TIGER is tax exempt! TIGER has received notice from the IRS that it is tax exempt under section 501 (c) (3) of the Internal Revenue Code.

57 Developed the International Committee Chair - Heimar Marin, RN, MS, PhD, FACMI Co-Chair Margaret Kennedy, RN, PhD, CPHIMS-CA, Canada Polun Chang, PhD, Taiwan Dr. Ursula Hübner, Germany Dr. Peter J. Murray, UK The purpose of the TIGER International Committee is to promote the advancement of the TIGER Initiative Foundation Vision & Mission, through increasing the awareness of TIGER in the international community, enabling international dialogue and increasing educational opportunities for TIGER internationally.

58 TIGER: Now Developing International Participation with New Potential Collaborators & Sponsors to TIGER VLE VLE Contact: Patricia Hinton Walker at: Michelle michelletroseth@cpmrc.com and/or Sally Schlak at: sschlak@himss.org

59 TIGER Board of Directors Want to Hear from YOU! Marion J. Ball, Ed D, FHIMSS, FCHIME, FACMI, FAAN Board Co-chair Michelle Troseth, RN, MSN, DPNAP, FAAN Board Co-chair Roy L. Simpson, DNP, RN, DPNAP, FAAN Foundation Development Committee Chair Diane J. Skiba, PhD, FACMI, FAAN Education Committee Chair Carol Petersen, RN, BSN, MAOM, CNOR Interdisciplinary & Community Engagement Chair Sally Schlak, RN, MBA Secretary Dennis James, CPA Treasurer Dana Alexander, RN, MSN, MBA, FHMISS, FAAN Barbara B. Frink, PhD, RN, FAAN Josette Jones, RN, PhD Rosemary Kennedy, RN, MBA, FAAN Melinda Y. Costin, CHICO, FHIMSS Carolyn Padovano, PhD, RN Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN Susan Hull, MSN, RN Mary Walker, BS, MBS Patricia Hinton Walker, PhD, RN, FAAN Senior Advisory Board Member Marisa L Wilson DNSc, MHSc, RN-BC Christel Anderson Advisory Board Member

60 Topics of Interest: from TIGER Newsletter Survey 11.Telehealth 53% (no change) Learning Technologies 47% (down 2 %) Legal aspects to documenting in the Electronic Health Record 55% (no change) Legislation & Policy issues related to health information technology. 41% (up 1 %) Meaningful Use 47% (down 2 %) Mobile Health Technologies 49% (up 3 %) The impact Health Information Technology has on safety, outcomes & continuum of care. 53% (no change) Legal aspects to documenting in the Electronic Health Record 55% (no change) Patients and their caregivers perspectives about health information technology 41% (up 1 %) Personal Health Record 40% (no change) 20

61 Topics of Interest: from TIGER Newsletter Survey 1. Clinical Decision Support Systems 57% (up 2%) Data, Information & Knowledge Management 3. Different roles in health information technology 49% (no change) 49% (no change) Effective change management strategies for the implementation of HI 43% (up 1 %) Electronic Health Record 55% (down 2%) Health Information Technology Competencies 7. Health Information Technology resources (journals, manuals, books, software, reports, newlines, blogs...) 59% (no change) 55% (no change) How to improve adoption of health information technology 53% (down 2%) Information about the TIGER Initiative 57% (down 4 %) Learning Technologies 47% (down 2 %) 24

62 Sharing Re: What do you need from TIGER in your future? What is one message you would share with TIGER Leaders about what you need in YOUR future? How can the TIGER VLE better serve you?

63 The HOPE for the Future... The BlueBird of Happiness... Satisfaction of our Clients (Persons) Empowered of HEALTH and WELL BEING! Copyright: Bonnie T. Barry