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Welcome/coffee/registration Martin Lysser, KIS Erweiterungsmanager, Informatik, Uniklinik Balgrist, Zürich. Fintan Sheerin, Vice-President ACENDIO. ACENDIO and eHealth: Work to Date. Wolter Paans/Helen de Graaf, Hanze University, Netherlands. eHealth: European Context Adrian Schmid, Leiter "eHealth Suisse". eHealth in the Swiss Context. Susanna Bürki, Nursing Representative at "eHealth Suisse" eHealth in the Swiss Context. Panel Discussion on eHealth Thematic Working Groups Lunch Thematic Working Groups Feedback and Discussion Closing
ACENDIO The Association for Common European Nursing Diagnoses, Interventions and Outcomes Dr. Fintan Sheerin Vice-President www.acendio.net
ACENDIO - History • December 1993 – 1st European Conference on Nursing Diagnosis, Copenhagen – Steering group set up • Huda Huijer Abu Saad (Neth) • Karin Axelsson (Swe) • Cecile Boisvert (Fr) • June Clark (UK) • George Evers (Neth)
Walter Sermeus (Bel) Fintan Sheerin (Ire) Kathy Mølstad (Nor) Ulla-Mari Kinnunen (Fin) Anna Ehrenberg (Swe)
• Martin Lysser (Swi) • Susana Martin Iglesias (Spa) • Claudio de Pieri (Ita)
ACENDIO - History • Inaugural meeting of the General Assembly of ACENDIO held on 19th May 1995 at the EXPO Conference Centre, Brussels at the 2nd European Conference on Nursing Diagnoses and Interventions
ACENDIO – History and Aim •
ACENDIO is a European leader in nursing language and classifications. In addition we seek to inform and develop eHealth and nursing. In particular, we wish to: – Identify themes and concepts in eHealth; – Promote nursing and eHealth in education, leadership and research; – Develop and implement nursing diagnoses, interventions and outcomes and work towards their integration into nursing practice; – Develop and implement nursing classifications and databases relevant to health and health care throughout Europe; – Develop and implement information systems to support nursing practice; – Develop a common European nursing minimum data set; – Support the identification, validation, standardisation, translation and use of the terms to represent nursing concepts; – Promote research on standardised nursing languages and information systems in order to increase the body of nursing knowledge; – Promote inclusion of the above across all levels of nursing education.
Strategic Priorities 2013-2015 • • • • • •
eHealth Strategy European Observatory of Nursing Standards Curriculum Development Collaboration Membership Marketing and Publications
What do we mean when we say ‘eHealth’?
eHealth • Leading and coordinating the development of an eHealth Strategy for Europe • Work to date...
ACENDIO’s eHealth Agenda • Initial Meeting in Madeira – Continuation of Ongoing Work • ACENDIO survey of standards • ACENDIO website must be developed, with the aim of creating a repository for eHealth knowledge.
– Dissemination • It is vital that the outcome of ACENDIO surveys and work be disseminated.
– Networking and Communication • There is a need to access and bring together those who are involved in eHealth.
– Research • We need people who can do research in nursing and eHealth.
– Nursing Content • Any eHealth strategy must have nursing content.
– Education • There is a need for education about eHealth.
– eHealth strategies. • Make all the eHealth strategies available on our website with links to standards.
Approach • An evolving quasi-research approach quantitative-qualitative, mixed-methods (modified Delphi and Focus Workgroup), design – Sequential online surveys – Four focused group meetings (Dublin, Reykjavik, Torino and Zürich)
Stage 1 – Survey 1 • Initial ‘brainstorming’ survey using Google Form® focused around the following headings/concepts: – patient – nursing – ethics – system requirements
– governance – education – research
Stage 1 –Survey 2 • The next step was to prioritise themes and to identify what ACENDIO members considered to be the sub-themes under each theme
Stage 1 –Survey 3 • The next step was to prioritise the sub-themes
Results • Textual responses were thematically analysed – 12 thematic areas 1. Safety and Quality of Care through eHealth Technologies 2. Usability from a Nurse’s Perspective 3. Remote Patient Support Devices 4. Remote Patient Monitoring Devices 5. Individuality of Patient Data 6. Education/Training on Information Technologies
7. Research and eHealth 8. European Nursing Minimum Data Set (NMDS) 9. Information Technology and Diagnostic Reasoning 10. Foci for Research 11. Virtual Learning 12. Data Storage and Access
Results Theme 1. Individuality of Patient Data
Sub-Themes Patient access to own data (home and healthcare setting) Patient validation of who data can be shared with Contribution of nursing to the patient record and patient summary
2. Remote Patient Monitoring Devices
3. Remote Patient Support Devices
Access to health records Potential for people to remain at home using devices to compensate for impaired function and for health monitoring and evaluation Patient education requirements to support use of devices
Use of web-based social interaction and support Patient involvement in self-assessment Data collection and documentation Remote consultations Potential for distancing person from health personnel Patient education requirements to support use of devices
Theme 4. Usability from a Nurse’s Perspective
Sub-Themes Human interfaces Nursing information model Open documentation process across health care professionals Continuity of care Decision-support tools Taxonomic nursing framework Standard for flexibility in different settings Nursing education requirements to support use of devices
5. Safety and Quality of Care through eHealth Technologies
6. European Nursing Minimum Data Set
Standards for security (privacy) Standards to avoid data loss Legal requirements Accountability Workload and monitoring of results Avoidance of mistakes/risk management International NMDS Indicators of nursing problems (diagnoses, epidemiology Indicators of nursing interventions (management of personnel and material resource) Indicators of nursing outcomes (effectiveness) Benchmarking between different countries Political use of nursing indicators European NMDS
Theme 7. Education/Training on Information Technologies
8. Virtual Learning
9. Information Technology and Diagnostic Reasoning
Sub-Themes Education/Training for nurses in informatics Education/training for educators and head nurses Role of information in decision making and skills required Model of education/training – separate certification or inclusion in nursing programmes Specialist or generalist education/training Practice-based education/training IMIA recommendations Blended learning and communities of practice, for basic and continuous education of nurses Blended learning and communities of practice, for basic and continuous education of patients Naming nursing Choosing common care-classification system Background mapping of different classifications, interoperability with other parts of the patient/health records for multi-professional communication
Theme 10. Research and eHealth
11. Foci for Research
12. Data Storage and Access
Sub-Themes Access to patient data Collecting and using data in research The common good versus privacy of the individual Using health service databases Multicentre studies about specific experiences with eHealth Mapping of terminologies in national contexts Documentation models Creation of evidence from nursing data to produce better care Quality of nursing documentation User perspectives on eHealth Aging with support of eHealth Critical interventions survey Life-span perspective on storage of data Centrally archiving health data Risk to data security Procedures for permitting access Log-in and log-out procedures Use of identity cards Adherence to ISO and CEN standards
Stage 2 – Focus Groups • eHealth Focused Working Groups – Dublin (February 2012) – This work centered on further developing the areas of: • Safety and Quality of Care through eHealth Technologies • Usability from a Nursing Perspective • Remote Patient Support Devices
Stage 2 – Focus Groups • More eHealth Focused Working Groups – Reykjavik (June 2012) • This was a broad discussion of topics
– Torino (November 2012) • This meeting worked on: – Remote Patient Monitoring Devices – Individuality of Patient Data – Research – Education/Training on Information Technologies www.acendio.net
Safety and quality of care through ehealth technologies • • • •
The goal of care is, first of all, to do the patient no harm! Drive behaviour change Systems for quality and safety – the need to monitor quality Designs and understanding (for example for medications – tools that provide safety – right medicine to the right patient at the right time). Correct information at different points in care. • Continuity • Knowledge – Better decisions – better outcomes • Patient centred. The goal needs to be clear: empowering the patient. We need more technology that supports nursing in order to provide patient centred care.
Usability from a nursing perspective • Focus of usability should be on the EHR. Factors influencing this are: – Perception of it being useful and easy to use – There must be competency in informatics – The architecture of the software must be userfriendly – Environmental factors must be considered
Perception of it being useful and ease of use • Usefulness includes: – Ability of EHR to monitor complexity of patients’ conditions and intensiveness of nursing in different situations – Capability to give relevant information and alert in real time – Quick access to patient history – Capability to offer relevant reports – Capability to act as an expert system
Perception of it being useful and ease of use • Ease of use includes: – Good graphics – Possibility to have a clear synthetic snapshot of a single patient condition and workflow related to care – Traceability – Decision-support
Competency in informatics • Nurses must be able to record, update, store and retrieve data • Ability to use information and knowledge in nursing practice • Implications for nursing educators
Architecture of software • Open software decision support systems are preferable to closed systems • Need EHRs to have ability to be individualised according to nursing specialism, to produce tailored lists, as required
Environmental factors • Resources, infrastructure and staff – Lack of personnel makes implementation of the EHR difficult – Need for wireless infrastructures – Effective and efficient tools for use with patients (workstation/laptop/tablet/phone)
Usability from a nursing perspective: Recommendations 1. European nursing position should be established 2. Decision to use standard nursing language and NMDS 3. Work on interface language to include nursing perspective and nursing knowledge 4. Emphasize nursing process – as an interactive conceptual process (flexible) 5. Involvement. Nurses need to be involved in the discussions where decisions are made. They must also be involved in implementation 6. Bring together problem lists and definitions 7. A point of contact when recording 8. It must be structured for secondary use – data-mining
Remote patient support devices • eHealth and eSupport • These should promote greater patient independence • Potential for provision of therapies over a distance (for example cognitive behaviour therapy) • There is a need for person-centeredness to remain – this is a challenge to ‘holism’ • It also challenges the role of the nurse who may be a facilitator of support rather than the primary giver of support • ‘Communities of Support’
Remote patient monitoring devices • Homecare and Remote Electronic Monitoring • The role of the nurse may change to being one of ‘coordinator’ rather than provider. Skill development implication? • Education role to patients via the internet (validating/certifying web-based information). • Development of training materials • Consideration of the broader perspective of ‘health’ (society/rights/education) • eLiving and eLife focused on ‘wellness’ or persons and society.
Information focus • European Nursing Minimum Data Set – Central in identifying nursing contribution – Country differences
• Risk of information becoming fragmented due to improper use of systems (e.g. history and data shared by other team members)...need for integration of the health record
Information focus: Recommendations • General regulations regarding a European NMDS be developed across the wider European region with limited local adaptation possible • European NMDS should collect the following: – Demographics – Medical diagnostics – Assessment criteria, defining characteristics and risk factors – Patient Outcomes – Nursing Interventions
Information technology and diagnostic reasoning • Includes background mapping of different classifications and inter-operationality – Prioritisation of nursing diagnoses – Differential diagnostic facility – Flexibility and theoretical neutrality – Customisable vis a vis specialism etc. – Taxonomic standards; maybe unique taxonomy? – Interoperability – Accessibility
Research • We need to make nursing visible in eHealth research – Research into eHealth (into discipline) – Research using eHealth (applied)
• We recognise that the technical aspect came first, excluding nursing (e.g. ePrescription) • Expand this agenda to include, for example, eMedication Management. Shift agenda to put patient at the centre instead of data
Research • Using eHealth/nursing data to develop a nursing epidemiology to: – Improve nursing through education and service provision – Identifying most prevalent nursing diagnoses in a given population
Research • Topics for research: – Evidence for better care – Quality of documentation – Workload measurement – Systems implementation research – Experiential research into eHealth – User perspectives – eHealth and patient empowerment – Risk factors associated with outcomes www.acendio.net
Research: Recommendations • Need for careful though on consequences of collecting date in research • All legal and practical requirements must be stringently adhered to
eHealth plans 2013-3015 • Complete focused working groups – Zurich, Switzerland 9th May 2014 • Education and Training on Information Technologies • Data Management, Storage and Access
• International Expert Working Group – Barcelona Late-2014 • Two-day working meeting to produce a consensus document on eHealth.
• Develop platform for community of expert practice (Claudio de Pieri) • Present report to General Assembly in Bern, April www.acendio.net 2015
eHealth Plans 2013-3015 Zurich 2014 • ACENDIO Working Group • Education • Data Management
Final Draft Development
• International Expert Group
• Community of Practice • Expert Group
• Consensus document
• Final Draft
Working Groups • Data Management, Storage and Access – Risk to data security – Procedures for permitting access – Adherence to ISO and CEN standards – Centrally archiving healthdata – Life-span perspective on storage of data – Patient access to own data (home and health care setting) – Role of patients in Electronic Patient Records
• Education/Training on Information Technologies – Education/training for nurses in informatics – Education/training for educators and head nurses – Best practices and strategies for the implementation of electronic information systems in nursing – Role of information in decision making and skills required – Blended learning and communities of practice, for basic and continuous education of nurses