Nicholas R. Hardiker

Factors that influence public engagement with eHealth: A literature review

PURPOSE Public engagement with eHealth is generally viewed as beneficial. However, despite the potential benefits, public engagement with eHealth services remains variable. This article explores reasons for this variability through a review of published international literature. METHODS A focused search, conducted in January 2009, of three bibliographic databases, MEDLINE, CINAHL and EMBASE, returned 2622 unique abstracts. RESULTS Fifty articles met the inclusion criteria for the review. Four main types of eHealth service were identified: health information on the Internet; custom-made online health information; online support; and telehealth. Public engagement with these services appears to depend on a number of factors: characteristics of users; technological issues; characteristics of eHealth services; social aspects of use; and eHealth services in use. CONCLUSIONS Recommendations for policy makers, developers, users and health professionals, include: targeting efforts towards those underserved by eHealth; improving access; tailoring services to meet the needs of a broader range of users; exploiting opportunities for social computing; and clarifying of the role of health professionals in endorsement, promotion and facilitation.

Standards for Nursing Terminology

Terminology work in nursing has given rise to an increasing number of nursing terminologies. These generally take the form of controlled vocabularies. Because of the limitations of the controlled vocabulary approach, individual terminologies tend to be tuned to meet the specific needs of their intended users. Differences between terminologies are now a significant barrier to the comparison and interchange of health information. To agree on a single, multipurpose terminology would be problematic. However, several options for resolving unnecessary differences between nursing terminologies are currently being explored by international standards bodies and other groups, such as the U.S. Nursing Vocabulary Summit. One such option is the use of a terminology model to facilitate evolution toward a more coherent range of terminologies. The authors describe the motivation behind the development of a standard for nursing terminologies. They explain how a terminology model might form the basis for such a standard through a description of the approach taken by CEN TC251 (the Health Informatics Technical Committee of the European Committee for Standardization). They also discuss possible limitations of standardization.

Modeling Nursing Terminology Using the GRAIL Representation Language

OBJECTIVE The purpose of the study is to explore the use of formal systems to model nursing terminology. DESIGN GRAIL is a formal, compositional terminologic language, closely related to frame-based systems and conceptual graphs, which allows concepts to be formed from atomic-level primitives and automatically classified in a multiple hierarchy. A formal model of the alpha version of the International Classification for Nursing Practice (ICNP) classification of nursing interventions was constructed in GRAIL. MEASUREMENTS The model was analyzed for completeness, coherence, clarity, expressiveness, usefulness, and maintainability. RESULTS GRAIL is capable of representing the complete set of atomic-level concepts within the ICNP as well as certain cross-mappings to other vocabularies. It also has the potential to represent many more concepts, to an arbitrary level of detail. CONCLUSIONS Formal systems such as GRAIL can overcome many of the difficulties associated with traditional nursing vocabularies without restricting the level of detail needed to describe nursing care.

Structural Validation of Nursing Terminologies

OBJECTIVE The purpose of the study is twofold: 1) to explore the applicability of combinatorial terminologies as the basis for building enumerated classifications, and 2) to investigate the usefulness of formal terminological systems for performing such classification and for assisting in the refinement of both combinatorial terminologies and enumerated classifications. DESIGN A formal model of the beta version of the International Classification for Nursing Practice (ICNP) was constructed in the compositional terminological language GRAIL (GALEN Representation and Integration Language). Terms drawn from the North American Nursing Diagnosis Association Taxonomy I (NANDA taxonomy) were mapped into the model and classified automatically using GALEN technology. MEASUREMENTS The resulting generated hierarchy was compared with the NANDA taxonomy to assess coverage and accuracy of classification. RESULTS In terms of coverage, in this study ICNP was able to capture 77 percent of NANDA terms using concepts drawn from five of its eight axes. Three axes-Body Site, Topology, and Frequency-were not needed. In terms of accuracy, where hierarchic relationships existed in the generated hierarchy or the NANDA taxonomy, or both, 6 were identical, 19 existed in the generated hierarchy alone (2 of these were considered suitable for incorporation into the NANDA taxonomy and 17 were considered inaccurate), and 23 appeared in the NANDA taxonomy alone (8 of these were considered suitable for incorporation into ICNP, 9 were considered inaccurate, and 6 reflected different, equally valid perspectives). Sixty terms appeared at the top level, with no indenting, in both the generated hierarchy and the NANDA taxonomy. CONCLUSIONS With appropriate refinement, combinatorial terminologies such as ICNP have the potential to provide a useful foundation for representing enumerated classifications such as NANDA. Technologies such as GALEN make possible the process of building automatically enumerated classifications while providing a useful means of validating and refining both combinatorial terminologies and enumerated classifications.

Dashboards for improving patient care : review of the literature

AIM This review aimed to provide a comprehensive overview of the current state of evidence for the use of clinical and quality dashboards in health care environments. METHODS A literature search was performed for the dates 1996-2012 on CINAHL, Medline, Embase, Cochrane Library, PsychInfo, Science Direct and ACM Digital Library. A citation search and a hand search of relevant papers were also conducted. RESULTS One hundred and twenty two full text papers were retrieved of which 11 were included in the review. There was considerable heterogeneity in implementation setting, dashboard users and indicators used. There was evidence that in contexts where dashboards were easily accessible to clinicians (such as in the form of a screen saver) their use was associated with improved care processes and patient outcomes. CONCLUSION There is some evidence that implementing clinical and/or quality dashboards that provide immediate access to information for clinicians can improve adherence to quality guidelines and may help improve patient outcomes. However, further high quality detailed research studies need to be conducted to obtain evidence of their efficacy and establish guidelines for their design.

Semantic mappings and locality of nursing diagnostic concepts in UMLS

One solution for enhancing the interoperability between nursing information systems, given the availability of multiple nursing terminologies, is to cross-map existing nursing concepts. The Unified Medical Language System (UMLS) developed and distributed by the National Library of Medicine (NLM) is a knowledge resource containing cross-mappings of various terminologies in a unified framework. While the knowledge resource has been available for the last two decades, little research on the representation of nursing terminologies in UMLS has been conducted. As a first step, UMLS semantic mappings and concept locality were examined for nursing diagnostic concepts or problems selected from three terminologies (i.e., CCC, ICNP, and NANDA-I) along with corresponding SNOMED CT concepts. The evaluation of UMLS semantic mappings was conducted by measuring the proportion of concordance between UMLS and human expert mappings. The semantic locality of nursing diagnostic concepts was assessed by examining the associations of select concepts and the placement of the nursing concepts on the Semantic Network and Group. The study found that the UMLS mappings of CCC and NANDA-I concepts to SNOMED CT were highly concordant to expert mappings. The level of concordance in mappings of ICNP to SNOMED CT, CCC and NANDA-I within UMLS was relatively low, indicating the need for further research and development. Likewise, the semantic locality of ICNP concepts could be further improved. Various stakeholders need to collaborate to enhance the NLM knowledge resource and the interoperability of nursing data within the discipline as well as across health-related disciplines.

Formal nursing terminology systems: a means to an end

In response to the need to support diverse and complex information requirements, nursing has developed a number of different terminology systems. The two main kinds of systems that have emerged are enumerative systems and combinatorial systems, although some systems have characteristics of both approaches. Differences in the structure and content of terminology systems, while useful at a local level, prevent effective wider communication, information sharing, integration of record systems, and comparison of nursing elements of healthcare information at a more global level. Formal nursing terminology systems present an alternative approach. This paper describes a number of recent initiatives and explains how these emerging approaches may help to augment existing nursing terminology systems and overcome their limitations through mediation. The development of formal nursing terminology systems is not an end in itself and there remains a great deal of work to be done before success can be claimed. This paper presents an overview of the key issues outstanding and provides recommendations for a way forward.

Interpretation of an international terminology standard in the development of a logic-based compositional terminology

PURPOSE Version 1.0 of the International Classification for Nursing Practice (ICNP) is a logic-based compositional terminology. International Organization for Standardization (ISO) 18104:2003 Health Informatics-Integration of a reference terminology model for nursing is an international standard to support the development, testing and implementation of nursing terminologies. METHODS This study examines how ISO 18104:2003 has been interpreted in the development of ICNP Version 1.0 by identifying mappings between ICNP and the ISO standard. Representations of diagnostic and interventional statements within ICNP are also analyzed according to the requirements mandated by the ISO standard. RESULTS All structural components of ISO 18104:2003 i.e. semantic categories, semantic domains, qualifiers and semantic links are represented either directly or in interpreted form within ICNP. The formal representations within ICNP of diagnostic and interventional statements meet the requirement of the ISO standard. CONCLUSIONS The findings of this study demonstrate that ICNP Version 1.0 conforms to ISO 18104:2003. More importantly perhaps, this study provides practical examples of how components of a terminology standard might be interpreted and it examines how such a standard might be used to support the definition of high-level schemata in developing logic-based compositional terminologies.

Collaborative development of clinical templates as a national resource

There is growing interest in the development of standards which structure information round discrete clinical concepts, in a way that supports system development and interoperability. Most notable are the openEHR Archetypes and Templates, and HL7 Templates. A project is described which explored the potential for these to engage and support clinical practitioners in developing clinical information standards in an open and accessible way. The project defined a clinical template as a clinical information model, which could be used to define the content of a form in a health record system, for example a continence assessment. The project followed three phases: professional development, including networking for content development; library implementation, including modelling and processes for managing content and relating to information standards; and implementation in working systems in a manner that is professionally acceptable. The project findings are encouraging although there remain some important issues to be explored in further work. The topic has now emerged as an important area of standards development, and a useful focus for international cooperation.

Empowerment an essential ingredient in the clinical environment: A review of the literature

Empowerment is an important concept worthy of attention in healthcare. The merits of empowerment are irrefutable including benefits to the organisation and to the individual nurse. Empowered nurses contribute to the clinical learning environment in a positive way. There is a dearth of literature on how or indeed if nursing students are empowered. The process of empowering registered staff/nursing students is not clear. Ward environment and culture are important contributors to patient care, patient safety and staff well-being. It is therefore necessary to address how empowerment can contribute positively to improving the environment in which care is provided.