Polun Chang

Building a portable data and information interoperability infrastructure-framework for a standard Taiwan Electronic Medical Record Template

Traditional electronic health record (EHR) data are produced from various hospital information systems. They could not have existed independently without an information system until the incarnation of XML technology. The interoperability of a healthcare system can be divided into two dimensions: functional interoperability and semantic interoperability. Currently, no single EHR standard exists that provides complete EHR interoperability. In order to establish a national EHR standard, we developed a set of local EHR templates. The Taiwan Electronic Medical Record Template (TMT) is a standard that aims to achieve semantic interoperability in EHR exchanges nationally. The TMT architecture is basically composed of forms, components, sections, and elements. Data stored in the elements which can be referenced by the code set, data type, and narrative block. The TMT was established with the following requirements in mind: (1) transformable to international standards; (2) having a minimal impact on the existing healthcare system; (3) easy to implement and deploy, and (4) compliant with Taiwans current laws and regulations. The TMT provides a basis for building a portable, interoperable information infrastructure for EHR exchange in Taiwan.

Use of a mobile device by nursing home residents for long-term care comprehensive geriatric self-assessment: a feasibility study.

Long-term-care comprehensive geriatric assessments, such as the Minimum Data Set 3.0, are used to evaluate the clinical, psychological, and personal status of residents in long-term-care nursing facilities. Nursing staff conducts assessment interviews, thereby increasing the workload of nurses and the cost of patient care. This study explored the ability of nursing home residents to use two different mobile devices for a geriatric self-assessment. Study participants were residents of long-term-care nursing homes. A modified Minimum Data Set 3.0 was converted to a format for use with a 6-inch mobile pad and a 3.7-inch mobile smartphone. The survey completion rate and the response time were measured. A Technology Assessment Model questionnaire analyzed the participants’ experience. All participants were able to use a 6-inch pad, with an average completion rate of 92.9% and an average time for completion of 21 minutes. Only 20% of the participants could complete the assessment with the 3.7-inch smartphone. The participants found the 6-inch pad easier to use than the 3.7-inch smartphone. This exploratory study suggests that nursing home residents are able to use a mobile device to perform a geriatric self-assessment and delineates the importance of the ergonomics of the device.

Development of a daily mortality probability prediction model from Intensive Care Unit patients using a discrete-time event history analysis

As studies have pointed out, severity scores are imperfect at predicting individual clinical chance of survival. The clinical condition and pathophysiological status of these patients in the Intensive Care Unit might differ from or be more complicated than most predictive models account for. In addition, as the pathophysiological status changes over time, the likelihood of survival day by day will vary. Actually, it would decrease over time and a single prediction value cannot address this truth. Clearly, alternative models and refinements are warranted. In this study, we used discrete-time-event models with the changes of clinical variables, including blood cell counts, to predict daily probability of mortality in individual patients from day 3 to day 28 post Intensive Care Unit admission. Both models we built exhibited good discrimination in the training (overall area under ROC curve: 0.80 and 0.79, respectively) and validation cohorts (overall area under ROC curve: 0.78 and 0.76, respectively) to predict daily ICU mortality. The paper describes the methodology, the development process and the content of the models, and discusses the possibility of them to serve as the foundation of a new bedside advisory or alarm system.

Towards implementing a global competency-based nursing and clinical informatics curriculum: Applying the TIGER initiative

This workshop will review the history of the TIGER initiative in order to set the framework for an understanding of international informatics competencies. We will include a description of clinical nursing informatics programs in 37 countries as well as the results of a recent survey of nursing competencies in order to further discussions of internationally agreed-upon competency definitions. These two surveys will provide the basis for developing a consensus regarding the integration of core competencies into informatics curriculum developments. Expected outcomes include building consensus on core competencies and developing plans toward implementing intra- and inter-professional informatics competencies across disciplines globally.

The Use of Health Smart Card in Bridging Discontinuity of Care for Pregnant Woman

This research proposed an innovative way of protecting pregnant woman from potential risky drugs by implementing clinical reminder system based on health smart card. A computerized risky drug reminders system for pregnant woman on the Computerized Physician Order Entry (CPOE) was implemented. During the study period, there were 1106 pregnant women visits and ranged in age from 15 to 50 years. Significant effect in physicians’ specialty, seriousness of risky drugs, and trimesters of pregnant woman were found. X category drugs are observed with more relevant to the clinical settings and with higher acceptance rate (22.39%). Physicians other than obstetrics and gynecology, dermatologist, endocrinologist are with higher acceptance to the reminders (46%). Pregnant woman in first trimester (19.39%) are with more concerns and also with highest acceptance rate on the risky drug reminders.

Technology Informatics Guiding Education Reform (TIGER). The Future of Interprofessional Education Is Here

This session will describe the TIGER Initiative journey, its evolution and accomplishments nationally and internationally. A powerful demonstration of the TIGER Virtual Learning Environment (VLE) will be highlighted along with case studies from around the world, with emphasis on global competencies and opportunities for engagement in all current TIGER activities and future plans.

Technology Informatics Guiding Education Reform – TIGER

Summary Background: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework. Objectives: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings. Methods: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics. Results: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains “data, information, knowledge”, “information exchange and information sharing”, “ethical and legal issues”, “systems life cycle management”, “management” and “biostatistics and medical technology”, all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas. Conclusions: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.

A preliminary study on the use of clinical care classification in nursing documentation data sets

This study analyzed and organized the content coverage of the clinical care classification (CCC) system to represent nursing record data in a medical center in Taiwan. The nursing care plan was analyzed using the process of knowledge discovery in the data set. The nursing documentation was mapped based on the full list of nursing diagnoses and interventions available using the CCC system. The result showed that 75.45% of the documented diagnosis terms can be mapped using the CCC system. A total of 21 established nursing diagnoses were recommended for inclusion in the CCC system. The results also showed that 30.72% of assessment/monitor tasks and 31.16% of care/perform tasks were provided by nursing professionals, whereas manage/refer actions accounted for 15.36% of the tasks involved in nursing care. The results showed that the CCC system is a suitable clinical information system for the majority of nursing care documentation, and is useful for determining the patterns in nursing practices.