William T. F. Goossen

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

A Comparison of Nursing Minimal Data Sets

It is often argued that Nursing Minimal Data Sets (NMDSs) have advantages for the nursing profession. The NMDSs that have been developed and applied in some countries have many features in common, but there are differences in purpose, content, sampling, collection approach, and developmental stage as well. This paper examines the advantages and disadvantages of data sets of nursing practice, and the differences and similarities of five national and international NMDS systems. The purpose is to apply this information toward an NMDS initiative in the Netherlands. Future initiatives in NMDS development should include international coordination.

Development of a Provisional Domain Model for the Nursing Process for Use within the Health Level 7 Reference Information Model

OBJECTIVEnSince 1999, the Nursing Terminology Summits have promoted the development, evaluation, and use of reference terminology for nursing and its integration into comprehensive health care data standards. The use of such standards to represent nursing knowledge, terminology, processes, and information in electronic health records will enhance continuity of care, decision support, and the exchange of comparable patient information. As part of this activity, working groups at the 2001, 2002, and 2003 Summit Conferences examined how to represent nursing information in the Health Level 7 (HL7) Reference Information Model (RIM).nnnDESIGNnThe working groups represented the nursing process as a dynamic sequence of phases, each containing information specific to the activities of the phase. They used Universal Modeling Language (UML) to represent this domain knowledge in models. An Activity Diagram was used to create a dynamic model of the nursing process. After creating a structural model of the information used at each stage of the nursing process, the working groups mapped that information to the HL7 RIM. They used a hierarchical structure for the organization of nursing knowledge as the basis for a hierarchical model for Findings about the patient. The modeling and mapping reported here were exploratory and preliminary, not exhaustive or definitive. The intent was to evaluate the feasibility of representing some types of nursing information consistently with HL7 standards.nnnMEASUREMENTSnThe working groups conducted a small-scale validation by testing examples of nursing terminology against the HL7 RIM class Observation.nnnRESULTSnIt was feasible to map patient information from the proposed models to the RIM class Observation. Examples illustrate the models and the mapping of nursing terminology to the HL7 RIM.nnnCONCLUSIONnIt is possible to model and map nursing information into the comprehensive health care information model, the HL7 RIM. These models must evolve and undergo further validation by clinicians. The integration of nursing information, terminology, and processes in information models is a first step toward rendering nursing information machine-readable in electronic patient records and messages. An eventual practical result, after much more development, would be to create computable, structured information for nursing documentation.

Using the nursing minimum data set for the Netherlands (NMDSN) to illustrate differences in patient populations and variations in nursing activities

RATIONALEnA nursing minimum data set (NMDS) provides data that are useful to legitimate nurses contribution to healthcare. In Belgium and the US, such NMDS are operational, other countries are developing it, among which is the Netherlands.nnnOBJECTIVEnTo evaluate whether the nursing minimum data set for the Netherlands (NMDSN) is suitable to describe the diversity of patient populations and the variability of nursing care.nnnMETHODOLOGYnUsing the NMDSN data collection forms, patient data were collected from 15 different hospital wards. During one week, nurses manually completed the NMDSN list for every patient. The data analysis methodology from the Belgian MVG was used, including ridit analysis and graphs.nnnRESULTSnThe NMDSN includes items related to hospital, patient demographics, medical condition, nursing process, nursing phenomena, nursing interventions, outcomes of nursing care, and complexity of care. There were 686 individual patients in the study, while for the data analysis their 2090 patient days in the hospital were used. Frequencies of nursing phenomena, nursing activities and results of care were calculated, transformed into ridit scores, and presented graphically as fingerprints.nnnCONCLUSIONnThe set of NMDSN items allows illustrating the diversity of patient populations, and variation in nursing care by means of fingerprints.

Criteria for nursing information systems as a component of the electronic patient record. An international Delphi study.

&NA; In many countries nurses lack an adequate tool to assist in determining the essentials of an information policy in health care institutions and to outline the nursing component of the electronic patient record. In the United States criteria exist for systems that support the nursing process and for the electronic patient record, and the United Kingdom has the disposal of an Information Management and Technology Strategy that includes nursing information. The objective of this study was to determine international criteria for nursing information systems when such systems become part of the electronic patient record. Using the Delphi methodology, criteria for nursing information systems development, content, structure, and use are established by an international panel of 36 experts in three succeeding rounds. Most criteria gained consensus and are useful for application in practice for development of information policy and information systems for nursing. Eventually, the list of criteria will be included in a nursing information reference model. Nursing will benefit from the application of the reference model and the criteria to develop adequate information and communication technology.

Can we solve current problems with nursing information systems

Dutch nurses are confronted with health care information systems quite often. However, they do not take full advantage of electronic support for their care activities and professional development. The nursing process is often considered the core of nursing care delivery and guides the documentation of care. Currently, this process can be supported electronically. However, the actual use of nursing information systems (NISs) in the Netherlands is limited to a few sites. Therefore, it is timely to analyse the problems that exist in the development and use of NISs and to look for solutions to solve them. This paper proposes both the nursing information reference model (NIRM), and structured discussions for a proper course of action in the development and use of NISs.