Transcript HeartCare: Tailoring WWW Information for Patients

Research in Nursing Informatics:
Naming,
Claiming,
&
Changing
Health Outcomes
Patricia Flatley Brennan,RN, PhD, FAAN
University of Wisconsin-Madison
Supported by grants from the NIH and the UW-Madison Graduate School
School of Nursing
University of Wisconsin-
Nursing Informatics
Diagnosis &
treatment of
human responses
Health Policy
Genomics
Semantics
Representation,
Transformation,
Manipulation &
Application of
Information
Syntax
Knowledge
building
in
health
informatics
System Definition
System Evaluation
System Validation
System Construction
System Description
Health Care
Health Policy &
Clinical Practice
25 Years of
Progress
In
Nursing Informatics Research
Clinical Practice
System Evaluation
System Validation
System Definition
System Description
System Construction
2001
Reference
Models
Ontologies
Vocabularies
Controlled Terms
Clinical Practice
System Evaluation
System Validation
1976
System Definition
Terms
System Description
System Construction
Health Care Vocabularies
Formalism
that is
R
comprehensible,
computable,
and
translatable
Artifact
(e.g. clinical record)
Standardized
vocabularies are
sufficiently robust to
capture most terms
needed to describe the
problems nurses treat
(~ 70%--80%)
Bakken (Henry), 1994
Nursing-Specific Terminologies
•
•
•
•
•
•
•
•
•
NANDA
NIC
NOC
HHCC
Omaha System
ICNP
NILT
Patient Care Data Set
AORN Data Set
Nursing terminologies
provide a rich set of
terms to represent
nursing concepts
BUT
lack the grammars and
syntax rules, and
granularity, needed to
support full
computerization
Hardiker, 1999
2001
Genomic Data Mining
Bayesian Belief Nets
Explanation
Clinical Practice
System Evaluation
1976
System Validation
System Definition
AI, Probability Models
System
Construction
and certainty
factors
System Description
Decision Support for Diagnostics & Therapeutics
Clinical Decision Support
Supports!
Patients in a nursing
home had fewer
wetting events when
nurses used UNIS to
help plan care
Petrucci, 1993
Clinical Information systems
Clinical Practice
System Evaluation
System Validation
System Definition
System Construction
Bringing knowledge
to the point of care
System Description
Clinical Information Systems Help
Structured
assessment and
clinical guidelines,
integrated in the
clinical information
system, facilitate
compliance
Nurses using a
graphical interface
to manipulate
order sets
completed tasks
faster, and with
fewer errors, than
when using text
entry.
Staggers & Kolbus, 2001
Computer screens
effect
performance
Home
Telenursing
Aids
Recovery
SIP
Access to HeartCare
helped patients
recovering from
CABG surgery to get
better, faster.
35
30
25
20
15
10
5
0
CHIP
HeartCare
0
1
2
3
4
5
Months Since Surgery
6
Lessons
Learned
Where nursing
goes,
nursing informatics
follows and
sometimes leads!
You’ve got to
build it
to use it
Sometimes a rose
by any
other name
isn’t recognizable
Structured
data entry
helps
Decision support
works
behind the scene
Data
security
wins
Patients
are
Users, too
Genes are more
than bits of people,
and
People are more
than bits of genes
We like to
work
together
How does
Nursing Informatics
Research
differ from other
NURSING Research
endeavors?
Different Knowledge Products
Nursing Informatics
Research
• Focus on the structure
and manipulation of
the data
• Provides manipulation
tools specific to
knowledge
• Emphasizes system
acceptability & effect
Nursing Research
• Focus on the
substance of the
discipline
• Makes nursing
phenomena explicit
• Develops and tests
clinical therapeutics
Vision
for the
Future
System Definition
System Evaluation
System Validation
System Construction
System Description
Health Care
Health Policy &
Clinical Practice
CS
System Definition
System Evaluation
System Validation
HSR
System Construction
System Description
Health Care
Nursing
Science
Health Policy &
Clinical Practice
Visions for the future
• Innovative care models with a balance of human and
techological resources
• Development of a full range of nursing practice tools
• Linking genomic data to genetic information, and then
to the patient record and placed in to the patient’s hand
• Technical solutions to the challenges of privacy and
security
• Natural language and speech recognition
– The problem lies in creating representation of the context
within which the speech is produced and should be interpreted
• Virtual Human -- genomic functions & anatomy
Guidance for
the Future
“ask yourself if the step you contemplate is
going to be of any use to the
poorest and weakest man whom you have seen
Will he gain anything by it?
Will it restore him to
control over his life and destiny?…
then you will find your doubts and yourself
melting away”
Gandhi,1947
…if we can call it nursing to set
up the emergency shelter after the
dam has burst, isn’t is also
nursing to lobby to be sure that
the dam never gets made in the
first place?
Florence Storlie, 1971
Acknowledgements
• The work of colleagues over the past 50 years
• Conversations and debates with many including
– AMIA colleagues: Mark Musen, Gil Kuperman, Carol
Friedman, Bonnie Kaplan, Charley Safran
– UW-Madison colleagues: Rima Apple, Richard Staley,
Barbara Bowers, Josette Jones & the Brennan research
team
• The Moehlman Bascom Professorship
• NIH
http://healthinfo.engr.wisc.edu
[email protected]