Transformed (transforming) Health Care System

Connie White Delaney, PhD, RN, FAAN, FACMISchool of Nursing Professor & DeanAcademic Health Center Director, Biomedical Health Informatics (BMHI) Associate Dir. CTSI-BMI

Nursing Knowledge: Big Data Research for Transforming Healthcare

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Current State of Health Care System

• Challenges of healthcare access, quality, safety, efficiency, and effectiveness

• Recent financial crisis within the context of an annual cost of medical errors

• Influx of patients in 2014 of ~32 million Americans Bi

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Vision for the Future Health Care System

• Health IT & Patient Safety http://www.iom.edu/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx

• Computational Technology for Effective Health Care http://www.nap.edu/catalog.php?record_id=12572

• Digital Infrastructure for the Learning Health System http://www.iom.edu/Reports/2011/Digital-Infrastructure-for-a-Learning-Health-System.aspx

• Best Care at Lower Cost: The Path to Continuously Learning Health Care in America http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx

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Big Data Invitational 2013

Continuously Learning Health System Vision

• Generate and apply the best evidence for the collaborative health care choices of each patient and provider;

• Drive the process of new discovery as a natural outgrowth of patient care

• Ensure innovation, quality, safety, and value in health care.

(Charter of the Institute of Medicine Roundtable on Value & Science-Driven Health Care)

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Federal Health IT Strategic Plan 2011 - 2015

HealthIT.gov

• Program creates a definable academic home for clinical and translational research.

• CTSA institutions work to transform the local, regional, and national environment to increase the efficiency and speed of clinical and translational research across the country

http://www.ncats.nih.gov/research/cts/cts.html; https://www.ctsacentral.org/

Clinical and Translational Science Awards (CTSAs)

Big Data Invitational 2013

Health & Nursing Knowledge Discovery & Dissemination

Health & Nursing Knowledge Discovery & Dissemination

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• CONNECT WITH CTSIhttp://www.ctsi.umn.edu/index.htm

• CONNECT WITH CTSA NURSE SCIENTIST SPECIAL INTEREST GROUP

https://www.ctsacentral.org/committee/ctsa-nurse-scientist

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NINR Strategic Plan:

InnovationNINR will invest in research that:•Develops new technologies and informatics-based solutions that promote health, including comprehensive high-throughput technologies

•Develops and creatively applies new and existing knowledge to the implementation of health information technology, including electronic health records

•Expands knowledge and application of health care technologies to facilitate decision support, self-management, and access to health care

•Uses genetic and genomic technologies to advance knowledge of the “symptome,” including the biological underpinnings of symptoms associated with chronic illness

•Encourages risk-taking, innovation, re-invention, and creativity, including high-risk/high-return concepts

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• Nursing informatics agenda for 2008–18 must expand users of interest to:

Include interdisciplinary researchersBuild upon the knowledge gained in nursing concept representation to

address genomic and environmental dataGuide the reengineering of nursing practiceHarness new technologies to empower patients and their caregivers for

collaborative knowledge developmentDevelop user configurable software approaches that support complex data

visualization, analysis, and predictive modelingFacilitate the development of middle-range nursing informatics theoriesEncourage innovative evaluation methodologies that attend to human-

computer interface factors and organizational context

Nursing Research

Bakken et al In McDaniel, A. & Delaney, C. (Guest Editors). 2008. Informatics: Science and Practice.  Nursing Outlook, 56(5), 195-279.

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microscopic macroscopic

molecular and cellular processes

tissues & organs

individual patients

populations

Human Health & Disease

[translational bioinformatics]

Clinical Research

Informatics

ConsumerHealth

Informatics

REDCap (Research Electronic Data Capture)

UMN Profiles

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UMN AHC IE PlatformClinical Data Repository (CDR)

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UMN AHC IE PlatformClinical Data Repository (CDR)

• Extended Clinical Data • Other Clinical Partners• Research Data Marts

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Vision for Nursing Data in a Clinical Data Warehouse

Continuum of Care

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NIH BIG Data Centers http://www.nih.gov/news/health/jul2013/nih-22.htm

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Nursing Minimum Data Set (NMDS)

Werley, HH & Divine, E., & Zorn, C. (1988). Nursing Minimum Data Set Data Collection Manual. University of Wisconsin, Milwaukee, WI

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Nursing Management Minimum Data Set (NMMDS)

Huber D, Schumacher L, Delaney C. Nursing management minimum data set (NMMDS). J Nurs Adm. 1997;27(4):42-48.

Call to action – Roadmap • Standardized representation of nursing knowledge• Integration within broader essential spectrum of clinical care data

into clinical data warehouses• Engage in big data science for discovery of new knowledge that

enables evidence-based practice.

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