Actionable Barriers and Gaps:Nursing Initiatives
Bonnie L. Westra, PhD, RN, FAANAssociate Professor, University of Minnesota School of NursingDirector, Center for Nursing Informatics
Nursing Knowledge: Big Data Research for Transforming Healthcare
Purpose• Identify gaps, barriers, and challenges to achieving the vision
and value of nursing data for big data research to transform healthcare.
• Describe resources for closing gaps and overcoming barriers to• Evaluate recommendations for usefulness in the action plan
Standardized Terminologies
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Minimum Data Sets & NursingNursing Care Elements
1. Nursing Diagnoses2. Nursing Interventions3. Nursing Outcomes4. Nursing Intensity of Care
Patient Demographics5. * Personal Identification 6. * Date of Birth7. * Sex8. * Race 9. * Ethnicity10. * ResidenceService11. * Unique facility or agency number12. Unique number of principle RN13. * Episode Admission or Encounter Date14. * Discharge or Termination Date15. * Disposition of patient or client16. * Expected payer for this bill
Environment1. Unit/Service Unique Identifier *2. Type Of Nursing Delivery Unit/Service3. Patient/Client Population4. Volume Of Nursing Delivery Unit/Service5. Care Delivery Structure And Outcomes6. Patient/Client Accessibility7. Clinical Decision Making Complexity8. Environmental Complexity9. Autonomy10. Nursing Delivery Unit/Service Accreditation
Nurse Resources11. Management Demographic Profile12. Staff Demographic Profile13. Staffing14. Satisfaction
Financial Resources15. Payer Type *16. Reimbursement17. Nursing Delivery Unit/Service Budget18. Expenses
Health Information Exchange
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Criteria for a NIS
•Nomenclature•Clinical Content•Data Repository•General Systems Characteristics
ANA (1997). NIDSEC (Nursing Information & Data Set Evaluation Center): Standards and Scoring Guidelines. ANA: Washington, DC.
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Clinical Data Repository/ Warehouse
Continuum of Care
NDNQI
• Strengths• National nursing quality
measurement program• Hospital with unit-level
performance comparison • Reflects structure, process,
and outcomes• Limitations• Not reusing EHR data• Hospital focused• Not comprehensive
Faculty PreparationEssentials•Bacalaureate•Master’s•Doctor in Nursing Practice
Informatics Certification
Future – Advanced Certification – AMIA working on this
Informatics Organizations• Also many local nursing informatics organizations
Actionable Barriers and Gaps:Nursing Initiatives
Judith J. Warren, PhD, RN, FAAN, FACMIConsultantWarren Associates, LLC
Nursing Knowledge: Big Data Research for Transforming Healthcare
Transforming NDNQI into eMeasures
Feasibility studies with partners to extract information from EHRs
Continuity of Care Document• Required through health care reform• Does a great job of communicating physician care and
reimbursement issues• Does a partial job of communicating nursing care and patient
status on discharge• Many patient issues that lead to readmission within 30 days
are issues addressed by nursing care• C-HOBIC in Canada
• Need to add patient information of concern to nursing practice to CCD
S&I Framework
• Working on Care Plan specifications• Scope and attention to the work will be driving
EHR design, build and implementation
• Need more nurses involved
Funding for big data research
• Clinical and Translational Science Awards Consortium
• Big Data analytics
• Implementation Science
Standard Occupational Classification (SOC) Codes
• Used to classify workers for the collecting, calculating, or disseminating data.• The SOC code for Registered Nurses is 29-1141• Need informatics nurse code to demonstrate
need and support education program support
National Provider Identifier
• Solution to unique nurse identifier in the NMDS and MMDS• Must encourage every nurse to apply upon
licensure
Nurses in Decision-making Circles
• Office of the National Coordinator• National Committee on Vital and Health Statistics• CMS Panels• NQF committees and panels• IOM• S&I Framework• HL7• IHTSDO and LOINC• Other committees • and Task Forces???????
Actionable Barriers and Gaps:Recommendations
Bonnie L. Westra, PhD, RN, FAAN and
Judith J. Warren, PhD, RN, FAAN , FACMI
Nursing Knowledge: Big Data Research for Transforming Healthcare
Recommendations• Survey health systems about perceived value and current use of
standardized nursing terminologies for documentation, quality improvement, and research• Create a central resource for mapping nursing data to terminologies –
particularly assessments, interventions, and outcomes. • Centralize mappings through the NLM• Work with vendors to include standardized nursing terminologies,
eliminating the need for each health system to map local codes to standards• Require coding in information systems to be consistent with the
NMDS/ NMMDS data elements – new nursing knowledge model• Integrate the NIDSEC criteria into meaningful use certification criteria
of EHRs
Recommendations• Add a criteria for Magnet Status to integrate standardized
nursing terminologies in EHRs and reuse the data for quality reporting
• Expand the NDNQI criteria to include data across settings and to use standardized nursing terminologies/ minimum data sets
• Share the nursing knowledge model across CTSAs to include in their CDRs
• Support strategies to educate all faculty about how to teach nursing informatics across levels of education
• Empower with nurse informaticians to value and advocate for standardized nursing terminologies and the value of these
• Develop strategies to work with nursing organizations on a common set of goals and consistent reporting on progress