Nursing informatics: Dutch developments in an international perspective Dr. William Goossen Acquest consulting
Introduction !
Problems of the past
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Context
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Dutch nursing organizations
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Solutions of today
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Future plans
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Ways to achieve that
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Conclusions
Problems of the past Unstructured and incomplete documentation ! Limited use of nursing terminology ! Limited use of information and communication technology (ICT) ! No measurement of outcome indicators ! No use of ICT for gaining evidence of the effectiveness and efficiency of nursing care ! No use of ICT for transmural care ! Nursing is not visible in health statistics. !
Context - 1 - ICT in health Many years of laisez faire! ! 1999: Information Platform Care (IPZ) : consensus body (poldermodel) including ministry of health, insurance companies, professional organizations, health institutional organizations and PATIENTS ! National strategy for information and communication technology in health: EPR = key ! Nursing organization (LCVV) member ! EPR office per 1-1-2002? !
Context -2- IPZ agreement !
Infostructure: content, terminology, standards, models,education
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Infrastructure: technical solutions that allow plug and play access to information
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Safety: unique numbers for patient & provider, patient control on data use, logging, security standards,certification,penalties.
Context - 3 - projects Translation of CEN health standards, including Nursys (14032) ! Standardization organizations cooperate (Enigma 303 = NEN + CSIZ) ! Hospitals association & doctors work on VIZI models of care: including nursing work ! Leidschendam agreements: nursing associations say they will deliver information on effectiveness of nursing care !
Dutch nursing organizations !
LCVV: office • nursing expertise, information, co-ordination and bringing together groups, facilitator
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AVVV: co-operation of 45 organizations • • • • • •
2001 action program: Influence, Quality (including ICT), Professional development, Communication, Service.
Solutions of today - 1 !
Terminology: ICIDH development of • nursing assessments, care plans, clinical pathways
Research in nursing Informatics, evaluation ! Nursing information reference model and Nursing minimum data set NL ! Small scale solutions and systems for continuity of care ! Guidelines nursing documentation ! Research program evidence based nursing care and guidelines !
Solutions of today - 2 Official position in IPZ group: formal decision of nursing to take ICT seriously! ! Informal discussion group: interested nursing organizations (LCVV, AVVV, NU’91, Orion). ! AVVV nursing EPD strategy ! Key elements in strategy: patient needs, nursing actions, resources and results ! Multidisciplinary actions, nursing explicit ! VIZI health information model: nursing included ! HL7 RIM modeling neonatology care !
Nursing Information Reference Model Structure characteristics: service items etc.
Unified nursing terminology for comparable data
Layer 4: VMDSN: national & international purposes Layer 3: Use of Nursing Minimal Data Set Netherlands on Institutional level Layer 2; registration of: Nursing diagnoses Nursing interventies Results of nursing care Layer 1: Facts: - Demographical data - Observations: signs & symptoms - Aetiology: facts causal relations / data other disciplines etc.
Policy decisions
Management decisions
Clinical decisions
Neurology ward nursing phenomena -0,5
-0,4
-0,2
-0,3
-0,1
0,0
0,1
0,2
0,3
0,4
Patiënt is volledig onafhankelijk Behoefte aan stimuleren van zelfzorg Behoefte aan structuur Behoefte aan begeleiding Behoefte aan hulp bij uitvoering Volledig overnemen van zorg probleem ADL: a] bereiden voedsel probleem ADL: b] zelfstandig eten probleem ADL: c] persoonlijke hygiëne probleem ADL: d] aan / uitkleden probleem ADL: e] veranderen van houding probleem ADL: f] lopen, voortbewegen probleem ADL: g] toilet gaan / verzorgen. Risico complicaties Risico ongevallen Risico vallen Risico decubitus Risico Infecties / ontsteking Risico op slechte wondgenezing Stoornis ademhaling Stoornis bewustzijn Stoornis circulatie Stoornis uitscheiding Stoornis temperatuurregeling
-0,5 -0,4 -0,3 -0,2 -0,1
General medicine Surgical Surgical General medicine Neurology / Orthopedics Transplants Cardiology Oncology / surgery Neurology Oncology / surgery General medicine Oncology / Nefrology Infectious diseases Thoracic surgery Neuro and plastic surgery
0
0,1
0,2
0,3
0,4
0,5
Fingerprint ‘nursing outcome satisfaction with care for pain’. (Goossen, Epping and Feuth, 1999).
0,5
Dimension 2
‘National map’ (15 wards test) 2,0 1,8 1,6 1,4 1,2 1,0 ,8 ,6 ,4 ,2 -,0 -,2 -,4 -,6 -,8 -1,0 -1,2 -1,4 -1,6 -1,8 -2,0 -2,2 -2,4 -2,6 -2,8 -3,0
91
99
200
92
87
Cognition, behaviour & communication
85 (25)
(16) 98 (12)(2) (13) (14) (10) 81 (15) (47) (48) (31) (1)(39) (46) 86 95 (11) (17) (29) (45) (9) (30)(32) (44) (35) (37) (41) (18) (34) (38) (3) (43) (20)(26) (22) (33)(36) (21) (6) (5) (23) (4) (19) (40) (28) (42) (24) (7)(27)(8)
82
96 93
94
ADL
Fear & uncertainty, information & risks
Dep end enc y
Lifethreatening 97
-2,0
-1,6
-1,8
-1,2
-1,4
Dimension 1
-1,0
-,8
-,4 -,6
,0 -,2
,4 ,2
,8 ,6
1,2 1,0
1,6 1,4
2,0 1,8
2,4 2,2
2,8 2,6
3,2 3,0
3,6 3,4
4,0 3,8
Griens, van der Kloot en Goossen, 2000
Future plans ICNP translation: formal government project? ! Testing of the CEN pre-standard for mapping ICIDH to ICNP for some 24 'variables' only ! Development projects nursing parts of the EPR to start early 2002: modeling ! Integrating evidence, information and terminology in clinical templates (XML) ! Overzorg: feasibility study on successful projects and systems in nursing ! Participation International NMDS !
Class model NICU Vitals subklasse van 'observation' -hartfrequentie -hartritme -ademfrequentie -ademritme -kreunen -intrekken -neusvleugelen -ademgeruisen -hartgeruisen -temperatuur -systolische bloeddruk -diastolische bloeddruk -vochtbalans
Groei_na_bevalling -lengte -gewicht -schedelomtrek -toename / afname gewicht
Functioneren subklasse van 'observation' -urineproductie -meconiumlozing -slaapritme -huilen -onrust -spiertonus -zuigreflex -reactie op prikkels +Note bij attributen: values nog allen bepalen()
Funtioneren -urinelozing -meconiumproductie -gedrag -slaapritme -huilen -onrust -zuigreflex -reactie op prikkels
Karakteristieken -navelstreng kleur -navelstreng geur -navelstreng doorlekken -spiertonus -slijmvliezen_conditie -kleur_huid -elasticitiet_huid -oedemen
Voeding -hoeveelheid -soort_voeding -tijdstippen_voeden -duur_voeden
Risico's -infectieverschijnsel_roodheid -infectieverschijnsel_overig
Screening en Vaccinaties -PKU -CHT -vaccinatieschema
Draft Template HL 7 style:
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Name: Code: Instantiation of: Part of: Description:
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Slot 1: subject: Activity
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structured data and vocabulary to represent Braden scale in HL7 information model • attributes: • values: • terminology:
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Braden Scale ‘termsum0001’ HL 7 RIM class: ‘Observation’ Nursing process model ‘ Findings’
Scale 1-4 bedfast = 1, chairfast = 2, walks occasionally = 3, walks frequently = 4 ICNP codes ‘prst’, ICF codes ‘abc’
Slot 2-n: subject: Mobility etc. etc. Slot 9: sum score:
Practical projects: e-assessment
Conclusions !
Dutch nursing organizations are taking information management and ICT seriously
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Nursing in the Netherlands is generally accepted as key player in health care
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Nursing ICT strategy for EPR development has started
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Synergy in several projects possible
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Government funding available
