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Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director, Center for Nursing Informatics Nursing Knowledge: Big Data Research for Transforming Healthcare
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Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Dec 15, 2015

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Page 1: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 2: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 3: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Standardized Terminologies

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Page 4: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 5: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Health Information Exchange

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Page 6: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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.

Page 7: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,
Page 8: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,
Page 9: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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Clinical Data Repository/ Warehouse

Continuum of Care

Page 10: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 11: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,
Page 12: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Faculty PreparationEssentials•Bacalaureate•Master’s•Doctor in Nursing Practice

Page 13: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Informatics Certification

Future – Advanced Certification – AMIA working on this

Page 14: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Informatics Organizations• Also many local nursing informatics organizations

Page 15: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Actionable Barriers and Gaps:Nursing Initiatives

Judith J. Warren, PhD, RN, FAAN, FACMIConsultantWarren Associates, LLC

Nursing Knowledge: Big Data Research for Transforming Healthcare

Page 16: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Transforming NDNQI into eMeasures

Feasibility studies with partners to extract information from EHRs

Page 17: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 18: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 19: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

Funding for big data research

• Clinical and Translational Science Awards Consortium

• Big Data analytics

• Implementation Science

Page 20: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 21: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

National Provider Identifier

• Solution to unique nurse identifier in the NMDS and MMDS• Must encourage every nurse to apply upon

licensure

Page 22: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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???????

Page 23: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 24: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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

Page 25: Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director,

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