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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]