Thinking about Informatics Competency

I listened to an interview posted by CHCF at: http://www.ihealthbeat.org/articles/2008/6/23/Efforts-Aim-To-Increase-Health-Care-IT-Informatics-in-US-Nurse-Training-Programs.aspx?av=1&topicID=54 entitled "Efforts Aim To Increase Health Care IT, Informatics in U.S. Nurse Training Programs". It featured comments from Connie Delaney, (University of Minnesota), Beverly Malone, (NLN) and Joyce Sensmeier, (HIMSS).

From the website: "The National League for Nursing says schools and colleges need to incorporate more IT training into their curricula. It's not enough just to train nurses in basic computer skills, nurses also need to be proficient in how health care IT works and be able to use the technology to its best advantage, the league contends."

I reviewed the presentations by Joyce Sensemeir, Carol Gassert and Mary Anne Rizzolo at the Rutgers Conference and it got me thinking a bit more about the whole issue of nurses and informatics competencies.

Multiple sources point to a need for “informatics training” but how can we make the definition mean something to the bedside nurse or unit level manager? “The intersection of nursing science, information science and cognitive science” is a wonderful phrase but still seems distant from practice. Some people describe computer literacy is informatics, some focus on the electronic health record; others concentrate on the electronic tools used to capture data. At one level it’s a matter of functional competency – how do I enter/retrieve data from a record or how do I create a spreadsheet. At another level it is about how to use technology to make sense out of data, how to seek technologies that will enable them to work, communicate and collaborate more efficiently.

I think we need examples relevant to nurses, students and faculty other than using PDAs as a mobile library and how to enter/retrieve data from an EMR. I see informatics as about collecting, storing and retrieving data; interpreting data to become information, and applying information as knowledge not only to patient care but also personal and professional development.

It seems that in the IS world we give our clients lots of wonderful tools. Office applications, Internet access, project management software, and hardware of all sorts are pretty much everywhere. The big disconnect I see is our customers often don’t know how to use these tools beyond a very elementary level. Many still use yellow legal pads to collect data, then enter it into a spreadsheet or database. Once it’s there they may still resort to manually counting because they don’t know how to use formulas and sorting. PowerPoint presentations get too big to email because they have added high resolution photographs and resized them to display a fraction of the original dimensions but did not compress the images or change the file size. Using RSS feeds to keep abreast of news and publications is a totally new concept to many.

It reminds me of the story about a hardware salesman who sold chain saw to a customer who wanted to cut firewood. After a month the customer brought the saw back to the shop and said the new saw made life harder than ever before. The salesman looked at the saw, started it up, and the customer said “What’s that noise?”.

Today I met with the director of the Staff Development Office and we chatted about a series of workshops on practical informatics (I call it guerilla informatics). The plan is to meet with a group of staff educators to brainstorm the need for short, practical modules directed at nurse managers with the goal they will become the champions of the concept who spread it to their staff. I can see modules on using spreadsheets, presentation software and databases to collect, analyze and display information. I can see modules on how to use CINAHL and PubMed effectively as well as other sessions on using electronic tools to collaborate, educate and create personal learning environments that draw on information from multiple sources.

Two sources to gauge informatics competency

Results of aA Delphi Study to Determine Informatics Competencies for Nurses
at Four Levels of Practice
Nancy Staggers, PhD, RN, FAAN
Carole A. Gassert, PhD, RN, FAAN, FACMI
http://www.nurs.utah.edu/informatics/competencies.doc

Nursing Informatics Competencies: Self - Assessment
http://www.nursing-informatics.com/niassess/index.html

More on Rutgers and a couple of very useful links

At the Rutgers Conference one of the outstanding presentations I attended was entitled: "Using Blogs and Wikis to Promote Community, Collaboration, and Creativity", presented by JoAnne Herman, PhD, RN and Vera Polyakova-Norwood, MEd from the University of South Carolina College of Nursing. They have incorporated both blog and wiki use into graduate and undergraduate nursing courses with resounding success.

Great visual to compare working by email and working by wiki is at: http://www.flickr.com/photos/lafabriquedeblogs/2431125685/
It was posted on Beth's Blog associated with an article called "Working Wikily"
http://beth.typepad.com/beths_blog/2008/06/working-wikily.html

Another presentation that answered questions I have been dealing with was entitled "Reaching Digital Nirvana: A Paradigm to Automate Clinical Documentation and Transform Clinical Practice" by Jim Cato, EdD(c), MSN, RN, CRNA, MHS. His presentation dealt with the advantages of electronic documentation but what I found most interesting was his reponse to the question I asked about the prevelance of approved nursing taxonomies actually being used in the clinical setting. His response was that nobody was doing it well and that until a single standard is defined, and vendors actively incorporate those features in response to customer demands, it won't be a reality.

Mary Anne Rizzolo, EdD, RN, FAAN of the NLN presented "The NLN 2006 Survey of Informatics Competencies: Findings and Implications". There are far too many nurses who are unprepared or underprepared in informatics competencies. This applies to nurses in practice, nursing faculty and nursing students. Read the NLN position statement: Preparing the Next Generation of Nurses to Practice in a Technology-rich Environment: An Informatics Agenda, Approved May 9, 2008 on the NLN site.

Via the Work Literacy Blog: http://www.workliteracy.com/the-crap-test

The Crap Test for Internet resources: Currency, Reliability, Authority, Purpose. Just the mnemonic to assist my informatics students to critically evaluate Internet resources for healthcare!

Patrick Scollin, EdD, MT, CLS from the University of Massachusettes at Lowell presented "Bridging the Gap Between the PDA and Tablet in Healthcare: the Ultra Mobile Portable Computer at the Bedside". He described a small study where nursing students were given a 1 lb pc with a keyboard and stylus loaded with several reference materials to use during clinicals. After using the UMPC they had an opportunity to use a PDA loaded with similar software. To my surprise they preferred the PDA citing ease of use, speed, and battery life.

For the past year I've been following the development of low cost UMPCs starting with the One Laptop Per Child program. These have a full qwerty keyboard for touch typing (not thumb typing), wi-fi and a full suite of software. Intially running on Linux, some are now appearing with Windows Home. Asus was the first with the eeePC http://event.asus.com/eeepc/microsites/en/index.htm. Now contenders are appearing from HP (HP 2133), Acer (Acer Aspire One), Dell and MSI (MSI Wind). All weigh about 2lbs, and range in price from $299 and up. These small notebooks have been dubbed "netbooks".

Free Microsoft eLearning System

http://www.microsoft.com/learning/tools/lcds/default.mspx

This is a newly released (May 2008 I belive) tool from Microsoft. I haven't worked with it yet, but it sure looks like something to try.

From the website:

"The Learning Content Development System (LCDS) is a free tool that enables you to create high quality, interactive, online courses. Virtually anyone can publish e-learning courses by completing the easy-to-use LCDS forms that seamlessly generate highly customized content, interactivities, quizzes, games, and assessments—as well as Silverlight-based animations, demos, and other multimedia."

Work Literacy - A "Must Read" Blog

I have just found a new blog started June 1 that is on my “must read” list. It’s Work Literacy and is located at http://www.workliteracy.com/. Started by Tony Karrer and Michele Martin, this blog addresses issues of workplace information literacy, obstacles to developing new skills and learning new tools, and methods to encourage change. Two great posts to share:

“In a video presentation at Enterprise 2.0, two of the CIA Intellipedia folks mention a document on their Wiki that was put together by the OSS (precursor to the CIA) which describes how to best sabotage an organization” http://www.workliteracy.com/knowledge-work-sabotage

“…a new kind of illiteracy. And it’s worse, because it’s not a conscious illiteracy. You feel like you can still do your job. But you are slowly falling behind and as time goes by it becomes harder to catch up because you lack the learning skills that are part of this new literacy.” http://www.workliteracy.com/cognitive-age-illiteracy

This falls in quite nicely with the current initiatives in nursing to increase informatics literacy among nurses, nursing faculty, and nursing students. See the National League for Nursing newly published Preparing the Next Generation of Nurses to Practice in a Technology-rich Environment: An Informatics Agenda and The Tiger Summit Initiative. The 2007 Tiger Summar Report is at https://www.tigersummit.com/uploads/TIGERInitiative_Report2007_bw.pdf.

Of course the big question is how to accomplish those goals? I believe both clinicians and administrators want applications and education sessions they can use NOW, a "guerilla informatics" approach.

• How can I keep up to date with my clinical specialty?
• How can I use office productivity applications to decrease manual data recording and analysis?
• How can I communicate effectively with my staff or committe?
• How can I lean these things quickly with minimal classroom time or cost?

26th Annual Nursing Computer and Technology Conference

The 26th Annual International Nursing Computer and Technology Conference was held June 4-7 at Bally’s Hotel in Las Vegas, Nevada. Good attendance, great speakers, and wonderful weather made it a delightful time. Ramona Nelson, PhD, RN, FAAN, ANEF was the recipient of the Recognition Award for the Advancement of Computer Technology in Healthcare. A well deserved recognition for someone who has been involved in informatics and touched many lives in her career. While Ramona will be retiring from active teaching, she will still be very busy consulting and writing.

There were four outstanding keynote speakers. All spoke of the evolution of clinical computing and the need for clinician education as well as the need to adapt technology to the workflow of nurses. MP3 files of their presentations and hopefully video to include their slides will be posted on the Rutgers CPD website. They’re not posted as of June 15, 2008, but please visit the site for more information http://nursing.rutgers.edu/cpd.

The Opening Plenary Session speaker was Joyce Sensmeier, MS, RN, who is VP for Informatics at HIMSS. She spoke on the Tiger Initiative: Implications for Nursing Service and Nursing Education. Two websites of note are the Tiger Summit https://www.tigersummit.com/ and the accompany SIG wiki http://tigercompetencies.pbwiki.com/. Joyce spoke of the need to codify and promote informatics competencies in nursing students, faculty and staff.

Janet Grady, DrPH, RN, spoke on “Using Innovations in Technology to Advance Nursing Practice and Education. She presented a number of education initiatives and examples from the Nursing Telehealth Applications Initiative . Two of special interest were a program to help teenage diabetics visualize variations in their blood glucose levels and a “Virtual Clinical Practicum ® ” between Mount Aloysius College and Walter Reed Army Medical Center as well as Brooke Army Medical Center.

After the networking dinner there was a bus tour through Las Vegas to see the lights and sites that included a stop at the light show on Freemont Street. This was the main gambling area of “Old Las Vegas” and is now a pedestrian only area with nightly light shows on a huge screen running the length of the street. Very impressive!

On the second day of the conference the opening keynote speaker was Carole A Gassert, PhD, RN, FACMI, FAAN who presentation “Technological Solutions to Nurse Workflow Inefficiencies” addressed the study by the American Academy of Nursing supported by the Robert Wood Johnson Foundation. The study involved a “drill down” approach to determine clinical technology needs. The data is still being analyzed and will be published soon. The Academy website is at http://www.aannet.org/ .

The endnote speaker was Judy Murphy, RN, FACMI, FHIMSS from the Aurora Health System in Wisonsin with her talk entitled “What Nurses/Students/Faculty Will Need to Know When Practicing in an EPR Envirioment: Future Predictions”. Judy spoke of the challenges and barriers to adopting health information technology in the clinical environment and the types and prevalence of technologies being fielded. A key point was the need to appropriately plan and educate before implementing technology and to always remember that technology is only a means to improving quality patient care, not an end unto itself.

My presentations were well received and a couple of the attendees have begun to create a Personal Learning Environment using Pageflakes and have begun investigating social networking sites.

Next year’s Rutgers conference will be in Washington, DC. Check the Rutgers website for abstract submission information, dates, and a final venue location.