Top Drawer in the Literature, from Vendors, and Through Networking

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✓ ✓ NEWS Top NEWS OMAHA SYSTEM of standards, meaningful use of INTERNATIONAL CONFERENCE electronic records, and partnership 2009 Drawer results were highlighted.

The Omaha System International Applications of Standards Conference took place in Eagan, A standardized terminology such as MN, on April 16 to 18, 2009. Those the Omaha System is essential for attending were from Estonia, Hong documentation and information Kong, New Zealand, The Nether- management. International partici- lands, and 17 states. More than 40 pants described current initiatives representatives of practice, educa- to standardize and automate tion, research, and information tech- • healthcare documentation in their nology presented information about ESSENTIAL countries. The diverse initiatives their use of the Omaha System. They INFORMATION ON were designed to describe the recip- are employed in home care, public NEW PRODUCTS ients of service; quantify practice health, hospice, acute care, case and the outcomes of that practice; SOFTWARE management, long-term care, nurse- integrate clinical, statistical, and fi- managed centers, parish nursing, BOOKS nancial data; and communicate child care, and university settings. MEETINGS data efficiently and economically. The Conference was presented by The need for nurses and other INTERNET RESOURCES Martin Associates, and the school healthcare professionals to work as host was the University of Minnesota • partners with managers, adminis- School of Nursing (UMN-SoN). trators, system engineers, and soft- Partnership was the conference ware developers was emphasized. theme. Presentations focused on a healthcare services. The need for common goal: working in partner- data exchange and interoperability ship to improve the quality of permeated discussions. Applications Meaningful Use of Electronic Health Records Electronic health records (EHRs) demand standardization to capture data meaningfully. Clear, consistent, and accurate use of a standardized terminology such as the Omaha System requires effort. Par- ticipants indicated that they se- lected the Omaha System because of the simplicity and comprehen- siveness of its three relational com- ponents (Problem Classification Scheme, Intervention Scheme, and Problem Rating Scale for Out- comes). Many speakers emphasized the need to have a vision, strategic plan, and adequate resources. They shared “lessons learned” during their planning, implementation, maintenance, and evaluation phases. As the rich discussions sur- rounding these lessons illustrated, FIGURE 1. Karen Monsen, poster presenter. new adopters can benefit from the

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✓ site, at workshops and conferences, CALENDAR Top Drawer in the literature, from vendors, and through networking. 2009

JULY 2009 July 13–17, 2009, 20th International Nursing Research Conference Focusing on Evidence-Based Practice, Cancun, Mexico. Sponsored by Sigma Theta Tau International, 550 W North Street, Indianapolis, IN 46202. For more information, visit the conference Web site at http://www. nursingsociety.org/STTIEVENTS/ RESEARCHCONGRESS/Pages/ congress.aspx. July 20–25, 2009, Informatics at the Point of Care—A Barrier or a Bridge? 19th Annual Summer Institute in Nursing Informatics, Baltimore, MD. Sponsored by the University of Maryland School of Nursing, Office of Continuing FIGURE 2. Standing L to R: Karen Martin, Karen Lindberg, Pam Correll, Judy Riemer, Karen Education, 655 West Lombard St, Monsen, Madeleine Kerr, Planning Committee; seated: Louis Henry, Jr, speaker Baltimore, MD 21201. For more information, visit http://nursing. umaryland.edu/sini/index.htm. insights gained by experienced Partnership Results Preconference sessions will be held users. Many resources are available Omaha System partnerships are July 20–22, 2009. online at the Omaha System Web achieving the kinds of results that administrators and decision makers expect from EHR data. AUGUST 2009 ✓ August 31– September 2, 2009, • State and local public health Medical Informatics in a United agencies and university and Healthy Europe: researchers are partnering to 22nd International Congress of evaluate the effectiveness of a the European Federation for statewide family home visiting Medical Informatics, Sarajevo, Your contributions to Top program using Omaha System Bosnia and Herzegovina. Sponsored Drawer (news, calendar intervention and outcomes data. by the Society for Medical Informatics items, products for review) • Systems engineers and home of Bosnia and Herzegovina. For care nurses in The Netherlands more information, visit are welcome. Send them to: are transforming care delivery for http://www.mie2009.org/. CIN Editorial Office their patients and measuring outcomes of care. 10A Beach Street Suite 2 SEPTEMBER 2009 • Public health administrators, Portland, ME 04101 September 17–18, 2009, Medicine university educators, state and 2.0: Web 2.0 in Health and Telephone: 207-553-7750 local public health staff, and Medicine, Toronto, Ontario, Fax: 207-553-7751 systems engineers are Canada. Sponsored by the E-mail: [email protected] developing partnerships to International Medical Informatics enhance data and practice Association, 5782-172 Street, quality for diverse community programs.

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✓ NOTES FROM THE NET NOMAD . . . The Internet has brought the spirit of global commu- blogging and it started being about micro- nication and collaboration to nurses and other health- sharing across personalized networks.—The Social care professionals in ways never before thought possible. Enterprise blog: http://dwilkinsnh.wordpress. These resources are offered to expand your opportuni- com/2009/05/11/the-truth-about-twitter/ ties for discussion, reference, education, and research. I have been following articles about the application Twitter for a couple of years. The Web site How do you start? Go to the Twitter Web site describes it as the way to respond to the question (http://www.twitter.com) and create a free account. “What are you doing?” in 140 characters or less. Just as with a Listserv or discussion board, you are Early examples of Twitter messages, or “tweets,” not obligated to post, although the greatest value in consisted of personal bits and pieces of information social learning comes from the exchange of ideas. sent to the world at large and seemed silly. What The initial goal is to find and follow the messages relevance could it have to a clinical or education from individuals or groups with interests similar to setting? It took me a while to understand that it is yours. One list of healthcare twitter addresses is not the same as 1:1 “texting,” but it is an applica- “Twitter Doctors, Medical Students and Medicine tion to create short, information-rich posts to a related” at http://medicalstudentblog.co.uk/ central area that others can elect to follow either twitter-doctors-medical-students-and-medicine- online or by cellular phone. As with any Web site or related/. There are dozens of nurses, physicians, and blog, the challenge is to find those with similar inter- agencies using Twitter. The Centers for Disease ests and content you want to follow. As of this Control is on Twitter at http://twitter.com/ writing, there are more than a million Twitter CDC_eHealth, and The Healthcare Information and accounts, and it is finding a real place in education Management Systems Society (HIMSS) is at and healthcare. http://twitter.com/HIMSS. Phil Bauman, RN, A CINAHL search for the word Twitter yielded 13 published a free e-book called “140 Health Care articles. Diane Skiba’s article entitled “Emerging Uses for Twitter” at http://philbaumann.com/ Technologies Center. Nursing Education 2.0: 2009/01/18/free-ebook-140-health-care-uses-for- Twitter & Tweets. Can You Post a Nugget of twitter/. The Cleveland Clinic Continuing Medical Knowledge in 140 Characters or Less?” in Nursing Education department is using Twitter (http://twitter. Education Perspectives (http://nln.allenpress.com/ com/cleveclinic_cme) to post news and course pdfserv/i1536-5026-029-02-0110.pdf) would be my updates, and the Henry Ford Hospital used Twitter primary recommendation to someone curious about to “to provide real-time updates on a robot-assisted Twitter. It is an excellent, succinct introduction surgery” (http://www.ihealthbeat.org/Articles/2009/ to the application, and Dr Skiba gives several 2/10/Hospital-Uses-Twitter-To-Provide-RealTime- personal and published examples of how educators Updates-on-Surgery.aspx). are using Twitter. As with any Internet application, there are potential hazards. There have been reports of malicious links on David Wilkins, a social learning and computer- Twitter messages that can result in downloading mediated education consultant, wrote, infected files and phishing scams that attempt to In 24+ months and across 1000+ posts, I think capture user account information (http://news.cnet. I might have answered “What I’m doing” less com/twitter-phishing-scam-may-be-spreading/). than 50 times. The rest of what I post? Links. Universal precautions apply to computing as well Comments on other people’s links. Responses as healthcare. to people’s questions. Suggestions for people to What role Twitter will play in my professional life connect. Twitter, for me, is not about sharing is still evolving. I am still exploring and urge you to the minutia of my day but about sharing the create an account and explore as well. It is truly insights and sources that shape my professional becoming an application to foster communication, thinking. And by following the contributions of collaboration, education, and research in healthcare others, I can see what’s shaping their thinking, and education. what sources they follow, how they connect their professional dots. You see, a funny thing happened when the community began shaping Twitter’s usage: it stopped being about micro- William Perry, MA, RN

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✓ opportunities for students and CALENDAR Top Drawer faculty to incorporate the Omaha System into their simulation laboratory. Edmonton, Alberta, Canada T6M • Acute care and ambulatory 1B4; the Journal of Medical Internet care settings are partnering It was evident from the presenta- Research (http://www.jmir.org/); the to improve discharge tions and discussions that the Canadian Medical Association; and communication, follow-up, and Omaha System enables the develop- others. For more information or to client care. ment and maintenance of exciting register, visit the conference Web • Public health nursing experts are partnerships and exchange of clinical site at http://www. working with Omaha System data. The Omaha System exists in medicine20congress.com/. users to develop evidence- the public domain, has been recog- September 23–26, 2009, Ease on based pathways that can be nized as a standardized terminology Down the Road: Exploring disseminated via computerized by the American Nurses Association Pathways to Excellence in documentation systems. since 1992, passed the Healthcare In- Clinical Education, NLN Education • Home care staff initiated a formation Technology Standards Summit, Philadelphia, PA. multidisciplinary quality Panel selection criteria in 2007, and Sponsored by the National League improvement program designed is registered (recognized) by Health for Nursing, 61 Broadway, New to improve their clients’ pain and Level Seven. It is integrated into the York, NY 10006. For more dyspnea scores; in the process, National Library of Medicine’s information, visit the Web site at they increased their partnerships Metathesaurus; Logical Observation http://www.nln.org/Summit/index.htm. with their clients and their clients’ Identifiers, Names, and Codes; and families. SNOMED-CT. • Nursing and computer science OCTOBER 2009 researchers are partnering to Contributed by Karen S. Martin, October 31–November 4, 2009, I use sophisticated data mining Am a Nurse…and I Am a Member RN, MSN, FAAN and Karen A. techniques to discover new of a Global Nursing Community: Monsen, RN, PhD. 40th Biennial Sigma Theta Tau intervention models and test Convention, Indianapolis, IN. predictive validity. Sponsored by Sigma Theta Tau • Nursing researchers, advanced International, the Honor Society of practice nurses, a major Nursing, 550 W North St, insurance company, and a major Indianapolis, IN 46202. For more health plan are working together 27TH ANNUAL INTERNATIONAL information, visit the Web site at to evaluate the success and NURSING TECHNOLOGY http://www.nursingsociety.org/ cost-effectiveness of a CONFERENCE STTIEvents/BiennialConvention/ transitional care program, Pages/biennialconvention.aspx. translating evidence-based research into standards of care. Rutgers’ College of Nursing Center 2010 • Researchers, educators, and for Professional Development hosted students from nursing, social the 27th Annual Rutgers Nursing work, and pharmacy formed Technology Conference held from APRIL 2009 partnerships with community- April 24 to 26 in Arlington, VA. April 22–24, 2010, ReEvolution in based health workers “Bridging the Technology Gap Nursing Informatics: 2010 (promotoras) to jointly plan, Between Nursing Service and Educa- ANIA/CARING Conference, implement, and evaluate care for tion” was the official title, with the Boston, MA. Jointly sponsored by underserved populations with concept of collaboration emphasized the American Nursing Informatics chronic health problems. in all the keynote talks. The proceed- Association and the Capital Area • Two schools of nursing ings given to all participants at regis- Roundtable in Nursing Informatics. developed a partnership with the tration contained abstracts and, For more information, visit assistance of an alumni often, PowerPoint slides for almost http://www.ania.org/ businessman. His sponsorship all the simultaneous sessions so that Conference%202010.htm. Call for enabled two graduate students participants could gain an idea of presentations and posters from July to attend the conference, and he what they had missed when con- 27 to August 31, 2009. is providing additional fronted with the “How can I be in encouragement and financial more than one place at the same

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As a result, consumers want differ- must address the emerging practice Top Drawer ent things from their provider. realities by linking practice needs Healthcare at present has ignored with education. the ability of the Internet and Web- “Creating a partnership is a slow time?” conflict. There were 130 based applications to contribute to process.” It involves trust, hard participants. health information technology work, high-level genuine support, The conference opened with the (HIT). While healthcare was in and patience. Corporations and keynote talk of Diane Skiba, PhD, standards meetings, Google and academia have different cultures and FAAN, FACMI, “Nursing Education Microsoft jumped into the market- different missions. Corporations Collaboration With Nursing Ser- place with personal health records. must satisfy the stockholders and vice.” She emphasized the need for Dr Eysenbach’s article in the Jour- lawyers, while education must satisfy service and education to collaborate nal of Internet Medical Research various committees. The result is to reach the common goal of about combining personal health that faculty do not understand the preparing high-quality nurses. records with social networking in culture of industry and the industry Given the federal push for EHRs, it healthcare (http://www.jmir. does not understand the academic is necessary to prepare nurses to use org/2008/3/e22) provides more culture; a situation that requires them as a tool. It is not enough, in examples of Web 2.0 uses in health- work by both sides. Benefits, how- either education or service, to just care. One of the things necessary to ever, can accrue to both parties. Ven- teach EHR users what button to accommodate this new word is to dors can realize product exposure push; they need to know how to prepare nurses to show caring in and good public relations. They also use the system so that it becomes a non–face-to-face situations. learn about nursing workflow and tool like the stethoscope and use it Data visualization, which means other nursing issues that impact the to find data and create information data representation beyond graphs, next generation of their software. and knowledge. The best way to was another topic in Dr Skiba’s pre- These partnerships also provide an meet these demands, as well as oth- sentation. Taking complex data and established site for potential clients ers, is collaboration with service, a presenting it in ways that people can and offer the potential for joint re- vendor, or both. understand are tools that will be search and the testing of new ideas. Dr Skiba pointed out that health- needed in healthcare, both in our Dr Bowles pointed out that care is on the federal agenda with electronic records and for working schools of nursing benefit because the goal of remedying the situation with consumers. (Search the Web for students learn skills in cutting-edge in which only 9% of healthcare data visualization for some excellent nursing informatics, are prepared to agencies have anything resembling examples of her meaning.) participate in system selection, and a full electronic medical record. Saturday morning opened with a become proactive informatics users Most agencies, however, have joint presentation by Jim Cato, EdD, instead of reactive. At the master’s started this journey. One of the rea- MSN, RN, CRNA, MHS, CPEHR; level, students are able to compare sons for introducing an EHR, the Kathryn Bowles, PhD, RN, FAAN; products and suggest modifications, ability to get data out, is con- and Patricia Abbott, PhD, RN, understand linkages within the founded by the fact that today’s FAAN, FACMI, about a joint part- record, and develop deeper analysis electronic healthcare systems are nership among the Eclipsys Corpora- and evaluation skills. Faculty and designed with the idea of getting tion, the University of Pennsylvania, PhD students learn the interdepen- data in but make it difficult to use and Johns Hopkins Schools of Nurs- dence of systems and appreciate the the data to produce evidence. Not ing to bring EHR to nursing stu- ability to use data. only does this need to change, but dents. Dr Cato, who is the vice presi- The process involved in develop- also nurses must be educated to use dent of nursing at Eclipsys, opened ing a partnership is lengthy. The con- this data for evidence-based care. the presentation. He informed us tract alone took from February to With the above ability of consumers that this collaboration was a result October to develop. In creating a to find information previously re- of the parties involved realizing partnership like this, it is important stricted to healthcare personnel, the that nurses today function in a com- that each party appoint a project nature of healthcare is changing. plex environment that requires “new manager who can sell the project. Consumers are engaged in learning age” education. Nurses must have With the full support of all the chairs about any disease condition they or confidence in their skills in effec- and the dean, the two schools of a loved one may have. Although tively using technology to participate nursing organized faculty retreats to novice searchers at the beginning of in decision making in new healthcare discuss the project. The ultimate goal an illness, as their condition becomes environments. To meet these needs, was to integrate healthcare infor- worse, their search skills improve. the curriculum and teaching methods matics at all levels of the program.

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Dr Abbott reported that the goals as 1974, the idea of health profes- constitutes nursing informatics, were to increase the healthcare in- sionals needing education in infor- which leads to the question of the formatics competencies of their matics was introduced. It was the quality of informatics education that nursing graduates. It is hoped this 1987 National League for Nursing students are receiving. The survey in- will lead to the design of safe and (NLN) Guidelines for Basic Com- formation was used to develop the efficient healthcare using HIT. This puter Education in Nursing by NLN position statement about partnership will allow students to Judith Ronald and Diane Skiba that preparing the next generation of be taught to interact easily with first officially addressed the compe- nurses (http://www.nln.org/aboutnln/ technology and use the wealth of tencies needed by nurses in infor- PositionStatements/informatics_ evidence in the health record to de- matics. Since then, there have been 052808.pdf). The report includes velop best practices in clinical care. other calls for the use of healthcare recommendations for faculty, deans The reality of the collaboration re- informatics in the curriculum and and chairs, and the NLN itself. vealed interesting outcomes. For one, practice areas, including the Institute The results also spearheaded a the school had the advanced version of Medicine (IOM) reports. Progress, program by the University of Col- of the software, and students in the however, still feels like the child’s orado Health Sciences Center clinical areas found a mismatch be- game of “Chutes and Ladders,” in School of Nursing in Denver, Indi- tween interface and functionality. which we take a few steps forward ana University School of Nursing in Additionally, an educational system only to slide back down. However, Indianapolis, the University of needs more granularity of data than one state’s Board of Nursing, North Kansas in Kansas City, and the the clinical area does because differ- Carolina, has mandated that schools NLN, funded by a grant from the ent purposes are served. The genera- of nursing incorporate the IOM US Department of Health and tion divide between the digital immi- core competencies, one of which is Human Services, Health Resources grants who did not grow up with informatics. and Services Administration’s Divi- technology and digital natives who In March 2006, the NLN’s Infor- sion of Nursing to prepare nurse did created certainty and uncertainty matics Competencies Task Group of educators in informatics. Called the in the faculty. the Educational Technology and In- HITS (Health Information Technol- Students who practiced outside of formation Management Council sent ogy) Scholar Program, it is to last agencies related to the nursing separate but similar e-mail surveys to for 5 years (see http://www.hits- schools had to chart using paper be- determine the level of informatics ed- colab.org/ for more information on cause the firewalls would not let ucation in the curriculum to NLN this program). them access the system. Addition- member and nonmember faculty and To promote the inclusion of in- ally, for faculty grading purposes, nursing education administrators at formatics in the curriculum, educa- reports had to be generated and schools of nursing, from the practical tors and practitioners can seek part- printed. Still, the gains outweighed nurse to the doctoral level. The most nerships and provide informatics the difficulties, the faculty were en- disturbing findings from these sur- resources. Practitioners can support gaged, creative thinking occurred, veys were that few faculty or admin- faculty efforts and demonstrate and everyone became aware of what istrators could differentiate between informatics benefits to patients. is “behind the curtain” in healthcare educational technology such as the Faculty can be a champion for their records. When students cannot use use of PowerPoint, or the Web, and school and provide informatics re- the hospital system, they never de- the practice of informatics. Com- sources for all. Both faculty and velop these skills. Under this collab- ments such as “all courses are Web practitioners can expose faculty to oration, students can learn elec- enhanced” and “informatics is avail- informatics applications they can tronic documentation and use of able through the library and inte- understand. information as a nursing purpose. grated into English class” demon- Saturday evening, there was a Dr Abbott ended with the thought strated this confusion. One wrote networking dinner at the Spy Mu- that there is no stopping the train of that “Students are encouraged to seum, where we all had a chance to progress, “If you are not part of the e-mail instructors with questions, take on a different persona and un- future, you are history.” but that less than five percent take dertake a spy mission, not virtually, The topic of Mary Anne Rizzolo, advantage of this.” Preparing for but in a progression of dioramas. EdD, RN, FAAN, was “Are We the National Council Licensure We had to memorize our character’s Preparing Nursing Students to Func- Examination on the computer was persona and our mission then an- tion in a Technology Rich Environ- also seen as informatics. Some, truth- swer questions based on this infor- ment?” She opened by asking the fully, admitted that they were not mation while being scrutinized by a audience this question; only one par- sure what informatics is. Thus, there virtual guard. There were other fas- ticipant thought we were. As early is considerable confusion about what cinating exhibits, including one on

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women spies, the most famous of Available 24/7, they use compe- nary teams, use evidence-based prac- whom was Mata Hari, whose ex- tency-based, not time-based, train- tice, apply quality improvement, and ploits, alas, were mostly in her ing. The result has been more reten- effectively use informatics. Partner- head. The dinner that followed tion and more nurse satisfaction. ships allow for expertise and re- honored Dr Mary Anne Rizzolo, The primary focus of the training sources to create better outcomes. who is retiring from the NLN in centers is to train new nurses and Collaboration, however, is a jour- December. A slide show of events those new to a speciality. The sec- ney, not a destination. It is personal in her professional career was pre- ondary purpose is multidiscipline as well as procedural. When being sented by Karen DuBois and Diane team training. They found that this developed, expect strain; “You are Skiba, along with remembrances by gave all participants a view of oth- stepping out of your comfort zone, many attendees of the effect of ers’ world. Physicians learned about taking risks.” Interpersonal relation- Dr Rizzolo’s many accomplishments. the problems and frustrations that ships are an integral part of the The Sunday morning keynote nurses face, and nurses learned process and must be cultivated. The speaker was Kathy Scott, PhD, RN, about the difficulties faced by physi- first stage is to assemble and decide whose talk was “The Use of Tech- cians, all of which has led to a better why the collaboration is needed. The nology to Promote Effective New understanding of the role of each. next stage has been termed storm Graduate Performance.” She stated New hires spend their first week and order in the Bailey Koney model. that to provide this, we need to in their home facility, then spend 2 In this stage, who plays what role is challenge assumptions and use all weeks in basic skills simulations for discussed as well as how to make it the possible tools to create the best their speciality area. The next 9 happen. “Norm and perform” care possible. One of Banner Health weeks are spent with their floor follows, in which roles are decided System’s four missions is to provide preceptor, where they integrate and things are made to happen. The innovative approaches to new grad- their skills into practice and move last stage, “transform and adjourn,” uate education. This is accom- to independent care. After 12 is arrived at when the collaboration plished through virtual training, weeks, they graduate, but they re- is complete and functioning. simulations, and academies. Dr main in residency for 1 year. Resi- The last stage has been arrived at Scott stated that new nurses, or dency groups meet for 4 hours by the Kansas University School of nurses changing specialities, need every month to examine profes- Nursing and the Cerner Corpora- help with technical skills that other- sional issues such as delegation and tion. This journey started with a wise can paralyze them. Banner scope of practice. handshake at a chance meeting of Health has created a competency- The conference concluded with the Dr Connors and Neil Patterson, based orientation program across keynote speech “Where Do We Go chief executive officer of Cerner. all their seven state agencies. Their From Here? How Do I Implement Like the collaboration among Johns first efforts at providing this educa- Collaboration Between Education, Hopkins, the University of Pennsyl- tion were students viewing an in- Services, and Other Partners” by vania, and Eclipsys, the collabora- structor giving a lecture, something Helen Connors, PhD, RN, DrPs tion involved merging two different they found wasted time, dollars, (Hon), FAAN. Dr Connors started cultures whose metrics for measur- and resources. Instead, they devel- by examining the concept of collabo- ing are different. It involved learn- oped several centers, one of which is ration. She defined it as “the process ing each other’s differences and mobile for their rural facilities. of two or more people coengaged in working through them, as well as These centers have high-fidelity a process where the result is the working with lawyers on both sides. manikins and equipment, also the emergence of shared understanding The final collaboration created a Nintendo Wii. They have found or a creative output.” True collabo- health documentation system that is that in 5 to 7 seconds using the Wii, ration is a process that needs atten- taught as part of skills. For example, which allows natural hand move- tion; it does not develop by itself. when assessment is taught, students ments and the use of fine motor There are various levels of collabora- are taught to document on the sys- skills, they can determine if a person tion. The lowest level is cooperation, tem instead of on paper records. Stu- is qualified to perform a skill. The which is seen in networking and co- dents are also taught to use the infor- Wii has also been used with practi- operative work. The second level is mation. Realizing that not every tioners who have had bad outcomes coordination and involves partner- school is positioned to create this to perfect their skills. To fund these ships. The highest level creates a type of partnership, they created a centers, Dr Scott demonstrated that merged and unified whole. Collabo- center that can host other school’s within 18 months, they would result ration is needed if we are to reach use of the system. Currently, there in enough reduction in patients’ the IOM goals of providing patient- are many schools that take advan- hospital stays to fund the program. centered care, work as interdiscipli- tage of this program. As can be seen

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It was recognized that this was of • Strategies to increase Top Drawer importance to the broader nursing collaboration from healthcare community. The Minnesota Orga- organizations for standardization in the above discussion, the confer- nization of Leaders in Nursing and of EHR across the country and ence was very stimulating. Each of the Minnesota Association of Col- the world the keynote speakers added value to leges of Nursing (MACN) were in- • EHR barrier identification, the general theme of collaboration, vited to cosponsor the meeting. The problem solving, and as did the individual sessions. first Minnesota TIGER Summit was negotiations within healthcare held in January 2008 in Minneapo- organizations Contributed by Linda Q. Thede, lis. It was designed to introduce the • Active participation—hands-on PhD, RN-BC. TIGER pillars and then provide learning through local exemplars of the pillars in ac- demonstrations/simulation tion. The participants came from all roles within nursing and also from Tabletop breakout sessions outside the nursing profession. The offered opportunities for partici- MINNESOTA TIGER SUMMIT response from 210 participants was pants to discuss and share signifi- overwhelmingly positive, with an cant issues, ideas, and recommen- especially positive response to the dations for improving practice in How do you engage a local nursing local exemplars. the face of new and evolving tech- community in a discussion about Feedback from the first summit nologies and diminishing HIT? This became a topic of discus- led the organizers plus the Min- resources. sion after the national TIGER Sum- nesota Nursing Association The energy and outcomes ex- mit held in the fall of 2006 entitled (MNA) to plan a second summit pressed by the Minnesota TIGER “Evidence and Informatics Trans- in 2009. The second Minnesota Summit participants were truly forming Nursing.” More than 100 TIGER Summit, “Springing Into contagious. Participants were ex- leaders from across the nation cre- Action,” was convened in January citedly anticipating their ability to ated a vision to bridge the quality 2009, with 174 participants at- share the information with col- chasm with information technol- tending the Summit. Almost all the leagues and administration. A few ogy, enabling nurses to use infor- attendees (96%) indicated overall lessons learned for the next Sum- matics in practice and education to that the conference and its practi- mit and our constituents were the provide safer, higher quality patient cal application to their informatics following: care. Since that time, hundreds of work or practice were good, very volunteers have joined the collabo- good, or excellent. In addition, in- rative teams on nine key topics to terest areas for further exploration • Increase time for interactive accelerate the action plan. An exec- included the following: questions with speakers. utive summary of TIGER activities • Provide hands-on through 2008 was recently published demonstrations and and is available on the TIGER Web • The integration and incorporation opportunities for practice. site (www.tigersummit.com). of EHRs into diverse practice • Create scorecards and other The president of the Minnesota arenas reports by data extraction. Nursing Informatics Group (MIN- • Prevailing approaches to the • Address legal ramifications, ING) at the time, Tess Settergren, adoption of new technologies challenges, and responsibilities returned from the summit ready to focusing on legalities, associated with electronic activate Minnesota nurses. She in- overcoming challenges, and documentation. vited a TIGER Advisory Council creating solutions, especially • Define and develop consistent member, Dean Connie Delaney from relating the use of voice processes for successful best the UMN-SoN, to a MINING meet- recognition and data extractors practice implementations. ing to discuss the summit vision and • Maintaining personalized care • Foster nursing informatics from a action plan. At this meeting, it was when using standardized “bottom-up” involvement instead decided that MINING and the electronic flow sheets of top-down. UMN-SoN would develop and orga- • Expanded discussion of nize a Minnesota TIGER Summit to successful EHR best practice The Minnesota TIGER Summits share national and local experiences experiences and lessons learned have brought education, informatics, with HIT and discuss issues related from hospital nurses at the leadership, and clinical practice to the effective adoption of EHRs. bedside together around the informatics

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conference, and providing continu- the holidays, and both years, the reg- Top Drawer ing education credits and Internet istrations began slowly and then registration. A wiki site for the con- flooded in during the last 2 weeks. challenges we all face in our respec- ference planners to post minutes, Looking forward, the planning tive roles. There were a number of documents, and others was pro- committee will use the results of the factors that contributed to the suc- vided by MINING. This was ex- brainstorming session to make cess of the Summit which united tremely helpful as it meant that all plans. It would be easy to simply nursing professionals, who tend to committee members had access to establish an annual conference. have limited interaction profession- all the planning that had occurred. Judging from past experience, that ally. The first factor that influenced We were literally on the same page. would be popular with the commu- the success of the Minnesota TIGER It also reduced the stress of having nity. But we would also like to take Summit was the national TIGER ini- to maintain and track our own the feedback from the summit and tiative, which provided Minnesota files. find ways to work outside the with a framework and vision to or- Another factor that contributed to framework of an annual conference ganize on a state level. The second a second successful 2009 Summit to advance informatics and the success factor was the existence of was building on suggestions from the TIGER vision. We have a commit- four strong organizations, UMN- 2008 Summit. The 2009 goals were ted group of volunteers, a large net- SoN, MINING, MACN, and MNA, to connect to the national initiative, work of nursing professionals, and who each brought their own con- highlight and celebrate local initia- a small fund from two successful stituency, along with a willingness to tives, and increase personal skill lev- conferences. It is an opportunity collaborate for the benefit of all els with technology. We invited two that we do not want to waste. nurses. Each organization pledged a national speakers, Donna Dulong willingness to underwrite the first and Judy Murphy, to provide an up- Summit financially as well as provide date on the national efforts and de- CONTRIBUTORS TO THIS ISSUE… active members for the planning scribe how other sites implemented Kathryn Hoyman, PhD, RN-C, committee. Each organization also TIGER recommendations. Most of clinical knowledge engineer publicized the conference to its mem- the day was spent on local initiatives at Fairview Health Services, bership using the communication such as the role of staff nurse coun- Minneapolis, MN; Kim Zemke, methods with which they were famil- cils in EHR governance, the chief in- MS, RN, clinical assistant profes- iar (brochures, e-mail, etc). This sim- formation officer as a nursing role, sor, director of practice and pro- plified the work of the planning and use of the EHR to address pres- fessional development at the committee. sure ulcer prevention. The opportu- UMN-SoN, Minneapolis-St Paul; Any statewide effort by busy pro- nity to provide a platform for nurses Julia Behrenbeck, MS, MPH, RN, fessionals faces the obstacles of to make their work visible to the patient education specialist- information systems at the Mayo time and distance. In each round of larger healthcare community was a Clinic, Rochester, MN; and planning, we had one in-person primary benefit of our Summit. We Bonnie Westra, PhD, RN, assistant meeting to put names and faces to- saved a fun topic for the last presen- professor and codirector, ICNP gether. After that, the work was tation, Extreme Googling, which Center at the UMN-SoN, completed by regularly scheduled focused on the use of technology for Minneapolis-St Paul. conference calls. This allowed par- managing one’s life. This was appre- Karen S. Martin, RN, MSN, ticipation by those who lived ciated by many in the audience who FAAN, Health Care Consultant, outside the metropolitan area, as may work in informatics but are not Martin Associates, Omaha, NE. well as those working clinical shifts. able to keep up with all of the pro- Each of the organizational members ductivity tools available. Karen A. Monsen, RN, PhD, As- sistant Professor, UMN-SoN, took his/her responsibility to con- Typically, one would not expect Minneapolis. tribute seriously, and attendance on that offering a conference in January conference calls was high and each in Minnesota would be successful. William Perry, MA, RN, is Ad- member of the planning committee However, it does have advantages. junct Instructor, Wright State actively contributed to the work. Ad- Conference space is readily available, University, Dayton, OH. ditionally, the UMN-SoN provided and there is not as much competition Linda Q. Thede, PhD, RN-BC. Dr support for marketing, designing and with other conferences. However, we Thede is the editor of CIN Plus. duplicating materials, staffing the were asking people to register over

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