SUMMER INSTITUTE IN NURSING INFORMATICS 2005

The largest nursing informatics conference yet was held at the University of Maryland School of Nursing in Baltimore, MD, July 20-23, 2005. Titled Breaking the Barriers of Healthcare Informatics: People, Process & Technology, there were 680 attendees including 115 for the Webcast version. One of the main themes that permeated the conference was the fact that implementation is 80% a psychosocial and political process and 20% about hardware and software. One speaker emphasized that when planning a system, cost should be calculated by doubling the vendor cost to provide resources for the psychosocial and political pieces of implementation. Other general themes were making systems serve the user, looking at shortcomings of systems, and retrieving data. Attendees also heard several speakers describe implementing systems first on a pilot unit or two so that many bugs could be fixed before the system went live for the entire institution.

The keynote address was given by Linda Fischetti, who told attendees that if nursing is to be represented in healthcare policy, nurses need to become involved. She suggested that nurses testify at public hearings about real practice issues, and become involved in legislative changes. She also stated that if you find yourself at a meeting where all are nurses, get up and leave, meaning that we must attend meetings where we are the only nurse present, to be sure that nursing viewpoints are heard. The day ended with a social hour and dinner at the 1840s Ballroom in Baltimore.

Margaret McClure opened Thursday's program with a talk about Magnet hospitals and technology. She included information on lessons learned about practice from Magnet hospitals. These include a need for enlightened management who understand that nursing is the core business of a hospital. For this reason, nurse leaders must be part of decision making at all levels and represented on all committees. She divided the role of the nurse into two different aspects: caregiver and integrator. In the integrator role, which is a silent role, the nurse functions to pull information from various sources together, often requiring her to chase down missing pieces such as lab and radiology reports, as well as missing medications. In poorly run hospitals, this role can take 50% of the nurse's time. Facilitating the integrator role with information systems can provide more time for the caregiver role.

Friday's program opened with Patricia Brennan's address on Personal Health Records. Her main theme was that healthcare is experienced at the individual patient level, yet involves many stakeholders. As healthcare professionals, we tend to think that healthcare occurs primarily in our healthcare agencies, but in reality most of it occurs in the community with friends, family, and the Internet. The primary integrator at the patient level is the kitchen calendar, where all appointments are recorded. Providing a personal health record to replace the kitchen calendar enables patients to self-monitor, have access to clinical records, communicate with providers, and have decision support. Achieving this means balancing the rights of patients to know and have privacy with care provider rights and society's right to awareness of potentially harmful situations.

The last plenary sessions of the conference focused on implementations. Nancy Lorenzi informed participants that between 50% and 70% of systems fail at implementation, or never achieve their full potential. This usually occurs because the people and organizational issues are not given a high enough priority. Selecting a unit or two with the highest probability of success and using them to pilot test a system are policies that, when combined with attention to the people and organizational issues, can improve the rate of success. Some of the factors that should be weighed in selecting pilot units include staff experience with and affinity for technology, their responses to previous change initiatives, and their history with technologic change. Each of the overall categories are given a score of one to eight and the highest scoring units are selected.1 Above all, users on all units must want the new system to be "our" system, not a "your" or "my" system.

Charlotte Weaver closed the plenary sessions with an address on the 10 top reasons why implementation of systems fail. These include a culture of mistrust, clinical executives' not being in a lead role, and an executive team that does not play well together. Charlotte pointed out that a nurse executive may be marginalized by the CIO, CFO, or CEO, or that the CEO may not demand accountability of staff. Each of these things, as part of the existing culture, will jeopardize the success of implementing a new system, as will a friction between a third-party consultant and a vendor.

Judy Murphy introduced the last session, which was a panel of speakers who provided information about innovations that help the nurse provide care more efficiently and effectively. The first panel member, Diane Carr, presented information about the use of smart cards to turn data into useful information. Queens Health Network, an agency consisting of 13 community medical centers as well as 550 physicians, and serving a very poor area of New York City, turned ID cards into smart cards by adding a 64K chip that contains a patient summary. At each encounter, the summary is updated with a current problem list, allergies, active medications, and lab results. Some 10,000 patients own these "Health Connection Cards." Some savings that have resulted from their use are a reduction of length of stay from 5.1 to 4.1 days, $2,553,500 in radiology supplies, $1,224,344 in transcription services, and $1,006,500 in adverse drug events.

The second panel member, Patsy Sublett from Danville Regional Health System, a small rural hospital on the border of North Carolina and Virginia, gave participants a glance into their use of bar coding for medications. Not only has this improved the safety of their drug administration, but the system provides nurse managers six reports a day, presenting information about the prevention of potential errors and medication omissions. This information is used to identify units with good medication stability. These units are then observed to determine what they are doing right so those practices can be adopted in other units.

Christine Gamlen, the last panel member, demonstrated the use of the Vocera Device. This device is a hands-free, 2-ounce, wearable, voice-activated device that uses a Wi Fi network to provide instant communication between physicians, nurses, unit secretaries, and ancillary staff. This device and its use was described in an article in the September/October issue of CIN by Breslin, Greskovich, and Turisco.

Besides the plenary sessions described above, the conference featured many concurrent sessions of peer-reviewed papers. The presentations were excellent, and made participants wish they could be in more than one place at a time. There were also excellent peer-reviewed poster presentations as well as time allotted to see them. SINI is an annual conference, and one worth planning on attending each July.

Contributed by

Linda Q. Thede, PhD, RN

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