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Geary CR, Hook M, Popejoy L, Smith E, Pasek L, Heermann Langford L, Hewner S. Ambulatory Care Coordination Data Gathering and Use. Comput Inform Nurs 2024; 42:63-70. [PMID: 37748014 PMCID: PMC10841852 DOI: 10.1097/cin.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Care coordination is a crucial component of healthcare systems. However, little is known about data needs and uses in ambulatory care coordination practice. Therefore, the purpose of this study was to identify information gathered and used to support care coordination in ambulatory settings. Survey respondents (33) provided their demographics and practice patterns, including use of electronic health records, as well as data gathered and used. Most of the respondents were nurses, and they described varying practice settings and patterns. Although most described at least partial use of electronic health records, two respondents described paper documentation systems. More than 25% of respondents gathered and used most of the 72 data elements, with collection and use often occurring in multiple locations and contexts. This early study demonstrates significant heterogeneity in ambulatory care coordination data usage. Additional research is necessary to identify common data elements to support knowledge development in the context of a learning health system.
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Affiliation(s)
- Carol Reynolds Geary
- Author Affiliations : College of Medicine, University of Nebraska Medical Center, Omaha (Dr Geary); Center for Nursing Research and Practice, Advocate Aurora Health, Downers Grove, IL (Dr Hook); Sinclair School of Nursing, University of Missouri, Columbia (Dr Popejoy); School of Nursing, University at Buffalo, NY (Dr Hewner and Mss Smith and Pasek); Logica, Inc., Salt Lake City, UT (Dr Heerman Langford); and College of Nursing, University of Utah, Salt Lake City (Dr Heerman Langford)
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Monsen KA, Heermann Langford L, Bakken S, Dunn Lopez K. Standardized nursing terminologies come of age: advancing quality of care, population health, and health equity across the care continuum. J Am Med Inform Assoc 2023; 30:1757-1759. [PMID: 37855451 PMCID: PMC10586026 DOI: 10.1093/jamia/ocad173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Karen A Monsen
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Karen Dunn Lopez
- College of Nursing, University of Iowa, Iowa City, IA, United States
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Dunn Lopez K, Heermann Langford L, Kennedy R, McCormick K, Delaney CW, Alexander G, Englebright J, Carroll WM, Monsen KA. Future advancement of health care through standardized nursing terminologies: reflections from a Friends of the National Library of Medicine workshop honoring Virginia K. Saba. J Am Med Inform Assoc 2023; 30:1878-1884. [PMID: 37553233 PMCID: PMC10586049 DOI: 10.1093/jamia/ocad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To honor the legacy of nursing informatics pioneer and visionary, Dr. Virginia Saba, the Friends of the National Library of Medicine convened a group of international experts to reflect on Dr. Saba's contributions to nursing standardized nursing terminologies. PROCESS Experts led a day-and-a-half virtual update on nursing's sustained and rigorous efforts to develop and use valid, reliable, and computable standardized nursing terminologies over the past 5 decades. Over the course of the workshop, policymakers, industry leaders, and scholars discussed the successful use of standardized nursing terminologies, the potential for expanded use of these vetted tools to advance healthcare, and future needs and opportunities. In this article, we elaborate on this vision and key recommendations for continued and expanded adoption and use of standardized nursing terminologies across settings and systems with the goal of generating new knowledge that improves health. CONCLUSION Much of the promise that the original creators of standardized nursing terminologies envisioned has been achieved. Secondary analysis of clinical data using these terminologies has repeatedly demonstrated the value of nursing and nursing's data. With increased and widespread adoption, these achievements can be replicated across settings and systems.
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Affiliation(s)
- Karen Dunn Lopez
- Division of Acute and Critical Care, The University of Iowa, College of Nursing, Iowa City, IA, USA
| | | | | | | | | | - Greg Alexander
- Columbia University, School of Nursing, New York, NY, USA
| | | | - Whende M Carroll
- Healthcare Information Management and Systems Society (HIMSS), Chicago, IL, USA
| | - Karen A Monsen
- University of Minnesota School of Nursing, Minneapolis, MN, USA
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Backonja U, Langford LH, Mook PJ. How to Support the Nursing Informatics Leadership Pipeline: Recommendations for Nurse Leaders and Professional Organizations. Comput Inform Nurs 2022; 40:8-20. [PMID: 34996883 DOI: 10.1097/cin.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a need for nursing informatics leaders. However, there are not enough people educated and trained in informatics and leadership to fill that need. Therefore, the purpose of this study was to understand how professional organizations and nurse leaders support nursing informatics leadership development. This cross-sectional, descriptive study collected data via a scan of Web sites for eight nursing, informatics, and/or leadership professional organizations; interviews and surveys with nursing informatics leaders within the eight organizations; and a review of Web site, interview, and survey findings by nursing informatics leaders involved in leadership development. We found that nursing informatics leaders and professional organizations can support the nursing informatics leadership pipeline several ways. Examples included mentoring, education/training, and providing opportunities for networking and engagement in leadership roles. To help meet the need for nursing informatics leaders, professional organizations and current leaders can engage in various activities that provide training, education, and experiences for emerging leaders.
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Affiliation(s)
- Uba Backonja
- Author Affiliations: School of Nursing & Healthcare Leadership, University of Washington Tacoma (Dr Backonja); Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine (Dr Backonja), Seattle; Intermountain Healthcare (Dr Langford), Salt Lake City, UT; Nursing Informatics, College of Nursing, University of Utah (Dr Langford), Salt Lake City; and Atrium Health (Ms Mook), Charlotte, NC
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Affiliation(s)
- Susan A Matney
- Intermountain Healthcare, Salt Lake City, Utah, USA.,University of Utah College of Nursing, Salt Lake City, Utah, USA
| | - Laura Heermann Langford
- Intermountain Healthcare, Salt Lake City, Utah, USA.,University of Utah College of Nursing, Salt Lake City, Utah, USA
| | - Nancy Staggers
- University of Utah College of Nursing, Salt Lake City, Utah, USA
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McClay JC, Park PJ, Janczewski MG, Langford LH. Standard for improving emergency information interoperability: the HL7 data elements for emergency department systems. J Am Med Inform Assoc 2015; 22:529-35. [PMID: 25769684 DOI: 10.1093/jamia/ocu040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/02/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Emergency departments in the United States service over 130 million visits per year. The demands for information from these visits require interoperable data exchange standards. While multiple data exchange specifications are in use, none have undergone rigorous standards review. This paper describes the creation and balloting of the Health Level Seven (HL7) Data Elements for Emergency Department Systems (DEEDS). METHODS Existing data exchange specifications were collected and organized into categories reflecting the workflow of emergency care. The concepts were then mapped to existing standards for vocabulary, data types, and the HL7 information model. The HL7 community then processed the specification through the normal balloting process addressing all comments and concerns. The resulting specification was then submitted for publication as an HL7 informational standard. RESULTS The resulting specification contains 525 concepts related to emergency care required for operations and reporting to external agencies. An additional 200 of the most commonly ordered laboratory tests were included. Each concept was given a unique identifier and mapped to Logical Observation Identifiers, Names, and Codes (LOINC). HL7 standard data types were applied. DISCUSSION The HL7 DEEDS specification represents the first set of common ED related data elements to undergo rigorous standards development. The availability of this standard will contribute to improved interoperability of emergency care data.
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Affiliation(s)
- James C McClay
- Department of Emergency Medicine, University of Nebraska Medical Center, 981150 Nebraska Medical Center, Omaha, NE 68198-1150, USA
| | - Peter J Park
- Department of Emergency Medicine, Naval Medical Center San Diego (NMCSD), 4170 Norman Scott Rd., Bldg 3232, San Diego, CA 92136-5597, USA
| | - Mark G Janczewski
- Medical Networks, L.L.C., 438 Holly Road, Annandale, VA 22003-1266, USA
| | - Laura Heermann Langford
- Homer Warner Center for Informatics Research, Intermountain Healthcare, South Office Building, 2nd Floor, 5171 South Cottonwood Street, Salt Lake City, UT 84107, USA
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Harris MR, Langford LH, Miller H, Hook M, Dykes PC, Matney SA. Harmonizing and extending standards from a domain-specific and bottom-up approach: an example from development through use in clinical applications. J Am Med Inform Assoc 2015; 22:545-52. [DOI: 10.1093/jamia/ocu020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/02/2014] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective Currently, the processes for harmonizing and extending standards by leveraging the knowledge within local documentation artifacts are not well described. We describe a collaborative project to develop common information models, terminology bindings, and term definitions based on nursing documentation systems, and carry the findings through to the adoption in standards development organizations (SDOs) and technical implementations in clinical applications.
Materials and Methods Nursing flowsheet documents from six large organizations were analyzed to generate a common information model and terminologies that fully expressed documentation across all systems, and were sufficient for evidence-based decision support, reporting, and analysis.
Results Significant gaps in existing standards were identified. The models and terminologies were submitted to and incorporated by SDOs, are published, implemented, and now serving as a foundation for an eMeasure.
Discussion There are few examples in the literature of success working through the standards development process from a bottom-up perspective. Subsequently, standards do not yet fully address the need for detailed clinical data that enables, for example, decision support as well as a range of reporting and analytic requirements. Recommendations from this project include transparent processes within SDOs, registries that make models and associated terminologies freely available, and coordinated governance processes.
Conclusion We demonstrated the feasibility of using documentation artifacts in a bottom-up approach to develop common models and sets of terms that are complete from the perspective of clinical implementation. Importantly, we demonstrated a process by which a community of practice can contribute to closing gaps in existing standards using SDO processes.
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Affiliation(s)
- Marcelline R Harris
- Department of Systems Leadership and Effectiveness Science, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Laura Heermann Langford
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Holly Miller
- Terminology Division, Knowledge Based Systems, Veterans Health Administration Office of Informatics and Analytics, Salt Lake City, UT, USA
| | - Mary Hook
- Knowledge-Based Nursing Department, Aurora Health System, Milwaukee, WI, USA
| | - Patricia C Dykes
- Center for Nursing Excellence, Harvard Medical School, Boston, MA, USA
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Abstract
OBJECTIVE This paper describes Health Level 7 (HL7) V.3 Care Transfer, Care Record Query, and Care Record messages. This is the core of the Care Provision Domain in the HL7 standard which became normative at the end of 2012 and is an American National Standards Institute (ANSI)-approved HL7 standard. BACKGROUND AND SIGNIFICANCE Using a message is somewhat different from the approach offered in the current HL7 Clinical Document Architecture (CDA). The overall advantage is human-to-human communication and system-to-system processing of structured data through electronic messages, supporting continuity of care and interactive structured data exchange through querying. MATERIALS AND METHODS The Care Provision Domain Model in HL7 was developed based on use cases from several projects internationally. Use case and information analysis, model building, HL7 consensus methods (eg, working group meetings), conference calls, balloting, a draft standard for trial use, pilot implementations, and subsequent evaluation were applied. RESULTS The membership and pilot implementers gave feedback to improve the draft standard. After the formal ballot process, HL7 membership accepted it as a normative standard and it is now ANSI approved. The Care Provision Domain Model defines the structure (data exchanged) and dynamics (workflow and communications) of the Care Record, Care Record Query, and Care Transfer. DISCUSSION AND CONCLUSIONS The HL7 V3 Care Provision Domain differs from the HL7 CDA regarding support of the dynamics of care (eg, for continuity of care) as provided through a series of interactions and queries, but is similar with respect to the data and their organization.
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Affiliation(s)
- William Goossen
- Patient Care Work Group, Health Level 7 International, Ann Arbor, MI, USA Results 4 Care, Amersfoort, The Netherlands
| | - Laura Heermann Langford
- Patient Care Work Group, Health Level 7 International, Ann Arbor, MI, USA Homer Warner Center for Informatics Research, Intermountain Healthcare and College of Nursing, University of Utah, Salt Lake City, Utah, USA
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McClay J, Park P, Marr SD, Langford LH. The HL7 standards-based model of emergency care information. Stud Health Technol Inform 2013; 192:1180. [PMID: 23920954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Electronic medical record interoperability remains an elusive goal for the clinical informatics community. The HL7 Emergency Care Workgroup created an emergency care domain analysis model that organizes existing HL7 standards into a clinician friendly information model. The model supports the capture of domain knowledge and encoding in a sharable format. The result is a domain information model that supports interoperability of information and processes in diverse Emergency Department information systems.
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Affiliation(s)
- James McClay
- University of Nebraska Medical Center, Omaha, NE, USA
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