1. Actionable Barriers and Gaps: Nursing Initiatives Bonnie L. Westra, PhD, RN, FAAN Associate Professor, University of Minnesota School of Nursing Director, Center for Nursing Informatics Nursing Knowledge: Big Data Research for Transforming Healthcare

2. Purpose Identify gaps, barriers, and challenges to achieving the vision and value of nursing data for big data research to transform healthcare. Describe resources for closing gaps and overcoming barriers to Evaluate recommendations for usefulness in the action plan

3. Standardized Terminologies 3

4. Minimum Data Sets & Nursing Nursing Care Elements 1. Nursing Diagnoses 2. Nursing Interventions 3. Nursing Outcomes 4. Nursing Intensity of Care Patient Demographics 5. * Personal Identification 6. * Date of Birth 7. * Sex 8. * Race 9. * Ethnicity 10. * Residence Service 11. * Unique facility or agency number 12. Unique number of principle RN 13. * Episode Admission or Encounter Date 14. * Discharge or Termination Date 15. * Disposition of patient or client 16. * Expected payer for this bill Environment 1. Unit/Service Unique Identifier * 2. Type Of Nursing Delivery Unit/Service 3. Patient/Client Population 4. Volume Of Nursing Delivery Unit/Service 5. Care Delivery Structure And Outcomes 6. Patient/Client Accessibility 7. Clinical Decision Making Complexity 8. Environmental Complexity 9. Autonomy 10. Nursing Delivery Unit/Service Accreditation Nurse Resources 11. Management Demographic Profile 12. Staff Demographic Profile 13. Staffing 14. Satisfaction Financial Resources 15. Payer Type * 16. Reimbursement 17. Nursing Delivery Unit/Service Budget 18. Expenses

5. Health Information Exchange 5

6. Criteria for a NIS Nomenclature Clinical Content Data Repository General Systems Characteristics ANA (1997). NIDSEC (Nursing Information & Data Set Evaluation Center): Standards and Scoring Guidelines. ANA: Washington, DC.

9. 9 Clinical Data Repository/ Warehouse Clinical Data NMDS Management Data NMMDS Other Data Sets Continuum of Care

10. NDNQI Strengths National nursing quality measurement program Hospital with unit-level performance comparison Reflects structure, process, and outcomes Limitations Not reusing EHR data Hospital focused Not comprehensive

12. Faculty Preparation Essentials Bacalaureate Master’s Doctor in Nursing Practice

13. Informatics Certification Future – Advanced Certification – AMIA working on this

14. Informatics Organizations Also many local nursing informatics organizations

15. Actionable Barriers and Gaps: Nursing Initiatives Judith J. Warren, PhD, RN, FAAN, FACMI Consultant Warren Associates, LLC Nursing Knowledge: Big Data Research for Transforming Healthcare

16. Transforming NDNQI into eMeasures Feasibility studies with partners to extract information from EHRs

17. Continuity of Care Document Required through health care reform Does a great job of communicating physician care and reimbursement issues Does a partial job of communicating nursing care and patient status on discharge Many patient issues that lead to readmission within 30 days are issues addressed by nursing care C-HOBIC in Canada Need to add patient information of concern to nursing practice to CCD

18. S&I Framework Working on Care Plan specifications Scope and attention to the work will be driving EHR design, build and implementation Need more nurses involved

19. Funding for big data research Clinical and Translational Science Awards Consortium Big Data analytics Implementation Science

20. Standard Occupational Classification (SOC) Codes Used to classify workers for the collecting, calculating, or disseminating data. The SOC code for Registered Nurses is 29-1141 Need informatics nurse code to demonstrate need and support education program support

21. National Provider Identifier Solution to unique nurse identifier in the NMDS and MMDS Must encourage every nurse to apply upon licensure

22. Nurses in Decision-making Circles Office of the National Coordinator National Committee on Vital and Health Statistics CMS Panels NQF committees and panels IOM S&I Framework HL7 IHTSDO and LOINC Other committees and Task Forces???????

23. Actionable Barriers and Gaps: Recommendations Bonnie L. Westra, PhD, RN, FAAN and Judith J. Warren, PhD, RN, FAAN, FACMI Nursing Knowledge: Big Data Research for Transforming Healthcare

24. Recommendations Survey health systems about perceived value and current use of standardized nursing terminologies for documentation, quality improvement, and research Create a central resource for mapping nursing data to terminologies – particularly assessments, interventions, and outcomes. Centralize mappings through the NLM Work with vendors to include standardized nursing terminologies, eliminating the need for each health system to map local codes to standards Require coding in information systems to be consistent with the NMDS/ NMMDS data elements – new nursing knowledge model Integrate the NIDSEC criteria into meaningful use certification criteria of EHRs

25. Recommendations Add a criteria for Magnet Status to integrate standardized nursing terminologies in EHRs and reuse the data for quality reporting Expand the NDNQI criteria to include data across settings and to use standardized nursing terminologies/ minimum data sets Share the nursing knowledge model across CTSAs to include in their CDRs Support strategies to educate all faculty about how to teach nursing informatics across levels of education Empower with nurse informaticians to value and advocate for standardized nursing terminologies and the value of these Develop strategies to work with nursing organizations on a common set of goals and consistent reporting on progress