1. Nursing Knowledge Model Susan Matney, MSN, PhD(c), RN-C, FAAN Informaticist 3M Health Information Systems Chair SNOMED CT Nursing Special Interest Group Chair Clinical LOINC nursing Subcommittee Nursing Knowledge: Big Data Research for Transforming Healthcare

2. Purpose Define knowledge model Demonstrate nursing knowledge models Historical Electronic Discuss the data and information required to support an electronic nursing knowledge model

3. Nursing Knowledge Knowledge Translation: The exchange, synthesis and application of knowledge within a complex system. Knowledge Transfer: A systematic approach to capture, collect and share tacit knowledge in order for it to become explicit knowledge. Knowledge Model: The capture of knowledge in an electronic reusable format for the purpose of preserving, improving, sharing, aggregating and reapplying it. Knowledge Translation: The exchange, synthesis and application of knowledge within a complex system. Knowledge Transfer: A systematic approach to capture, collect and share tacit knowledge in order for it to become explicit knowledge. Knowledge Model: The capture of knowledge in an electronic reusable format for the purpose of preserving, improving, sharing, aggregating and reapplying it.

4. The Nursing Process

5. Nursing Informatics DIKW Framework ANA, 2007

6. CAUSES REASON FOR Care Plan Relationships (Happy Path Health Concern [mood EVN] Goal [mood GOL] Outcome Observation [mood EVN] Intervention [mood: INT/ RQO/ etc.] [mood: EVN] SUPPORTS Observation [mood EVN] RELATES TO IS COMPONENT OF EVALUATES

7. Storyboard Example Joe is a 24 year-old male quadriplegic admitted to an inpatient unit from his home. During admission assessment, the nurse notes that he has no sensation from the shoulders down. He is confined to a wheelchair and requires two- person assist. His skin is occasionally moist. Joe reports that he is a “good eater” and is on a normal diet. The nurse completes the Braden Skin Scale score is 13. Further assessment by the nurse reveals skin is intact with no pressure ulcers. Hx. Subjective Findings Setting Assessment Observations

8. CAUSES REASON FOR Simple Skin Assessment (Happy Path) Health Concerns: Impaired mobility Risk for alteration in skin Integrity Goal: No skin breakdown Outcome Observation Interventions: Turn q 4 hours Assess skin q shift SUPPORTS Observations: Decreased Sensation Limited Mobility Braden scale = 13 RELATES TO IS COMPONENT OF EVALUATES

9. Interoperability using the DIKW Framework

10. Skin Assessment

11. Interoperability using the DIKW Framework

12. Terminology Coding 12 TypeTextTerminologyCodeFully Specified Name QuestionSkin MoistureLOINC39129-2Moisture:Type:PT:Skin:Nom:: ValueDiaphoreticSNOMED CT52613005excessive sweating (finding) ValueMoistSNOMED CT16514006moist skin (finding) ValueClammySNOMED CT102598000clammy skin (finding) QuestionSkin TemperatureLOINC44968-6Temperature:Type:PT:Skin:Ord:Palp ValueConsistent With Body TemperatureSNOMED CT297977002Skin normal temperature (finding) ValueWarmSNOMED CT102599008warm skin (finding) ValueCoolSNOMED CT427733005cool skin (finding) QuestionSkin TurgorLOINC39109-4Turgor:Imp:PT:Skin:Nom:: ValueGood Elasticity (normal)SNOMED CT297956000skin turgor normal (finding) ValueDecreased Elasticity (Poor)SNOMED CT425244000decreased skin turgor (finding) ValueTentingSNOMED CT297957009stretched skin (finding)

13. Key drivers in enabling knowledge model  Knowledge exists in paper - Care plans  Knowledge exists in vended EHRs (non standardized)  Structured Nursing Knowledge beginning to emerge (e.g. Pressure Ulcer Models)  Standardized terminology  SNOMED CT, LOINC, RxNORM, CPT, ICD-10-CM  HIT standards  HL7, ONC, PHIN-VADS, VSAC

14. NURSING IS VISIBLE Vision of the Future In Health Information Systems NURSING DATA ARE AVAILABLE To Promote Evidence-Based, Quality Nursing Practice

15. Questions? samatney@mmm.com