NIH: Suggest social justice items for Electronic Health Records

My source: Spirit of 1848 list [The collaborative tool is very interesting]
Let's make suggestions for inclusion of social justice factors in Electronic Health Records by participating in the NIH activity described below.

Dear colleague,

Your input is requested to help make recommendations for a standardized set of patient-reported variables to be collected in primary care and public health electronic health records (EHRs), which will lead to unprecedented data harmonization and opportunities for health research. In order to participate in this process:

• Please visit the website for the collaborative tool: www.gem-beta.org
• Click on the blue button at the top titled "EHR Campaign." Or alternatively, click on the News tab and then the associated EHR campaign title.
• Read the summary statements written by the expert panels
• Enter your comments on the recommended measures, and if needed, suggest alternative measures (see attachment for detailed instructions).
• Forward this request to your colleagues who may be interested in this initiative

Comments will be accepted through April 4, 2011.

Background about this Collaborative Effort

Several institutes within the National Institutes of Health in collaboration with the Society of Behavioral Medicine are coordinating an effort to identify a core set of brief, practical measures to recommend for use in adult primary care and public health electronic health records (EHRs), and we are inviting you and all members of your affiliated organizations to join this collaborative effort.

The HITECH Act and the Patient Protection and Affordable Care Act place new emphasis on the widespread and meaningful use of electronic health records (EHRs). This is an important advance, with one significant exception: Currently EHRs fail to capture data reflecting crucial health behaviors and psychosocial issues. Such patient-reported variables are both health outcomes themselves, and major determinants of other health outcomes.

To address the critical need for patient-reported data, we are organizing an effort to evaluate and recommend actionable, patient-reported measures of health behaviors and psychosocial factors for use in electronic health records (EHRs) within adult primary care and public health settings. In order to facilitate broad participation in the development of standard measures we are using a three-phase process of consensus building.

In the first phase panels of subject matter experts were convened for each of 13 behavioral domains to review available measures and to recommend up to 4 reliable, practical measures for each domain that would be appropriate to utilize in primary care and public health settings and to be reported in EHRs.

*Your input is being requested for the second and third phases of the project.*

For the second phase we are using the NCIs Grid-Enabled Measures (GEM) Database to gather feedback from all stakeholders. In order to participate in this process, please visit the GEM website, www.gem-beta.org, and click on the blue button at the top titled "EHR Campaign." Or alternatively, click on the News tab and the associated header for the EHR campaign. Begin by reading the summary statements written by the expert panels, view the recommended measures, enter your comments on the recommended measures, and if needed, suggest alternative measures. Comments will be accepted through April 4, 2011.

The third phase will be a workshop/town hall meeting on May 2, 2011 at the NIH bringing together scientists, practitioners, policy makers, and patient/consumer representatives to review the results of this campaign and make recommendations on standard consensus measures for behavioral health and health behavior screening in primary care and public health settings. We encourage everyone interested in this effort to participate, and more information about this meeting will be forthcoming. Immediately following this workshop there will be a closed session meeting of key stakeholders to make final recommendations based on feedback obtained from the GEM tool and the open meeting.

Workshop participants will receive a summary of the meeting as well as information on final recommendations. Subsequent to the meeting, organizers and key stakeholders will discuss strategies to build support and implement plans to advance the adoption and incorporation of a core set of patient-reported behavioral and psychosocial measures in primary care and public health EHRs.

We truly thank you for your participation in this project to standardize the collection of behavioral data in EHRs because it will enable the collaborative group to put forth the best possible recommendations and ultimately improve patient outcomes.

Sincerely,

The EHR Measures Meeting Planning Committee
Maureen P Boyle, Ph.D.
AAAS Science and Technology Policy Fellow
Office of Behavioral and Social Sciences Research
Office of the Director, NIH
31 Center Drive, Building 31, Room B1-C19; MSC 2027
Bethesda, MD 20892-2027

compose, direct, conduct and 'dilute to taste' outcomes

In Drupal musings 12 I mentioned that the classification of nursing practice is not necessarily at the forefront of nursing's mind set against the turbulence and rush of clinical areas.* This is especially so at the moment as nurses on wards, clinics and community try to identify savings.

I am interested in classification in part as this is the raison d'être for the health career model; on a mental (cognitive) level, in practice and potentially in virtual representations of health care activities. For learners it is an extra to hold the bicycle saddle for those first turns of the pedals. Additionally, for those who have completed many rides and races (lifelong learners) they can reflect on how they got there, and plan for the next round.

As a conceptual framework then h2cm is, like classification, in the background. The model can help to compose, direct and conduct (c-d-c) nursing (health and social) care. Classification matters to ALL nurses because we need to know not only the c-d-c of nursing but the outcomes too.

If all the above is in the background, then together with classification the health career model can help differentiate nursing as a discipline and make nursing visible. We can only take heed of the adage "divide and conquer" by being able to differentiate nursing from other disciplinary contributions. Then perhaps we can truly identify and so define the facets of integrated, interprofessional and multidisciplinary care that must also be person-centred. As nurses and the team respond to the individual's trauma (assault, illness, chronic disease ...), they can also assure their combined values, which must be defined and articulated if there is to be a unified philosophy.

If the respective professions have not noticed (I am sure they have) 'professionalism' is itself under assault in terms of unique knowledge and skills, respect, power and status. To a degree this a good thing. It is also called 'progress': countering restrictive practices, improving service access and challenging institutionalised and state paternalism. Professionalism is accorded for reasons of accountability, education, responsibility, integrity and advocacy. Amid the public (mental) health disaster that we face - the professions - are needed more than ever and if the assault is taken too far ... ?

* Should you know of examples where classification IS at the forefront of nursing practice please let me know - h2cmng @ yahoo.co.uk.

Drupal musings 13: Packaged care and modules

Although I do not need to sit at the front for presentations anymore, I did so at Drupalcon as the electricity plugs were few and forward. There was a bonus. Being in the right place... I picked up a free book c/o Packt Publishing who were among the exhibitors and valued sponsors. The book is Michael Peacock's Social Networking (don't panic I'm not going to review it!). Since returning from Copenhagen I've been using Drupal 6 and 7 on a daily basis. Checking just what some of the key modules, such as Taxonomy, Taxonomy Manager, and Groups have to offer. What are the configuration options and how well do modules integrate?

In the book Michael lists the Drupal modules he relies on to create a site worthy of the book's title. He explains that many modules are themselves 'packaged' for example - the Activity module:

Activity: Activity
Activity: Activity history
Activity: Comment activity
Activity: Node activity
Activity: OG# activity (#organic groups) p.140

This highlights the multifunctional capability of modules which leads me to wonder* about what functionality might be found in future modules:

Intrapersonal: Communication Intrapersonal: Mood Intrapersonal: Cognition Intrapersonal: Diagnosis Intrapersonal: Interests Intrapersonal: Risk Intrapersonal: Skills-Education	Sciences: Observations Sciences: Physical attributes Sciences: Mobility Sciences: Nutrition Sciences: Diagnosis Sciences: Physical safety
Sociology: Relationships Sociology: Ethnicity Sociology: Interests Sociology: Religion Sociology: Carer assessment	Political: Marital status Political: Employment Political: Benefits-Welfare Political: Capacity Political: Autonomy Political: Mental Health Act status

Further news:
The new PC is ordered 10-12 days until its arrival. Yes, I could go DIY, but I'm busy.

This Saturday evening I will have some 4-5 hours with the client of the basic Drupal 6 site. Very much looking forward to that. Must remember KISS!

*Not necessarily an actual proposal!

Drupal musings 12: Semantic Web, ICNP, Case studies and Care domains

Drupalcon 2010 Copenhagen is over for me. It's been a really useful week: awesome indeed. My head is dizzy with all the options, sources and resources to consider. I will contact the London Drupalcon group for 2011 with some suggestions regards beginners, networking and outreach.

Ever since setting off on the Drupal road, the semantic web has been a constant item of street furniture. In Szeged '08, Paris last year and this past week in Copenhagen the semantic web, RDF and terminologies have had a pivotal presence. I did not attend all the rdf / SW sessions but Wednesday's Semantic Terminologies was sit on the floor popular (even though at that point the program hit a bottleneck from 6 to 3 streams). Whatever the cause - I was there, late and my pivot ached (no padding!).

As a Drupal 7 prelude I'm creating a Drupal 6 site, a basic homepage for someone. The content for the latter is fixed - sorted. Apart from the pages for the archive, the new h2cm content involves me figuring out how to combine:

1. the health career model;
2. nursing - in theory and practice;
3. external sources and resources;
4. and Drupal.

Johannes Wehner's terminology session above did not emphasize RDF, but highlighted Open Linked Data by means of Open Calais as a tool to extend existing content. I've downloaded the Drupal OC module and obtained a key.

As for the list: #1 The health career model is straight forward really. Four care domains - get on with it! From there though it is quite a reach to encompass #2 & #3. My options appear to be:

• free tagging, auto tagging - let the users of the site decide;
• pre-define a data set, a terminology (classification) for the health career model;
• use an existing nursing classification / terminology scheme - perhaps a subset.
  

Before I decide I need to be aware of what is available. I e-mailed Derek Hoy in Scotland - contact for the International Classification for Nursing Practice® [ICNP]. This is another thing I pick up, put down. ... Now thanks to Derek I'm sorted now with ICNP downloaded (and I will need a module to import .csv files). There are videos on the ICNP website.

I have followed the development of nursing terminologies for quite some time. The most striking thing to me is how removed they are from the day-to-night life on wards and other care encounter situations. With mental health as a Cinderella in terms of the politics and recognition of nursing service provision I am in effect professionally twice removed. For the vast majority of nurses on the ground and from where I work in community mental health the ICNP, SNOMED CT, Omaha and other schemes are rather esoteric things. They are there in the background, part of management and reporting 'function'. This is not to say that the above initiatives have few followers, or lacks experts in this field. Make no mistake nursing has its own geeks, nursing classification its experts!

The scope of ICNP makes it a great candidate (from the website) -

Diagnosis/outcome

Interventions

Individual 7 axes

1. focus
2. action
3. client
4. judgement
5. location
6. means
7. time

Plus:

• it's International;
• it's by nurses, for nurses;
• it has momentum (political and financial support);
• So it is credible, and research based.

Despite this, I must take a critical look at what is available for my needs and time available. All the above provide way too much for a first bash - prototype, proof of concept. I have the luxury of not worrying about safety. My project does not constitute an electronic health record or other variant. Yes, I want to prove the health career model and to this end I must also find or create several nursing case studies to interrogate within Drupal and h2cm.

Perhaps as things improve economically, nursing classification will be revived and will allowed the time to fully mature? I recall in 2006 plans to explore mental health within SNOMED which unfortunately did not materialise. So, when I say mature, I mean like cheese in the holistic senses of the ingredients: nursing care concepts across contexts that also incorporate self-care, recovery, demographic trends ...; and the process across communities of practice (integrated care) through to academic and management applications - research / reporting.

In March 2010 plans were announced of plans to harmonize the efforts of the ICNP and SNOMED CT nursing:

http://www.ihtsdo.org/nc/about-ihtsdo/harmonization/icn/?sword_list[]=nursing

So, with a possible jumpstart - a sprint for my site this autumn in Manchester, UK and work afoot to make nursing classification matter on the 'ground' there is more to follow on several fronts. ... I remember a presentation Derek did in the 1990s about classification and making nursing visible - let's do it!

contact: h2cmng @ yahoo.co.uk

International Journal of Integrated Care

Dear IJIC reader,

Recently PUBLISHED in the International Journal of Integrated Care

A Research and Theory paper:

An evaluation of SNOMED CT® in the domain of complex chronic conditions,
by Tara Sampalli, Michael Shepherd, Jack Duffy and Roy Fox

… It is the hypothesis of this work that showing the availability of multidisciplinary concepts for one complex condition can generate a similar expectation of available terms for other chronic conditions …

A policy paper:

Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management,
by Nick Goodwin and Simon Lawton-Smith

… the lesson from the CPA experience suggests that there is potential for better care integration to be had in a strategy based on personalised care planning and investment in care co-ordination for people with chronic and sometimes complex needs …

And a book review:

Managing transition. Support for individuals at key point of change, edited
by Alison Petch and reviewed by AnneLoes van Staa

…This book is unique in its broad focus on different transitions in various contexts, and its exploration of the evidence for support given to people who risk getting ‘lost in transition’. This makes this publication highly interesting to readers of the International Journal of Integrated Care …

The IJIC journal is freely available at: http://www.ijic.org/

10th INTERNATIONAL INTEGRATED CARE CONFERENCE

“All together now: Exploring the Many Faces and Facets of Integrated Care”,
Tampere Finland, June 16-18, 2010.

The INIC Conference 2010 will make an effort to look at and evaluate the challenges and status quo of mutual many-faceted collaboration of integrated care from the point of view of benefits to patients, service users and carers. The annual conferences offer an ideal meeting place for the integrated care community to discuss recent developments and future challenges across systems and continents.

On the website you can find more information on the keynote speakers, the pre-conference and site-visits, the program of the conference and the parallel sessions.

Visit the conference website at: http://www.integratedcare.org for more information and registration.

Thanks for the continuing interest in our work.

Erika Manten
Managing editor IJIC
ijic at uu.nl
___________________________________________________
Erika Manten - Managing editor International Journal of Integrated Care,
http://www.ijic.org/ - IJIC Editorial office: Igitur, Utrecht Publishing &
Archiving Services, University Library Utrecht, P.O. Box 80124, 3508 TC
Utrecht, The Netherlands.

MCQ (answer) on clinical coding and classification

The answer to the multiple choice question is item 4:

- a product of the 18th century driven by death?

François Bossier de Lacroix (1706-1777*), better known as Sauvages, is credited with the first attempt to classify diseases systematically.

Sauvages' comprehensive treatise was published under the title Nosologia methodica.

A contemporary of Sauvages was the great methodologist Linnaeus (1707-1778), one of whose treatises was entitled Genera morborum.

Beginning of the 19th century, the classification of disease in most general use was one by William Cullen (1710-1790), of Edinburgh, published in 1785 under the title Synopsis nosologiae methodicae.

My source:
http://www.who.int/classifications/icd/en/HistoryOfICD.pdf

* I note sources that record Sauvage's year of death as 1767.
http://www.persee.fr/web/revues/home/prescript/article/rhs_0048-7996_1969_num_22_4_2601

MCQ (question) on clinical coding and classification

Q. The development of clinical coding and classification systems, such as International Classification of Diseases (ICD) is …

1. a manifestation, since the 1960s, of health care specialisation and technology in medicine?
2. a product of the National Programme for Information Technology and the International Health Terminology Standards Development Organisation (IHTSDO)?
3. a product of Körner statistics and resource management in the 1990s?
4. a product of the 18th century driven by death?
5. an international initiative prompted by The Plague and launched by Dr Who?

Answer and further reading to follow next month.

Evidence Hodges' model #1: Research in Nursing

When as a nurse (OT, physio, medic....) you are on a course, especially one about research you may be required to complete a study or more significant piece of research. Courses at graduate and post graduate level invariably include such demands and stress the hope that this course will spur you to continue the research effort in the work place. The ideal is of course to routinise research in clinical settings. Whatever the debate regarding the merits of evidence-based nursing, medicine and so on, this still needs to happen in part to help bridge the theory - practice gap.


In the same way all nurses have a professional responsibility to educate their student peers, (patients and carers...) there is an expectation that nurses are like embedded media commentators in a war zone. Part of your time in practice will be devoted to research, audit and governance.

While there are audit and governance teams there willing to help, many people multi-task in their work and nurses are seasoned practitioners. Many just want to do what they were trained for and nurse. They recognize this as they hear the expectations of the course leaders, lecturers and yet they are aware of the constraints. The scope for research is weighed against other commitments, notably:

• direct(ing) patient care and safety
• management and supervision
• audit duties for management information

There are of course a host of psychosocial influences that come into play. What is my personal interest in research? Where do I prefer to be at work: office, ward, or home or retired? Cynical? No! Just being realistic. The information systems frequently in place can assist as a research tool, but their chief role is to provide management information through the collation of aggregated data. This is done by-and-large transparently in the background ('back-end'), and that is the problem. Nurses need to get their feet wet. The option must be there, and not just when on courses. Nurses need to immerse themselves in the data and information streams they help to create and source.

As the list above suggests nurses and not just senior nurses need direct access to the icon labelled 'reports'. There should be ways for nursing work to be captured in-situ, but how? Many clinical information system vendors have their solutions to this, but as regular readers know for a long time I've been wondering about -

1. How can the balance between management data and intelligence needs and clinical needs be supported and bridged?*
   
2. What is the evidence base to support Hodges' model in theory, practice, management and policy?
3. What is the state, characteristics, access and usability of nursing terminology, taxonomy, classification systems in informatics - information and communication systems?
4. If I am individually compelled (nuts!) to create a new website could I ally this aim with a course?

More to follow - including some of the sessions at Drupalcon Paris.....

*To this list we also need to add other stakeholders - members of the public.

Additional links:
http://www.icn.ch/icnp.htm

Image sources:
Mind the gap: http://ci.coe.uni.edu/facstaff/zeitz/web/itag/mindthegap/
Report icon: http://artistsvalley.deviantart.com/art/Free-Task-Icons-Reports-Icons-89509953