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

Notes (i) from Paipa Conference: Q & A and sessions

Questions from the delegates (once more interpreted by Andrea Ramirez) at the plenary session on Friday 25th February included  - with my response (extended here):

Q. Could you please give some specific examples of the model's application and its achievements?

A. The model was created by Brian Hodges to facilitate reflective practice and encourage holistic care - especially balancing physical and mental health - psychological - care. In the mid-1980s the model was used in several locations in England and the Isle of Man. The model was taught and learning assessed through case studies in community mental health nursing, learning disability and health visiting.

As highlighted in the presentation unlike other models of care h2cm has not had the benefit of specific research. The models of care we use must be evidenced based. The website and blog represent a call for research in the health care domains model. This is why I appreciate so much this invitation to Colombia and being able to present what I believe is a very useful and increasingly relevant care resource.

In terms of achievement there are an as yet limited number of papers published and listed on the blog in a bibliography.

A couple of individuals have contacted me for advice on using the model in academic work, which has also been posted on the blog (see application).

In my presentation and the plenary I did not mention the planned workshop in the afternoon!

Q. What has been the experience of applying the model in the practice (clinical area) and in the community?

A. The model is used in two centers for forensic psychiatry (low and medium secure) where the inclusion of the interpersonal and political care domains are pivotal in the tensions between the custodial context and need for person-centred nursing care that arise.

In forensic nursing the model informs care philosophy and is also represented in care documentation. A paper is in production describing the model and this application.

The model is I understand being used in a research project investigating bullying within midwifery. I will post more details on this when I have them. The researchers approached me seeking permission to use the model, I indicated the model's origin - as in "It is not 'mine'", and furnished a letter indicating the model's status. I understand the appeal of the model in this instance may be in scoping the research project.

Currently the model is helping me in my role (as a Nursing Home Liaison Specialist) to plan and deliver education sessions to residential care staff on communicating with people who are coping with dementia.

Being simple in structure and basic content once learned the model is accessible as an aide memoire, while you are assessing, planning and evaluating.

I have also used the model when working on informatics projects, as the model can help integrate the SOCIAL and TECHNICAL aspects of ICT.

More Q and A to follow plus photos.

Presentation(s) at 1st Int. Congress of Nursing Models and Theories in Colombia

I will revise this post over the coming week and add more, including one of the Spanish slides.

Many thanks to Danny Eduardo Rodriguez for meeting me at the airport (and to everyone who waited  with Eduardo). Hearing my name and seeing the university transport proved instantly reassuring. Thanks also Eduardo for the in-session translation - a great help and for your efforts to ensure I felt at home and a part of things: I certainly did. ... 

Well I am due to leave Paipa soon for Bogota El Dorado airport and the trip home via Paris. It is a beautiful day in Paipa. Very warm, bright sun, from my room I can see people water skiing on the lake.


Yesterday's presentation, workshop and Q and A session were very well received through a lecture and workshop. These would not have been as successful with the brilliant work* of Interpreter Andrea Ramirez on both occasions.
I had started to add some Spanish translations to my slides and these were checked and extended by Luz Stella Saray and Prof. Wilson Canon Montanez, (UDeS) to whom I extend sincere thanks (a good photographer too!).


In the morning session Andrea related each slide in Spanish after my account. For the workshop I had emailed the case study in English with a Spanish version c/o Google translate. This had been checked and improved and the format we followed was for students to read the case study and then individually draw out the aspects of Alice's case (fictitious yet based on 20+ years of experience) which they feel significant across the care domains. During this exercise for 20-25 minutes Andrea assisted again with some questions from individual students. Then in groups of 4-5 they collectively reflected on their 'results'. Finally each group in turn offered one item for each of the four domains. Astute questions from the floor and discussions followed. Not having done this before, with the addition of translation I was surprised at how well it worked: instant teamwork!

At 5.30 Luz had arranged to meet to discuss nursing in England. A little jet-lagged, I thought she meant with 2-3 colleagues, but in the end the room was filled as we were joined by 60-70 students in a circle. I can't believe that 90 minutes passed. The students and faculty are so very enthusiastic, charming, friendly and knowledgeable. Two days is not long to learn and make judgements, but from the student's questions they seem acutely aware of the specific health challenges and issues they face in Colombia. Their professor's approach in pursuing this meeting reflected an awareness of 'nursing as it is learned and practiced elsewhere'. I advised I was not able to speak generally, outlining my specific role and location. I let them know I was drawing from matters I do know (as highlighted on W2tQ) and personal experience. The notion of 'basic nursing care' is clearly and unsurprisingly universal given this encounter.

You do need to consider such travel very carefully: your health, security, travelling alone... The organisers took care of this assuring a personal meeting at the airport, transport and accommodation. The journey was hard for me from the UK. A short hop Manchester to Paris 1.15-30 was followed by an 11 hr and 10 hr flight back home passing through Bogota. Travel is difficult due to the condition of the roads, driving laws and the traffic situation that the populous of Bogota faces; but where there are 'gaps' (pot holes!) there is a way through.

I never would have believed I would set foot in South America. To stand under Orion and see Canopus was another dream come true. As Space Shuttle Discovery set off on her last flight I was making discoveries of my own in helping others do the same.

I am very grateful to GICS - the three Universities UPTC, UdeS and Unillanos who invited me and supported my attendance; plus my employer Lancashire Care NHS Foundation Trust and colleagues covering duty for new referrals at the Beechurst Unit, Chorley, Lancashire. This has been a marvellous experience, with many contacts made that I hope will grow in the future.

*Presenting in Spanish at the conference (Teoría “Marco de la Organización Sistémica” con enfoque en Familia), Dr Marie Luise Friedemann - RN, PHD and her husband informed me of Andrea's effectiveness and memory feat. Dr Friedemann, Profesora de la Universidad Internacional de la Florida, in Miami and I also hope to compare our respective interests.