WEEK 11: Nursing Informatics in Canada

🇨🇦

Information & Communication Technology

ICT

1. Active dissemination of relevant information

2. Provision of opportunities for informatics education

3. Development of entry to practice competencies

4. Promotion and deployment of nursing data standards

5. Development of a national nursing report

Collective efforts of several professional Canadian nursing organizations (CNA, ACEN, CASN, CNIA) include:

right

One of the things that make the Canadian healthcare system unique is the belief in health as a _____ rather than a privilege or an economic commodity.

Canada Health Act

This philosophy is reflected in the principles upon which the provincial and territorial health systems in Canada are based, and it is legislated through this

• Universality

• Portability

• Accessibility

• Comprehensiveness

• Public Administration

Principles that provide the basis for Canadian provincial and territorial health systems:

False; Health is a provincial and territorial responsibility in Canada, not a federal one

True or False: Health is a federal responsibility in Canada.

• Aging demographic

• Escalating costs associated with chronic disease management

• Care being deinstitutionalized

• Importance of nurses

• Consumerism

Factors driving nurses’ use of ICT

1. Canadian Institute for Health Information (CIHI)

2. Canada Health Infoway

3. Canadian Nurses Association (CNA)

4. Canadian Nursing Informatics Association (CNIA)

5. National Nursing Reference Group (NNRG)

Key National Organizations (Support for the Advancement of Effective Nursing Information Management)

Canadian Institute for Health Information (CIHI)

Key National Organizations (Support for the Advancement of Effective Nursing Information Management)

Created in 1992, an independent, pan-Canadian, not-for-profit organization, established jointly by federal, provincial, and territorial ministers of health that provides essential data and analysis on Canada’s health system and the health of Canadians.

• Healthcare services

• Health spending

• Health human resources

• Population health

CIHI reports focus on:

Canada Health Infoway

Key National Organizations (Support for the Advancement of Effective Nursing Information Management)

Incorporated in January 2001, an independent, not-for-profit organization funded by the federal government that jointly invests with every province and territory to accelerate the development and adoption of EHR projects in Canada

Federal/Provincial/Territorial Advisory Committee on Health Infostructure

Who set its top priority as the development of EHR and telehealth?

1. Client Registries

2. Provider Registries

3. Drug Information Systems

4. Laboratory Information Systems

5. Diagnostic Imaging Information Systems

6. Telehealth Systems

7. Public Health Surveillance Systems

Most Canadian jurisdictions have the beginnings of a basic infrastructure in place to support an interoperable EHR including:

International Health Information Standards Development Organization (IHTSDO)

Through Infoway’s leadership, Canada became a charter member of the what?

Canadian Nurses Association (CNA)

Key National Organizations (Support for the Advancement of Effective Nursing Information Management)

• Established its eNursing Strategy in 2006 based on 3 principles

• Has actively led, participated in, and/ or provided a nursing perspective on numerous national health informatics initiatives

Nurses’

1. Access

2. Competence

3. Participation

What 3 principles is the CNA’s eNursing Strategy based on?

Canadian Nursing Informatics Association (CNIA)

Key National Organizations (Support for the Advancement of Effective Nursing Information Management)

Was established with the goal of engaging nurses in all sectors and in all roles.

COACH

CNIA has a formal alliance with Canada’s Health Informatics Organization, called what?

International Medical Informatics Association Special Interest Group Nursing Informatics (IMIA SIG-NI)

CNIA and COACH facilitated the appointment of the Canadian nurse nominee to the what, which provides an opportunity to engage with international nursing informatics colleagues and share our knowledge beyond national borders.

1. To provide nursing leadership for the development of nursing and health informatics in Canada

2. To facilitate informatics educational opportunities

3. To establish national networking opportunities for nurse informaticists for all nurses in Canada

4. To engage in international nursing informatics initiatives

5. To act as a nursing advisory group in matters of nursing and health informatics

6. To expand awareness of nursing informatics to all nurses and the healthcare community

6 Overall Objectives of the CNIA

National Nursing Reference Group (NNRG)

Key National Organizations (Support for the Advancement of Effective Nursing Information Management)

In 2009, in partnership with the CNA, the Canada Health Infoway Clinical Adoption group established this to provide national nursing leadership, engagement, expertise, and input to inform Infoway’s nursing strategy and plans to accelerate nursing’s adoption and realization of the benefits of EHRs

1. Provide strategic-level advice and input on policies, priorities, and strategic plans aligned with Infoway’s Clinical Adoption business strategy and clinical engagement

2. Review and provide feedback on products, ser- vices, and projects under consideration, or being implemented where appropriate

3. Provide strategic input on the needs and engagement of nurses in practice, education, policy, administration, and research

4. Provide ongoing oversight and input into the established six key nursing strategic directions and tactical plans and associated working groups

5. Act as liaisons and promote a coordinated approach of activities and strategies within their organizations and across partners

5 Objectives of the NRG

1. Identification of nursing key business and functional requirements

2. Development of a structure and strategy for collaboration

3. Development of an education strategy

4. Development of a communications strategy

5. Advancing and leveraging the C-HOBIC implementation

6. Advancing and leveraging the NurseONE portal

6 Strategic Goals of NRG (established to accelerate nursing engagement and EHR adoption)

1. NurseONE

2. Entry to Practice Informatics Competencies for Nurses

Key National Initiatives Advancing Informatics in Nursing (Support for the Advancement of Effective Nursing Information Management)

NurseONE

Key National Initiatives Advancing Informatics in Nursing (Support for the Advancement of Effective Nursing Information Management)

• An innovative, Web-based portal created and maintained by the CNA as a service for its members to assist them in “keeping current, credible, competent, and connected”

• Nurses and nursing students across the county can connect with each other through communities of practice and to credible, up-to-date electronic resources that support patient care and tools for lifelong learning such as, e-books, e-learning courses

Entry to Practice Informatics Competencies for Nurses

Key National Initiatives Advancing Informatics in Nursing (Support for the Advancement of Effective Nursing Information Management)

Canadian Association of Schools of Nursing (CASN) secured funding from Canada Health Infoway to develop this and a toolkit to support faculty delivering the essential content

Uses information and communication technologies to support information synthesis in accordance with professional and regulatory standards in the delivery of patient/client care

CASN Over-Arching Competency

1. Information & Knowledge Management

2. Professional & Regulatory Accountability

3. Information & Communication Technologies

Nursing Informatics Entry-to-Practice Competencies for Registered Nurses (2012)

1. Health Information: Nursing Components

2. Canadian Health Outcomes for Better Information and Care (C-HOBIC) Project

3. National Nursing Quality Report-Canadian

Developing the Nursing Components of Health Information for Use in Canada

1. Client Status

2. Nursing Interventions

3. Client Outcome

4. Nursing Intensity

5. Primary Nurse Identifier

During the 1990s, the work of individual nurse leaders and the Canadian Nurses Association led to the 1997 consensus on five data elements:

Client Status

One of the 5 data elements

• Label for the set of indicators that reflect the phenomena for which nurses provide care, relative to the health status of clients

Nursing Interventions

One of the 5 data elements

• Refer to purposeful and deliberate health-affecting interventions (direct and indirect) based on assessment of client status, which are designed to bring about results that benefit clients

Client Outcome

One of the 5 data elements

• Defined as a “clients’ status at a defined point(s) following healthcare [–affecting] intervention”

• It is influenced to varying degrees by the interventions of all care providers.

Nursing Intensity

One of the 5 data elements

• Refers to the amount and type of nursing resource used to [provide] care

Primary Nurse Identifier

One of the 5 data elements

• A single unique lifetime identification number for each individual nurse.

• This is independent of geographic location (province or territory), practice sector (e.g., acute care, community care, and public health), or employer.

think tank

In 2009, a nursing informatics ___ ____ was hosted by the CNA and Infoway. It resulted in a renewed part- nership with national nursing organizations representing nursing education, unions, nurse administrators, as well as professional colleges and associations that identified key strategies to advance nursing informatics in Canada.

International Classification of Nursing Practice (ICNP)

• A clinical terminology to adequately represent the practice of registered nurses across all regions and settings

Canadian Health Outcomes for Better Information & Care (C-HOBIC) Project

Developing the Nursing Components of Health Information for Use in Canada

• Infoway provided funding for this work

• The CNA partnered with the Ministries of Health in three Canadian provinces to undertake the inclusion of 32 nursing-sensitive patient outcomes measures in four categories in EHRs

• This project supports the advancement and use of standardized patient assessments and related documentation.

Ontario

C-HOBIC builds upon work originating in what province?

1. Functional Status

2. Symptoms

3. Safety

4. Readiness for Discharge

C-HOBIC integrated 32 nursing-sensitive outcomes measures into EHRs, across 4 categories:

1. Acute Care

2. Long-Term Care

3. Home Care

4. Complex Continuing Care

The measures are constituted by 32 data elements that are being collected in four sectors of the healthcare system:

National Nursing Quality Report-Canadian (NNQR-C)

Developing the Nursing Components of Health Information for Use in Canada

• a pilot project to determine the feasibility of using outcomes and productivity indicators to establish a monitoring system for health professionals, utilizing existing databases

• Academy of Canadian Executive Nurses (ACEN)

• Canadian Nurses Association (CNA)

What organizations conceived the National Nursing Quality-Canadian Report?

• Manitoba

• Ontario

• New Brunswick

• Nova Scotia

What provinces has the NNRQ-C been piloted in?

1. Implement a National Nursing Quality Report (NNQR-C)

2. Evaluate Feasibility & Costs

3. Assess the Impact on Quality Improvement

Key Goals of NNQR-C

Implement a National Nursing Quality Report (NNQR-C)

Key Goals of NNQR-C

• Create a standardized reporting system for nursing across Canada

Evaluate Feasibility & Costs

Key Goals of NNQR-C

• Assess the practicalities and financial viability of

  these quality indicators.

Assess the Impact on Quality Improvement

Key Goals of NNQR-C

• Examine how these indicators influence organizational quality and healthcare outcomes.

1. Structure Indicators

2. Process Indicators

3. Outcome Indicators

Structure of NNQR-C

Structure Indicators

Structure of NNQR-C

• Focus on the resources, environment, and organizational

  attributes

Process Indicators

Structure of NNQR-C

• Assess methods, procedures, and activities used during

  care.

Outcome Indicators

Structure of NNQR-C

• Measure the results of nursing care on patients’ health

  outcomes.

International Classification for Nursing Practice (ICNP)

CNA formally endorsed this as a foundational classification system for nursing practice in Canada

ICNP Catalogue, Nursing Outcomes Indicators

The first formally approved and accepted Canadian catalogue or subset of ICNP® available for international use.

Systematized Nomenclature of Medicine-Clinical Terms (SNOMED)

Canada Health Infoway adopted this as the terminology for the pan-Canadian EHR

True

True or False: Although Canada Health Infoway adopted SNOMED-CT as the terminology for the pan-Canadian EHR, ICNP remained the preferred terminology for nursing.

• International Council of Nurses (ICN)

• International Health Terminology Standards Development Organization (IHTSDO)

Who announced an equivalency table between the ICNP and SNOMED-CT concepts?