Nursing Process Model Mapped to Health Level 7 Reference Information Model

The nursing profession generates a large number of documents, and despite a number of terminology standards in existence, lack of interoperability in process and data structure still persists. The purpose of carrying out this study was to develop an integrated, comprehensive structure of nursing process as a domain information model which could be suitable for message development which potentially can be used when implementing clinical information software. We present phases of nursing process modeling, followed by mapping the resultant model to the HL7 Reference Information Model, generating a nursing domain message information model. Also, reviewing the Clinical Document Architecture in relation to the nursing process, we present our proposal for changes required to its object model for better support of nursing documents

Doctor of Philosophy

dissertationThe problem of information transfer between healthcare sectors and across the continuum of care was examined using a mixed methods approach. These methods include qualitative interviews, retrospective case reviews and an informatic gap analysis. Findings and conclusions are reported for each study. Qualitative interviews were conducted with 16 healthcare representatives from 4 disciplines (medicine, pharmacy, nursing, and social work) and 3 healthcare sectors (hospital, skilled nursing care and community care). Three key themes from a Joint Cognitive Systems theoretical model were used to examine qualitative findings. Agreement on cross-sector care goals is neither defined nor made explicit and in some instances working at cross purposes. Care goals and information paradigms change as patients move from hospitalbased crisis stabilization, diagnosis and treatment to a postdischarge care to home or skilled nursing recovery, function restoration, or end of life support. Control of the transfer process is variable across institutions with little feedback and feed-forward. Lack of knowledge, competency and information tracking threatens sector interdependencies with suspicion and distrust. Sixty-three patients discharged between 2006 and 2008 from hospitals to skilled nursing facilities were randomly selected and reviewed. Most notably missing are discharge summaries (30%), nursing assessments or notes (17%), and social work documents (25%). Advanced directives or living wills necessary for end of life support were present in only 6% of the cases. The presence of information on activities of daily living (ADLs), other disabling conditions, and nutrition was associated with positive outcomes at the 0.001, 0.04 and 0.08levels. Consistent geriatric information transfer across the continuum is needed for relevant care management. An interoperability gap analysis conducted on the LINC (Linking Information Necessary for Care) transfer form determined its interoperability to be the semantic level 0. Detailed Clinical Models representing care management processes are challenged by the lack of consensus in terminology standards across sectors. Construction of information transfer solutions compliant with the Centers of Medicare and Medicaid Services (CMS) Stage 2 meaningful use criteria must address syntactic and semantic standards, map sector terminologies within care management processes, and account for the lack of standard terminologies in allied health domains

Investigation Interoperability Problems in Pharmacy Automation: A Case Study in Saudi Arabia

The aim of this case study is to investigate the nature of interoperability problems in hospital systems automation. One of the advanced healthcare providers in Saudi Arabia is the host of the study. The interaction between the pharmacy system and automated medication dispensing cabinets is the focus of the case system. The research method is a detailed case study where multiple data collection methods are used. The modelling of the processes of inpatient pharmacy systems is presented using Business Process Model Notation. The data collected is analysed to study the different interoperability problems. This paper presents a framework that classifies health informatics interoperability implementation problems into technical, semantic, organisational levels. The detailed study of the interoperability problems in this case illustrates the challenges to the adoption of health information system automation which could help other healthcare organisations in their system automation projects

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A semantic web service-based architecture for the interoperability of e-government services

We propose a semantically-enhanced architecture to address the issues of interoperability and service integration in e-government web information systems. An architecture for a life event portal based on Semantic Web Services (SWS) is described. The architecture includes loosely-coupled modules organized in three distinct layers: User Interaction, Middleware and Web Services. The Middleware provides the semantic infrastructure for ontologies and SWS. In particular a conceptual model for integrating domain knowledge (Life Event Ontology), application knowledge (E-government Ontology) and service description (Service Ontology) is defined. The model has been applied to a use case scenario in e-government and the results of a system prototype have been reported to demonstrate some relevant features of the proposed approach

An evaluation of pedagogically informed parameterised questions for self assessment

Self-assessment is a crucial component of learning. Learners can learn by asking themselves questions and attempting to answer them. However, creating effective questions is time-consuming because it may require considerable resources and the skill of critical thinking. Questions need careful construction to accurately represent the intended learning outcome and the subject matter involved. There are very few systems currently available which generate questions automatically, and these are confined to specific domains. This paper presents a system for automatically generating questions from a competency framework, based on a sound pedagogical and technological approach. This makes it possible to guide learners in developing questions for themselves, and to provide authoring templates which speed the creation of new questions for self-assessment. This novel design and implementation involves an ontological database that represents the intended learning outcome to be assessed across a number of dimensions, including level of cognitive ability and subject matter. The system generates a list of all the questions that are possible from a given learning outcome, which may then be used to test for understanding, and so could determine the degree to which learners actually acquire the desired knowledge. The way in which the system has been designed and evaluated is discussed, along with its educational benefits

Technology and Caregiving: Emerging Interventions and Directions for Research.

An array of technology-based interventions has increasingly become available to support family caregivers, primarily focusing on health and well-being, social isolation, financial, and psychological support. More recently the emergence of new technologies such as mobile and cloud, robotics, connected sensors, virtual/augmented/mixed reality, voice, and the evermore ubiquitous tools supported by advanced data analytics, coupled with the integration of multiple technologies through platform solutions, have opened a new era of technology-enabled interventions that can empower and support family caregivers. This paper proposes a conceptual framework for identifying and addressing the challenges that may need to be overcome to effectively apply technology-enabled solutions for family caregivers. The paper identifies a number of challenges that either moderate or mediate the full use of technologies for the benefit of caregivers. The challenges include issues related to equity, inclusion, and access; ethical concerns related to privacy and security; political and regulatory factors affecting interoperability and lack of standards; inclusive/human-centric design and issues; and inherent economic and distribution channel difficulties. The paper concludes with a summary of research questions and issues that form a framework for global research priorities

Developing a Business Case for the Care Coordination and Transition Management Model: Need, Metrics, and Measures

In this descriptive qualitative study, nurse and healthcare leaders\u27 experiences, perceptions of care coordination and transition management (CCTM®), and insights as to how to foster adoption of the CCTM RN role in nursing education, practice across the continuum, and policy were explored. Twenty-five barriers to recognition and adoption of CCTM RN practice across the continuum were identified and categorized. Implications of these findings, recommendations for adoption of CCTM RN practice across the care continuum, and strategies for reimbursement policies are discussed