DCU ICNP® user group summary report 2016

An annual summary report and evaluation of research activity completed with working groups in the SNHS ICNP Center in 2016

Creating archetypes for patient assessment with nurses to facilitate shared patient centred care in the older person

The process of what information is captured in documenting patient care assessment and how it is summarised, communicated and interpreted by nurses across different healthcare services is the main focus of this thesis. Currently in Ireland, systems within the domain of healthcare are undergoing transformation. Existing practices where health information is collected at one local health organisation level and often duplicated across differing services will not support the strategic goals of the newly established clinical directorates. The political vision is simple: Ireland must move towards a nationally integrated electronic record to support patient centred care. Whilst the political vision may be simple, the process of implementation is not and forms the main topic of this thesis. Strategic goals to move nationally towards integrated electronic records are motivated by the global concerns of an ageing population associated with an increase in the prevalence of chronic illness and co-morbidity. The main objective of this thesis is to evaluate the impact of a pilot study which identified the semantic and syntactic clinical requirements for the testing and implementation of a shared discharge/transfer summary assessment record for persons over the age of 65. This summary record was designed in accordance with ISO 13606, the International standard for Electronic Healthcare Record (EHR) communication and is underpinned by ISO 18104, the international standard for Categorial Structures for Representation of Nursing Diagnosis and Nursing Actions in Terminological Systems. A participatory action research approach was adopted, using an exploratory mixed methods research study design. This translational study was completed in two local health organisation areas in Dublin with six service providers across the primary, acute and continuing care services over a two year period. The qualitative element of the study involved 17 interviews, 7 focus group sessions with participants including policy makers and nurses from each of the participating services. Quantitative data included questionnaires from nurses (n = 14) and patients (n=5) evaluating the effectiveness of the summary record. The quantitative data also analysed information from a set of cumulative assessment records (n = 16) which were interpreted in tandem with the qualitative data and then analysed statistically. The shared discharge/transfer summary care record was piloted on 16 patients over an extended timeframe. The quantitative data showed a statistical significance commensurate with the qualitative data collected on patient participants. An evaluation of the pilot study produced qualitative data which was used to gain insight into the differing contexts that healthcare professionals practice within. This data was illustrated in graphical configurations to make evident to policy makers the various roles that nurses engage with in the course of their care delivery. Data collected from both the qualitative and quantitative analysis suggest that the test implementation of the record template was fit for purpose. Identification of the clinical requirements and testing of the summary record over a two year period was a labour intensive process which was logistically difficult to implement. One consequence of this study was the education of the nursing participants on gaining a common understanding of what needs to be measured in patient assessment to inform future theory testing for outcome based research. A second consequence was the empowerment of the nursing participants to develop archetypes for inclusion in future electronic healthcare records in Ireland. The prototype archetypes designed for assessment of the older person in this study are at present informing a number of practical applications within the nursing community in Ireland. Over the course of the study the participatory action research design altered in its focus and emerged as a dominant qualitative mixed methods study

The PARTNERS programme: an evaluation report

The focus of this project is inter- agency communication. This report evaluates how formal terminology underpinned by health informatics standards can assist health care providers to communicate patient centred information across traditional service boundaries more efficiently and effectively. It provides evidence on how nurses work between different environments across different settings. The tool devised for shared care by the project team may serve as a starting point for those individuals who are engaged in the development of discharge or transfer of patient centric care documentation e.g. the newly established clinical directorates. The participants in this project who are primarily nurses recognise that formal communication processes involving interagency communication between the primary care, continuing care, and acute care sectors is currently dependent on informal communication processes such as the telephone or fax machine. The process of approaching formal communication using health informatics standards and adopting formalised concepts and terms facilitates shared meaning between health care parties which the group maintain could enhance existing inter agency communication. In the longer term such initiatives may directly impact upon patient safety. This report is an evaluation of phase one of a pilot study project entitled PARTNERS, which is an acronym for Participatory Action Research To develop Nursing Electronic RecordS. The PARTNERS project identified two key objectives, firstly to educate and train nurses in health informatics, specifically in relation to a health informatics standard developed internationally to guide nursing records development on nursing diagnosis and interventions (ISO 18104). Secondly, to identify formalised concepts and reference terminologies for future inclusion in nursing documentation practices. The identified set of concepts and terms in this report, whilst crude, may inform future interagency communication on discharge planning or transfer of care, not only for nurses but also other members of the multidisciplinary team. To demonstrate these objectives in action a purpose built assessment form using a set of design restrictions in the form of an archetype was devised. The archetype is designed in accordance with a health informatics standard entitled EHRcom (EN13606) and is defined as follows “an agreed, formal and interoperable specification of the data and their inter-relationships that must or may be logically ©PARTNERS 2010 7 persisted within an electronic health record for documenting a particular clinical observation, evaluation, instruction or action” (Kalra 2004). These two objectives were made possible by liaising with the Dublin Institute of Technology on a research programme entitled EHRland. The EHRland project supported by the Health Information and Quality Authority (HIQA) is a research programme which is testing the health informatics standard EN13606. The standard EN13606 is the European standard for the electronic health care record. The PARTNERS group defined the requirements, concepts and terms for the archetype and the EHRland group designed the archetype and created a database for use for the duration of the pilot study. The information presented in this evaluation will draw from both of the PARTNERS and EHRland projects. This is made possible as the author is the Principal Investigator of the PARTNERS project and is a member of the EHRland project team. Whilst the focus of the project was the development of an archetype to enhance interagency communication the EHRland group also devised a prototype information system to collect and store patient centred outcomes as defined by Almost et al (2003). The PARTNERS group were keen to collect patient data which could minimally present patient centred outcomes, and involve the patient in the decision making processes relating to their care. For example did the patients like the idea of having access to and keeping their own record? Because of the size and resources associated with the project, the project team opted to complete a small pilot study and evaluate the overall effectiveness on a group of over 65 year olds and on those practitioners who sought to pilot the tool (practitioners n = 14, Cases n = 16 Settings = 6). Initial thoughts suggested that this evaluation would focus on whether the PARTNERS assessment form was effective or indeed ineffective, simply stated putting into practice the 3 W’s which are if the prototype archetype/s ( assessment form) worked for whom and under what circumstances. Over time it became apparent that the evaluation required a more inclusive focus. This evaluation therefore focuses on exploring both the mechanisms (processes) and outcomes relating to the assessment form and also seeks to identify those mechanisms which will impact on the overall sustainability of such practice development initiatives in the future. In this way the PARTNERS group can offer the reader an honest account of the lessons learnt by practitioners, patients and the evaluator’s overall experience

HL7-FHIR-based ContSys formal ontology for enabling continuity of care data interoperability

The rapid advancement of digital technologies and recent global pandemic-like scenarios have pressed our society to reform and adapt health and social care toward personalizing the home care setting. This transformation assists in avoiding treatment in crowded secondary health care facilities and improves the experience and impact on both healthcare professionals and service users alike. The interoperability challenge through standards-based roadmaps is the lynchpin toward enabling the efficient interconnection between health and social care services. Hence, facilitating safe and trustworthy data workflow from one healthcare system to another is a crucial aspect of the communication process. In this paper, we showcase a methodology as to how we can extract, transform and load data in a semi-automated process using a common semantic standardized data model (CSSDM) to generate a personalized healthcare knowledge graph (KG). CSSDM is based on a formal ontology of ISO 13940:2015 ContSys for conceptual grounding and FHIR-based specification to accommodate structural attributes to generate KG. The goal of CSSDM is to offer an alternative pathway to discuss interoperability by supporting a unique collaboration between a company creating a health information system and a cloud-enabled health service. The resulting pathway of communication provides access to multiple stakeholders for sharing high-quality data and information

ContSOnto: a formal ontology for continuity of care

The global pandemic over the past two years has reset societal agendas by identifying both strengths and weaknesses across all sectors. Focusing in particular on global health delivery, the ability of health care facilities to scale requirements and to meet service demands has detected the need for some national services and organisations to modernise their organisational processes and infrastructures. Core to requirements for modernisation is infrastructure to share information, specifically structural standardised approaches for both operational procedures and terminology services. Problems of data sharing (aka interoperability) is a main obstacle when patients are moving across healthcare facilities or travelling across border countries in cases where emergency treatment is needed. Experts in healthcare service delivery suggest that the best possible way to manage individual care is at home, using remote patient monitoring which ultimately reduces cost burden both for the citizen and service provider. Core to this practice will be advancing digitalisation of health care underpinned with safe integration and access to relevant and timely information. To tackle the data interoperability issue and provide a quality driven continuous flow of information from different health care information systems semantic terminology needs to be provided intact. In this paper we propose and present ContSonto a formal ontology for continuity of care based on ISO 13940:2015 ContSy and W3C Semantic Web Standards Language OWL (Web Ontology Language). ContSonto has several benefits including semantic interoperability, data harmonization and data linking. It can be use as a base model for data integration for different healthcare information models to generate knowledge graph to support shared care and decision making

A micro credential for interoperability

In the midst of a global pandemic the need for health and social care providers to commit to, and deliver on, integrated patient-centered care services has been accelerated. Globally, health and social care programme administrators are turning to digital devices and applications to provide supporting infrastructure which can offer safe access to health information at the point of care. Digitalisation is increasingly considered a key requirement to support diagnostics and therapeutic care services in health care delivery. The open source community are responding to this need to advance integrated care and digital services by providing targeted resources to address the interoperability challenge. Addressing interoperability in health systems is a core part of achieving sustainable enterprise wide integrated care. Using Open Innovation 2.0 methods for advancing knowledge on interoperability, this paper describes the development of a micro credential for knowledge transfer on interoperability created by the Centre for eIntegrated Care (CeIC). Designed and developed to signpost interested stakeholders to targeted material and build understanding and capacity on the topic. The design approach and initial resource content are explained through the lens of a specific research project funded by an Elite S Fellowship to advance leadership and standardisation for Information and Communications Technology (ICT) in Europe