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In This Issue
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Note
. . . .. .International
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Telehealth for Chronic Disease
Re(-E)volutions
Nursing
Management in
Part
2 . . . .Informatics
. . . . . . . . . . . .. .. .. .. .. .. 21
Webcast Event- ANA 2007 Scope and
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ANIA--CARING Member News
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ANIA--CARING Member Spotlight

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Another Successful CARING Dinner at the
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ANIA-CARING 2010 Annual Conference
Conference Report: 17th Annual Summer
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Vol. 25, No. 2

2nd Quarter, 2010

ISSN: 1551-9104

A Boston IT Party
International Re(-E)volutions in Nursing Informatics
Dr Peter J Murray
Executive Director, International Medical Informatics Association (IMIA)

o we need a revolution in the theory and practice of nursing informatics, or


can the discipline evolve slowly to address the emerging possible future(s)
and changing issues that face us, and that will affect the practice of healthcare, and
of nursing? The word 'revolution' is variously defined; it may be a radical, sudden
and pervasive change in an aspect of society and the social structure, or of a
discipline, or a thorough replacement of an established system. It can also be a
return to a point relatively the same. An
evolutionary change is a gradual process
Welcome
in which something changes into a
from the Editor and Secretary
different and usually more complex or
better form. Whichever approach we
am thrilled to have the keynote speaker
adopt, we need to try to 'future-proof' our
from our 2010 conference in Boston, Dr.
thinking and our practice, to improve
Peter Murray provide an article for the
health and nursing, rather than returning
newsletter. This will be a reminder of his
to past approaches or practices that may
excellent presentation for those who were
no longer be of use to us.
fortunate enough to attend, and will provide
With the aid of an understanding of our
a glimpse at what he covered for those who
history and development, nurses and
were not able to be there. The conference
nurse informaticians can be better
was a huge success. The speakers and
equipped to consider what they need to do
posters were excellent, the vendor area
to define the future nature and direction
provided opportunities to see the newest and
of our disciplines, and consider whether
best, with multiple opportunities to network.
we need a revolution or an evolution in
For those who attended, thank you for
nursing and nursing informatics. The
helping make it such a huge success. For
purpose of this article is to stimulate
those who were unable to attend, start
nurses and nurse informaticians to
planning for next year.
consider this historical development, in
For those of you who have not signed up
particular through the way in which
yet - the electronic list is back and as active
definitions of nursing informatics have
as ever. It is an excellent resource for
changed, but retained certain
current information and assistance with
consistencies. From an understanding of
current practices and an excellent source of
our past development, and with
what others are doing, and what they have
immersion in the realities of the present,
learned. One of the methods for determining
we can consider what possible futures we
what is of interest to our members is the
may face, and what factors will determine
discussion on the electronic list. This is the
the future development of nursing and
reason I asked Christine Lippincott to share
healthcare. As the Spanish philosopher
her recent experience as a masters student.
Miguel de Unamuno said, My aim is to
Hopefully we will be able to include other
agitate and disturb people. Im not selling
similar vignettes, case studies and lessons

learned.

continued on page 2

Member News
A Boston IT Party International Re(-E)volutions in Nursing Informatics
By Susan K Newbold,
PhD RN-BC FAAN FHIMSS

ANIA-CARING
Membership Profile

As of 06/21/2010, there are 3052 members from 50 states and 30 countries:


Australia, Bermuda, Brazil, Canada,
Chile, Croatia, England, Finland,
Germany, India, Ireland, Israel, Jordan,
Kuwait, Lebanon, Malaysia, New
Zealand, Pakistan, Panama,
Philippines, Qatar, Saudi Arabia,
Singapore, Slovenia, South Korea,
Spain, Taiwan, Thailand, UAE, USA.
Graduations

Graduation Doctor of Nursing Practice


(DNP)
Beth M. Kilmoyer, Baltimore, MD was
awarded the Doctor of Nursing Practice
degree May 27, 2010 from Johns
Hopkins University School of Nursing,
Baltimore.
Verna Tereceita Terry Laidlow,
Timonium, MD, presented her capstone
project April 19, 2010 and was awarded the Doctor of Nursing Practice
degree May 27, 2010 from Johns
Hopkins University School of Nursing,
Baltimore. Margaret M. Semancik
served on her committee. Her capstone
project was, The Efficacy of a
Multidisciplinary Standardized
Electronic Protocol Using SymptomTriggered Therapy and Escalating Dose
of Benzodiazepine in the Management
of Alcohol Withdrawal Syndrome
(AWS): A Quality and Safety
Initiative.
Teresa C. Moore, Wood Ridge, NJ
obtained her DNP from Fairleigh
Dickinson University, New Jersey, May
2010.
Stephanie S. Poe, Baltimore, MD was
awarded the Doctor of Nursing Practice
degree May 27, 2010 from Johns
Hopkins University School of Nursing,
Baltimore. Her capstone project is
titled, Building Nursing Intellectual
Capital for Safe Use of Information
Technology.
Patricia P. Sengstack, Damascus, MD,
DNP, Vanderbilt School of Nursing,
Nashville, TN. Drs. Susan K. Newbold
and Betsy Weiner served on her committee. Her scholarly project was,
CPOE Configuration To Reduce
continued on page 3

continued from page 1

bread, Im selling yeast (Wikipedia, 2010); which can be roughly translated into
saying that I am asking people to think for themselves, and reach their own
answers, rather than my necessarily providing them with ready answers to the
issues.
The historical overview of definitions of nursing informatics should be of
particular value to younger nurses, and those new to the field, who may not have
been as immersed in our history over the past 30 years. While the focus is on
nursing informatics, we must always take into account the fact that we do not
work in isolation, but that many outside influences exist, which we may not be
able to control, and which will have inevitable impacts on the future of health and
healthcare, and of our own disciplines.
Nursing has long been concerned with the collection and use of information to
support nursing care. Florence Nightingale, considered by many to have been the
first nurse informatician (Betts & Wright, 2003), was concerned with the
collection and analysis of data. Nightingale is also renowned as an early
statistician, and developed graphical representations of data (her coxcomb to
illustrate causes of mortality among British forces fighting in the Crimean War)
(Betts & Wright, 2006). While the technologies used to collect, analyse and
manipulate the data to provide meaningful information may have changed
significantly over the years, the basic concerns remain unchanged. The following,
written 150 years by Florence Nightingale, suggests that we may not have made a
great deal of progress as we would like to believe in resolving some of the
underlying issues. She said that:
"In attempting to arrive at the truth, I have applied everywhere for
information but in scarcely an instance have I been able to obtain
hospital records fit for any purpose of comparison. If they could be
obtained, they would enable us to decide many other questions
besides the one alluded to. They would show subscribers how their
money was being spent, what amount of good was really being
done with it or whether the money was not doing mischief rather
than good." (Nightingale, 1863)
Nursing has, it seems, long been concerned with information and records, and
using them to support and improve care. The underlying purpose of nursing
informatics has been similar; it has not been just about using the technology,
although sometimes nursing informatics has been criticised for an apparent focus
on the technologies at the expense of their appropriate use. Nightingale's words
point to the absence in her time of 'fit for purpose' information and records, and to
the need show good use of healthcare funds. Despite the advances made, we seem
still to be concerned with many of the same basic issues, in particular the need for
information to demonstrate that the huge sums of money that go into healthcare,
and healthcare technologies, in all countries of the world are improving patient
care. We can extrapolate from her concerns, and suggest that, if she were with us
today, she might point out the need to appropriately analyse the data we collect to
provide meaningful information, use that information to generate knowledge to
improve health and healthcare, and that IT systems do not necessarily result in
better data quality and use of information.
Evolving definitions of nursing informatics

While the term medical informatics is generally accepted to have been


developed in the mid 1960's, the first published use of the term 'nursing
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A Boston IT Party International Re(-E)volutions in Nursing Informatics
continued from page 2

informatics' was at the 1980 Medinfo conference held in Tokyo, Japan by


Maureen Scholes and Barry Barber, who defined it as ...the application of
computer technology to all fields of nursing--nursing services, nurse education,
and nursing research. (p.73) (Scholes & Barber, 1980; Thede & Sewell, 2009)
Perhaps the most famous, and still the most widely used and cited definition, is
that developed over 20 years ago by Graves and Corcoran (1989, p.227), who
defined nursing informatics as a combination of computer science, information
science, and nursing science designed to assist in the management and processing
of nursing data, information, and knowledge to support the practice of nursing and
the delivery of nursing care." Many other similar definitions and models have
been offered over the years, including Turley's model (Turley, 1996), which
combined computer science, information and cognitive science with an overall
envelope of nursing science. More recently, Simpson (2006, p.5) described
nursing informatics as using technology, research, and professional experience to
manage nursing data, information, and knowledge to improve practice and deliver
better health care. Good overviews of the many definitions, and their evolution,
are provided in Thede & Sewell (2009), Kaminski (2007), Staggers & Thompson
(2002) and Guenther (2006).
The world body for nursing informatics, the Nursing Informatics Special
Interest Group of the International Medical Informatics Association (IMIA-NI
www.imiani.org) updated its definition at its annual meeting at the NI2009
nursing informatics congress in Helsinki, Finland. Their definition sees that
Nursing informatics science and practice integrates nursing, its information and
knowledge and their management with information and communication
technologies to promote the health of people, families and communities world
wide (IMIA-NI 2010; Saranto & Casey, 2009). From the IMIA-NI definition, we
can identify a range of areas and issues that nursing informatics needs to address:
the practice and theory of nursing, information management and knowledge
management, the appropriate use of information and communication technologies,
and the effects on the health of people, families and communities, through the
influence of local, national and global factors.
In closing this historical overview, before moving on to the current context of
nursing informatics internationally, it is worth briefly mentioning how the
visibility of nursing informatics has risen in the wider field of health and
biomedical informatics. Marin & Marques (2005) reviewed the growth of the
number of nursing informatics papers. This can be taken as a form of proxy for
the nature and levels of activity of nursing informatics. In the first Medinfo
conference, held in Stockholm, Sweden in 1974, five of the 177 papers can
retrospectively be described as nursing informatics, while in the Geneva,
Switzerland Medinfo conference of 1992, 20 of the 259 oral presentations were in
nursing informatics. By Medinfo98 in Seoul, Korea, nursing informatics had
become closely integrated into the overall programme, a trend that has continued
since with Medinfo conferences.
The first international nursing informatics conference was held in London, UK
in September 1992, with the theme 'The Impact of Computers on Nursing'
(Scholes, Bryant & Barber, 1983), and has been followed every three years by NI
Congresses held under the auspices of IMIA-NI. An overview of the content of
these events up to 2000 (Scholes, Tallberg & Pluyter-Wenting, 2000) is a useful
proxy to show, from the published proceedings of these events, how the nature of
nursing informatics has evolved since the early 1980s. Among the common themes
that have persisted in the conference literature that the discipline of nursing
continued on page 4

Page 3 2nd Quarter 2010

Medication Errors. A paper about the


project was approved for publication in
the fall edition of the Journal of
Healthcare Information Management.
Marianela E. Nelita Zytkowski,
Avon, OH., DNP, Case Western
University, Cleveland, OH, November,
2009.
Graduation MSM
Debra Roper, Hampstead, MD, Master
of Science in Management (MSM)
with a concentration in Information
Systems. University of Maryland
University College, August 2009.
Graduation MSN
Karen M. Bavuso, Woburn, MA graduated May 2010 with an MSN from Duke
University.
Rebecca Carter, Pendleton, SC, MSN,
June 2009, Walden University.
Yong Il Choi, Raleigh, NC, MSN in NI
graduated May 2009, Duke University,
Durham, NC.
Michael F. Dougherty, New Canaan,
CT, MS in Collaborative Nursing
Informatics, May 2010, Pace
University, NY.
Nancy Douglas-Kersellius, Stafford, VA,
MSN in Nursing Informatics, July,
2009, Excelsior College, Albany, NY.
Helen Fong, Orlando, FL graduated May
2009 with an MSN in Nursing
Education from Duke University
School of Nursing. She also holds a
Post Master's Certificate (PMC) in
Nursing Informatics (NI) ( Dec 2009).
Daniel Gracie, Charleston, SC graduated
December, 2009 from the Medical
University of South Carolina with a
Masters in Nursing Administration.
Bryan M. Lankford, OFallon, IL completed his MSN March 2010 with the
ceremony Summer 2010 from Walden
University.
Christine Lippincott, Las Vegas, NV
received her MSN in nursing with an
emphasis on NI from Excelsior College
July 2010. She participated in the graduation ceremony I Albany, NY.
Larissa A. Lozano, Doral, FL obtained
her MSN in Nursing Informatics at
Walden University, February 2010.

continued on page 4

Member News
Karen L. Parker, Cochranton, PA completed her MSN in Nursing
Informatics, November 2009 at Walden
University.
Bonnie R. Rieger, Trenton, OH, graduated May 2010 with an MSN from Duke
University.
Doris M. Ross, Franklin, OH, received
her MS August 2009 at Wright State
University, Dayton, OH. It is a Masters
of Science in Nursing Administration
and Healthcare Services with an
emphasis in Informatics.
Shirley Schiavone, Vineland, NJ finished
her MSN in Nursing Informatics, April
2010, Walden University.
Cindy L. Sunderman, Garland, TX
graduated May 2010 with an MSN
from Duke University.
William Mike Tedrick, Tulsa, OK,
MSN, Clinical Research Management,
May 2010, Vanderbilt University
School of Nursing, Nashville, TN.
Sunita Waddell, Waldorf, MD, received
her MSN from Walden University in
2010.
Lauren E. Wiseman, Normal IL, completed her MSN from Duke University
School of Nursing with an emphasis on
nursing informatics June 2010.
Kathleen Yaple, Snellville, GA, MSN in
Nursing Informatics, August 2009 from
Walden University.
Ann M. Yonce, Palmyra, VA graduated
Feb 2010 from Walden University with
a Masters of Science in Nursing (MSN)
and a specialization in Informatics.
Graduation MS (in Nursing)
The following graduated from the
University of Maryland School of
Nursing, Baltimore, MD:
Kelly Cochran, Laytonsville, MD
May 2010
Michelle Garonzik, Brooklandville,
MD
Leslie Simko, Hinckley, OH
Emily L. Boyce, Henderson, NV
Robin Stout, Pasadena, CA
Myong Woo, Fort Meade, MD

continued on page 5

A Boston IT Party International Re(-E)volutions in Nursing Informatics


continued from page 3

informatics has explored are information systems, technology and communication


systems, education and training, and research, statistics, modelling.
Looking Towards the Future

As we consider the future of nursing, of nursing informatics, and of the nature


of health and the delivery of healthcare, both in individuals countries and globally,
we can see that a range of issues and developments - societal, scientific,
technological, and health and disease-related will potentially have an influence.
While not everyone may have the luxury of time to give detailed consideration to
what might seem esoteric philosophical musings, the assertion by the British
statesman and philosopher, Edmund Burke, that those who don't know history
are destined to repeat it, coupled with the motto of the Institute for Alternative
Futures (http://www.altfutures.com), that the challenge is not only to anticipate
the future, but to create it, bring together the key themes of this article.
Many of the factors that will influence health and nursing in the future, and in
particular the use of information and communications technologies, and hence the
role of the nurse informatician, are factors that we can see already in existence, or
know are emerging or likely to develop. As the novelist William Gibson,
originator of the term 'cyberspace' has noted, 'the future is here. It's just not evenly
distributed'. Many nurse informaticians have provided explorations of the future,
in attempts to explore the possible development of nursing and of informatics (e.g.
McCormick, 2005; McCormick et al, 2007). One of the most detailed explorations
took place during the NI2006 Post Congress Conference, where over 30 nursing
informatics experts from around the world spent three days possible future
developments. The resulting publication of the proceedings, 'Nursing informatics
2020: towards defining our own future' (Murray, Erdley, Park & Kim, 2007)
provides an exploration of several areas, including the possible evolving role of
the nurse as the nature of health and care change, and as new technologies become
increasingly embedded in healthcare and people's everyday lives. Among the
issues identified, that the participants felt that nursing informatics needed to
address were changing healthcare models, the changing role of the nurse as a
knowledge professional, the rise of patient/citizen informatics and of citizens as
drivers of the nature of care and interaction, and the influence of genomics.
McCormick et al (2007) also took the view that the future of nursing informatics
will be impacted by the genomic revolution. At the same time, it was deemed vital
that nurses keep an ethical stance.
What will influence health in the future? Many individuals and groups have
explored the issues, and the United Kingdom's Ministry of Defence's 'Strategic
Trends' (DCDC, 2007) look into a possible future is typical of many. They
suggested that factors that would influence health included that by 2010, 50% of
the world's population would live in cities and urban areas; the effects of global
warming and climate change would impact health directly and many other factors
such as food availability; there would be increasing global inequalities, with
continuation of absolute poverty for many people; continuing population growth,
and increasing competition for scarce resources, such as water; the continuing
impact of communicable diseases in many countries; the effects of conflict and
global or local crises in displacing large numbers of people; and the increasing
pervasiveness of information and communications technologies, with resultant
impact of information access.
Many other factors will affect nursing in the future, and the nature of how
nursing informatics develops. Among these are the need to manage the potential
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members news
A Boston IT Party International Re(-E)volutions in Nursing Informatics
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information overload we will face, consideration of whether new social


networking and Web 2.0, 3.0, etc. tools will help us, the rise of mobile tools and
health-related applications (mHealth) that will facilitate even more instant access
to information resources, in particular in countries where such access has
previously been limited. In many countries, the increasing role of empowered
citizens, demanding greater control over many aspects of their healthcare, will
influence the future development not only of nursing, but of the nature of health
and the inter-relationship of health professionals with their patients and families
(Saranto, Brennan & Casey, 2009).
It is likely, for a variety of factors, not least the varying amounts of money that
different countries can and do spend on healthcare, that different combinations of
new technologies can offer possibilities for differing solutions in different
countries to the similar problems that we know many are likely to face. However,
through the exchange of information and experiences among and between nurses
facilitated by international groups such as IMIA-NI and ANIA-CARING we
can celebrate nursings commonalities, while at the same time considering its
necessary evolution and adaptation to new challenges.
Do we need a revolution, or a re-evolution, or perhaps a little of both to enable
the discipline, and individual nurse informaticians to consider possible futures and
determine how best to anticipate, and prepare for, the variety of changes that will
affect the ways in which we all live and work? Nursing informatics has a solid
base and history on which to build. We should not ignore, or throw out, that
history, and what we have built so far, but we do need to recognise that it cannot
stay the same forever, but must adapt and change. Some of what we do now may
no longer be relevant in the future; the skill will be to decide what to keep, what
to change, and what we need to do or learn afresh. Perhaps, in addition to
evolving from where we are now, we may need a revolution in thinking and
attitudes to enable nurses/informaticians to deal with evolving change. Education
will be a key means to supporting nurses in coping with change, and continuing
education and professional development will be vital to providing the
development of skills to deal with new knowledge, new forms of knowledge, and
simply the vast amount of information to which we will have access.
Note: This article summarises some of the main content and points from my
keynote presentation given at the recent ANIA-CARING conference in Boston, MA
on April 23, 2010. The views expressed are personal and should not necessarily
be taken to be any official IMIA position on any issues.
References
Betts, H., & Wright, G. (2003). Was Florence Nightingale the First Nursing Informatician? In H. de Fatima
Marin, E.P. Marques, E. Hovenga, & W. Goossen (Eds.), e-Health for all: designing nursing agenda for
the future. Proceedings of the 8th International Congress in Nursing Informatics; 2003 2025 June, Rio
de Janeiro, Brazil.
Betts, H.J., & Wright, G. (2006). Lessons on Evidence-based Practice from Florence Nightingale. In
Weaver, C.A., Delaney, C.W., Weber, P. & Carr, R.L. (Eds.), Nursing Informatics for the 21st Century:
An International look at Practice, Trends and the Future, First Edition (pp. 285-289). Chicago IL:
HIMSS.
Development, Concepts and Doctrine Centre (DCDC). (2007). The DCDC Global Strategic Trends
Programme 20072036. Swindon: DCDC, Ministry of Defence.
Graves, J. R., & Corcoran, S. (1989). The study of nursing informatics. Image: The Journal of Nursing
Scholarship, 21 (4), 227 231.

Graduation Post Masters Certificate


Kathryn W. Patterson, Reston, VA
received a post masters certificate in
Nursing Informatics from the
University of Maryland and will enter
the DNP program at the University of
Maryland, Fall 2010.
Graduation MBA
Sara Esperti, Concord, NH, MBA
Spring 2009 from Plymouth State
University in Plymouth, NH.
Certification in Nursing Informatics from
the American Nurses Credentialing
Center (ANCC):
Shiny Abraham, Levittown, NY,
January, 25, 2010
Irene L. Berger, Marengo, IL,
March 20, 2010.
Lynn Marie Choromanski, New Hope,
MN. May 10, 2010
John M. Delaney, Lubbock, TX,
April 3, 2010
Elizabeth Gondek, Waban, MA
Patrick Hess, Irving, CA, January 2010
Lynn Jessup, Maumelle, AR, October
2009
Anne M. Krouse, Sewell, NJ, October,
2009
Lynne T. MacAllister, Brookline, NH,
June 7, 2010.
Samantha B. Miles, Memphis, TN,
March, 2010
Stephen W. Prouse, Bel Air, MD,
recertified March 2010.
Karen L. Sarver, Wanatah, IN,
November, 2009.
Katherine C. Skarbek, Danville, VA,
May 24, 2010.
Diana M. Tubera, Madera, CA, June,
2009
Sara Winters Turchotte, Nashville, TN,
April 26, 2010
Andrea L. Whisnant, Knoxville, TN,
03/16/2010
CPHIMS
John M. Delaney, Lubbock, TX,
July, 2009
Laura Sorg, Springboro, OH,
12/22/2009

continued on page 6
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Page 5 2nd Quarter 2010

Member News
A Boston IT Party International Re(-E)volutions in Nursing Informatics
FHIMSS
Brenda D. Herrmann, Greenwood, SC,
qualified for Fellow in the Healthcare
Information and Management Systems
Society (FHIMSS) in February, 2010.
Publications:

Swindle, C. and Bradley, V. (2010) The


Newest O in the C-suite: CNIO. Nurse
Leader AONE 8(3): 28-30.
Mary Benham-Hutchins, Boston, MA,
wrote, Benham-Hutchins, M., &
Effken, J. (2010). Multi-professional
patterns and methods of communication during patient handoffs.
International Journal of Medical
Informatics, 79, 252-267. doi:
10.1016/j.ijmedinf.2009.12/005
Susan K. Newbold, Franklin, TN, has a
publication in press: Newbold, S.K. (in
press). ANIA-CARING 2010
Conference. CIN: Computers
Informatics Nursing, 28(4).

continued from page 5

Guenther, J.T. (2006) Mapping the literature of nursing informatics. Journal of the Medical Library
Association, April; 4(2 Suppl): E92E98.
IMIA-NI. (2010) Website of IMIA-NI, Nursing Informatics Special Interest Group of the International
Medical Informatics Association. Retrieved May 25, 2010 from http://www.imiani.org
Kaminski, J. (2007). The Revealing of Nursing Informatics: Exploring the Field [Electronic Version at
http://www.nursing-informatics.com/revealing/NI_comp2.pdf], University of British Columbia: 71
pages.
Marin, H., & Marques, E. (2005). Nursing informatics: learning from the past to build a new future.
Revista Brasileira de Enfermagem, 58(2), 143-146.
McCormick, K.A. (2005). Future directions. In V.K. Saba, K.A. McCormick (Eds.), Essentials of Nursing
Informatics. 4th ed. New York: McGraw-Hill.
McCormick, K., Delaney, C.J., Brennan, P.F., Effken, J.A., et al. (2007). Guideposts to the FutureAn
Agenda for Nursing Informatics. JAMIA, Journal of the American Medical Informatics Association,
14:1924.
Murray, P.J., Park, H-A., Erdley, W.S., & Kim, J. (Eds.). (2007). Nursing Informatics 2020: towards defining our own future. Proceedings of NI2006 Post Congress Conference. Amsterdam: IOS Press.
Nightingale, F. (1863) Notes on Hospitals. London: Longmans, Green and Company; 1863:176
Saranto, K. & Casey, A. (2009) Connecting Health and Humans Summary of the 10th International
Nursing Informatics Congress. In K. Saranto, P.F. Brennan & A. Casey (Eds.) Personal Health
Information Management: Tools and Strategies for Citizens' Engagement. Kuopio, Finland: University
of Kuopio, p.13.
Saranto, K., Brennan, P.F., & Casey, A. (Eds.) (2009). Personal Health Information Management: Tools
and Strategies for Citizens' Engagement. Kuopio, Finland: University of Kuopio.

Jeanne Sewell, Milledgeville, GA,


penned, Creating a bibliography with
Microsoft word 2007 and 2008. CIN:
Computers, Informatics, Nursing,
28(3), 134-137.

Scholes, M., & Barber, B. (1980). Towards nursing informatics. In D. A. D. Lindberg & S. Kaihara (Eds.)
MEDINFO: 1980. Amsterdam, Netherlands: North-Holland, 7-73.

Bonnie L. Westra, Blaine, MN, wrote,


Westra, B. L., Oancea, C., Savik, K.,
& Marek, D., K. (2010). The feasibility
of integrating the Omaha system data
across home care agencies and vendors. CIN: Computers, Informatics,
Nursing, 28(3), 162-171.

Simpson, R. (2006). Coherent heterogeneity: Redefining Nursing in a Consumer-smart World. In H. A.


Park, P. Murray, & C. Delaney, C. (Eds.). Consumer-Centered Computer-Supported Care for Healthy
People. Amsterdam, Netherlands: IOS Press, 3-8.

Presentations:

Bradley, V. and Norris, B. (2010) NI as


a Future Career. May 17 Webinar for
the Philippine Nursing Students sponsored by the Philippine Nursing
Informatics Association.
Peter Kokol, Limbus, SLOVENIA;
Heimar Marin, Sao Paulo, Brazil; and
Susan K. Newbold, Franklin, TN, presented at the International Summer
School 2010 Healthy Living
Health.: The focus this year was on
educational and information technology. It was held 14-25 June 2010 in
Maribor, Slovenia. See
http://www.fzv.uni-mb.si/iss2010

continued on page 7

Scholes, M., Bryant, Y., & Barber, B. (eds). (1983). The Impact of Computers on Nursing: An International
Review. Amsterdam: North-Holland.
Scholes, M., Tallberg, M., & Pluyter-Wenting, E. (2000). International Nursing Informatics: A history of
the first forty years 1960-2000. Swindon: The British Computer Society.

Staggers, N, & Thomspson, C.B. (2002). The Evolution of Definitions for Nursing Informatics
A Critical Analysis and Revised Definition. JAMIA, Journal of the American Medical Informatics
Association, 9(3): 255261.
Thede, L.Q, & Sewell, J.P. (2009). Nursing informatics definitions. Retrieved May 25, 2010 from
http://dlthede.net/Informatics/Chap01Overview/NIDefinitions.html
Turley, J. (1996) Toward a model for nursing informatics. Image, 28:309313.
Wikipedia (2010). Miguel de Unamuno. Retrieved May 25, 2010 from
http://en.wikipedia.org/wiki/Miguel_de_Unamuno

Presidents Message: Project Vital Signs


veryone is so busy implementing health information technology (HIT)
systems to meet meaningful use or as an imperative to help achieve
organizational goals. I fear that time for project checkups are not included in the
implementation plan. We wouldnt dream of omitting a regular assessment of our
patients, so I suggest we do the same due diligence with HIT projects.
Performing an accurate assessment is a critical essential skill for nurses in all
specialties including clinical informaticists. In the hospital or office we use a head
to toe assessment or assess functional health patterns but what are we looking for
as we check progress of an implementation? I believe assessment of nursing
acceptance of the system provides invaluable information on the status of an
implementation. The basic assumption is that if clinicians do not use the system or

continued on page 7

ania-CARING Page 6

Member News
Presidents Message: Project Vital Signs
continued from page 6

employ workarounds, the organization will not realize the intended benefits and
may in fact experience some negative unintended consequences.
In Nursing Informatics Standards and Scope of Practice, assessment is the first
standard. The informatics nurse is to use evidence-based assessment techniques
and instruments in collecting pertinent data to define the issue or problem1. I
propose that the Unified Theory of Acceptance and Use of Technology (UTAUT)
by Venkatesh, Morris, Davis and Davis (2003)2 be used as a model to guide
assessment of a projects vitals signs. I have used this model as a checklist to
ensure tasks have not been omitted from a project, as a pre/post survey of
clinicians acceptance, and as a guide for assessment and analysis of
implementation success. UTAUT has four core determinants: performance
expectancy, effort expectancy, social influence and facilitating condition.
Performance expectancy is the degree to which an individual believes that
using the system will help him or her to attain gains in job performance
(Venkatesh, et al, 2003, p. 447)2. Think of this as the temperature of your project.
What benefits do clinicians tell you that they are receiving from the system, do
they feel like they have more time to spend with patients, are they able to organize
their care more efficiently, has the system help decrease the cost of patient care,
reduce patient care errors, improve the quality of patient care, or increase the
timeliness of the care delivery process? Typically these benefits relate to quality of
patient care and patient safety, clinician and patient satisfaction, workflow and
productivity and costs of care. If the users feel like they or their patients are
receiving little benefit from using the system, they have no incentive to use the
system. This first category helps to identify which benefits clinicians perceive are
occurring and compare them to the benefits promised upon system
implementation. Is there a gap or any unanticipated benefits? Are clinicians hot,
cold or lukewarm about this project?
Figure 1: Acceptance Model Components as Project Vital Signs

Sterling, MA, Bradley, V., and Shaha, S.


(2010) EHR Usability: Pain Points
Facing Today's EHR User findings
from the HIMSS EHR Usability
Taskforce User Pain Points Workgroup.
HIMSS Virtual-conference Expo. June
2010.
Rhonda Struck, Madison, WI. presented
an ANIA-CARING Webcast. 6 April
2010. Developing and Implementing a
Nursing Informatics Functional
Practice.
Upcoming
Conferences:

12-15 September, 2010; MedInfo2010,


Capetown South Africa,
www.medinfo2010.org Sponsored by
the International Medical Informatics
Association.
12-14 May, 2011, ANIA-CARING
Annual Conference. Las Vegas Hilton,
Las Vegas, NV.
12-14 April, 2012 ANIA-CARING
Annual Conference. Renaissance
Orlando at SeaWorld, Orlando, FL.
2-4 May, 2013, ANIA-CARING Annual
Conference, Marriott Rivercenter, San
Antonio, TX.
23-27 June, 2012, NI2012, Montreal
Canada, www.ni2012.org. Sponsored
by the International Medical
Informatics Association.

Temperature

Performance expectancy

Blood pressure

Effort expectancy

Awards and Honors:

Pulse

Social influence

Respirations

Facilitating conditions

What they like least and most

Pain level

Susan A. Matney, Woods Cross, UT,


Jacqueline A. Moss, Trussville, AL,
and Joyce E. Sensmeier, Chicago, IL.
were selected for Fellowship in the
American Academy of Nursing. This
honor will be bestowed at a ceremony
at the annual conference in
Washington, DC. in November, 2010.
After the ceremony, they will be able to
designate FAAN in their credentials.
Julie A. McAfooes, Logan, OH, was
selected as a Fellow of the National
League for Nursing Academy of
Nursing Education. Julie will be
inducted at the 2010 NLN Education
Summit at a ceremony on October 2 in
Las Vegas, NV. She will be able to use
the letters, ANEF after her name.

Think of effort expectancy as blood pressure. Effort expectancy is the degree


of ease associated with the use of the system (Venkatesh et al., 2003, p. 450)2.
This part of the assessment address usability of the system. What do nurses say
about the system? Was it easy for them to become skillful in its use? Is it easy to
find information? Is information displayed in a format that facilitates decisionmaking? Or do they complain about too many clicks, too many screens, and too
much complexity? Do some specialties or disciplines find it easier than others?
Are there themes of the type of work processes that staff struggling with? Fill in
the blanks: Systolic (easy to do): ____ Diastolic (hard to do): ____. What is your
mean ease of use score, high or low?
Social influence, the degree to which an individual perceives that important
others believe he or she should use the new system (Venkatesh et al., 2003, p. 451)2
is the pulse of the project. Assess the support rate of the clinicians peers, their
manager and senior administration. What do other clinicians on their unit say about
continued on page 8

continued on page 8

Page 7 2nd Quarter 2010

Member News
Karen Hughart, Nashville, TN. received
the Five Pillar Leader Award from
Vanderbilt University in recognition of
her leadership on the journey to excellence on December 8, 2009. Karen is
the Director of Systems Support at
Vanderbilt University, Nashville, TN.
which is one of the Most Wired hospitals in the country.
The National Quality Forum (NQF) has
formed a new Health Information
Technology Advisory Committee
(HITAC). Inaugural HITAC members
include Patricia A. Abbott, Columbia,
MD., and Caterina E.M. Lasome,
Dunn Loring, VA.
The following were inducted into the Iota
Chapter (Vanderbilt School of Nursing)
of Sigma Theta Tau International Honor
Society of Nursing, March 2010.
Kristin A. Humm, Nashville, TN
Giles A. Lippard, Hendersonville, TN
Stephanie L. Philo, Franklin, TN
Donna Stephens, Oakridge, TN
Hollie Tamez, Hemet, CA
William Mike Tedrick, Tulsa, OK
Thomas W. Andrews, Chicago, IL, was
selected at a Nursing Spectrum,
Greater Chicago Nursing Excellence
Finalists: Management. Nursing
Spectrum April 19, 2010,
www.nurse.com/Chicago
Susan J. Vaughn, Spencer, IN, was
appointed by the American Nurses
Credentialing Center as the new Chair
of the Informatics Content Expert
Panel. Her term of appointment is
from 07/01/2010 to 6/30/2012.
Susan K. Newbold, Franklin, TN, and
Robin S. Raiford, Washington, DC.
are elected members of the HIMSS
Nominating Committee.
Bytes of Interest:

Connie B. Bishop, Gibsonville, NC,


redesigned the Nursing Alumni
Association website,
nursealum.duke.edu, for Duke
University School of Nursing.
Sara Winters Turchotte, Nashville, TN
was married June 21, 2010 in Las
Vegas, NV. in a hot air balloon!
ANIA-CARING is on facebook, linkedin
and twitter per Daniel Gracie,
Charleston, DC.
Please send items for future newsletters
to: Susan K. Newbold,
sknewbold@comcast.ne

Presidents Message: Project Vital Signs


continued from page 7

the system, are others on their units more knowledgeable about the system than
they are? What about their manager? Does their manager use the system, does their
manager support nurses in their efforts to use the system and help when challenges
arise? What about senior administration, have policies/procedures been updated to
support use of the system. Documenting both positive and negative examples of
support will provide ideas for interventions in areas where social influence is
negative or weak. Is the pulse slow, fast or just irregular?
The respiratory vital sign is facilitating conditions which is the degree to which
an individual believes that an organizational and technical infrastructure exists to
support use of the system (2003, p. 453)2. If access is a challenge, if devices are
inadequate or poorly maintained they will struggle. Are there recurring issues with
connectivity? And how would they rate training and ongoing support. Some of this
information can be gained from help desk and from device usage reports. Asking
staff is to ensure you havent missed something that is blocking system usage.
Then, just to make sure no major areas have been missed check the fifth vital
sign of pain, ask what they like the least about the system and what they like the
most? Sharing their top dislikes gives you more information on pain points for
problem resolution and may uncover issues that were not identified earlier. What
they like most helps uncover functionality and interventions that have been
successful in reducing the pain of adjusting to the new system. Who knows, you
may discover some unintended benefits or at least identify the benefits that can be
shared with others to ensure that staff is aware of what value the system brings.
So how are your vital signs? Is the implementation basically stable and just a
few preventative measures are needed to maintain a healthy project? If there are
major issues in all four categories no doubt you already know your project is in a
state of shock that requires rapid resuscitation with significant resources to bring
the project back on track? This model is proposed so that performance expectancy,
effort expectancy, social influence and facilitating conditions are considered
during planning and monitored at regular intervals during implementation to
prevent any project from needing the rapid response team. Routine assessment of
clinician acceptance is recommended as a strategy for nurse informatists to guide
project teams in their pursuit of a successful implementation that achieves positive
outcomes. I hope you will share what vital signs you have found to be essential
for monitoring in your projects through the ANIA-CARING electronic list, by
submitting to present at the annual conference or writing up an article for this
newsletter.
Footnotes:
1
American Nurses Association. (2008). Nursing informatics: Scope and Standards of Practice. Silver Spring, MD: Nursesbooks.org

Venkatesh, V., Morris, M. G, Davis, G.B., Davis, F., 2003 User acceptance of information technology: Toward a unified
view. MIS Quarterly, 27(3), 425-479.

ania-CARING Page 8

ANIA-CARING 2010 Annual Conference


Re-Evolution in Nursing Informatics
Lisa Anne Bove, MSN, RN-BC
James J. Finley, MBA, RN-BC

presented topics on implementations


e-Evolution in Nursing
in many units and facilities, education
Informatics was the theme
at the staff nurse, physician and
of the newly merged ANIAhigher education level, as well as
CARING organization, held in
innovative ideas from many
Boston, MA April 22 24, 2010.
Board member Patrick Shannon and Maura Kenny at the regional meeting.
informatics nurses.
The ANIA-CARING Conference
All participants were invited to join
Planning team led by James J. Finley, MBA, BSN, RN-BC did a great job in
the ANIA CARING Board of
engaging excellent speakers and attracting exhibitors and attendees. Thanks go to
Directors for our first business
the ANIA-CARING Board and especially the Conference Planning Committee
meeting luncheon. During the
members: Lisa Anne Bove, MSN, RN-BC, Victoria Bradley, DNP, RN, FHIMSS,
meeting, President Victoria M.
PHIMS, Debra Fortin, M.Ed, RNC, CNOR, Daniel Gracie, MSN, RN, FHIMSS,
Bradley, RN, DNP, CPHIMS,
CPHIMS, Libertad (Liberty) Rovira, MN, RN-BC, CPHIMS, and Patrick
FHIMSS introduced the current board
Shannon, MS, RN, CPHIMS.
and thanked previous members of both
We started the conference with pre-conference sessions offering a more in depth
ANIA and CARING who helped to
look at a variety of topics. Due to popular demand, the full day Writing for
form the new group. The role of the
Publication tutorial was repeated and taught by Kathleen C. Kimmel and Carlene
Regional Director and Nominations
Anteau. All the other pre-sessions were half-day sessions. Starting the day was
Committee were also discussed. The
Victoria M. Bradley and Steve Shaha who led the workshop entitled
Maggie Cox award was presented to
Substantiating Value: Evaluation Tools in HIT Implementation Questionnaires
Daniel Gracie for his article on Wiki
and Focus Groups and Lisa Anne Bove and Susan Houston discussed Program
Basics for Healthcare Informatics.
Management. Two afternoon sessions were also offered. Marina Douglas,
MS, RN presented Making Change: Understanding the Team Mindset and
Rosemary Kennedy, RN, MBA, FAAN, Connie White Delaney, PhD, RN,
FAAN, FACMI, and Judith J. Warren, PhD, RN, BC, FAAN, FACMI
presented Nursing Informatics Impact on the National HIT Agenda.
The main conference kicked off on Thursday evening with our first
Regional Meeting and Welcome Reception. With the merger, we have added
Regional Directors so we can better support our members where they live and
work. The four Regional Directors met with members in each region to
network on options for education and networking at the regional level.
This reception gave everyone an opportunity to network, get re-acquainted
with colleagues and friends, and meet new friends in the Region where they
work and/or live.
Board member Vicky Vallejos at the regional meeting.
Friday mornings opening keynote session set the tone for the rest of the
conference. Despite potential flight issues due to the Icelandic volcano ash, Peter
Service Awards for dedication to the
J. Murray, PhD, RN, FBCS CITP arrived from the UK and presented an
profession of nursing informatics were
international look at nursing informatics with his keynote entitled A Boston IT
presented to Sandy Alfon RN, MSN,
Party International Re-Evolutions in Nursing Informatics.
FNP-BC, Barbara Medling RN, BSN,
After the opening keynote, participants were invited to browse the exhibit hall
CNOR, RN-BC, Linda Wittrup RN,
and view posters. There were over 30 posters and a whole host of healthcare
MA, Liberty Rovira MN, RN-BC,
vendors who supported the conference. The rest of the day included breakout
CPHIMS, Katherine A. Holzmacher,
following four tracks including
MS, RN-BC, NP, CPHIT, CPEHR,
Education and Career
Marianela Zytowski DNP, MS, BSN,
Development, Improving System
RN-BC and Cathy M. Walter RN,
Implementation, Contributions to
MBA, MS.
Patient Care, and Innovations in
We ended Friday with an optional
Nursing Informatics. Speakers
session that almost all attendees
came from the US and abroa
attended! Patricia Hinton Walker,

2009 Maggie Cox Aware winner


Daniel Gracie and Editor Denise Tyler.

continued on page 10

Page 9 2nd Quarter 2010

ANIA-CARING 2010 Annual Conference Re-Evolution in Nursing Informatics


continued from page 9

PhD, RN, FAAN, CMC presented


Keys to Meaningful Use Success:
TIGER Initiative Phase IIIs Virtual
Learning and Interdisciplinary
Collaboration. This session will be
updated at the next years conference.
Saturday started with a keynote
entitled Ten Steps for Creating your
Roadmap to EHR Meaningful Use
presented by Judy Murphy, RN,
FACMI, FHIMSS. Judy outlined the
federal initiatives and agencies
focused on increasing the widespread
adoption of electronic health records
(EHRs) and defined the key funding
streams from American Recovery and
Reinvestment Act (ARRA) aimed to
accelerate EHR adoption and describe
the key components that comprise the
definition of EHR meaningful use
required for access to the ARRA
funds in 2011. In addition, Judy

explained the maturation model of "meaningful use" criteria through 2015, and
discussed how to create a roadmap for an organization to achieve EHR
meaningful use and receive the federal incentives. At the conclusion of her
dynamic presentation, it was like a rock concert where the stage was rushed by
attendees hoping to meet and talk with Judy.
Participants then spent the rest of the day in a variety of breakout sessions, and
another chance to visit posters and the vendors.
We closed the session with Rosemary Kennedy, RN, MBA, FAAN who
presented on the Re-Evolution of Quality Measurement Through Informatics.
Rosemary reviewed requirements necessary to enable automated quality
measurement as a byproduct of EHR data capture. She also shared some examples
showing how standardized quality data sets can enable the power of the EHR in
quality measurement will be presented.
The poster presentation section of the conference continued this year to be one
of the more popular and engaging activities. This year set a record with 38
post--ers presented by ANIA-CARING members. The range of topics extended
from education to practice, research and implementation work. The second year of
the Peoples Choice Award for posters was a very successful judging activity, and
Shirley Schiavones, poster, An Informatics Council Re-Evolutionizes Bedside
Nurses Relationship with Technology took home the top prize and a
complimentary registration to the 2011 ANIA-CARING conference.
continued on page 11

Figure 1: Regional Director Map

What are the 4 Regions?

Region III
n=899
Patrick Shannon

Region I
n=551
Includes AK, HI
Vicki Vallejos

Region IV
n=974
Stephen Prouse

Region II
n=660
Includes International Members
Brian Norris

ania-CARING Page 10

ANIA-CARING 2010 Annual Conference


Re-Evolution in Nursing Informatics
continued from page 10

Connecting, Sharing, and Advancing Nursing Informatics

ANIA-CARING Contacts
Newsletter

A special thank you to our sponsors: Zynx Health,


Enterprise Software Deployment, Eclipsys, and CMIO
2010 Poster Recipients, 2nd runner up
Media, a division of TriMed Media, and our 19
Rhonda Struck, 1st runner up Nancy
Russell, and the winner, Shirley Schiavone.
exhibitors Center for Healthcare Innovations, Code
Corporation, Elsevier - CPM Resource Center, Enterprise Software Deployment,
Hospira, Howard Medical, Intermetro Industries, Jannetti Publications, inc.
MEDITECH, PEPID, ProVation Medical, RMS Omega Technologies, Thomson
Reuters, University of Washington School of Nursing, Welch Allyn, and Zebra
Technologies.
We had over 390 attendees at this years event. Most of the presentations were
available to attendees on a flash drive distributed at the conference. Attendees
could obtain contact hours for participating. Evaluations indicated that most
attendees received value from attending the conference.
Next years conference is scheduled for Las Vegas Hilton on May 12 - 14,
2011. The call for abstracts for posters and presentations is July 19 - August 27,
2010. Please consider submitting an abstract for a poster and/or a presentation. We
look forward seeing many of you next year!

Denise Tyler, RN-BC, MSN/MBA


Tel: 1-866-552-6404 x 716
E-Mail: secretary@ania-caring.org

.
Membership

Susan K. Newbold, PhD, RN-BC, FAAN,


FHIMSS
Tel: 1.866.552.6404 x 703
E-Mail: membership@ania-caring.org

.
ANIA--CARING
Board of Directors:

Need access to any of your board members, member services


or support, give us a ring at 1.866.552.6404

President
Victoria M. Bradley RN, DNP, FHIMSS
x714 / president@ania-caring.org

Vice President
Jerry Chamberlain MS, RN-BC

x702 / vicepresident@ania-caring.org

Treasurer

Amy K. Jacobs, MSN, RN-BC

x704 / treasurer@ania-caring.org

Secretary and Publications

Denise Tyler, RN-BC, MSN/MBA


x716 / secretary@ania-caring.org

Past board member Sandy Alfon, board member Amy jacobs


and LTC Nicole Kerkenbush

Education

James J. Finley, RN, MBA, BC


x717 / education@ania-caring.org

Education

Lisa Anne Bove. MSN, RN-BC

x715 / education@ania-caring.org

Relations Management

Curtis N. Dikes, RN, MSN, BC-ACNP, CLNC


x719 / relations@ania-caring.org

Membership

Membership Chair Susan Newbold and past board


member Kathleen Smith.

Susan K. Newbold, PhD, RN-BC, FAAN,


FHIMSS
x703 / membership@ania-caring.org

Regional Director Region I


Vicki Vallejos RN-BC, BSN

x713 / region1@ania-caring.org

Regional Director Region II


Brian Norris RN-BC

x712 / region2@ania-caring.org

Regional Director Region III

Judy Murphy and Pat Button.

Patrick Shannon MS, RN

x707 / region3@ania-caring.org

Regional Director Region IV

Susan Hinck,
Board
Member
Brian Norris
and Holly A.
Bronson.

Stephen W. Prouse MS, RN-BC


x701 / region4@ania-caring.org

.
Board Members hand off Liberty Rovira, Sandy Alfon,
Barb Medling, Linda Busk, Katherine Holzmacher.

Board Members Victoria Bradley,


Stephen Prouse and Curtis Dikes.

ANIA--CARING
Web site: Homepage

http://www.ania-caring.org

2010 The ANIA--CARING Newsletter is


produced with support from:
Editor: Denise Tyler, RN-BC, MSN/MBA
Newsletter Team for this Issue:

Rosemarie Almonte, Debi Camp, Elissa Chandler, Mary B Crandall, Michelle


Downing, Rae Frazer, Carol Hullin, Maureen Johnson, Stacey Kagan, Diane Kievet,
Kathleen R. Krane, Terri Lockhart, Debra Lurns, Chris Malmgreen, Jean Mcgill ,
Susan Newbold, Cindy Pipes, Karen Pope, Meri Shaffer, Florence Shrager, Margaret
Swanson, Cathy Turner, Sandra Wilson

Board Members Jim Finley, Curtis Dikes, Susan Newbold and Denise Tyler.

Page 11 2nd Quarter 2010

CNIdesign

WEBSITES, ETC.

clorinda@cnidesign.net http://www.cnidesign.net