Guiding Principles for Big Data in Nursing Developed by: HIMSS CNO-CNIO Vendor Roundtable

About HIMSS HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology (IT). Vision: Better health through information technology Mission: Globally, lead endeavors optimizing health engagements and care outcomes through information technology

About the HIMSS CNO-CNIO Vendor Roundtable Established in January 2014 Includes HIMSS Diamond and Platinum member nurse executives Co-facilitators Gail Latimer, MSN, RN, FACHE, FAAN Roy Simpson, DNP, RN, DPNAP, FAAN 3 workgroups established Staff liaisons Maria Thornblad, Christel Anderson & Joyce Sensmeier

HIMSS CNO-CNIO Vendor Roundtable Purpose & Objectives To optimize health engagement and care outcomes through IT by leveraging the thought leadership of HIT vendor nurse executives Serve as an advocate and leader for the nursing community Provide guidance on informatics competencies for nursing Provide guidance on EHR related topics including analytics, interoperability, usability, terminology, workflow, quality and outcomes

Human Factors, Usability, Safety Workgroup Structure Vendor Nurse Role Define the nurse vendor leadership role, identify competencies and value to the profession Human Factors, Usability, Safety Identify resources and opportunities to improve knowledge re: human factors, usability & safety Big Data Principles Develop big data principles/recommendations

Big Data Principles Workgroup Member Title Organization Ellen Harper, DNP, RN-BC, MBA, FAAN co-chair Vice President, CNO - Premier West Cerner Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN co-chair Vice President, Informatics HIMSS Sue Lundquist, BSN, RN-BC Director, Patient Care Solutions, Health Services Marion McCall, BBA, RN, CNOR, CPHIMS Chief Clinical Officer OverSite Solutions Beth Meyers, RN, MS, CNOR Chief Nurse Executive, Analytics Strategy Director Infor Sara Parkerson, RN, MSN Clinical Solution Development Manager Philips Libby Rollinson, MSN, RN Director, Content Solutions, Enterprise Information Solutions McKesson In response to recommendations by the HIMSS CNO-CNIO Vendor Roundtable, the Big Data Principles Workgroup was established. The Workgroup was tasked with developing a paper to: identify big data principles, barriers and challenges; develop a framework for universal requirements; identify differences in the context of nursing outcomes; address the impact of health IT system versions/configurations; analyze the variation in quality measures; and discuss implementation challenges. This paper will also provide the foundation for future discussions with the broader nursing community including nurse executives in hospitals, healthcare systems and other key stakeholder groups to explore and advance shared objectives.   Dr. Ellen Harper and Joyce Sensmeier were selected to co-lead the broad and diverse group of individuals who represent the nursing leadership perspective of health IT suppliers around the world.

Why Big Data? Organizations are keen on gaining insights and instituting organizational change from the vast amounts of data being collected from their EHR systems. Participants in the healthcare ecosystem are trying to reduce the cost and improve the quality of care by applying advanced analytics to both internally and externally generated data. Technological advances enable larger volumes of structured and unstructured data to be managed and analyzed  through faster, more efficient and cheaper computing (processors, storage, and advanced software) and through pervasive computing (telecomputing, mobile devices and sensors). HIMSS Data and Analytics Task Force July 2014

Big Data - Sharable & Comparable Harper, E. (2015). Clinical Integration and the Continuum of Care [PowerPoint slides]. Retrieved from http://files.himss.org/2015Conference/handouts/NI5_1428848643264_4.pdf Harper, E. (2015). Clinical Integration and the Continuum of Care [PowerPoint slides]. Retrieved from http://files.himss.org/2015Conference/handouts/NI5_1428848643264_4.pdf

Promote Standards and Interoperability Top 10 Recommendations Promote Standards and Interoperability 1) Nurses should promote the use of standardized and accepted terminologies that address the documentation needs of the entire care team regardless of care setting. All care delivery settings should create a plan for implementing an ANA- recognized nursing terminology that is mapped to national standards i.e. SNOMED CT or LOINC The ability for nurses to make optimal clinical decisions is dependent upon having access to accurate, real-time information regardless of care setting. Data must also be structured in standard ways to enable sharable, comparable information.

Promote Standards and Interoperability Top 10 Recommendations Promote Standards and Interoperability 2) Nurses should recommend consistent use of research-based assessment scales and instruments that are standardized through an international consensus body. The lack of standardization makes comparison of data challenging and adds to the burden of cost for copyright permissions and/or licensing of such instruments

Promote Standards and Interoperability Top 10 Recommendations Promote Standards and Interoperability 3) The ANA-recognized nursing terminologies should be consistently updated and made available to international standards organizations for translation and complete, comprehensive mapping

Promote Standards and Interoperability Top 10 Recommendations Promote Standards and Interoperability 4) Minimize use of free text documentation. When ‘within defined limits’ is used, discrete data elements should be stored within the EHR to enable decision support, research, analytics and knowledge generation

Cerner. (2015). Clinical Integration and the Continuum of Care [PowerPoint slides]. Retrieved from http://files.himss.org/2015Conference/handouts/NI5_1428848643264_4.pdf Cerner. (2015). Clinical Integration and the Continuum of Care [PowerPoint slides]. Retrieved from http://files.himss.org/2015Conference/handouts/NI5_1428848643264_4.pdf

Advance Quality eMeasures Top 10 Recommendations Advance Quality eMeasures 5) Efforts to develop and design quality eMeasures must ensure the data to be collected and measured are aligned with the clinician’s workflow, not as additional documentation Measurement of quality data, including Meaningful Use clinical quality measures and nursing sensitive performance indicators, in a complex process. The data needed to populate these measures come from multiple sources, some of which are not available in the EHR today. Therefore, alignment on the data to be collected, how they are collected, and the terminologies needed to support them is critical to the ability to share data across settings and organizations.

Advance Quality eMeasures Top 10 Recommendations Advance Quality eMeasures 6) To advance nursing sensitive quality eMeasures, paper measure sets must be evaluated for appropriateness, and expectations set for which data should be collected, how the data are collected and the required terminologies to be used

Advance Quality eMeasures Top 10 Recommendations Advance Quality eMeasures 7) Initiatives and programs that define and promote new quality eMeasures and their requirements should allow time for testing and piloting with defined timeframes that consider all stakeholders

Advance Quality eMeasures Top 10 Recommendations Advance Quality eMeasures 8) Clinical quality eMeasures must support evidence-based, cost effective care that follows clinical practice guidelines and minimizes the negative impact on clinicians’ workflow

Research – Bridge the Gap Financial Data Benchmark Data Health Plan Data Device Data Monitors, Vents, Smart Pumps EHR Data Claims Data Staffing Data Medication Data Move to a Learning Health System Cerner. (2015). Clinical Integration and the Continuum of Care [PowerPoint slides]. Retrieved from http://files.himss.org/2015Conference/handouts/NI5_1428848643264_4.pdf

Leverage Nursing Informatics Experts Top 10 Recommendations Leverage Nursing Informatics Experts 9) Healthcare organizations should utilize nurse informaticists who will provide valuable insight into concept representation, design, implementation and optimization of health IT to support evidence- based practice, research and education Nursing informatics is a specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice (ANA, 2015). NI supports nurses, consumers, patients, the interprofessional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desires outcomes. This support is accomplished through the use of information structures, information processes, and information technology (ANA, 2015). The application of nursing informatics knowledge is essential to enable capturing health and care data in a structured way to accomplish the vision of accurate, reliable, clinically meaningful measurement across systems and settings of care. http://www.himss.org/ni-impact-survey

Leverage Nursing Informatics Experts Top 10 Recommendations Leverage Nursing Informatics Experts 10) To achieve the desired outcomes, nurse informaticists should have formal informatics training education and certification

Learn More Guiding Principles for Big Data in Nursing www.himss.org/big10 HIMSS CNO-CNIO Vendor Roundtable www.himss.org/cno-cnio-vendor-roundtable HIMSS Nursing Informatics Community www.himss.org/ni

Contact Information Joyce Sensmeier MS, RN BC, CPHIMS, FHIMSS, FAAN Vice President Informatics, HIMSS jsensmeier@himss.org Maria Thornblad, MPA Clinical Informatics Coordinator, HIMSS mthornblad@himss.org HIMSS Nursing Informatics Community www.himss.org/ni