The Power of CollaborationHINZ 2015

Karen A. Monsen mons0122@umn.edu

Share – Solve – Achieve - Measure

Greetings from Minnesota• Land of 10,000 Lakes including Lake Superior• Center of North America, bordering Canada• Known for climatic extremes and informatics expertise

Minnesota

New ZealandS

Collaboration• Naku te rourou nau te rourou ka ora ai te iwi.

With your basket and my basket the people will live. (Maori proverb)

Exemplars of Collaboration • Building a health care quality infrastructure • Conducting research • Enabled by use of a shared data model

Challenge• Terminology

Share – Solve – Achieve - Measure

Classify

And Relate

omahasystem.org

Share – Solve – Achieve - Measure

History of Collaboration with the Omaha System

• 1975 – Research began• 1992 – First version published• 2001 – Omaha System Users Group• 2005 – Second version published• 2008 – Evaluation of the Omaha System for New Zealand• 2010 – Omaha System Partnership• 2012 – Omaha System Guidelines• 2015 – Omaha System Warehouse

ChallengeHow to use the data infrastructure to deliver clinical decision support using a standardized terminology

Share – Solve – Achieve - Measure

Building a health care quality infrastructure within the EHR

• Evidence + Terminology = health care quality infrastructure • Most EHRs have one or the other. • Most of the time you pay extra for one or both.

Evidence of need for shared data infrastructureWhen clustering a big data set of interventions from 15 agencies

• If no agency ID included• no clusters were formed• It’s not enough to use standards. We have to use

them in standardized ways.

Monsen, K. A., Westra, B. L., Yu, F., Ramadoss, V. K., & Kerr, M. J. (2009). Data management for intervention effectiveness research: Comparing deductive and inductive approaches. Research in Nursing and Health, 32(6), 647-656. doi:10.1002/nur.20354

Consensus process for development of guidelines• 2008 – Washington State Public Health Nursing Directors – Maternal/Child

guidelines development• 2010 – Nurse Maude, New Zealand, Home Care • 2011 – International Home Care (NZ, NL, CA, US)• 2012 – Peer review process• 2013 – Omaha System Guidelines process, libraries• 2014 – Additional libraries/disciplines• 2015 – Instrument normalization

omahasystemguidelines.org

SNOMED CT codes

Omaha System terms

Evidence (sources and text)

Value of data infrastructure for reuse of data• Consensus on knowledge representation• Clear meaning and shared understanding• Clinical decision support for practice• High quality data• Enables meaningful comparisons

Observational process to confirm use of interventions

• TimeCat.org (The Ohio State University)• Time-Motion study with inter-rater reliability, data analysis, and workflow

analysis capabilities• Customizable for any setting and practice• Available without charge for academic research

Mean: 1.24 minRange 0.017-48.9 minFratzke (2013) mean 1.1 min

Schenk, E., Schleyer, R., Daratha, K., & Lazo, M. L. (2015). Capturing Complexity: Use of TimeCaT & the Omaha System to Study Multi-tasking Activities of Acute Care Nurses. Paper presented at the Second International Conference on Research Methods for Standardized Terminologies. West St. Paul, MN.

Interventions per Category

Case Mgmt

Surv

Teach/Guide/Coun

Treat/Proc

0 200 400 600 800 1000 1200

530

236

366

196

569

260

349

187

976

383

347

348

ICUMSTele

43.7%

22.4%

18.5%

15.4%

70% of interventions were in the problem: Health Care Supervision

Multidisciplinary ResearchPharmacy documentation (Garza, 2015)• Pharmacists provided/recommended 6.7 interventions per patient (Range: 1-16)

Sickle Cell Guideline Practice Patterns

Data inform us:How Guidelines are Used

Monsen, K. A., Swenson, S., & Johnson, K. J. (in review). Evidence-based Family Home Visiting Guideline: Development, Implementation, and Data.

Researchomahasystempartnership.org

• Omaha System Partnership for Knowledge Discovery and Healthcare Quality• Scientific Teams• Affiliate Members• Data

Sickle Cell Anemia Guideline130 Interventions for 19 ProblemsRajput, Stewart, & Monsen (2015)

Diabetes Signs/SymptomsMonsen, K. A., Handler, H. E., Le, S. M., & Riemer, J. G. (2014)

Serious and Persistent Mental Illness Gapp, N., Weber, J., Monsen, K.

A., & Darst, E. (2014)• One Client, Nine Problems

Measuring Complexity of Acute Care Nursing Schenk, E., Schleyer, R., Daratha, K., & Lazo, M. L. (2015).

CM44%

S19%

TGC22%

TP15%

34.7% of minutes had at least two interventions

Policy-Practice Comparisons• Federally Qualified Health

Center USA• How do FQHCs reach out to

underserved?• Surveillance

• Buutzorg Nederland• How do nurse-led teams tailor

interventions to meet the unique needs of community dwelling home care and hospice patients?

• Case management

• Advanced Nursing Care Japan• How does the Japanese government define the

interventions that nurses with special advanced training may perform in Japan?

• Treatments and procedures

• Nurse-led Clinics Mexico• How do nurses provide holistic care

in nurse-led academic healthcare centers?

• Teaching, guidance and counseling

• Terminology• Expertise

• Shared understanding

• Shared data model

• Clinical decision support

• Quality infrastructure

Share Solve Achieve Measure

• Knowledge representation challenges

• Outcomes

The Power of Collaboration

• Classify And Relate• Collaborate • Achieve improvements in

healthcare, and rise to a new level of understanding and practice

The All Blacks

62-15

Who Benefits?• Naku te rourou nau te rourou ka ora ai te iwi.

With your basket and my basket the people will live. (Maori proverb)

• If the patient doesn’t benefit, we should stop all efforts now. • Clinicians benefit from rational and coherent clinical decision support and

documentation• EHR developers benefit from a sound information structure• Administrators and researchers benefit from excellent data to show outcomes

and improve care

Let’s Collaborate!• mons0122@umn.edu