National action plan has led to advances in use of nursing data

By Bonnie L. Westra, PhD, RN, FAAN, FACMI & Connie White Delaney, FACMI

June 30, 2016

Progress is being made on accessing comparable and sharable patient data within electronic health records (EHRs) and contextual data about the environment in which care is delivered. Since the first gathering of national nursing leaders in 2013, a coordinated movement has gained substantial momentum to align policies and systems to better standardize, integrate, and use the valuable patient and family information nurses to improve health outcomes. By convening the decision makers and leaders from practice, government agencies, system and software vendors, professional associations, and education and research institutions, the University of Minnesota–led national initiative is aligning efforts to effectively identify and remove long-standing barriers to comparable and sharable nurse-sensitive data.

What is the point of this work? Our vision is one of standardizing and sharing the information nurses gather in EHRs to advance insights and evidence used to prevent, diagnose, treat, and evaluate health conditions. Additionally, the data that describes the context of the workplace has been standardized and is now moving toward implementation to explain care delivery factors that influence patient outcomes, such as staffing, turnover, or nurse satisfaction.

At the fourth annual Nursing Knowledge: Big Data Science Conference held earlier this summer in Minneapolis, MN, 170 participants heard advice from Pamela Cipriano, President of the American Nurses Association (ANA); Deborah Trautman, CEO of the American Association of Colleges of Nursing; Norma Lang, a long-time nurse leader in quality and outcomes; and representatives from the Patient-Centered Outcome Research Institute (PCORI) and legislature on how to advance the policy agenda to integrate these essential data.

The Big Data summit, with year-round working groups, is clear evidence that a compelling shared vision, collaboration, and partnership within and interdisciplinary teams can find solutions for the common good. Here are a few examples of what we have achieved over four years:

Standardized vocabulary for documentation. Earlier this year the Office of the National Coordinator (ONC) for Health Information Technology announced its recommendation for use of Logical Observation Identifiers Names and Codes (LOINC®) and Systematized Nomenclature of Medicine — Clinical Terms (SNOMED CT) as the standard terminologies for coding and electronic exchange of clinical health information. The ONC is the principal federal entity charged with coordinating efforts to implement the most advanced health information technology and the electronic exchange of health information. Big Data summit participants had launched an aggressive advocacy effort to bring about this outcome, in collaboration with the ANA.

Collecting contextual data enables health care systems to objectively evaluate and compare the effectiveness of their nursing care, staffing, and facilities – unit-by-unit and shift-by-shift. The Nursing Management Minimum Data Set (initiated by Diane (Gardner) Huber and Connie Delaney in 1997) supports administrative and management decision making that aligns the needs of the patient with the skills and knowledge of nursing providers, and has recently been added to an internationally adopted standard.

Streamlining documentation and creating useful data to support research. Information systems contain redundant data even within the same EHR, resulting in duplicate documentation and inconsistent data across settings such as emergency departments, intensive care units, medical-surgical units, rehabilitation, or home care. Recommendations for streamlining documentation and creating information models that integrate redundant data are emerging from the Nursing Big Data Initiative. Additionally the products of these efforts will be placed in an open-source repository for anyone to access once the work is ready for use by others.
Nurses’ competency in technology and documentation has been extended through nursing education standards. Completion of the American Association of Colleges of Nursing and the Gordon and Betty Moore Foundation initiative has advanced informatics competencies of nursing faculty.
Big data research is empowered. EHR data is necessary for ground-breaking research using nursing big data. Moving from disparate data and documentation within organizations to data sharing across systems and organizations allows for new big data science. Using social and behavioral factors that influence individual health expand research personalizing research for better health. Using information about the context of health care, for example who is providing care and what their expertise and experience are, a swell as where the care is occurring help nurses individualize high quality, safe, and low cost care.

Fueled by a shared vision of a more efficient health system, leaders from major vendors, government, and academia are collaborating more than ever. The volunteers who have advanced this work recognize that each accomplishment is dependent upon progress across disciplines. After 35 years of discussion, leaders, care providers and payers are integrating their systems and expertise to support nurses in delivering the most effective health care.