From clinical practice to information system, a long way throught

Transcription

A Bridge Between Data and Language,
the Swiss Issues:
NURSING data
Alain Junger
ISE
Lausanne
Bern
http://www.hospvd.ch/ise/nursingdata
NNN02/april 2002
From clinical practice to
information system,
a long way throught data and
terminologies
NNN02/april 2002
Swiss health information system
26 autonomous
cantons
26 health systems
No central data
production
Many lobbies
Economic
restrictions
Health policy
Comparisons
Coordination
Many different
information systems
NNN02/april 2002
Federal laws
Federal Law on statistics (1992)
Federal Law on health insurance (1994)
Since 1998, compulsory collecting
of data for
Statistics
Economy/
Management
Federal Law on data protection
NNN02/april 2002
What is NURSING data ?
The future nursing information system for
Switzerland
An add-on for the health information
system
An information system for pricing nursing
care
It covers:
Acute care, Long term care, Home care
and Psychiatry care
NNN02/april 2002
Why NURSING data ?
To standardize nursing information
To layout the foundations for nursing
data comparability
To determine a nursing data set
To coordinate the swiss effort with
international developments
To show nursing makes a difference!
NNN02/april 2002
How NURSING data came to life ?
1998: political decision gave green light
1999: Nursing information model ready
2000: proposals for the future,
a global and pragmatic solution
2001: phase 2 and extension of the
partnership:
(federal administration, insurance,
professional associations, providers,…)
NNN02/april 2002
Conclusions of the 1st part
Need for a
uniform nursing
language to
describe nursing
phenomena and
nursing
interventions
Definition of relevant
concepts
Choice of a standardised
language for data collection
and treatment
Coordination on international
level
Ability for nurses to work in
natural or «home» language
Use of technical developments
(informatics)
NNN02/april 2002
Part 2 : business plan
2001
2002
2003
2004
2005
TP1: Project management
TP2 : Classifications
TP3 : CH-NMDS
TP4: Data mining
TP5: Information
TP6 : Nat. and internat. coordination
TP7: Normalisation
NNN02/april 2002
Organigram
Direction de projet
NURSING data
TP1 : Gestion
opérationnelle
TP2 -TP3 - Groupe national de
terminologie et de
données infirmières
TP4 : Validation du modèle
d’exploitation des
données
TP5 :
Information
TP 7 : Préparation du
système de
normalisation
TP 6 : Coordination
TP2 : Groupe régional de
terminologie infirmière
(francophone) (GRTI)
TP2 : Regionale
Expertengruppe für
Pflegefachsprache (REP)
Réseaux régionaux
Regionale Netzwerke
TP2 : Gruppo regionale per
una terminologia
infermieristica (GRTI)
TP3 : Groupe d’experts
national pour le NMDS
(GN-NMDS)
Reti regionali
NNN02/april 2002
NURSING data
The conceptual framework
…
NNN02/april 2002
Nursing Data Sets
Nursing
Phenomena
Set
Nursing
Management/financial
Set
Patient Structure
Prof.
Nursing
Intervention
Set
NNN02/april 2002
NURSING data in four models
Clinical
process
Physiopathological
Psychological
Social
Concern
e
+ resources
Interventions
Patient /
Client
Nursing phenomena
Emploi
Object/data
model
Réalise/
applique
Devient
un nouvel
état de santé
Modifie
Institution
5 Functions
Soins & traitements
Autres
Séjourne/
habite
B-Sate observed
Outcomes
Patient
Médecin
Descriptifs
spécifiques
inf irmiers
Agit
- problems
Diagnostic
aspects,
objectives
Autres
Analyse/fixe des
objectifs
Observe/
décrit
Autres professions
Patient
Médecins
Inf irmières
Environment
Clinical
status
Etat de santé
Les acteurs
A-State observed
Facts
Traitements
Actes /
interventions
Alain Junger/99
Induit
Prescrit/
demande
Travaille
Lieu
Séjour
Etape
Episode
Information
flow
Se
situe
Appartie nt
Version 2.0
Alain Junger/9 9
Statistics of population
NURSING data
Statistical Data
External
NMDS
NDS
Data
aggregation
Planification data
Management reporting
Management data
Internal
Nursing records
Clinical data
Reality / practice
Facts
Alain Junger/99
NNN02/april 2002
Model of the clinical process
A-State observed
Facts
Environment
Clinical
status
Physiopathological
Psychological
Social
+ resources
- problems
Diagnostic
aspects,
objectives
Interventions
Outcomes
Nursing phenomena
5 Functions
B-State observed
Alain Junger/99
NNN02/april 2002
Care as an object
Permanent concepts:
Patient
Actor/professional
Institution
Point of care
Episode
Health status
Interventions, actions
NNN02/april 2002
The object: « care »
Etat de santé
Les acteurs
Autres professions
Patient
Médecins
Infirmières
Autres
Patient
Analyse/fixe des objectifs
Hea
lth s
Médecin
Observe/décrit
ors
Act
Descriptifs
spécifiques
infirmiers
Agit
tatu
s
Concerne
Patient /
Client
Devient
un nouvel
état de santé
Emploi
Réalise/applique
Modifie
Institution
Organisation
Soins & traitements
Autres
Séjourne/
habite
Traitements
Interventions
Actes /
interventions
Travaille
Induit
Prescrit/demande
Lieu
Séjour
Etape
Episode
Appartient
Place
Se situe
Episode
Version 2.0
Alain Junger/99
NNN02/april 2002
Micro to macro
ion
Statistics
gat
Policy
Dat
aA
gr e
Management
Clinical
documentation
Nursing process
NNN02/april 2002
Linkage between data
e
lleri
Ph y
siot
hér
Fina
n ce
ape
u te
Stat.
Population
DS
NM S
ND tairtm
. .
Sf
rs. n
Nut. I
tion
Sta cumsesnitea r
o
o
DD
ns
Soai re
M éd
ec i n
e
e
Hot
C
NNN02/april 2002
CH-NMDS - 1
Patient
Health status
ID Number*
Medical diagnoses*
Date of birth*
Nursing phenomena
Sex*
Caracteristics of the
Region of residence*
phenomena
Episode
Outcomes related to the
Date of entry
phenomena
Date of exit
Interventions
Number of intern transfer
Hospital:
Interventions
In Operating Theater; Intensive
Frequency, contribution of
care (Y/N)
social network, home
Long term care:
assistance
With Hospitalization (Y/N)
Overall intensity of the
Place
episode (class, length of
Type*
required or dispensed care)
* link with medical and
administrative statistics
NNN02/april 2002
CH-NMDS - 2
Nurse
ID Number
Nationality
Diploma
Year of qualification
Activity
Function
Date of engagement
Date of resignation
Work rate
Firm Information (year)
Total
number of
working hours of
temporary workers
(Nursing)
Total number of
working hours of
temporary workers
(Other)
Total number of
working hours for a full
time worker
NNN02/april 2002
NURSING data & other statistics
Medical
statistic
Hospital
statistic
Long-term
care
statistic
(Establishment)
Future ?
NURSING data
CH-NMDS
NNN02/april 2002
What will we show and see ?
NNN02/april 2002
Mais...
Aber...
Ma ...
– But
NNN02/april 2002
Terminology: what for ?
Specificity of Switzerland:
use
Four national languages
No common professional language
No compatibility between systems in
Workload measure, measure of
given care
• measure of needs, staffing, …
•
Rapid development of electronic
patient record
NNN02/april 2002
From data to terminologies
From practice to concepts
Practice
Data
Language
Abstraction
NNN02/april 2002
LEP/PRN
NNN02/april 2002
Phenomena / Diagnosis
?
Phenomena
Statistical
Level
Aggregation
Nursing
Diagnosis 1
Target 1
Nursing
Diagnosis 2
Target 2
Nursing
Diagnosis 3
Target 3
Clinical
Level
Clinical
Judgement
Description
Description
Symptoms
Description
Description
Clinical situation
NNN02/april 2002
Future
many years of data and research
No
known
classification
Classification
Classification
characteristics
Classification
characteristics
Clinical oriented
definitions
Clinical definitions
Hierarchical classification
=
Gathering nursing diagnosis with common
characteristics
Typology
=
Gathering different Nursing
diagnosis and other data
(Nutritional state control, parenteral feeding, weight
control = Care for nutritional troubles)
(Hyperthermia, 86 years, pain, ...)
?
Phenomena
NNN02/april 2002
Health phenomenon
Health aspect from one or
many individuals justifying the
nursing interventions
Definition accepted at 82%,
rejected by 5%
NNN02/april 2002
Classification developments 1
Phase 1
June 2001
Experts
selection:
3 groups
3 languages
60 persons
Sept. 2001
Course on
basic
terminology
concepts
Nov. 2001
Selection of
Delphi I
nursing significant two lists
concepts for
per language
phenomena
interventions
Febr. 2001
Dead line
for answers
NNN02/april 2002
Delphi questionnaire
Speaking :
Sent
Received
%
French
46
32
70%
German
50
37
74%
Italian
55
40
73%
Total
151
109
72%
NNN02/april 2002
Delphi I & II
I
Other
Other
School
Psychiatry
Home care
Long term
care
Hospital
II
Other
School
Psychiatry
Home care
Long term
care
Hospital
Nurse
Nurse
Nursing Board
manager practitioner teacher nurse
9
10
2
1
10
5
2
1
3
6
4
5
Other
6
24
2
7
2
Nurse
Nurse
Nursing Board
manager practitioner teacher nurse
14
10
2
1
8
5
2
1
2
5
1
2
2
22
6
22
49
2
5
9
2
12
1
12
2
19
13
9
9
12
50
112
1
3
26
11
9
11
11
17
10
42
109
NNN02/april 2002
Classification developments 2
Phase II
March 2002
May 2002
Results analysis
Feedback
Publication
of the first
version of the
two lists
translated in:
•French
•Italian
•German
June 2001
Dead line
for answers
Test
in
2003
NNN02/april 2002
Nursing phenomena
Structure
Content
Qualifiers
ICF (WHO)
50 items
ICF
4 steps scale
ANATOMICAL
STRUCTURE
ORGANIC FUNCTION
ENVIRONMENTAL FACTORS
ACTIVITY AND PARTICIPATION
NNN02/april 2002
Nursing interventions
Structure
Content
ICF (WHO)
64 items
Qualifiers
Observe/survey/monitor
Prevent
Inform
Teaching
Advise/guide
Assist/help/accompany
Treat
/ act / intervene / supply
Re-educate
NNN02/april 2002
Future of NURSING data
Theory
Research
Future
improvement
Development Engineering NURSING data
Operational
Nursing
practice
Future
application
NNN02/april 2002
Information policy
Ambitious information with modern tools
Web site
http://www.hospvd.ch/public/ise/nursingdata/
Restricted forum
Regular publications in professional and
other journals
Communications, conferences, lectures
NNN02/april 2002
Thank you
for your attention
and
Looking forward
to continue the discussion
NNN02/april 2002

From clinical practice to information system, a long way throught

Transcription

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