1. Effken, Judith PhD, RN, FACMI, FAAN
  2. Chair, AMIA Nursing Informatics Working Group

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The AMIA 2007 Fall Symposium is now history, and as I reflect on the meeting, I am struck by the wonderful papers, posters, workshops, tutorials, and of course, the Nursing Informatics (NI) Symposium. This was a very special meeting in terms of quality-and also in attendance, with over 2000 participants.


The keynote address was given by Michael Leavitt, US Secretary of Health and Health Services. Secretary Leavitt has been a strong advocate for creating a national health infrastructure as a network of networks in which local health information exchanges are combined into a larger network, but with most of the control for the network remaining at the local health information exchange level-but with standards that allow interoperability and communication developed nationally. Still, Leavitt hasn't quite recognized the critical importance of nursing to this endeavor, a point emphasized by Dr Suzanne Bakken, who asked during the question-and-answer session about the role of nurse practitioner-run clinics in the health information exchange. Leavitt appeared to be quite taken aback and simply had no answer to Dr Bakken's question. However, he did make a note to himself to include this as an action item. Kudos to Dr Bakken for educating the Secretary! Still, I suspect it will take many pointed reminders to fully involve nursing in this effort, and I urge each of you to help ensure that nursing is at the table leading the discussion as health information exchanges are designed and implemented throughout the country.


Empowering and educating patients through personal health records was prominent at the symposium. In addition to the NI Symposium, which focused exclusively on personal health records, there were numerous presentations relating to the topic. A number of them explored how the personal health record fit into a health information exchange, for example, looking at standards needed for information exchange, patients'and clinicians' concerns for privacy and accuracy, etc.


A new feature at the symposium was a set of "Late Breaking Sessions," in which we were updated on the most recent news in policy and research. This format provided a way to get around the long time between when regular papers are submitted and presented, and it was clear from the number of attendees at these sessions that they were a welcome addition. One of the "late breaking" sessions that had standing room only allowed participants to learn about Microsoft's recently announced HealthVault from Bert van Hoof, as well as observations and questions raised by AMIA's own Nancy Lorenzi and Justin Starren. There was general agreement that Microsoft's entry into the field has stimulated progress and attention more in 1 month than the informatics community as a whole has done in 10 years. At the same time, there are issues around trust and privacy, individual patient and clinician engagement, whether personal health data will be used by clinicians, standards for interoperability, and whether personal health records might, in fact, reinforce the digital divide and further increase healthcare disparities between those who have the technology and those who don't.


Several sessions noted the "mixed" results of Health Information Exchange/Regional Health Information Organization (RHIO) implementations. As Bill Hersh noted that, in general, those that are thriving have had effective informatics leadership; those that have not survived more often than not have forgotten key informatics best practices, such as broad stakeholder/political support, early involvement by practitioners, sharing small wins, engaging consumers, focusing on improving population health and improving care delivery, aligning incentives, and ensuring privacy and confidentiality. Joan Ash noted similar success factors that she had identified in computerized physician order entry implementation: sufficient time, meeting information needs flexibly, adopting a sociotechnical systems approach, paying attention to the organization's culture, focusing on value but paying attention to costs and any tradeoffs that must be made, and finally ongoing evaluation throughout the project. I would argue that these principles apply broadly to all our implementations. Marion Ball reminded us of Einstein's dictum: "No problem can be solved within the same consciousness that caused it." We need to engage many different perspectives (consumers, providers, payors, designers, human factors) if we are to have an effective healthcare information system in this country.


AMIA's Nursing Informatics Working Group (NIWG) was highly visible throughout the conference in papers, panels, workshops, tutorials, and of course the full-day NI Symposium. The NI symposium on personal health records attracted nearly 100 attendees, who had a great time learning and networking with old and new colleagues. NI-WG sponsored two workshops. The first, "Toward a Greater Collaboration and Focus in Building the Nursing Practice Information Infrastructure," was led by Gail Keenan. The second, "Implementing an EHR using Structured Terminology," was led by Susan Matney, Marcelline Harris, Laura Heerman-Langford, and Rosemary Kennedy. Connie Delaney and Judith Warren gave a tutorial on Evidence-based Nursing Knowledge-Content and System Design. Judith Warren and her colleagues presented a workshop on Systematized Nomenclature of Medicine Clinical Terms Encoding of Clinical Documentation in EHRs in Support of Interoperability. Patricia Flatley Brennan, David Lansky, and Kenneth Mandl offered a tutorial on Personal Health Records and E-health portals. Suzanne Bakken, James Cimino, and Christopher Chute presented the tutorial "Clinical Classifications and Biomedical Ontologies."


Dr Susan Grobe, University of Texas-Austin, received AMIA's Virginia K. Saba Award. The award recognizes an individual's distinguished career and significant impact on the care of patients and the discipline of nursing. Clearly, Dr Grobe meets those criteria.


Dr Jacqueline Moss, University of Alabama-Birmingham, received AMIA's Harriet W. Werley Award for the paper most likely to have an impact on the field of NI. Moss's paper, "An Analysis of Narrative Nursing Documentation in an Otherwise Structured Intensive Care Clinical Information System," and was co-written by Margot Andison and Heather Sobko. Hyeoneui Kim received the NI-WG student award for her paper "Beyond Surface Characteristics: A New Health Text-specific Readability Measurement."


Elected to the NI-WG Leadership Team for 2008 were: Charlotte Weaver, Chair-Elect; Laura Heerman Langford, Secretary; Patti Dykes, Member-at-Large, and Heather Sobko, Student Representative. Bonnie Westra was elected to the AMIA Board of Directors. Congratulations to all!


As health information becomes increasingly important in public policy, even more informatics professionals will be needed to lead the design, implementation, and evaluation of these systems. Key to our ultimate success is our developing informatics science, which was evident in the papers and posters presented throughout the conference. Perhaps more than any other educational event, the AMIA Fall Symposium allows participants to focus on how our science informs practice and policy.


All in all, it was a wonderful event. With memories of this year's symposium only beginning to fade, we're all looking forward to next year's AMIA Symposium, which will be held in Washington DC. Submissions for papers and posters will be due in mid-March (check the AMIA Web site for details), so start thinking now about what you might submit. We look forward to seeing all of you there!