1. Bove, Lisa Anne MSN, RN-BC
  2. Dobransky, Deb BSN, RN-BC

Article Content

On November 2, 3007, the Delaware Valley Nursing Computer Network (DVNCN) presented an all-day conference, "Making Evidence Based Documentation a Reality-Roadmap for Success" at Siemens Corporation in Malvern, PA. More than 120 nurses from the across the country participated in the learning and networking activity. Most attendees were from local hospitals and clinical software vendors.


Planning committee members for the conference included: Lisa Anne Bove, Accenture, LLC; Deb Dobransky, Main Line Health; Vicky Cosgrove, Riddle Memorial Hospital; Deborah Evenson, Main Line Health; Pat Friedman, The Chester County Hospital; Rosemary Kennedy, Siemens; Loretta Mansi-Nelson, Siemens; Linda Matz, Siemens; Deb Polatty, Main Line Health; Anne Satterthwaite, The Chester County Hospital; Fran Spivak, Siemens; Mary Denise Stanton, New Courtland Elder Services; and Tim Steffe, Main Line Health.


The day started with a networking breakfast where participants could speak with each other and with the sponsoring vendors. The sponsoring vendors included Terry Pickering from Cerner; Kim Skinner from Eastern University; Chris Shelton from Lionville; Human Resources representative from Siemens; Rosemary Keane from Skilled Nursing Inc (SNI); and B. Michael Cook from Zynx Health. The vendors then remained for the rest of the sessions to allow for more interaction with attendees. In addition, Zynx Heath sponsored a raffle. The winner, Kelli Nelson, BSN, RN, Nemours, was the winner of the $100 gift card. Congratulations Kelli!


The first speaker, Patricia S. Button, EdD, RN, presented a discussion on Evidenced Based Documentation. Dr Button is the director of nursing content for Zynx Health and a national leader in the development of models and tools to support the use of standardized nursing and healthcare languages in software systems. She is active in the healthcare industry with a focus on the use of system and process modeling to produce business model architectures that can be meaningfully mapped to support organizational system and software engineering architectures. Dr Button is particularly active in key efforts to incorporate nursing terminologies in computer-based systems. She is a past chair of the AMIA Nursing Informatics Working Group and is a member of the executive steering committee of the Nursing Terminology Summit.


After an overview of the history of plan of care, including the feelings of many caregivers that it is an academic exercise, Dr Button discussed the relationship between evidence based documentation and the electronic health record (EHR). She also talked about the benefits of the integration of usable plans of care. Plans of care should tell the care provider about the clinical standards, which are based on evidence and facilitate the communication of patient status as well as support the provision of care. Dr Button said that it is the use of evidence that makes it work; evidence alone is not enough to make a decision. Dr Button also told the participants that best practice is not always evidence based. Best practice is instead based on anecdotal experience. While best practice is also useful to determine the way to care for patients, evidence is needed to strengthen decision making at the point of care.


Our next speaker, Virginia Saba, EdD, RN, FAAN, presented a session on the key initiatives that are under way related to the development of nursing terminology models. She also reviewed the ways nurses can integrate structured nursing terminology into their practice. Dr Saba is the President and CEO of Clinical Care Classification (CCC) and has pioneered the integration of computer technology in the nursing profession. For more than 30 years, she spearheaded the NI movement, designed computer-based information systems, and has been involved in the field of healthcare information technology (HIT). Dr Saba is nationally and internationally known for her work in informatics. She has written several books, chapters, and articles, including her most recent publication Clinical Care Classification (CCC) System Manual: A Guide to Nursing Documentation (2007), which provides a complete overview of the CCC System.


When asked, "What do you perceive to be the greatest potential contribution of information technology to the future of nursing practice?" Dr Saba responded: "I have a firm belief that in the future if we become visible, nursing practice will be revolutionized, and we will truly be a profession of nurses with our own classification systems, bibliographic systems, and payment systems. We need to think 'outside the box.' We need to use the Internet to enhance our practice and provide telenursing care. We need to become wireless and conduct our services using all the newer IT tools. We have a long way to go, but if we utilize information technology effectively, informatics will become an integral part of our profession and the healthcare industry. I do believe we have the knowledge and perseverance, and I am convinced it will come to pass."


Dr Saba discussed how the use of standardized nursing terminology in the EHR systems support capturing discrete patient care data for measuring the relationship of nursing care to patient outcome. She then discussed the differences in classification, taxonomy, and terminology. She defined classification as a hierarchal structure of terms arranged in categories and groups. Taxonomy is a classification with levels and types. Terminology is a classification based on unique coded concepts.


The keynote presentation was followed with a panel of NI experts who discussed the importance and benefits of standardized terminology and evidence based nursing to everyday practice. They reviewed real-life case scenarios at their facilities exploring opportunities, challenges, and potential approaches to the integration of evidence based practice within the facets of the EHR.


Amy Larsson, MBA, BSN, RN, moderated the panel. Ms Larsson is the Associate Vice President, Requirements Management, McKesson Health Solutions. She has been with McKesson for 14 years in various roles in clinical development, product management and services. She has also been a part of the Nursing Terminology Summit for several years and has worked with a subgroup of the Summit focusing on modeling nursing interventions.


Ruth Mooney, PhD, MN, BSN, presented the first panel discussion topic. Dr Mooney received her BSN from Pennsylvania State University, her master's degree from the University of California, Los Angeles, and her doctorate from the University of Florida. She has held various positions, including being a University of Florida faculty member and is currently a clinical nurse educator in geriatrics with Main Line Health.


Dr Mooney described how she is using real data within her facilities to define evidence based practice. Specifically, she described how Main Line Health implemented a medication bar-code system and revised the organization's fall risk assessment and the methods used to assess the impact of the changes. Dr Mooney said that one of the most important "take-aways" is that "you can have the best tool in the world and if you aren't using it appropriately, it doesn't make any difference." She discussed methods that Main Line Health used to assess findings from practice and worked to change practice following the evidence in the literature.


Leslie Haugland-Smith, MA, was the second presenter. Ms Haugland-Smith works for McKesson Health Solutions, a division of McKesson. She is a senior clinical information specialist with InterQual Products. She is also a member of McKesson's Evidence Based Medicine (EBM) Task Force and EMB Core Group.


Ms Haugland-Smith described how McKesson's EBM Task Force standardizes their evidence based medicine process and consistently incorporates it into the clinical content of the CareEnhance products. Required search steps that she uses in her practice are a review of PubMed (National Library of Medicine), the Cochrane Database and specialty society, and regulatory agency Web sites. In addition, she discussed findings with a panel of more than 850 clinical experts, which includes practitioners from a mix of disciplines, including physicians, nurses, social workers, physical therapists, psychologists, and occupational therapists in more than 42 specialties and 99 subspecialties geographically distributed across North America.


Terry Pickering, RN, closed the presentations. Mr Pickering is the Chief Nursing Officer, Academics of Cerner Corporation. He has 15 years of expertise in the healthcare industry. He has practiced as a provider of care, as well as in leadership positions within the care delivery environment. He joined Cerner as part of the Clinical Adoption team in 2003. Most recently, he supports the academic segments at Cerner as the Chief Nurse Executive for this segment. He has worked closely with Cerner clients and nurse leaders within the organization to help drive development and adoption of technology to support evidence based nursing practice to ultimately improve patient care outcomes.


During his presentation, Mr Pickering described Cerner's strategic partnership with Aurora Health in Wisconsin on clinical workflow. Cerner is partnering with the University of Wisconsin and Norma Lang to try to take the paper care plan and make it meaningful to the clinician; that is, make it part of the actual workflow.


The panel then answered participant's questions about implementing evidence based practice. Dr Mooney said the biggest challenge is having people decide how it should be-making up their mind. Mr Pickering told the participants that Norma Lang feels the biggest challenge is making evidence behind the scenes for the clinicians so the knowledge updates and is smooth to the clinician. In addition, Mr Pickering felt another big issue was having nurses agree on the evidence and the way to move forward. It is hoped that as we automate, it will be easier to define. We also need to make sure that the clinician doesn't become dependent on the system and stop thinking.


One attendee asked, "At what point does the professional practice of the nurse affect the evidence?" Ms Haugland-Smith said that professional practice will often take you 80% of the way. Dr Mooney said that in developing its fall risk assessment, Main Line Health included interventions for standard fall risks and additional interventions to allow for nursing judgment of why the nurse thought the patient was at high risk. Main Line Health then can go back and identify commonalities for the nursing judgment interventions to determine if they can be codified.


Dr Mooney stated that "as we see more individualization, we will see some improvements. Some argue that if you put everyone on intake and output, they won't forget to do it; however what nurses really want is to spend their time providing the care for the patients who need it. The hope is that the system can help figure it out, so they will have more time to do real work. By streamlining and having the computer determine what is needed for this patient, the nurse will have more time to do the work."


After the educational conference, DVNCN conducted its annual members' business meeting with the opportunity for attendees to join the organization and participate in regional NI initiatives and programs. This gave members the opportunity to review the organization's drafted bylaws in preparation for a membership vote. The DVNCN is a not-for-profit organization of NI professionals established to provide educational and professional opportunities for career growth. Membership in the organization is free.

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The American Nursing Informatics Association (ANIA) and CARING have combined forces for the 2008 Annual Spring Conference. This year's program, "Nursing Informatics: Monuments and Milestones for the Future" will be held April 18-19, 2008 in National Harbor, Maryland, minutes from Washington, DC. ANCC Continuing Education hours are approved.


This conference marks the 15th annual conference for ANIA and the second one held jointly with CARING. Highlights from our program include:


* Three keynote speakers-Dr. Kathleen A. McCormick, Ms. Judith A Murphy, and Dr. Charles P. Friedman;


* A lunchtime panel discussion with Chief Nursing Officers from four major EHR vendors;


* Over 36 speakers and more than 20 posters;


* A choice of two pre-conference workshops on April 17 on Writing for


* Publication or Project Management for Nurses;


* An opportunity to earn up to 19 hours of continuing education;


* An exhibit hall of vendors; and


* Networking Opportunities.



The entire conference brochure and hotel registration links are available through the ANIA ( and CARING ( websites. We look forward to seeing you at our conference.


2008 Annual Conference Committee


Conference Chair


James J. Finley, MBA, BSN, RN-BC, San Francisco, CA.


Jerry Chamberlain, MS, RN-BC, Kansas City, MO.


Barbara Medling, BSN, CNOR, RN-BC, Vancouver, WA.


Susan K. Newbold, PhD, RN-BC, FAAN, FHIMSS, Nashville, TN.


Edward A. Stern, RN, Alexandria, VA.


Vicki Vallejos, BSN, RN-BC, Jeffersonville, IN.