by Dr. Kathryn H. Bowles, Senior Editor
Associate Professor University of Pennsylvania
This column was made possible by an educational grant from
Chamberlain College of Nursing
Bowles , K. (June, 2011). Achieving Meaningful Use with Standardized Data. Achieving Meaningful Use in Research with Information Technology Column. Online Journal of Nursing Informatics (OJNI),15 (2). Available at http://ojni.org/issues/?p=574.
I recently attended the 2011 Omaha System International Conference in Eagan, Minnesota. The Omaha System is a standardized classification system used to document patient care in practice, education, and research (Martin, 2005). It contains a Problem Classification Scheme of 42 patient problems and associated symptoms, an Intervention Scheme with four major categories of interventions and 75 targets that further describe the care, and a Problem Rating Scale for Outcomes to rate progress in knowledge, behavior, and status of each problem.
The conference presentations clearly show the coming of age for the use of standardized data. The level of sophistication and maturity of the presentations demonstrate that after years of hard work, we are achieving meaningful use. This hard work includes educating nurses and our interdisciplinary colleagues about the value of standardized data, requesting and achieving that vendors build systems containing recognized American Nurse Association standardized terminologies, and placing a huge amount of effort on educating users and achieving inter-rater reliability to produce high quality data. Below are some highlights about the research based presentations from the conference.
Scholars at the University of Minnesota are leaders in educating users, encouraging use, housing and analyzing Omaha System data, and disseminating new knowledge. Examples of meaningful use of Omaha System data included presentations by Dr. Karen Monsen. Karen announced the Omaha System Partnership for Knowledge Discovery and Health Care Quality located at the University of Minnesota School of Nursing and accessed at http://omahasystempartnership.org/index.php. This partnership represents collaborations among scientists from universities and practice agencies to create new knowledge using Omaha System data. In addition they offer a warehouse of de-identified Omaha System data that students and researchers can access with permission. Affiliate members include people from practice, academic, and information system organizations as well as individuals and funding organizations. What a great resource for collaboration and certainly a site for doctoral and post doctoral students to obtain data for secondary analyses.
Dr. Bonnie Westra leads a team at the University of Minnesota using Omaha System data to explore various data mining techniques for data analysis. Her work also combines Omaha System data with other datasets to explore associations and predict outcomes. She discussed logistic regression, decision trees, and Ripper Rules as data analysis and data transformation methodologies. Oladimeji Farri impressed the crowd with sophisticated Problem Outcomes Rating Scale output demonstrating survival analyses and the development of a risk index using number of Omaha System problems and baseline knowledge scores.
Two newcomers to Omaha System research spoke on their dissertation studies. Dr. Cindy O’Sullivan shared findings from her dissertation research conducted at Yale University. Cindy created new knowledge from a secondary analysis of advanced practice nurse documentation during the care of ovarian cancer patients. Her work demonstrated how intervention patterns changed over time and how some patients with psychological distress related to the cancer diagnosis need more time to accept help from clinicians. Dr. Bev Zabler from the University of Wisconsin creatively used the Omaha System along with reports of violence among African American women living with HIV/AIDS to describe patterns among the reports and the relationship to life events and health.
Our team from the University of Pennsylvania School of Nursing demonstrated how clinicians use Omaha System data to indentify caregivers at risk for caregiver burden. Advanced practice nurses documented the care of older adults with cognitive impairment as they received care guided by the Transitional Care Model (Naylor, et al, 2011). Baseline assessments of burden using a valid and reliable tool, the Caregiver Burden Index (Caserta, 1996) were used to identify caregivers with no to low or moderate to high burden scores. Omaha System data was used to link the symptoms and problems reported for the patients associated with the various levels of caregiver burden. Using Omaha System data in this meaningful way enables clinicians to identify the characteristics of patients most likely to generate burden for their caregivers and to create targeted interventions to resolve problematic symptoms.
These are just a few examples of the exciting work reported at the conference. In addition, cohorts of international researchers, educators, and practitioners reported on their work and of course Karen Martin, one of the original Omaha System creators and expert consultant led the way as conference coordinator with San Jose State University School of Nursing as sponsors.
We have reached a tipping point in database development and sophisticated use of standardized and electronic documentation to produce high quality, meaningful research and clinical output. We need more scholars to engage in Omaha System research to reach our potential with this rich data. I hope I have sparked your interest in learning more about achieving meaningful use with standardized languages. If you are interested in learning more about the Omaha System log on to www.omahasystem.org or attend the next conference in April 2013. To learn more about standardized languages in general go to http://nursingworld.org/npii/terminologies.htm
Martin, K. S. (2005). The Omaha System: A key to practice, documentation, and information management (Reprinted 2nd ed.). Omaha, NE: Health Connections Press.
Naylor, M. D., Bowles, K. H., McCauley, K. M., Maccoy, M. C., Maislin, G., Pauly, M. V.,…Krakauer, R. (2011). High value transitional care: Translation of research into practice. Journal of Evaluation of Clinical Practice. [E-publication ahead of print] PMID: 21410844.
Caserta, M. S., Lund, D. A., & Wright, S. D. (1996). Exploring the caregiver burden inventory (CBI): Further evidence for a multidimensional view of burden. International Journal of Aging and Human Development, 43 (1), 21-34.
Proofed by Monica Key.
Dr. Bowles holds a BSN from Edinboro University of Pennsylvania, an MSN from Villanova, and a PhD from the University of Pennsylvania. In addition to her position at the Penn School of Nursing, she is the Beatrice Renfield Visiting Scholar for the Visiting Nurse Service of New York, a Senior Fellow in the Leonard Davis Institute, a faculty member in the Ackoff Center for Advancement of Systems Approaches, and Director of the Health Informatics Minor. Dr. Bowles leads a program of research in the use of information technology to improve healthcare for elders and support healthcare provider’s decision-making regarding hospital discharge referrals for elders.
Dr. Bowles’ program of research examines decision making supported by information technology to improve care for older adults. Her ongoing study, funded by the National Institute of Nursing Research, focuses on decision-making and the development of decision support for hospital discharge referral decisions. Other research areas include telehealth technology, quality of life among frail elders, intervention research to close the health care racial divide, and the use of large databases in home care to support clinical decision-making.