Nursing Knowledge: Big Data
Research Summit Clinical LOINC
Report
Susan Matney, MSN, PhD(c), RN-C, FAAN
Informaticist 3M Health Information Systems
Chair SNOMED CT Nursing Special Interest Group
Chair Clinical LOINC Nursing Subcommittee
Nursing Knowledge: Big Data Research
for Transforming Healthcare
Conference Purpose
• National leaders in nursing, healthcare, and informatics came
together to develop an action plan for shaping health policy
and informatics initiatives that use a national nursing
knowledge model.
• Goal was to guide consistent nursing documentation and data
collection to support big data research
• Presentations given re:
• vision of the future
• enablers, gaps and challenges
• Participated in multiple, iterative, facilitated discussions
Ultimate Goal
• As knowledge workers, nurses must leverage clinical data
from the EHR to:
•
•
•
•
•
•
Optimize workflow and support clinical decision-making
Tell the patient’s story
Collaborate to foster knowledge translation
Leverage analytics to extract actionable knowledge
Use sharable, comparable data
Build evidence out of nursing practice
Nursing Knowledge
Knowledge Translation: The exchange, synthesis and
application of knowledge within a complex system.
Knowledge Transfer: A systematic approach to
capture, collect and share tacit knowledge in order for
it to become explicit knowledge.
Knowledge Model: The capture of knowledge in an
electronic reusable format for the purpose of
preserving, improving, sharing, aggregating and
reapplying it.
Nursing Informatics DIKW
Framework
ANA, 2007
Care Plan Relationships (Happy Path
RELATES TO
REASON FOR
Goal [mood
GOL]
IS COMPONENT OF
Observation
[mood
EVN]
RELATES TO
EVALUATES
REASON FOR
SUPPORTS
Health
Concern
[mood EVN]
Intervention
[mood: INT/
RQO/ etc.]
[mood: EVN]
CAUSES
Outcome
Observation
[mood EVN]
Storyboard Example
Setting
• Joe is a 24 year-old male quadriplegic admitted
to an inpatient unit from his home. During
Hx. that he
admission assessment, the nurse notes
Subjective
has no sensation from the shoulders
down.
He
Findings
is confined to a wheelchair and requires twoperson assist. His skin is occasionally moist. Joe
reports that he is a “good
eater” and is on a
Assessment
normal diet. The nurse
completes the Braden
Observations
Skin Scale score is 13. Further assessment by
the nurse reveals skin is intact with no pressure
ulcers.
Simple Skin Assessment (Happy
Path)
RELATES TO
REASON FOR
Goal: No skin
breakdown
IS COMPONENT OF
Observations:
Decreased Sensation
Limited Mobility
Braden scale = 13
RELATES TO
EVALUATES
REASON FOR
SUPPORTS
Health Concerns:
Impaired mobility
Risk for alteration
in skin Integrity
Interventions:
Turn q 4 hours
Assess skin q
shift
CAUSES
Outcome
Observation
Interoperability using
the DIKW Framework
Data
Skin Assessment
class Skin Inspection Detail
«enumeration»
Skin Moistness
normal
moist
diaphoretic
clammy
Pressure Ulcer Risk Assessment Item
Skin Inspection
-
«enumeration»
Skin Temperature
cool
warm (normal)
cold
hot
skin
skin
skin
skin
color :Skin Color
moistness :Skin Moistness
temperature :Skin Temperature
turgor :Skin Turgor
«enumeration»
Skin Turgor
good elasticity (normal)
poor, decreased elasticity
tenting = not found
«enumeration»
Skin Condition
dry
extremely dry
normal
friable
«enumeration»
Skin Color
normal for ethnic group
ashen
cyanotic
flushed
jaundiced
mottled
pale
Interoperability using
the DIKW Framework
Data
Terminology Coding
Type
Text
Terminology Code
Fully Specified Name
Question
Skin Moisture
LOINC
39129-2
Moisture:Type:PT:Skin:Nom::
Value
Diaphoretic
SNOMED CT
52613005
excessive sweating (finding)
Value
Moist
SNOMED CT
16514006
moist skin (finding)
Value
Clammy
SNOMED CT
102598000 clammy skin (finding)
Question
Skin Temperature
LOINC
44968-6
Value
Consistent With Body Temperature SNOMED CT
297977002 Skin normal temperature (finding)
Value
Warm
SNOMED CT
102599008 warm skin (finding)
Value
Cool
SNOMED CT
427733005 cool skin (finding)
Question
Skin Turgor
LOINC
39109-4
Value
Good Elasticity (normal)
SNOMED CT
297956000 skin turgor normal (finding)
Value
Decreased Elasticity (Poor)
SNOMED CT
425244000 decreased skin turgor (finding)
Value
Tenting
SNOMED CT
297957009 stretched skin (finding)
Temperature:Type:PT:Skin:Ord:Palp
Turgor:Imp:PT:Skin:Nom::
12
Key drivers in enabling knowledge
model
 Knowledge exists in paper - Care plans
 Knowledge exists in vended EHRs (non standardized)
 Structured Nursing Knowledge beginning to emerge (e.g.
Pressure Ulcer Models)
 Standardized terminology
 SNOMED CT, LOINC, RxNORM, CPT, ICD-10-CM
 HIT standards
 HL7, ONC, PHIN-VADS, VSAC
Action Plan
• Integrate nursing information into health and healthcare
knowledge systems
• Optimize nursing language and healthcare information
• Influence policy
• Modify and standardize the informatics educational
framework.
Specific Actions
• Develop a strategy/campaign for educating front line nurses,
students, and faculty on informatics competencies and the
value of standardized nursing data;
• Advocate for the adoption of SNOMED CT and LOINC as
national standards for clinical data, and link them with nursing
terminologies through mappings;
• Convene a consensus conference with leaders of the major
nursing organizations and interprofessional stakeholders to
educate them, hear their views, and ultimately, speak with
one voice;
• Refresh and activate the ANA’s NIDSEC (Nursing Information &
Data Set Evaluation Center) criteria to advance systems that
represent and value nursing data; and
• Participate in standards and profile development to ensure a
nursing voice.
Clinical LOINC Committee
Actions
• Clinical LOINC Nursing Subcommittee
• Have a specific landing page on LOINC site.
• Provide access to all LOINC tutorials.
• Call and hold a meeting to gather nursing LOINC requirements
• Slides for informatics educators.
• Assessment Panels
• Organize in one place in RELMA
• Provide SNOMED CT enumerated values where available.
• Maintain LOINC mappings to nursing terminology
• CCC Outcomes
• Omaha Outcomes
• Structured Docs
• Review ANA’s NIDSEC (Nursing Information & Data Set Evaluation
Center) where it pertains to clinical observations.
Vision of the Future
NURSING IS VISIBLE
In Health Information Systems
NURSING DATA ARE AVAILABLE
To Promote Evidence-Based, Quality
Nursing Practice
Questions?
samatney@mmm.com