25 × 5 Symposium to Reduce Documentation Burden: Report-out and Call for Action.

BACKGROUND: The widespread adoption of electronic health records and a simultaneous increase in regulatory demands have led to an acceleration of documentation requirements among clinicians. The corresponding burden from documentation requirements is a central contributor to clinician burnout and can lead to an increased risk of suboptimal patient care. OBJECTIVE: To address the problem of documentation burden, the 25 by 5: Symposium to Reduce Documentation Burden on United States Clinicians by 75% by 2025 (Symposium) was organized to provide a forum for experts to discuss the current state of documentation burden and to identify specific actions aimed at dramatically reducing documentation burden for clinicians. METHODS: The Symposium consisted of six weekly sessions with 33 presentations. The first four sessions included panel presentations discussing the challenges related to documentation burden. The final two sessions consisted of breakout groups aimed at engaging attendees in establishing interventions for reducing clinical documentation burden. Steering Committee members analyzed notes from each breakout group to develop a list of action items. RESULTS: The Steering Committee synthesized and prioritized 82 action items into Calls to Action among three stakeholder groups: Providers and Health Systems, Vendors, and Policy and Advocacy Groups. Action items were then categorized into as short-, medium-, or long-term goals. Themes that emerged from the breakout groups' notes include the following: accountability, evidence is critical, education and training, innovation of technology, and other miscellaneous goals (e.g., vendors will improve shared knowledge databases). CONCLUSION: The Symposium successfully generated a list of interventions for short-, medium-, and long-term timeframes as a launching point to address documentation burden in explicit action-oriented ways. Addressing interventions to reduce undue documentation burden placed on clinicians will necessitate collaboration among all stakeholders.

AI in Healthcare.

The potential value of AI to healthcare, and nursing in particular, ranges from improving quality and efficiency of care to delivering on the promise of personalized and precision medicine. AI systems may become virtually indispensable as ever more data is amassed about every aspect of health. AI can help reduce variability in care, while improving precision, accelerating discovery and reducing disparities. AI can empower patients and potentially allow healthcare professionals to relate to their patients as healers supported by the combined wisdom of the best medical research and analytic technology. There are, however, many challenges to understanding the optimal uses of AI; addressing the technological, systemic, regulatory and attitudinal roadblocks to successful implementation; and integrating AI into the fabric of health care. This paper provides a grounding in the origins and fundamental building blocks of AI, applications in healthcare and for nursing, and the critical challenges facing implementation in healthcare.

Clinician and Health Care Leaders' Experiences with-and Perceptions of-COVID-19 Documentation Reduction Policies and Practices.

BACKGROUND: Substantial strategies to reduce clinical documentation were implemented by health care systems throughout the coronavirus disease-2019 (COVID-19) pandemic at national and local levels. This natural experiment provides an opportunity to study the impact of documentation reduction strategies on documentation burden among clinicians and other health professionals in the United States. OBJECTIVES: The aim of this study was to assess clinicians' and other health care leaders' experiences with and perceptions of COVID-19 documentation reduction strategies and identify which implemented strategies should be prioritized and remain permanent post-pandemic. METHODS: We conducted a national survey of clinicians and health care leaders to understand COVID-19 documentation reduction strategies implemented during the pandemic using snowball sampling through professional networks, listservs, and social media. We developed and validated a 19-item survey leveraging existing post-COVID-19 policy and practice recommendations proposed by Sinsky and Linzer. Participants rated reduction strategies for impact on documentation burden on a scale of 0 to 100. Free-text responses were thematically analyzed. RESULTS: Of the 351 surveys initiated, 193 (55%) were complete. Most participants were informaticians and/or clinicians and worked for a health system or in academia. A majority experienced telehealth expansion (81.9%) during the pandemic, which participants also rated as highly impactful (60.1-61.5) and preferred that it remain (90.5%). Implemented at lower proportions, documenting only pertinent positives to reduce note bloat (66.1 ± 28.3), changing compliance rules and performance metrics to eliminate those without evidence of net benefit (65.7 ± 26.3), and electronic health record (EHR) optimization sprints (64.3 ± 26.9) received the highest impact scores compared with other strategies presented; support for these strategies widely ranged (49.7-63.7%). CONCLUSION: The results of this survey suggest there are many perceived sources of and solutions for documentation burden. Within strategies, we found considerable support for telehealth, documenting pertinent positives, and changing compliance rules. We also found substantial variation in the experience of documentation burden among participants.

Forecasting Informatics Competencies for Nurses in the Future of Connected Health.

This presentation will be in a workshop format with a panel of presenters representing four countries. All speakers are authors and will address various aspects from the content of the book published as a result of the NI 2016 Post Conference in Switzerland, Forecasting Informatics Competencies for Nurses in the Future of Connected Health [1], before inviting the audience to discuss and share their views. The discussion will be focused on defining the informatics competencies for nurses in practice and the requirements for informatics training in nursing programs around the world.

Effect of Monthly High-Dose Vitamin D Supplementation on Cardiovascular Disease in the Vitamin D Assessment Study : A Randomized Clinical Trial.

Importance: Cohort studies have reported increased incidence of cardiovascular disease (CVD) among individuals with low vitamin D status. To date, randomized clinical trials of vitamin D supplementation have not found an effect, possibly because of using too low a dose of vitamin D. Objective: To examine whether monthly high-dose vitamin D supplementation prevents CVD in the general population. Design, Setting, and Participants: The Vitamin D Assessment Study is a randomized, double-blind, placebo-controlled trial that recruited participants mostly from family practices in Auckland, New Zealand, from April 5, 2011, through November 6, 2012, with follow-up until July 2015. Participants were community-resident adults aged 50 to 84 years. Of 47 905 adults invited from family practices and 163 from community groups, 5110 participants were randomized to receive vitamin D3 (n = 2558) or placebo (n = 2552). Two participants retracted consent, and all others (n = 5108) were included in the primary analysis. Interventions: Oral vitamin D3 in an initial dose of 200 000 IU, followed a month later by monthly doses of 100 000 IU, or placebo for a median of 3.3 years (range, 2.5-4.2 years). Main Outcomes and Measures: The primary outcome was the number of participants with incident CVD and death, including a prespecified subgroup analysis in participants with vitamin D deficiency (baseline deseasonalized 25-hydroxyvitamin D [25(OH)D] levels <20 ng/mL). Secondary outcomes were myocardial infarction, angina, heart failure, hypertension, arrhythmias, arteriosclerosis, stroke, and venous thrombosis. Results: Of the 5108 participants included in the analysis, the mean (SD) age was 65.9 (8.3) years, 2969 (58.1%) were male, and 4253 (83.3%) were of European or other ethnicity, with the remainder being Polynesian or South Asian. Mean (SD) baseline deseasonalized 25(OH)D concentration was 26.5 (9.0) ng/mL, with 1270 participants (24.9%) being vitamin D deficient. In a random sample of 438 participants, the mean follow-up 25(OH)D level was greater than 20 ng/mL higher in the vitamin D group than in the placebo group. The primary outcome of CVD occurred in 303 participants (11.8%) in the vitamin D group and 293 participants (11.5%) in the placebo group, yielding an adjusted hazard ratio of 1.02 (95% CI, 0.87-1.20). Similar results were seen for participants with baseline vitamin D deficiency and for secondary outcomes. Conclusions and Relevance: Monthly high-dose vitamin D supplementation does not prevent CVD. This result does not support the use of monthly vitamin D supplementation for this purpose. The effects of daily or weekly dosing require further study. Trial Registration: clinicaltrials.gov Identifier: ACTRN12611000402943.

Introduction: Forecasting Informatics Competencies for Nurses in the Future of Connected Health.

This introduction to the book discusses how the topic of competencies for nurses in a world of connected health needs to be addressed at the curriculum level to achieve the specific competencies for various roles, including practicing nurse, nurse teacher, nurse leader, and nursing informatics specialists. It looks back at milestone publications from the international Nursing Informatics post conferences that still serve a purpose for inspiring developments today and looks forward to the way nurses can use connected health to improve the health and health care for their patients. Specific emerging topics in health information technology are addressed as well, such as semantics, genetics, big data, eHealth and social media.

Engaging Nurses in the Design and Adoption of mHealth Tools for Care Coordination.

This panel will share ideas for the Nursing Informatics Specialists in the audience on how mHealth tools are being designed and used for clinical practice, education and research. They will describe specific mHealth projects they are involved in, give practical examples, and provide tangible tactics for nurses to make a difference. They will provide insight into new technology and standards developments that make it easy to connect the mobile app ecosystem - from open application program interfaces (APIs), to traditional health information technology tools like Electronic Health Records (EHRs).

The Vitamin D Assessment (ViDA) Study: design of a randomized controlled trial of vitamin D supplementation for the prevention of cardiovascular disease, acute respiratory infection, falls and non-vertebral fractures.

Observational studies have shown that low vitamin D status is associated with an increased risk of cardiovascular disease, acute respiratory infection, falls and non-vertebral fractures. We recruited 5110 Auckland adults, aged 50-84 years, into a randomized, double-blind, placebo-controlled trial to test whether vitamin D supplementation protects against these four major outcomes. The intervention is a monthly cholecalciferol dose of 100,000IU (2.5mg) for an estimated median 3.3 years (range 2.5-4.2) during 2011-2015. Participants were recruited primarily from family practices, plus community groups with a high proportion of Maori, Pacific, or South Asian individuals. The baseline evaluation included medical history, lifestyle, physical measurements (e.g. blood pressure, arterial waveform, lung function, muscle function), and a blood sample (stored at -80°C for later testing). Capsules are being mailed to home addresses with a questionnaire to collect data on non-hospitalized outcomes and to monitor adherence and potential adverse effects. Other data sources include New Zealand Ministry of Health data on mortality, hospitalization, cancer registrations and dispensed pharmaceuticals. A random sample of 438 participants returned for annual collection of blood samples to monitor adherence and safety (hypercalcemia), including repeat physical measurements at 12 months follow-up. The trial will allow testing of a priori hypotheses on several other endpoints including: weight, blood pressure, arterial waveform parameters, heart rate variability, lung function, muscle strength, gait and balance, mood, psoriasis, bone density, and chronic pain.

Partnering to provide simulated learning to address Interprofessional Education Collaborative core competencies.

Learning to effectively communicate and work with other professionals requires skill, yet interprofessional education is often not included in the undergraduate healthcare provider curriculum. Simulation is an effective pedagogy to bring students from multiple professions together for learning. This article describes a pilot study where nursing and social work students learned together in a simulated learning activity, which was evaluated to by the Readiness for Interprofessional Learning Scale (RIPLS). The RIPLS was used before and after the simulated activity to determine if this form of education impacted students' perceptions of readiness to learn together. Students from both professions improved in their RIPLS scores. Students were also asked to identify their interprofessional strengths and challenges before and after the simulation. Changes were identified in qualitative data where reports of strengths and challenges indicated learning and growth had occurred. In conclusion, this pilot study suggests that interprofessional simulation can be an effective method to integrate Interprofessional Education Collaborative core competencies into the curriculum.

The impact of policies promoting health information technology on health care delivery in jails and local communities.

The 1976 Supreme Court decision in Estelle v. Gamble declared that jails must provide medical treatment to detainees consistent with community standards of care. Yet despite their important role providing health care to about ten million people a year, jails remain largely siloed from the surrounding health care community, compromising inmates' health and adding to health care spending. Health information technology promises solutions. The current policy landscape, shaped by the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Affordable Care Act, is favorable to jails' implementation of health information technology (IT). In this article we examine how decisions largely external to jails-coming from the Supreme Court, Congress, and local policy makers-have contributed to the growth of health IT within jails and health information exchange between jails and local communities. We also discuss privacy concerns under the Health Insurance Portability and Affordability Act and other legislation. This article highlights a rare confluence of events that could improve the health of an overlooked population.

A national action plan to support consumer engagement via e-health.

Patient-centered care is considered one pillar of a high-performing, high-quality health care system. It is a key component of many efforts to transform care and achieve better population health. Expansion of health information technology and consumer e-health tools--electronic tools and services such as secure e-mail messaging between patients and providers, or mobile health apps--have created new opportunities for individuals to participate actively in monitoring and directing their health and health care. The Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services leads the strategy to increase electronic access to health information, support the development of tools that enable people to take action with that information, and shift attitudes related to the traditional roles of patients and providers. In this article we review recent evidence in support of consumer e-health and present the federal strategy to promote advances in consumer e-health to increase patient engagement, improve individual health, and achieve broader health care system improvements.

An Overview of the National Quality Strategy: Where Do Nurses Fit?

The definition of quality healthcare, its accurate measurement, and its effective management is nebulous and constantly evolving. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means. Levels of measurement, as well as questions of whom, how, and when to measure are topics of continual deliberation. These discussions occur at multiple levels through councils, committees, workgroups, task forces, and expert panels. Many policy-related decisions these groups make affect nurses and nursing care. All of them affect how patients receive or engage in healthcare. This article discusses the National Quality Strategy by offering a description and history of the quality conversation, including federal advisory committees and quality measurement data standards. There are several gaps in the quality conversation to which nurses could contribute valuable insights. The authors describe ways that nurses can engage in the national quality agenda. The article concludes with a call to action to encourage nurses to take a larger role in driving the National Quality Strategy.

The nursing informatics workforce: who are they and what do they do?

Nursing informatics has evolved into an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care. New nursing informatics workforce data reveal changing dynamics in clinical experience, job responsibilities, applications, barriers to success, information, and compensation and benefits. In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing informatics officer (CNIO). The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. With their fused clinical and informatics background, informatics nurses and CNIOs are uniquely positioned to help with "meaningful use" initiatives which are so important to changing the face of health care in the United States.