December 2013

Columbia Nursing Presents Research at Annual Informatics Association Symposium

Entrance View with Logo

Nursing informatics is the science and practice that integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families and communities. Columbia Nursing presented a broad range informatics research at this year’s annual symposium of the American Medical Informatics Association (AMIA) in Washington, D.C., including a paper that won one of the most prestigious prizes in the field, the Harriet H. Werley award.

Following are highlights of the presentations.

Method for the Development of Data Visualizations for Community Members With Varying Levels of Health Literacy; Arcia A., Bales M., Brown W., Co M., Gilmore M., Lee Y., Park C., Prey J., Velez M., Woollen J., Yoon S., Kukafka R., Merrill J., Bakken S.

AMIA awarded the Werley prize to lead author Adriana Arcia, PhD, RN, postdoctoral research fellow, for exploring methods for designing and evaluating the effectiveness of visual tools to convey medical information. It was completed as part of the Washington Heights-Inwood Informatics Infrastructure for Comparative Effectiveness Research (WICER), a multidisciplinary project that aims to understand and improve the health of a largely Hispanic community in New York City. Suzanne Bakken, PhD, RN, FAAN, FACMI, Alumni Professor of Nursing and Professor of Biomedical Informatics, is the principal investigator for WICER, funded by the Agency for Healthcare Research and Quality.

Arcia joins a distinguished group of Columbia Nursing faculty, students, and alumni who have previously served as first authors of papers that have won the Werley award: three-time winner Suzanne Bakken; Leanne Currie ’04 PhD; Sookyung Hyun ’07 PhD; Sarah Collins ’09 PhD; and Patricia Dykes ’04 PhD.

Patients’ Self-Reported Desire to Participate in Shared Decision Making; Cato K., Bakken S.

Shared decision making can contribute to patient adherence with treatment and achieve better outcomes. But not all patients feel comfortable participating in this process. In research related to the WICER project, Kenrick Cato, RN, MPhil, predoctoral fellow, examined attitudes toward shared decision using survey interviews in ambulatory clinics in the largely Hispanic community. Most patients said they would prefer to have decisions made by the “clinician alone” or “mostly by the clinician,” the study found. To achieve optimal participation in shared decision making, cultural attitudes about medicine and health must be taken into account, the research suggests.

Analysis of Motivational Concepts in Tweets Related to Jogging; Yoon S., Shaffer J., Momberg J., Bakken S.

In health and fitness, social media is an emerging motivational tool, especially on mobile platforms. In another WICER-related project, Sunmoo Yoon, RN, PhD, postdoctoral research scientist, examined tweets by joggers for clues about what motivated the activity. About 40 percent of the joggers revealed details about their motivation on Twitter – guilt was the most common, followed by a desire for personal well-being and enjoyment of the sport. While this research suggests that social and mobile tools may be effective at encouraging positive health behavior, there are still many mobile health applications that fail at this goal because of poor design.

Use of the Health-ITUEM for Evaluating Mobile Health Technology; Schnall R., Yen P., Rojas M., Brown W.

Little rigorous research has assessed the usability of mobile health technology. Rebecca Schnall, PhD, RN, assistant professor, found that an existing evaluation framework known as the Health-ITUEM, originally developed to assess web-based technology, can also help explain usability issues with mobile health technology. Smartphones and tablets can present several issues not present with larger desktop computers: small, low-resolution screens; poor color contrast; tiny text; no mouse or keyboard; a slow operating system; and variable connectivity. There may also be a confounding effect between the usability of the hardware and the health application or software installed on the device. As the development of interventions using mobile technology increases, future work in this domain necessitates the use of a rigorous usability evaluation framework, which will make the Health-ITUEM particularly relevant.

Impact on Immunization Registry Reporting Following Adoption of an Electronic Health Record; Merrill J., Keeling J., Phillips A., Kaushal R., Senathirajah Y.

Electronic health records, or EHRs, can improve public health by encouraging the creation and maintenance of robust vaccination registries. Jacqueline Merrill, PhD, RN, MPH, associate professor of clinical nursing in biomedical informatics, evaluated 1.7 million immunization records submitted in New York City from 2007 to 2011, a period when primary care practices in underserved communities received public funds to subsidize the use of EHRs with automated tools for submitting vaccination records. By the end of the study period, 75 percent of records were submitted within two days, up from 60 percent at the start of the project. Computerized systems can consolidate fragmented data sets, making it easier to pinpoint communities where intervention is needed to get more people vaccinated.

Change in Health Department Organizational Networks After an Evidence-Based Performance Improvement Intervention; Park C., Byon H., Keeling J., Beitsch L., Merrill J.

Computers can serve another essential function in pubic health – assessing and improving the effectiveness of management to ensure the best use of limited resources. Chin Park, MBA, RN, predoctoral trainee, examined how online organizational network analysis tools were used by seven local health departments in Florida to pinpoint gaps in communication and inefficiency. A web-based survey measured the frequency of communication within departments and managers also received training on strategies to improve organizational integration and coordination. The preliminary results: health departments pinpointed weaknesses in communication and worked to increase cross-divisional briefings and staff interaction. One of the local health departments reported an increase in customer satisfaction based on revamped service protocols.

Predisposing, Enabling and Reinforcing Factors for Health Information Exchange Opt-In Consent for Persons Living With HIV/AIDS; Ramos S.R., Bakken, S.

In New York, patient consent is required before clinical information can be reported to a public health information exchange (HIE) that is used to coordinate care and improve community treatment and outreach efforts. New York State’s opt-in requirement for HIE consent makes it crucial that health providers understand what factors may influence participation. Doctoral student S. Raquel Ramos, MSN, MBA, RN, observed and interviewed registration clerks in an HIV clinic and found that the most common barriers to patient consent were issues with trust, privacy concerns and time constraints. The research suggests some improvements to work flow might increase consent, and the project will continue with patient focus groups and interviews with clinicians.

Interest in Using an Electronic Personal Health Record Among a Largely Hispanic Immigrant Population; Lucero R.J., Shang, J., Liu J., Bakken S.

Personal electronic health records have the potential to help patients monitor and improve their health. But some of the people most likely to benefit from the technology – vulnerable populations and frequent users of medical services – don’t adopt it. As part of the WICER project, Robert Lucero, PhD, MPH, RN, assistant professor, looked at factors influencing the use of personal electronic health records among a population of Hispanics in the Washington Heights and Inwood communities in New York City. Approximately half of the people surveyed reported good health and expressed interest in using this tool. Younger and better educated people were most likely to indicate their interest in using the records in the future. The analysis suggests that patients who are older or in poor health need more education on the potential benefits of using these records.