Pirkko Kouri Principal Lecturer in Healthcare Technology Savonia University of Applied Sciences (Thursday, 3.45pm, Forum Room)

1. Health Informatics Penetrating Nurse Education
– An examination of the Aims Overall Health Informatics Education Through Planning,
Implementation, Evaluation and Administration of
Information Resources in Health Sector
PIRKKO KOURI PhD, PHN, RN
Principal Lecturer in Healthcare Technology, Savonia University of Applied Sciences, Finland
Member of eHealth Strategic Group at the ICN
Member of ICN Telenursing Advisory Board
Member of IMIA-NI Education working group
Secretary of Finnish Society of Telemedicine and eHealth Board
CONFERENCE : HINZ, Health Informatics into Clinical Practice
TIME: November 7th – 9th 2012,
PLACE : Energy Events Centre, Rotorua, NZ

2. Contents
• Concepts around Health Informatics and e-Health
• eHealth phase – brief national viewpoint from Finland
• Health Informatics Education
– Standarised nursing language
– ICT – eHealth - Educational change
– Three examples of HI-related education projects
• ICN eHealth programme
• Learning today and future

3. Concepts around
Health Informatics and e-Health

4. Health Informatics 1/2
• Health Informatics is a scientific field
• e-Health is a domain of practice
• Both are about the use of information and information -and
communication technologies for improved healthcare services
and thus indirectly for better health

5. Health Informatics 2/2
• Health Informatics is a scientific field
– E.g., ‘mixture’ of technology, particularly artificial intelligence, computer
science, and informational science relates to the health care field.
-> field of study is applied to nursing, clinical care, public health, and
biomedical research, for instance
Jobs in Health Informatics field:
• Nursing information officer
• Chief information officer
• Medical informatics specialist/Health informatics specialist
• Certified health information specialist
• Informatics consultant
• Information systems manager
• Clinical informaticist
• Project manager in health information
• Healthcare administrator
• Medical and health services manager

6. WHO: eHealth
• eHealth is the use of information and communication
technologies (ICT) for health.
• Examples include treating patients, conducting research,
educating the health workforce, tracking diseases and
monitoring public health.
– EPR, Telehealth and telecare, Decision making support systems and
online knowledge sources, Web-based patient information and PHRs,
Social networking groups, etc…
http://www.who.int/topics/ehealth/en/

7. Public Health and ICT Policy - European Union
Telehealth was first….eHealth, the integration of telehealth technologies with
the Internet..
eHealth means
1. the use of modern information and communication technologies (ICT) in
support of health and health-related fields, and
2. to meet needs of citizens, patients, healthcare professionals, healthcare
providers as well as policy makers.
3. eHealth covers the interaction between citizens/patients and health-service
providers, institution-to-institution transmission of data, or peer-to-peer
communication between citizens/patients and/or health professionals.

8. Telehealth/telemedicine applications in use
• Teleconsultation (emergency transportation)
• Telediagnosis
• Telemonitoring
• Telelaboratory services
• Videoconferences (telepsychiatry, teleophtalmology, teledermatology)

9. Health care education - Telecommunication
• (Tele)phoning
• Videoconferencing
• Using Simulation laboratories
• Social media, Moodle, Adobe connect pro, Skype, SL

10. eHealth use by GPs
• Storage of administrative patient data
• Storage of medical patient data
• Use of a computer during consultation
• Use of a Decision Support System
• Transfer of administrative patient data to reimburses or other carers
• Transfer of lab results from the laboratory
• Transfer of medical patient data to other carers
• e-Prescribing
Source: empirica, Pilot on eHealth Indicators, 2007.

11. FINLAND - eHEALTH

12. Facts about Finland
• Population 5 400 000
• People under 15 years constitute about 18 % of the total population
• People over 65 years some 15 %. The population is aging.
• Life expectancy was 83.2 years for women and 76,7 years for men in
2010.
• Home of Nokia, Linux and Santa Claus
• The proportional ratio of mobile phones and internet connections is very
high

13. Finnish Telehealth/eHealth policy development
• 1996: Strategy for Utilising Information and Communication Technology in the field
of Social Welfare and Healthcare (citizen-centred, seamless service-chain, horizontal
integration of social and health services)
• 1998: Update of the strategy, placing emphasis on several issues, e.g.
digital patients records, nationwide interoperability or privacy protection
• 2002: Decision-in-Principle by the Council of State for the introduction of
nationwide patient records
• 2007, and 2009: “eHealth Roadmap for Finland” is published by the Ministry of
Social Affairs and Health
eHealth strategy 2010

14. Legal acts - Telehealth/eHealth development
1999 Personal Data Act
2000 Act on Experiments with Seamless Service Chains in
Social Welfare and Care Services
2001 Decree on the Storing of Patient Data
2007 Regulation on the Use of Electronic Social and
Healthcare Client and Patient Information from, also
called the “Client Data Act”
2007 Legislation on the Use of ePrescription
2011 1st of May New Health Care Act

15. Finnish eHealth development
• Nationwide archive system (KanTa), connected to e-
prescribing and personal health records (on process –
pilots)
– Within the KanTa the internet-based eView service for
citizens is being developed.
• Early political commitment to e-health issues, making it
well-prepared for e-health products and services.

16. Data stored in the national eArchive:
First phase
- Administrative/ demographics
- Electronic medication record
- GP record/ summary
- Medical record
- Referral and discharge letters
- Laboratory results
Challenges: in the areas of interoperability and
the decentralisation of the healthcare system.
- Radiology reports
- Summary of nursing information
- Emergency care data
- Log information
Next steps
- Radiology, endoscopy etc images
- Medical statements
- Dental healthcare
- Biosignals
PKo 2012

17. Nursing documentation – an integral part of development

18. Nursing Information Reference Model
L a ye r 5
S tru c tu re in te rn a tio n a l N M D S
c h a ra c te ris tic s : L a ye r 4 :
s e rv ic e ite m s NMDS:
e n v iro n m e n t n a tio n a l P o lic y d e c isio n s
c o n te xt p u rp o s e s
L a ye r 3 :
U s e o f N u rs in g
M in im u m D a ta S e t N M D S
o n In s titu tio n a l le v e l
M anagem ent
d e c is io n s
U n ifie d L a ye r 2 : d o c u m e n ta tio n o f:
n u rs in g
N u rs in g d ia g n o se s
te rm in o lo g y
N u rs in g in te rv e n tio n s
fo r
c o m p a ra b le O u tc o m e s o f n u rs in g c a re
d a ta :
IC N P ®
L a ye r 1 : F a c ts :
C lin ic a l d e cisio n s
- D e m o g ra p h ic a l d a ta
- O b s e rv a tio n s : s ig n s & s ym p to m s
- A e tio lo g y: fa c ts c a u s a l re la tio n s / d a ta
o th e r d is cip lin e s e tc . Epping & Goossen 1997

19. The Use Of Nursing Data In Patient Care Management
Turku University Hospital /Orthopedics

20. Use of structured nursing data
MULTIDISCIPLINARY
INFORMATION RETRIEVAL
SUMMARIES
INFORMATION ABOUT
SYSTEMATIC DOCUMENTATION HEALTH STATUS AND PROGRESS
OF NURSING CARE OF NURSING CARE
NURSING STATISTICS
Nurses care 80% for the patients
AND REPORTS
By David Benton CEO in ICN
eARCHIEVE

21. Moving more toward communities
---
personalised care
---
eHealth

22. Tools for Citizens – challenge for Nurses
Mobile phone
uHealth Digi-TV
tools
… or using printers
Computer/PC Writing notes
Tarja Meristö 25.3.2010

23. How to linkages Consumers/Citizens and Healthcare Personnel?

24. People/community-centred approach in health care
• Legislation supports
• Increase of patient/client/consumer/community independence
• At the same time, patients themselves create, access, process and
exchange information about their health situation

25. 25
Humberto Muquingue, UEM/Moz, presentation 2012

26. Using health information to
• Promote healthy living (personal, community)
• Empower individuals and community about e.g. drugs
• Provide resources for the health of the people
• Enlighten patients on self-care
• Educate on diseases and conditions
• Make decision regarding products and services
• Keep health care professionals updated about client’s
condition
Source: Retha de la Harpe, CPUT/SA, presentation 2012

27. Health information
ICN eHealth programme
Patients

28. Future Citizen participating in his/her health care path
• Self care & Following – at home
• Result documentation
• Sending/receiving results e.g portable monitoring systems/ on-line feedback
• eView
• (Patient) health records
• Laboratory results
• Appointments - online booking
• Information share - reporting
• Q/A
• Health history forms
• Electronic interviews
• Locating services
• Controlling/Managing payment orders
• Information search, health information networks and health literacy
Slide by Pekka Muukkonen 25.3.2010

29. Health Informatics –
Three Educational Projects

30. INDEHELA-ICI curriculum development
briefly
Pirkko Kouri, senior advisor
www.uef.fi/indehela/ici

31. Summary
• the INDEHELA-ICI (Institutional Collaboration Instrument for Informatics
Development for Health in Africa) project, is funded by the Finnish
Ministry for Foreign Affairs (MFA) within the new Higher Education
Institutions Institutional Collaboration Instrument (HEI ICI) programme.
• The project focuses on developing the capacities of three African HEIs in
HI and e-health education.

32. Partners
The African partners:
• Obafemi Awolowo University (OAU), Department of Computer Science and
Engineering (CScE), Ile-Ife, Nigeria
• Eduardo Mondlane University (UEM), Department of Mathematics and Informatics
(DMI), Maputo, Mozambique
• Cape Peninsula University of Technology (CPUT), IT Department (ITD), Cape Town,
South Africa
The Finnish partners:
• University of Eastern Finland (UEF), School of Computing (coordinator) and
Department of Social and Health Management, Kuopio, Finland
• Savonia University of Applied Sciences, Unit of Health Care, Kuopio, Finland

33. Objectives
The three specific objective are:
• Staff development; The core groups of 6-10 junior and 3-5 senior staff
• Educational capacity development; Each African has the curriculum
and a timed plan for implementing its Masters and/or certificate
programme
• Administrative capacity development

34. Basis of Curriculum work – widely accepted model
Recommendations of the International Medical Informatics Association
(IMIA) on Education in Biomedical and Health Informatics. Methods in
Inf Med 2. by Mantas, J., Ammenwerth, E.
Demiris, G., Hasman, A., Haux, R., Hersh, W., Hovenga, E.
Lun, K.C., Marin, H., Martin-Sanchez, F. and Wrigth, G. 2010.
Source: http://www.schattauer.de/en/magazine/subject-areas/journals-
a-z/methods/contents/archive/issue/1053/manuscript/12538.html

36. Sub-disciplines within HI
Dimension of IT
History, Tech. Info. Software Comp. Comp. Math &
Adapted from: Saranto K, Korpela M, eds. Tietotekniikka ja
philosophy assessm Systems Eng. Eng. Science physics
tiedonhallinta sosiaali- ja terveydenhuollossa, WSOY 1999
ent
Dimension of wellness services
Health Paradigm of Paradigm of Paradigm of
promotion
organisational Engineering Natural
Self-help by and work Sciences
citizens sciences
Healthcare
delivery
system
Healthcare
Health IS
management
Social services
& sciences
Nursing work Nursing
& science Informatics
Clinical
medicine Medical Informatics
Biomedical
research
Other
6 Feb 2012 biosciences Mikko Korpela 36

37. Information systems for healthcare delivery
Information system for
inter-organizational Information system for
Korpela et al., HELINA’2003: Preconditions for sustainable …
networking in citizen-to-healthcare
healthcare = ”IOHIS” linkages = ”eHealth”
H e a lth c e n tre s
T e a c h in g h o s p ita l G e n e ra l h o s p ita l
M a na ge me nt M a na ge me nt M a na ge me nt
Contr ol, C lin ic s ,
c oor dination,
Inf or mation r es our c es s p e c ia ltie s
H e a lth S u p p o rt H e a lth H e a lth
C a re re co rd s C a re re co rd s C a re C itiz e n s ,
re co rd s se rvi ce s
p ro vi sio n p ro vi sio n p ro vi sio n
c o m m u n itie s
Ser v ic es Ser v ic es Health s er v ic es
Inf or mation Data
Needs Needs Health needs
S o c ia l s e rv ic e s
Information system for
clinical healthcare Information system for
delivery = CIS regional integration of P riv a te c lin ic s e tc .
L e g e n d: healthcare and social
For mal
or ganiz ation services = ”RHSIS”
N G O s , tra d it io n a l
Ac tiv ity
h e a le rs , e tc .
Need/s er v ic e
r elations hip

38. Information systems for healthcare management
N a tio n a l h e a lth
a d m in is tra t io n Information system for district
Information system S ta te / p ro v in c e health management = DHMIS
Contr ol,
Korpela et al., HELINA’2003: Preconditions for sustainable …
c oor dination, h e a lth a d m in is t ra tio n L o c a l g o v e rn m e n t
for national Inf or mation r es our c es
D is tric t h e a lth
Contr ol,
healthcare Inf or mation
c oor dination,
r es our c es
a d m in is tra t io n
management = Contr ol,
c oor dinatio n,
NHMIS Inf or mation r es our c es
H e a lth c e n tre s
T e a c h in g h o s p ita l G e n e ra l h o s p ita l
M a na ge me nt M a na ge me nt M a na ge me nt
Contr ol, C lin ic s ,
c oor dination,
Inf or mation r es our c es s p e c ia ltie s
H e a lth S u p p o rt H e a lth H e a lth
C a re re co rd s C a re re co rd s C a re C itiz e n s ,
re co rd s se rvi ce s
p ro vi sio n p ro vi sio n p ro vi sio n
c o m m u n itie s
Ser v ic es Ser v ic es Health s er v ic es
Inf or mation Data
Needs Needs Health needs
S o c ia l s e rv ic e s
Information system for
healthcare facility
management = ”HFMIS” P riv a te c lin ic s e tc .
L e g e n d:
For mal
or ganiz ation
N G O s , tra d it io n a l
Ac tiv ity
h e a le rs , e tc .
Need/s er v ic e
r elations hip

39. FUNDAMENTALS OF HEALTH INFORMATICS EDUCATION
developed during INDEHELA-ICI Workshop 3, 6-10 Feb 2011, AOU, Ile Ife, Nigeria
1. Basic terms and concepts in Health Informatics
2. Health care systems
3. Information recording in healthcare
4. Using information for healthcare professional
5. Using Health Information for patients and communities
6. Information systems in healthcare
7. Using information technologies in Healthcare
8. Socio-technical issues in healthcare
9. Integration of service, work and information flows in practice
10. Legal and ethical issues
11. Principles of project management

40. Basic terms and concepts in Health Informatics 2/2
Learning outcomes (tentative):
At the end the learner should be able to:
1.1 Explain the difference between data, information and
knowledge,
1.2 Describe the manifestation of health informatics as a
discipline and e-health as a practice.
1.3 Describe health informatics related concepts in relation to
health informatics and e-health
Assessment (tentative)

41. Learning methods
Independent learning
Home work
Identifying own learning needs
Learning activities
Independent practice eLearning
Interviewing Problem solving
Evaluation of Reading
Acquiring and evaluating learning
Observing Group work
knowledge
Reflecting Study groups
Writing Inde
Learning
Face-to-face Group works and
sessions Practice periods discussions
Simulations
Skill tests
Study visits
Exams Evaluation –giving and
receiving
Face-to-face learning
41

42. Educational Project 2

43. Sexual Health Centre
‘Ayvot’ project
Project funded by European Social Fund

44. Partners
Finnish On-line University of Applied Sciences (coordinator),
Hiv support centre,
Sexpo Foundation, Helsinki Deaconess Institute,
Lahti University of Applied Sciences (LAMK), Jyväskylä University of
Applied Sciences (JAMK), Centria University of Applied Sciences, Turku
University of Applied Sciences, Häme University of Applied Sciences
(HAMK) and Laurea University of Applied Sciences.

45. The project creates
• Aims of the learning environment:
– offer modern tools for interaction between the
teachers and the learners, especially youngsters
– enhance learning
– increase motivation for information acquisition

46. Sexual health centre
•Open and authentic learning environment for
sexual health : Seksuaaliterveysasema.fi
•Sexual health centre can be used in
–education for social services and health care
–further education
–independent information acquisition
–teacher education, when applicable
•The learning environment acknowledges the vast
scope of sexual health, diversity and the course of a
person’s life

47. Image 1. Front page of the sexual health centre. At this
point the contents are only in Finnish.

48. Contents of the sexual health centre
The topics include:
–safe sex and sexually transmitted disease
–sexual rights
–relationships
–sexual violence
–sexual dysfunction
–safety on-line
Learning at the centre is made more interesting by e.g.:
– videos
– discussions
– authentic customer cases

49. Travelling & Sexual Health
Image 2. Course at the sexual health centre. The course contents will be
published in early 2013.

50. Educational Project, example 3

51. Project Whole Name Funding Objectives
A Virtual ideal home for 2010-2013 To renew the teaching and learning
HIMA Senior Citizens as a learning processes and methods with
(Finnish and development regard to the care of old people
slang for the environment and gerontological teaching by
word Home) developing a virtual ideal home for
Senior Citizens in the Second Life
virtual world. To develop a learning
game for theoretical studies. On
top of the virtual studies a practical
training among Senior Citizens is
included.

52. The IDEAL HOME
• Second Life is an online virtual world in Internet where
users can socialize, connect and create using free voice and
text chat
• Interaction with each other happens through avatars, a
digital ‘person’, that a student can create and customize.
• Aim is provide elderly people’s home and environment as
unimpeded and safe as possible

53. The EXERCISE PATH in IDEAL HOME

54. The IDEAL HOME IN SECOND LIFE
• Learning material for elderly care studies
• Information and networking forum for the companies and associations
• Updating education environment to social and health care professionals
• Pilot is ongoing, at the moment our students are practising and app. 400
senior citizens involved

55. The BUILDING in IDEAL HOME
Building includes information about security, accessibility, domestic lighting...
Companies and associations are using this building as an exhibition area, today
28 companies and 13 associations present their products in the Ideal home

56. LEARNING MATERIAL in IDEAL HOME
• Exercises, for example:
– Life stories
– Ethical issues
– Older people´s ability to function
– Different appliances
– Social and health care services
– Nutrition
– Medication
• Multiprofessional learning environment
– Practical nurses, nurses, midwifes, public health nurses, social workers etc.

57. VIVA GAME as part of HIMA project
• Virtual home visits - > different home environments
– Three different clients
– Three different life stories
– > Students can practice there e.g. How to behave at
client´s home, Interaction skills, Home
modifications, Medication, for instance

58. VIVA GAME: clients
Iltaleena, 77- years old woman, who has memory disease. She is living with her husband.
Viljo, 67 years old single man. He has problems with his circulation.
Viivi, 63 years old woman, who has problems with alcohol. She is living alone.
Memory disease, circulation problems and alcohol problems are very common within older people.

59. VIVA- GAME – Iltaleena`s home
This is Iltaleena´s home outside. Before student can start playing the game they
must notice a task: they must sweep snow off from the outdoor stairs. After that it is
possible to go inside and continue playing.

60. Iltaleena`s home inside
During practice period students meet real older people. (senior citizen`s home or other places
having a laptop with her/him). They play together Viva-game

61. Collaboration with Different Enterpises
Ideal home - enterprises Ideal home – private health
care providers

62. Collaboration with others
Ideal home – voluntary associations, parishes
The Association of Finnish Pensioners
The Finnish Parkinson Association
Finnish Rheumatism Association
Carers Association
The Alzheimer Society of Finland
(in local level)
Local Cancer Association
The Association for Stroke Patients
Orthodox Church

63. eHealth Programme
International Council of Nurses

64. Leading thought
If we cannot name it,
we cannot control it,
finance it,
research it,
teach it
or put it into public policy.
(Clark & Lang 1992)
64

65. eHealth Strategic Advisory Group at the ICN, Oct 2012, Geneva
Chair prof Nicholas Hardiker

66. ICN eHealth programme
• Transforming nursing through the visionary application of
information and communication technology
• Over 20 years of making
• Announced at the ICN conference in Malta, 2011
ICN – Advansing Nursing and Health Worldwide

67. ICN eHealth Programme Goals
• Transforming nursing through the visionary application of
information and communication technology
• To be recognised as an authority on eHealth (professional)
• To be positioned centrally in the eHealth community
(business)
http://www.icn.ch/pillarsprograms/ehealth
ICN – Advansing Nursing and Health Worldwide

68. Why ICN eHealth?
• ICN informs, supports and advocates for nursing and its
members
• Worldwide proliferation of ICT
• ICT in health care provides new opportunities, not least equity
and improved access
• eHealth threads through ICN processes and products
ICN – Advansing Nursing and Health Worldwide

69. International Classification for Nursing Practice (ICNP®)
• ICN has supported ICNP® since 1989
• A standardised terminology used to represent nursing
diagnoses, interventions and outcomes
• Available in 15 languages
• A formal infrastructure that facilitates cross-mapping and allows
output in multiple formats
• A related classification in the WHO Family of International
Classifications
• Harmonisation agreement in place with IHTSDO* (SNOMED-CT)
• Collaborative agreements with other nursing terminologies
* International Health Terminology Standards Development Organisation

70. ICN Accredited Centres for ICNP® Research & Development
• Australia – Canberra
– ICNP® and evidence-based practice
• Australia – Flinders
– ICNP® and disaster nursing
• Brazil
– Development and use of ICNP®
• Chile
– ICNP® and family nursing
• German-speaking countries
– 3 NNAs and 3 national user groups – Translation - Development and use of ICNP®
• Iran
– Translation - Development and use of ICNP®
• Korea
– Translation - Development and use of ICNP®
• Poland
– Translation - Development and use of ICNP®
• Portugal
– Improve quality of care through Nursing Information Systems and ICNP®
• USA
– ICNP® and minimum data sets

71. ..Connecting nurses..
• A forum for expert healthcare professionals from around the
world to share their ideas, advice and innovations
• Learning from each others
• A contest that highlights nursing innovations and helps to put
them into practice
http://www.information-shareapy.com/

72. FUTURE…Learning is changing..
Challenging education

73. Today --- Fast Forward 25-30 Years…
• Right care - right patient - right medication - right time…right
documented (literate)
-------------------- ICT/eHealth --------------------
• “Anyone can now learn anything from anyone at any time.”
(also illiterate)

74. Education 2022: Improve ICT skills of users (citizens,
patients, health professionals)
1. Learner-Driven – > patient driven –> community driven
2. Openly Accessible
3. Personalized
4. Social (MOOC = Massive open online course )
5. Ubiquitous
6. Holistic
7. Teaching Redefined -> nurse counselling, teaching methods
8. Policy Redefined
9. Industry Engaged
10. Achievement Redefined
Source: Lecture Education 2022: A 360 Degree View Ten predictions of 2022
by Curtis J. Bonk, Professor, Indiana University,
http://trainingshare.com/pdfs/I_am_Not_content_Deakin.pdf

75. We-all-learn: Ten Forces that Opened the Learning World
 eHealth era
1. Web Searching in the World of e-Books
2. eLearning and Blended Learning
3. Availability of Open Source and Free Software
4. Leveraged Resources and OpenCourseWare
5. Learning Object Repositories and Portals
6. Learner Participation in Open Info Communities
7. Electronic Collaboration and Interaction
8. Alternate Reality Learning (e.g., MMOG*, Second Life)
9. Real-Time Mobility and Portability (e.g., iPhone)
10. Networks of Personalized Learning (e.g., Blogs)
* MMOG = massively multiplayer online game
Source: Lecture Education 2022: A 360 Degree View Ten predictions of 2022
by Curtis J. Bonk, Professor, Indiana University, http://trainingshare.com/pdfs/I_am_Not_content_Deakin.pdf

76. Issues Timeline….
How to
Can you trust handle
Can we trust Can you non-visit
health information
the trust care?
on the Internet?
Internet? personal
health
records?
1998 1999 2000
How to handle Should patients
patients with How to say
see their health
Internet health “I don’t Know”?
information?
information? Lab Reports?
C. P Waegemann’s
presentation 2008 in Stakes

77. First snow came yesterday

78. Thank you!
Email: pirkko.kouri@savonia.fi