Rio de Janeiro 20-25 June 2003

A personal review by Rod Ward


This is not the official conference web site which can be found at:

As ever with these reports it is being written on a daily(ish) basis & uploaded to the web whenever I can get a connection. There are a personal comments (written during lunch breaks etc.), not an academic review or journal report & should be read in that manner, and it should be recognised that I can only report on the bits I managed to attend.

The third day (Tuesday) started with a plenary presentation by Otto Rienhoff who considered "The request for interoperability - the International Challenge of Health Informatics in the 21st Century". This was for me the best keynote presentation so far.

He started with a historical perspective which included initiative in the US, Europe & developing countries over the last 40 years, identifying the constant growth and diversity of applications and argued that the importance of the business case for health informatics developments has now come to the forefront. he identified key current issues around interfacing the myriad of existing applications and maintaining their integrity as they change - what he described as linking "moving bubbles".

He identified short term and long term initiatives;

Short term

Long term

He described the Integrated Healthcare Enterprise (IHE) approach to software - don't worry about how the interface happens as long as it works and asked lots of questions about the ways forward - to which no answers may exist at present - and highlighted the importance of health technology assessment processes.

I then attended a "Panel Session" Bringing Evidence-Based knowledge into nursing practice

Heather Starchen The first speaker was Heather Strachen who described clinical governance systems from a Scottish perspective from National to NHS trust level.

She highlighted the importance of good information systems to make these initiatives a reality.
The second speaker was Judith Warren who described "Planting SEEDS of evidence based practice in nursing education" which is being used at the Kansas University School of Nursing.

This system uses the same clinical record system which is being experienced in clinical settings within the clinical skills labs in the school of nursing to provide charting for virtual patients as a learning tool but with additional screens attached to nursing assessment or intervention terms to provide students with the reference data behind the clinical criteria & current work to get graduate students to provide literature searches and evaluations linked to the records.
Judith Warren
Charlotte Weaver The system vendor view was then provided by Charlotte Weaver (Cerner Corp) who addressed issues raised by the US national healthcare quality report towards the development of computerised patient records/person based health records and linking this to evidence databases.

She described how healthcare providers could use their own patient data for quality audit and to provide indicators of outcome measures. She argued that these indicators could then be dynamic rather than the static tick box approach of JCAHO.
The final speaker of the panel was Dr. Connie Delaney who talked about closing the loop in the development of evidence based protocols and linking these to system integration and quality assurance. Dr Connie Delanie

The speakers presentations were then followed by a fairly lively Q&A session with the audience.

In the afternoon I attended another group of paper presentations:

The first speaker was Brian Gugerty(US) who described the "Development and piloting of the CISQ-MA to assess nursing attitudes towards electronic medication administration modules of healthcare information systems."

He clarified the difference between the systems themselves and the implementation process (although these distinctions may not be recognised by users) and the phases involved in the process.

CISQ has produced a family of measurement instruments & this report was on a medication administration module however the numbers of subjects were too small to be generalisable, and provided some pointers for future users.

Further information is available from
Brian Gugerty
Carol Bond Carol Bond then provided a UK view of "Nursing Informatics for all", with a variety of definitions and exploration of required competencies - which have showed that they are not held by NHS nurses.

She went on to describe her own study of over 1000 students which asked about word processing and Internet skills which showed the majority had poor skills - even if they rated themselves more highly.

She concluded with comments about change strategies for the future and the need for IT skills to be core for all nurses.
A "Connectionist Expert System: The use of computing in the systematization of Nursing Assistance" was the next area explored by Igor Wanderley Cavalcanti (BR). This is a project still in its early stages to use neural networks to model and enhance nursing decision making based on basic rules and fuzzy logic which are then refined based on patient examples. Igor Wanderley Cavalcanti
Salem Aljareh Another UK speaker was Salem Aljareh from Newcastle upon Tyne who described the model his team are developing to examine "Satisfaction of Health Record Security Principles through Collaborative Protocols".

He explored some of the issues, regulations and legislation (DPA & Caldicott) involved in multiagency record systems and described how their Collaboration Task Creation Protocol (CTCP) and Collaboration Task Runtime Protocol (CTRP) model the relationships, ownership, authentication and responsibilities in relation to record creation and access.
The final presentation in this session was by Ulrich Schrader (DE) who described his study of "What nurses and patients think should be on a clinics website."

He explored the role of the Internet and various methodologies for studying it. He concentrated on the RIDID analysis process which showed that the priorities of the health professionals were very different from the priorities of the patients.
Ulrich Schrader

The final session of the day which I attended was a theatre style demonstration.

Martha "Muffie" Martin Martha "Muffie" Martin described and demonstrated the "Partners Handbook: Point of Care Access to clinical knowledge resources". This system provides resources to the desktops of all staff in this large US organisation of hospitals and primary care physicians, both patient specific and generic knowledge which was under consideration here.

The resources available included those produced by the organisation and from external suppliers, such as journals, text books and pharmacological databases. She explained how this is provided from an SQL server and the content is kept separate from layout and design, while recognising limitations such as the inability to include external resources in the search engine.

She presented some statistics about usage showing those pages most frequently accessed and the increasing uptake of the resource.
The final demonstration was by Ron Sharkey (AU) who gave an on-line demonstration of "NURAPID: Recording and assessing competencies in an on-line portfolio", which had originally been designed at Loughborough in the UK and licenced for use in Australia !

This system has several sections:
  • PACE - Personal information, Achievements, Career Developments and Evidence
  • SPEED - Survey, Plan, Execute, Evaluate & Document
  • CV creator

This is used for core skills, expected by the university from all disciplines (e.g. organisation skills, research etc.) & discipline specific skills set out in the Australian Nurses code & enables the students to assess their own level and provide evidence to support it.

The students can print out the evidence in the form of a CV or reports for particular competencies.

Available at:

Ron Sharkey

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Page Created: 18.6.03

Last Updated: 1.7.03