Timothy Landers, RN, CNP, PhD, is an assistant professor at The Ohio State University and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.

The Great Challenges Program is an ongoing effort by the TEDMED community to provide innovative, interdisciplinary perspectives on the most complex and challenging issues in health care. A year-long dialogue facilitated through social media tools and panels of experts continued at the annual gathering of TEDMED 2013.

One of the themes of TEDMED 2013 was the creative and thoughtful use of big data and small data to improve health and health care.

Small data includes individual level information specific to an individual or circumstance. In small data, “n=ME.” A vast amount of individual level information is now routinely collected. However, a large volume of data is not required for small data to be useful—in the words of one TEDMED speaker, it’s not the volume of the data, but the complexity of existing data. Data must be available and accessible in order to be useful as well.

Big data refers to patterns of data and information available at the population level. The goal of big data is to use information and take a “macroscopic” view of health. It includes the ability to recognize patterns that are not obvious or readily apparent. Big data analysis permits us to go from pieces of data to collective wisdom, a theme of TEDMED 2013.

Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.

Technological innovation is rapidly transforming patient care. A new generation of innovations will potentially change the most fundamental aspect of the patient experience – patients’ interactions with physicians and nurses. The FDA recently approved the first autonomous telemedicine robot for use in acute care hospitals. Even more advanced technologies, some capable of processing up to tens of millions of pages of plain medical text per second, are being tested and may soon be used to diagnose conditions and recommend treatment, with limited input from clinicians.

"We suggest that nurses should embrace rather than fear these innovations."

This new technology has the potential to perform several tasks more efficiently than clinicians, albeit with some limitations. It can quickly and effectively sift through large amounts of information and, based on a complex set of guidelines, create a probability-weighted list of diagnoses and recommendations. The result will be purely evidence-based and free of human cognitive decision-making biases.  The technology can drastically speed diffusion of new research and guidelines through electronic dissemination, similar to automatic software updates, and make most novel treatment regimens instantly available to patients.

Ann Marie P. Mauro, PhD, RN, CNL, CNE, is a clinical associate professor, fellow with the Hartford Institute for Geriatric Nursing, and the program liaison and project director for the Robert Wood Johnson Foundation New Careers in Nursing scholarship program at the New York University (NYU) College of Nursing, which has made extensive use of simulation. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

For students in the health professions, the beauty of simulation is the ability to apply their critical thinking and assessment skills in a safe environment where they can learn without fear of harming a patient. Sometimes I think people learn much better from their mistakes. While simulation does not completely replace traditional clinical experiences, it is a great teaching strategy to help standardize students’ learning experiences, at both the undergraduate and graduate levels.

You can achieve targeted learning outcomes for students who have the opportunity to work with patients with specific health concerns. When we take students into a traditional clinical setting, we do not have control over which patients might be available and what students might be able to do. It is getting particularly challenging not only to find clinical sites, because of competition among schools, but to deal with health care organizations that have transitioned to electronic health records and electronic medication administration records, which are difficult for faculty and students to access. Furthermore, it is time-consuming and costly for faculty to be trained on different systems.

Tom Delbanco, MD, MACP, is Koplow-Tullis Professor of Medicine at Harvard Medical School, Beth Israel Deaconess Medical Center. He is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program.

In a recent blog post, Anjali Gopalan, MD, a Robert Wood Johnson Foundation Clinical Scholar, weighed the pros and cons of OpenNotes—an effort to share clinicians’ notes with patients that is a stimulating collaboration among a large group of investigators, practitioners and patients in Boston; Danville, Pennsylvania; and Seattle.

Dr. Gopalan made a number of insightful observations that I’d like to comment on, but I need first to correct a fundamental misperception: OpenNotes is decidedly not a software program!!!

OpenNotes is an effort to convince patients, families, and clinicians to share openly any and, most often, all material that pertains to a patient’s care. The goal of such action is to improve communication between clinicians and patients, and to help patients engage more actively in managing their health and health care.

OpenNotes doesn’t depend on electronic health records or other software. Purely and simply, we are suggesting to patients that they routinely ask for a copy of their providers’ notes (to which they are legally entitled through HIPAA). And we are suggesting to clinicians that they routinely invite their patients to read them. Pull down the invisible firewall that we clinicians have long established, and the patient (and others whom he or she wishes to involve) can view the thinking that leads us to conclusions and recommendations.

To be sure, patient portals can facilitate sharing information with patients, and their future potential is enormous. But unblinding the story, the warp and woof of an individual’s experience that’s documented in clinicians’ notes, can also be done by low-tech means such as providing print copies of the notes at the end of a visit or later by mail.

A Robert Wood Johnson Foundation Evaluating Innovations in Nursing Education program (EIN) grantee team from the New York University College of Nursing, along with their collaborating partner at Johns Hopkins University School of Nursing, will give a presentation at the American Association of Colleges of Nursing’s Fall semi-annual meeting in Washington, D.C., on Tuesday, October 30.

Investigators Hila Richardson, DrPH, Lloyd A. Goldsamt, PhD, and Pamela Jeffries, PhD, will discuss findings related to the impact of simulation on use of faculty resources, whether simulation should replace traditional clinical hours, and models of effective integration into the curriculum.

The session, "Clinical Simulation: Issues, Outcomes, Challenges and Future Directions," is scheduled for 10:30 a.m. - 12:00 p.m.

Learn more about the meeting.

Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the latest nursing news, research and trends.  Here are descriptions of some of the stories in the September issue:

Advocates Call on Nurses to Take Leading Role in Palliative Care
The United States is facing a growing need for palliative care, which focuses on symptom relief and optimizing quality of life at all stages of serious illness—but the country has a serious shortage of palliative care providers.  Experts say nurses can help fill the void. Advanced practice registered nurses can provide high quality palliative care, and nurse leadership can help reshape and build the field.

Study: Nurse-Led Intervention Can Dramatically Reduce Deadly, Costly Infections
A study funded by the RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) reveals that combining several tested and proven practices for preventing central line associated bloodstream infections with a program to improve safety, teamwork and communication can dramatically reduce infection rates. While health care teams using the bundles were interdisciplinary, in each unit, nurses were responsible for ensuring adherence to the intervention.

Nurse’s Mobile App Idea Helps New Parents
Anna Wroble, a nurse and a mother of four in Nevada, recently won a contest sponsored by Dignity Health, a national hospital chain, for her idea for a mobile application that would enable parents to track their babies’ growth during the first year of their lives. The NICU Baby Growth Tracker app—one of three projects that received funding through the contest—became available for free download in August.

2012 RWJF Nurse Faculty Scholars: The Next Generation of Leaders in Academic Nursing
Twelve talented and diverse junior nurse faculty from across the country have been chosen as the fifth cohort of RWJF Nurse Faculty Scholars. The award is given to junior faculty who show outstanding promise as future leaders in academic nursing. It is designed to promote their academic careers, support their research, and reduce the severe nurse faculty shortage that is facing the nation. Each scholar receives a three-year $350,000 grant to pursue research, leadership training in all aspects of the faculty role, and mentoring from senior faculty at his or her institution.

See the entire September issue here. Sign up to receive Sharing Nursing’s Knowledge here.

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Kate Driscoll Malliarakis, PhD, CNP, MAC, assistant professor and program coordinator, Nursing Leadership and Management at the George Washington University School of Nursing. Malliarakis is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (ENF) and president-elect of the RWJF ENF Alumni Association.

Nursing has afforded me the opportunity to serve in numerous non-traditional positions. Now as an academic, I work to provide my students with a broad view of health care. Today, nurses enjoy a variety of educational opportunities that differ from the old one-size-fits-all approach. Thanks to technological advances in education, hybrid formats enable nurses to experience new educational opportunities through online course work and flexible, asynchronous learning.  

Online education encourages diversity as students hail from a variety of geographic locations and experiences. Unlike the standard classroom where a student can sit in the last row and not participate, online discussions demand the student’s involvement not only with the faculty but with each other. The result is a richer interaction and learning experience.

The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? This post is by RWJF Investigator Award in Health Policy Research recipients Robert L. Wears, MD, PhD, a professor in the Department of Emergency Medicine at the University of Florida, and Kathleen M. Sutcliffe, PhD, The Gilbert and Ruth Whitaker Professor of Business Administration at the University of Michigan’s Ross School of Business.

There are many aspects to the problem of what is or is not working in health professionals’ education today, and the changes needed to address them.  From our view as researchers studying issues of safety, resilience, and managing for the unexpected, some of the more important are that health professionals’ education is seriously deficient in the social sciences; is limited almost exclusively to largely positivist ideas about what counts as scientific activity; and is almost totally devoid of the humanities. 

None of these deficiencies are new, and that is what concerns us.  The lack of engagement with the sciences of safety, and of human and organizational performance, has implications for practice, for safety, and for understanding and creating actionable knowledge.

With respect to practice, for example, without sufficient exposure to humanities and social sciences we risk socializing people to become authoritative but inhuman techno-nerds, even if they didn’t start out that way.  

With respect to safety, we risk training people in positivistic methods and research approaches that oversimplify and even miss local contextual specifics that create real threats to safety. 

With respect to understanding and knowledge creation, we risk training people to revere scientific and technical rationality and ‘objectivity’ at the expense or even denial of any sort of constructivist or interpretive understanding.

Nancy Hanrahan, PhD, RN, CS, FAAN, is associate professor and faculty member of the Center for Health Outcomes and Policy Research at the Penn School of Nursing. She is a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar alumna. As a health systems researcher, she develops innovative models that promote an integrated mind/body approach to mental and physical health care.

At a time when there is an urgent need for innovative solutions to health care challenges, educators have a responsibility to prepare a generation of students who can think outside the box. The Inaugural Game Solutions for Healthcare Symposium at the University of Pennsylvania School of Nursing showcases such transformative learning experiences.

At this event, students from nursing and other schools within the University of Pennsylvania show what happens when you “mix-it-up” and work together to build innovative games and applications that target specific health care problems. More than 60 undergraduate students, staff and faculty participated in the game projects from five different schools at Penn. Teams included students from nursing, engineering, computer science, law, medicine and business. Nursing students defined a health care problem and then a team of engineers, or computer scientists, developed a technological solution.

The Human Capital section of the Robert Wood Johnson Foundation (RWJF) website is frequently updated with stories, profiles and features about the work of the scholars, fellows and grantees the Foundation supports. Check out a few of the new stories:

Grantee Triumphs Over Culture and Politics to Care for Women

When RWJF Clinical Scholar Crista Johnson, MD, realized that Somali, Sudanese, and other refugee or immigrant women who have undergone the traditional practice of female circumcision weren’t receiving desperately needed, culturally sensitive Ob-Gyn care, she checked her opinions at the door and set out to help. Today, she has created a model to help others learn how to treat circumcised women.

For Brain Injury Survivors, New Ways to Connect

RWJF Community Health Leader Fran Rooker is supporting a groundbreaking online program that brings brain injury survivors together despite distances and disabilities to help them overcome the long-term challenges that often come with their injury. Rooker’s telehealth program provides therapeutic supports, coaching, and encouragement.

Teaming Up Helps People Lose Weight

Years of research from RWJF Community Health Leader Rajiv Kumar’s successful Shape Up Rhode Island program has shown that individuals’ weight loss outcomes are significantly influenced by team factors. For instance, having multiple teammates pursuing weight loss and having supportive social interactions among those teammates improves outcomes.

Scholar Publishes "Cliffs Notes" for Colleagues on Top Medical Research

A new book published by RWJF Clinical Scholar Michael Hochman summaries 50 Studies Every Doctor Should Know, making the most influential medical research easily accessible for physicians and emphasizing findings that might help providers make better decisions.

See these stories and more on the Human Capital section of the RWJF website.