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The Gap in Big Data: Getting to Wellbeing, Strengths, and a Whole-person Perspective


Background: Electronic health records (EHRs) provide a clinical view of patient health. EHR data are becoming available in large data sets and enabling research that will transform the landscape of healthcare research. Methods are needed to incorporate wellbeing dimensions and strengths in large data sets. The purpose of this study was to examine the potential alignment of the Wellbeing Model with a clinical interface terminology standard, the Omaha System, for documenting wellbeing assessments.

Objective: To map the Omaha System and Wellbeing Model for use in a clinical EHR wellbeing assessment and to evaluate the feasibility of describing strengths and needs of seniors generated through this assessment.

Methods: The Wellbeing Model and Omaha System were mapped using concept mapping techniques. Based on this mapping, a wellbeing assessment was developed and implemented within a clinical EHR. Strengths indicators and signs/symptoms data for 5 seniors living in a residential community were abstracted from wellbeing assessments and analyzed using standard descriptive statistics and pattern visualization techniques.

Results: Initial mapping agreement was 93.5%, with differences resolved by consensus. Wellbeing data analysis showed seniors had an average of 34.8 (range=22-49) strengths indicators for 22.8 concepts. They had an average of 6.4 (range=4-8) signs/ symptoms for an average of 3.2 (range=2-5) concepts. The ratio of strengths indicators to signs/symptoms was 6:1 (range 2.8-9.6). Problem concepts with more signs/symptoms had fewer strengths.

Conclusion: Together, the Wellbeing Model and the Omaha System have potential to enable a whole-person perspective and enhance the potential for a wellbeing perspective in big data research in healthcare.

Karen A. Monsen, PhD, RN, FAAN, United States; Judith Peters, RN, DNP, United States; Sara Schlesner, BS, United States; Catherine E. Vanderboom, PhD, RN, United States; Diane E. Holland, PhD, RN, United States

May 2015
Abstract is public domain information from the National Library of Medicine (NLM).

Presenting the Omaha System in Hong Kong and China: 2010

“We don’t speak English … but, yes, we can speak the Omaha System language!”

An exciting Omaha System lecture and workshop tour was conducted in Hong Kong and China from October 18-31, 2010. The co-leaders were Karen Martin from Omaha, Nebraska and Frances Wong from Hong Kong.  Tour sites included Hong Kong, Hangzhou, Tianjin and Guangzhou. The respective host organizations were The Hong Kong Polytechnic University and Hospital Authority, Hong Kong; Hangzhou Normal University; Tianjin Medical University and Tianjin Nursing Association; and Guangzhou Nursing Centre, Ministry of Health.   At each site, Karen and Frances presented an overview of the Omaha System in large auditoriums, and clarified questions about adopting the Omaha System in practice.  The overview was followed by case studies conducted in smaller rooms. This arrangement enabled participants to actively engage in the learning process using their preferred language, and to have personal experience applying the Omaha System to realistic but fictitious client case studies.  A total of 900 participants attended, and represented diverse clinical, education, and management settings. Some participants were students.

The Omaha System tour was a success. Many participants purchased the Omaha System book, signed up for the Omaha System Listserv, and continue to communicate with Karen and Frances.  Dr. Wong’s team was instrumental in making the trip possible. They are Susan Chow and Sue Yeung from Hong Kong, Xuejiao Zhu from Hangzhou, Yue Zhao from Tianjin, and Shaoling Wang from Guangzhou.

Frances Wong and her research team translated the Omaha System into Chinese and subjected it to rigorous testing in numerous studies.  Publications authored by that research team are listed on www.omahasystem.org/references.html. The demand for using the Omaha System in China is so great that the research team is working with Karen Martin to post the translated Chinese version of the Omaha System on the Web site so that it is accessible to all who want to use it.  The Omaha System has been used in multiple Chinese populations including those who have cardiac, renal, respiratory, stroke, and hospice needs. Many clients/patients are in acute and long-term care facilities; others are elders who reside in the community.

Frances Kam Yuet Wong, RN, BSN, Dip Ned, MA, PhD
The Hong Kong Polytechnic University School of Nursing
Kowloon, Hong Kong, China SAR

March 2012

Using a Standardized Terminology

In our public health nursing agency, we use the Omaha System, one of the ANA-recognized standardized nursing terminologies. Use of this standardized terminology has been very valuable from my perspective as both a field nurse and informatics consultant. The Omaha System has improved my ability to articulate the essence and the details of nursing care, in both my roles. Although it has taken patience and commitment for me to become proficient in “speaking the language”, the results, in terms of strengthened patient care, have been well worth the effort. The learning task is made easier because the grammatical rules, syntax, concepts, and content are those of the nursing process: assessment, planning, intervention, and evaluation.

The terminology is fully integrated into my agency’s computerized nursing information system (CNIS). On the basis of the terminology’s foundation, powerful care plans have been created and are easily accessible at the point of care. They help me plan care and allow my charting to be more efficient and complete at the point of care. The care plans are easily customizable, allow me to address the unique needs of my patients, and reflect the organization’s policies and procedures. Because we are using a standardized terminology, we can engage in electronic exchange of information across the state. This has created opportunities to learn from and collaborate with my nursing colleagues in the delivery of highly diverse public health nursing services, from tuberculosis control to the prevention of childhood lead poisoning.

The standardized data generated by the terminology and stored in the CNIS enables quality assurance and improvement activities to be based on actual patient care data rather than data extracted from charting. The data are sufficiently atomic to generate meaningful information that enables me to describe to public health payers and partners the needs of patients, outcomes of nursing care, and the unique services that nurses provide in meeting the public’s health needs.

Pamela J Correll, RN, MS
Nursing Informatics Consultant
Public Health Nursing Program, Maine Center for Disease Control and Prevention
Bangor, Maine, USA

Reprinted with permission: Correll PJ. (2009). Using a standardized terminology. In LQ Thede, JP Sewell (Eds.), Informatics and nursing: Competencies and applications (3rd ed.) (302). Philadelphia: Lippincott, Williams, & Wilkins.

September 2009