Getting Nurses Comfortable With Big Data

Emory School of Nursing has launched a data science certificate program to help nurses better understand informatics.

How comfortable are nurses with mining Big Data?

"Zero, zero, zero, zero," responds Roy Simpson, DNP, RN, DPNAP, FAAN, FACMI, assistant dean of technology management and clinical professor at the Emory University Nell Hodgson Woodruff School of Nursing.

That’s why Simpson and Vicki Stover Hertzberg, PhD, FASA, a professor and director of Emory’s Center for Data Science, helped create an online, self-paced data science certificate program—to help nurses use Big Data to solve problems in healthcare settings.

Big Data is a relatively new concept for nursing—it’s been around two, perhaps three years, Simpson says—but its capabilities are unlimited in developing patterns of patient care.

"To compare six patients and 10 patients and 30 patients and 400 patients is not a good indicator of evidence. You need large trillion data sets," Simpson says.

"Large data gives you patterns; you cannot get patterns out of small data sets," Simpson says. "So, if you're looking for whatever you're doing in nursing, whether it's getting a med, turning a patient, or deciding if it's the right room for them, you cannot gather evidence and research on small data sets today. You have to have large data sets to develop patterns of care."

For example, from Big Data, nurses know that new patients to a hospital who are over 65 and dehydrated will develop pressure ulcers, which can result in longer lengths of stay. Knowing that helps to develop a care plan.

"We're the only profession in the organization that is there 24 by 7—every other healthcare provider is an episodic engager with the patient—so we have to develop and understand care needs for our patients," he says. "We have to know what interventions we need to do for patients to decrease length of stay for the patient because our goal is to get a patient out of a hospital."

That’s not only for the patient’s sake but for the organization, as well.

If a patient is admitted with a pressure ulcer or develops one while hospitalized, it becomes the responsibility of the healthcare organization to discharge that patient with no pressure ulcer; otherwise, the hospital will not be reimbursed, Simpson notes.

Despite the benefits of Big Data, nurses tend to be uncomfortable with it for a couple of reasons.

"Evidence is hard to accept for change," he says.

Simpson referred to a recent announcement by a World Health Organization agency that artificial sweetener aspartame, used in low-calorie products such as Diet Coke, sugar-free gum, and tabletop sweeteners is "possibly carcinogenic to humans."

"I've had more people call me, asking, ‘Should I drink Diet Cokes or not?’" he says. "I say, ‘If you drink 20 a day you probably shouldn't drink it, but if you're drinking three or four, you're probably ok.’"

"How do you translate the evidence?" he says. "That's not a human behavior to follow the true evidence; people's inquisitions are not that strong."

The newness of Big Data is also a factor. "You have early adopters," he says, "and you have laggards and Big Data is a huge component."

Project NeLL

The new certificate program provides students with access to Emory's own vast stores of data—Project NeLL, the School of Nursing’s "pioneering" suite of apps that provides access to 2.7 million de-identified patient records and more than 37 trillion data points, providing information on diverse populations, countless conditions, and a wide spectrum of care.

Project NeLL, which stands for Nurse’s Electronic Learning Library, is singular in its presentation of data, Simpson says.

"There are other large data sets, but they don't have the clinical text data transcribed into natural languages that can be retrieved," Simpson says.

"For instance, MIMIC-III is a Massachusetts General data set which a lot of people use in research, but it is only data that is put in as data," he says. "NeLL looks at other types of data sets, so it has a lot of uniqueness to the marketplace."

Emory nursing students who used NeLL to complete capstones and dissertations discovered racial disparities in opioid administration for breast cancer patients, a cost value associated with nurse anesthetists compared to other provider types, and predictors of death among patients with pressure ulcers, according to Emory University.

The program

The new data science certificate program was conceived by Simpson and Hertzberg to move nurses forward in understanding Big Data and evidence and to advance Emory’s Doctorate in Nursing program to include a focus on evidence and systems work, he says.

"What we learned was not all nurses are interested in getting doctoral degrees," Simpson says. "They're looking at more scalable certificates as a way to advance their knowledge base and their criteria for work or being hired. We felt that more people wanted to understand informatics and Big Data before they decided whether they should go for degree granting in informatics."

Nurses completing the program will earn an Emory Nursing digital certificate and badge and receive continuing professional development contact hours.

‘New opportunity’

Getting comfortable with Big Data can only help nurses in their clinical practice.

"Every specialty in nursing has a component of informatics, and the weakness of those disciplines is the lack of informatics in their discipline," Simpson says.

Nurses need Big Data, Simpson says.

"Big Data is a new opportunity for the world at large, not just nursing," he says. "But for nursing to be successful in the future, we have to embrace it. We have to understand it and know how to use it."