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The integration of Big Data from electronic health records and other information systems within and across health care enterprises provides an opportunity to develop actionable predictive models that can increase the confidence of nursing leaders' decisions to improve patient outcomes and safety and control costs. As health care shifts to the community, mobile health applications add to the Big Data available. There is an evolving national action plan that includes nursing data in Big Data science, spearheaded by the University of Minnesota School of Nursing. For the past 3 years, diverse stakeholders from practice, industry, education, research, and professional organizations have collaborated through the "Nursing Knowledge: Big Data Science" conferences to create and act on recommendations for inclusion of nursing data, integrated with patient-generated, interprofessional, and contextual data. It is critical for nursing leaders to understand the value of Big Data science and the ways to standardize data and workflow processes to take advantage of newer cutting edge analytics to support analytic methods to control costs and improve patient quality and safety.

Patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) are typically sedentary and functionally limited as a consequence of their condition. The purpose of this study is to test the effect of a lifestyle physical rehabilitation program (The Life Readiness Program) on physical function in patients with ESRD undergoing HD. Physical function was measured by the Kidney Disease Quality of Life Short Form (KDQOL-SF) physical function score (range, 0 to 100). Eighty-two patients were randomly assigned to a 6-month rehabilitation program (intervention; n = 39) or to standard clinical management alone (control; n = 43). The groups were frequency matched by age, sex, ethnicity, and diabetes as the cause of ESRD. General linear modeling of the change in physical function score was used for multivariate analysis. Physical function scores were not different between groups at baseline. Change in physical function score increased significantly in the intervention group compared with the control group when data were adjusted for the matching variables and adequacy of dialysis (3.2, -3.6; P = 0.04). Additionally, the control group reported more problems with work or daily functions because of emotional problems (P

While this case study uses an example of a home health team, it is meant to describe a system in which clinicians and healthcare organizations specialize and develop expertise by performing a large volume of specific services, procedures for given medical conditions or diagnoses. We introduce the concept of "consumer as a direct employer" of healthcare services. In this model, nurses may work as independent contractors, or as a member of a team contracting out as a unit, as in our example of the Rhine Home Health Team. Nrses also may work as employees to healthcare organizations as they do today.

Simulated e-Health Delivery System (SEEDS) uses a clinical information system (CIS) to teach students how to process data from virtual patient case studies and work with information technology. SEEDS was developed in response to the Institute of Medicine recommendation that students be taught about information systems in order to improve quality patient care and reduce errors. Curriculum implications, implementation of the system, and technology challenges are discussed.

A jointly funded partnership between the school of nursing at a large midwestern university and a premier health care information technology supplier represents a pioneering event for education and for the health care information technology industry. The impetus for this partnership arose from Institute of Medicine reports published in late 1999 and early 2001 addressing the quality, error, and waste in the health care system in the United States. The Simulated E-hEalth Delivery System (SEEDS) provides opportunities based on best practices in education to learn and practice clinical skills in a state-of-the-art environment using a live-production, clinical information system designed for care delivery. A pilot project that began with a small cohort of baccalaureate nursing students has been implemented and extended. SEEDS will also be extended to other health professional programs.