3. Table of content :
Organization Profile
Introduction
Review of Literature
Objectives
Methodology
Implementation Process
Discussion
Recommendation
Summary
References
4.
5. ORGANIZATION Profile:
1. History
First conceived in 1984 by Delhi Government
Finally India's first full-fledged trauma centre to treat victims of road
accident- 2006
2. Area & Infrastructure :
20,600 sq meters
seven storey's consist of five operation theatres
152 inpatient
30 casualty beds,
26 ICU beds to provide both pre-hospital and emergency care.
12. DATABASE:
VistA was developed using the M or Mumps language/ database
An open source Mumps database engine, called GTM for Linux & Unix
computers has also been developed
GTM is an implementation of the Standard M programming system (M =
MUMPS)
PUTTY
PuTTy is a free and open-source terminal emulator, serial console and
network file transfer application.
It supports several network protocols, including SCP, SSH, Telnet and rlogin.
The name "PuTTy" has no definitive meaning,[1] though "tty" is the name for
a terminal in the Unix tradition, usually held to be short for Teletype.
14. MGWSI
The M/Gateway Services Integrator (MGWSI) is a software module for
integrating disparate environments. Its primary purpose is to provide the
connection between the Enterprise Web Developer (EWD) runtime
environment and PHP and Java Server Pages, but it can be used as a
standalone product and deployed for your own purposes if required
EWD
Enterprise Web Developer (EWD) is the advanced web application
development technology
EWD's unique approach makes it one of the world's most productive
platforms for web application development, allowing building sophisticated,
modern Ajax database-driven applications as simply and as quickly as
building static web pages.
15. MIRTH:
Mirth is an open source Java-based integration engine sponsored & primarily
developed by Web Reach, Inc. Mirth was designed based on the client-
server style & the enterprise service bus architecture.
Mirth delivers the industry's first free, open source HL-7 messaging
middleware. The standards-based mirth software is designed to dramatically
reduce the time & cost required to achieve health information system
interoperability & data exchange, & to speed secure information sharing
across communities of healthcare professionals.
"Mirth's ability to support multi-channel messaging modes, multi-protocol
connectors, multiple languages for transformer scripting, & a full complement
of end-point technologies make it an attractive interface engine for VistA-
based solutions"
16. Read :
VistA NURSING USER MANUAL;
Implementation of VistA Nursing Module at JPNATC
Computerized Patient Record System (CPRS)
Read-Only User Guide:
Learnt how to use CPRS
VistA-Healthe Vet Monograph;
EHR
Clinical Nursing Module
Site referred was :
VISTA NURSING MODULE http://www.va.gov/
Got technical manual to get technical assistance in
implementing VistA Nursing Module
17. General:
The objective of this project is to implement VistA Nursing EHR in
JPNATC, AIIMS, New Delhi & ensure smooth & uninterrupted running of
the same
Specific:
To understand the Clinical workflow of the nursing in OT & wards.
To perform gap analysis of existing clinical nursing workflow, with
respect to
i) WHO Checklist & VistA Nursing Module in OT
ii) VistA Nursing Module only in Wards
To map & customize the existing manual nursing procedures to the VistA
Nursing EHR form.
To liaise & update with various stakeholders in the implementation
project
To train the Nursing Informatics In charge & Technical Staff (JPNATC)
18. Review of Existing VistA EHR Modules
Process Mapping of OT & Wards
Gap & Need Analysis
Designing, Customizing & Updating Templates
User Testing
Training: hands on , onsite imparted to NIS and technical team
Tools: observation using WHO checklist, feedback from staff.
19. Process Mapping
Need & Gap Analysis
Designing/Creating/Updating Templates
User Testing
Training
Operation & Maintenance
26. DISCHARGE/TRANSFER PATIENT
PERFORM PROCEDURES NEEDED
NURSE:
1.MONITOR VITAL SIGNS
2.MEASURE INTAKE OUTPUT
3.ADMINISTER MEDICATION
NURSE ADMITS PATIENT IN NURSING LOCATION
PATIENT ARRIVES AT RECEPTION
Workflow In Wards:
27.
28. Gap Analysis In OT :
Done through WHO checklist
Lacunae:
It was supposed to be a group activity, but in practice checklist was
filled randomly by anyone who is free.
29.
30. SURGERY MODULE AT JPNATC : (OPERATION THEATRE)
v/s
NURSING MODULE OF VISTA (TO BE IMPLEMENTED AT JPNATC)
▢PATIENT CLASSIFICATION
▢PATIENT ASSESMENT
▢PATIENT CARE ASSIGNMENT
▢NURSING CARE PLAN WHICH ARE
SYSTEM FOCUSED & CONTAIN BOTH
NURSING PROBLEM & MEDICAL
DIAGNOSIS
▢CLINICAL PROTOCOLS/GUIDELINES
FOR CARE,
PATIENT EDUCATION MATERIAL
▢DISCHARGE PLANNING & OTHER
PATIENT RELATED MEDICAL RECORD
DATA
NURSING CLINICAL
MODULE
CONSISTS
31. Gap Analysis in Wards through
VistA Nursing Module
Following recommendations were made based on the analysis,
which are enlisted in table of list of register made.
32. S.No. Name of Registers/Fields Contents/Remarks Related Formats
1. SURGERY OT LIST: Similar list can be found
in Surgery Template of
JPNATC's Software
a.TC No. Filled by User
b. Date Filled by User
c. Consultant Filled by User
d. Diagnosis Filled by User
e. Surgery Filled by User
f. Blood Request Filled by User
g. Special Request Filled by User
h. Department VISTA CPRS will show
I. Case No VISTA CPRS will show
j. Case Type VISTA CPRS will show
k. Name-Age –Sex VISTA CPRS will show
l. Ward Bed VISTA CPRS will show
1. Preoperative Registers
JPNATC Manual Process
ListofRegistersmadeduring GapAnalysisin OT& Wards:
33. S.No. Name of Registers/Fields Contents/Remarks Related Formats
2. PATIENT ID SLIP Patient ID Slip can be made through
Patient Data Objects in Shared
Templates of VISTA CPRS Demo
a) TC No. Filled by User
a) Diagnosis Filled by User
a) Posted for Filled by User
a) On Date Filled by User
a) Name VISTA CPRS will show
a) Age/Sex VISTA CPRS will show
3. TRANSFER IN BOOK Can be made through (Section 1:-Chapter 4 Special
Functions; Admit/Transfer Pt. (Nursing Pkg. Only);pg no
155)
a. Patient Details VISTA CPRS will show
a. Things Received with
Patient
Filled by User
a. Received time/by Filled by User
a. Sent To OT (Time/By) Filled by User
a. Remark Filled by User
Recommendation :- We can Create New Template
4 REPORTING BOOK
(Morning/Evening Shift)
4 & 5 are Non Clinical Registers
5 Gate pass for Class IV
34. S.
N
o.
Name of Registers Contents/
Remarks
Related Formats
6 RECORD KEEPING
A. Patient's Detail VISTA CPRS will
show
A. Staff on Duty Filled by User Similar to VA*SU Brief Operative
Visit ,
(Surgery Template) in VISTA CPRS
DEMO, additional fields needed
can be edited.
A. Date Filled by User
A. Diagnosis & Operation Filled by User
A. In/Out Time Filled by User
A. Circulatory/Scrub Nurse Filled by User
A. Anesthesia Filled by User
A. Sets Used Filled by User
A. Sets Packed By Filled by User
A. Sponges Filled by User
A. Specimen Filled by User
A. Extra Items Filled by User
A. Remark Filled by User
7 NURSES RECORD BOOK
I. Date & Time Filled by User
I. Medication & Treatment Filled by User Recording can be done through
Brief Assignment
Worksheet (Nursing User Manual;
pg. no. 473)
I. Diet Filled by User
Intra-operative Registers List:
35. S. No. Name of Registers Contents/Remarks Related Formats
8 VITALS CHARTING VITALS & I/O MODULE ALREADY BEING
IMPLEMENTED IN JPNATC
9 I/O MONITORING
10 NURSES RECORD BOOK Similar to Register 7
11 Transfer Out Book
To Staff on Duty, Already Printed Similar to Transfer Out Book of JPNATC, changes required
can be done by editing Template
Kindly receive the patient; Already Printed
Date/Time Filled by User
Name of Ward Filled by User Can also be made through (Section 1:-Chapter 4 Special
Functions; Admit/
Transfer Pt. (Nursing Pkg. Only);pg no 155)
Name VISTA CPRS will show
Age/Sex VISTA CPRS will show
TC No. VISTA CPRS will show
With complete file + nurses notes Already Printed
Other Material Received Filled by User
Post-operativeRegisters List:
36. S.
No.
Name of Registers Contents/Remarks Related Formats
1. ADMISSION REGISTER Somewhat similar to JPNATC Admission Assessment Note,
changes required, need to be configured.
CR No. Filled by User Can also be made through
(Section 1:-Chapter 4 Special Functions; Admit/Transfer Pt.
(Nursing Pkg. Only);pg no 155)
DOA/TOA (Date/Time of Admission) Filled by User
MLC Filled by User
NLC Filled by User
Ward Admitted Filled by User
Time of Shifting Filled by User
Name VISTA CPRS will show
Sex/Age … VISTA CPRS will show
Father’s/Husband Name:- VISTA CPRS will show
Local Address:- VISTA CPRS will show
2 VITALS CHARTING Register 3D.2 & 3D.3 are similar to register 3C.1 & 3C.2 resp.
3 I/O MONITORING
4 Treatment/Assignment Book Similar to Complete Assignment Worksheet (Nursing Manual
Section 3 :-Clinical; Chapter 2 Patient Assignments; pg no
475)
Name VISTA CPRS will show
Bed No. VISTA CPRS will show NANDA Nursing Care Plan can be made
through (Section 3 :- Clinical; Chapter 3 Patient Plan
of Care)
Diagnosis Filled by User
Medicine Filled by User
Time Filled by User
Treatment Filled by User
Recommendation :- Interdisciplinary Plan Care Management in
VISTA CPRS TEMPLATES can be used.
5 NURSES RECORD BOOK Same as Register 3C.3
Clinical Registers List:
37. 2 VITALS CHARTING Register 3D.2 & 3D.3 are similar to register 3C.1 & 3C.2
resp.
3 I/O MONITORING
4 Treatment/Assignment Book Similar to Complete Assignment Worksheet (Nursing
Manual Section 3 :-Clinical; Chapter 2 Patient Assignments;
pg no 475)
Name VISTA CPRS will show
Bed No. VISTA CPRS will show NANDA Nursing Care Plan can be made
through (Section 3 :- Clinical; Chapter 3 Patient Plan
of Care)
Diagnosis Filled by User
Medicine Filled by User
Time Filled by User
Treatment Filled by User
Recommendation :- Interdisciplinary Plan Care Management in
VISTA CPRS TEMPLATES can be used.
5 NURSES RECORD BOOK Same as Register 3C.3
38. S.
No.
Name of Registers
17 Specimen Book
18 Daily Maintenance & Repair Record Book
19 Inventory Record
20 Laundry Receiving Book
Non Clinical Registers List:
S.
No.
Name of Checklist Related Format
1 PREOPERATIVE CHECKLIST Somewhat similar preoperative checklist was found in VA SU PRE-
OP VISIT in VISTA CPRS DEMO, since both the checklists are not
exactly same ,to meet the need of JPNATC, an entire new
template need to be created
Recommendation :-
2 WHO SURGERY SAFETY
CHECKLIST
Need to create entire checklist via Template
Checklist:
39. OT:
Designed Templates for entire clinical nursing
process
WARDS:
For existing templates : Modified & customized
templates as per users feedback
For Manual Recordings: Created/ Designed
entirely new templates
58. USER TESTING:
Nurse used the Template for live patient in Orthopedics Ward & gave
following feedback for modification:-
1.Nurses Daily Record:
Wants entire list of medication used in JPNATC
2.Nursing Care Plan:
Wants whole customized care plan for various intervention which
they were actually carrying out for patient.
60. LIASED WITH STAKEHOLDERS
STAKEHOLDERS
HEAD IT,
JPNATC
CEO, GTI
INFOTEL
IIHMR
TRAINEES
NURSE
INFORMATIC
S ,JPNATC
IT TEAM ,
JPNATC
TECHNICAL
STAFF AT
GTI
PROJECT
MANAGER,
VISTA EWD
61. Implementation of Nursing Module of VistA EHR, in JPNATC,
AIIMS enable the client to meet its said objective to a larger
extent & be self sufficient in carrying out operations
It provides following benefit:
Time- Real time flow of information
Place-Remote dissemination of information
Standardization-Processes & Workflows
Coordination- Among care providers
Decision support-Clinical knowledgebase, Clinical
pathways & protocols
Retrospective analysis- Trends, audits, outcomes
62. JPNATC, AIIMS should make all the clinical process
recording paperless
HIS ,being an open source application, does not increase the
expense for the organization but at the same time enhance
the quality by improving the processes such as making all
clinical documentation electronic thus’
decreasing duplicity to a great extent,
save time & cost to patient
since the patient record can be accessed from any of
JPNATC's locations rather than one patient consulted in
the previous visit, it will help the Management to keep a
strict control over functioning of the organization & thus
help spread a good word of mouth for JPNATC, AIIMS.
63. With the implementation of VistA EHR, JPNATC AIIMS would
gain in the following arenas
Better management control
Standardization of operations & functioning
Decrease in cost
Better quality of services
Development of a good brand image
Higher growth prospects
64. 1. JPNATC PROFILE http://www.jpnatc.com/
2. GTI INFOTEL PROFILE http://www.gtiinfotel.com/
3.U.S. Department of Veteran Affairs (VA);1985;VistA;
http://en.wikipedia.org/wiki/VistA
4. James. M. Walker, Eric J Bieber, Frank Richards, &
Sandra Buckley; Implementing an
Electronic Health Record System (Health
Informatics); Paperback- June 28, 2006
5.Jerome Carter; Electronic Health Records, Second
Edition; Paperback- March 15,2008
