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Informatics in Clinical Practice: Designing and Implementing an Electronic Record

Sheree East
Nurse Maude Association
(Friday, 9.35am, Sigma Room)
Associated video #1 is
Associated video #2 is

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Informatics in Clinical Practice: Designing and Implementing an Electronic Record

  1. 1. Informatics in Clinical Practice: Designing and Implementing an Electronic Record Sheree East – Nurse Maude Association Kay Poulsen – Help4U Ltd 1
  2. 2. Project GAIN community knowledge evidence understanding meaning inclusion outcomesgetting access information now
  3. 3. What is community care?Who does it benefit? Why is it important?
  4. 4. How is it delivered?
  5. 5. The journey so far: HINZ presentations• 2009• Changing the Way Nurses and Allied Health Professionals Document Care• 2010• Developing a community care dataset for structuring clinical documentation.• 2011• Implementation of a community care dataset in an electronic clinical record• 2012• Pilot implementation of electronic record needs analysis prototype done done solution design done now we have done a trial implementation – this is what we are talking about
  6. 6. People’s lives are put at risk because of a lack of shared information We can change this 7
  7. 7. an interoperable configurable platformand a process of data collection thatmirrors current clinical work flows recognisable configurable clinician-led platforminteroperable familiar 8
  8. 8. “Start and Chart” methodologymeant that we weren’t changing usual practice to suit a technical solutionbut rather presented familiar formats based on existing paper based documentation but with all of the efficiencies and ease of use that a computer delivers. 9
  9. 9. OverviewProblem definitionDesign PhilosophyImplementation ApproachLessons Learned 10
  10. 10. Canterbury IS: where we fitNurse Maude CCMS OPH e-SCRV view SPOE Care CONCERTO Coordination General Practice Pegasus Pharmacy
  11. 11. Rachael Haldane, CNSSee associated video #1
  12. 12. Nursing in the EHR revolution• Intelligent content• Inclusive• Evidence based• Safe• Ownership• User engagement
  13. 13. Rachael Haldane, CNSSee associated video #2
  14. 14. Lighting the touchpaper……. Need for residential care bedsClinical documentation project Desire to provide best practice Earthquakes System to support care in home
  15. 15. Requirements Integrated 12 clinical assessment tools appointments, consumables, provi ders, support New devices New IT platform Omaha System terminology for outcomes-based evaluation Structured progress notes New terminologyFirst fully electronic process Care planning forms with integrated intervention-based coding Comprehensive structured nursing assessment (limited free text) New service / model of care New team 4 week implementation deadline
  16. 16. KNOWLEDGEINFORMATION EVIDENCE INCLUSION
  17. 17. Knowledge, Meaning & UnderstandingCommunity Activities Data Index (CADI)Architected integrating SNOMED-CT & Omaha SystemPrototype in Dynamics CRMFast charting – ‘start and chart’ - Mobile devicesOutcomes in standardised measurable termsPlain language for patients and staff
  18. 18. The needs analysis, the solution design and the prototype were largely clinician (nurse)-led 19
  19. 19. Outcomes• 18 month + in use• Fully paper-less service• Very limited training required• Admin user runs reports & manages L1 issues• Nurses manage appointments, consumables, referrals• Electronic charting on mobile devices• Comprehensive reporting: client profile, inputs, clinical outcomes and service quality indicators
  20. 20. *Behavior is significantly higher for TC (differences for knowledge and status are not significant) Comparison of Baseline Knowledge, Behaviour, and Status Ratings 54.5 4 3.723.5 3.32 3.02 3.00 3.05 NPS 3 2.76 TC2.5 21.5 1 Knowledge Behaviour Status
  21. 21. Baseline assessments for all problems:Individual/Family/Community Level 232 Individual 34 70 Family 4 TC NPS 5Community 0 64 Missing 29 0 50 100 150 200 250
  22. 22. Lessons Learned• Mobility – fit for purpose hardware• Electronic Progress Notes – live in their world• Nursing Workflow – follow the flow
  23. 23. Progress NotesHow does a clinical team that relies on narrativedocumentation and story telling move to structureddata collection?• Allow for Free Text (apply limits)• Accept that some information will not be captured• Ensure the data structure captures the important stuff• Reduction in narrative will happen as users learn to trust the electronic record 31
  24. 24. The Importance of FlowClinicians want simple tools that follow their workpractice.The electronic record needed to be designed tosupport its use by clinicians in a way that it promotesthe natural flow of practice We used SOAPE to inform the workflow 32
  25. 25. ReferencesButler M, Treacy M, Scott A, Hyde A, Mac Neela P, Irving K, Byrne A, Drennan J. 2006 Towards a nursingminimum data set for Ireland: making Irish nursing visible. J Adv Nurs. Aug;55(3):364-75.Monsen, K.A., Westra, B.L., Paitich, N., Ekstrom, D., Mehle, S.C., Kaeding, M., Abdo, S., Natarajan, G., &Ruddarraju, U. (2012) Developing a shared personal health record for elders and providers: Technology andcontent. Journal of Gerontological Nursing.Jacobsen, M.S., Juste, F. (2010) Information Technology: Nursing in the era of meaningful use. NursingManagement 41, 1, pg. 11-13.www.omahasystemguidelines.org 33
  26. 26. Questions? sheree@nursemaude.org.nz kayp@help4u.co.nz 34

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