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

1. Informatics in Clinical Practice:
Designing and Implementing
an Electronic Record
Sheree East – Nurse Maude Association
Kay Poulsen – Help4U Ltd
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2. Project GAIN
community knowledge
evidence
understanding
meaning
inclusion
outcomes
getting access information now

4. What is community care?
Who does it benefit?
Why is it important?

5. How is it delivered?

6. 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

7. People’s lives are put at risk because of a lack of
shared information
We can change this
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8. an interoperable configurable platform
and a process of data collection that
mirrors current clinical work flows
recognisable
configurable
clinician-led
platform
interoperable
familiar
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9. “Start and Chart” methodology
meant that we weren’t changing usual practice
to suit a technical solution
but rather presented familiar formats based on
existing paper based documentation
but with all of the efficiencies and ease of use
that a computer delivers.
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10. Overview
Problem definition
Design Philosophy
Implementation Approach
Lessons Learned
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11. Canterbury IS: where we fit
Nurse Maude CCMS
OPH
e-SCRV view SPOE
Care CONCERTO
Coordination
General
Practice Pegasus
Pharmacy

12. Rachael Haldane, CNS
See associated video #1

13. Nursing in the EHR revolution
• Intelligent content
• Inclusive
• Evidence based
• Safe
• Ownership
• User engagement

14. Rachael Haldane, CNS
See associated video #2

15. Lighting the touchpaper…….
Need for residential care beds
Clinical documentation project
Desire to provide best practice
Earthquakes System to support care in home

16. 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 terminology
First 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

17. KNOWLEDGE
INFORMATION
EVIDENCE
INCLUSION

18. Knowledge, Meaning & Understanding
Community Activities Data Index (CADI)
Architected integrating SNOMED-CT & Omaha System
Prototype in Dynamics CRM
Fast charting – ‘start and chart’ - Mobile devices
Outcomes in standardised measurable terms
Plain language for patients and staff

19. The needs analysis, the solution design
and the prototype were largely
clinician (nurse)-led
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20. 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

25. *Behavior is significantly higher for TC (differences for
knowledge and status are not significant)
Comparison of Baseline
Knowledge, Behaviour, and Status Ratings
5
4.5
4 3.72
3.5 3.32
3.02 3.00 3.05
NPS
3 2.76
TC
2.5
2
1.5
1
Knowledge Behaviour Status

26. Baseline assessments for all problems:
Individual/Family/Community Level
232
Individual
34
70
Family
4
TC
NPS
5
Community
0
64
Missing
29
0 50 100 150 200 250

27. Lessons Learned
• Mobility
– fit for purpose hardware
• Electronic Progress Notes
– live in their world
• Nursing Workflow
– follow the flow

31. Progress Notes
How does a clinical team that relies on narrative
documentation and story telling move to structured
data 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
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32. The Importance of Flow
Clinicians want simple tools that follow their work
practice.
The electronic record needed to be designed to
support its use by clinicians in a way that it promotes
the natural flow of practice
We used SOAPE to inform the workflow
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33. References
Butler M, Treacy M, Scott A, Hyde A, Mac Neela P, Irving K, Byrne A, Drennan J. 2006 Towards a nursing
minimum 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 and
content. Journal of Gerontological Nursing.
Jacobsen, M.S., Juste, F. (2010) Information Technology: Nursing in the era of meaningful use. Nursing
Management 41, 1, pg. 11-13.
www.omahasystemguidelines.org
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34. Questions?
sheree@nursemaude.org.nz
kayp@help4u.co.nz
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