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A Nurse-Operated PDA-Based Preventive Services Reminder System and Registry

A Nurse-Operated PDA-Based Preventive Services Reminder System and Registry. James W. Mold, M.D., M.P.H. Zsolt Nagykaldi, Ph.D. University of Oklahoma Health Sciences Center. Oklahoma Center for Family Medicine Research. In collaboration with Computer Risk Managers, Inc. Funding provided by:

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A Nurse-Operated PDA-Based Preventive Services Reminder System and Registry

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  1. A Nurse-Operated PDA-Based Preventive Services Reminder System and Registry James W. Mold, M.D., M.P.H. Zsolt Nagykaldi, Ph.D. University of Oklahoma Health Sciences Center

  2. Oklahoma Center for Family Medicine Research In collaboration with Computer Risk Managers, Inc. Funding provided by: • Oklahoma State Medical Association -Education and Research Foundation • OSMA – Physician’s Campaign for a Healthier Oklahoma • Oklahoma Health Care Authority • Agency for Healthcare Research and Quality

  3. Preventive Services Reminder System • Provides individualized reminders to office nurses regarding needed immunizations and other primary and secondary preventive measures (e.g. EPSDT, mammography) • Captures information on services provided as well as patient demographics, risk factors, contraindications, and prior services received, and stores it in a central registry

  4. Principles of Immunization Delivery in Private Practice • Physician must believe it’s important • Responsibility must be delegated to someone else (nurse) • Physician must provide ongoing oversight and reinforcement

  5. Features of the Preventive Services Reminder System • Physician requested (Oklahoma Physicians Resource/Research Network (OKPRN) • Nurse operated (PDA’s) • Printed report of services due and services provided for review by physician at time of visit

  6. Components • Central file server running SQL • Decision rules on the server and linkage programs written in Java • PDA running PenDragon Internet Forms • Local PC connected to the internet • Local printer with infrared port

  7. Work Flow • Nurse uses PDA to identify patients to be seen the next day (from list of patients stored in PDA); cradles the PDA and synchronizes it (1 minute) • Central registry/database receives information; generates a list of services needed by each patient • At visit, nurse records services given and updates risk factors, contraindications, and past services received; prints a report for the physician/chart • At the end of the day, synchronizes to download new information to registry

  8. Decision Rules • Determines whether patient is at risk for each of a set of preventable diseases (based upon age and risk factors) • If so, determines whether there are any contraindications to each of the preventive measure(s) related to that disease • If not, determines whether patient has received the preventive measure(s) within the recommended time frame

  9. Preventive Services Included • All common immunizations (child and adult) • EPSDT/WCC • Seat belts/bike helmets • Sun exposure advice • Smoking

  10. Preventive Services Included (cont.) • Pap smear • Cholesterol evaluation • Mammography • Colon cancer screening Note: Decision rules are based upon CDC (immunizations), USPSTF, PPP, and/or Oklahoma Medicaid (EPSDT)

  11. Immunization Information Captured • Type of vaccine • Product • Manufacturer • Lot number • Date given • Given by ______ Program uses pull-down menus and defaults *Slide added since handouts were printed

  12. Current Status • Initial test of efficacy favorable (nurses used it and it appeared to increase preventive services) • Ready for beta testing with 10 intervention and 10 control clinician-nurse teams – begins in November

  13. Linkage with Oklahoma State Department of Health’s OSIIS Registry • We are working with the Oklahoma State Department of Health to link and hopefully eventually merge the two registries • Plan to begin to test data exchange in November

  14. Advantages Over OSIIS • Quicker (we think) • Portable • Decision rules include risk factors and contraindications • Other preventive services included *Slide added since handouts were printed

  15. Planned Enhancements • Postcard reminder system • Interfaces with EMR’s • Card-sized CD for patients • More robust health risk appraisal functions *Slide added since handouts were printed

  16. CONTACT INFORMATION • james-mold@ouhsc.edu • zsolt-nagykaldi@ouhsc.edu • dean@higganbotham.com Jim Mold, M.D. 900 NE 10th St. OKC, OK 73104 405-271-2370

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