171 Clinical Flowsheets Application Overview

1. #171 Clinical Flowsheets Application Overview Faculty Jeremy Ackley Paul Jurevicius Dan Petit August 21, 2007

2. 2

3. 3 Team Overview Anne RegaAnne Rega

4. 4 Project Scope

5. 5 Project Scope (cont.) Clinical Connectivity system defined Clinical Flowsheets Application (User Interface) Clinical Console Application (Administrator User Interface) CliO Back-end Service (System Framework) CP Gateway (HL7 Message Processing) ICU Instruments, CIS (HL7 Interface)

6. 6 The system will share data with Clinical Reminders Index Vitals Lite CPRS HDR 3rd Party Vendors, COTS Products Project Scope (cont.)

7. 7 The system will Provide a common interface with variety of instruments in a clinical setting Allow secure access to ICU patient data from any networked VA workstation Provide a customizable, flowsheet-based user interface to enter, view, edit patient data Provide reporting functionality Interface with Care Fusion hand-held devices (e.g., Code Blue) Provide ADT feed to minimize data re-entry Project Scope (cont.) Reporting functionality (standard: End of Shift, Transfer, PMI) and custom. Reporting functionality (standard: End of Shift, Transfer, PMI) and custom.

8. 8 Project Scope (cont.)- Recognizing the Need -

9. 9 Project Objectives and Business Benefits

10. 10 Business Benefits Provide mechanism for data standardization for internal and external systems Link disparate vendor ICU systems to VistA Allow observed data to be stored in VA central database Offer automated process for paper-based VA ICU sites Allow observed data to be viewed, edited, analyzed over an unlimited time-span Provide improved data security Provide user friendly access to data Reduce errors in manual data entry Promote efficient, safe clinical decisions and care Project Objectives and Business Benefits Data standardization � Jeremy will touch onData standardization � Jeremy will touch on

11. 11 Target Audience and Target Uses of the System

12. 12 Project Accomplishments To-date Development: Reporting functionality, role based privelages, abnormal range alerts, nursing care actions, ADT interfaceDevelopment: Reporting functionality, role based privelages, abnormal range alerts, nursing care actions, ADT interface

13. 13 Usability Study for Flowsheets applicationand CP Console application Stage I, Hines VAMC Stage II, Charleston VAMC Preliminary/ Alpha Testing Charleston VAMC - Spacelabs bed-side monitors Fayetteville VAMC - Philips Intellivue bed-side monitors Hines VAMC � GE Marquette bed-side monitors Beta Testing St. Louis Denver West Palm Beach Project Accomplishments To-date

14. 14 Future Project Milestones 12/14/2007 Complete defect fixes Complete Beta testing of Clinical Flowsheets System 12/31/2007 Transition MD*1.0*16 to Enterprise Product Support (EPS) Team CY - 1Q/2008 Production implementation Scope-out second release of Clinical Flowsheets application Prepare for interfacing with additional ICU instrument vendors

15. 15 Terminology History Initially identified terms going over several paper flowsheets From a variety of sites Entered all data into spreadsheet Data Advisory Committee reviewed all data elements and their attributes Committee members from all over the nation Hold a variety of different positions (CAC�s, Nurse Managers, Nurses, etc.) Have met regularly for over 2 years now

16. 16 Terminology Observations are the cornerstone of terminology What is an observation? A single observable measurement or assessment for a single patient at a specific time Usually quantifiable Assessments may be simple or an in-depth analysis may be required (for scalar assignments)

17. 17 Components of an Observation 1 Observation Name Description of the observation being taken Abbreviation Help Text for the observation Value Type Length, Width etc. for unit conversions Data Type Complex, Pick List, Numeric, Boolean, String

18. 18 Components of an Observation 2 Anatomical Location Body Position Laying, standing, sitting, etc. Method of Observation Example: heart rate; apical, carotid, Art. Line Product Juice, blood, water

19. 19 Components of an Observation 3 Quality of Measurement Actual, estimated Units of Measurement cm, mm, kg, events per hour

20. 20 VUID Based VA Unique Identifiers (VUIDs) Integers associated with terminology elements such as concepts, expressions, etc. Generated by and used as a Primary Key for Enterprise Reference Terminology (ERT) and Standard Data Services (SDS). Used to uniquely identify a medical concept or expression independently of application, user interface contexts or VHA site.

21. 21 Next Steps Working with STS to get standardized terms through VA Data Standardization Process Working in concert with STS to ensure terminology compatibility for later data standardization Continue to identify observations Working with various assessment Scales/Scoring systems Braden, Glascow Coma, etc. Mapping to SNOMED-CT terminology system Mapping existing terms into CP Gateway Mapping Tables and Views to further test the application

22. 22 System Overview - 2007

23. 23 CP Console

24. 24 View Designer

25. 25 Column Definition

26. 26 View as Flowsheet

27. 27 View as Input

28. 28 Observation Display

29. 29 Audit Warning

30. 30 Correction Screen

31. 31 Flowsheet with Correction

32. 32 Date Range Selector

33. 33 Viewing Log Files (Verified)

34. 34 Viewing Log Files (Corrected)

35. 35 Another View

36. 36 HL7 Monitor

37. 37 HL7 Patient Match

38. 38 HL7 Instrument Match

39. 39 HL7 Message Viewer

40. 40 Q/A Questions