Attention Viewer,

1
Introduction

• Attention Viewer,
• Thank you for taking the time to view this
  presentation. It is automated, meaning it will
  play by itself, and it has an audio track, so
  you need speakers.
• The ideas conveyed here support a poster
  presented at the NANDA-I conference in Miami on
  November 13, 2008.
• contact Hank Amundsen 218-724-4262
• hanque_at_hotmail.com

2
Terms

• Electronic Health Record EHR
• Hypothetical EHR brand BedPoint
• Hypothetical Cardiac Unit CU

3
Nurses need help with EHRs

• Encourage collaboration among nurses for
  information hand off by better documenting the
  patient bedside "activities" that are not
  specific to the EHR.
• Provide a knowledge base (KB) that accumulates
  key phrases that local nursing units use to build
  a vocabulary.
• Automate the work assignment scheduling in one
  unit as a first project.

4
Original Assumptions No Longer Valid

• EHR installation is the dominant system for
  clinical information but does not contain 100
  of information needed.
• Nurses need a layer that helps to organize work
  flow, those items that they track personally.

5
Where We Want to Go

• Implementation of a self-sponsored work
  assignment process for nurses.
• Make sure that an adjunct process will complement
  the existing EHR.
• Get quick results by fixing a broken application.

6
How do we get there?

• Run a proactive familiarity of concepts
  campaign to get nurses more familiar with the
  EHR.
• Populate a KB with nursing terminology, policy
  statements, and procedural references to help
  nurses get work done.

7
Environmental Assessment

• 12 Registered Nurses (RN) were surveyed to
  determine what information they would want on a
  pre-printed assignment sheet.
• Many RNs have designed their own brain sheets
  for self-qualifying their patients assessment
  information.

8
Many different ways of reporting patients
current assessment
Michaels form
Kathys form
9
Many different ways of reporting patients
current assessment
Pats form.
Margarets form.
10
Many different ways of reporting patients
current assessment
Clares form.
(back side)
11
Comments of Interest
Heart sounds, Rhythms(18) Pulses, Pedal pulses
(16) IV fluids (10) Tube feeding(12) Vital
signs(10) Procedure/Test coming (9) Admit
Diagnosis(3) Dx(1) Diagnosis(2) diagnosis
"this time"(1) update of surgeries/plasties
etc(1) Current vs (just most recent) (maybe
just 1)(1)9 Blood sugar(5) Abnormal labs(4)9
Pain, last med by name, time given(7) Meds just
show the and category by time(1)8DNR
status7Input/Output(3) Output(4)7Bowel
Sounds(5) GI / GU(1)6 Activity out of bed5 Wound
Care 5 Lung Sounds(5) Doctor(s)5Age4Admit
date4Pertinent History(3) Assessments(4) Diet(3)
Diet "NPO"(4) Angio instructions HOB up?,
walk?(1) Groin site report (4) Pt. Name(3) New
Orders (3) Edema present(3) Transfers with how
many people and how well (2) If confused or
impulsive - I want to know (1) neurological
considerations (2) Allergies (2) Miscellaneous
"whatever (2) To do(1) cares (2) Nickname
(2) L/hr rate (1) Date of admission1team
mate(s)1CV1
12
What New Features to Offer

• Standardized daily assignment sheets.
• Ad hoc Accucheck, Daily Weight and Diet slips.
• Policy Indexing and Terminology Searching.
• Current Staff Assignments Dashboard.

13
Phase I (May 2008)

• Key users to assist in KB start-up (such as RNs
  to serve on vocabulary committee).
• Address legal issues of private health
  information.
• Set up functional processes (including vocabulary
  and procedural references. )
• Allocate resources (minimum .3 FTE, PC, desk).

14
Phase II (August 2008)

• Move current Policy Procedures in.
• Marketing and public relations stunts.
• Recruit medical advisory board.
• Seek members, sponsors and grants.
• Seek moderators to host subgroups (based upon
  findings of needs assessment).

15
Phase III (2009)

• Spin off subgroups.
• Add peer reviewed content.
• Add interactive programs ( newsletter, message
  boards, chat, blogs, and informal surveys)
• Form alliances with strategic partners and
  sponsors.
• Set standards for national nursing vernaculars.
• Build foundation of revenues through licensing,
  memberships, sponsorships and grants.
• Continue to monitor costs and examine capacity to
  deliver a larger program

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Beta Version is Ready!
Beta site under development
17
References

• Tapscott, D.and Williams, A., (2007). Wikinomics
  How mass collaboration changes everything. NY
  Penguin Group
• Jennings, M., (2000). Health Care Strategy for
  Uncertain Times. Chicago Jossey-Bass