clinical connectivity system defined. clinical flowsheets a

1
171 Clinical Flowsheets Application Overview

• Faculty
• Jeremy Ackley
• Paul Jurevicius
• Dan Petit
• August 21, 2007

2
Class Agenda

• Team Overview
• Project Scope
• Project Objectives Business Benefits
• Target Audience Target Uses of the System
• Accomplishments To-date
• Future Project Milestones
• System Overview
• Terminology
• Demo Screenshots of Clinical Flowsheets
  Application
• Q/A

3
Team Overview
Project
Clinical Flow Sheets, Medical Device Interfacing
Procedure Reporting

• Project Team

• Brian Juergensmeyer Developer
• Paul Jurevicius Project Lead
• Chad Peterson Interface Specialist
• Dan Petit Lead Developer
• Jeff Sartori ESM
• Richard Shew Training Mgr.
• Frank Traxler Developer

• Bill Ackerman Interface Specialist
• Shirley Ackerman Developer
• Jeremy Ackley Lead Analyst
• Mike Braithwaite - Sr. PM
• Al Bustamante Tech. Writer
• Charles Cadwallader - Impl. Mgr.
• Al Cardilli SQA

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Project Scope
To provide a secure system that allows for
interfacing and collection of patient information
from variety of sources in a clinical setting.
To provide a means for data from various vendor
systems to be placed into the patient Electronic
Health Record (EHR) in VistA. To allow
subsequent data entry, viewing and storage of the
data in VistA using any VHA networked
workstation.

• Supported clinical instrument vendors will
  include
• GE (Jan. 2008)
• Spacelabs (Jan. 2008)
• Phillips Intellivue (TBD)
• PICIS
• Philips CareVue Chart

• CareFusion
• Clinicomp
• Nihon Kohden
• Eclypsis

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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)

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Project Scope (cont.)

• The system will share data with
• Clinical Reminders Index
• Vitals Lite
• CPRS
• HDR
• 3rd Party Vendors, COTS Products

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Project Scope (cont.)

• 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

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Project Scope (cont.)- Recognizing the Need -
35 ICUs
89 ICUs
Source 2007 VA ICU Informatics Survey
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Project Objectives and Business Benefits

• Project Objectives
• Plan, design, develop, test and deploy the
  Clinical Connectivity System
• Manage the project using approved development
  system lifecycle process
• Meet the requirements of the BCEP team
• Deliver final product meeting business
  requirements, on the date established and within
  acceptable cost projections

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Project Objectives and Business Benefits

• 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

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Target Audience and Target Uses of the System

• Audience

• Nurses (primary)
• Physicians

• Settings

• Mixed ICU
• Step-down Units
• Any clinical care setting with the appropriate
  terminology set can use flowsheet for data
  collection

• ICU
• SICU
• MICU
• CCU

12
Project Accomplishments To-date

• Project Planning
• Project Management Plan
• Work Groups
• Project Advisory Board
• Data Advisory Committee
• Software Requirements Specifications Baselined
• Development and Defect Fixes
• System Testing

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Project Accomplishments To-date

• 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

14
Future Project Milestones

• 12/14/2007
• Complete defect fixes
• Complete Beta testing of Clinical Flowsheets
  System
• 12/31/2007
• Transition MD1.016 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

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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 (CACs,
  Nurse Managers, Nurses, etc.)
• Have met regularly for over 2 years now

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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)

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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

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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

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Components of an Observation 3

• Quality of Measurement
• Actual, estimated
• Units of Measurement
• cm, mm, kg, events per hour

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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.

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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

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System Overview - 2007
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CP Console
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View Designer
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Column Definition
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View as Flowsheet
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View as Input
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Observation Display
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Audit Warning
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Correction Screen
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Flowsheet with Correction
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Date Range Selector
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Viewing Log Files (Verified)
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Viewing Log Files (Corrected)
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Another View
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HL7 Monitor
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HL7 Patient Match
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HL7 Instrument Match
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HL7 Message Viewer
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Q/A

• Questions