; _211H Clinical Flowsheets Application Overview_ VHA eHealth
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_211H Clinical Flowsheets Application Overview_ VHA eHealth


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									#211H Clinical Flowsheets Application
               Jeremy Ackley
                 Dan Petit
           Brian Juergensmeyer
             August 11, 2010
        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
                 Team Overview

 Clinical Flow Sheets, Medical Device Interfacing &
 Procedure Reporting
                                   • Brian Juergensmeyer – Developer
Project Team
                                   • Joe Niksich – Project Manager
• Dan Petit – Lead Developer       • Andrey Andreyevskiy - Developer
• Shirley Ackerman – Developer     • Beth Wodzinsky – SQA Lead
• Jeremy Ackley – Lead Analyst     • Tin Yong – ESM
• Mike Braithwaite - Sr. PM        • Richard Shew – Training Mgr.
• Rachel Wilder – Tech. Writer     • Shane Clark – SQA
• Debra Williamson - Impl. Mgr.    • John Service – SQA
• Charmaine Reznik – SQA           • Greg Spalding – Implementation
• Geoff Stevens - Implementation   • Will Sada - Analyst
               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)
 • Nihon Kohden
              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)
           Project Scope (cont.)

• The system will share data with
  –   Clinical Reminders Index
  –   Vitals Lite
  –   CPRS
  –   HDR
  –   3rd Party Vendors, COTS Products
           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
  – Provide ADT feed to minimize data re-entry
                 Project Scope (cont.)
                 - Recognizing the Need -
Yes, we use GE Marquette Medical Systems
Yes, we use Eclipse
Yes, we use Other Non VA CIS
Yes, we use Picis
No, we do not use a Non VA CIS but are considering using a Non VA CIS within the next fiscal year
Yes, we use CareVue
No, we do not use a Non VA CIS

                                  1.1% 4%        7%
                                                              19%                  35 ICUs

89 ICUs

                                                            Source: 2007 VA ICU Informatics Survey
          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
  – Deliver final product meeting business
    requirements, on the date established and within
    acceptable cost projections
           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
  – Offer automated process for paper-based VA ICU
  – 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
         Target Audience and
         Target Uses of the System

• Audience
– Nurses (primary)
– Physicians

• Settings
– ICU        – Mixed ICU
– SICU       – Step-down Units
– MICU       – Any clinical care setting with the
– CCU        appropriate terminology set can use
             flowsheet for data collection
        Project Accomplishments To-Date

• Project Planning
  – Project Management Plan
  – Work Groups
  – Project Advisory Board
  – Data Advisory Committee
• Software Requirements Specifications
• Development and Defect Fixes
• System Testing
          Project Accomplishments To-Date

• Usability Study for Flowsheets application and
  CP Console application
  –   Stage I, Hines VAMC
  –   Stage II, Charleston VAMC
• Preliminary/ Alpha Testing
  – Hines VAMC – GE Marquette bed-side monitors
• Beta Testing
  –   St. Louis
  –   Denver
  –   Charleston
  –   Lexington
  –   Pittsburgh
  –   Baltimore
          Future Project Milestones

• 08/2010
  – Complete Beta testing of Clinical Flowsheets System
  – Complete Operational Readiness Testing/Review
• 09/2010
  – Transition MD*1.0*16 to Enterprise Product Support
    (EPS) Team
• CY - 3Q/2010
  – Production implementation
  – Scope-out second release of Clinical Flowsheets
  – Prepare for interfacing with additional ICU instrument
         Terminology History

• Initially identified terms going over several
  paper flowsheets
  – From a variety of sites
  – Entered all data into spreadsheet
• Standards and Terminology Workgroup
  reviewed all data elements and their
  – 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

• Observations are the cornerstone of
• What is an observation?
  – A single observable measurement or
    assessment for a single patient at a specific
    • Usually quantifiable
    • Assessments may be simple or an in-depth
      analysis may be required (for scalar assignments)
          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
         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
        Components of an Observation 3

• Quality of Measurement
  – Actual, estimated
• Units of Measurement
  – cm, mm, kg, events per hour
        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.
          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
   – 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
                          System Overview - 2007

                                         User                                  VistA
                                                                           Local Instance

                                                                                                    Planned Migration
                                                                                                    Other applications i.e.,
                                                                                                    - CP User
                                                    CliO HL7 Receiver       CliO Engine             - Vitals
                                                                                                    - Vitals Lite
                                                                                                    - Hemodialysis
Monitor            Vendor CIS
                 Or Concentrator
                                                                               Clinical     - To view, edit, add clinical observations
                                                                             Application    - View, print reports

                                                                                            - To set-up Views, Flowsheets
                                                                             CP Console     - To set-up site specific parameters
    User              User                                                                  - To set-up Standard Reports
Set-up Patient     If CIS Verify             User

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


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