Download Clinical Data Viewer What is it and How can it help?

Clinical Data Viewer
What is it and How can it help?
Keri Martin
Lead Systems Analyst
Young-Shin Park RN, MSN, CNOR
Nursing Clinical Analyst
All presenters have indicated they have no relevant financial relationships to disclose in regard to the content of this presentation.
Memorial Sloan-Kettering Cancer Center
Memorial Sloan-Kettering Cancer Center
Academic medical center focusing on cancer
treatment and research, located in NYC and Tri-state
region
Est. 1884 – The world's oldest
and largest private cancer center
470 Inpatient Beds
595,000 Outpatient Visits
19,000 Surgical Cases
11,400 Employees
2,000 Nursing Staff
Memorial Sloan-Kettering Cancer Center
Contents
Objectives
Flowsheet Implementations
Current Process and Challenges
Clinical Data Viewer (CDV) Overview
CDV Functionality
Design Process, Considerations and Configuration Tools
Staff Training
Outcomes
Lessons Learned
Next Steps
Memorial Sloan-Kettering Cancer Center
Objectives
Demonstrate the Clinical Data Viewer (CDV)
functionality to show how data maintained within
various areas of the application is pulled together into
one comprehensive view.
Demonstrate how config tools can be used to create
different profiles and the flexibility for selecting what
data to include and how it can be tailored to display on
the front end.
Highlight where MSKCC has worked with Allscripts to
customize various areas of Clinical Data Viewer.
Memorial Sloan-Kettering Cancer Center
Flowsheet Implementations
Continuous Medicated Infusion Flowsheet
I & O Flowsheet
Vital Signs and Vital Signs-Critical Monitoring Flowsheets
Vent Flowsheet
Flowsheet
Pilot
1 Medicine
Unit
2nd Unit Roll
Out
with Device
Interface
Memorial Sloan-Kettering Cancer Center
ICU FS GoLive
with CDV
(ICU profile)
Phased Flowsheet
Implementation
Created Med and
Surg CDV Profiles
Workflows
The pertinent data in SCM resides in various areas/tabs
within the application
 Flowsheet Tab:



Continuous Medicated Infusions, I&O
Vital Signs, Vital Signs – Critical Monitoring
Vent Flowsheets

Results Tab: Laboratory Data

Patient Info Tab: Allergies, Significant Events and
Health Issues

Task Viewer (eMAR): Active Medications
Memorial Sloan-Kettering Cancer Center
Challenges
Usability of flowsheet data: To display numerous data
elements from multiple flowsheets for review and trending.
 Requires multiple clicks to open each flowsheet
individually
Consolidation of clinical data: “One Stop Shopping”
All relevant clinical data can be reviewed in a central
location.
Time Management: Clinicians felt it was quicker to
review the data on paper then electronically.
Memorial Sloan-Kettering Cancer Center
Challenges
Customized “views”: Each clinical area is interested in
seeing different data elements relevant to their patient
population.
Graphing: No functionality in the Flowsheets tab to
select data from a variety of flowsheets and display
comprehensive data in one graphical view.
Printing: No system functionality to allow for data
elements captured in different areas of the application to
be printed as one concise report.
Memorial Sloan-Kettering Cancer Center
Clinical Data Viewer Overview
CDV is a new custom tab
CDV parameters can include data from:


Flowsheets (including I&O, Drips, Vital Signs)
Lab Results
CDV includes “Flyouts” for data such as:





Active Medications
Microbiology
Allergies
Significant Events
Health Issues
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Clinical Data Viewer
New tab
Categories
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Profiles
Timespan
CDV Functionality
Calendar
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CDV Functionality
“Comments” icon
Tooltip icon
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CDV Functionality
Double clicking
the icon displays
the comments
Hovering over
the icon displays
the full text
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CDV Functionality
Observation Set
names display
All truncated data
displays full text
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CDV Functionality
I&O Grand
Totals
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CDV Functionality
Memorial Sloan-Kettering Cancer Center
CDV Functionality
Memorial Sloan-Kettering Cancer Center
CDV Functionality
Memorial Sloan-Kettering Cancer Center
CDV Functionality
Active Meds
Micro Labs
More Info
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Flyouts
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Design Process
Allscripts
Clinical
Documentation
Team
Nursing
Informatics
Clinician
Feedback
Design Group
Approval Group
Memorial Sloan-Kettering Cancer Center
Physician IT
Planning Committee
Design Considerations
Profiles


User views (MD, RN)
Departmental views (Critical Care, Med, Surg)
Parameters to include:



Flowsheets (I&O, Vital Signs, Vent)
Drips
Labs
Categories


3 default categories (I&O, Drips, Labs)
Up to 9 custom categories
Color Preferences
Alternate Names and Sort Order
Timeframe Defaults
Memorial Sloan-Kettering Cancer Center
Configuration Tools
Memorial Sloan-Kettering Cancer Center
Add/Remove Flowsheet
1
2
3
4
1. Select Add/Remove Flowsheet.
2. Select a flowsheet from the “Select Flowsheet To Be Added”
dropdown.
3. Click the Add button.
4. Repeat for each flowsheet that has data elements to be included in
CDV.
Memorial Sloan-Kettering Cancer Center
Create Profile/Manage Display
1. Select Create Profile/Manage Display.
1
2. Click Add/Remove Profile button.
3. Type the profile name in the “Enter
Profile Name:” field.
2
3
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4
4. Once the profile is named, click the Add Profile button.
Memorial Sloan-Kettering Cancer Center
5
6
7
5. Select the newly created profile from the dropdown menu.
6. Click in the “CheckBoxLabel” field to name the custom categories. Up
to 9 custom categories can be defined.
7. Deselect any standard parameters not to be included (Drips, I&O,
Labs).
Memorial Sloan-Kettering Cancer Center
8
 In this example, the 1st custom category had been named “Vital Signs”.
8.
Custom color selections can be made as well.
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9
9. Select the Additional Item Colors button to make additional custom
color selections.
Memorial Sloan-Kettering Cancer Center
 The profile can be configured to have alternate row colors.
 For I&O, color selections can be made to distinguish between Intake,
Output, Net and Other parameters as well as the Shift, Daily and Grand
Totals columns.
Memorial Sloan-Kettering Cancer Center
10
10. Once all categories have been defined and color selections made, click
the Save button.
 Please note that selecting “Show All Labs” could cause a performance
impact on the front end when accessing the profiles in CDV.
Memorial Sloan-Kettering Cancer Center
Assign Parameters to Profile Categories
2
3
1
1. Select Assign Parameters to Profile Categories.
2. From the 1st dropdown, select either the Flowsheet or Lab category
that contain the parameters to be assigned to your profile.
3. From the 2nd dropdown, select the Profile to which those parameters
are being assigned.
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4. Before assigning any
parameters, be sure to click on
the slider bar of the Category that
you want these parameters to be
included in.
4
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5
5. Click on a parameter to select it.
 The control and shift keys can
be used to multi-select
parameters as well.
6. Once parameters are selected,
click the Add Parameters
button.
6
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 To remove a parameter, click on the
parameters to select them and then right
click. An option will appear to Remove
all Selected Items. Select this option to
remove the parameters.
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1
2
1. Continue with parameter assignment by
selecting the next Flowsheet/Lab Category.
2. Select the appropriate Category slider bar.
3. Once additional parameters have been
selected, use the Add Parameters button.
4. Click the Save button once parameter
assignments are complete.
3
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4
Assign Alternate Parameter Name/Sort Order
2
1
1. Select Assign Alternate Parameter
Name/Sort Order.
2. From the Choose Profile dropdown
menu, select the profile.
Memorial Sloan-Kettering Cancer Center
 Use the Alternate Name column to name the observations as
you would like them to appear on the front end.
Memorial Sloan-Kettering Cancer Center
 Use the Alternate Sort column to assign a particular sort order on
the front end.
Memorial Sloan-Kettering Cancer Center
Assign SCM Security Groups To Profile
2
1
3
1. Select Assign SCM Security Groups To Profile.
2. Select the profile from the Profile dropdown.
3. Select a security group from the Security Group dropdown.
Memorial Sloan-Kettering Cancer Center
4. Once a security group is
selected, click the Add Group to
Profile button.
 Continue with security group
selections until all appropriate
groups have been assigned.
4
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Backup/Restore Profiles
1. Select Backup/Restore Profiles.
2. Select a profile to backup from the
Choose Profile To Backup dropdown
menu.
1
2
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Clone Profile
1. Select Clone Profile.
2. Enter a new profile name in the “Enter
New Profile Name” field.
3. Select a profile to clone from the Select
Clone Source Profile dropdown menu.
4. Select the backup profile from the Select
Clone Source Backup dropdown menu.
5. Click the Clone New Profile button.
1
2
3
4
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5
Enhanced CDV Functionality
Original
Flyout
Flyout placement
Enhanced
D/C Obs
IO Totals display
by default
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FS Comments
Original
48 Hr default
Show Obs Set
Refresh Timespan
12 Hr option
Enhanced
24 Hr default
Meds
Category
Refresh
Flyouts
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Show
Sub Cat
Refresh
Enhanced CDV Functionality
• Default View:
▫ Include IO Totals
▫ New Meds default Category available
• Timespan:
▫ Default to 24 hours
▫ Add 12 hour option
• Rename buttons: user friendly name
• Discontinued observations display with gray background
• Include Comments entered on Flowsheet data cell
• Ability to navigate to Next/Previous patient
• Config: Ability to select I&O parameters
Memorial Sloan-Kettering Cancer Center
Enhanced CDV Functionality
• Active Meds Flyout:
▫
▫
▫
▫
Remove Auto Hide
Suppress Discharge meds
Show non-formulary drug names
Move PRN between Frequency and Route
• More Info Flyout:
▫ Suppress inactive Health Issues
• Flyout placement
▫ Move the flyouts to the left side of CDV
• Refresh Flyouts button
▫ Add a new button that allows for flyouts to be refreshed
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Staff Training
MDs: Overview at
Dept. meetings
NPs: Group
overviews
RNs: Classroom
training
Training Materials:
Instructions
available on Nursing
Informatics website
Memorial Sloan-Kettering Cancer Center
Outcomes
CDV facilitated flowsheet adoption for the providers.
CDV resulted in an increase in overall staff satisfaction
related to electronic flowsheet documentation.
CDV provides an enhanced, consolidated view of clinical
data.
CDV provided for meaningful use of an Electronic Health
Record.
Memorial Sloan-Kettering Cancer Center
Lessons Learned
CDV does not have an express load utility. Plan, plan,
plan your profiles so that you don’t have to make
iterative updates in all of your environments as it is a
manual process.
It is important to ensure that the flowsheets and the CDV
remain in synch so each time a config change is made to
a flowsheet, don’t forget about the corresponding CDV
updates.
Decide by committee. Make sure to have a central group
that will review and approve all enhancement requests.
TESTING! All enhancement requests are revisions to
the code.
Memorial Sloan-Kettering Cancer Center
Next Steps
Patient Stats Flyout – a new flyout available for
CDV.
Active Meds Flyout – additional columns being
added to allow for enhanced sorting.
Graphing functionality – currently being developed
by Allscripts.
Printing – under review as an enhancement as it is
being requested by many clinicians to enhance their
workflow.
Memorial Sloan-Kettering Cancer Center
Team Members
Nursing Informatics
• MaryAnn Connor RN
• Hyun Joo Lee RN
• Young-Shin Park RN
ClinDoc Team
•
•
•
•
•
•
•
Richard Donopria
Keri Martin
Mary Mitchell
Jessica Stone
Tamara Vullo
Jackson Wan
Laurie Williams
Memorial Sloan-Kettering Cancer Center
Clinical Team
•
•
•
•
•
•
•
•
•
David Artz MD
Kevin Browne RN
Mary Dowling RN
Neil Halpern MD
Joyce Kane RN
Douglas Levine MD
Monika Shah MD
Patricia Spellman RN
Holly Wallace RN
Information Systems
• Janet Mak
• Wei Xiong
Questions
&
Answers
Memorial Sloan-Kettering Cancer Center