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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 Memorial Sloan-Kettering Cancer Center Clinical Data Viewer New tab Categories Memorial Sloan-Kettering Cancer Center Profiles Timespan CDV Functionality Calendar Memorial Sloan-Kettering Cancer Center CDV Functionality “Comments” icon Tooltip icon Memorial Sloan-Kettering Cancer Center CDV Functionality Double clicking the icon displays the comments Hovering over the icon displays the full text Memorial Sloan-Kettering Cancer Center CDV Functionality Observation Set names display All truncated data displays full text Memorial Sloan-Kettering Cancer Center CDV Functionality I&O Grand Totals Memorial Sloan-Kettering Cancer Center 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 Memorial Sloan-Kettering Cancer Center Flyouts Memorial Sloan-Kettering Cancer Center 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 Memorial Sloan-Kettering Cancer Center 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. Memorial Sloan-Kettering Cancer Center 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. Memorial Sloan-Kettering Cancer Center 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 Memorial Sloan-Kettering Cancer Center 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 Memorial Sloan-Kettering Cancer Center 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. Memorial Sloan-Kettering Cancer Center 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 Memorial Sloan-Kettering Cancer Center 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 Memorial Sloan-Kettering Cancer Center Backup/Restore Profiles 1. Select Backup/Restore Profiles. 2. Select a profile to backup from the Choose Profile To Backup dropdown menu. 1 2 Memorial Sloan-Kettering Cancer Center 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 Memorial Sloan-Kettering Cancer Center 5 Enhanced CDV Functionality Original Flyout Flyout placement Enhanced D/C Obs IO Totals display by default Memorial Sloan-Kettering Cancer Center FS Comments Original 48 Hr default Show Obs Set Refresh Timespan 12 Hr option Enhanced 24 Hr default Meds Category Refresh Flyouts Memorial Sloan-Kettering Cancer Center 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 Memorial Sloan-Kettering Cancer Center 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