# Presentation: 458983

## #171 Clinical Flowsheets Application Overview

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

## 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

- Project

- Clinical Flow Sheets, Medical Device Interfacing & Procedure Reporting

- Project Team

-   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

-   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

**Notes:**
Anne Rega

## 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

## 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)

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

-   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
Interface with Care Fusion hand-held devices   (e.g., Code Blue)
 Provide ADT feed to minimize data re-entry

- 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

- Project Scope (cont.)

**Notes:**
Reporting functionality (standard: End of Shift, Transfer, PMI) and custom. 

## Project Scope (cont.)- Recognizing the Need - 

- Source: 2007 VA ICU Informatics Survey

**89 ICUs**

**35 ICUs**

## 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

## 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

- 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

- Project Objectives and Business Benefits

**Notes:**
Data standardization – Jeremy will touch on

## Target Audience and Target Uses of the System

-  Physicians

- Target Audience and Target Uses of the System

-  ICU
-  SICU
-  MICU
-  CCU

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

-   Settings

-   Audience

## 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

**Notes:**
Development: Reporting functionality, role based privelages, abnormal range alerts, nursing care actions, ADT interface

## Usability Study for Flowsheets applicationand 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

-  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

- Project Accomplishments To-date

## Future Project Milestones

**12/14/2007**
- Complete defect fixes
- Complete Beta testing of Clinical Flowsheets System
**12/31/2007**
- Transition MD*1.0*16 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

## 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 (CAC’s, Nurse Managers, Nurses, etc.)
- Have met regularly for over 2 years now

## 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)

## 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 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

## System Overview - 2007

## 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

## Q/A

- Questions