Making our practice open and transparent: the potential of electronic data capture

Improving outcomes through community health research and development

Making our practice open and transparent: the potential of electronic data capture

NZICHC Director: Dr Chris Hendry RN, RM, BA, MPH, DM.


www.nzichc.org.nz

We are a NFP collaboration of clinician researchers (mainly nurses and midwives) who form research teams around specific projects with the aim of contributing to best practice and improved patient outcomes in community health care through the integration of education, research and clinical practice.


We are now in a phase of transparency by default.

Nurses are fast becoming the main contributors of data captured.

Who is interpreting the data?

Do we know how this data is being used?

1. Henke, Kelsey & Whately 2011.

Transparency - the most powerful driver of health improvement1.


The impact (and potential) of data transparency can be

categorised within the following six domains:

1. Accountability

2. Choice

3. Productivity

4. Care quality and clinical outcomes

5. Social innovation

6. Economic growth

Why should nurses and midwives be interested?


1. Accountability

Data is used in investigation and audit often by those removed from the

workplace. Sources include:

Staffing Systems based

− Trendcare .- Incident reporting

− Payroll - e-booking /scheduling systems

Client based - service feedback

− Diagnostics timing and results - telephone and computer timing

− E-referral - e-access to spaces and technology

− Admission data− Electronic health records

− Discharge data.

How or are nurses involved in making the

connections?


Hospital productivity becomes transparent – no hiding spare capacity.


2. Choice

Availability of comparative information enables choice.

Variation in performance is identified.

www.eldernet.org.nz reporting availability in ARC facilities last week,

54 of the 87 facilities listed vacancies.

Many facilities are now becoming more engaged in quality benchmarking activities.This added to the introduction of InterRAI within the ARC sector, will require nurses to have IT literacy as an expected competency.

What can nurses do to raise their profile?

Consumers are becoming more aware of quality expected.


3. Productivity

This has been a key focus for ‘re-engineering’ of service pathways.

Data is being used and interpreted in a way far removed from the initial

purpose…………..all information entered/recorded in an electronic form will be

used in variety of ways for variety of different purposes.



Nursing sensitive indicators are increasingly being used for benchmarking quality. Indicators include:

• urinary tract infections, • patient falls prevalence and injury,• skin pressure ulcers, • hospital acquired pneumonia,• deep vein thrombosis/pulmonary embolism,• wound infection• failure to rescue.

How are we monitoring these? Where does the data come from?

Is incident reporting accurate and timely? Could this data be extracted

from existing systems for nurses to monitor and benchmark?



Do you know what is being monitored?

How they are being monitored?

Where does the data come from? Are you involving yourself with these activities?





Will challenge old ways of working and rebalance relationships.



Innovations initiated and supported by the NZ Health IT Board

http://healthitboard.health.govt.nz/




6. Economic growth

Large sets of public data are becoming more available.

Provides potential to:• Develop new products and services

• Increase safety and efficiency of current services

• Spot disease trends

• Impact of population changes on health service needs

• Career development opportunities in health


6. Economic growthImmunisation Greater help for smokers to quit


Future health needs


Challenges for us: Prioritising

http://healthitboard.health.govt.nz/ The National Health Information Technology Board (NHITB) supports the Ministry of Health to improve the health of New Zealanders by providing trusted and secure integrated health information systems and IT solutions that enable the delivery of better and more convenient health care.

The Health IT Board has 2 nurse representatives among the 8 members.

The National Information Clinical Leaders Group also have nursing and midwifery representation.





Challenges for us: Active participation


Challenges for us: influencing IT developments

There are opportunities for nurses and midwives to become more informed

about IT developments.

Once informed then become involved in the action.There are real opportunities for nurses and midwives to

become involved in IT development…..after all we will likely be the main users!


Challenges for us: Terminology

Health information Standards Organisationhttp://

healthitboard.health.govt.nz/health-it-groups/health-information-standards-organisation-hiso

Standards have been developed in:• Mental health• Clinical documentation• Palliative care• Consumer health identity• Cancer core data set• Others

A standard is an agreed and repeatable way of describing something to achieve a common understanding.

http://healthitboard.health.govt.nz/health-it-groups/health-information-standards-organisation-hiso




Challenges for us: Documentation

For nursing and midwifery, documentation provides evidence of decision making, action taken and the impact/effectiveness of the actions.

We know what we do, how and why we do it.We need to make that understood by others, visible and

measurable….… or it does not count.


Challenges for us: Data quality

http://www.google.co.nz/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCM7-vv2AwcgCFcRdpgodUZsAdg&url=http://www.bicoastaltechnologies.com/branding.html&psig=AFQjCNE2XSYTcOF2iJ3jCW2aU3NhWiRhDw&ust=1444879293591282


Take control of your own data:ending with a story from practice

The big question:What is the value of the Nurse Specialist role?

DON response was to request data from the nurses (87 of them) on their activities over the past 12 months to develop a picture of their contributions.

Action: Work with the NS to identify indicators based on the 6 domains of advanced nursing practice (Mick/Strong Model).

There was very little transparency and in some cases no e-data at all.


Take control of your own data:A story from practice

Domains of advanced nursing practice

2 workshops and e-communication refined the indicators.

The new version of Trendcare contains a Nurse Specialist module that will then be used to trial provision of data on NS contribution to the service.

1. Provision of direct comprehensive care.2. Involvement in support systems.3. Research4. Education5. Publication and professional leadership


Any questions?

Interested in being involved and/or involving us in any projects?

[email protected]

www.nzichc.org.nz

Thank you for listening.

mailto:[email protected]

http://www.nzichc.org.nz/

Healthcare

Making our practice open and transparent: the potential of electronic data capture