clinical data viewer - penn medicine data viewer...clinical data viewer what is it and how can it...

Clinical Data Viewer

What is it and How can it help?

Keri MartinLead Systems Analyst

Young-Shin Park RN, MSN, CNORNursing 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


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


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


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.


Flowsheet Implementations

Continuous Medicated Infusion Flowsheet

I & O Flowsheet

Vital Signs and Vital Signs-Critical Monitoring Flowsheets

Vent Flowsheet


Phased FlowsheetImplementation

Created Med and Surg CDV Profiles

ICU FS Go-Live

with CDV

(ICU profile)

2nd Unit Roll Out

with Device

Interface

FlowsheetPilot

1 Medicine Unit

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


Workflows

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.


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.


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


Clinical Data Viewer


New tab

Categories Profiles Timespan

CDV Functionality


Calendar

CDV Functionality


“Comments” icon

Tooltip icon

CDV Functionality


Hovering over the icon displays the full text

Double clicking the icon displays the comments

CDV Functionality


All truncated data displays full text

Observation Set names display

CDV Functionality


I&O Grand Totals

CDV Functionality


CDV Functionality


Active Meds

Micro Labs

More Info

Flyouts


Design Process

Allscripts

Clinical

Documentation

Team

Nursing

Informatics

Clinician

Feedback

Physician IT

Planning Committee

Design Group

Approval Group


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


Configuration Tools


Add/Remove Flowsheet


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.

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4

3

Create Profile/Manage Display


1. Select Create Profile/Manage Display.

2. Click Add/Remove Profile button.

3. Type the profile name in the “Enter

Profile Name:” field.

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2

3


4. Once the profile is named, click the Add Profile button.

4


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).

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6

7


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. Select the Additional Item Colors button to make additional custom

color selections.

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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.


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.

10

Assign Parameters to Profile Categories


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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2

3


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


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.

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6


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.


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.

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2

43

Assign Alternate Parameter Name/Sort Order


1. Select Assign Alternate Parameter

Name/Sort Order.

2. From the Choose Profile dropdown

menu, select the profile.

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1


Use the Alternate Name column to name the observations as

you would like them to appear on the front end.


Use the Alternate Sort column to assign a particular sort order on

the front end.

Assign SCM Security Groups To Profile


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.

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2

3


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

Backup/Restore Profiles


1. Select Backup/Restore Profiles.

2. Select a profile to backup from the

Choose Profile To Backup dropdown

menu.

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2

Clone Profile


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5

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.

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3

4

Enhanced CDV Functionality

Flyout

Original

D/C Obs

FS Comments

IO Totals display by default

Flyout placementEnhanced



Refresh Flyouts

24 Hr default

Meds Category

Show Sub Cat Refresh

Show Obs Set Refresh Timespan

48 Hr default

12 Hr option

Original

Enhanced



• 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



• 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


Staff Training

MDs: Overview at Dept. meetings

NPs: Group overviews

RNs: Classroom training

Training Materials: Instructions available on Nursing Informatics website

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.


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.


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.


• MaryAnn Connor RN

• Hyun Joo Lee RN

• Young-Shin Park RN

• Richard Donopria

• Keri Martin

• Mary Mitchell

• Jessica Stone

• Tamara Vullo

• Jackson Wan

• Laurie Williams

Team Members

• 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

• Janet Mak

• Wei Xiong

Nursing Informatics


Clinical Team

ClinDoc Team

Information Systems

Questions

&

Answers


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