minnesota tiger summit: together we can do it… june 16, 2010 northland inn – brooklyn park, mn...
TRANSCRIPT
Minnesota TIGER Summit:Together We Can Do IT…
June 16, 2010Northland Inn – Brooklyn Park, MN
1:00 pm - 5:00 pm
Meaningful Use of the Omaha System
for Program Evaluation in Public Health Nursing
Vision: Evidence-based Program Evaluation• CHS Administrators envisioned using electronic
health records to gather data for program evaluation, starting in the 1990’s
• 3 software programs adopted in CHS agencies – CareFacts– CHAMP– PH DOC
• Common denominator: the Omaha System
Minnesota Omaha System Users Group
• By 2000, 87% of counties in Minnesota had a public or private agency using one of the 3 software systems
• Users began to recognize the potential to work together
• Minnesota Omaha System Users Group started in 2001, led by state and county public health nurses
• omahasystemmn.org
Diverse Stakeholders
• Over 200 participants – state and local public health– private home care & hospice– Universities (faculty & students)– Software industry– Metro, central MN, southeastern MN– Wisconsin– Washington State
Diverse Programs
• Using the Omaha System to support programs – Family home visiting– Disease prevention and control– Waiver programs– Home care– Hospice– Healthy Communities
Results
• Grass roots collaboration– Internationally recognized leaders– Documentation and practice quality– Dissemination of tools – Two scientific publications– A national American Public Health Association
award– International visitors
Panelists/Topics
• Overview– Karen Monsen, PhD, RN, University of Minnesota
School of Nursing, [email protected]• Implementation
– Katie Halder, MS, RN, PHN, Douglas County Public Health [email protected]
• Quality– Jill Timm, JD, RN, PHN, Program Manager, Maternal Child
Health, Washington County Department of Public Health & Environment, [email protected]
• Using Data– Diane Thorson, MS, RN, PHN, Director/CHS Administrator, Otter
Tail County Public Health, [email protected]
Software
• Learning curve for implementation– Computer literacy– Unique attributes of each program– Always adapting and changing– Gets easier with time and software
improvements
The Omaha System
• Learning curve for the Omaha System– The Omaha System is the standardized
language within the software – Provides structure
• Client assessments• Client outcomes• Practitioner interventions
Mysteries
• Learning curve for both software and terminology– What is a software mystery?
• Have a great relationship with vendors to solve these• Examples: Entering dailies and Omaha Interventions
– What is an Omaha System terminology mystery?• Use Omaha System resources to solve these
– Book
– Web sites
– Meetings
Efficiencies
• Documentation efficiency– Keeps improving– Initial charting time
Outcomes
• For all 3 software programs, it is the Omaha System that allows us to work together, describe our practice, and show our outcomes
• Software implementation needs to include Omaha System training and support
Quality
• Vision to use data to demonstrate outcomes relies on having quality data
• Omaha System users share this vision and have developed tools– Manuals– Pathways– KBS rating guides
Manuals
• Supporting documentation efficiency and quality– Provided by vendors– Adapted & edited by local agencies– Updated periodically to reflect changes– Utilized during orientation and early use of an
electronic documentation system
Pathways
• Started in 2001 to describe practice – Helped with documentation efficiency and
convenience– MOSUG pathways web page – Now developing evidence-based, peer
reviewed pathways
Inter-rater Reliability
• Started in 2002 in Ramsey County– Based on the information in the Omaha
System book– Expanded definitions for improved accuracy– Revised every 1-2 years– This summer’s revision will include
Washington State Omaha System users
Commitment
• See the results transforming practice– Knowing standards of care– Incorporating evidence into practice– Valuing reliability and avoiding bias– Confidence in the quality of our programs as
well as our data
Otter Tail County Program Evaluation
• Nurse-Family Partnership evaluation
• Otter Tail County uses the PHDOC software program
• Omaha System data
• Can analyze Problems, Signs and Symptoms, Targets, and Knowledge, Behavior, and Status outcomes
The Future of Omaha System Program Evaluation
• LTBI
• Breastfeeding
• Obesity
• Early Childhood Screening
• MSHO
Challenges
• Assessment forms required with other programs do not match with the Omaha System
• Working with other agencies and state officials to resolve issues in data collection
• Starting to see the benefits of using standards (meaningful use of data)
Nurse-Family Partnership
• Serves high risk pregnant women and children ages 0-2
• Program has been carefully tested
• Omaha System pathways will support our nurses
• Omaha System outcomes will allow us to evaluate our local program and results
Developing Standards of Care
• Surveillance/Assess: Signs/Symptoms Physical: pregnancy discomforts, danger signs…
• Teaching: Anatomy/Physiology: prenatal classes, childbirth preparation
• Case Management: other community resources such as Quit Line, WIC
Looking at the NFP data
• Most Frequent Problems were Pregnancy and role Change
• Most Frequent Signs/Symptoms were low income, loss of previous role, and difficulty with prenatal exercise/rest/diet/behaviors
• Most Frequent Category is Teaching
• Most Frequent Targets are signs/symptoms and feeding procedures
Outcomes Evaluation
• KBS rating data
80.1380.1380.38Role Change
100.310-0.11101.1Pregnancy
ClientsAv ChgClientsAv ChgClientsAv ChgOmaha System Problem
StatusBehaviorKnowledgeKBS Ratings
Thank you! Questions?