Taranaki District Health Board will begin a pilot this month of a tablet-based system of electronic templates and forms to better enable data capture for its public health nurses.
Taranaki DHB is using the AMS mobile solution developed by NZ firm the Kinross Group and hosted in a Spark data centre to replace the heavy and burdensome paper files that public health nurses often have to lug around to schools.
Taranaki DHB IT project manager John Moodie said the trial would involve three different types of form involving about nine forms in total that will be accessible by nurses in the field. The nurses have chosen to use Samsung 8-inch tablets, which will also function as their phones and allow them to access their email, calendars and GPS.
If successful, there is the potential to roll it out to other health services such as the district nursing service.
The new application is based on AMS, a customisable data capture technology developed by the Kinross Group that sits on a server in the Spark data centre. The Taranaki DHB IT team can access the application through a web-based console that allows them to set up new users on mobile devices, view messages that have been sent by a device and to build customised templates that can be updated in real time if required.
The DHB's public health nurses use three different kinds of form, Mr Moodie said. One is what is called a direct through, or a form that is a one-off and just needs to be filled out and sent, such as a pregnancy test.
The second is a two-step form, which includes forms dealing with communicable diseases such as impetigo or scabies or with contraception, which require treatment or a co-sign from a doctor. These forms are not automatically routed back to the DHB's database but first to a doctor, who signs off on the form and it is then sent to the database.
The third is what Taranaki calls a 'running a record' form, which includes those for adolescent health records and public health nursing assessments which then require a follow-up appointment. Mr Moodie said his team had developed some extra functionality that can do a find a patient search to ensure demographic and NHI details are correct, and using this retrieve a patient's previous public health nursing summary.
His team has also developed a number of routing options using the system's template capabilities. One is an email template that has an inbuilt router, so if the nurse clicks on that option it will turn the data captured into a PDF and it can be sent to a particular recipient.
Another is an XML route in which data is sent to the AMS server, and then on to the DHB server for processing and inserted into a database from which the DHB can do reporting.
There is also a template that only contains demographics, part of a data quality improvement exercise that can be used to update details such as phone numbers on the device. If there has been a change then this triggers another email to be sent to an administration person to update the DHB's patient administration system.
The risk of patient misidentification in the field is minimised with what Mr Moodie calls a nifty bit of integration that requires the nurse to do a find a patient search based on name and date of birth that will bring up their demographic information and their NHI.
“We've taken things a step further so you can create a PDF and send it to a person, but one of the other routes that we have set up is that it basically sends a PDF wrapped in HL7 and that attaches a copy of the PDF to the patient's record in our webPAS system.,” Mr Moodie said.
“At the moment there is no visibility of any public health information for any child anywhere in our hospital.”
The forms and templates are completely customisable for the required need and because public health nurses are out in the field, the forms have as few text boxes as possible and mainly work off drop-down lists or multiple choice fields.
“They only have to click and it is nice and standardised,” Mr Moodie said. “The aim is to try and standardise as many of the fields as possible, to not have much writing but still have benefits in the reporting.”
While public health nurses are the first to try it out it would be similar arrangement for district nurses. Mr Moodie's team will assign a meta tag of 'public health' to a set of templates and to each nurse, and this will allow them to download and see only the forms that are relevant.
“You just download the app from the AMS website and you install it on your device. As a user you can open it with your username and password, which I have already set up through the front-end, and that will authenticate you through as a true user.
“Because I have assigned the meta tags to that person, when you click refresh it downloads all of the appropriate templates onto their device. Now they have all of those templates to use and if I want to make a change to a template, I can make that through the front-end console and let them know and they just have to refresh on their device.”
Mr Moodie's team gave the public health nursing team the choice of which device to use, and at the same time did a technical evaluation themselves. “Thankfully we both came up with the same one,” he said. “We're going down the Samsung tablet approach, it's approximately an 8-inch device.
“From a technical side we were interested in clarity of screens, what the images looked like, battery life, processing speed, durability and all of those things. For the nurses, the tablet will double as their phones, as there is no point in them carrying two devices.”
He said there were a number of key benefits the project is looking to achieve. For the nurses, it is a reduction in the amount of forms they have to carry around with them. At the moment they have to re-enter data captured on the paper forms into an Excel spreadsheet, which is not only time-consuming for the nurses but makes reporting almost impossible.
The DHB hopes to be able to do some in-depth reporting with the new and hopefully improved data, and will also save money on paper, photocopying and toner.
Mr Moodie said a production database was just about finished and the public health nurses had pretty much given final sign-off to the new forms. “We are about to have our final meeting next week to make sure everyone is hunky-dory and then we'll get the pilot nurses into a room and set the devices up specifically for them.”
It is possible to set up new routes if required – to GPs for example, although this isn't something Taranaki has explored as yet – but for the time being the ability to send information back to the PAS and to do a search on the patient is an achievement in itself, he said.
Other DHBs interested in adopting the technology are more than welcome. Taranaki DHB CIO Ngaio Crook said the collateral being developed can be shared and re-used by other DHBs and healthcare providers.
“If we had a number of DHBs using this technology who we could share and collaborate with, we would speed up what can be delivered to our clinicians across the country,” Ms Crook said.