Project: Improve Code and Documentation for the EHR system

@elizabeth, use this topic for all discussion about your project on the forums

@rhoyt Our intern Elizabeth is working on your project and had a couple of questions.

I have started with the process of adding the Nursing Assessment forms here Administration -> Other -> forms . I have not created the table for data storage yet because we have not agreed on how to implement the data store that is, if we are using another table for it.

I was thinking, If a patient gets to stay in the hospital for say a week, how many encounters will the patient have? It could be one or many depending on whether for every rounds nurses make in a day to check on patient is considered an encounter. If this is the case, we can walk around the issue of data duplication for the vitals form by having the nurse fill out the default vitals form, then the detailed vitals form found in the Nursing Assessment, having fields already filled grayed out. Now, any ‘view’ wishing to display vitals data for a particular encounter will then have to read the data from the two tables in order to have the complete readings that were taken. But if it is one encounter per stay in the hospital it might be difficult to track this data.

My response was:

I think each round a nurse makes is an encounter. In this case it should be okay to have data duplication because we are monitoring each new encounter. Then we can track all encounter data.

We just need to know if this logic is correct.

@KoniKodes @htuck

With most nurses now working 12-hour shifts, I anticipate one encounter per shift of two per day. Most patients are in the hospital for only about 4 days. Those are average numbers so the encounters will have duplicate information. I have often wondered why US nurses could not use a template with checkboxes and free text for each encounter. Let me know if you would like for me to ask an RN PhD friend at UMN

Thank you so much. I will let her know. If you don’t mind asking, it would be appreciated. All information to help us make this work is great.

@KoniKodes

I guess the other difficult question is whether nurses can use an ambulatory EHR for an inpatient experience??? In other words, nurses write their notes at the end of a shift in the hospital. LibreHealth is clearly an outpatient or ambulatory EHR. I can bounce this off the nurse specialist

@rhoyt Yes, that is an important question. I’m not that well-versed in healthcare environments so this is very helpful.

Please continue this discussion here.

Thank you @r0bby I would like to invite @elizabeth to join this discussion, as she’s the intern working on this section of the project.

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@rhoyt and @aethelwulffe Good Morning.

@elizabeth has been working on a couple of projects at the same time. She is almost ready to be live with the Nursing Assessment Visit Forms.

Can you both please offer feedback to her?

Rob, does this have what are looking for?

Art, is this a workable solution and can she submit a pr for it? Do either of you have other suggestions?

Her link is here: https://docs.google.com/document/d/1HTzvIRye_ws-XUSARBREUDYpuMj-rlmybH-jyc7bCPo/edit?usp=sharing

Thank you.

@KoniKodes @r0bby @elizabeth

I wonder about asking for feedback from the nursing department at MSU Denver who requested the forms

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Yes, I think that is a great idea. Do you mind doing that?

Meanwhile Elizabeth is continuing to code based on what she’s created.

Thank you.

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@elizabeth has posted her first blog for Outreachy!

https://ngaieliabeth.wordpress.com/

@rhoyt @elizabeth has been continuing to work on the coding for your project and should have a mock-up ready for you soon.

Did you receive any feedback from the nursing department at MSU Denver? Is there anything that she needs to add before we present it?

@KoniKodes @elizabeth

Unfortunately, I have not heard back from my contact Dr. Jeff Helton at MSU Denver

Thank you @rhoyt

We’ll just continue moving forward until we hear from you then…

@rhoyt catching up on the developments here I saw your question about inpatient nurses’ charting workflows. LibreEHR is indeed an outpt- oriented EHR but its usage can be adapted to inpt workflows. It is ‘encounter’ based, i.e., all clinical data generated from interacting with a pt is ‘contained’ in an encounter. Outpatient workflows tend to have 1 encounter for the patient’s appointment that day, and the encounter summary form contains all activities that occurred during the appointment. However, the EHR allows a couple ways to be used in an inpt setting. 1) you can have one encounter open for a patient all day and add all activities to it, then (for example) night shift would come in, close the encounter and start a new one for the next day. Alternatively, LibreEHR does permit multiple encounters in the same 24hr period. This means that healthcare pros can come in, make an encounter for their activity then close it. Another caregiver comes in, makes a new encounter, enters their activities and closes it.

The difference in the methods is largely a readability issue of scanning through a large number of encounter summary displays per pt per day, /vs/ having a unified display of the day’s activities in a single encounter summary screen.

@rhoyt One other thing that has come up is the question of how the ‘reports’ will be used of the data collected in the ‘New Student Charting Front End Tables’. Will they want to individually print out a copy of each form? Or grouped in some way, like print out all nursing assessments in a given date range? Or even, will they want reports similar to those in the EHR’s Main Menu ‘Reports’ section, where specific data columns present in those nursing forms are selected and a report is generated for all patients that have that data?

@htuck

All excellent questions for which I don’t have answers. I’m disappointed that I have not heard back from nursing at MSU Denver

Sometimes academia moves slowly.

We’ll just keep moving forward until you hear back. Do feel free to let us know if we need to make changes on anything.

I think it would be appropriate to put the nursing clinical reports in the same place the other clinical reports go, accessed through the ‘Reports’ link in each patient’s Summary screen. That way they will be managed consistently with the other reports of a similar nature.

Then if the MSU people want them put somewhere else for their own purposes the specs can be worked out. Does that sound like something we can have the Intern work on? That way she can continue to work on the other reports in the spreadsheet while waiting for word from MSU.

We’re having delays getting EHR code committed to the LHEHR codebase, but as soon as the Nursing Assessment is coded we’ll get you some screenshots from the developer’s local instance of LibreEHR for review.

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