Electronic Health Records: Making Your Data Sing
Gerri Harvey
Never mind that I can now create my health alerts list in about 5 minutes. Not to mention that the dreaded immunization survey I used to spend weeks on now takes about 15 minutes, and
generates my custom letter to each parent stating which immunizations due. I have just discovered the power of electronic data!
generates my custom letter to each parent stating which immunizations due. I have just discovered the power of electronic data!
The visits log was my last holdout. I am in my second year of using SNAP. But logging my visits was hard enough with my old handwritten jotting and flow sheets method. I couldn't imagine how I would ever get every one into my computerized log. Templates and Freeze was the answer.
In my preSNAP life, I bustled along seeing the kids in my office as quickly as possible, talking, moving, assessing, listening, triaging, writing, and occasionally ducking into my "conference" room (aka the bathroom) for a private conversation. No one ever had to wait too long and I kept my revolving door going at a pretty good pace. My logs were sometimes sketchy at best and hopeless at worst. Sometimes I knew I had seen way more kids than I had logged (or did it just seem that way?)
Having templates that you create from an actual visit just once means that you can have pre-entered all of your common complaints right along with what you will assess and what you will probably do about it. Take the old standby, an abrasion.
Chances are I am going to assess it as a minor injury, wash it with soap and water, apply a non-stick bandage, send the child back to class, and recheck him if needed. One click on my abrasion template enters all of this in one click.
How about the kid who shows up complaining of a sore throat? My systematic approach is the same every time. Take his temp, inspect his throat, feel for enlarged glands, advise plenty of fluids and possibly offer a cough drop. One click on my Sore Throat Minor template, and there it is. I can edit and add additional data and comments for that specific visit if I want to. So, now I have templates for everything from belly aches to menstrual cramps to finger jams, etc.
Freeze is how I make sure every visit gets logged in the first place. Obviously, you cannot stop and enter every time another child walks in the door. So I keep on working until I decide to have a logging moment. I ask the kids to Freeze where they are while I get them all logged in. I pick up wherever I left off before, get their names, pull up the template I need for each child, then click finish later. My busy office becomes a study in silent suspended animation while the kids all watch me as if I were the Mad Scientist, mouthing their questions to one another, "What does she mean, log us in? She keeps track of how many times we come like for our report card or something??" Once they are logged in, the action resumes. I log them out as they leave and I spend odd moments and the last few minutes of each day filling in any other details I might want to add to my entries before locking the visit.
Amazingly, now that I have my templates and freeze-to-log moments, I know, possibly for the first time in my school nursing career, how many visits I actually have in a day. Also how many parent contacts and how many staff consultations about students. It is so easy to log that I even log these, in more detail than I was ever able to do before.
Initially, having all this data depressed me. The numbers were so high. If I was seeing 55 kids in a day the first week of school, what was winter going to be like? But once I started breaking it down, I knew I had a great tool at my finger tips. Just for the fun of it, I was able to quickly determine who sent the most kids. Which classrooms generated the most belly aches. What was really going around. How much class time was being lost on hang nail visits. How many kids I had seen with fevers, how many I sent home, how many came back for a second visit the same day. One little fifth grade frequent flyer was amazed when I shared with her that she was my top visitor and had missed a total of two hours of class time in her first three weeks of school coming to the nurse. Her eyes widened in disbelief. "I guess my mother wouldn't like me to be famous for that."
Data sings when you can use it to plan interventions. I am still thinking about the interventions part, but first you need the data and nothing delivers it better than an electronic log.
