AUTOMATION OF DHHSMHB INPATIENT TREATMENT PLANNING
PRESENTATION

INTRODUCTION

Treatment plans – essential r/t reimbursement, licensing, service… Show blank forms and example

Preliminary Treatment Plan - within 2 hours of admission. Master Treatment Plan – stay > 72 hours, completed 36 - 72 hours

ADVANTAGES OF THE AUTOMATION

Medical Necessity – determines reimbursement. Can be forced / encouraged [current, flexibility] – drop down customizable problem lists; minimum default number of problems is two for medical necessity [dts, dto, gd due to mi]

Efficiency – problem statements through menus, other items typed in. Proper formatting is automated… Efficiency – function of experience and training. Training may be automated. Dates, times, repeat entries, caps, format is automated. Print first, any, all pages… Problems may be added / subtracted and [coming] the default number of problems is adjustable… development may be interactive with nurses – in the workplace, IS, UR, admin

A single template is used for preliminary and master plans – information from the preliminary plan/previous admits does not need to be reentered unless changed. Significant reduction of redundant data entry

Training and tutorial – the template lends itself to tutorial format. Framework for new nurses and encourages professional content

Professional appearance and content

Security

Flexibility – customizable, can be viewed/edited from workstations

Connect with client, medications, assessment [universal], diagnostic [DSM IV] databases is possible

Expand to other areas of documentation

IMPLEMENTATION

Microsoft Word 2000 forms and Visual Basic

USE / DEMONSTRATION

Preparation: nurse will have client information and treatment plan concept

The sequence of operations is “manifest” e.g. master / preliminary ® enter client name ® initial save

Entry and cues

Navigation by TAB, SHIFT+TAB, UP/DN, CTRL + HOME/END etc…MOUSE/POINTER, SCROLL

Visual cues

Help text: F1, status bar

Edit: as for entry; PROBLEM/GOAL UP/DOWN; DELETE problems / goals; CUT & PASTE; ADD problems / goals – under development – with a default of two

Some items have “Help cues”

Review

Save

Print and exit

PLANS

Primary needs to implement: documentation [part of this document], sequencing in case of new vs. existing vs. old plan, name and stamp conventions, eliminate or improve readable version, revise menu of options, possible: hide other menus

Nursing: validity of help cues, dropdown lists, what to save

IS: saved versions, vs. read

Naming

Automation, development

Code items: repeated code as sub/function, modules; dim; line level modules, enumerating heterogeneous items; _change vs. _click; faulty object: textentry; hierarchy: field, line, group; process hierarchy: rewrite, add/delete, automate entry, up/dn

Automating the automation

Use / contact

Microsoft

Software and Solutions for the Healthcare and Life Sciences Industries from Microsoft

Electronic Medical Records Management [http://www.microsoft.com/Resources/Government/medicalrecords.aspx]

DETAILS AND PLAN

Use letters –and description– for Axis IV?

On Open / Close: require save. On Open: hide toolbars, full screen, lock commands, show interface. On close: revert

Other kinds of problems: s/r, social, generic, placement. Other problem statements:

Cross check number of problems, goals for consistency: ea. Problem will have at least one stg, one ltg… show this information

Levels of editing: before / after data entry; protected / unprotected

Training in use, development and principles; automation of some aspects of development; passwords – read, edit, develop

Learning aspects: store problem definitions etc. in a text file that can be edited from a main console [or separately]; learning = processing integrated with memory

AMB: wording to support problem / necessity

R/T: allowed conditions; is “unknown etiology” acceptable; probable / possible

Accessing databases: client, medications, DSM IV

Controlling Word’s default actions without words message boxes…

Friday, September 13, 2002

Moving problems and goals up and down

If the result of a field is “ “ then move to the next non-” “ field

Med concerns: change “[none]” to “Enter med. concern; when deleting/adding a concern, delete/add all subsequent

Make less memory intensive: edit out the i = 1 to n operations where Item[“name”] will work; divide up the programming into different sets of tasks assigned to different templates and load/unload as needed

Macros to insert “stock” text

Naming for documents – especially Inpatient

Note that with respect to “history” there are at least three kinds of documents: those that are written once and never modified e.g. admitting psychiatric evaluation and discharge summary; cumulative documents that are added to once a shift/day – primarily progress notes…; and “evolving” documents such as the treatment plan. These “definitions” and distinctions are not rigid. Thus corrections [Word comments] additions and ~~cross outs~~ are made to treatment plans, errors to progress notes are corrected. The question: how to record this electronically and how many version to save e.g. versions [MS Word] vs. comments. And the optimal number of versions for usefulness e.g. continuity of care, research is not the same as for legal requirements

Naming elements: client name and number, preliminary/master plan, date/time, admission number, version and permanent vs. editable – I leave this open because multiple inputs are needed – see needs below… perhaps the only version to be editable will be the editable copy of the latest version for a given plan [e.g. master, client name and number, admit date…] Word’s versions

Tuesday, September 17, 2002

Begin with enter name and work on name through dialog box &or namefields first, middle, last

Elim unneeded code

Activate problems one/more at a time from default of 2 problems and goals

Whiteout

Begin without field shading and introduce at edit

With ActiveDocument

Formfields[i].Result = “text”

…

Introduce functions to allow For i = 1, count

Code to generate forms/code

OOP

Standard subs e.g. “NotNecessary”, “Lock”, “Enter all fields”…

Before « after

Rationalize close / open

Add lines where “date met/resolved” will be entered – both “__________________” and the date

Move across blank or fixed [disabled] fields to next unblank one – disable the fields

Three name fields [more – addl names, titles?] – first, middle, last… instead of one [then, normally we don’t need to decompose names]

Needs

Paid time / contract / time for development

Improve coding r/t expansion

Implement locally first, with training

Confer: nursing, admin, IS