| Abstract | Abstract This is a database software application for
information a neonatologist routinely considers in the
newborn intensive care unit (NICU). Users enter
data at the point of care on a handheld device that
also encrypts the data. Data management follows
synchronization via an ODBC DSN to a secure
Microsoft Access application. User feedback guides
software modification over time. The poster
illustrates the data model, the software user interface,
and data management products.
The Problem Though clinicians increasingly use
NICU database software, the contribution of these
tools to learning or clinical improvement is unclear.1
Users may be satisfied if the new tool creates chart
notes that are more legible and complete than when
done by hand. But the impact of the software on the
daily work may be far greater than this. There is an
important interaction between the daily work and
how workers model it.
Introducing an explic it data model and its software
implementation alters the very processes of care the
software aims to represent. Work flow and data
structure, previously variable among clinicians, is
now fixed. This may confound clinicians’ ability to
apply and evaluate the software.2 Further, evaluative
criteria like chart note legibility are anchored in the
old technology of hand written notes. To discover
the possibilities for data management with the new
technology calls for fresh ways of thinking about the
work to be represented.3 Moreover, important
features and problems of information technology may
surface only after it is extensively put to use.3 So for
NICU database software continually to improve user
effectiveness and resonate with the work (itself,
always changing), it seems sensible to invite user
reflection and feedback to inform a continual process
of modifying the software over time.4,5
The Project NICU Notes aims to facilitate daily
patient care and promote learning by: a) ever more
accurate data modeling; b) storing and retrieving
increasing amounts of useful patient data; c) fostering
decision support. With a focus on information that a
neonatologist routinely considers, NICU Notes
produces integrative notes (incorporating graphical
data display to reveal patterns) that describe
telephone consultations, admission, AM and PM
rounds, and discharge. It automates physician signout,
can report professional charges, informs NICUlevel
evaluation, and can support extramural
databases like the Vermo nt Oxford Network.6 Data
entry and management appear not to alter the
duration of the user’s workday.
Users collect data on a Palm OS handheld running
an application written in Pendragon Forms 3.2; the
data are encrypted (PDA Defense™). The emphasis
for the handheld component is on point of care data
collection and uniform terminology over data review.
During synchronization, the data move via an ODBC
DSN to a secure Mircrosoft Access application.
NICU Notes differs in scope and aims from another
NICU database that used the same software
platform.7 NICU Notes is not a complete EMR, nor
is it intended to replace all handwritten notes.
NICU Notes evolved in a NICU with about 800
admissions/year. A total of 7 users have now worked
with the tool and incrementally applied it to the
components of daily work, starting with the process
of admitting a newborn. Users met periodically to
discuss their improvement ideas. In the first 2 years,
model and software revisions occurred at least
monthly. Wireless synchronization is under study. |