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Each public health nurse has entered client record
information into CareFacts. They continue to print out
their work to include a paper trail in the medical record.
The review of the automated client records shows that
extraneous narrative charting has decreased, problem-focused
care is becoming evident and ease in reading client
charts is a reality. However, the majority of public
health nurse documentation continues to be paper charting.
With the introduction of HIPAA, patient privacy and
accuracy in documentation have become even more important
reasons to have a clear and concise way of recording
client care. In January, the plan is to move to all-online
charting. Staff will be accountable to document services
in this format.
The Omaha System promotes additional focus on client
outcomes, as it contains a Likert-type rating scale.
This feature in the Omaha System parallels the Healthy
People 2010 Objectives, a U.S. public health initiative
to increase the quality and years of healthy living
while eliminating health disparities.
At the County of Los Angeles Department of Health Services,
policy-makers needed a more precise way to measure the
severity of public health concerns as stipulated in
Healthy People 2010. For the first time, software is
about to be deployed to drill down into localized areas
of the county, using a new Public Health Nurse Assessment
Tool. A beta version of the software already was being
tested by PHNs in two health districts in October.
"Traditionally, a part of the public health nurse's
work has been involved with assisting individuals,"
said Kathleen Smith, MPH, of CLADHS. "More and
more, a bigger part of their work needs to be working
with communities and systems at the larger level."
The first phase, implemented in 2001, involved a detailed
public health assessment survey, where nurses gathered
information about a variety of health concerns across
an entire household. From preliminary data analysis,
it was possible to determine, for instance, that residents
of a particular service planning area identified access
to health care as their No.1 concern. "That's going
to be very helpful when we're looking to target our
effort," Smith said. The software being built could
potentially drill down all the way to the census tract
level, she said.
The MIS division of CLADHS is writing the software
that will allow computers to aggregate and analyze the
data being collected via PHN assessment. "Because
we're not going the way of a medical model or the Omaha
system, and we're looking at it from a public health
perspective, we're having to create [the software] ourselves,"
Smith said.
The remaining barrier for Los Angeles County is funding
for full support of the system, as well as additional
hardware. If that funding is found, the system could
be deployed countywide by next July, Smith said. "Ideally,
the assessment tool could be on a tablet [PC] so the
nurse could complete it in the field, and, ideally,
wirelessly transmit it from the field to a server."
But at more than $2,000 each, the cost of providing
tablet PCs to 190 district public health nurses remains
an obstacle. (In addition, the county has 300 other
PHNs who are not district PHNs, but who work with targeted
populations.)
"One of our mantras is, there's unlimited good
work to be done, so we have to prioritize and focus,"
Smith said. "We want to have some data to help
guide that process."
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