Minnesota TIGER Summit:Together We Can Do IT…

June 16, 2010Northland Inn – Brooklyn Park, MN

1:00 pm - 5:00 pm

Meaningful Use of the Omaha System

for Program Evaluation in Public Health Nursing

Vision: Evidence-based Program Evaluation• CHS Administrators envisioned using electronic

health records to gather data for program evaluation, starting in the 1990’s

• 3 software programs adopted in CHS agencies – CareFacts– CHAMP– PH DOC

• Common denominator: the Omaha System

Minnesota Omaha System Users Group

• By 2000, 87% of counties in Minnesota had a public or private agency using one of the 3 software systems

• Users began to recognize the potential to work together

• Minnesota Omaha System Users Group started in 2001, led by state and county public health nurses

• omahasystemmn.org

Diverse Stakeholders

• Over 200 participants – state and local public health– private home care & hospice– Universities (faculty & students)– Software industry– Metro, central MN, southeastern MN– Wisconsin– Washington State

Diverse Programs

• Using the Omaha System to support programs – Family home visiting– Disease prevention and control– Waiver programs– Home care– Hospice– Healthy Communities

Results

• Grass roots collaboration– Internationally recognized leaders– Documentation and practice quality– Dissemination of tools – Two scientific publications– A national American Public Health Association

award– International visitors

Panelists/Topics

• Overview– Karen Monsen, PhD, RN, University of Minnesota

School of Nursing, mons0122@umn.edu• Implementation

– Katie Halder, MS, RN, PHN, Douglas County Public Health katie.halder@mail.co.douglas.mn.us

• Quality– Jill Timm, JD, RN, PHN, Program Manager, Maternal Child

Health, Washington County Department of Public Health & Environment, jill.timm@co.washington.mn.us

• Using Data– Diane Thorson, MS, RN, PHN, Director/CHS Administrator, Otter

Tail County Public Health, dthorson@co.ottertail.mn.us

Software

• Learning curve for implementation– Computer literacy– Unique attributes of each program– Always adapting and changing– Gets easier with time and software

improvements

The Omaha System

• Learning curve for the Omaha System– The Omaha System is the standardized

language within the software – Provides structure

• Client assessments• Client outcomes• Practitioner interventions

Mysteries

• Learning curve for both software and terminology– What is a software mystery?

• Have a great relationship with vendors to solve these• Examples: Entering dailies and Omaha Interventions

– What is an Omaha System terminology mystery?• Use Omaha System resources to solve these

– Book

– Web sites

– Meetings

Efficiencies

• Documentation efficiency– Keeps improving– Initial charting time

Outcomes

• For all 3 software programs, it is the Omaha System that allows us to work together, describe our practice, and show our outcomes

• Software implementation needs to include Omaha System training and support

Quality

• Vision to use data to demonstrate outcomes relies on having quality data

• Omaha System users share this vision and have developed tools– Manuals– Pathways– KBS rating guides

Manuals

• Supporting documentation efficiency and quality– Provided by vendors– Adapted & edited by local agencies– Updated periodically to reflect changes– Utilized during orientation and early use of an

electronic documentation system

Pathways

• Started in 2001 to describe practice – Helped with documentation efficiency and

convenience– MOSUG pathways web page – Now developing evidence-based, peer

reviewed pathways

Inter-rater Reliability

• Started in 2002 in Ramsey County– Based on the information in the Omaha

System book– Expanded definitions for improved accuracy– Revised every 1-2 years– This summer’s revision will include

Washington State Omaha System users

Commitment

• See the results transforming practice– Knowing standards of care– Incorporating evidence into practice– Valuing reliability and avoiding bias– Confidence in the quality of our programs as

well as our data

Otter Tail County Program Evaluation

• Nurse-Family Partnership evaluation

• Otter Tail County uses the PHDOC software program

• Omaha System data

• Can analyze Problems, Signs and Symptoms, Targets, and Knowledge, Behavior, and Status outcomes

The Future of Omaha System Program Evaluation

• LTBI

• Breastfeeding

• Obesity

• Early Childhood Screening

• MSHO

Challenges

• Assessment forms required with other programs do not match with the Omaha System

• Working with other agencies and state officials to resolve issues in data collection

• Starting to see the benefits of using standards (meaningful use of data)

Nurse-Family Partnership

• Serves high risk pregnant women and children ages 0-2

• Program has been carefully tested

• Omaha System pathways will support our nurses

• Omaha System outcomes will allow us to evaluate our local program and results

Developing Standards of Care

• Surveillance/Assess: Signs/Symptoms Physical: pregnancy discomforts, danger signs…

• Teaching: Anatomy/Physiology: prenatal classes, childbirth preparation

• Case Management: other community resources such as Quit Line, WIC

Looking at the NFP data

• Most Frequent Problems were Pregnancy and role Change

• Most Frequent Signs/Symptoms were low income, loss of previous role, and difficulty with prenatal exercise/rest/diet/behaviors

• Most Frequent Category is Teaching

• Most Frequent Targets are signs/symptoms and feeding procedures

Outcomes Evaluation

• KBS rating data

80.1380.1380.38Role Change

100.310-0.11101.1Pregnancy

ClientsAv ChgClientsAv ChgClientsAv ChgOmaha System Problem

StatusBehaviorKnowledgeKBS Ratings

Thank you! Questions?