1. Minnesota TIGER Summit: Together We Can Do IT… June 16, 2010 Northland Inn – Brooklyn Park, MN 1:00 pm - 5:00 pm Meaningful Use of the Omaha System for Program Evaluation in Public Health Nursing

2. 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

4. 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

5. 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

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

7. 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

8. 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

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

10. 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

11. 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

12. Efficiencies Documentation efficiency –Keeps improving –Initial charting time

13. 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

14. 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

15. 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

16. Pathways Started in 2001 to describe practice –Helped with documentation efficiency and convenience –MOSUG pathways web page –Now developing evidence-based, peer reviewed pathways

17. 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

18. 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

19. 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

20. The Future of Omaha System Program Evaluation LTBI Breastfeeding Obesity Early Childhood Screening MSHO

21. 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)‏

22. 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

23. 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

24. 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

25. Outcomes Evaluation KBS rating data 80.138 80.38Role Change 100.310-0.11101.1Pregnancy ClientsAv ChgClientsAv ChgClientsAv Chg Omaha System Problem StatusBehaviorKnowledgeKBS Ratings

26. Thank you! Questions?