A nurse navigator at Vidant Medical Center in Greenville, NC, spearheaded the integration of navigation data into the electronic health record that greatly streamlined navigation reporting.
At the 2016 Oncology Nursing Society Annual Congress, Judy B. Koutlas, RN, MS, OCN, Coordinator of the Nurse Navigator Cancer Services at Vidant, a tertiary care center, described how she incorporated navigation data and documentation into Epic electronic health record (EHR) software and generated reports from this tool. The effort has produced greater efficiency and timelier reporting.
“Prior to 2013, the data we were collecting from our navigation team lacked uniformity. Navigators within our healthcare system had different reporting structures, and regional navigators were not linked to our Vidant Medical Center team,” she said.
Within the Vidant Cancer Care Navigation Model are 6 disease-specific navigators, all oncology-certified nurses, who navigate patients across the continuum of care. At Vidant’s 6 regional hospitals, nurses and social workers may function as navigators.
Going Electronic
Before this project started, data collection was in paper form with a manual spreadsheet entry. This was time-consuming, cumbersome, and fraught with error, she said.
In March 2014, one of the navigators developed a Google document on an iPad that allowed for real-time entry of data that could then be automatically tabulated and summarized. A setback occurred 1 year later when the center’s legal team saw the potential for privacy issues. The method was discontinued and the navigators returned, unhappily, to the paper format.
But the team persevered in their effort to go digital, and a few months later their information system (IS) specialists had produced a navigator-specific encounter tool (document flow sheet) within the EHR. The navigators continued manual data collection as well, temporarily, to validate the accuracy of the new system. Today, all their data collection is done within, and reports are generated by, Epic.
Demographic data are automatically extracted from the EHR by the IS team. This eliminates the time-consuming task of manually recording it. In addition to standard demographics, the patient identifiers include insurance status (a potential barrier to care).
On the encounter-specific side, navigators enter chief complaint, diagnosis, location of visit, barriers/needs, interventions/referrals, referral sources, home situation, and acuity scores. Navigators can add a narrative note if they wish.
“It’s common that navigators are coordinating care, but that can mean a lot of different things for a disease-specific navigator. On the intervention form, with just a few clicks and in less than a minute, I can see where the navigator saw the patient, the home situation, and so forth,” Ms Koutlas said.
They have recently updated the form to indicate the amount of time spent with the patient in a particular encounter, and the complexity of that encounter.
Progress Report
“There are still some barriers, and I am still working with IS,” she reported. “Building the form into the EHR was not difficult, but getting the reports out and have them accurately show all the data has been our biggest challenge.”
Having the IS staff understand the “language” of navigation has been a bit of an issue, she added.
The system has been considered a big success, however, based on the data being more consistent and more accurate, and the reports being more timely. The navigators have appreciated the improved efficiency and greater productivity, she said.
Further refinements are in store. Ms Koutlas would like her system to have the ability to analyze specific data within the multidisciplinary teams across the whole healthcare system. Ideally, she could know, on a particular day, what each navigator at the various sites is dealing with.
“We are not there yet,” she said. “But now I get reports by the 10th of the next month, which is much better than with manual collection, where we could be several months behind.”
She sees opportunities for standardization of navigation data nationally among other Epic users, and research opportunities based on these data.
“And we are all in tune with the fact that we need to show return on investment, to grow our programs and increase staff,” she added. This electronic system should be able to demonstrate outcome measures that will do that.
Meanwhile, the navigators at Vidant Health, she said, “take pride in knowing that what they did is being captured. And by streamlining the data, they have more time to focus on their patients, which is what we are all about.”
