This document discusses the potential for electronic data capture in community health research and development. It notes that nurses are becoming major contributors of electronically captured data, but that the data is often interpreted and used in ways removed from its original purpose. It outlines six domains where increased data transparency could impact: accountability, choice, productivity, care quality, social innovation and economic growth. However, it stresses the importance of nurses actively participating in and influencing how this data is captured, interpreted and used.

1. Improving outcomes through community health research and development
Making our practice open and
transparent: the potential of
electronic data capture
NZICHC Director: Dr Chris Hendry RN, RM, BA, MPH, DM.

2. Improving outcomes through community health research and development
www.nzichc.org.nz
We are a NFP collaboration of clinician researchers (mainly
nurses and midwives) who form research teams around
specific projects with the aim of contributing to best practice
and improved patient outcomes in community health care
through the integration of education, research and clinical
practice.

3. Improving outcomes through community health research and development
We are now in a phase of transparency by default.
Nurses are fast becoming the main contributors of data captured.
Who is interpreting the data?
Do we know how this data is being used?
1. Henke, Kelsey & Whately 2011.
Transparency - the most powerful
driver of health improvement1.

4. Improving outcomes through community health research and development
The impact (and potential) of data transparency can be
categorised within the following six domains:
1. Accountability
2. Choice
3. Productivity
4. Care quality and clinical outcomes
5. Social innovation
6. Economic growth
Why should nurses and midwives
be interested?

5. Improving outcomes through community health research and development
1. Accountability
Data is used in investigation and audit often by those removed from the
workplace. Sources include:
Staffing Systems based
− Trendcare .- Incident reporting
− Payroll - e-booking /scheduling systems
Client based - service feedback
− Diagnostics timing and results - telephone and computer timing
− E-referral - e-access to spaces and technology
− Admission data
− Electronic health records
− Discharge data.
How or are nurses
involved in making the
connections?

6. Improving outcomes through community health research and development
Hospital productivity becomes
transparent – no hiding spare capacity.

7. Improving outcomes through community health research and development
2. Choice
Availability of comparative information enables choice.
Variation in performance is identified.
www.eldernet.org.nz reporting availability in ARC facilities last week,
54 of the 87 facilities listed vacancies.
Many facilities are now becoming more engaged in quality benchmarking activities.
This added to the introduction of InterRAI within the ARC sector, will require nurses
to have IT literacy as an expected competency.
What can nurses do to raise their profile?
Consumers are becoming more aware of quality expected.

8. Improving outcomes through community health research and development
3. Productivity
This has been a key focus for ‘re-engineering’ of service pathways.
Data is being used and interpreted in a way far removed from the initial
purpose…………..all information entered/recorded in an electronic form will be
used in variety of ways for variety of different purposes.

9. Improving outcomes through community health research and development
4. Care quality and clinical
outcomes
Nursing sensitive indicators are increasingly being used for benchmarking
quality.
Indicators include:
• urinary tract infections,
• patient falls prevalence and injury,
• skin pressure ulcers,
• hospital acquired pneumonia,
• deep vein thrombosis/pulmonary embolism,
• wound infection
• failure to rescue.
How are we monitoring these? Where does the data come from?
Is incident reporting accurate and timely? Could this data be extracted
from existing systems for nurses to monitor and benchmark?

10. Improving outcomes through community health research and development
4. Care quality and clinical
outcomes
Do you know what is being
monitored?
How they are being monitored?
Where does the data come from?
Are you involving yourself with
these activities?

11. Improving outcomes through community health research and development
4. Care quality and clinical
outcomes

12. Improving outcomes through community health research and development
5. Social innovation
Will challenge old ways of working and rebalance relationships.

13. Improving outcomes through community health research and development
5. Social innovation
Innovations initiated and supported by the NZ Health IT Board
http://healthitboard.health.govt.nz/

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6. Economic growth
Large sets of public data are becoming more available.
Provides potential to:
• Develop new products and services
• Increase safety and efficiency of current services
• Spot disease trends
• Impact of population changes on health service needs
• Career development opportunities in health

15. Improving outcomes through community health research and development
6. Economic growth
Immunisation Greater help for smokers to quit

16. Improving outcomes through community health research and development
Future health needs

17. Improving outcomes through community health research and development
Challenges for us:
Prioritising
http://healthitboard.health.govt.nz/
The National Health Information Technology Board (NHITB) supports the Ministry of
Health to improve the health of New Zealanders by providing trusted and secure
integrated health information systems and IT solutions that enable the delivery of
better and more convenient health care.
The Health IT Board has 2 nurse representatives among
the 8 members.
The National Information Clinical Leaders Group also
have nursing and midwifery representation.

18. Improving outcomes through community health research and development
Challenges for us:
Active participation

19. Improving outcomes through community health research and development
Challenges for us:
influencing IT developments
There are opportunities for nurses and midwives to become more informed
about IT developments.
Once informed then become involved in the action.
There are real opportunities for nurses and midwives to
become involved in IT development…..after all we will likely
be the main users!

20. Improving outcomes through community health research and development
Challenges for us:
Terminology
Health information Standards Organisation
http://healthitboard.health.govt.nz/health-it-groups/health-
information-standards-organisation-hiso
Standards have been developed in:
• Mental health
• Clinical documentation
• Palliative care
• Consumer health identity
• Cancer core data set
• Others
A standard is an agreed and repeatable way of describing
something to achieve a common understanding.

21. Improving outcomes through community health research and development
Challenges for us:
Documentation
For nursing and midwifery, documentation provides evidence of decision
making, action taken and the impact/effectiveness of the actions.
We know what we do, how and why we do it.
We need to make that understood by others, visible and
measurable….… or it does not count.

22. Improving outcomes through community health research and development
Challenges for us:
Data quality

23. Improving outcomes through community health research and development
Take control of your own data:
ending with a story from practice
The big question:
What is the value of the Nurse Specialist role?
DON response was to request data from the nurses (87 of
them) on their activities over the past 12 months to
develop a picture of their contributions.
Action: Work with the NS to identify indicators based on
the 6 domains of advanced nursing practice (Mick/Strong
Model).
There was very little transparency and in some cases no
e-data at all.

24. Improving outcomes through community health research and development
Take control of your own data:
A story from practice
Domains of advanced nursing practice
2 workshops and e-communication refined the indicators.
The new version of Trendcare contains a Nurse Specialist
module that will then be used to trial provision of data on
NS contribution to the service.
1. Provision of direct comprehensive care.
2. Involvement in support systems.
3. Research
4. Education
5. Publication and professional leadership

25. Improving outcomes through community health research and development
Any questions?
Interested in being involved and/or involving us in
any projects?
Chris.hendry@nzichc.org.nz
www.nzichc.org.nz
Thank you for listening.