MN-CMS Supporting Safe Care Delivery & Team Response during the COVID -19 Crisis
The Maternal & Newborn Clinical Management System (MN-CMS) team is providing an ‘Agile’ response to the current and unfolding healthcare crisis for the management of patients at Cork University Maternity Hospital, University Hospital Kerry, The Rotunda Hospital and The National Maternity Hospital which are providing maternal, newborn and gynaecology care using MN-CMS
In keeping with the MN-CMS ethos of ‘Patient centred, Clinically led’, the national project team in close collaboration with these four hospitals and supported by CernerIrl have developed enhancements to the system to enable monitoring of actual and potential COVID-19 cases. It is supporting improved care with new reports, lab and medication functionality as well as leveraging the benefits already realised. Experienced team members have also re-deployed to support and enhance the vital ‘Front-line’ effort.
MN-CMS Supporting Safe Care Delivery
Infection Prevention and Control (Staff and Patient Safety)
The MN-CMS electronic record has already supported better Infection Prevention and Control (IP&C) measures with the reduction of transmission of pathogens on paper records and prescriptions, as clinicians no longer need to be holding a patient’s paper record to access or add clinical information, thereby avoiding the handling of potentially contaminated paper record.
‘Physical distancing’ is supported as the members of multi-disciplinary teams can access the patients chart from anywhere within the organisation to record and access patient care and progress and can avoid any unnecessary contact with other members of staff or patients.
Clinicians continue to support care in real time as they can logon, with relevant credentials, to MN-CMS remotely to access records, view results and observations in order to assist colleagues in care reviews and decision making. This benefit has become more significant throughout this crisis.
Midwifery & Nursing Managers can make informed decisions in relation to identification of patients with COVID-19 for appropriate bed management and the allocation of resources and therefore patients may be assured that the most appropriate care is given to them with up to date information from real-time reports, with their safety in mind, so that their care is delivered in the most appropriate location.
EHRs have been noted internationally to have the ability to respond to clinical issues arising from extraordinary healthcare situations. MN-CMS has already realised changes to identify and clearly mark patients at risk of COVID-19 to instigate droplet precautions as per HSE protocols. In Ireland the benefits of using an EHR for staff safety during a pandemic have recently been discussed in the Medical Independent: ‘EHR would help protect healthcare workers from covid-19 infection says ex-IMO President’: https://www.medicalindependent.ie/ehr-would-help-protect-healthcare-workers-from-covid-19-infection-says-ex-imo-president/
The use of SNOMED codes in MN-CMS Diagnosis fields will give added transparency to the patient records and facilitates consistent reporting in an internationally recognisable format.
MN-CMS Team Response
Brian O’Sullivan (MN-CMS Reporting Lead) has developed business intelligence Reports and Dashboard to support midwifery, nursing and hospital management in their operations management with up to date relevant data, including ‘Virtual Appointments’ reports to monitor this new but vital service.
Searches a given location for patients at a specific date/time
Corona-Covid in ‘Other’
Searches for Covid; COVID; Corona in ‘Other’
Covid-19 - Problem Onset
Based on Problem Onset Date
Covid-19 - Problem Life Cycle
Based on Problem Life Cycle Date
Covid-19 - Diagnosis
Based on CODE 287060018
Based on: Certain Covid related clinics for one site
Brian is currently developing Dashboards which are a clear visualisation of the current status within a hospital in terms of actual numbers of patients with COVID-19 detected, COVID-19 detected: Confirmed COVID-19’, ‘Numbers in Isolation’, ‘Enhanced Droplet Precautions’ and by ‘Age Range’, ‘Location’ and ‘Encounter type’, as below:
Workstream Development in MN-CMS
Two workstreams which are developing the system further in response to the COVD-19 crisis are the Laboratory and the Medications workstreams.
Gwen Malone (MN-CMS Order Comms and Laboratory Workstream Lead) has developed and implemented electronic requests for laboratory testing of SARS-CoV-2 (COVID-19) tests across all 4 hospitals, and is focused on the incorporation of real time electronic reporting of all SARS-CoV-2 test results from the individual hospital laboratories into the EHR. As part of this, Gwen has developed a customised electronic test request form to include fields for mandatory data required by the labs for statistical reporting to the HSE, CIDR, etc. She has also developed a COVID-19 order set of laboratory investigations, comprising a suite of diagnostic lab tests which is focused around disease management.
This real-time electronic requesting of SARS-CoV-2 tests directly from the bedside or clinic to the lab, and reporting of all SARS-CoV-2 test results from the individual hospital labs automatically and directly into the EHR greatly speeds up and allows for safer processes both at the patient bedside and within the lab; and allows for instant access to test results from anywhere in the hospital, from outpatient clinics, and from remote-access devices.
Standardisation across all MN-CMS hospitals and laboratories of the requests and results of SARS-CoV-2 tests streamlines and optimises workflows for clinical staff across hospitals, and allows for the prompt collation of data on both the testing status and test results of patients across multiple hospitals.
The on-going and rapidly changing nature of SARS-CoV-2 testing in response to scaling of laboratory capacity around the country, challenges with sampling and testing supplies and equipment, and expansion of the scope of referral testing is proving a challenge to reflect and maintain in an EHR setting in a timely manner, but it is a challenge MN-CMS are rising to, at both a local hospital and a national system level.
Brian Kehoe (MN-CMS Chief II Informatics Pharmacist), Eavan Higgins (MN-CMS Clinical Informatics Pharmacists) and Prof. Brian Cleary (MN-CMS Medications Lead) have been developing the system to support medication management through the COVID-19 crisis with:
- New orders for safe prescribing and antimicrobial stewardship in COVID-19 cases
- COVID- 19 related Medication Treatment Plans
- COVID -19 Prescribing reports and linked them to treatment plans
- Developed Dashboards/reports to present real-time data on COVID related prescribing
- The rapid deployment of new functions e.g. electronic medication requests allows ordering from areas that have IP&C restrictions to ensure the provision of safe service to patients in isolation
The use of MN-CMS Medication functionality also provides Pharmacy services with remote review and collaboration between onsite and offsite staff.
Emma Flaherty and Elmarie Cottrell (MN-CMS Senior Clinical Informatics Pharmacists) are working with the national meds team and with their colleagues in UHK & CUMH, to ensure the developments are disseminated and supported.
The collaborative nature of the Clinical Informatics team also ensures that they are to the forefront of emerging benefits. One interesting finding in their collaboration with RCSI colleagues is the potential time-saving made looking for paper drug charts thereby ‘Releasing time to care’.
Not confined to MN-CMS but welcomed by the team is the legislative change to enable electronic prescribing. Various workflows are being evaluated for the generation and electronic transmission of prescriptions to support prescribers in collaboration with local IT departments. This means that the prescription reaches the pharmacy before the patient, saving queuing time, potential for transmission of pathogens on prescriptions and enabling Pharmacies to manage workflows efficiently and maintain social distancing. This development also supports novel work practices with remote outpatient clinics and prescribers working off-site.
MN-CMS Staff have been front and centre for answering Ireland’s call to support the HSE during this crisis
Orla Sheehan (MN-CMS NICU Workstream Lead) returned to support the specialist area of Neonatal Intensive Care to help provide specialist care to the most vulnerable of our patients. During her time of redeployment Orla has also become a Champion Nurse for implementing the vCreate Digital Platform to share photos and messages of babies with parents and family during a time a significant visiting restriction to the NICU. This has made a tremendous difference to new parents.
Deirdre O’Regan (Senior Project Manager) re-deployed to work on the design, development, testing and deployment of the Covid Care Tracker system (CCT) functionality, including the COVID19-ID API and transferring data between the CCT and multiple systems including ‘Healthlink’, ‘Swiftqueue’ and lab data. The CCT system is being used across Ireland in Contact Tracing, Assessment Hubs, Test Centres, Intermediary Care Centres, Acute Settings and Primary Settings. The CCT design principles are:
- To be accessible any time on any device as long as the user has internet connectivity
- To be scalable and secure
- To prioritise delivery of minimum viable solutions in shortest time frames to support the business operating model
- To allow improvements in subsequent release phases
Deirdre has also been involved in system support and visiting Assessment Hubs or sites to provide support and guidance to ensure the optimal use of this vital system in the tracking of the pandemic in Ireland.
Sharon Young (MN-CMS Testing Lead) has also been deployed to assist with the development, testing and use of the CCT system. At present she is concentrating on the integration of CCT and Swiftqueue. As data quality is crucial to the use of information being gleaned from the system Sharon is also working on Data Quality Management within the CCT system.
Fiona Lawlor (ADOM Business Manager) and Joan Malone (Maternity & Gynae Workstreams Lead). With their considerable clinical experience, Fiona and Joan have redeployed to the Contact Management Programme (CMP). The aim of the CMP is to notify results to people tested (or proxies) and to identify and manage contacts of known COVID-19 positive people, putting in place measures to ensure these exposed people do not further transmit disease. This is being done through a number of Contact Tracing Centres around the country.
Fiona has been deployed to work with the Mid West Public Health Department based in Limerick.
In this role, Fiona works with the Public Health Team and Surveillance Scientists monitoring and carrying out contact tracing in respect of nursing homes, residential care centres and various other complex settings throughout the mid-West Region.
Joan has been deployed as a Contact Tracing Support lead to provide clinical support and supervision within the Contact Tracing Centre in the Curragh Army Camp. In this role, Joan works with members of the Irish Defence Forces including the Cadet School and the Army band who are supporting the Contact Tracing effort.
Contact tracing is fundamental to the effort to monitor and control COVID-19 spread. Staff working in the Covid-19 Contact Tracing Service use the CCT system, they contact persons who have been confirmed with the Covid-19, identify close contacts and add their details to the CCT for follow up. They provide advice to those confirmed with Covid-19 and their contacts to ensure people receive the best guidance for their own health and to stop the spread of the virus.
National Back Office and Project Team
Meanwhile the National Back Office (NBO), Project Team (NPT) and the Office of the Chief Information Officer (OoCIO), while supporting the development of changes with the workstream leads, continues to enhance the functions and use of MN-CMS for patient and staff safety.
Gayle Reilly (MN-CMS Training Lead) is managing the Train Domain refresh from an out of date version of functionality, which is not fit for purpose. Once completed, the refreshed Train Domain will give the staff an opportunity to train on an up-to-date EHR with all the current functionality of the ‘Live’ system (PROD). New COVID-19 documentation and functionality will also be available on the refreshed domain for BAU (Business As Usual) Training. The decision to complete this project now will also have a positive and beneficial impact for patient safety and documentation.
Caroline Cahill (Programme Manager) and Catherine Jinks (National Back Office Manager) are continuing to lead the NBO and NPT team with its own development in addition to other BAU work associated with ‘Live site’ support as listed below.
Change Request (CR) management
All NBO and NPT
Cross Programme Millennium CR management,
Catherine Jinks, Gwen Malone, Brian O’Sullivan, Damien Duffy (NPT Application Specialist), Mary Mullins
PPG and Core configuration standardisation
Catherine Jinks, Gwen Malone, Damien Duffy, Brian O’Sullivan, Mary Mullins
Train Domain Refresh
Gayle Reilly, Orla Sheehan, Mary Mullins, Joan Malone
Internal team training
Interface testing for iPMS- DNE to Millennium in collaboration with MedLIS
Catherine Jinks, Damien Duffy, Eileen Burke (Senior Project Manager), Gayle Reilly, Orla Fox (Senior Project Manager)
Business Continuity Support Planning and Development
HIE Template testing
Mary Mullins, Aileen Murphy (NPT Clinical Lead), Fiona Lawlor
Communication and Project documentation
Mary Mullins (Change and Transformation Lead)