Comparing Costs of Data Entry: Manual Charts vs Computerized

Registry

Allan Lieberthal MD, Marlene Lugg Dr.P.H, Stephen Tannenbaum MD

Kaiser-Permanente, Southern California

Problem Addressed

• Clinicians are concerned that data entry into a registry will increase office work and costs compared with current manual procedures

Study Plan

• Compare nurse’s time entering immunization data and preparing patient and school immunization records using manual and electronic methods

Methods

• 10 LVN’s and NA’s– All active KITS users– Most with prior experience with manual logs

• 9 case scenarios typical of daily immunization practice

Methods

• Nurses performed same procedure using KITS followed by manual system– Enter data into KITS or manual log plus AAP

immunization record– Enter data into or print California Immunization Record– Prepare or print school report when needed

• Observed and timed by investigator or nursing supervisor

• Statistics– 3 way ANOVA, 2 way blocked design

KITSKaiser-Permanente Immunization

Tracking System

• Operational since 1994

• Mainframe-Character based

• 910,000 patients - 0-18 Y/O

• > 20 million immunizations

• Approx. 5000 users– MD’s, NP’s, RN’s, LVN’s, NA’s etc.

KITS MenuKITS KAISER IMMUNIZATION TRACKING SYSTEM 10/21/02 SELECT INJECTION CLINIC FUNCTION 15:01:54 Make a selection and press ENTER. A. ADD INOCULATIONS/SKIN TESTS B. ADD DETAILED INOCULATION C. ADD DETAILED SKIN TEST D. DISPLAY INOCULATION HISTORY E. DISPLAY SKIN TEST HISTORY F. CHANGE INOCULATION G. CHANGE SKIN TEST H. MAINTAIN MANUFACTURER/LOT DEFAULTS I. DISPLAY MANUFACTURER/LOT DEFAULTS M. ADD MULTIPLE INOCULATIONS N. ADD INOCULATION/SKIN TEST HISTORY P. MAINTAIN PATIENT IMMUNITY PROFILE Q. DISPLAY PATIENT IMMUNITY PROFILE S. DISPLAY PATIENT IMMUNIZATION STATUS T. TABLE MAINTENANCE V. DISPLAY VIS GIVEN HISTORY W. MAINTAIN VIS GIVEN HISTORY SELECTION: _ F03=EXIT

Manufacturer/Lot Defaults

KILX KAISER IMMUNIZATION TRACKING SYSTEM 10/21/02 COMMAND: ________ DISPLAY MANUFACTURER LOT DEFAULTS 11:48:42 FACILITY: 007 MOANALUA MEDICAL CENTER DEPARTMENT: 2383 PEDIATRIC MODULE ID: PED1 Lines 001 To 010 Of 012 Agent Agent Name Manufacturer Lot Number Exp Date DTaP DTaP GLAXOSMITHKLINE C0083 10/18/2004 Td TD ADULT GLAXOSMITHKLINE U1687 02/12/2003 IPV IPV AVENTIS PASTEUR, INC. T012 10/01/2003 HepB HEPB PED/ADOL MERCK & CO., INC. 5050 01/15/2004 HEPB HEPB ADULT MERCK & CO., INC. ENG123 12/31/2003 HibHBV HIB-HEPB COMVAX MERCK & CO., INC. 0149M 11/04/2004 PRPOMP HIB PEDVAXHIB MERCK & CO., INC. 1234 10/10/2003 PCV7 PREVNAR WYETH-AYERST 484-203 04/30/2003 PPV23 PNEUMOCOCCAL 23 WYETH-AYERST 55555 01/01/2005 MMR MMR MERCK & CO., INC. U0357 05/19/2008 ______________________________________________________________________________ PF3: Exit to KITS menu PF5: Refresh PF7: Scroll Up PF8: Scroll Down PF12: Cancel

Add InnoculationKICI KAISER IMMUNIZATION TRACKING SYSTEM 09/20/02 COMMAND: ADD STANDARD INOCULATION 11:45:51 MORE: + MRN: 00 0000000001 NAME: PACE, APPOINTMENT AGE: 45.08 DOB: 01/01/1957 SEX: F ADMINISTRATION DATE: 09202002 <= MMDDYYYY 09/20/2002 ADM RESOURCE CODE: SOLLE - SOLLEZA, MARILYN D. FAC / DEPT / MODULE: 552 / 2090 / PED1 C TOT LAST ADMIN. ¦ BODY AGENT ---------SELECTIONS--------- GROUP M INJ AGENT DATE ¦ SITE RTE ID AGENT SHORT NAME DOSE DTP 7 H-DTP 07/12/02 ¦ ___ IM DT DIP TET PEDI _0.50 ¦ ___ IM DTaP DTaP _0.50 POLIO Y 8 OPV 07/12/02 ¦ ___ PO OPV ORAL POLIO _0.50 ¦ ___ SC IPV POLIO - SALK _0.50 HIB 5 COMVAX 08/21/02 ¦ ___ IM COMVAX COMVAX _0.50 RV ¦ ___ PO ROTA ROTAVIRUS VACC. _2.50 MMR 6 MMR 09/19/02 ¦ ___ SC MMR MMR _0.50 HEPA 1 HEPA 01/22/02 ¦ ___ IM HepA HEPA-CHILD _0.50 ¦ ___ IM HEPA HEPA-ADULT _1.00 HEPB 5 COMVAX 08/21/02 ¦ ___ IM HepB HEPB-RECO/CHILD _0.50 I:002 Ready to continue editting. F02=COMMENT F03=EXIT F05=REFRESH F07=PREV F08=NEXT F10=SKNTESTS

VIS

KIVC KAISER IMMUNIZATION TRACKING SYSTEM 10/04/01 COMMAND: MAINTAIN VIS GIVEN HISTORY 19:46:54 MRN: 00 0000012345 Name: SNOWMAN, FROSTY SELECT (S) VIS ID VIS DESCRIPTION VIS VERSION DATE _ VIS-DTP NEW DIPHTHERIA/TETANUS/PERTUSSIS-NEW V 07-30-2001 _ VIS-DTP DIPHTHERIA/TETANUS/PERTUSSIS 08-15-1997 _ VIS-PNED PNEUMOCOCCAL CONJUGATE 07-18-2000 _ VIS-PNED NEW PNEUMOCOCCAL CONJUGATE-NEW VIS 07-09-2001 _ VIS-IPV POLIO, INACTIVATED 01-01-2000 _ VIS-OPV POLIO, ORAL SUPPLEMENT 01-01-2000 _ VIS-HEP B HEP B 12-16-1998 S VIS-HEPB NEW HEP B-NEW VIS 07-11-2001 S VIS-HIB HAEMOPHILUS INFLUENZA TYPE B 12-16-1998 _ VIS-MMR MEASLES/MUMPS/RUBELLA 12-16-1998 _ VIS-VZV CHICKENPOX 12-16-1998 _ VIS-TD TETANUS/DIPHTHERIA 06-10-1994 _ VIS-HEPA HEPATITIS A 08-25-1998 _ VIS-MENG MENINGOCOCCAL 03-31-2000 _ VIS-PNEUM PNEUMOCOCCAL POLYSACCHARIDE 07-29-1997 _ VIS-INFV NEW INFLUENZA-NEW VIS 04-24-2001 _ VIS-INFV INFLUENZA 04-14-2000 _ VIS-LYME LYME DISEASE 11-01-1999 F03=EXIT F07=PREV F08=NEXT F12=CANCEL

NurseInitial

DTaP IPV Comvax Prevnar MMR VZV Hep B Hep A

MFR

Lot #

California Immunization Record

Scenarios

XXX2CurrentRoutine shots12 yr8

XXXX3NewBehind, new school8 yr7

XX0CurrentUTD, lost CIR, school13 yr6

XXKITS0NewUp to date, school3 yr5

XXXX3CurrentRoutine shots5 yr4

XXX5CurrentRoutine shots12mo3

XXX4CurrentRoutine shots4 mo2

XXX4CurrentRoutine shots2 mo1

XAM Setup

SchoolForm

CIRChartKITS/Log

ImmGiv

PatientScenarioAge

Results

0.020:160:440:28Scenario 8

0.62-0:023:073:09Scenario 7

<.0011:512:280:37Scenario 6

0.470:082:512:42Scenario 5

<.0011:041:470:43Scenario 4

<.0011:082:171:09Scenario 3

<.0011:011:500:49Scenario 2

<.0011:572:440:47Scenario 1

0.020:333:252:51Setup

P-ValueDifferenceManualRegistry 

Registry vs Manual Data Entry

0:00

0:28

0:57

1:26

1:55

2:24

2:52

3:21

3:50

Setup Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6 Scenario 7 Scenario 8

Tim

e

Registry

Manual

Conclusions

• Use of a registry takes less office time than use of a manual system

• Greatest time savings occurs when immunization and/or school records require completion

• If each scenario is done twice a day, average time saved per day would be approximately 16 minutes

Acknowledgements

• Joan Franco RN• Martin Lee PhD• KITS Administrative

Team• Jacqueline Arana, MA• Gloria Arguello, LVN• Doreen Ayala, LVN

• Elena Doronio, LVN• Susana D’Souza, MA• Celia Gonzalez, LVN• Herena Hartenstein, LVN• Marcella Jackson, LVN• Roy Judiong, LVN• Frances Martinez, LVN