Neonatal Notes Manager Product Description

OVERVIEW

Neonatal Notes Manager (NNM) is an innovative software tool used to support the patient documentation needs of a Neonatal Intensive Care Unit. It combines comprehensive clinical data with a powerful database and a friendly graphical user interface to assemble patient documentation – all guided by individualized user preferences and templates. NNM is a multi-discipline tool which can be used by any clinician or consultant treating NICU patients. It was designed by and for clinicians working in the Neonatal Intensive Care Unit.

The Nursing Module is the core of Neonatal Notes Manager. It can be used to track the hour-by-hour activities of nursing care. Typical flowsheet data such as IVs, vitals, monitors, intake, output, assessments, nursing care, wound/line care, environment, parent interactions, cardio-respiratory events, and O2 therapy can be tracked. The nursing flowsheet is fully user-customizable. Selection options are determined by the user and data fields can be added or removed from the flowsheet as needed at your site.

As an additional option, links are provided to Isoprime’s market-leading NeoData physician note generation tool so that nursing data can be used directly for the generation of physician notes in NeoData.

Data collected by Neonatal Notes Manager is used to generate patient documents for nurses, respiratory therapists, nutritionists, social workers and other support staff. Many reports are available to communicate patient status to third-parties, to generate daily sign-out sheets, and act as a source for clinical research.

Neonatal Notes Manager significantly reduces the time required to collect data and develop patient flowsheets and notes. The resulting documentation is clear, complete and legible. NNM recognizes that each practitioner has their own style and level of detail for developing notes and accommodates those differences. However, the previous work done by other staff members is easily incorporated into a new note to eliminate duplicate work

NNM can also be used to plan and track the tasks associated with the ongoing management and discharge of the patient – and helps ensure that critical tasks are not missed. Reminders to complete any type of task (hearing tests, eye exams, immunizations, parental education, state-mandated reporting, etc.) can be created and tracked in NNM. These reminders can be entered manually or created automatically based on rules established by the NNM user. Through the reminder generation function, a discharge plan can be automatically created based on the clinical status of the patient on admission, and constantly updated as the status of the patient changes.

In sum, the benefits of Neonatal Notes Manager include:

- Central source for clinical data – eliminating duplicate, sometimes inconsistent information- Reduced time to develop comprehensive patient flowsheets and notes- Clear and legible notes in a format preferred by the individual clinician- Improved communication among NICU staff and with third parties such as referring physicians and long-term care

organizations- Comprehensive planning and tracking of tasks required for ongoing management and discharge of the patient- Rich source of data for clinical research, management analysis and external reporting

The net result is improved patient care and a more efficient neonatal intensive care unit.

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FEATURES

Clinical Data

Perinatal Data and Demographics

Demographic and medical history data for both the mother and infant is tracked. The maternal data includes perinatal history such as medications, complications, risk factors, screens, prenatal care, and delivery details, along with extensive demographic data. Infant data includes demographic data along with detailed information about the birth.

Nursing Care

The nursing flowsheet is used to track the hour-by-hour activities of nursing care. Typical flowsheet data such as IVs, vitals, monitors, intake, output, assessments, nursing care, wound/line care, environment, parent interactions, cardio-respiratory events, and O2 therapy can be tracked. Typical calculations for fluid totals, calories, GIR, and output are done automatically.

The nursing data is entered and viewed in the form most commonly used by the nursing staff – the flowsheet. All selections are user-defined and each flowsheet entry is associated with the person who made it. Revisions are tracked and text comments can be entered for any type of data. Nursing flowsheet data can then be automatically retrieved into nursing and support staff notes. Any numeric information entered in the flowsheet, such as vital signs, can be graphed for the day or for any extended period of time. In addition, four levels of warning ranges can be setup for each number field. If an entry is made into the flowsheet that is outside one of the warning ranges, the entry will be highlighted in a certain color.

In the nursing flowsheet, detailed data on oxygen therapy is tracked from simple to complex. Based on the type of support being provided, data is collected on delivery mode, vent settings, and patient status. Delivery modes range from mask, to nasal cannula, to CPAP, to volume or pressure ventilation, to high frequency ventilation. Additional data can be tracked by the respiratory therapist and the combined nursing and respiratory therapy data is stored and displayed in one place.

The nursing flowsheet is fully customizable to meet the specific needs of your site. Data fields can be added or removed from the flowsheet as needed without the assistance of Isoprime or a local IT staff.

Labs

Labs such as CBC, blood gas, bili, blood screen, LFT, electrolytes, medication levels, urine test, toxicology screen, and a variety of cultures can be tracked with multiple entries per day. Infrequent or very unique lab tests can also be tracked through the special labs feature. A combined view of lab data is provided that can display all lab results for a particular time period and generate a graphical display of individual readings over that time period.

Diagnostic Exams

Diagnostic exams such as head ultrasound, CT scan, hearing test, and eye exam can be tracked with detailed findings along with a notation for when the next exam should be done.

Physical Exams

System-based physical exams can be tracked using common findings available through drop-down selections. Free-form text is available along with user-defined selections for findings and typical exam defaults. Prior exams can be copied and modified for current findings. Detailed vital signs are also tracked.

Fluid/Nutrition

The nursing flowsheet is used to track fluids from all sources and automatically calculate and classify fluid totals and calories. Output detail can also be tracked. Links to bar code scanners are available to scan from within the nursing flowsheet to allow

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scanning of the patients ID and breast milk containers for verification. Lot numbers of any feeding can also be scanned and tracked.

Base on the data collected in the nursing flowsheet, a nutrition calculator is provided that can provide realtime data on a variety of nutrition (input and output) meaures. Each site can choose from over 80 calculations ranging from TPN and enteral feeding amounts and ratios, source of calories (lipids, protein, etc.), feeding history, growth statistics, and output measures.

Oxygen Therapy

Detailed data on oxygen therapy is tracked in the nursing flowsheet from simple to complex. Based on the type of therapy being provided, data is collected on delivery mode, vent settings, and patient status. Delivery modes range from mask, to nasal cannula, to CPAP, to volume or pressure ventilation, to high frequency ventilation. Additional data can be tracked by the respiratory therapist and the combined nursing and respiratory therapy data is stored and displayed in one place.

The respiratory therapist can use the nursing flowsheet to enter information or a special flowsheet designed to track only the data needed by the therapist. In either case, respiratory data entered by the nurse or respiratory therapist is stored and displayed together.

Diagnoses

Patient diagnoses are tracked noting the onset and resolution times and the staff member making the diagnosis.

Procedures

Patient procedures are tracked noting the staff member performing the procedure, the time of the procedure and the reason for the procedure. Procedure comments can be collected and later used to generate text for an admission note or procedure note.

Medications

Ordered medications are tracked and cross-referenced to administered mediations. Medications administration can be done through IV entries and a medication flowsheet.

Images

Computer-based images can be managed and accessed. Patient images with comments can be viewed along with images of people who may interact with the patient.

General Tasks

NNM provides a means to track patient management information or patient assessment information that cannot be easily tracked using a typical data entry screen.  This is done using the flexible General Tasks feature.  

There are three types of General Tasks.  Each of these is designed for a specific purpose:

Single Task

This type of General Task is used to track a single task or activity completed by a single clinician.  The task may not be directly related to clinical care, but is still important for patient management or general administration.  For example, you can set up tasks for infant care instruction, CPR training, certain assessments, and even state reporting.  

Checklist

This type of General Task is used to track an activity that has multiple steps that may be performed over an extended period of time.  For example, you can set up a checklist for parent education which could have all of the possible educational activities

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that can be provided over the course of the infant's stay in the NICU.  As each step is performed, it can be checked as completed.  A checklist General Task can also be used for nursing care plans.

Each step can be recorded independently by different clinicians. The clinician can include comments for each step, the date and time it was performed and the name of the clinician who completed the step (as it may be someone other than the clinician completing the checklist). If a step is not applicable, this too can be noted.  The date/time the overall checklist was started and completed are also recorded.  

Special checklist items can be setup to allow for multiple clinicians to record that they performed that checklist item along with the date and time they performed that item.  

Score Tree

This type of general task is typically used as an assessment tool.  It is presented in the form of a scoring tree and is completed by only one clinician.

A series of categories are established under which specific signs, symptoms and/or activities can be listed.  Numerical ratings are assigned to each item.   As individual items are checked, a total score for each category is tallied. Scores from each category are then combined into an overall rating.

The Finnegan Neonatal Abstinence Score tool provided in NNM is an example of a complex scoring tree.

A score tree General Task can be linked to certain cells in the nursing flowsheet. For example, a pain scoring General Task can be linked to the pain score cell in the nursing flowsheet so that the scoring tool can be used directly from the flowsheet and be available for reference after the overall score is entered.

Reminders

Reminders for any type of General Task can be generated automatically based on reminder rules.  General Task reminders can also be created manually.  When a General Task is completed, the associated reminder will be marked as completed.   The completion of a General Task can also be configured to trigger a reminder for any other action in NNM for which a reminder can be generated.

Patient Notes

Note Generation

The clinician builds a patient note by simply selecting, through drag-and-drop, the high-level outline of the note. The outline of the note can be problem-based, system based, or in any other format preferred by the practitioner. Based on the outline topics selected, NNM automatically retrieves the appropriate clinical data for inclusion on the note. Additional comments can be added through drag-and-drop selections of frequently-used comments that are specific to the individual practitioner and the current outline topic. Free-form text comments can also be entered.

Previous notes can be copied and used as a basis for a current note. In addition, user-defined templates can be used to automatically generate a note outline, or re-arrange an existing note outline. The copy function and use of templates make it even faster to develop a comprehensive note.

With these features, nursing notes can be created quickly and easily with very little additional typing.

Note Types

A variety of note types can be generated. For example, an Admission Note can be generated where infant demographic and maternal history are automatically retrieved along with text relating to admission procedures. Other note types include Nursing Progress Notes, Nursing Care Plans, Consult Notes, Procedure Notes and Discharge Summaries.

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When creating a Discharge Summary, the clinician can direct NNM to review the clinical data from the entire stay and summarize key points such as diagnoses, medications, oxygen therapy and referrals. Also, during the course of the stay, the clinician can mark comments made in daily notes as “discharge comments”. These comments can be automatically retrieved and copied into a discharge summary. The end result is that most of the Discharge Summary is automatically created from the clinical data and note comments that were entered during the course of the stay.

Note Tracking

Notes can be written and edited by any authorized staff member. When the note is complete it is “signed” by the staff member. When signed, all text on the note is frozen and cannot be changed or deleted.

Notes can be created by a staff member and reviewed, updated and signed by a different, higher-level staff member.

The final note can be reviewed and printed as a single note or printed as a batch of signed notes for a particular staff member.

Physician Notes

The industry-leading NeoData product, also from Isoprime Corporation, can be used in conjunction with NNM to develop notes based on data entered into the Nursing Flowsheet.

Hospital Interfaces

Clinical data can be entered into NNM through easy-to-use data entry screens. Data can also be collected through the NNM HL7 interface. This interface can receive data from other hospital systems, in the industry-standard HL7 format, and load that data into the NNM database.

The interface includes functions that receive the HL7 transactions, send acknowledgements that the transactions have been received, validate the transactions, and load the accepted transactions into the database. For example, NNM can receive HL7 transactions from the hospital’s Admission-Discharge-Transfer (ADT) system to accept patient data for both the infant and mother. NNM can also receive lab data from the hospital’s Laboratory system and eliminate the need for manual entry of most labs. Finally, NNM can receive data from vitals monitors and other devices that have the capability to send their data via HL7 transactions.

Data received by the HL7 interface can be used directly for patient documentation and can be augmented manually with additional data that has not been collected by any other clinical system.

Nursing flowsheets and any clinical notes written in NNM can be transmitted to the hospital document management system also via the HL7 interface.

The NNM HL7 interface is provided and supported directly by Isoprime. Isoprime can also provide extensive implementation assistance on the HL7 interface to customize it to each hospital’s unique data requirements. The result is the benefit of working with just one vendor for the NICU software, interfaces, and implementation support.

Vermont Oxford Interface

The Vermont Oxford Network (VON) is a collaboration of more the 1,200 hospital NICUs working to improve neonatal care around the world with data-driven quality improvement and research. A critical component of that work is to collect de-identified patient data from each member of the network.

To help facilitate that effort for NNM users, the NNM VON Interface module used to export de-identified patient information to the Vermont Oxford Network’s eNICQ data entry software.   The VON eNICQ software is then used to finalize the data and transmit the data to VON.

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The NNM VON Interface identifies the eligible patients, enrolls those patients into VON’s eNICQ database and then extracts all applicable data from the NNM database into the eNICQ database.

This tool can save a significant amount of time for the hospital’s VON administrator.

Discharge Planning/Follow-up

Task Planning and Tracking (TPAT) Module

The Task Planning and Tracking (TPAT) module in NNM provides reminders for a wide array of tasks that can be tracked in the system. These reminders can be for clinical activities such as head ultrasounds or eye exams, and also for patient management activities such as infant care instruction or CPR training. Reminders can also be generated for follow-up activities such as referral confirmation or submission of reports to the state or other external agencies.

Reminders can be generated manually by individual users and can be targeted for all clinicians, a specific job type (e.g.: all nurses) or even a specific user. These reminders can be for pre-defined tasks or can be for an ad hoc task that does not require detailed tracking.

Once a reminder is created, the system will track the status of that reminder. If a reminder is overdue, a number of reports will highlight this fact for NNM users. Also, a real-time indicator on the main patient screen will flash if critical reminders are due or overdue. Once the task for an associated reminder is completed, the reminder is marked complete and is linked to the task that fulfilled it. This means that the user can quickly see what has been done, and view the detailed result of a task that fulfilled a reminder.

In addition to the manual creation of reminders, complex rules can be established for the automatic creation of reminders. These rules are created by the system administrator and can be triggered by a long list of clinical events for the patient. For example, a reminder for an eye exam can be automatically generated for any patient admitted with a birth weight lower than a certain value or gestational age lower than a certain value. An eye exam reminder could also be automatically generated for any patient with certain diagnoses or who are on O2 for more than a specified number of hours. Using the reminder generation function, a discharge plan can be automatically created based on the clinical status of the patient on admission, and constantly updated as the status of the patient changes.

Reminders are a key component of discharge planning. A centralized view of all the discharge planning reminders is also provided. All of the reminders associated with discharge tasks are organized on a single screen for review and tracking. In addition, quick access to the tasks which fulfilled completed reminders is available and minutes of discharge planning rounds can be tracked.

Signout Sheet

A signout sheet can be generated giving a summary of all patients currently on service. A brief history, along with current fluid/nutrition, O2 therapy, diagnoses, medications, referrals and plans are listed for each patient and can be used for signout, discharge planning or even daily rounds.

Referrals

Over the course of a hospital stay, referrals can be entered for a patient. Referrals can be made to specific physicians or to organizations such as long-term care facilities and governmental support agencies.

Data: Views, Reports and Extracts

NNM includes a number of clinical data views and reports to help answer the questions typically asked in an NICU. Questions arise such as “How many patients were diagnosed with a particular set of problems over a particular time period?”, or “How many patients were treated with a specific medication or class of medications over a particular time period?”, or “What was our starting census, ending census, minimum, maximum and average census over a particular time period?”. These can all be answered using the built-in data views and reports of NNM.

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Clinical data for a specific patient is also displayed in views and reports. Here are some examples of clinical views:

- The Quick View can be used by the neonatologist, nurse and other clinicians to get an immediate impression of the patient’s progress over the last 24 hours. Presented in flowsheet format, the Quick View consolidates information about IV fluids, enteral fluids, output, apneas and bradycardias, O2 delivery, and key lab values. Nursing comments, diagnoses and ordered medications are also easily accessible. Like the nursing flowsheet, this view is customizable by each site.

- The O2 Therapy View consolidates detailed information such as O2 sats, FiO2, O2 delivery modes, ventilator settings and blood gases to give a comprehensive view of the respiratory therapy and the results of that therapy.

- The Service Stay View provides a quick look at all the service stays of the patient. The initial admission and re-admissions are displayed along with any movements between levels of care or physical locations. Selection of a particular service stay takes the clinician directly to the data associated with that stay.

- The Nutrition Calculator is used to display a variety of nutrition (input and output) calculations. Each site can choose from over 80 calculations ranging from TPN/enteral feeding amounts and ratios, sources of calories (lipids, protein, etc.), feeding history, growth statistics, and output measures.

- Growth charts plot the progress of statistics such as weight, length and head circumference against percentile standards. These charts can be viewed or printed. The Fenton 2013 standards are provided with NNM and customized standards can be entered by each site.

Here are some examples of clinical reports:

- The Notes Log can print a running log of all signed notes for a specific patient over a particular time period. This is an easy way to view the history of a patient or print documentation for surgery, diagnostic exams, or external transfers.

- The Service Stay Summary is a report summarizing the key data related to the patient’s stay in the NICU. Birth statistics, maternal history, transfers, diagnoses, procedures, medications, nutrition summary, and O2 therapy are all consolidated into a report that can be used for planning the discharge or reviewing the stay. This report can also be used as the source for external reporting into Vermont Oxford or state-mandated studies.

NNM provides a wealth of views and reports. However, there are an unlimited number of ways to review and analyze data from a comprehensive database like NNM. For cases where you need to go beyond the built-in views and reports, NNM provides an easy way to use the industry-standard Crystal Reports tool for creation of user-defined reports. Crystal Reports can not only generate complex reports from the database, but can also be used to export data into formats such as Microsoft Excel, Microsoft Word, and PDF in instances where those formats are needed.

NNM provides a read-only view of the database that is available for user-defined reports. In addition, NNM includes a number of sample reports that can be used as a starting point for the development of any report needed by the NNM user. Finally, NNM provides a means for organizing user-developed reports so they can be made available to other NNM users – without the need to have Crystal Reports installed for those other users.

Customized data extracts can also be defined and run by users of NNM. Data extracts for research studies, statistical analysis, or import into external databases can be designed through a simple drag-and-drop process. The result of an NNM data extract is a file built in the industry-standard XML format which can be easily imported into spreadsheets, databases, and statistical analysis programs.

Reference Source and Tools

Personnel

Detailed biographical and contact information can be stored for each clinician. Information such as specialties, certifications, physician groups, employment agencies, and contact methods can be tracked for physicians, nurses, technicians, and unit secretaries. This eliminates the need for paper contact lists.

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Organizations

Information on the organizations that support your NICU patient, during their stay and after discharge, is tracked. Addresses, phone numbers, departmental contacts and even driving directions can be stored for hospitals, agencies, support organizations and payers. This eliminates the need for paper contact lists.

Guidelines

Medication guideline sheets, in either text or image format, can saved and referred-to in the course of ordering or administering medications.

Clinician Tools

Tools that assist the NICU clinician with the management of the NICU patient are constantly being added into NNM. Some examples:

- The New Ballard Gestational Age calculator is available directly from the patient’s screen to select graphical and text-based observations. Those selections are then used to estimate the patient’s gestational age. This eliminates the need for the paper forms and tracks a history of the observations and calculation on the NNM database.

- A link is provided in NNM to access the Bilitool website. Anonymous data can be sent to that third-party website which is then used to calculate and display the risk of hyperbilirubinemia.  Other information, including AAP Phototherapy Guidelines, is also displayed.

User-Defined References

The system administrator can setup a help file that is specific to their organization. The administrator can also setup general references which can point to internal documents or even external web sites. For example, a reference to a web-based calculator could be included or a reference to an internal policies document could be setup. Any document or web site that can be viewed with Microsoft Internet Explorer or Microsoft Edge can be setup as a reference in NNM.

Security and Privacy

HIPAA Compliance Tools

NNM offers a number of tools to assist the organization in complying with the HIPAA Privacy and Security Standards. In addition to the features noted below, NNM provides a unique information event tracking feature. This tool allows the organization to store a record of all events related to the release of protected data for a particular patient. Events such as notification of privacy rights, authorized disclosure of information, and requests for changes to the patient record can all be tracked. The other HIPAA-related features are listed below.

Secured Login

Each user has a unique User ID and password. The password is encrypted and cannot be viewed even by the system administrator. Users can modify their passwords as needed. Password expiration timeframes can be set.

Access Tracking

Each attempted access to the system is tracked. For authorized users, their time of login and logout is tracked. Unsuccessful attempts to login are also tracked noting the time of the attempt and the reason for the failure. In addition, access to individual patient records can be tracked. Reports are available to show all system access activity.

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Security Levels

Each user has an assigned security level which defines the allowed activities within NNM. Users can be limited to view-only, clinical data edit only, or a master level of full administration of codes and users.

Signing Levels

Each user has an assigned job category (e.g.: administrative assistant, medical student, nurse, resident, attending, etc). Signing authorities can be established between these job categories that define which job type can sign a note created by another job type. In all cases, a history of who created the note and who signed the note is kept.

Update logging and Audit Trails

Every record that is entered into NNM is tagged with the User ID of the person who added the data along with the time it was entered. If data is changed, an audit trail record is saved which records the original data and the changed data and also notes the User ID and the time of the change.

Screen locking

After a user-defined time period of inactivity, NNM will lockout entry of data and display a screen that blocks a view of the data displayed on the screen. In order to return to their work, the active user needs to re-enter their ID and password. In key locations, the user also has the option of pressing a button to display the lockout screen in order to block view of patient data if they need to leave their workstation temporarily.

TECHNOLOGY PLATFORM

A Microsoft Windows network is required, comprised of a server running Windows 2003 Server or above and Microsoft’s SQL Server (2008 or above) as the database engine. The server should have at least a 2.4 GHz processor with 2Gb of memory. However, a dual-core processor with as much memory as possible is recommended. Disk space needs can vary widely depending on the number and complexity of patients. A general guideline is 240Kb per patient-day.

The database and optional HL7 interface are the only components running on the server. The server computer and SQL Server software do not need to be dedicated to NNM as long as there is adequate capacity to support NNM. The HL7 interface can run on the same server as the database or a totally separate machine. The server(s) can be virtual servers although Isoprime does not certify its products on any particular virtualization technology.

All other components run on the client PCs. For the client (desktop) PCs, Microsoft Windows 7 or above is required with a minimum 1GHz processor and 1Gb of memory.  We recommend a monitor as large as possible, particularly for nursing charting. The NNM program, and a few temporary files, are stored on the client PC, so some hard drive space is required but is well under 50Mb.

MORE INFORMATION

For more information, please contact our sales team at 630-737-0963.

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