Minnesota TIGER Summit:
Together We Can Do IT…
Meaningful Use of the
Omaha System
for Program Evaluation
in Public Health Nursing
June 16, 2010
Northland Inn – Brooklyn Park, MN
1:00 pm - 5:00 pm
Vision:
Evidence-based Program Evaluation
• CHS Administrators envisioned using electronic
health records to gather data for program
evaluation, starting in the 1990’s
• 3 software programs adopted in CHS agencies
– CareFacts
– CHAMP
– PH DOC
• Common denominator: the Omaha System
Minnesota Omaha System Users Group
• By 2000, 87% of counties in Minnesota had a
public or private agency using one of the 3
software systems
• Users began to recognize the potential to work
together
• Minnesota Omaha System Users Group started
in 2001, led by state and county public health
nurses
• omahasystemmn.org
Diverse Stakeholders
• Over 200 participants
– state and local public health
– private home care & hospice
– Universities (faculty & students)
– Software industry
– Metro, central MN, southeastern MN
– Wisconsin
– Washington State
Diverse Programs
• Using the Omaha System to support
programs
– Family home visiting
– Disease prevention and control
– Waiver programs
– Home care
– Hospice
– Healthy Communities
Results
• Grass roots collaboration
– Internationally recognized leaders
– Documentation and practice quality
– Dissemination of tools
– Two scientific publications
– A national American Public Health
Association award
– International visitors
Panelists/Topics
• Overview
– Karen Monsen, PhD, RN, University of Minnesota
School of Nursing, mons0122@umn.edu
• Implementation
– Katie Halder, MS, RN, PHN, Douglas County Public Health
katie.halder@mail.co.douglas.mn.us
• Quality
– Jill Timm, JD, RN, PHN, Program Manager, Maternal Child
Health, Washington County Department of Public Health &
Environment, jill.timm@co.washington.mn.us
• Using Data
– Diane Thorson, MS, RN, PHN, Director/CHS Administrator, Otter
Tail County Public Health, dthorson@co.ottertail.mn.us
Software
• Learning curve for implementation
– Computer literacy
– Unique attributes of each program
– Always adapting and changing
– Gets easier with time and software
improvements
The Omaha System
• Learning curve for the Omaha System
– The Omaha System is the standardized
language within the software
– Provides structure
• Client assessments
• Client outcomes
• Practitioner interventions
Mysteries
• Learning curve for both software and
terminology
– What is a software mystery?
• Have a great relationship with vendors to solve these
• Examples: Entering dailies and Omaha Interventions
– What is an Omaha System terminology mystery?
• Use Omaha System resources to solve these
– Book
– Web sites
– Meetings
Efficiencies
• Documentation efficiency
– Keeps improving
– Initial charting time
Outcomes
• For all 3 software programs, it is the
Omaha System that allows us to work
together, describe our practice, and show
our outcomes
• Software implementation needs to include
Omaha System training and support
Quality
• Vision to use data to demonstrate
outcomes relies on having quality data
• Omaha System users share this vision
and have developed tools
– Manuals
– Pathways
– KBS rating guides
Manuals
• Supporting documentation efficiency and
quality
– Provided by vendors
– Adapted & edited by local agencies
– Updated periodically to reflect changes
– Utilized during orientation and early use of an
electronic documentation system
Pathways
• Started in 2001 to describe practice
– Helped with documentation efficiency and
convenience
– MOSUG pathways web page
– Now developing evidence-based, peer
reviewed pathways
Inter-rater Reliability
• Started in 2002 in Ramsey County
– Based on the information in the Omaha
System book
– Expanded definitions for improved accuracy
– Revised every 1-2 years
– This summer’s revision will include
Washington State Omaha System users
Commitment
• See the results transforming practice
– Knowing standards of care
– Incorporating evidence into practice
– Valuing reliability and avoiding bias
– Confidence in the quality of our programs as
well as our data
Otter Tail County
Program Evaluation
• Nurse-Family Partnership evaluation
• Otter Tail County uses the PHDOC
software program
• Omaha System data
• Can analyze Problems, Signs and
Symptoms, Targets, and Knowledge,
Behavior, and Status outcomes
The Future of Omaha System
Program Evaluation
•
•
•
•
•
LTBI
Breastfeeding
Obesity
Early Childhood Screening
MSHO
Challenges
• Assessment forms required with other
programs do not match with the Omaha
System
• Working with other agencies and state
officials to resolve issues in data collection
• Starting to see the benefits of using
standards (meaningful use of data)
Nurse-Family Partnership
• Serves high risk pregnant women and
children ages 0-2
• Program has been carefully tested
• Omaha System pathways will support our
nurses
• Omaha System outcomes will allow us to
evaluate our local program and results
Developing Standards of Care
• Surveillance/Assess: Signs/Symptoms
Physical: pregnancy discomforts, danger
signs…
• Teaching: Anatomy/Physiology: prenatal
classes, childbirth preparation
• Case Management: other community
resources such as Quit Line, WIC
Looking at the NFP data
• Most Frequent Problems were Pregnancy
and role Change
• Most Frequent Signs/Symptoms were low
income, loss of previous role, and difficulty
with prenatal exercise/rest/diet/behaviors
• Most Frequent Category is Teaching
• Most Frequent Targets are
signs/symptoms and feeding procedures
Outcomes Evaluation
• KBS rating data
KBS Ratings
Omaha System
Problem
Knowledge
Behavior
Status
Av Chg
Clients
Av Chg
Clients
Av Chg
Clients
Pregnancy
1.1
10
-0.11
10
0.3
10
Role Change
0.38
8
0.13
8
0.13
8
Thank you!
Questions?