Seite - 185 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Because of the distributed nature of visits, HCPs have hitherto recorded results of these screening assessments within a paper record. However, there is some concern that these paper records may not easily be integrated into team discussions of care planning (e.g. because the paper records are not always readily available). In order to address this, the team are now implementing an electronic system to record screening results, and retrieve them for team discussion and care planning. Intervention: the team already use an electronic patient record system for most of the information regarding patient treatment and care, and the intervention updates this system to include a nutritional care component. Screening is performed on home visits by HCPs, who then enter the results into electronic record system. These records are then retrieved by team leaders and presented for discussion at team meetings, and where necessary care plans are agreed. These care plans are then entered into the system by team administrators who are present at the meetings and retrieved by HCPs prior to their next visit with the patient (care plans are integrated into patient information retrieval processes that already exist within the team). Outcome measures for success of the new system include numbers of patients screened (compared with previous years using the paper record), and changes in nutritional health of patients identified as being at risk of undernutrition. Context: The community care team operates in a highly distributed fashion. Typically, HCPs will begin their shift by visiting the team base to retrieve patient records, after which they will begin their home visits. The work involves a range of patients with diverse needs and capacities, meaning that working conditions are variable and can be highly unpredictable, for example, a routine visit may uncover urgent care issues requiring immediate attention, reducing time for visits to other patients and increasing pressure on the individual HCP. Team meetings at which care planning takes place are also subject to time pressure. These may only last 30 minutes, during which 10 patients may be discussed, before HCPs are required to begin visits. The intervention stems from concerns among managers and senior HCPs that this changeable working context often leads nutritional work to fall down the list of priorities, and that paper records of screening are vulnerable to exclusion from team care planning discussions because they aren’t stored in one place. In addition, embedding retrieval of nutritional care information within the existing patient records system was intended to reduce the time taken to source material for discussion, and reduce the likelihood that such information would be absent from care planning discussions. Aim: The aim of this exercise is to identify questions that can be used to inform prospective planning and/or ongoing evaluation of implementation (readers are invited to explore one or both kinds of application depending on their interest). In both cases, the objective will be to identify factors that may promote or hinder implementation and longer-term embedding in routine practice, of the nutritional component of the electronic patient record system. M.BracherandC.R.May / ImplementingandEmbeddingHealth InformaticsSystems 185