Lori A. Modly
MSN, RN, CPNP-PC
MY WORK
FWFHP
The Farm Worker Family Health Program (FWFHP) is an Emory School of Nursing led, interprofessional academic program
which aims to fulfill two main goals; 1. To provide primary health care, including physical examinations, health screenings, health education, physical therapy, and dental care to the predominantly Hispanic population of migrant farm workers and their families in an ambulatory setting in Moultrie, Georgia; and 2. To provide an
immersive, interprofessional clinical education experience for health professions students.
•The Farm Worker Family Health Program (FWFHP) is a nursing-led, interprofessional healthcare training program over 26 years, which provides care to migrant farm workers.
•There is a need for more critical health information about farm workers and their children in the United States.
•FWFHP collects clinical data during patient encounters
•Program staff expressed dissatisfaction with process as:
•Static due to using spreadsheets
•Time consuming
•Vulnerable to security breaches
•Prone to errors
•Disconnected data sets
•Unable to support data queries
•Clinical data is desired to inform operational decisions and improve care.
Goals & Aims
To design a more efficient data collection and management process incorporating a relational database capable of timely and effective clinical query.
•Increase faculty satisfaction scores from 50% to 80%.
•Increase faculty perception of data usability from 50% to 90%.
•Decrease defects to 20%
Defect = (# of patient charts not entered into system during camp)/(total # of charts)
Project Team
Lori Modly project lead, principal investigator
Erin Ferranti clinical partner; director FWFHP
Sharon Quinn nurse informaticist; data management for FWFHP over last 10 years
Elizabeth Downes lead nurse practitioner faculty; FNP
Students various public health and work-study students to facilitate data entry and database implementation
Alex Edwards data management expert, will assist with database creation and implementation
Previous State. State of data management workflow prior to LEAN waste walk and implementation of relational clinical database program year 2019.
Improved workflow this figure illustrates the changes to the FWFHP data management workflow post database implementation. This model reflects real-time data entry.
PDSA cycles
Plan Do Study Act
PDSA cycle 1- Mobile hotspot required; Data input form required a yes/no for each data field
PDSA cycle 2- Reset data input fields to pertinent information only, data saved locally to tablets uploaded to cloud after clinic.
PDSA cycle 3- Data clerks remained at data entry stations for 100% of clinic time.
Results
Project goals achieved:
Faculty satisfaction and Data usability
Data entry defects over the course of database implementation. Excel defects are at baseline. Defects were calculated on last night of clinic, by clinic close, all data was entered into the database
-Satisfaction represents faculty perception of the process of data entry and timely access to the data for clinical inquiry.
-Usability represents accessibility to data for query.
-Results were obtained using a pre and post test Likert scale via electronic survey.
A rating of four or five on the scale = goal.
Conclusions
•The process has improved and the data is more usable
Specifically:
•Reduced waste, redundancy, and variation
•Easier work flow
•Live data entry is possible
•More secure & HIPPA compliant
•Capable of data query to:
•Answer clinical questions
•Address operational concerns
•Link current and historical data
•Facilitates future research or improvement work
•Next steps:
•Complete a secondary analysis of the dataset
•Apply for funding to address identified clinical needs
•Future plans for advancement:
•QR scanner technology to reduce input work
•More tablets to assure data entry in real time
Acknowledgement:
This project was funded by an internal nursing workforce grant, granted by Nell Hodgson Woodruff School of Nursing and Emory Healthcare Center for Data Science.