Clinical Data Management in Health Care Technology

1. Introduction:

Emerging technologies in Clinical data management playing a prominent role in health care system. In clinical practices client or case management software system maintains, tracks, monitors and reports on medical qualification status and compliance with health assessment requirements. These activities are currently paper driven and require the manual coordination and record keeping of medical files in many organizations. These medical files entail a great deal of duplication of data documentation. In addition data collected is inputted in multiple database spreadsheets.

 Evidence-based, community health care technologies that helps transform the lives of patients with their first child. Each patient served by the health care programs is partnered with a registered nurse early in her pregnancy and receives ongoing nurse home visits that continue through her child’s second birthday. The primary objective of this initiative entails delivering a case management system that will allow nurses and health advisors to create and maintain a case record of all interactions with their associated clients. The main purpose is to enhance the collection and management of all data accrued throughout the case management lifecycle and enable nurses, nurse supervisors and all other designated health care staff to have ready access to electronic case files.

 The creation of this system will also enable and facilitate the implementation of a more thorough and accurate quality assurance program. In addition, the case management system will enable program staff access to data and reports to gain better insight into the operations of the various program.

An efficient Data management system streamlines medical examinations through use of Artificial Intelligence will reduce the need to do routine tasks such as organizing, filing and retrieving patient information and increase productivity for other essential tasks. This technology helps to coordinate the implementation of Electronic -Clinical Works.

The Data entry Assessment Forms are among the longest and most complex of those used in the 3D bio printing , which likely explains this low completion rate. Currently, technology does not support a multi-column approach with out-of-the-box functionality. Therefore, all forms were developed with a single column format and, in order to ease the user experience, the Software integrations broke these forms into sections to eliminate long scrolling through the forms. Despite these efforts, end users still reported that one of the biggest challenges was navigation within long forms and they were frequently unsure of what section of the form they were on. During field observations, nurses kept the paper copy of these forms at hand to aid in navigation on the tablet. Nurses stated that these navigation issues led to an increase in the amount of time needed to complete the forms on the tablet compared to the paper forms. Another potential barrier to the completion of these forms is that they include nurse notes and require the most typing. During the field works nurses used the virtual keyboard on the Samsung tablets for typing notes. At times, nurses did not use the virtual keyboards in the field since typing notes proved to be slow during the appointments with clients, and instead hand wrote the notes and later entered them into the tablet. The ability to enter notes via external keyboard or to create a voice recording would greatly enhance the user experience and simplify the process. The nurses would like to have an option between virtual or external keyboards for a final application. Prior to the initiation of the pilot, IT conducted research into the possibility of purchasing keyboards for the Samsung Android tablets used for the health care technology applications . It was determined that due to the age of the Samsung tablets, no keyboard solution is available.

Fully integrated system to capture and process referrals and assign to other eligible program sites. These Software System will also facilitate oversight function, workflows, reports, dash boards and communication between various users and roles in Online Version. Serve as a single point of entry for access, assessment, and referral of families to appropriate home visiting services. Use a standardized form or other mechanism to assess for each family member’s risk factors and social determinants of health, as well as ensure that the family is referred to the appropriate services. The top priority for the Health care practitioners is to transform the technolgy by migrating to the cloud, and implementing augmented virtual reality, so that application be intuitive and easy to use and well managed in online versions.

The primary objective of this initiative entails delivering a case management system that will allow health advisors to create and maintain a case record of all interactions with their associated clients. The main purpose is to enhance the collection and management of all data accrued throughout the case management lifecycle and enable health advisors, supervisors and all other designated Clinical data management staff to have ready access to electronic case files. The creation of this system will also enable and facilitate the implementation of a more thorough and accurate quality assurance program. selections made in one section will inform the next steps of data collection and automatically skipping the steps to complete the form that are not applicable to the client to minimize the data entry efforts. In addition, the case management system will enable Data management staff access to data, reports and analytics to gain better insight into the operations who use the current and emerging technologies to support Health care and clinical practices.

2. Benefits of clinical data management software in Health Care are

• Improve the organization of medical examination data
• Streamline the examination process
• Provide anonymous data to for surveillance and analysis
• Save significant hours of Staff Time per day thus improving bottom line.
• Reduce administrative paperwork.
• Improve patient cycle management.

The intention is to provide an efficient web-based and Mobile “Case Management System” software as an efficient method for Clinical practices to develop and maintain a clinical record of all services provided to active clients. Administrative Assistants/Data Managers will use the application to review the data for accuracy and will be able to submit confidential information through various databases electronically. The solution should encompass a replacement of the current Client Management System and this will enable the program to have one robust system to fulfill the Medical Practices.

• Referral management: referral forms are currently received via fax and the data administrator manually enters the form in the Client Management Systems and Databases.
• The various forms are billing form, registration form, several nursing assessments (Pre-natal, Post-partum, Infant & Toddler), home visit forms, ASQ, ASQ-SE, HOME form, family database form, Baby Buggy form, PHQ-9 Screening forms, Laproscopic Angioplastic Vascular surgical history,Mental Health Clinician’s notes and psycho-social assessments, forms for Cribs for Kids & Electric Breast Pump distribution & TCM Care Plans, TANF, TCM, referrals to outside community sources. A web interface is needed to enter these forms which are not uploaded in the database.
• Nurse progress notes: the system provides fields where upon the nurses can enter progress notes to document the visit with a client (or fields where they can document a telephone check-in and follow-up notes.)
• Electronic signatures: Several forms, namely the client consent form and the authorization for release of health information form, contain client signatures. (Note that these forms are not uploaded in the database.) These forms need to be printed out, signed and then scanned to retain a record of the client signature. Or, a preferred alternative is to capture signatures electronically for these forms, but this is a lower priority than automating the ETO forms, billing forms and referral forms
• Mobile devices: the system will be compatible with mobile devices that can be used in the field, such as tablets. The mobile devices should be able to connect to the Wi-Fi network and also support off-line data entry in case a connection cannot be established in a particular field location. Data should be able to be entered in offline mode and then later upload the forms into the Case Management System.
• Ability to review and approve forms electronically.
• Functionality to support billing activities for services provided through medical staff. Currently the billable services are documented on paper forms and the paper forms are manually entered for Medicaid claiming by an external vendor. In the future, the system should generate electronic files for billing purposes.
• Report generation: the system should include a suite of preset reports and also have the ability for advanced users to generate their own ad-hoc reports.
• Education and Training: the system should have the ability to store educational and training materials for both end users and clients.

3. Data Security and Confidentiality:

Scientific and Clinical Data Management cases are displayed based on each user’s profile and cases assigned to them. But all staff can view cases at any time and can make changes to any case – including others’ cases if it is unlocked. In the future, a role-based, access control function is required so that only those staff whose duties involve the case should be able to view or edit information about that case. Furthermore, permission to access information within the Application should be hierarchical, based on a need-to-know basis. Any alterations to access permissions can easily maintained via role assignments, to be made by users with the appropriate Application System Administration or Database Administration authorization. For exception cases – for example access to client records in an emergency, these can be accomplished via a service ticket escalation (i.e., database change via Database Administrator) or an alternation in account permissions (i.e., application change via System Administrator).

4. Auto-detection of duplicate client records:

Currently to avoid duplicate records, Clinical staff search the database for the client’s name and information before adding it as a new case. In the future, the software will support an Auto-detection option while entering the record. The system will reference common attributes found in datasets etcetera. In addition, the technology will support a feature to de-duplicate clients via a merge process. The system shall help the user to maintain only a single client record. This will be useful to correct duplicate enrollment counts. This Merge function will be based upon user access levels via roles in order to minimize the possibility of erroneous de-duplications.

The system should be able to track service duplication. Lastly, the system shall support improved auditing and logging of system changes to track who made which changes to records and when it was done.

5. Data Entry, Stability and Data Retrieval:

Clinical Staff have reported issues with data integrity. After the completion of the forms they have observed data loss when uploading the record back into the database, or when navigating between forms. In the past, this has included the Head of Case (HOC) ID, but this is now fixed. These lost attributes currently include the Client information in the field review forms. In the future, the client has proposed an auto-save feature to prevent the data from being lost. Further, they would like a confirmation message to appear when forms are successfully submitted, or when additional action is required that will be helpful. Artificial Intelligence will explore these and other new features and functions to improve data retention. The Referral Tracking and Data System’s scope and sophistication would depend in part on available financial resources to invest in the technology, but they would also rely on partners and users successfully negotiating and reaching agreement on what data to collect and share.

6. Automate Communications in Clinical data Management:

The emerging technologies are able to automate communications to assist with referral management. For example, Clinical staff would get an automatic reminder to call a potential client back at an agreed-upon day and time, or provider would receive a referral with detailed information with a click of a button by the Outreach and Screening Coordinators. This functionality may take longer to actualize, it would be critical to link any Referral Tracking and Data System with electronic health records currently used by large medical centers, health systems and health plans. Embedding selected data fields into patient/member records that could be easily answered during routine intake procedures and existing workflows would increase the likelihood that these types of providers would refer to centralized databases. “Data System Development for Cross-sector Referrals.”

Based on input from certain clinical practices in medical technology, integrating the centralized data system into electronic health records (EHRs) seems to be crucial to increase its prospects for success. Consider this reference point: referrals from primary care providers in one upstate New York county to its Central Intake dwindled once they switched to Electronic Health Records. Providers are incredibly busy, and those in the health care field started transitioning to electronic records and data transfers years ago. For them, it is an organizational cultural norm, and many would be likely reluctant to make referrals outside of an Electronic health records.

The data system that would support CI&R operations should play a pivotal role in supporting continuous quality improvement efforts and fostering trust among home visits providers. If participants commit to transparent data reports and quality initiatives, they would be more likely to believe that the CI&R system is achieving parity and operating in a way that places the interests of families at the forefront. Robust data systems enable data-driven conversationsand decision making based on facts, not egos or personal agendas. Any centralized database system would require ongoing CQI and implementation monitoring. Even the best-designed system could fall apart without diligent monitoring and quality controls, implementing subsequent course corrections as needed. One example would be to monitor the amount of time that it takes for referrals to come into the system and get processed through a screening, for a home visit appointment to be made, and for the first home visit to be completed and a family enrolled.

Technology Overview The technology platform that was used in the Pilot was Microsoft Dynamics CRM mobile client. The Microsoft Dynamics CRM mobile client option allows program to operate a case management solution in a secure, off-line mode as well as a secure on-line mode when connected to the organizations network. The following significant advantages are available under this option. Microsoft Dynamics mobile client versions are available for iOS, Android and Windows devices. Standard Microsoft Dynamics CRM solutions can be run in different environments. These mobile technologies offers both on-line and off-line modes; therefore internet data service plans are not needed.

 Data synchronization between mobile device client and CRM server can be controlled at the CRM entity level. Data synchronization can be automatic or manually initiated assesments. Synchronization policies provide rules to resolve data discrepancies: Server Wins, Device Wins, and User Manually Decides. The entire application database is stored on the mobile device with 256-bit AES encryption. Most native Dynamics CRM features are supported by the mobile clients. New application versions can be automatically deployed to devices when they are on-line. Communications with the CRM server are conducted via secure web services. Central support for authorizing a device to access a specific CRM application. Central support for de-

 7. The information gathered by the centralized data bases generates different reports and analytics

• Support clinical practice.
• Provide documentation of services received by clients enrolled in the program.
• Provide documentation of services received for which Targeted Case Management (TCM) component is reimbursed by Medicaid.
• Monitor the number of completed visits.
• Monitor mean visit length.
• Track referrals made to and from government and community services.
• Monitor time spent on program domains, e.g., personal health, environmental health, life
• Measure Program Effectiveness.
• Monitor Program Performance.
• Assist team supervisors in providing feedback to individual nurse home visitors on strengths and areas for improvement in implementing the program model.
• Assist administrators and program staff in planning quality improvements to enhance program implementation and outcomes attained locally.

Citations and References:

• https://www.ehidc.org/sites/default/files/resources/files/The_Role_of_Case_Management_in_Value-based_Health_Care
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326906/
• https://www.evariant.com/faq/why-is-healthcare-data-management-important
• https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-7843.2006.pto_368.
• https://www.ahrq.gov/research/findings/final-reports/iomracereport/reldata5.html
• https://www.archer-soft.com/en/blog/how-healthcare-data-management-overcomes-challenges-hospitals