NICU Notes: A Palm OS^® and Windows^® Database Software Product and Process to Facilitate Patient Care in the Newborn Intensive Care Unit

Abstract

This is a database software application for information a neonatologist routinely considers in the newborn intensive care unit (NICU). Users enter data at the point of care on a handheld device that also encrypts the data. Data management follows synchronization via an ODBC DSN to a secure Microsoft^® Access application. User feedback guides software modification over time. The poster illustrates the data model, the software user interface, and data management products.

The Problem

Though clinicians increasingly use NICU database software, the contribution of these tools to learning or clinical improvement is unclear.¹ Users may be satisfied if the new tool creates chart notes that are more legible and complete than when done by hand. But the impact of the software on the daily work may be far greater than this. There is an important interaction between the daily work and how workers model it.

Introducing an explic it data model and its software implementation alters the very processes of care the software aims to represent. Work flow and data structure, previously variable among clinicians, is now fixed. This may confound clinicians’ ability to apply and evaluate the software.² Further, evaluative criteria like chart note legibility are anchored in the old technology of hand written notes. To discover the possibilities for data management with the new technology calls for fresh ways of thinking about the work to be represented.³ Moreover, important features and problems of information technology may surface only after it is extensively put to use.³ So for NICU database software continually to improve user effectiveness and resonate with the work (itself, always changing), it seems sensible to invite user reflection and feedback to inform a continual process of modifying the software over time.^4,5

The Project

NICU Notes aims to facilitate daily patient care and promote learning by: a) ever more accurate data modeling; b) storing and retrieving increasing amounts of useful patient data; c) fostering decision support. With a focus on information that a neonatologist routinely considers, NICU Notes produces integrative notes (incorporating graphical data display to reveal patterns) that describe telephone consultations, admission, AM and PM rounds, and discharge. It automates physician signout, can report professional charges, informs NICU-level evaluation, and can support extramural databases like the Vermont Oxford Network.⁶ Data entry and management appear not to alter the duration of the user’s workday.

Users collect data on a Palm OS^® handheld running an application written in Pendragon Forms 3.2^®; the data are encrypted (PDA Defense^™). The emphasis for the handheld component is on point of care data collection and uniform terminology over data review. During synchronization, the data move via an ODBC DSN to a secure Mircrosoft^® Access application. NICU Notes differs in scope and aims from another NICU database that used the same software platform.⁷ NICU Notes is not a complete EMR, nor is it intended to replace all handwritten notes.

NICU Notes evolved in a NICU with about 800 admissions/year. A total of 7 users have now worked with the tool and incrementally applied it to the components of daily work, starting with the process of admitting a newborn. Users met periodically to discuss their improvement ideas. In the first 2 years, model and software revisions occurred at least monthly. Wireless synchronization is under study.