What about Care Planning?

In the world of hospital information technology, automated care planning is as under-appreciated and Computerized Physician Order Entry is over-hyped. Typically care planning software was used outside of the care process to produce documentation for Joint Commission (JCAHO) surveys. This is not the promise of good care planning software.

The care plan should be the plan produced by all disciplines, and led by the physician, that defines the goals of the patient stay and ensures that all of the key interventions take place at the optimal time in order to achieve those goals as quickly as possible (shortest length of stay) with the least amount of resources (lowest cost). The care plan is the hospital’s assembly line. I believe it is the most important element of nursing informatics.

Focusing on medication process automation and Computerized Physician Order Entry (CPOE), to the exclusion of good care planning automation, is like a car company that wants to build really good tires and engines, but does not have a way to build a car in a timely, defect-free manner.

I believe nurses, no – all care givers, need a single dashboard where they can see every intervention (including administering post-operative antibiotics, ambulating patients, assessing skin, patient education, etc,). That dashboard can function as the caregivers worklist presenting the tasks to be completed in the most efficient sequence by the most appropriate member of the care team

Additionally, all of the care plans could be monitored centrally to identify key interventions that have been missed (think population management for inpatients). This would allow interventions of key quality indicators before it is too late, as opposed to the status quo where the quality indicators are available 6 weeks after the patient is discharged and coded.

Why isn’t care planning an element of meaningful use? In my opinion, It holds more promise to manage cost and achieve outcomes than CPOE.

4 thoughts on “What about Care Planning?

  1. Do you see this software as a mashup of various checklists and plans like a NANDA nursing diagnosis and perhaps a surgical checklist such as http://www.nejm.org/doi/full/10.1056/NEJMsa0810119 ?
    It would be interesting in seeing additional analogies drawn from things like Toyota’s quality control methodology and their concept of “kaizen” or continual improvement used as a driver for adaption of such software. Especially if all care-givers of a patient care are looking at the same information and if someone spots a problem, can call it out. Add in opportunities such as mobile technology like iPads to access such software as the staff is moving the hospital and you have yourself a real winner.

  2. The care plan is also written by the team. The purpose of the care plan is to spell out the areas in which care is needed by the resident and to spell out the manner in which the staff plans to address and meet these needs.

  3. I couldn’t agree more. First problem I see is that everyone talks past each other as to the purpose and content of a care plan as well as who participates, uses it, and updates it. There is no accepted definition that I have seen.

    The second opportunity for improvement, from what I have seen of most vendor EHR products, is that inpatient care planning was an add-on that overlaps with orders and task management. In some, there is no cohesive linkage between orders and tasks (examples: nursing, physician). With these EHR products in-flight, it is difficult or impossible to make fundamental changes to foundational elements of the data model. Vendors need to define a cohesive model.

    Similar issues exist in the ambulatory world but the definition is even cloudier with registry interventions often being in third party tools. In the standards documents backing the early definitions of Meaningful Use, the CCD defines the Plan of Care as future orders. This may be able to be retrofit to work if there is a cohesive linkage with tasks.

    Hopefully, careful design of the next generation EHR data models with thought toward orders, tasks, and interventions will occur once there is an accepted definition.

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