Public health nurses (PHNs) are the largest group of nurses in the Irish primary care setting, providing population health screening, health promotion, acute and continuing care to a range of population subgroups. If PHN services are to direct healthcare in the most effective manner, and contribute to a knowledge management framework in primary and secondary care, quality information systems are crucial.  

The Population Health Information Tool (PHIT),¹ funded by the National Council for Nursing and Midwifery and the HSE, was developed and implemented by the PHN service in one local health office. 

The PHIT is a pragmatic paper-based framework for individual and population health data collection. It is a system of care planning, registration and caseload analysis. Interval and annual reports provide unprecedented information on public health, acute and chronic care, case review, case dependency and PHN performance indicators through a population health approach.  

Health information challenges identified and supported by recent evidence (from HIQA³) include the urgent need to develop national PHN core documentation data and the progression of the paper-based PHIT to an electronic solution.  This will allow the immediate availability of health information and facilitate migration to a national electronic health record (EHR).

The PHIT resource needs to be further developed so that it can be included in a future EHR. This involves mapping its core concepts to a clinical reference terminology such as SnomedCT. 

Consideration was given to the type of electronic solution chosen for the digiPHIT pilot in 2012, when project funding was awarded from the Institute of Community Health Nursing. The use of the digital pen system requires minimal new technology and digiPHIT pilot nurses advise that it supports the traditional nurse-patient interview process. The encrypted digital pen can capture and hold a significant amount of data before transferring to a laptop or PC. It will record and hold data even when out of range and data can later be transferred by either mobile phone or docking device.  

Digital forms can be configured for either digital pen only, tablet only, or for combined use, ensuring a choice in future data collection devices. Currently, the digital pen would seem to be the most cost-effective option. But, although it will significantly reduce the amount of paperwork, the pilot team are not yet convinced that the PHN nursing service will ever become part of a fully paperless system. 

The digiPHIT pilot phase has permitted the project team to continue with the collaborative approach that was established under the action research method used in the original PHIT project.¹  This has allowed the researchers time to investigate other similar projects. 

The Single Assessment Tool is a primary care project that has been agreed in the HSE National Service Plan. It will identify older people’s health and social needs, and promote access to information across healthcare services.²

Christine Chlad, ehealth project officer for NHS Western Isles, attributes the success of the Scottish digital pen project to the team effort and engagement of community nurses, who were heavily involved from the beginning of the project. The implementation of the community nursing digital pen system in the Western Isles of Scotland frees nursing time for more visiting and planning; captures data from patients at point of care; writes the information once; dramatically cuts administration time and allows immediate availability of information; and, crucially allows the patient to retain their notes.⁴

A HSE business case template to support the national roll out of an electronic version of the PHIT, supported by the HSE ICT Business Planning Unit, is at advanced draft level. Addressing the urgent need for national core PHN documentation, combined with evidence of active engagement by the PHN service with the development of a national electronic PHIT will be critical to the success of this business case.

References

1. McDonald A, Frazer K, Cowley S. Caseload management: an approach to making community needs visible. British Journal of Community Nursing 2013; 18 (3): 140-147
2. HSE. Single Assessment Tool to improve services for older people. Health Matters, Spring 2013; l 9 (1): 37
3. Health Information Quality Authority. Draft Standards for National Health Information Resources, HIQA, Dublin Regional Office, 2011. Available at:  www.hiqa.ie
4. National Health Service. NHS Western Isles Poster 2013 per email from Christine Chlad, ehealth project officer, Western Isles Hospital, March 2013