Nurse Developer Column

by Raymund John Ang, RN, MAN

Raymund is a medical-surgical RN with an interest in health informatics. He graduated with a BSN degree from the University of St. La Salle, and earned his Master of Arts in Nursing degree from the University of the Philippines Open University. He is currently the project lead of the Open Nursing Information System (Open-NIS) Project – with the aim of democratizing web application development for health professionals, especially nurses, using open source platforms, like WordPress.

COLUMN

Nurses rely on information from electronic medical records (EMR) and other sources of healthcare data to effectively and efficiently provide healthcare services to patients. The electronic medical record has various modules that cater to the needs of different healthcare professionals. Physicians use computerized physician order entry (CPOE) when placing orders. These orders are then available for nurses to browse through and carry out, for pharmacists to verify and prepare medications, and for medical technologists to analyze biological samples. Nurses use documentation and medical administration modules to scan patients’ medications and to chart entries. The EMR has become a multidisciplinary platform for healthcare professionals in terms of collaboration.

Prior to the electronic means of storing and accessing patient information, nurses used the nursing kardex to streamline the workflow of caring for patients. In the nursing kardex, nurses would be able to browse through patient information, such as name and demographics, allergies, chief complaints or reason for admission, resuscitation code, list of medications, and plan of care. This can be thought of as a cheat sheet when skimming through information of different patients. But, how can the concept of the “nursing kardex” still be relevant in the advent of the electronic medical record system?

There are at least three ways that the nursing kardex could be integrated today as a patient care summary for nurses.

First, the nursing kardex or patient care summary can be integrated as a module within the EMR itself. Presentation of healthcare data from the EMR database generally depends on who will be viewing the relevant information. For physicians, a presentation layout can be in the form of physician’s progress notes where patient information is laid out based on how physicians would want the history, laboratory and diagnostic results, and medical plan of care presented. This can vary depending on vendors or technical specifications from implementing healthcare institutions. For nurses, this can be in the form of a patient care summary or nursing kardex. The nursing kardex module would allow access to EMR database information relevant to the provision of nursing care. As with physician progress notes, the presentation layout would depend on default settings by the EMR vendor or requirements set forth by nurses who will be using the said module.

The second configuration for a patient care summary for nurses would be through application programming interfaces (API). An API is a programming script that allows external applications to interface or interact with the EMR application, particularly the database layer. An electronic medical record system may have API specifications that would allow an external application to view details in the database without having direct access to the EMR database. This is particularly useful in extending the reach of EMR applications to integrate custom-built applications that share data with the electronic medical record. The custom application need not be built using the same programming language as the EMR application, but, must have the right credentials to access the API to extend EMR functionalities.

The third and final configuration is the patient care summary for nurses as an entirely separate application from the electronic medical record system. This means the application does not have access to the EMR database, either directly or through an API, and has its own database and schema structure. The create-read-update-delete or CRUD operations within the application does not affect data stored in the EMR database. Being disconnected from the EMR database has its disadvantage – specifically, not being able to synchronize data between the two applications. However, having a separate application and database structure means the nurse developer has more flexibility in designing what and how data should be stored in the database based on user specifications. As an example, there may be trivial information that do not need to be included in the EMR, or synthesized information or processed knowledge from data in the EMR that would need human interpretation for data presentation.

The nursing kardex or patient care summary is a tool that is by and for nurses. Nurses should have a sense of ownership of the nursing kardex since it has been serving the needs of countless nurses for decades. The introduction of the electronic medical record system should not diminish the value of the nursing kardex in the clinical setting. Nurse developers should be creative on how they can integrate the concept of the nursing kardex into the electronic medical record systems being implemented in their respective institutions.

References

Hager, L., & Munden, J. (2008). Complete guide to documentation (2nd ed.). Ambler, PA: Lippincott Williams & Wilkins.

Jacobson, D., Brail, G., & Woods, D. (2012). APIs: A strategy guide. Sebastopol, CA: O’Reilly Media, Inc.

Richardson, L., Amundsen, M., & Ruby, S. (2013). RESTful Web APIs: Services for a changing world. Sebastopol, CA: O’Reilly Media, Inc.

Timby, B. K. (2009). Fundamental nursing skills and concepts (9th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.

White, L. (2005). Foundations of basic nursing (2nd ed.). Clifton Park, NY: Thomson Delmar Learning.