As many who know me would profess, I’m often an abstract thinker who tends to speak in metaphors with somewhat of a tinge of ‘tongue-in-cheek’ humor. Often I liken things to popular sci-fi characters and shows since I’m a self-professed nerd/geek (others would probably agree).  I find that this is just the way my brain works and to think otherwise is just not in my makeup. Often I get blank stares when I use my many metaphors and with others the connection is instantly made for what may have been a very challenging concept to sink in.

Within the CPM Framework™ and its Health Informatics Model, we address the entry of not only data but taking that data and making it something meaningful for all members of the interdisciplinary team. At the top of this hierarchy of data entry and utilization is wisdom, which is really the foundation for the meaningful use movement at the center of ARRA’s HITECH Act. Without wisdom driven by data, data for data’s sake is pretty much worthless as a driver of outcomes. I liken it to trying to drive a car without an engine. You could have the latest automobile import with all the bells and whistles, but without the engine you aren’t going anywhere (see, a metaphor!). In this case the engine is the wisdom that is the ultimate outcome of gathering data within any HIT software system.

Where wisdom is concerned we need to think of how we get to this level of data utilization. CPM’s evidence-based documentation and care planning within the CPM Framework™ is designed intentionally to drive outcomes by data entry grounded on the foundations of content and practice interoperability. Content interoperability involves the use of consistent professional data (content) that is exchanged accurately and effectively within the technological systems across the continuum of care.  Practice interoperability supports utilizing a professional practice framework with tagged-data to guide care and exchange patient information amongst the interdisciplinary team across all clinical settings (2009, 2010, 2011; CPM Resource Center).

What if I, as an RN, document a respiratory assessment that both shares, as well as documents, the same information (same row/observation/result) with the RT? Historically disciplines have documented their own assessments, evaluations, and interventions in a silo—with neither of the two concepts ever meeting. This was not uncommon in the paper world or even poorly designed online documentation systems already in use. Often the patient suffers from this design, as he or she has to live through numerous respiratory assessments over the course of the day since the RN and the RT don’t use the same set of data to capture the assessment detail. This same issue is pervasive with historical data about the patient. The CPM Framework™ and intentionally designed automation (IDA™) dictates that regardless of what member of the interdisciplinary team enters the data, the data is shared both with content AND practice interoperability. This paradigm shifts for many organizations can be challenging, but behind the movement is taking data and using it to drive wisdom for the patient and indeed outcomes related to overall interdisciplinary patient care. When all members of the care team are on the same page we actually begin to put the patient at the center, rather than centering on our individual disciplines activities dictated throughout the shift or episode of care.

To address the bewildering title and why I chose this metaphor “Practice and Documentation in the 4^th Dimension”, let me explain the first two dimensions. When we used to document on paper it was limited in that we entered data physically on the paper and signed/dated so we could locate the assessments and interventions we performed (documenting two dimensionally). This is usually done by each and every member of the healthcare team and often, if not always, was siloed and kept in different tabs in the same chart or in another chart. Many organizations have moved these two dimensional concepts online with flowsheets or notes functionality. Often with this migration we take common observations/rows/results and share them between documents so we minimize duplication within nursing documentation (most of the time allied health isn’t invited to the party)—this could be thought of documenting in the 3^rd dimension. What is different with CPM documentation and care planning is that it driven practice and documentation to the fourth dimension, which helps clinicians live practice interoperability. This fourth dimension is where few others have ventured. It’s sort of like “going where no one has gone before” to quote a famous pop vernacular. So, to all those have ventured to the 4^th dimension—“Second star to the right…and straight on ’til morning.”

Cheers,

Chad