Karen S. Martin, RN, MSN, FAAN
Martin Associates
Health Care Consultant
A. Why is a comparable PMRI required, and what functions does it serve?
I would like to respond from the perspective of the administrators and clinicians who are employed in community-focused settings (e.g. home health, public health, school, nursing center, ambulatory care/clinic, and case management programs). Clinician teams include multidisciplinary professionals and paraprofessionals, and provide wellness and illness services in partnership with their clients who are individuals, families, and groups. Most teams include nurses, physical therapists, registered dietitians, occupational therapists, social workers, speech-language pathologists, and home health aides. They use email, phones, and faxes to contact each other while they travel throughout the community. They also communicate with physicians, dentists, local community resources, and others involved in client care. They need a comparable record to share details about the concerns and needs of the clients they serve, the services they provide, and the outcomes of those services. Administrators need a comparable record to track essential clinical, staffing, program, and cost data as they generate reports and manage their agencies, and as they seek, obtain, and renew contracts with third party payers. While I will use the term client today, some of my community-focused colleagues use the term patient. Most refer to the client or patient record, rather than the medical record, and to health care terminologies rather than medical terminologies.
B. How comparable, precise, and accurate does a PRMI have to be? A structured record is an essential component of an automated, integrated community-focused information system. Administrators need precise and accurate detailed data before they can aggregate data accurately to calculate trends and risks. Complete and accurate record information is a requisite for successful continuous quality improvement programs, reimbursement, accreditation visits, and audits.
A. The purpose of the Omaha System is to provide a simple, yet comprehensive, research- based structure to describe and quantify the concerns of clients and the practice of nurses and other health care professionals.
B. The Omaha System was developed for use in community-focused service settings.
However, the number and type of users has expanded dramatically as the emphasis on a seamless continuum of health care and shift toward a community-focus for health care delivery increase. Omaha System users now include nurse-managed center staff, hospital-based and managed care case managers, nursing educators and students, acute care setting staff, nurse practitioners, and the international community.
C. Further examples of market acceptance include recognition by ANA, incorporation into the International Council of Nurses’ International Classification of Nursing Practice, inclusion in the JCAHO and NLN accreditation standards, increase in commercially available software, and publication in the health care literature and inclusion at major health care conferences. Because of the increasing community-focus throughout health care delivery and need for students to value standardized clinical data, the first college of nursing based their revised curriculum on the Omaha System in 1997. Note: more details about the Omaha System are included on the handout.
D. See 2B.
A. Developers of the six ANA recognized vocabularies meet regularly and present together at Conferences, in large part due to ANA’s efforts. The purpose and focus of the three parts of the Omaha System are similar to the other five vocabularies: the Problem Classification Scheme is similar to NANDA; the Intervention Scheme is similar to the Nursing Interventions Classification, the Home Health Care Classification, and the Patient Care Data Set; and the Problem Rating Scale for Outcomes is similar to the Nursing Outcomes Classification. Differences include timing of development, terminology, structure and level of detail, users, and research. For example, reliability and validity have been established for the entire Omaha System.
B. The Omaha System is intended to be used with other vocabularies. Because the National Library of Medicine’s Metathesaurus includes the Omaha System and the other five ANA recognized vocabularies, it is useful for literature searches. Many clinicians, administrators, and agencies use the Omaha System, the ICD-9-CM, and the CPT codes when they need medical diagnoses, billing codes, and clinical data for practice, documentation, and reimbursement. Outcome and Assessment Information Set (OASIS) was mandated by HCFA for use by all Medicare-certified home health agencies earlier this year, although the mandate has now been delayed. Many home health agencies integrated the OASIS data set with the Omaha System to produce a comprehensive assessment framework, and continued to use the Omaha System’s Intervention Scheme and Problem Rating Scale for Outcomes.
A. The Omaha System is a terminology designed to describe multidisciplinary clinical practice. Software developers who include the Omaha System in their products control their selection of platforms and the message format standards preferred within the industry.
A. Governmental agencies should help coordinate and disseminate terminology information as the NCVHS and the National Library of Medicine are doing. The ANA has developed a model that focuses on the evidence-based practice of nurses and addresses standards and guidelines for nursing vocabularies. Governmental agencies should coordinate efforts between the clinical work of professional organizations and the reimbursement issues of third party payers, review and update terminology standards and guidelines, and address security issues for the entire range of clients, health and illness services, and health care providers.
B. I will not attempt to suggest a schedule.
A. The National Library of Medicine’s Metathesaurus is one example of the benefits of government involvement. The Metathesaurus offers a crosswalk of the ANA recognized vocabularies to compare available literature. Federally funded research is another benefit as it enhanced the development, refinement, and extension of the six nursing vocabularies. For example, nursing educators, masters’ and doctoral students, and practitioners are currently conducting federally funded Omaha System research that will result in improved identification of client problems, selection of interventions, and measurement of client outcomes. Research will also result in refinements of the Omaha System, improved documentation and information systems, and an extension of nursing science.
B. & C. There is a need to increase coordination among terminology developers and between terminology developers and message standard developers. Discussions during the 1997 NCVHS meeting, this meeting, and others illustrate the value of testimony and discussions, and the need to consider issues involving all clients and the entire health care delivery system. A proactive, collegial attitude is needed to advance the work on these very complex issues. C. I will not attempt to suggest a schedule.I brought several overheads of the Omaha System if clarification is needed. I want to thank the NCVHS members for today’s invitation and look forward to continued involvement.