The New York State Office of Mental Health Is Deploying Tablet Pcs Running Microsoft Windows

Mental Health Provider Streamlines Incident Reporting with Tablet PCs

Published: November 2002

The New York State Office of Mental Health is deploying Tablet PCs running Microsoft® Windows® XP Tablet PC Edition to clinical staff responsible for managing incident reporting and investigations. Instead of recording findings on paper to rekey later, clinicians and clinical risk managers can carry the Tablet PCs right into the examination room, or use them on the ward to gather information. Mobile access to OMH’s incident management and reporting system ensures that users efficiently and accurately collect incident findings and that incident information is saved as soon as it is collected.

Situation

New York State has a large, multifaceted mental health system that serves more than 500,000 individuals each year. The Office of Mental Health (OMH) operates 28 psychiatric centers across the state, serving both inpatients and outpatients. It also regulates, certifies, and oversees more than 2,500 programs that are operated by local governments and nonprofit agencies.

The Office of Mental Health has a complex and diverse computing infrastructure that must meet the information technology needs of dispersed hospitals, outpatient clinics, local patient providers, and a mobile workforce. OMH has a production wireless computing environment consisting of a mixture of 802.11 (primarily at the Central Office) and CDPD devices.

OMH is constantly reevaluating and piloting new technologies with the ultimate goal of improving patient care, and it strives to maintain a flexible infrastructure that easily accommodates new technologies. To that end, OMH had tested deploying personal digital assistants (PDAs) to field clinicians so they could download patient, clinical, and medical records. However, the agency quickly found that PDAs offered less functionality than it required.

When OMH heard about Tablet PCs running the Microsoft® Windows® XP Tablet PC Edition operating system, it decided to use the Tablet PC to evaluate the latest evolution of the notebook PC as a platform for mobile patient care applications. This time the agency would be working with Microsoft’s most advanced desktop operating system, plus additional features to enable pen-based computing in a lightweight “Slate Tablet PC” form factor that weighs less than three pounds. “The Tablet PC is not just a PDA replacement,” says Mark Mitchell, Programmer, OMH. “It provides the full power and functionality of a regular business notebook PC that can be used on the ward, at the office, or at home.”

The Office of Mental Health chose the clinical risk management–incident process for the RAP project. Historically, staff had followed a paper-based incident reporting process. Recently, OMH created a proprietary, Microsoft Visual Basic®–based application called the New York State Incident Management & Reporting SystemTM SM (NIMRSTM SM), to replace the paper-based process and to facilitate the reporting, tracking, and analysis of incidents that endanger the safety and well being of patients. However, the absence of a suitable mobile computing platform for the NIMRS application has meant that staff must still rely in part on paper recoding. “The Tablet PC project enables us to realize the paperless potential of NIMRS and opens possibilities for further development,” says Jayne Van Bramer, Director of the Bureau of Quality Management.

Staff first record incidents on a paper form that is reviewed by several levels of staff before being entered into NIMRS. In conducting investigations of incidents, clinical risk managers rely on their handwritten notes, which are later typed into a document. “Typing data into a desktop computer while conducting an examination or interview would be intrusive to the process and is not practical. This plus the lack of wireless connectivity on the wards limited the mobility needed by staff to use NIMRS in the way it was intended—dynamically and in real time,” says Cindy Sherwood-Judd, Mental Health Program Specialist.

Clinical risk managers, responsible for determining if a follow-up investigation is required, had also been using pen and paper during interviews and while taking statements from witnesses. Delays in getting the data into NIMRS meant that there were also delays in making that information available to other staff with appropriate security rights to access the data remotely.

Solution

The Office of Mental Health deployed the Fujitsu Stylistic Tablet PC to two user groups in a proof-of-concept project to assess the potential benefits of loading NIMRS onto a tool that nurses, clinicians, and clinical risk managers can carry and use anywhere on the OMH wards. The agency chose two wards in a juvenile facility and a ward for high-risk patients in an adult facility. “In order to take full advantage of the built-in wireless access and mobility of the Tablet PC, OMH set up these wards with 802.11b access points secured with Virtual Private Network encryption between the Tablet PCs and the wired, private network,” says Mark Bilanski, Data Communications Specialist. “In addition, to boost the wireless connectivity range we installed Aironet 350 Wireless LAN Adapters.”

The first user group, including doctors and nurses, accesses NIMRS on shared units. The second group, the clinical risk managers, have access to NIMRS and Microsoft Office XP Professional, using the Tablet PC as a general productivity tool to carry to meetings, record minutes, send and receive e-mail, and take statements from witnesses. The pilot is still ongoing and OMH is assessing its results.

Working with Microsoft Consulting Services, OMH is extending NIMRS with pen and ink capabilities by using the customized ink control in combination with the full inking application programming interface that comes with Microsoft Windows XP Tablet PC Edition. As a first step, Tablet PC users are taking advantage of the handwriting recognition engine to allow them to write directly on the Input Panel at the bottom of the screen for automatic conversion into text within the appropriate NIMRS narrative field. User groups are pleased to see improvements in handwriting recognition and look forward to further technological refinements.

“We were able to port our existing application quickly and easily to the Tablet environment using Windows XP Tablet PC Edition, ” says Chip Felton, Chief Information Officer, New York State Office of Mental Health. “The custom software controls added to supply ink to the NIMRS narrative fields seamlessly interact with the Visual Basic COM layer and minimally intrude into the established production code base.”

Benefits

“The mobility, power, and ease of use offered by the Tablet PC are key to developing a paperless risk management system and improving quality assurance,” says Nancy Gutterman, Director of Application Development and MIS. “We expect to streamline the incident management workflow and facilitate incident investigations.”

Improving Information Gathering

Nurses responding to an incident on a ward can take the Tablet PC with them into the examination room and enter initial findings directly into NIMRS. Similarly, physicians, many of whom are used to writing notes during examinations, can also enter their findings using the stylus.

“The Tablet PC can help staff to easily access NIMRS when they need it—while dealing with the immediate aftermath of an incident. Its ease of use and portability mean that the Tablet PC will help staff gather information quickly and easily using a familiar input tool,” says Gutterman. “NIMRS has built-in business rules that ensure that staff follow the proper procedure and fill out the requisite information. Now that the staff have access to NIMRS on the Tablet PC, we believe information will be gathered more efficiently,” says Van Bramer.

Streamlining Incident Management

Other staff members, including the ward administrator and the team leader, are involved in completing the incident form in NIMRS before it reaches the clinical risk manager. In the past, this meant that pieces of paper and files were handed from one person to the next. Using the Tablet PC eliminates the paper-based steps and provides the added benefit of no longer requiring a data entry clerk or nurse to rekey the data into NIMRS. Now, every time a person enters information into the incident report on the Tablet PC, that data is automatically saved into the NIMRS database.

“With full implementation of the Tablet PC and a wireless LAN environment, we would have a cumulative, real-time dynamic record of the incident management process available to management with the requisite security,” says Gutterman. “So, for instance, when executive staff arrive in the morning and want to see what incidents, if any, have occurred overnight, they could simply run a report in NIMRS and know that the information is current and up-to-date.”

The Tablet PC also makes the NIMRS data available to clinical risk managers when they conduct ancillary investigations subsequent to the incident. Using the Tablet PC, risk managers can draw upon the NIMRS data during follow-up interviews with witnesses and use the inking capability for taking notes during interviews, as well as for taking notes at Incident Review Committee meetings. “Using the Microsoft Windows Journal note-taking utility, clinical risk managers no longer have to rekey minutes and type a separate committee word-processing document,” says Van Bramer. “The Tablet PC provides an easy way to ensure a more comprehensive summary of findings within NIMRS.”

Future Plans

The Office of Mental Health plans to further ink-enable NIMRS to facilitate medical examinations and information gathering on the ward. For example, physicians could draw an image of a body to more accurately delineate his or her findings, and when the narrative fields in NIMRS are ink-enabled, users can write directly on the form.

Other plans include ink enabling a separate application, called Special Investigations, for clinical risk managers to use for incidents that warrant intensive review. The project will involve the same Clinical Risk Managers. Instead of needing to commit the details of critical investigative steps to memory or having to consult a investigations manual, users will be prompted to follow the requisite policies and procedures by using the application loaded on the Tablet PC, gathering information in real time and collecting witness statements using the inking capability.

The Office of Mental Health is also working with county mental health authorities in a third pilot. Clinicians will carry Tablet PCs, loaded with four ink-enabled assessment forms and a calendaring function, to help them coordinate services and create individual care plans for individuals living in the community who require intensive mental health services. The pilot will assess the utility of the Tablet PC platform and the ink-enabled assessments to facilitate care coordination by field-based clinicians.

“We look to technology to improve the provision of health care services,” says CIO Felton. “The mobility and versatility of the Tablet PC provide us with a valuable new tool that may assist us in many areas of patient care.”

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