1. University of Oklahoma Health Sciences Center
A Nurse-Operated PDA-Based Preventive Services Reminder System and Registry
James W. Mold, M.D., M.P.H.
Zsolt Nagykaldi, Ph.D.
University of Oklahoma Health Sciences Center

2. Oklahoma Center for Family Medicine Research
In collaboration with Computer Risk Managers, Inc.
Funding provided by:
Oklahoma State Medical Association -Education and Research Foundation
OSMA – Physician’s Campaign for a Healthier Oklahoma
Oklahoma Health Care Authority
Agency for Healthcare Research and Quality

3. Preventive Services Reminder System
Provides individualized reminders to office nurses regarding needed immunizations and other primary and secondary preventive measures (e.g. EPSDT, mammography)
Captures information on services provided as well as patient demographics, risk factors, contraindications, and prior services received, and stores it in a central registry

4. Principles of Immunization Delivery in Private Practice
Physician must believe it’s important
Responsibility must be delegated to someone else (nurse)
Physician must provide ongoing oversight and reinforcement

5. Features of the Preventive Services Reminder System
Physician requested (Oklahoma Physicians Resource/Research Network (OKPRN)
Nurse operated (PDA’s)
Printed report of services due and services provided for review by physician at time of visit

6. Components Central file server running SQL
Decision rules on the server and linkage programs written in Java
PDA running PenDragon Internet Forms
Local PC connected to the internet
Local printer with infrared port

7. Work Flow
Nurse uses PDA to identify patients to be seen the next day (from list of patients stored in PDA); cradles the PDA and synchronizes it (1 minute)
Central registry/database receives information; generates a list of services needed by each patient
At visit, nurse records services given and updates risk factors, contraindications, and past services received; prints a report for the physician/chart
At the end of the day, synchronizes to download new information to registry

8. Decision Rules
Determines whether patient is at risk for each of a set of preventable diseases (based upon age and risk factors)
If so, determines whether there are any contraindications to each of the preventive measure(s) related to that disease
If not, determines whether patient has received the preventive measure(s) within the recommended time frame

9. Preventive Services Included
All common immunizations (child and adult)
EPSDT/WCC
Seat belts/bike helmets
Sun exposure advice
Smoking

10. Preventive Services Included (cont.)
Pap smear
Cholesterol evaluation
Mammography
Colon cancer screening
Note: Decision rules are based upon CDC (immunizations), USPSTF, PPP, and/or Oklahoma Medicaid (EPSDT)

11. Immunization Information Captured
Type of vaccine
Product
Manufacturer
Lot number
Date given
Given by ______
Program uses pull-down menus and defaults
*Slide added since handouts were printed

12. Current Status
Initial test of efficacy favorable (nurses used it and it appeared to increase preventive services)
Ready for beta testing with 10 intervention and 10 control clinician-nurse teams – begins in November

13. Linkage with Oklahoma State Department of Health’s OSIIS Registry
We are working with the Oklahoma State Department of Health to link and hopefully eventually merge the two registries
Plan to begin to test data exchange in November

14. Advantages Over OSIIS Quicker (we think) Portable
Decision rules include risk factors and contraindications
Other preventive services included
*Slide added since handouts were printed

15. Planned Enhancements Postcard reminder system Interfaces with EMR’s
Card-sized CD for patients
More robust health risk appraisal functions
*Slide added since handouts were printed

16. CONTACT INFORMATION
Jim Mold, M.D.
900 NE 10th St.
OKC, OK