Running head:DATA FLOW DIAGRAM FOR PERINATAL FOLLOW …

Running head:DATA FLOW DIAGRAM FOR PERINATAL FOLLOW UP

PROGRAM

Data Flow Diagram Project For Perinatal Follow Up Program

at IWK Health Center

By:

Hanan Mohsen Alyafei

B00562259

[email protected]

Performed at:

IWK Hospital – Division of Neonatal-Perinatal Medicine of the Department of

Paediatrics

In partial fulfillment of the requirements of the Master of Health Informatics Program,

Dalhousie University

HINF 7000

Report of Internship for the period May 2- July 31, 2016

Date Submitted: July 15, 2016

mailto:[email protected]

DATA FLOW DIAGRAM FOR PERINATAL FOLLOW UP PROGRAM

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Acknowledgment

I would like to express my sincere gratitude to Dr. Michael Vincer for his supervision at

IWK and Dr. Walid El-Nggar for his guidance and support.

I want to thank Shelly McHugh for providing valuable insight and effort during the work.

Also, I would like to thank all the Perinatal Follow Up Program members for providing

their help to make the project a success.

I am deeply thankful to Dr. Samina Abidi for her effort and supervision for assisting me

in completing the internship project.

Endorsement

This report has been written by me and has not received any previous academic credit at

this or any other institution.

Hanan Mohsen Alyafei


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Table of Contents

1. Executive Summary ............................................................................................................ 4

2. Introduction .......................................................................................................................... 4

3. Organization Description .................................................................................................. 5

4. Perinatal Follow Up Program Description.................................................................... 6

5. The data flow diagram project scope: ............................................................................ 7

6. Internship Work Description ........................................................................................... 7 6.1 The Author’s Main Tasks .............................................................................................................. 7

7. The PFUP Challenges and Problems Description ....................................................... 9

8. The PFUP Data Flow Diagram Project Description ................................................ 11 8.1 Business Process Reengineering ........................................................................................... 11 8.2 Theories .......................................................................................................................................... 12

8.2.1 The Management Theory ................................................................................................. 12

8.2.2 Information and Communication Theory ................................................................... 12

8.3 The Importance of the PFUP data flow diagram Project ..................................................... 13

9. The PFUP Data Flow Diagram Description .............................................................. 14 9.1 Context Diagram .......................................................................................................................... 14 9.2 Level – 0 Diagram ........................................................................................................................ 15 9.3 Level – 1 Diagram ........................................................................................................................ 15

10. Recommendations .......................................................................................................... 15

11. Conclusion ....................................................................................................................... 16

12. Appendix A ...................................................................................................................... 18

13. Appendix B ...................................................................................................................... 19 a) The Perinatal Follow Up Program Level- 0 (Term Visit) Diagram- Part 1 ............................ 19 b) The Perinatal Follow Up Program Level- 0 (Extremely High Risk) Diagram- Part 2 .......... 20 c) The Perinatal Follow Up Program Level- 0 (Very High Risk) Diagram- Part 3.................... 21 d) The Perinatal Follow Up Program Level- 0 (High Risk) Diagram- Part 4 ............................. 22

14. Appendix C ...................................................................................................................... 23 a) The Perinatal Follow Up Program Level- 1 Diagram ................................................................ 23

19. Reference .......................................................................................................................... 24


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1. Executive Summary

The author wrote this internship report to provide and describe, in detail, her duties to

successfully achieve the data flow diagram project. This internship project was conducted

from May 2 to July 29 2016 for the perinatal follow up program at IWK Health Centre,

Halifax, Canada.

The internship opportunity provided the author on-the-job training, which linked the

academic health informatics knowledge with real world healthcare as IWK Health

Center. The internship’s experiences comprised of a variety of responsibilities and

multitasking abilities, which made it a valuable learning experience for the author.

Moreover, it was a great chance to learn how to bridge the information-communication

gap between the PFUP director and the PFUP team members, and to map an accurate

data flow diagram that reflects a real world scenario at PFUP. The PFUP is a very busy

environment dealing with complex patient health conditions, such as extremely high-risk,

very high-risk, and high-risk. The author dealt with various challenges to find suitable

methods to visualize the PFUP complex processes by data flow diagram. At the end of

the internship the author made a presentation for the PFUP team members to explain the

project work and the final product was delivered to the director of PFUP as context,

Level -0, and level –1 data flow diagrams.

2. Introduction

The Canadian Neonatal Follow-Up Network (CNFUN) is a collaborative

multidisciplinary team from Neonatal and Perinatal Follow-Up Programs from different


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hospitals and universities across the country. CNFUN aims to develop a standardized set

of assessments for high-risk infants to create a national database (The Canadian Neonatal

Follow-Up Network, 2009). Among Nova Scotia and Prince Edward Island, the Perinatal

Follow Up Program (PFUP) at the IWK Health Center provides the healthcare service for

most the eligible high-risk infants for the program. Moreover, PFUP at IWK Health

Center is collecting the patients’ development assessment information and saving it in the

PFUP Database. Only infants who are born at less than 29 weeks have their development

assessment information stored at CNFUN Database.

3. Organization Description

The IWK Health Center Website Homepage is very useful for the author to gain a lot of

information about this organization history. In 1909, the children’s hospital in Halifax

provided the healthcare for newborns, children, youth and women. Izaak Walton Killam

(IWK) Hospital opened in 1970 as a healthcare provider that provides high quality

medical care for women, children, and youth in the Maritimes. The IWK Health Center

and Grace Maternity Hospital merged in 1996. Finally, in 2000, the name of the hospital

was shortened to the IWK Health Center. The IWK Health Center has variety of medical

care: Primary Care, which is available for the patient by a direct access; Secondary Care,

which is required a referred from a family doctor; and Tertiary Care, which is the highly

specialized and complex medical care which is involved the advance procedures or

treatments. In a recent report indicated that between April 2014 and March 2015, the

IWK Health Centre has more than 3600 employees and 928 volunteers providing health

care to its patients (IWK Health Center, 2016).


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4. Perinatal Follow Up Program Description

The PFUP enrolls the high risk infants with health problems who meet certain criteria

such as born < 31 weeks gestation, < 1500 grams or less, and born with, or suspected to

have brain injury at birth. In addition, infants with some risk markers; such as meningitis

and cerebral imaging abnormalities of hemorrhage or infarction will be accepted (Vincer,

2011). PFUP provides developmental assessments for the enrolled infants and support the

infant’s family members by adequate health education materials, medical treatments, or

services to fulfill their developmental potential (Family and Newborn Unit, 2015). The

multidisciplinary team works in the PFUP to provide comprehensive sequential

neurodevelopmental assessments for the high-risk infants during their first 3 years of life.

The multidisciplinary team includes physicians, registered nurses, physical and

occupational therapists, nutritionists, and more healthcare professionals who work

together to assess the registered infants’ health conditions. The multidisciplinary team

will evaluate the infants’ health condition to determine the suitable follow-up plan as

Extremely High Risk, Very High Risk, or High Risk patient’s plan (Vincer, 2011). The

assessment clinic will be held ether at IWK Hospital Center or as a Travel Clinic

depending on the enrolled patient’s location. The Travel Clinic includes Queen Elizabeth

Hospital at Prince Edward Island, Cape Breton Regional Hospital at Sydney, and

Moncton Hospital at New Brunswick. During each assessment clinic, the

multidisciplinary team members collect all patients’ information in forms then they write

the assessment reports that are saved in a paper-based chart after each visit. The assigned

physicians will review the patient’s chart and evaluate all the multidisciplinary team

reports, and then they will dictate the final reports. The medical assistant will transcribe


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the dictated reports and save it in the paper chart. The director of the PFUP will select

some of the required patients information from different sources to enter the information

to the PFUP Database. These sources are the PFUP paper-base patient chart and several

Health Records from different hospitals either ‘Meditech’ electronic systems or paper

based records.

5. The data flow diagram project scope:

This internship project is aimed to visualize the current PFUP processes. The author

attended the development assessment clinics, rounds clinics, and meetings with the PFUP

team members, clinical leaders, and director to capture all the possible tasks and

processes that are conducted within the PFUP. The author used the Microsoft Visio

software to complete the PFUP data flow diagram project.

6. Internship Work Description

The internship report section will outline and describe the author’s roles, tasks and

responsibilities to complete the internship project at IWK.

6.1 The Author’s Main Tasks

The author’s tasks started at the 1st and 2nd week by attending the development

assessment clinics, meeting with multidisciplinary team members, and meeting the

director of the PFUP. The author collected the information about the PFUP and the

existing system initial workflow from the official website, and the materials that were

provided in the PFUP clinic during these two weeks. This step is very important to help


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the author to gain a full understanding about the medical services that are provided in the

PFUP. Additionally, the author’s roles, during the internship period, included:

1. Attended the development assessment clinics

2. Analyzed the existing PFUP system and workflow

3. Performed literature review to identify the PFUP problems and the evidence to

find best solution

4. Proposed two different ideas for the internship project for the PFUP director:

a. Implement an electronic survey to measure parental satisfaction with quality

of care in PFUP

b. Create data flow diagram for the PFUP as Business Process Reengineering

project

5. Met the PFUP director and team member to choose the needed and more suitable

solution to work on it during the internship period

6. Met the Dalhousie supervisor to confirm the project idea, which PFUP director

chose

7. Planned the business process-reengineering project timeline

8. Observed the details of the development assessment clinics workflow

9. Observed the PFUP team members office workflow

10. Used Data Flow Diagram techniques for the Business Process Reengineering

project

11. Used Microsoft Office Visio as Business Process Reengineering tool

12. Create Context Diagram for the PFUP

13. Create Level - 0 Diagram for the PFUP


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14. Create Level - 1 Diagram for each complex process in Level - 0 Diagram

15. Met PFUP clinic leader each week to review and confirm the finished work in the

Data Flow Diagram

16. Met PFUP director every 2 or 3 weeks to review and confirm the finished work in

the Data Flow Diagram

17. Met the Dalhousie supervisor each moth to review and confirm the finished work

18. Presented the Data Flow Diagram project presentation to the PFUP team members

at the end of the internship period

7. The PFUP Challenges and Problems Description

A literature review was conducted to identify the problems and challenges that PFUP is

facing during its long, and complex processes of patents’ assessments by using research

databases through Dalhousie University libraries and PubMed. The main challenges in

PFUP processes appear while the multidisciplinary team members were collecting the

patient assessment information in a paper-based chart, and selecting some of the patient

data from several ‘Meditech’ systems to save it into the two different databases (PFUP

database and CNFUN Database). The multidisciplinary team assesses the patients and

collects the data by the paper-based forms in their charts. Majority of the paper-based

charts have several disadvantages such as illegible handwriting, inadequate information,

redundancy of patient information, overflowing patient information in between sections,

incomplete documentation, and accessibility problems when the chart is used by one

team member during the development assessment visit (Roukema et al., 2006). These

problems also appear in the Electronic Health Records ‘Meditech’ that includes some


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PDF medical documents that were scanned and saved in the patient electronic health

records (Steurbaut et al., 2013). The PDF documents may include medical reports, test

requests, test results, and signed consents for different medical procedures that are saved

in patients’ electronic health records in one category. Unfortunately, these PDF

documents are not organized alphabetically, or by date, which makes searching for

patient’s information very hard and time consuming. In addition, these challenges are

increasing the amount of time assigned physicians and administrative assistants use to

review the patient chart, and several ‘Meditech’ systems to dictate and generate the final

PFUP development assessment report that is to be transcribed after each patient

assessment visit. The dictation step is a complex step, which requires more effort from

the physicians to gather patient information from different reports and sources, such as

the PFUP chart, or several electronic health records from different hospitals. This step

may increase the human error while collecting information from the handwriting

document information to be dictated and to be transcribed (Bowman, 2013). In addition,

the transcript step causes a lot of delay to finalize each patient report and add it to the

patient chart. The assigned physician and the PFUP database manager do the final step by

selecting the needed information from the final development assessment reports, and

other patient health records as a chart or ‘Meditech’ systems, then save it in both

databases. This step is done by assigned nurse who entering the information manually to

the databases. This step requires a great deal of time and more effort to be completed and

updated to the databases for all PFUP enrolled patients.


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8. The PFUP Data Flow Diagram Project Description

This internship report section describes the Business Process Reengineering (BPR)

method, theories, and the importance of PFUP data flow diagram project. The

HINF 6110 course, Health Information Systems and Issues, was the main source of

knowledge that the author applied in this project.

8.1 Business Process Reengineering

Business process reengineering (BPR) was defined as ‘the fundamental rethinking and

redesign of business processes to achieve dramatic improvements in critical

contemporary measures of performance such as cost, quality, service, and speed’

(Bliemel & Hassanein, 2004). The BPR project will be dependent on the business process

modeling that describes the PFUP data flow in a simple way to be useful for the PFUP

users, team members and the internship student. BPM is defined as ‘a set of related tasks

performed to achieve a defined business outcome’ (Wenhong & Alex, 1999, para. 6).

Business process modeling has main three elements - entities, objectives, and activities.

BPM helps to share the understanding of the process among health professionals, and

support the analysis of process behavior and performance. BPM supports designing new

processes for the existing system to continue its improvement, and providing a software

program to control processes in the future when needed (Wenhong & Alex, 1999). This

software has several business objectives, to ensure the delivery of high quality systems,

provide strong management controls, and maximize productivity.

During the internship period, the analysis phase was done with consistent development

between the context, Level-0, and Level-1 diagrams to produce the data flow diagram as


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a process model of a system. The author used the standard set of Gane and Sarson

symbols, which contains four symbols: processes, data flows, data stores, and external

entities to accomplish the PFUP data flow diagram project (Hoffer, George, & Valacich,

2011). The data flow diagram tool helps the author as a system analyst, and the users to

describe the information data flow among the performed activities, and where the

development assessment information is saved as main data storage in the PFUP (Jun,

Ward, Morris, & Clarkson, 2009).

8.2 Theories

The author traced back the BPR project to both Management Theory and Information and

Communication Theory. The author used business process reengineering knowledge and

the data flow diagram as an important communication technique and tool among system

analyst, end users, and system programmers.

8.2.1 The Management Theory

In 1880, Frederick Taylor indicated that process-reengineering methods would help the

manager to determine the best processes to perform the work and enhance productivity.

This theory supports the PFUP needed to reduce time consuming challenges as well as

effort. The PFUP data flow diagram will help the PFUP director to identify these

processes that cause problems and redesign the processes to be more productivity (Chen,

2001).

8.2.2 Information and Communication Theory

In 1940, Norbert Weiner theory supports a framework that is summarized in the

component of all information communication system: ‘ the information source, the


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transmitter, the channel, the receiver, and the destination’ (Tan, 2001). This theory

supports the PFUP needed to improve the communication between the manager, users

and data analyst. Better communication will improve the performance within the PFUP.

Moreover, the PFUP director future plan is to have a PFUP electronic system that collects

the patient development assessment data instead the PFUP paper chart. This future plan is

required for better communication between the IT developer, users, and managers. Also

required, is an accurate data flow diagram, which will help the IT developer system to

understand the PFUP environment to easily develop a system that will accomplish the

PFUP needs.

8.3 The Importance of the PFUP data flow diagram Project

The author highly recommends the data flow diagram for the PFUP director. The author

notices that the PFUP did not have any type of diagram to describe the PFUP workflow.

The data flow diagram provides a clear and simple workflow description to be

understood. The data flow diagram has essential role in designing a complex information

system. Also, it is important to be used to computer aided information system

development. The data flow diagram has a main goal that bridge the existing

communication gap between the information system developers, users, and managers by

a simple diagram that contains very understandable symbols for the team members and

users (Jankowski & Lloyd, 1998).

Data flow diagram project is an important graphical representation of the data flow for

each clinical unit and its processes. Data flow diagram has many benefits as

demonstrating the patient data flow for staff easily, as well as demonstrating the


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weakness in the workflow processes for managers. This will highlight the cause of

problems in the current environment. As a result, several solutions will be created to

improve the data flow for the clinical service to approach future needs. A data analyst

will visualize and compare both the current dataflow and the suggested solution dataflow

for PFUP to find more productive solutions and new opportunities to improve the

healthcare service in the PFUP (Keel & Jennings, 2016).

9. The PFUP Data Flow Diagram Description

This internship report section describes the final sets of PFUP data flow diagrams, which

are context, Level – 0, and Level - 1 diagrams.

9.1 Context Diagram

The context diagram is a simple representation of the entire PFUP system. This diagram

illustrates the interaction between external entities (eligible patients, family members,

PFUP database, CNFUN database) and the PFUP system boundary under a special

construction or process. This single process is labeled ‘0’ that presents the entire system

(PFUP) (see Appendix A for more information about the PFUP context diagram). This

diagram is known as a highest-level diagram, which will give an overview of the input

and the output information for the PFUP system. Appendix 1 illustrate the external

entities, which are:

1. Eligible patient for PFUP from different hospitals and their family members as input

information to the PFUP system

2. PFUP database as input information to, and output information from the PFUP

system


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3. CNFUN database as second output information from the PFUP system

9.2 Level – 0 Diagram

In Level – 0 the author constructed the diagram to develop further a model. The author

described the main PFUP development assessment processes by identifying all main sub

systems in the PFUP system. In this diagram the full illustration for the main processes,

the data stores, and data flow between these process are identify clearly (see Appendix B

for more information about the PFUP Level - 0). The Level -0 diagram required a lot of

effort from the author, the PFUP clinical leader, and director to finalize it as it is appeared

in Appendix B.

9.3 Level – 1 Diagram

The author identified all complex processes in Level – 0 diagram that need to be

decomposed. The Level – 1 diagram illustrates the decomposition processes as clear logic

data flow, from the input data to output data. The decomposition level as Level-1 shows

that each process has one input and one output data flow. This diagram illustrates a very

simple and clear description for the data flow processes that perform a very complex

process in Level - 0 (see Appendix C for more information on the PFUP level -1

diagram).

10. Recommendations

This project may help the PFUP to work forwards for future new project. The PFUP

needs an electronic registry and electronic data collection system as a solution to improve

the quality of the data collection and the perinatal development assessment follow up.

The electronic system will provide automatic updating of the development assessment


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data between the PFUP patient’s chart and database, which will improve the quality

outcomes and development assessment services (Craswell, Moxham , & Broadbent,

2013). Implementing an electronic data collection system will reduce the time spent to

search the chart for collecting information, human error, and information redundancy. It

will improve patient safety and patient data flow in the PFUP. Also, the system will

increase the productivity by retrieving information easily and the timeliness of PFUP

staff by rapid and accurate communication to over come the PFUP daily challenges

(Silow-Carroll , Edwards, & Rodin , 2012).

11. Conclusion

The author’s internship at IWK – division of perinatal department was challenging at the

beginning, but experience was the greatest reward. This opportunity helped the author to

apply the Health Informatics knowledge to solve real medical organization problems. The

author gained critical thinking skills to accomplish the solution as system analysis.

The project objective was accomplished as the author planned at the beginning of the

internship period. The author was able to fulfill tasks and assigned responsibilities during

the internship. The PFUP data flow diagram as the context, Level-0, and Level-1

diagrams were completed by the author and confirmed by the PFUP director. This project

work was done as part of system analysis duties to develop the data flow diagram to meet

both director and end users need.


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The PFUP at the IWK Health Center was established more than two decades ago to

provide development assessment for the high-risk infants. The PFUP was conducted as

standard procedures; however, this medical service was developed frequently to improve

efficiency. The PFUP workflow contains complex processes, which make the

visualization of the PFUP processes one of management’s priorities. This data flow

diagram project is the first and unique work to visualize the PFUP processes at IWK. The

completed data flow diagram will be very useful to improve the communication between

the PFUP team members, new team members, internship students, data analyst, and IT

system developers.

The author recommends continuing the future PFUP plan for creating an electronic

development assessment data collection system, which will be very useful for the PFUP.

The implementation of an electronic system will improve the PFUP outcomes and help to

store and retrieve the PFUP patients’ development assessment information safely and

easily. Also, the electronic system will create new paperless environment for the PFUP at

IWK Health Center.


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12. Appendix A

The Perinatal Follow Up Program Context Diagram


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13. Appendix B

a) The Perinatal Follow Up Program Level- 0 (Term Visit) Diagram- Part 1

Singed Consent and Patient Demographic Information

All Selected Patient

information

4.0

Enroll Patient and Manage Patient Information for PFUP

D1IWK

Health Records (MediTech File or Paper Chart)

25.0

Select Patient Assessment Information

D3 PFUP Patient Chart

11.0

Calculate and Determine Risk Level

9.0

Update Patient chart

13.0

Query all Patients Appointments at IWK Clinic

Updated information

Enrolled Patient information

Select Patient information

Level -0 PFUP Data Flow Diagram Part 1 + Term Visit Part

D2 Other Hospitals Health Records

(MediTech File or Paper Chart)

PFUP Database

All Patient New File

IWK Discharge Summary Request

Request Patient Appointments Details

Health Education Materials

Initial Scheduling

Information

3.0

Collect both The Signed Patient s Consent for PFUP/Patient Demographic

Information Patient Demographic Information

5.0

Create All enrolled Patient File for PFUP/Demographic information

Enrolled Patient Information

6.0

Create Kardex Patient Chart for PFUP

/Demographic information

New Patient Chart

8.0

Request & Collect Patient Discharge Summary & needed information

Dis

ch

arg

e S

um

ma

ry

Re

qu

est

Discharge Summary

IW

K D

isch

arg

e S

um

ma

ry

Collected Discharge Summary

Risk LevelCalculation/ Determination

Result

Demographic Patient Information

14.0

Request both Patient scheduling for PFUP plan- for 3 years, and Family Approved

Patient Appointments Information

Patient Appointments List

Request Approval by Mail/Phone

Approved Scheduling by Mail/Phone

17.0

Determine Eligible Patient for Term Visit or Development Assessment Clinic /

Rescheduling

16.0

Update Patient Chart for Scheduling PFUP Plan

Rescheduling Information

Updated

Eligible patient for PFUP and

Patient s Family Members

Request Signing Consent

Signed Consent

18.0

Review the Eligible Patient Information by Term Visit

Rescheduling Eligible Patient for Term Visit


Review Patient Information Request

Patient Information

23.0

Assess Patient Age < 4 Month by Cranial Ultra Sound

For Special Case

20.0

Assess Patient at Age < 4 Month by Term Visit - Nutrition

Reviewed Patient Information


21.0

Update Development Assessment Forms/ Report

For Term Visit

Patient Assessment Information by

Nutrition


Cranial U/S

Updated Development Assessment

Information – Term Visit

22.0

Recommend Health Education Materials by Multidisciplinary Team

23.0

Recommend Patient for Special Test or Treatment by Multidisciplinary Team

RequestSpecial test or

treatmentFor all PFUP

patients

RequestSpecial test or

treatment for IWK

Patient

RequestSpecial test or treatment for

other HospitalsPatient

Patient Information Results

Report Information

24.0

Update Patient Chart by Term Visit

Updated Information

1.0

Provide Education Material about PFUP at NICU 2.0

Create an Initial File for Eligible Patient Information

Patient Information CNFUN Database

27.0

Query about Patient Assessment Information for Patient who

born < 29 weeks

Patient Information Born < 29 Weeks

Selected Patient Information

Initial File for Patient Information

Request Demographic Patient Information

Request Patient

scheduling Information

Term Visit Determination

Scheduling PFUP Plan

19.0

Assess Patient at Age < 4 Month by Term Visit - Nurse

22.0

Assess Patient at Age < 4 Month by Retinopathy of Premature

For Special Case

Patient Assessment Information by Retinopathy of

Premature

Patient Assessment

Information byNurse

Requested Patient information


Requested Patient information


26.0

Categorize Patient Assessment Information to be stored in PFUP

Database or CNFUN Database

Request patient information born

< 29 weeks

Patient Information Requested result

Education Information

Request Patient Demographic Information

12.0

Organize Initial Scheduling for Patient Depending on their Risk Level

Risk LevelCalculation/

Determination Result

Risk LevelCalculation/ Determination

Result

15.0

Coordinate Patient scheduling for PFUP plan- for 3 years

Approved scheduling

Scheduling PFUP Plan



7.0

Update Patient Information for PFUP( chart or database)

Updated information to PFUP chart

Patient New Information from PFUP Chart

Patient New Information from PFUP

Database

Updated information to PFUP Database

PFUP Database

10.0

Request Needed Patient Information for the Risk Level Calculation

Request Needed Patient Information

Patient Information

Result

Request Needed Patient Information

Patient Information Result

Needed Patient Information for the Risk Level Calculation

Done by : Hanan Alyafei Master Health Informatics



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b) The Perinatal Follow Up Program Level- 0 (Extremely High Risk) Diagram- Part 2

28.0

Review Extremely High Risk Patient Information

By Navigator Nurse for the 1st Year Development Assessment Visits



Patient Information

Scheduling Extremely High Risk Patient Information

29.0

Coordinate Extremely High Risk Patient At Age +4 Months for Assessment Clinics

30.0

Assess Patient by Nurse

31.0

Assess Patient by Physician

32.0

Assess Patient by Physiotherapist

33.0

Assess Patient by Occupational Therapist

36.0

Update Development Assessment forms After +4 Months Visit


Coordinated time

Coordinated time

Coordinated time

Coordinated time

Patient Assessment Information by Physiotherapist

Patient Assessment Information by OT

Patient Assessment Information by Nurse

Patient Assessment Information by Physician

44.0


45.0


46.0


47.0


48.0

Assess Patient by Nutrition

Coordinated time

Coordinated time

Coordinated time

Coordinated time

50.0

Update Development Assessment forms After +8 Months Visit




Patient Assessment Information by Nutrition

51.0


52.0


53.0


54.0


55.0


Coordinated time

Coordinated time

Coordinated time

Coordinated time

57.0

Update Development Assessment forms for +12 Months Visit



Patient Assessment

Information by Nutrition

Patient Assessment

Information by Physiotherapist

40.0

Produce a Final Report For Each Development Assessment Visit

Updated Patient

Information After Each Visit


Final Report for each Visit

41.0

Select Some of the Development Assessment Information for All PFUP Patients

PFUP Database

Selected Information for All

PFUP Patients

39.0

Recommend Additional Test /Treatment/ Referral for IWK Patient or Other Hospitals

Patient

D2Other Hospitals Health Records

(MediTech file or Paper Chart)

D1IWK

Health Records(MedtiTech file or Paper Chart)

Other Hospitals Test Results

Updated Development Assessment Information

Request Test Send to Other Hospital

Request Test Send to IWK

IWK Test Results

43.0

Provide Education Materials Eligible Patient for PFUP and


Updated Patient Information

Education Material

58.0


By Navigator Nurse for the 2nd Year Development Assessment Visits


59.0


60.0


61.0


62.0


63.0

Assess Patient by Bayley only Patient Born <29 weeks Done By

Development Associate (DA) or

Occupational Therapist (OT)

Coordinated time

Coordinated time

Coordinated time

Coordinated time

65.0

Update Development Assessment forms for +18 Month Visit


Patient Assessment InformationBy Physician

Patient Assessment

Information by DA or OT

Patient Assessment

Information by OT

66.0


67.0


68.0


69.0


Coordinated time

Coordinated time

Coordinated time

71.0




Patient Assessment

Information by Nutrition



73.0


74.0


75.0

Assess Patient by Bayley(done by Occupational Therapist or

Development Associate )

76.0

Assess Patient by Physician if needed

Coordinated time

Coordinated time

Coordinated time

78.0

Update Development Assessment forms +36 Months Visit

PatientAssessment Information by Physician

Patient Assessment Information

by OT or DA


by Nurse



72.0


By Navigator Nurse for the 3rd Year Development Assessment Visits


Patient Information

34.0


Coordinated time


38.0

Review Patient Information by PFUP Rounds To determine additional

Test/ Treatment/Referral or Rescheduling Patient

Rescheduling

patient

Reviewed Information



Patient Information


35.0

Assess Patient by Other Specialist If Needed

Coordinated time

Patient Assessment Information by Other

Specialist

49.0


Coordinated time


Specialist

37.0

Update Patient chart after Development Assessments and Test results

56.0


Coordinated time


Specialist

Updated Patient

Information for +12 Months

Visit

42.0

Select the Development Assessment Information for PFUP Patients

Born < 29 Weeks



Selected Information for PFUP

Patients Born < 29 Weeks CNFUN

Database

Updated Patient

Information for

+4 Months Visit

Updated Patient

Information for

+8 Months Visit



Updated Patient


Visit

Updated Patient


Visit

Updated Patient


Visit

64.0


Coordinated time

70.0


Coordinated time

77.0


Coordinated time


Specialist


Specialist


Specialist

Level -0 PFUP Data Flow Diagram

Extremely High Risk Patient – Part 2

Done By: Hanan AlyafeiMaster Health Informatics



21

c) The Perinatal Follow Up Program Level- 0 (Very High Risk) Diagram- Part 3

79.0

Review Very High Risk Patient Information By Navigator Nurse for the 1st Year

Development Assessment Visits



Patient Information

Scheduling Very High Risk Patient Information

80.0

Coordinate Very High Risk Patient At Age +4 Months for Assessment Clinics

81.0


82.0


83.0


84.0


86.0

Update Development Assessment forms for+4 Months Visit


Coordinated time

Coordinated time

Coordinated time

Coordinated time


By Physiotherapist


By Nutrition

PatientAssessment Information

By Nurse


By Physician

95.0


96.0


97.0


98.0

Assess Patient by PhysiotherapistAMS

Coordinated time

Coordinated time

Coordinated time

100.0


PatientAssessment Information

by Nurse


By Physician


Physiotherapist

101.0


102.0


103.0


Coordinated time

Coordinated time

105.0

Update Development Assessment forms after +12 Months Visit


by Nurse


by Physician

106.0

Review Very High Risk Patient Information By Navigator Nurse for the 2nd Year




Patient Information

107.0


108.0


109.0


110.0


111.0

Assess Patient by Bayley If the patient was born < 29 weeks Done by

Development Associate

Coordinated time

Coordinated time

Coordinated time

Coordinated time

113.0

Update Development Assessment forms For +18 Months Visit



Patient Assessment Information by DA

Patient Assessment

Information by OT

114.0

Send Ages + Stages Questionnaire for Family Members – Very High Risk Patient

At Age +24 Months

115.0

Update Development Assessment forms depending on

the Parents – assessment Ages + Stages Questionnaire

At Age +24 Months



117.0


118.0


119.0


120.0

Assess Patient by Bayley Done byDevelopment Associate or

Occupational Therapist

Coordinated time

Coordinated time

Coordinated time

122.0

Update Development Assessment forms for +36 Months




DA or OT





116.0

Review Very High Risk Patient Information By Navigator Nurse for the 3rd Year



Patient Information

Eligible Patient for PFUP and Patient s Family Members

New Questionnaire forms

Filled Questionnaire Assessment Information

85.0


Coordinated time


Specialist

99.0


Coordinated time


Specialist

90.0


Updated Patient




91.0


PFUP Database


PFUP Patients

89.0


Patient



D1IWK




Request Test/ Treatment / Referral

Send to Other Hospital

Request Test/Treatment / Referral

Send to IWK

IWK Test Results

94.0



Education Material

88.0



Rescheduling patient

Request


93.0


Born < 29 Weeks





Database

87.0



104.0


Coordinated time


Specialist

92.0

Schedule Patient for Additional Development Assessment Visit

If Needed


Scheduling Additional Visit Information

Updated Patient


Visit

Updated Patient

Information for

+8 Months Visit

Updated Patient


Visit

112.0


Coordinated time


Specialist

Updated Patient


Visit

121.0


Coordinated time


Specialist

Updated Patient Information for

+36 Months Visit

Updated Patient

Information By Ages + Stages Questionnaire

at age

+ 24 Months



Done By :Hanan Alyafei Master Health Informatics


Level -0 PFUP Data Flow Diagram

Very High Risk Patient – Part 3


22

d) The Perinatal Follow Up Program Level- 0 (High Risk) Diagram- Part 4

123.0

Review High Risk Patient Information By Navigator Nurse for the 1st Year




Patient Information

Scheduling High Risk Patient Information

124.0

Coordinate High Risk Patient At Age +6 Months for Assessment Clinics

125.0


126.0


127.0

Assess Patient by Physiotherapist AMS

128.0


130.0

Update Development Assessment forms for +6 Months


Coordinated time

Coordinated time

Coordinated time

Coordinated time




by Nurse


By Physician

139.0

Send Ages + Stages Questionnaire for Family Members - High Risk Patient

At Age +12 Months

142.0


143.0


144.0


145.0

Assess Patient by Bayley If Patient < 29 Week

Done by Development Associate

Coordinated time

Coordinated time

Coordinated time

148.0

Update Development Assessment formsFor +18 Months Visit



Patient Assessment

Information by DA


151.0

Review High Risk Patient Information By Navigator Nurse for the 3rd Year




Patient Information

152.0


153.0


154.0

Assess Patient by OccupationalTherapist

157.0

Update Development Assessment forms For +36 Months Visit


Coordinated time

Coordinated time




146.0


Coordinated time


155.0

Assess Patient by Bayley Done by Development Associate or

Occupational Therapist

Coordinated time

Patient Assessment Information by DA or OT

141.0

Review High Risk Patient Information By Navigator Nurse for the 2nd Year



Patient Information


149.0

Send Ages + Stages Questionnaire for Family Members - High Risk Patient

At Age +24 Months




140.0



At Age +12 Months

Eligible Patient for PFUP and Patient s Family Members



150.0



At Age +24 Months

Eligible Patient for PFUPAnd Patient s Family Members



129.0


Coordinated time


Specialist

147.0


Coordinated time


Specialist

134.0


Updated Patient




136.0


PFUP Database


PFUP Patients

133.0


Patient



D1IWK




Request Test/ Treatment / Referral

Send to Other Hospital

Request Test/Treatment / Referral

Send to IWK

IWK Test Results

138.0



Education Material

132.0



Rescheduling patient

Request


137.0


Born < 29 Weeks





Database

131.0



135.0

Schedule Patient for Additional Development Assessment Visit

If Needed


Scheduling Additional Visit Information

Updated Patient


Visit

Updated Patient


Visit

Updated Patient


Visit

156.0


Coordinated time


Specialist

Updated Patient


Visit

Updated Patient

Information By Ages + Stages Questionnaire

at age

+ 12 Months

Done By :Hanan AlyafeiMaster Health Informatics


Level -0 PFUP Data Flow Diagram High Risk Patient -Part 4


23

14. Appendix C

a) The Perinatal Follow Up Program Level- 1 Diagram

Initial scheduling plan for 3 years

17.1

Review Re-Scheduling patient Information and their Risk Level

17.4

Scheduling patient for Development Assessment

17.3

Scheduling Patient for Term Visit

17.2

Determine Eligible patient for Term Visit or Development Assessment Visit

Reviewed Patient

information

Determined Patient for Development Assessment

Determined Patient for Term Visit

17.5

Send Scheduling Time to be approved by Patient Family Member



17.6

Re-schedule New Visit Time for No Show Patient Family Member 17.7

Send Reminder for Patient Family Member at Least 3 Days Before Appointment

17.9

Determine to Opt Out No Show Patient Family Member After 3rd No Show times

17.10

Update PFUP database and PFUP chart to Opt Out Patient File

D3 PFUP Patient Chart PFUP Database

17.8

Update the Patient PFUP chart for scheduling Patient

Term Visit Schedule Development Assessment Schedule

Scheduling Patient

Appointment Approved

Reminder Before The Appointment

Scheduling Patient

Rescheduling Time

Reminder Before The Appointment

Rescheduling Time

Opt out Determination

Opt Out Patient File Opt Out Patient File

Level- 1 Data Flow Diagram Decomposition for The (17th ) Process Scheduling Patient for 3 Years Plan


24

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