Royal New Zealand Plunket Society Inc PlunketPlus ...

Royal New Zealand Plunket Society Inc PlunketPlus Requirements Specification

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Royal New Zealand Plunket Society Inc

PlunketPlus

Information System

Requirements Specification

Version 1.0



Table of Contents

1 Executive Overview ......................................................................................... 5

2 Introduction ................................................................................................... 6

3 Child Health Outcomes .................................................................................... 8

3.1 Plunket‟s Vision and Mission ......................................................................... 8

3.2 PlunketPlus Vision ...................................................................................... 8

3.3 PlunketPlus and its Four Pillars ..................................................................... 9

3.4 Improved Outcomes for Children .................................................................. 9

4 Background ...................................................................................................11

5 About Plunket ................................................................................................13

6 Key Plunket Concepts and Definitions ...............................................................15

7 Current Systems ............................................................................................25

7.1 As-Is Processes .........................................................................................25

7.2 Current Application Systems .......................................................................25

7.3 Current Data .............................................................................................26

7.4 Current Volumes .......................................................................................28

7.5 Technology Environment, Current and Planned .............................................28 7.5.1 Description of Current Plunket ICT Environment ......................................28 7.5.2 WAN Infrastructure ..............................................................................29 7.5.3 Systems Infrastructure .........................................................................30 7.5.4 PC Infrastructure .................................................................................31 7.5.5 Business Continuity, Disaster Recovery...................................................32

8 Requirements Definition .................................................................................33

8.1 Overview ..................................................................................................33

8.2 How Software Providers Should Read and Respond ........................................34

8.3 Requirement Numbering ............................................................................35

8.4 Ranking of Requirements............................................................................35

9 PlunketPlus Overview .....................................................................................36

9.1 PlunketPlus at a Glance ..............................................................................36

9.2 To-Be Process Scenarios.............................................................................38 9.2.1 Parent, Caregiver Role ..........................................................................38 9.2.2 Staff Role............................................................................................42 9.2.3 External Providers ................................................................................48

9.3 Screen Displays and Data Entry ..................................................................49 9.3.1 Client Contact Summary .......................................................................53 9.3.2 Well Child Health History ......................................................................56 9.3.3 Well Child Core Contact ........................................................................59 9.3.4 Additional Contact – Face to Face ..........................................................62 9.3.5 Group Contact .....................................................................................65 9.3.6 Contact – Volunteer Home Visit .............................................................68 9.3.7 PAFT ..................................................................................................70 9.3.8 B4 School Check ..................................................................................72 9.3.9 PPNAP ................................................................................................75

10 Standards Compliance Requirements ................................................................78

11 Data Requirements ........................................................................................83

11.1 Overarching Data Requirements ..................................................................84

11.2 Conceptual Data Model...............................................................................90 11.2.1 Context Diagram .................................................................................92 11.2.2 Person and Organisation .......................................................................93 11.2.3 Plunket Organisation .......................................................................... 101 11.2.4 Plunket Group ................................................................................... 103



11.2.5 Client ............................................................................................... 106 11.2.6 Event ............................................................................................... 110 11.2.7 Contracts and Service Delivery Plans .................................................... 114 11.2.8 Client Health Information and Actions ................................................... 118

11.3 Data Volumes - Future ............................................................................. 122

11.4 How Plunket will Store the Data ................................................................ 123

11.5 Retention, Disposal and Archiving of Data .................................................. 125

12 Functional Requirements ............................................................................... 127

12.1 Workflow Requirements ........................................................................... 127 12.1.1 Message Board .................................................................................. 129 12.1.2 Actions ............................................................................................. 131 12.1.3 Persons ............................................................................................ 132 12.1.4 Roles ................................................................................................ 132 12.1.5 Availability ........................................................................................ 133 12.1.6 Assignments ..................................................................................... 133 12.1.7 Reminders ........................................................................................ 135 12.1.8 Escalations ........................................................................................ 136 12.1.9 Other Workflow Requirements ............................................................. 137

12.2 Decision Support Requirements ................................................................. 138 12.2.1 Decision Support – Service Delivery Plans ............................................. 139 12.2.2 Decision Support – Clinical Advice ........................................................ 140

12.3 To-Be Process Flowchart........................................................................... 141

12.4 To-Be Processes ...................................................................................... 144 12.4.1 Incoming Referral .............................................................................. 146 12.4.2 Schedule Contact ............................................................................... 152 12.4.3 Client Transfer ................................................................................... 158 12.4.4 Incoming Communication ................................................................... 164 12.4.5 Contact ............................................................................................ 167 12.4.6 Prepare for Contact ............................................................................ 178 12.4.7 Enrolment ......................................................................................... 181 12.4.8 Identify Follow-up Actions and Update Service Delivery Plan ................... 184 12.4.9 Schedule Next Contact ....................................................................... 186 12.4.10 Make Referrals or CYF Notifications ...................................................... 188 12.4.11 Advise Referral Outcome .................................................................... 191 12.4.12 Make Recommendations ..................................................................... 194 12.4.13 Action Referral................................................................................... 196 12.4.14 Other Non-Contact Action ................................................................... 198 12.4.15 Outgoing Referral or CYF Notification .................................................... 200 12.4.16 Case Manager Plunket Nurse Responds to a Clinical Alert ........................ 202 12.4.17 Case Manager Plunket Nurse Responds to Request for Client Information . 205 12.4.18 Case Manager Plunket Nurse Updates EHR ............................................ 208 12.4.19 Referral Feedback .............................................................................. 210 12.4.20 Raise Clinical Alert ............................................................................. 216 12.4.21 Reminders to Clients .......................................................................... 219 12.4.22 Set Up Scheduled Contact ................................................................... 223 12.4.23 Update Records ................................................................................. 226 12.4.24 Connecting Client to Other Plunket Services .......................................... 229 12.4.25 Unplanned Service Delivery Staff Absence ............................................ 232 12.4.26 Discontinuation from a Plunket Service ................................................. 235

12.5 PlunketPlus Portal .................................................................................... 240

12.6 Interoperability with Other Systems ........................................................... 243 12.6.1 Transfer of Care ................................................................................ 243 12.6.2 Interoperability with Other Plunket Systems .......................................... 257 12.6.3 Interoperability with External Systems ................................................. 262

12.7 Changes to Other Systems ....................................................................... 267

12.8 Business Rules ........................................................................................ 267 12.8.1 Business Rule Functionality ................................................................. 267 12.8.2 Specific Business Rules ....................................................................... 267



13 Non-Functional Requirements ........................................................................ 271

13.1 Privacy ................................................................................................... 271

13.2 Security ................................................................................................. 277

13.3 The Health Network ................................................................................. 282

13.4 Access to Plunket and Client Information .................................................... 283

13.5 Reporting ............................................................................................... 284

13.6 Operational Reporting Requirements .......................................................... 284

13.7 Aggregated Reporting Requirements .......................................................... 287

13.8 Individual and General Reporting Requirements .......................................... 288

13.9 Reporting - General ................................................................................. 289

13.10 System Availability and Performance ......................................................... 289

13.11 User Devices ........................................................................................... 289

13.12 User Interface ......................................................................................... 291

13.13 Change Management ............................................................................... 292

13.14 Technology Infrastructure Requirements .................................................... 293

13.15 Implementation Approach ........................................................................ 295 13.15.1 General Implementation Approach ....................................................... 295 13.15.2 A Possible Sequence of Functional Steps ............................................... 295

13.16 Data Migration ........................................................................................ 297

13.17 System Support ...................................................................................... 298

13.18 Training ................................................................................................. 298

14 Appendix A: Plunket Organisation Chart ......................................................... 299

15 Appendix B: Data Dictionary ......................................................................... 300

15.1 Clinical Dictionary .................................................................................... 300 15.1.1 Client Contact.................................................................................... 300 15.1.2 Health History (Core 1)....................................................................... 311 15.1.3 Child Client record ............................................................................. 314 15.1.4 Caregiver Client Record ...................................................................... 317 15.1.5 Maternal Health (Core 1) .................................................................... 319 15.1.6 Paternal Health .................................................................................. 321 15.1.7 Family data (Core 1) .......................................................................... 321 15.1.8 Physical Assessment (Core 1) .............................................................. 323 15.1.9 Parenting Education Topics ................................................................. 325 15.1.10 Antenatal Parenting Education Programme ............................................ 327 15.1.11 Volunteer Support .............................................................................. 328 15.1.12 Parent as First Teachers - PAFT ........................................................... 329 15.1.13 Plunket Postnatal Adjustment Programme ............................................. 331 15.1.14 Before School Checks ......................................................................... 332

15.2 Entities and Attributes .............................................................................. 335

15.3 Mapping Attributes to Clinical Dictionary ..................................................... 352

15.4 Contract Event Templates – Well Child Contract .......................................... 356 15.4.1 Well Child Core Contact 1 – Child 4-6 weeks ......................................... 356 15.4.2 Well Child Core Contact 2 – Child 6–10 weeks ....................................... 357 15.4.3 Well Child Core Contact 3– Child 10–16 weeks ...................................... 359 15.4.4 Well Child Core Contact 4– Child 16 weeks to 8 months .......................... 360 15.4.5 Well Child Core Contact 5– Child 8 – 14 months .................................... 361 15.4.6 Well Child Core Contact 6 – Child 14-21 months .................................... 363 15.4.7 Well Child Core Contact 7 – Child 21-36 months .................................... 364 15.4.8 Well Child Core Contact 8 – Child 36-60 months .................................... 365

16 Appendix C: CYF Notification Form ................................................................. 367

17 Appendix D: Who Can Access What Matrix ...................................................... 371

18 Appendix E: Glossary ................................................................................... 372



1 Executive Overview

Plunket is recognised in New Zealand as the main provider

of support services for the development, health and

wellbeing of New Zealand children up to the age of five.

Plunket has embarked on the PlunketPlus initiative as an

important component of its strategy to further improve the

health outcomes of New Zealand children.

To support their activities, Plunket staff and volunteers

have been using long-established paper-based methods of

collecting and maintaining the necessary child, caregiver

and health information.

Plunket now wishes to significantly increase the support to

these frontline service delivery staff by introducing a

modern information system with point-of-care access to

information and the ability to update that information in

real time at the time of care delivery.

This Requirements Specification document forms part of

Plunket‟s Request for Proposal (RFP) to find and implement

a new system, that we‟re calling PlunketPlus. It follows on

from the Request for Information (RFI) issued in October

2009.

The scope of PlunketPlus is envisaged to cover:

A single electronic health record (EHR) for every child

client

A separate record for every adult involved in the care

and wellbeing of the child, whether family, caregiver or

Plunket service delivery staff

Rigorous security provisions to safeguard the privacy of

client information

A service delivery plan for each child client, based on

templates related to contracts and further input from

the Plunket Nurse

Electronic interoperability with other Plunket systems

and the systems of external organisations, through the

application of health sector standards.

PlunketPlus is a strategic Plunket project and seeks to

contribute significantly towards achieving Plunket‟s vision.



2 Introduction

Plunket is New Zealand‟s largest provider of support services

for the development, health and wellbeing of children.

Plunket has embarked on a project to implement a new

technology-based system that will support its service delivery

staff to carry out their frontline work with children and

families more effectively and efficiently.

Along with introducing the new system, Plunket will be

working to achieve incremental changes to its operational

practices, with the aim of achieving further improvements in

child health and wellbeing.

The name “PlunketPlus” encapsulates this dual initiative,

where the practices and the system are mutually dependent

and together will enable delivery of the improved outcomes.

The PlunketPlus Project covers the full procurement and

implementation of the new system and the changes to

nursing and operational practice.

Purpose of Document This document is the requirements specification for the new

PlunketPlus system.

It is an essential foundation for the procurement process and

forms the basis for Plunket‟s request for proposal (RFP).

This document will be included in the RFP package for

PlunketPlus.

The document has been developed for a dual audience:

Plunket clinical, operational, administrative and

management staff. These are significant stakeholders who

need to know that their requirements have been fully and

accurately described so that they can sign them off.

Software providers, who need to understand the

requirements that must be met by PlunketPlus.

Document Structure The document is structured according to common information

systems technology practice.

Introductory and explanatory information, including the

section “Key Plunket Concepts and Definitions” that is

explains terms used throughout the document.

Requirements definition, which comprises:

PlunketPlus overview

Standards compliance requirements

Data requirements

Functional requirements

Non-functional requirements

Appendices



Document Content Plunket has used its own clinical terminology throughout this

document, with explanations to ensure clarity of meaning.

This approach was necessary so that Plunket staff,

management and stakeholders could be assured their

requirements are fully and correctly expressed.

While Plunket has gone to considerable lengths to provide

sufficient information in this document to apprise software

providers of the requirements for PlunketPlus, it should be

noted that:

The requirements described in this document are not

complete in every detail.

There are some inconsistencies that can only be resolved

during the design phase.

Plunket expects the software provider to apply its

experience, skills and judgment to assess the quantity,

quality, nature and extent of the resources and materials

necessary to enable it to ensure that its proposal for the

PlunketPlus system meets Plunket‟s requirements for the

system.

This document summarises the requirements. To the

extent that any function, feature, component,

characteristic or element of PlunketPlus is not specifically

included within this document but is a necessary, inherent

or incidental part of PlunketPlus it will, to the extent that it

is reasonable to do so, be deemed implied by, and

included in, the scope of the requirements, as if described

in this document.

Each software provider must include in its proposal a

description of any process, information or other materials

that are not currently described in this document but are

required in order for PlunketPlus to meet the

requirements.



3 Child Health Outcomes

PlunketPlus is one of Plunket‟s strategic projects.

3.1 Plunket’s Vision and Mission

Together, the best start for every child

Mā te mahi ngātahi, e puāwai ai ā tātou tamariki

Our vision directs the way we work with parents, whānau and

other organisations to give the support needed to help children

grow up in healthy and safe environments. A good start in life

depends on many factors, including nutrition, education and social

support – for young children and for their carers.

Plunket‟s success comes from connecting with families, not just at

a single point but throughout a journey that can last a lifetime.

This long-term relationship builds through Well Child services

covering health assessments, advice, support and reassurance.

Our vision of working together is not just an internal mantra; it

means working better and stronger with other organisations,

government, sponsors and our communities. By joining together

and working towards the single goal of helping children, New

Zealand can aim for the best start for every child.

And our mission statement describes Plunket‟s approach to

achieving the vision:

Plunket believes in supporting the development of healthy families

E whakapono ana Te Wha-nau A-whina Ki te

tautoko te kaupapa o te hauora i te wha-nau

3.2 PlunketPlus Vision

The broader outcomes expected by Plunket in moving towards

capturing information electronically include:

Improved outcomes for New Zealand children by having access

to in-depth, accurate and timely information by those who

need it.

Working in partnership with parents, whānau and other

caregivers so that they have access to and receive the

information they need to allow them to parent safely.

Free up staff time to allow more time to provide care.



3.3 PlunketPlus and its Four Pillars

There are four pillars that underpin the procurement,

implementation and operation of PlunketPlus:

Improving the health outcomes of New Zealand children as

individuals and at a population level.

Integration of services, both internally and with external

service providers, supported by integration and interoperability

of systems – to ensure the support needs of every child in New

Zealand are met.

Service-led, to ensure the system is a tool that will assist staff

and volunteers in the provision of services.

Child and family centred – the child and family are at the

centre of the system. In the long term they will be able to

access and add to the information held, therefore making the

health records a partnership between Plunket and families.

3.4 Improved Outcomes for Children

The purpose of PlunketPlus is to improve the health outcomes for

New Zealand children by having access to accurate and timely

information regarding clients and the services provided by Plunket.

It is envisaged that by having a system that is interoperable with

other providers‟ systems such as1 LMCs, GPs, DHBs, CYF etc, there

will be another safety net to reduce the risk of families missing out

on the support they need. Working more effectively with these

other organisations to ensure information is current and shared

will contribute to this outcome.

The system will also provide Plunket with the ability to review

information and practices aimed at improving the health and

wellbeing of children in New Zealand.

Examples of improved outcomes include

Increasing breastfeeding rates in New Zealand to the level set

in “Breastfeeding: A Guide to Action” MOH 2002 by staff having

immediate access to information that they can use to support

clients and referring them to local support services.

Increasing immunisation to the target of 95% of two year olds

fully immunised by July 2012 as stated in “Health Targets

2009/10” from the Ministry of Health by having access to

information regarding the immunisation status of clients, and

therefore targeting conversations.

To reduce the incidence of family violence through the

identification of clients in family violence situations and working

with the families to get the support they need.

More timely intervention in child protection cases by using

1 LMC: Lead Maternity Caregiver, generally a midwife GP: General Practitioner DHB: District Health Board CYF: Child Youth and Family, a service of the Ministry of Social Development



technology to ensure those that need the information receive

the information as soon as possible, for example through CYF

Notifications.

Ensure that families are offered the services they want or need,

when and where they want them.

Less children falling through the gaps due to the integration of

services both internally and externally.

Reduce the rate of ambulatory-sensitive hospitalisations by

ensuring that families receive the primary health care services

they need through the integration of systems.

As PlunketPlus is introduced Plunket will use its features to develop

key outcome measures that will measure the effectiveness of

improved outcomes. The first step will be getting baseline

information from PlunketPlus then setting the goals for the future.

This approach will include measuring the impact of Plunket

services on individual clients as well as populations.



4 Background

PlunketPlus is for all of Plunket.

It will provide information to all Plunket‟s frontline staff and

volunteers to support contacts they have with their clients, and it

will enable them to record the clients‟ health information and

service delivery plan details.

At the frontline are Plunket service delivery staff who are:

Care delivery staff

– Plunket Nurses

– Health Workers (Community Karitane and Plunket Kaiawhina)

Volunteers.

PlunketPlus will be interoperable with the current PlunketLine and

Car Seat Rental Scheme systems and, in time, with external

systems.

Due to the size and complexity of the proposed system, Plunket

intends to roll it out in stages and areas over a period of time

alongside other initiatives to upgrade its information systems

technology infrastructure and other technology services.

Introduction to

the Requirements

Plunket wishes to procure and implement a new system that will

collect, store and report on all contacts that Plunket has with

clients, which are mainly face-to-face sessions in family homes and

Plunket clinics. PlunketPlus will bring together information collected

from a variety of internal and external sources into one system.

This system will be known as PlunketPlus. Previously it had the

working names of Point of Care (POC) then Plunket Primary Client

Information System (PPCIS).

A key component of the system will be the Electronic Health

Record (EHR) that will be used by Plunket‟s service delivery staff,

including PlunketLine and other Plunket services such as the Car

Seat Rental Scheme, who will access and maintain the EHR.

Ultimately caregivers will also have appropriate access to the

relevant parts of their EHR.

The requirements set out in this document form part of Plunket‟s

RFP and are built on the requirements outlined in its Request for

Information (RFI) issued in October 2009.

While the requirements specified in this document are extensive

and complex, they are not detailed to the extent that would be

necessary to design and build a system from scratch.

The level of detail provided is necessary to express the required

data entities and relationships and the necessary support for

clinical and operational workflow processes. This will enable

software providers to understand what is required and to prepare

proposals that are more likely to meet the requirements. This level

of detail also enables Plunket to carry out a meaningful evaluation

of proposals.

Plunket has made its best effort to ensure completeness and



consistency of the information in this document.

Principles Plunket has adopted these principles for the PlunketPlus

procurement:

Clear understanding and definition of requirements.

Requirements informed by best practice as found in other

successful systems.

Full recognition of client information privacy policies,

standards, requirements and processes.

An open, contestable procurement process, through both an

RFI and RFP.

PlunketPlus may be a single system, or an amalgam of multiple

smaller systems.

The client-centric electronic health record (EHR) will be at the

heart of the system or systems.

Processes must be client-led, which requires flexibility of both

the service delivery staff member and the system; there will

not be a set process followed during client contacts.

The system must exhibit a high level of performance to ensure

adequate response times for service delivery staff accessing it.

PlunketPlus will be implemented in a modular fashion, as part

of a larger change project, over a period of some two to five

years.

The system is the long-term solution and will be evaluated as

such.

Hardware is not in scope of the current procurement process,

and will be the subject of a separate procurement process once

the solution for PlunketPlus is selected.

Telecommunications services are not in scope of this

procurement process as Plunket has already selected its

providers through a recent procurement process.



5 About Plunket

Background Plunket is the largest provider of support services for the

development, health and wellbeing of New Zealand children.

A comprehensive network of Plunket clinical staff and volunteers

work together in communities nationwide to provide support for

parents, whānau and other caregivers with children up to five

years of age.

Plunket provides information, advice, resources and support

services to these parents, whānau and caregivers in their homes

and communities through the different stages of their children‟s

development from pre-birth to age five.

Plunket is a not-for-profit community-based organisation unique to

New Zealand providing free services that help to ensure young

children are cared for and nurtured by knowledgeable, confident

and healthy families.

These services include Plunket Nurse and Health Worker visits, Car

Seat Rental Schemes, Parent Groups, Parenting Education, Toy

Libraries, volunteer home visits and PlunketLine - the free

telephone advice service for parents, whānau and other caregivers.

Organisation

Structure

Plunket comprises 18 areas throughout New Zealand, each with a

number of branches and sub-branches, and the nation-wide

PlunketLine service. There are differing facilities and support

services across these.

The organisation chart showing Plunket‟s governance structure is

included in Appendix A, while the detailed organisation structure is

defined in the conceptual data model in Section 11.2.3 on page

101 and Section 11.2.4 on page 103.

Metrics Plunket provides services to the families of 57,600 new-borns in

the past year, which was over 90% of babies born. It employs 493

Plunket Nurses and 144 Health Workers based in 434 locations

throughout the country.

Plunket support services are delivered by a strong base of nearly

1,500 paid staff and volunteers, including 760 FTEs, who are in

turn supported through a large network of 8,000 volunteers.

Each year Plunket staff and volunteers make over 750,000

contacts with families of children aged from birth to five years and

27,900 referrals to other health and social service providers.

PlunketLine staff responded to a total of 83,866 calls in 2009.

Plunket also provides antenatal and postnatal education.

Plunket Services

and the

Child‟s Pathway

The diagram on the next page summarises the services that

Plunket delivers throughout the child-client‟s pathway, showing

which services will be supported by PlunketPlus.



6 Key Plunket Concepts and Definitions

Plunket uses a number of terms that have specific meaning

throughout Plunket. The most significant of these terms that are

used in this document are summarised here to ensure consistent

understanding.

The body of the document contains full descriptions of most of

these terms, mostly in the sections on data and to-be processes.2

Acronyms and other terms are defined in the Glossary at the rear

of this document.

Client and

Caregiver

Plunket considers that each of these people is a client:

The child receiving Plunket services.

The caregivers of that child:

Each parent of the child, biological or otherwise

The legal guardian(s) of the child

Other people who have active participation in the care of

the child who are:

- other family members, biological or otherwise;

- whānau

- other people.

Each other child in the same family or place of residence.

An adult receiving a Plunket service.

There are clear relationship linkages between child clients, each

child‟s caregivers and other people.

Client Contact The core client contact is the heart of Plunket’s service

delivery and it consists of a structured visit with the client,

who is generally a child and their mother or other caregiver,

usually in their family home or a Plunket clinic.

There are several other different types of client contact and there

are differing levels of information access or collection requirements

associated with each type.

The client contacts may be individual contacts (eg Plunket Nurse

with the caregiver and child), or they may be in groups (eg several

clients attending a parenting group). In some cases they may take

place by telephone or other messaging services.

Contacts are usually scheduled; they can be unscheduled.

During every client contact, Plunket Service Delivery Staff take the

following actions:

Make and record measurements.

Make and record observations.

Discuss defined topics, record that the topic was discussed and

2 To-be processes: Future, desired processes.



any information relevant to the topic.

Plunket Staff Plunket has a number of care delivery roles – the key roles for

PlunketPlus are Plunket Nurses, Community Karitane and Plunket

Kaiawhina – these are defined as Plunket Care Delivery Staff.

Volunteers, parenting facilitators and Car Seat Rental Scheme co-

ordinators will also need to use and add information to the system.

Management includes Clinical Leaders, Volunteer Service Leaders,

Area Managers, Advisor and Educators, any of who will on occasion

access and add information. However their key role is to access

information for reporting and management purposes.

Administrators also have a key role in updating data such as

demographic data, and in making, confirming and changing

appointments (Scheduled Contacts) for Service Delivery Staff.

The definitions of these roles as used throughout this document for

Plunket people approved to access PlunketPlus are:

Plunket Staff, paid and unpaid3

Service Delivery Staff

Care Delivery Staff

Case Manager Plunket Nurses

Plunket Nurses

Health Workers

Community Karitane

Plunket Kaiawhina

PAFT staff

PPNAP staff

B4 School Coordinators

Volunteers

Volunteers

Volunteer Funded role

Management and Administration

Areas

Management

Area Managers

Clinical Leaders

Volunteer Service Leaders

Administrators

3 These roles and acronyms are described on the following pages and in the Glossary.



National Office

Managers responsible for the delivery of

clinical services to clients

Clinical Advisors and their administrative

staff

Clinical Educators

Business Intelligence Analysts

Information Technology (IT)

PlunketPlus Systems Administrators

PlunketPlus Database Administrators

Workflow Administrators

Other Plunket people such as other National Office management

and administration, including HR, Marketing and IT, will not have

access to PlunketPlus client data.

Access rights are defined later in this document; this is an

overview to ensure clarity of who‟s who in the organisation and

their role titles.

Plunket Nurse A Plunket Nurse is a Registered Nurse with a current practising

certificate who has completed or is completing further specialty

training in the area of Well Child health and community child and

family/whānau health promotion.

The focus is on delivering a primary health care service based on

the Tamariki Ora Schedule (health promotion, education, clinical

assessment and whānau/family support) to child clients aged birth

to approximately 5 years, and their whānau, families and

caregivers.

Plunket Nurses work in a variety of community locations including

clinics, homes, marae and early childhood centres and have

extensive knowledge of the communities they work in.

Advanced assessment skills and knowledge of child health and

development enable Plunket Nurses to provide and co-ordinate

care, information, surveillance, and support appropriate to the

whānau/families situation.

Case Manager

Plunket Nurse

The Plunket Nurse who is assigned as the Case Manager for the

client.

The Case Manager Plunket Nurse has responsibility and

accountability for ensuring that the client and family receive the

appropriate care and services.

This is mandatory for Well Child Tamariki Ora clients.

Adults receiving certain Plunket services may also be assigned a

Case Manager.



Health Worker Health Workers are qualified para-professionals, who have

completed a Tamariki Ora certificate or equivalent. They focus on

enhancing family/whānau strengths and capacity, to meet the

needs of their children.

Health Workers mainly work with families/whānau who have

children up to five years of age and deliver health promotion,

health education, health protection and illness prevention concepts

in their work. They work under the delegation and direction of a

Plunket Nurse in supporting families with different needs.

There are two types of Health Worker:

Plunket Kaiawhina –Maori Health Workers who work mainly

with Maori Families

Community Karitane – work across all ethnicities

Volunteer Within Plunket there are two groups of volunteers:

Volunteers who choose to do unpaid work to help Plunket

achieve its vision. They work with clients either in a group

setting or on an individual basis such as volunteer home

visiting.

Paid staff who work in volunteer-funded programmes. These

activities include groups such as parenting programmes,

breastfeeding support and some family centre services. These

are classified in this document as a volunteer funded role.

PPNAP Staff Plunket Postnatal Adjustment Programme Staff work in areas that

provide a DHB funded service contract to support mothers with

mild-to-moderate postnatal depression. This is undertaken both in

group settings and on a one-to-one basis.

PAFT Staff Parents as First Teachers is an early childhood programme which

has a strong education focus. PAFT staff have an education

background and are usually qualified early childhood educators.

The focus of PAFT staff is to provide parents with information and

support to become more confident in their parenting role, making

effective use of family, whānau and wider networks.

B4 School Check

Staff

The B4 School Check programme is a nationwide programme

offering free health and development assessments for 4-year-olds

and is delivered by Plunket Nurses.

The B4 School Check staff aim to identify and address any health,

behavioural, social or developmental concerns which could affect a

child‟s ability to benefit from school. Examples include hearing

problems, nutrition issues or communication difficulties.



External

Providers

Plunket works with a number of different providers.

The majority of referrals to Plunket are from the Lead Maternity

Carers (LMCs) ie midwives. Other examples include DHB services,

GPs and PHOs4.

Plunket refers clients to a wide range of services including GPs,

DHB services, dental services, education services, NGOs and

government departments.

Electronic Health

Record (EHR)

Plunket intends to have an electronic health record (EHR) for each

client.

Any information from a client‟s EHR will be shared only under the

most stringent of privacy and security conditions.

The EHR is to be client (child) centric. It is to be the single record

for the client and available to Plunket staff as appropriate.

The EHR must be able to record all the relevant relationships

between the client and others, when appropriate, for example

parents, grandparents, whānau and siblings etc, who will also be

entered into the database as clients.

Plunket Service Delivery Staff will be able to access and update

each client‟s EHR before, during and after the client contact, using

a mobile computer. This may occur in any location using mobile

telecommunications.

Plunket service delivery staff must be able to use the system in

”online” and ”offline” modes, with access to the client‟s EHR at all

times. Information captured while offline must be synchronised

with the central PlunketPlus information system automatically at

the first opportunity.

Information included in the EHR or linked with it will include:

Identifying data.

All current and previous address and contact details.

Demographic details.

Service Delivery Plan.

Client Health Information, including observations,

measurements, needs assessment and risk assessments.

Other information provided.

Analysis.

Outcomes.

Clinical Alerts.

Contacts that have taken place, also those planned.

Hazard alerts about risks to staff when visiting client, eg a dog

on the property.

Any referrals and referral outcomes.

A record of pending and past workflow actions, including any

4 PHO: Primary Health Organisation.



escalations.

Contract details.

The default view of a client‟s EHR should be a summary of key

information and contacts.

All data is to be tagged with a date and time stamp and the unique

electronic signature of the person entering, updating, viewing or

printing it.

The data entities making up the client EHR are defined in the data

requirements in Section 11.2 starting on page 90. See these

pages:

Client on page 106:

The client entity and all other unshaded boxes.

Event on page 110:

The Event entity and all other unshaded boxes.

Contracts and Service Delivery Plans on page 114:

SDP for Client Event.

SDP for Client.

Client Health Information and Actions on page 118:

CHI (observed, measured, discussed).

Action Taken.

Client Health

Information

(CHI)

Information that the Service Delivery Staff record in the client‟s

EHR determined during a contact that is:

A measurement, or

An observation or conclusion, or

Topics discussed and any information relevant to that topic.

The client‟s EHR contains other information that is not Client

Health Information, for example address, contact details and

demographics.



Actions The word “action” is used throughout this document in two Plunket

defined contexts, in the names of three to be processes and as a

generic term for doing something or approving something.

The two Plunket defined contexts are:

Workflow actions – these are detailed in Section 12.1.2 on

page 131. The system or a Plunket Staff member can initiate

workflow actions for themselves or other Plunket Staff

members.

The two data entities:

Template Action,

Action Taken and Actions to be Taken.

These define what is to happen and what has happened at a

contact and are detailed in Sections 11.2.7 “Contracts and

Service Delivery Plans” on page 114 and 11.2.8 “Client Health

Information and Actions” on page 118.

The To-Be processes that use the word action are:

12.4.8 Identify Follow-up Actions and Update Service

Delivery Plan on page 184.

12.4.13 Action Referral on page 196.

12.4.14 Other Non-Contact Action on page 198.

“Action” in these instances is used as a term for something to do.

Plunket has taken care to be consistent in the use of the word

“Action” throughout this document and would like the reader to be

aware of the different uses.

Contracts Plunket has a number of contracts for provision of services. The

most significant of these currently is the Ministry of Health

contract for the Well Child service. Other examples include

PlunketLine and services funded by volunteers, grants, donors or

other government departments such as MSD5.

Each client contact needs to be carried out and recorded against a

contract to ensure the necessary actions are taken and to enable

effective reporting.

In the cases where services provided are not covered by a funded

contract, a contract will nonetheless be used to define the service.

This will enable Plunket to track and report on such services.

Service Delivery

Plan

The Service Delivery Plan will support Service Delivery Staff in

planning and carrying out client contacts.

The diagram on the page after this table shows a graphic

representation of the following explanation.

Plunket aims to establish an individual Service Delivery Plan for

each client. This will comprise all the Plunket services and actions

5 MSD: Ministry of Social Development.



that are scheduled, or waiting to be scheduled for that client.

The Service Delivery Plan is constructed as follows:

A contract is established between Plunket and a funding

organisation. A significant example is the Well Child Tamariki

Ora contract with the Ministry of Health. Another example is

the PEPE 1 programme.

The contract is set up in PlunketPlus.

For each contract, a number of “Contract Event Templates” are

set up in PlunketPlus, one for each standard client contact that

is prescribed by the contract.

Each Contract Event Template specifies what is required to

take place and be recorded at the prescribed client contact.

The Service Delivery Staff member responsible for coordination

of the service for that client sets up the specific Service

Delivery Plan for a client when enrolling the client in a service.

This will pull down the relevant Contract Event Template and

create the client‟s own “Service Delivery Plan for Client Event”

that will be used to guide the first contact. Any special factors

for a client can be added at this stage.

For clients enrolled in more than one service, a Service

Delivery Plan for Client Event may include items from the

Contract Event Templates of more than one contract.

During the client contact, the Service Delivery Plan for Client

Event acts as a checklist and prompting mechanism for all the

actions to be taken and Client Health Information to be

recorded.

As part of the client contact, the Service Delivery Staff member

pulls down the next Contract Event Template and creates the

Service Delivery Plan for Client Event for the next Scheduled

Contact. PlunketPlus populates it with relevant information

based on the information in the client‟s EHR and their contacts

to date. The Service Delivery Staff member checks it and adds

anything necessary.

All the occurrences of Service Delivery Plan for Contract Event

for a client comprise the client‟s overall Service Delivery Plan.

Contract details can change during the lifetime of the contract, in

which case Contract Event Templates would be changed and the

updated version would be ready for pulling down when planning

the next client contacts.

Contracts can be replaced by other contracts.

The contract, service delivery plan and related templates are

defined in the conceptual data model later in this specification;

Plunket will specify further details during the design phase.



Needs

Assessment Level

Plunket Nurses carry out a “needs assessment” of each client at

every contact, based on a number of observations and the

information in the client‟s EHR. This is an analysis which results in

determining a “needs assessment level” as at the time of the

contact and helps the Plunket Nurse decide any follow-up actions

and changes to the client‟s Service Delivery Plan.

The Plunket Nurse enters the Needs Assessment Level code into

the Client Health Information in the EHR as an observation from

that contact. Over time, there will be multiple Needs Assessment

Level codes for each client, so that trends can be noted and acted

on.

While there is significant clinical rigour in determining the Needs

Assessment Level, there is no current requirement for the system

to support this process.

Follow-up During a client contact, Plunket Service Delivery Staff usually

identify one or more follow-up actions that are required.

This may just involve scheduling the next client contact.

Mobile Computer It is envisaged that Plunket Service Delivery Staff will have mobile

computer devices that can access the EHR from any location using

mobile communications, such as client‟s homes, maraes and pre-

schools, and allow input or updating of information.

Plunket also requires that these devices can access other Plunket

and non-Plunket systems, including the internet, through Plunket‟s

secure network.

When on Plunket premises where there is Wide Area Network

(WAN) connectivity, the mobile computer should use the WAN

through either Wi-Fi or a physical Local Area Network (LAN)

connection.

Plunket‟s experience has indicated that the mobile computer needs

to be of the tablet style, or similar.

Details of the requirements for the mobile computer devices are

specified in Section 13.11 “User Devices” on page 289.

These devices will be the subject of a separate procurement

process once the solution for PlunketPlus is selected.



7 Current Systems

7.1 As-Is Processes

Analysis of current workflow processes was an integral part of

preparing this requirements specification.

There will be a significant degree of change to Plunket‟s processes

with the introduction of PlunketPlus. Plunket has commenced a

separate change management workstream for this, running

parallel to the PlunketPlus procurement and implementation.

Documentation of current processes will inform the change

management workstream, so is not included in this requirements

specification.

7.2 Current Application Systems

Plunket currently operates the following systems, with their

anticipated future disposition as shown.

POND The Plunket Operational National Database (POND) holds a large

volume of data about to Plunket‟s activity relating to its contracts

with funding organisations, mainly the Ministry of Health Well Child

Tamariki Ora contract.

There is an electronic interface between POND and the Kidslink

system operated by Counties Manukau DHB.

POND was developed for the Jade object orientated database and

is currently running on version 6.5.0.

This system is nearing the end of its life.

Data in POND will be progressively migrated to PlunketPlus and in

due course POND will be decommissioned.

PlunketLine PlunketLine is a call centre service that operates 24/7 and provides

support to caregivers for any issues relating to their babies and

young children.

All PlunketLine operators are Plunket Nurses.

PlunketLine has 5 sites on a Wide Area Network WAN based on a

Citrix server farm, with calls being delivered using VOIP.

An Avaya telephony platform supports Contact Centre Express

(CCE) software, which is used to display caller information, Call

Management System Supervisor (CMS) software, which is used for

data reporting and management of calls, NICE software for call

recording, and Microsoft SQL Server 2005.

The two main software applications are-CAS triaging and iMIS CRM

which is currently being replaced with another product.

PlunketLine will continue to be a strategic system for Plunket, with

the intention that interoperability will be established with



PlunketPlus as defined in this specification.

Car Seat Rental

Scheme

The Car Seat Rental Scheme system was custom-developed for

Plunket.

Plunket is currently in the early stages of transitioning from a

series of distributed Microsoft Access systems to a new system

built on .NET and Microsoft SQL 2005.

The Car Seat Rental Scheme will continue to be a strategic system

for Plunket, with the intention that interoperability will be

established with PlunketPlus as defined in this specification.

Human Resources To support HR, Plunket uses:

The Datacom payroll system.

Sonar 6.

15Q+.

Currently Plunket does not have a full HR system.

Finance For its finance systems, Plunket uses:

Navision

Jet Reports.

Marketing Member Card System

Plunket recently implemented a web-based system that enables

people to register as Plunket members, as a means of enhancing

Plunket‟s records of its volunteers.

Fundraising

Plunket uses the Raiser‟s Edge system supplied by Blackbaud Inc

to support its fundraising activities. This is built on Microsoft SQL

Server 2005.

7.3 Current Data

Currently Plunket‟s data is collected and stored in a variety of

ways.

Care Delivery

Staff

For the Care Delivery Staff the data is held in three key areas:

Plunket Health Record (PHR)

Paper based records which are stored in locked filing cabinets

at local clinics and Area Offices.

The information held in these records includes information

collected at the first assessment including demographics, Client

Health Information, physical assessment and hazards.

Then at every contact undertaken a “process recording page” is

completed which covers caregivers view, surveillance, analysis,



plan and needs assessment.

A copy of each outgoing Plunket referral and any other relevant

documents are attached to the client‟s PHR.

Plunket Operational National Database (POND)

The information in the POND database is recorded at the first

contact and then minimal static information is collected at each

further contact.

This information includes demographics, contact details,

contract details, types of contact, breastfeeding status,

immunisation status, smoking status, care delivery

components, referrals and recommendations by care delivery

component and place of visit.

Well Child Tamariki Ora Book

Often known as the “Plunket Book”, this is given to the primary

caregiver by the LMC and information is added to it over time

by LMCs, GPs and Plunket Nurses.

It contains parenting advice and certain key information about

the development of the child.

Volunteers For volunteers the data is held in two key areas:

Volunteer Files

Individual information held by the person responsible for the

group, usually paper-based.

POND

Some information regarding some of the contacts is entered

into POND. This information includes details of the child of the

parent receiving the volunteer service, the date of the service,

type of service, topics discussed and place of service.

PlunketLine Information from PlunketLine calls is stored in the PlunketLine

database.

This includes clinical, demographic and call details.

PAFT Each PAFT area has set up its own individual method of keeping

their records, usually paper-based.

B4 School Checks Currently this is paper-based with some of the key data entered

directly into a Ministry of Health system by Plunket Service

Delivery Staff.

Other Contracts Staff and volunteers providing services other than the Well Child

contract collect their information using a paper-based system,

stored in Area Offices, dependnt on each contract specification.

Some key information is transferred to POND.



7.4 Current Volumes

Plunket‟s existing computer systems store data about:

680,000 contacts per year, not including PlunketLine.

84,000 PlunketLine contacts per year, made up of 40,000

individual callers, many of these are enrolled clients.

267,000 enrolled clients; children only, not parents.

57,600 new baby cases per year (91% of NZ new baby cases).

376,000 outward referrals per year.

Car Seat Rental Scheme – which is a new system for which it is

estimated there will be 30,000 contacts per year.

There are approximately 267,000 paper records for clients in

Plunket clinic locations and approximately 500,000 files for

discontinued clients in the archives.

Anticipated future data volumes are described in Section 11.3 on

page 122.

7.5 Technology Environment, Current and Planned

The Plunket ICT environment is extensive, currently catering for

600 staff distributed across its locations. This number is increasing

and is expected to quickly reach 7,500 with the introduction of

PlunketPlus and other initiatives, comprising some 6,000

volunteers.

Plunket has developed a new technology architecture and has

commenced work on the anticipated one-year implementation.

This section describes the current and planned technology

environment.

The PlunketPlus technology environment requirements for software

provider response are set out in Section 13.14 “Technology

Requirements” on page 293.

7.5.1 Description of Current Plunket ICT Environment

Plunket currently has a centralised, outsourced service delivery

architecture made up of two primary network locations.

The primary location where the majority of information systems

and associated server infrastructure are hosted is located at

Maximum Internet Ltd‟s (MaxNet) Albany data centre, Auckland.

The National Office contains the remainder of the core network

services, including the primary Avaya VoIP telephony system, a

small VMware/EMC virtualisation system hosting several virtual

servers, LAN switching and WAN routing equipment.

POND was developed for Plunket by Jade Healthcare and is

currently hosted in Christchurch by Ascribe, who acquired Jade

Healthcare.



7.5.2 WAN Infrastructure

Plunket is transitioning its WAN Infrastructure from Telecom‟s One

Office IP based Network to a TelstraClear MPLS WAN core for the

major Plunket offices. Provisioning of minor offices is under

consideration.

There will be 20 major sites on the new WAN Infrastructure,

located at:

National Office in Wellington

Northland

Waitemata

Auckland City

Counties Manukau

Waikato

Lakes/Bay of Plenty

Taranaki

Tairawhiti

Hawkes Bay

Manawatu / Wanganui

Wellington / Wairarapa

Nelson / Marlborough/Westland

Canterbury /Mid-South Canterbury

Otago / Southland

Primary PlunketLine sites at:

- Wellington

- Takapuna

- Henderson

- Manukau

- Richmond

Plunket‟s National Office is connected to the Albany (MaxNet Ltd)

data centre via a layer 2 connection effectively stretching the

National Office LAN infrastructure across the WAN.



7.5.3 Systems Infrastructure

Virtualisation Plunket‟s Systems Infrastructure is a fully virtualised Microsoft

Windows Network Operating System environment hosted on a

VMware VI3 Data Centre platform.

Plunket plans to implement a Plunket Private Cloud Compute Environment (P2C2E) as part of its technology refresh.

The P2C2E environment will use the following technology platform

solutions, which when integrated, create a dynamic cloud

environment that allows for dynamic data protection, efficient

cloud storage, highly available and fault tolerant servers, rapid

service provisioning, integrated Business Continuity and Disaster

Recovery capabilities, centralised administration and management

/ control over the cloud infrastructure:

Virtualisation layer software using the VMware vSphere cloud

operating system;

Physical server hardware based on IBM xSeries server

infrastructure; and

Physical storage environment using the NetApp FAS2020

Unified Storage System .

The P2C2E will encompass two physical locations:

The primary data centre located in Wellington; and

The Disaster Recovery site located in Palmerston North

connected to the primary site by a private 10Mbps IP Network.

Server Operating

Environment

(SOE)

Currently, the Standard server Operating Environment (SOE) is

Microsoft Windows Server 2003 R2 Service Pack 2.

Plunket will be migrating to a new SOE based on Microsoft

Windows Server 2008 R2 over the next 12 months.

Directory

Services

Plunket‟s directory services environment is a Windows 2003 R2

Active Directory (AD) in Windows 2003 Native mode. The AD is a

”Single Forest” configuration which contains a ”Single Domain”

environment with no external trusts with any other organisations.

It contains the National Office, Manukau, Takapuna, Henderson,

and Richmond physical locations.

Plunket will be migrating to role-based authentication and adopting

Microsoft Identity Lifecycle Manager 2007 and Forefront Identity

Manager 2010 (FIM).

Web and Firewall Plunket‟s gateway is physically located in the Albany data centre

and consists of a pair of in-line firewalls (a Checkpoint firewall

fronting a Microsoft ISA firewall). The ISA 2004 server manages

Plunket‟s access to the internet, access to the Citrix Secure

Gateway, Virtual Private Network (VPN) access and Outlook Web

Access (OWA) email. Web services are delivered through Microsoft

IIS 6.5.

Under the new Plunket SOE, ISA 2004 will migrate to Forefront

Threat Management Gateway 2010 and IIS 6.5 to IIS 7.5.



Messaging Plunket‟s current messaging environment is a single virtual

Microsoft Exchange 2003 Server (SP2). The Exchange server is

provisioned with a single mailstore containing 665 mailboxes.

Plunket staff use either Microsoft Outlook 2007 or Outlook Web

Access (OWA) to access their email mailboxes, calendaring (diary)

and public folder information.

Under the new Plunket SOE, messaging will either be provisioned

from a Microsoft Exchange 2010 environment (including MBX, CAS,

Hub and Edge servers) or via Microsoft‟s Business Productivity

Online Standard Suite (BPos).

Collaboration

Services

Plunket is currently deploying Microsoft SharePoint Services and

will extend this implementation to Microsoft SharePoint Server

2010 in the new SOE.

Plunket will implement Microsoft Office Communications Server

2007 R2 to provide unified communications (presence, instant

messaging and unified conferencing).

Database Underpinning most Plunket information systems is Microsoft SQL

Server. Currently Plunket supports SQL Server 2000, 2005 and

2008 versions.

Over the next 12 months Plunket will migrate its SQL

environments to Microsoft SQL Server 2008 R2.

Anti-Virus Anti-virus capability is provided by Sophos 7.6.5 enterprise edition.

Sophos is deployed to all server and PC environments.

Microsoft Forefront Threat Gateway 2010 will replace the Sophos

anti-virus environment in the new Plunket SOE.

Software Update

Management

Automated software update management services are delivered

using Microsoft‟s Windows Software Update Services (WSUS).

7.5.4 PC Infrastructure

Plunket‟s PC environment is Microsoft Windows XP Professional SP

2. All PCs are members of the Windows 2003 domain environment

and are administered through the use of AD Organisational Units

and controlled through the application of security and configuration

Group Policy objects.

The standard PC application suite is Microsoft‟s Office 2007

Professional, Internet Explorer 7.0 and Sophos Enterprise Anti-

virus 7.6.5.

Plunket will migrate its PC SOE to Microsoft Windows 7 and

Microsoft Office 2010.



7.5.5 Business Continuity, Disaster Recovery

Plunket‟s P2C2E architecture is based on the principle of a primary

Data centre with a DR site configured as a failover for the recovery

of critical services and business functions in a Disaster.

Plunket‟s P2C2E architecture leverages VMware vCenter Site

Recovery Manager and NetApp FAS technology to implement

Business Continuity and Disaster Recovery processes that are

quick and easy to test, consume little additional storage, and

significantly reduce Recovery Time Objective6 (RTO) and Recovery

Point Objective7 (RPO) times.

6 Recovery time objective (RTO): RTO refers to how quickly Plunket can recover from the disaster, or specifically how long it takes to execute the recovery process, making Plunket‟s services available again;

7 Recovery point objective (RPO): RPO refers to how far back in time the data in the environment will be once it has been made available



8 Requirements Definition

8.1 Overview

The requirements set out in the following sections describe the ideal

system that Plunket would like to implement.

These requirements will form the basis for Plunket‟s evaluation of

proposals from software providers.

The requirements have been expressed in a style that suits its two

main audiences:

Plunket clinical, operational, administrative and management

staff. These are significant stakeholders who need to know that

their requirements have been fully and accurately described so

that they can sign them off.

Software providers, who need to understand the requirements

that must be met by PlunketPlus.

Plunket accepts that the way that systems meet these requirements

may differ from the way the requirements are described here; the

intent is that systems deliver functionality along these lines.

Where a software provider prefers to propose a solution that meets

Plunket‟s needs in an alternate manner to that set out here, Plunket

is prepared to consider such proposals.

There are a large number of requirements and there is no ideal

sequence to define them. To help set the scene, the requirements

start with a section titled “PlunketPlus Overview” that describes a

number of day-to-day scenarios that clients and staff will

experience, and shows mock-ups of some of the computer screen

views that Service Delivery Staff will use.

Requirement

Groups

Plunket‟s requirements have been defined in these groups:

PlunketPlus Overview

- PlunketPlus at a Glance

- To-Be Process Scenarios

- Screen Displays and Data Entry

Standards Compliance Requirements

Data Requirements

- Overarching data requirements

- Conceptual data model (this is a major section)

- Data volumes

- How Plunket will store the data

- Retention, disposal and archiving of data

Functional Requirements

- Workflow

- Decision Support

- To-Be Process overview flowchart

- Individual To-Be Processes (this is a major section)

- PlunketPlus Portal

- Interoperability

- Changes to other systems

- Business rules



Non-Functional Requirements

- Privacy

- Security

- The Health Network

- Access to Plunket and Client Information

- Reporting

- System Availability and Performance

- User Devices

- User Interface

- Change Management

- Technology Infrastructure

- Implementation Approach

- Data Migration

- System Support

Supplementary information is included in the Appendices.

Duplication There is some overlap and duplication of details throughout this

document, as some requirements are relevant in multiple situations.

Software providers are asked to respond and explain in every

instance. Plunket recognises this may result in some duplication.

8.2 How Software Providers Should Read and Respond

Plunket requests software providers to respond to each of the

numbered requirements in the following sections:

9 PlunketPlus Overview page 36

10 Standards Compliance Requirements page 78

11 Data Requirements page 83

12 Functional Requirements page 127

13 Non-Functional Requirements page 271

A response is necessary for every numbered requirement other than

those with a ranking of “informational”, and must be entered into

the appropriate response tables that are included in the RFP

package.

Software providers are requested to elaborate the response to every

numbered requirement. Terms such as “Complies”, “Met” or “Yes”

without elaboration may not be considered useful and are unlikely to

attract a favourable evaluation score.



8.3 Requirement Numbering

The numbering scheme for requirements is:

Heading n

eg 12 – Functional Requirements

Sub-Heading

n.m.o

eg 12.6 Interoperability with Other Systems

12.6.1 Transfer of Care

Requirement

n.m.o p [will be evaluated]

eg 12.6.1 1 Standards

Sub-requirement

n.m.o p q) [will be evaluated]

eg 12.6.1 1 a) HISO RSD Standard

8.4 Ranking of Requirements

Plunket has allocated the following codes to indicate the relative

priority of each requirement.

High Priority High priority requirements are ranked with “1” and have the

highest weighting. Solutions that meet these requirements will

score significantly in Plunket‟s evaluation.

1

Desirable Requirements ranked with “2” priority are important to Plunket

and have moderate weighting. Solutions that meet these

requirements will score well in Plunket‟s evaluation.

2

Nice to have Requirements ranked with “3” are genuine needs, with the

lowest weighting. Solutions that meet these requirements will

have least impact on Plunket‟s evaluation scores.

3

Informational Requirements ranked with “-” are explanations, not

statements of requirements, and will not be evaluated.

-



9 PlunketPlus Overview

This section contains explanatory notes to set the scene for readers

of the requirements specification document.

PlunketPlus at a glance: A simple overview of the whole

system.

Future Process Scenarios: A series of user experiences from

the viewpoint of several different

roles.

Screen Mock-ups: Prototypes of the main screens

that users will work with.

9.1 PlunketPlus at a Glance

This table shows a simple summary of…

who PlunketPlus supports

what they use for this

and what they do with it.

Who Client Child client

Adult client

Caregivers

Plunket Service

Delivery Staff

Plunket Nurses

Health Workers

Other Care Delivery Staff

Volunteers

Plunket

Management

Managers responsible for the delivery

of clinical services to clients

Area Managers and Administrators

Clinical Leaders, Advisors and

Educators

Volunteer Leaders

Business Intelligence

External Providers GPs

DHBs

CYF

…and others



Using Mobile Computers Tablet-style devices for Service Delivery

Staff

Mobile communication

Mostly online, can operate offline

EHR Secure record of client‟s health

information

Service Delivery

Plan

Customised for each contact with each

client by Case Manager Plunket Nurse

Based on standard contract templates

Contract For each service delivered

Defined as templates for that contract

Doing Case Management Case Manager, who is a Plunket Nurse

Contacts with clients

Scheduling of contacts

Decision Support

Workflow

Message Board

Interoperability With:

Other Plunket Systems

External Providers

For:

Referrals

CYF Notifications

Visit Summaries

Discontinue

Client Summaries

NHI

HPI

…and others

Using:

Secure Networks

Standards

Performance Outcome recording and reporting

Other reporting



9.2 To-Be Process Scenarios

The scenarios in this section have been written to describe the

envisaged future real-life workflow processes that Plunket

expects people in various roles to experience with PlunketPlus.

By demonstrating these real-life situations, the scenarios help to

explain the requirements detailed throughout the remainder of

this specification document.

The scenarios have been prepared from the point of view of

various participants:

Parents, caregivers.

Plunket Staff.

External Providers.

Each scenario has been tested against the “To-Be” processes

and the data requirements to ensure that the specifications are

as complete and consistent as possible.

Plunket requires that the system will provide functional support

for each of these scenarios, and is requesting an explanatory

response from software providers for each one. These responses

would be best prepared following review of the entire document.

Detailed specifications for all the data and processes that

support these scenarios are set out after these PlunketPlus

Overview sections.

-

9.2.1 Parent, Caregiver Role

These scenarios are from the viewpoint of a mother, a father

and a separate caregiver.

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1 Mother-To-Be Referral

I learnt from my midwife of an antenatal programme being

undertaken by Plunket. I rang to find out details – venue, time

and dates.

I attend the sessions as I am able. These are group sessions

with both parents able to attend. When attending the sessions I

am asked if I would like Plunket as my Well Child Provider – I

say yes. I am asked to complete a form with key details so I can

be enrolled in the database and provide them with my Expected

Date of Delivery (EDD) so I can be contacted after the baby is

born to confirm that I wish Plunket to be my Well Child Provider.

I had my baby around the time of the EDD. Four weeks after my

EDD, Plunket rings and asks if I still want Plunket as my Well

Child Provider. I say yes and an appointment is made for the

Plunket Nurse to come to my home the following week when the

baby is 4½ weeks old. I receive a txt the day before reminding

me of the appointment. I replied with a txt saying thanks. I

remembered that the Plunket person had said I could reply to

ask for a different appointment day or time if I‟d needed to.

This visit is approximately an hour with a long discussion about

how things have been going since baby was born and what my

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needs are. The nurse also advised me of the information she

needed to collect that will help ensure the health of my baby – it

included information not only about the baby but also myself,

the baby‟s father and extended family and about our living

environment. The nurse was careful to explain how the

information would be shared, stored and used. She examined

the baby from head to toe including weight, length and head

circumference. We talked about what could happen over the

next few weeks and who to call if I needed help. She also talked

about other services that Plunket offered. I agreed that the

nurse could share my contact details with the Plunket volunteers

in the area so I could get information about support groups,

parenting education and receive the newsletter.

At the end of the visit we made an appointment for the next

visit, another home visit, and we discussed how it will be for me

to come to the Plunket clinic for Well Child appointments after

the baby is about 3 months old

What is really great is that the nurse tells me how to access my

baby‟s record by using the internet and I am able to add things

like the first time she smiles, or photos etc.

2 Mother Referred by LMC after Birth

After having my baby the midwife spoke to me about the Well

Child Service. I chose Plunket as my provider and she said she

would do a referral that would share my contact details and

information about my pregnancy, labour, birth and baby‟s

progress up till now with Plunket. My midwife advised me that

the information on the referral would automatically populate the

Plunket database and that they would contact me to arrange an

appointment. I agreed that she could pass on my information.

Someone from the Plunket office rang to discuss when the best

time for a visit would be. She also talked about other services

apart from the Plunket Nurse that Plunket offered. I said I would

be interested in support groups and learning more about the car

seat rental scheme. She informed me what information she

would pass on to the support group and car seat rental scheme.

I have borrowed a capsule from a friend but need to think about

the car seat as the baby grows. The person checked my contact

details, and asked how I would like confirmations and reminders

of appointments. I chose emails. We arranged a time and she

made an appointment with the nurse in my area. The next day I

received an email confirming the appointment time with the

name and contact details of the nurse who would be visiting me.

And then I got another reminder email the day before the

appointment.

This visit was approximately an hour with a long discussion

about how things had been since baby was born, and our family

needs. The nurse explained the information she was collecting

that may affect the health of the baby – it included information

not only about the baby but also me, the baby‟s father and our

extended families. She examined the baby from top to toe

including weight, length and head circumference. The nurse

explained how the information would be shared, stored and

used. During the meeting we talked about the worries I had

about breastfeeding. The nurse suggested that I attend the local

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Plunket family centre and she brought up the diary for the family

centre and requested a phone call appointment for me. She also

gave me the details for PlunketLine so if I had any issues before

that visit I could contact them.

The nurse from the Plunket family centre called the next day and

we talked about my needs for support with breastfeeding. We

agreed it could help if I went to the family centre for further help

and the nurse booked an appointment in the family centre diary

for the next day. Later that day I received an email confirming

my appointment at the family centre that confirmed the address,

which was good because I had forgotten the street number.

That evening I had problems breastfeeding so I rang

PlunketLine, the nurse asked a couple of questions to confirm

that the record she had in front of her was that of my baby,

details such as the date of birth, address and my details. We

discussed the advice that the Plunket Nurse had given during the

day and the fact that I had an appointment the next day at the

family centre. She gave me some great support to get me

through the night. She informed me that a message would be

sent to the Plunket Nurse to let her know I had phoned

PlunketLine and that the Plunket Nurse would be able to access

the record of the call. She also asked if I would like an email

sent to the family centre since I had an appointment there the

next day.

I attended the family centre the next day – it was great that

they were able to access both the record from the visit with the

Plunket Nurse and my conversation with PlunketLine so it was

like we were all working from the same page. When I left the

family centre I felt much more comfortable with breastfeeding

and much more confident as a new mum.

The next day the Plunket Nurse sent me an email, just checking

that everything was OK and if I needed any more assistance

before her next visit, which was 2 weeks away. I emailed back

saying everything was fine at the moment and I would call her if

I needed anything.

3 Mother Receiving Additional Support From Health Workers

I had the first visit from the Plunket Nurse when my baby was 5

weeks old. We talked about a number of issues that were

affecting the way I was coping with my baby. One of the

services we discussed was someone called a Plunket Kaiawhina

providing some extra visits to see how things were going on. We

could discuss things like how I was settling the baby, how the

feeds were going and general parenting advice. I thought this

was a great idea so I said yes.

The Plunket Nurse brought up the Kaiawhina‟s diary and made

an appointment. She explained that I would receive a txt to

confirm it. She also showed me what she was writing to the

Kaiawhina, so I was aware of what the Plunket Nurse was asking

the Kaiawhina to speak to me about at the visit. Later that day I

received a txt confirmation from the Kaiawhina regarding the

appointment 3 days later.

The Kaiawhina arrived 3 days later as arranged, she had read

the referral that the Plunket Nurse had done, and was able to

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access my records. We talked about a number of things during

this visit, it was great. At the end of the visit we talked about

what she was going to tell the Plunket Nurse about the visit –

she actually showed me what she had put in my record; I

thought that was great too.

The Plunket Nurse arrived for her next appointment the following

week and we discussed the visit from the Kaiawhina. She

examined the baby and we talked about how everything was

going, the support I had and planned how I could get extra

support if I needed to. We also talked about the questions I had

about feeding and caring for my baby.

During this visit I mentioned that the baby had been sick over

night and had a rash on her bottom. The nurse looked at the

rash and we agreed that I should go to my GP that day for

further assessment. The nurse called the GP clinic and asked for

an appointment that day – it was great. She then did a referral

for the GP, which she emailed to the GP and printed me a copy.

We agreed time and date for my next appointment with the

Plunket nurse which would be at the local Plunket clinic. The

nurse said I would get a reminder 2 days before the

appointment and reminded me that I could call her or use

PlunketLine sooner if I had any problems.

4 Mother Receiving Additional Support From Volunteers

At the first visit, the Plunket nurse explained the different

services that Plunket offers. I said I was interested in parenting

education and support groups. The nurse that this would mean

that some of my information such as my address and contact

details needed to be shared with the volunteers, but my health

record details ie the assessment of my baby by the nurse would

not be shared. I agreed that my information could be shared and

protected in this way.

Two days later a Plunket volunteer rang me and provided me

with details of where a support group was meeting in my

neighbourhood – it was at the local community centre. She told

me all about the group and gave me details of the person who

will be running the group. She offered to email me the details of

the place and time. She also informed me that a parenting

education group was planned for 4 weeks time and if I was

interested I could put my husband‟s and my name down and

they will contact me closer to the time to confirm we still wanted

to attend.

I attended the local support group the following week. They had

my details on a sheet which I confirmed and they said that this

was used so that my attendance would be recorded on both my

record and my baby‟s record. The group was wonderful – we just

talked and talked about being new mothers. At one stage a

mother raised a particular issue and the co-ordinator of the

group asked if she wanted an appointment with her Plunket

Nurse to discuss that issue, and she said yes. I presume that the

co-ordinator contacted the Plunket Nurse for her – I thought that

was wonderful.

Three weeks later I had a call regarding the parenting course –

they ended up offering us two choices – the first was that we

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could both attend the course next week, or if my husband

wanted there was a course for fathers starting in 2 weeks which

he could attend. We decided that we should go to different

courses and it was so simple – all we did was turn up, signed a

form confirming our attendance and then participated.

5 Father Attending Parenting Course

I received a message from Plunket, via the method I chose when

I enrolled, like txt or email, to say they were running a father‟s

parenting group for all the fathers in the neighbourhood. I was

advised of the date, time and venue for the course. The course

was to be taken for fathers by fathers and the focus was

parenting from the fathers‟ perspective. My wife was attending

another parent‟s course which was only attended by mothers.

On the first night the facilitator asked if we agreed that others in

the course could see our contact details on the attendance sheet

as it was passed around for completion. We all agreed and each

session we checked our contact details and signed the form to

show we had attended. The facilitator also provided us with

recommended websites and other relevant resources that were

developed for fathers. They also provided us with details on how

we could set up a group chat room for fathers via the e-

parenting link that Plunket had on their website.

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6 Pre-school Teacher with Children Undertaking a Pre-school Assessment

The yearly Plunket visit to the pre-school was occurring in two

weeks. I sent all the parents a consent form for their child to be

seen, which also asked key questions for the parents to answer.

These forms come directly from Plunket. I collect all the forms

from the parents as they drop off their child. On the day I

arrange for all the children whose parents have consented into a

group when the Plunket Team arrive. As each child is seen by

the team I confirm the contact details with the nurse to ensure

that she has the correct file open. They go through all the

physical assessments with the child, and enter the details from

the forms completed by the parents. I am also aware that they

will ring the parents over the next few days to provide them

relevant follow-through details.

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9.2.2 Staff Role

These scenarios are from the viewpoint of Service Delivery Staff. -

1 Plunket Nurse

On Monday morning I did my daily check of my diary – I noted a

New Baby Case so I accessed the record which has information

that was automatically transferred from the LMC when the

referral was sent to Plunket. I am looking for anything that I

need to know before meeting the mother such as any hazards of

visiting the home, any particular issues that need to be

considered, and to see if there has been any contact with the

Plunket service before. I discover that the family also have a two

year old child who has been seen in another area. I access that

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child‟s record and note that the child is almost due for a Plunket

Core Contact.

I arrive and meet the mother, father and baby. I have a

conversation where I am collecting information for my

assessment – some of this information has already been

downloaded from the LMC and part of the conversation is

checking that this information is correct and is still relevant. I

click the button in PlunketPlus to tell it to accept the incoming

LMC referral into the client‟s EHR. I also process new information

to assist in making my assessment of the baby and family,

including some information about the two year old. I am careful

to explain how the information I collect will be shared, stored

and used. The parents agree that their contact details can be

shared with the local volunteers so they can receive a

newsletter. I complete a full physical assessment of the new

baby. From the information provided I am able to concentrate on

key areas for parenting education, anticipatory guidance, what

actions or other intervention needs to be undertaken. This is all

recorded at the visit on the Service Delivery Plan. The Service

Delivery Plan is based on an assessment of the family‟s needs,

and includes all the information I have collected about the

family‟s Client Health Information.

The other interventions include a referral to the Community

Karitane, which involves not only completing the referral but

gives me the ability to access the Community Karitane‟s diary

and make an appointment. I show the parents what I have

written in the referral. I also complete a referral to the GP as I

am concerned with the baby‟s hips. I do the referral with the

parents – I email it to their GP and I print a copy for the

parents.

While we were talking the two year old woke from her sleep and

the parents introduced me to her.

At the end of the visit I make an appointment for the next core

contact for the new baby, another home visit, and reassure the

mother that a reminder txt will be sent the day before the visit.

If for any reason she needs to change the appointment she can

ring the area office (I have already given her the number) and

they can change the appointment in my diary.

I also remind the parents that the two year old is due for a Well

Child assessment and ask the mother when she would like to

book this in, she is happy to wait until the baby is older, so I

book a double appointment for the baby‟s 3 month assessment

and the toddler‟s 2.5 year assessment, at clinic. The mother is

confident she will be able to manage to get to clinic with both

children once the baby is a little older, and I assure her that the

appointment time can be changed if something comes up to

change the plan. I also remind her that a txt will be sent closer

to the time to remind her of the appointment.

2 Community Karitane/Plunket Kaiawhina 1-to-1 Contact

I receive a referral from a Plunket Nurse, asking me to visit a

family at home regarding introducing solids. The nurse had

made a booking in my diary with the client, and an email was

sent to the client confirming my appointment in 2 days. I met

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with the mother and her baby and we went through recognising

when the baby was ready for solids, what type of foods to start

with and the continuation of breastfeeding.

As I was talking to the mother I entered the relevant information

into the system around the anticipatory guidance I was providing

and the mother‟s responses. I informed the mother about a

parenting education programme which covered her daughter‟s

upcoming age. She said she was interested so I asked her if I

could share her contact and demographic details, but not her

personal or health details, with the volunteers. Once she agreed,

I marked off the relevant area on the computer which would add

her details to the volunteer list for the upcoming parenting

group. I also let her know that the volunteers will be in touch

regarding the time and venue of the course.

While I was talking with the mother she raised a concern that

she had not spoken to the nurse about – she was concerned

about her husband and their relationship due to his increasing

signs of depression, she asked if I could write a referral to the

GP. I explained I could not write a referral to the GP, but I would

speak to the Plunket Nurse who could do that. I recorded the

mother‟s request and marked the record so that a message

would be sent to the Plunket Nurse to read this file urgently.

I also arranged a meeting between the Plunket Nurse and myself

via our electronic diaries to discuss the situation. Following the

meeting the Plunket Nurse called the mother to discuss her

concerns for her husband‟s health. As a result the Plunket Nurse

wrote the referral – she electronically sent the referral to the GP

and the mother (she had spoken to the mother regarding

receiving an electronic copy of the referral due to the sensitive

nature of the referral).

3 Community Karitane/Plunket Kaiawhina – Group Contact

I am running a PEPE 2 course commencing next week. The

Volunteer Co-ordinator has provided me with a list of contact

details including phone numbers and emails for those families in

the local neighbourhood who were interested in parenting

course, whose baby was coming up to the age for the “Your

Growing Baby” course. I contacted all the people on the list with

their preferred way of contact, letting them know the date, time

and venue for the course.

On the night of the first course – client details were printed off.

At the beginning of the evening I asked if everyone was ok for

others in the group to see their contact details. Once everyone

agreed, I asked them to check the printed list in case any

changes were needed, and then tick for attendance for that

evening. If anyone didn‟t agree, then I would check their details

on a 1-to-1 basis. The attendance record was undertaken at

each of the evenings, just to check that our records were up to

date and I also had a record of who attended each session. The

details they checked were their names, child‟s name and date of

birth, phone number and relationship to the child. If a couple

attended they were recorded as two separate attendees, but I

know that they could be linked in the system so I could report

not only on how many individuals attended but also how many

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families.

After each course I opened the form on the computer which was

used for the printout. All I then needed to do was to mark the

individuals who attended, make any changes to their details as

required and then record on the computer the topics that were

discussed. There was also a section on the form that I could

write anything specific to individual. After I had entered all the

information, I closed the form on the computer knowing that all

the information was then being transferred to the individual

child‟s record and the parents‟ record regarding their attendance

and the topics covered in the session.

4 Volunteer – Parenting Education

My role is to co-ordinate the parenting programmes in my local

area and I also undertake some facilitation of groups. Each week

I can go into the system and run a report which will provide me

with information on clients who have said to their Plunket Nurse

that they are interested in parenting education programmes. I

know that one of the many questions that the Plunket Nurse

asks is if a caregiver is interested in other Plunket services and

one of these is parenting education. If the client agrees to the

information being shared with volunteers the nurse then ticks a

particular section in her record. It is the details of the clients

who say yes that are on the report that I run. I am able to run

the report in a variety of ways including new parents over a

specific period who have said they are interested, location and

by age of the baby/infant so that I can look at specific

programmes which are designed for the age of the baby/infant.

I contact the family (usually the mother unless others notified)

to explain the parenting education programme in further detail.

If they are interested I either provide them with details of a

course commencing soon or I keep their details for an upcoming,

as yet unplanned course. For courses coming up we have a form

that has clients‟ details on it, that is sent to the person

organising the course to ring the week before it starts to confirm

time, venue etc. I register the person for the particular course

that they are interested in or I put them on a list for upcoming

unplanned courses.

As each course is planned I am able to access the list for

upcoming unplanned courses, which again I can sort by age of

the child or location to help with planning of the courses.

When I facilitate a course I print the list for that course, contact

the parents to confirm place, time and venue for the course. At

the actual course the form is circulated for parents to confirm

the details are still accurate and they tick their attendance for

the evening. All the course dates are on this form. I add to the

form the topics that were covered in the evening.

At the end of the session either I or someone else such as an

administrator can go on to the Internet and access the Plunket

site, where I have to sign on with my own special Plunket

password then I am able to access the parenting education form.

I make any changes to the client details and mark the

attendance for that particular session.

At key times I am able to run reports on how many courses in

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the area have occurred, the number of families attending, the

actual number of attendees and even the topics covered. I can

even look to see the most popular location and also locations

where we have not met the need – this can help us apply for

grants to fund the courses.

5 Volunteer – Support Services

The Volunteer Co-ordinator has provided me with a list of new

mothers in the neighbourhood who are interested in our Plunket

in the neighbourhood group for first time parents. I am aware

that this list is collated from the information collected by the

Plunket Nurse.

I contact the mothers on this list using the method of

communication they have chosen when they enrolled with

Plunket and let them all know that we will be meeting in the

local community centre for 1-2 hours every Wednesday for 6

weeks.

The list that the co-ordinator has provided me with has

information such as the baby‟s name, DOB, mother‟s name,

address and contact phone number.

At the first meeting I check the details with the mothers who

have attended, and I mark on the form their presence under

today‟s date.

After each session I return the form to the co-ordinator who

provides me with another copy for the following session. She

arranges for the administrator to enter the details of those who

have attended into the database.

At the end of the 6 weeks if the group choose to continue to

meet they can however it will not be seen as a formal Plunket

group. Most groups carry on meeting for years and many of the

members become volunteers.

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6 Volunteer – Home Visiting

I am a Volunteer Home Visitor for Plunket. The Plunket Nurse

has sent a referral via the Volunteer Service Leader for me to

provide support to a client who has 3 children at home under 5

years of age. The referral states that the mother would like help

with housework and general support for a few hours per week.

I visit the mother at home, assist with some laundry, general

housework and we sit and talk. The mother talks about some

things that cause me some concern. I let her know that I need

to tell the Plunket Nurse about the issues she has raised, and

that the nurse will arrange another home visit with her. The

mother was OK and understood this was important, so I rang

and left a message with the Plunket Nurse. When I got home I

used my home computer to access the section of the client

record available to me, wrote notes regarding my visit and also a

written referral to the Plunket Nurse confirming the information I

had shared with her in the morning. The referral is sent directly

to the Plunket Nurse with a link to the client‟s notes. After each

visit I record the tasks that I attended to in the home and any

concerns I noted in the client notes. The Plunket Nurse is able to

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access these records directly.

7 Volunteer Committee Organising a Fund-Raising Event

I am a volunteer in a sub-branch and we are planning a garage

sale at the Plunket rooms. I pull up a list of all the local families

who have consented to having their information shared with

volunteers for fund-raising activities. I email all the contacts on

the list to advise them of the event and ask if they have goods

to donate, or have time to help us on the day.

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8 Pre-school Core Contact by Plunket Nurse

It is time to undertake the pre-school assessments for those

children who cannot attend a clinic with their parents. We

arrange for forms to be sent to the preschool head teacher who

will provide them to all the parents of the children attending the

preschool. She is responsible for collecting in the forms and

providing them to us on the day.

Even though the form has all the contact details recorded by the

parents we do check with the head teacher the child‟s name

again to ensure we enter the details into the correct record.

Because this is a pre-school core contact we need to mark this

as a separate type of core contact as the information is entered

over three different times. We enter the details of the physical

assessment at the pre-school. On returning to the office we

enter the information provided by the parents on the form, and

once we contact the parents after the visit we then can mark off

the health promotion section of the contact. It is only after all

these components are entered that the contact can be officially

marked off as a core contact.

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9 Antenatal Education Facilitator

As the provider of antenatal education, clients are either referred

to us from the LMC or they self refer. At the first session the

women (and partners if attending) are asked to complete a form

with key details which are used to enrol them on to the Plunket

database. I inform the parents what their information will be

used for, how it will be stored and who will be able to access it.

At each session I mark off all the clients who attend the sessions

and the topics covered at each session. I am also able to write

any individual comments against the individual names. All this is

entered on one form and the information is then transferred to

the individual records – similar to the process used by parenting

education and support groups.

At the last session the women are asked if they would like

Plunket to be their Well Child Provider. If they agree then their

EDD is placed into the system so that a reminder is sent to the

administrator to ring 4 weeks after the EDD if a referral has not

been received from the LMC or other before then.

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9.2.3 External Providers

These scenarios are from the viewpoint of an LMC (midwife), a

GP and other external providers.

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1 Lead Maternity Carer

I discuss with each client who they would like as their Well Child

provider. If they choose Plunket, it is a simple process of

recording Plunket as their Well Child Provider. This then

activates a system that automatically transfers information from

my electronic record to Plunket‟s system. The information

transferred has been agreed to between Plunket and the College

of Midwives. It is the information collected when undertaking the

needs assessment, and that the parent has agreed to share. This

will then be validated when the Plunket Nurse undertakes her

assessment.

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2 GP

For all my Plunket clients I receive a summary of each Core

contact with the Plunket Nurse, well, for those clients who said it

was ok to do this. This allows me to know what is happening

with the family. However when Plunket Nurses want me to see

the family about something specific, they send me an electronic

referral which allows me to recognise the importance of this

visit. I also receive copies of other referrals that Plunket

receives.

Plunket receives summaries of visits when the family visit my

surgery and I provide them with a copy of any referrals I make

for the family as well. Our systems also update each other with

changes of addresses.

The sharing of information allows both professionals to be aware

of what is happening with the family and ensure that families do

not fall through the gaps.

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3 Social Services

When we receive referrals from Plunket, they are received

electronically over a secure line. The form used has been agreed

between Plunket and our service previously, therefore we

receive only the information that is needed. Once we provide the

services requested in the referral, Plunket is notified of the

outcome of the service.

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4 CYF

Plunket sends notifications to CYF electronically, after it has

been written by the Plunket Nurse, and approved by the Clinical

Leader. These are transferred over a secure line. When CYF send

a request for information to Plunket, Plunket completes the

same form with the required detail and sends it back to CYF. CYF

can also send an update or progress report to follow up on a

referral and advise Plunket of the action taken.

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9.3 Screen Displays and Data Entry

This section shows prototype layouts of several sample screen

displays that Plunket anticipates will support its main processes.

The prototypes give a general impression of the layout and

functionality envisaged, including display of data from the

client‟s EHR.

These screens will also be used for recording information,

especially including that gained during client contacts.

The prototypes are intended as a guide to help understand what

Plunket Staff will need in order to carry out their roles using

PlunketPlus.

Plunket recognises that further work will be required with the

software provider during the design phase to ensure that all the

necessary elements are identified and that they are positioned

appropriately on the correct screens.

Details of the screen designs and content will be confirmed

during the design phase, through appropriate consultation with

Plunket Staff from each of the services.

The data entities and attributes supporting these prototype

screens are set out in the Data Dictionary.

Additional screens will be required; the prototypes shown here

are examples of a few of the envisaged screens.

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1 General

Layout

Plunket requires the screen designs to be consistent with each

other and for all screens to conform to these general principles:

Name of screen across top.

PlunketPlus branding, minimal yet clear.

Client‟s identification details.

Main caregiver‟s identification details.

Navigation to each aspect of the client‟s EHR, using context-

sensitive buttons or tabs.

Where a button (or tab header) refers to a screen (or tab)

that collects data, it should indicate whether all required data

has been input or not. This could be achieved by a change in

colour or some other way to be agreed.

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2 Add and

Change

Screens

Plunket requires facilities to add new screens and change

existing screens.

Examples of the need for this are:

When Plunket enters into a new contract for a new service.

When there are changes to an existing contract or the

services under that contract.

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3 Who Can

See What

There are rules covering access to a client‟s EHR details, in

particular who can access what, as defined in Section 13.1

“Privacy” on page 271 and Appendix D, the “Who Can Access

What” matrix.

Plunket requires the screens to be sensitive to these rules, so

1



that the same screen layout can be used by multiple different

Plunket Staff roles, yet show only the information that is

pertinent to each role.

4 Client‟s Own

Language

Plunket would like the screens to have multi-lingual capability,

so that key phrases and clinical names and descriptions can also

be displayed in the preferred language of the client, as indicated

by the appropriate setting in the client‟s EHR.

The reason for this is to provide assistance to Service Delivery

Staff in describing things to clients and interpreting their

responses.

Plunket understands that this functionality would need to be

supported by the inclusion of the additional language words in

the relevant data attributes in the data dictionary.

The languages Plunket would like to see included are:

Maori

Samoan

Tongan

Mandarin

Korean

Cantonese

Chinese dialect (Mix of Cantonese & Mandarin)

Hindi

Spanish

Arabic

Portuguese

Japanese

with a capability to add further languages in future.

Plunket would accept a progressive approach on implementing

these languages, with the top left four on the list as the initial

priority, in the sequence shown.

Please describe your approach to delivering this functionality.

Plunket does not intend to record data in languages other than

English.

3

5 List of

Screen

Prototypes

Plunket requires PlunketPlus to include screens similar to the

following, for which mock-ups have been prepared:

Client Contacts Summary

Key information that staff need before a contact and to bring

up the correct Service Delivery Plan for a Service Event

Well Child – History

Key health information which is usually collected at the first

Core Contact

Well Child – Core Contact

The Core Contact which will have different information

dependant on the Core Contact number

Additional Contact – Face-to-Face

For the majority of Additional Contacts, which are face to

face contacts

Group Contact – Parenting Education/Antenatal Education

The ability to have a list of participants and highlight the

topics discussed only once instead of opening each individual

client HER

1



Volunteer Home Visiting

For record when volunteers working with individual clients in

their home

Parents As First Teachers (PAFT)

Specific contract

Plunket Postnatal Depression Programme (PPNAP)

Specific contract

B4 School Check

Specific contract

6 Additional

Screens

Plunket requires PlunketPlus to include further screens. Those

identified to date as necessary in PlunketPlus are:

Client Summary

This will be the main screen displayed when accessing a

client‟s EHR and will provide:

A summary of all key contact information

A list of all services for which they are enrolled

A list of all contacts including which Service Delivery Staff

were involved in the contact

A summary of any pending actions, eg incoming referrals

and referral feedback

Clinical Alerts and System Alerts

Navigation to all other screens relating to the client.

Additional Contact – Phone/Email

As the type of information you collect via the phone or email

is different to a face to face this page makes it easier to

focus on this type of information

Administration Screens

One or more screens will be needed for Area Administrators

and Clinical Leaders to use in their day-to-day duties.

Although these screens deal with client EHR data, These

screens are for the purpose of maintaining administrative

data rather than clinical data so will have quite a different

appearance to the other screens.

These screens may be delivered as a series of tabs on a

single screen.

Administrative functions to be carried out on client EHR data

using these screens include:

View all the services for which the client is or has been

enrolled

View upcoming contacts

Update contact details

Maintain relationships between clients, including showing

all the clients related to the current client and the ability

to click on each to open their EHR too

1



Discontinue a client

Assign or re-assign a Case Manager Plunket Nurse

Initiate workflow actions

Monitor referral processing, workflow actions, Clinical

Alerts and System Alerts relating to the client.

In addition there will need to be screens for Area

Administrators and Clinical Leaders to monitor and manage

workflow actions, queues, reassignment, etc.

HR Screen

This will be used by Plunket‟s HR staff to add, access and

update certain items of data for Plunket Staff.

Other screen shots for individual contracts

i.e. DHB contracts

Group Contact – Volunteer Support

Same as Group Contact – Parenting Education however the

type of support will be listed instead of individual topics

Viewing attached documents

There will be a variety of unstructured documents attached

to a client‟s EHR.

Examples include:

The pdf that accompanies incoming electronic referrals.

Incoming paper documents that have been scanned.

Data from POND that has been rendered as a pdf

document.

Data from the PHR that has been scanned.

Screens will need to be provided to access and view such

documents.

Further screens will be identified and designed during the design

phase.

7 Control of

Access by

Others

The Case Manager Plunket Nurse has control over the “Who Can

Access What” matrix for their clients EHR details, which is

described in Section 13.1 “Privacy” on page 271 and Appendix

D, the “Who Can Access What” matrix.

A method will need to be devised for the Case Manager Plunket

Nurse to do this from the appropriate client and contact screens.

1



9.3.1 Client Contact Summary



Client Contact Summary

1 Description

and Purpose

This screen shows the key information about a client, with the client identifying details and contact details across

the top.

This is used by Service Delivery Staff when preparing for and when attending a contact and allows them to check

they have accessed the EHR details for the correct client.

1

2 Information

Displayed

The groups of information to be displayed will include:

Identification details for the client.

Identification details for the primary caregiver.

Clinical Alerts for the client, the client‟s caregivers and anyone else at the same address.

Summary of all recent contacts.

Indicator that shows the Needs Assessment code for the client. This will be visible to only the client‟s Case

Manager Plunket Nurse and the relevant Clinical Leader.

Summary of recommendations and referrals from the previous contact.

List of pending incoming referrals and referral feedback.

List of all current Plunket services for which the client is enrolled, and access to a list of Plunket services

previously enrolled in.

1

3 How

Accessed

Service Delivery Staff can access this screen from:

The Client Summary screen.

A Scheduled Contact in their diary.

1

4 Key Functions Functionality provided by this screen will include:

The ability to access and update any information displayed, including the use of dialogue boxes or other

screens where necessary.

Access to other information related to the client and the services for which the client is enrolled.

Dynamic links to decision support material.

Select the Service Delivery Plan for Client Event that relates to the contact currently being planned or carried

out.

1



This will include the service (or in some case the multiple services) and therefore the contract(s) that apply to

the contact.

Once selected, this guides which screens and content are relevant to the contact, what actions are to be taken

and the Client Health Information that is to be collected.

The drop-down selection list is to provide the capability of positioning the most common services at the top.

The type of contact (eg Core Contact, Additional Contact) will automatically be determined by the Service

Delivery Plan for Client Event. The screen must allow the Service Delivery Staff member to override this, for

example during a scheduled Core Contact it may become apparent that there are insufficient criteria met and

that it must be changed to an Additional Contact.

A method to pull down the next Contract Event Template and from it create and add to the next Service

Delivery Plan for Client Event for the client.

A method to enter the type of contact, delivered with a drop down list of all the types of contacts, eg face to

face, phone, group.

A method to enter the location of the contact, delivered with a drop-down box.



9.3.2 Well Child Health History

v3

PlunketPlus 30/04/2010Well Child Health History

sex Male

Ethnicity 1

Ethnicity 2

Ethnicity 3

NZ European

Maori

Tongan

Name

Postcode

Deprivation

12 Davis Grove

Davidstown

6007

5

Address 1

Address 2

Address 3

Age when physical assessment completed

Birthmarks 1

Abdomen

Auckland

Address: 12 Davis Grove, Davidstown, AucklandChild's Name Dave Davis DoB 16-Sep-09 NHI ABC1234

SELECT Adults attending from the

drop down list below

Birthmarks 2 if 1 = yes

Breasts and nipples

Chest

Date

Ears appearance

Ears responsive

Eyes 1 - eyelids

Eyes 2 - cornea

Eyes 4 - pupils reactive

Eyes 5 - iris

see data dictionary as to the

units/type of measure

Edit Alerts

Hazard Alert 1Dogs on property call 09 333

4444

Hazard Alert 2Bad dresser - watch out for pencil

ties and winklepickers Eyes 6 - visual behavior

Hazard Alert 3 Rabid hamsters

Hazard Alert 4 Tap dancing sister

Eyes 3 - pupils shape

Eyes 7 - strabismus

Female genitalia - discharge

Female genitalia - labia

AND PLENTY MORE

History Contact Group Opening Page

Child DetailsChild Health Assessment

Maternal Health

Assessment

Family Health Assessment

Paternal Health Assessment

Main Caregiver 1 - Anna DavisMain Caregiver 2 - no oneOther nominated Caregivers

Change Details



Well Child – History

1 Description

and Purpose This screen will be used to display and enter all the necessary health history information for a Well Child client.

It will be used by a Plunket Nurse, usually at the first Core Contact.

This information comes from the discussion with the care giver at the first Core Contact and the full examination

of the baby and is then used as a baseline for all future contacts.

1

2 Information

Displayed

Various type of general information will be shown on the main page.

The large buttons across near the top of the page, which could be tabs, give access to a number of distinct

groups of information:

Child Details – this section contains all the general information about the child such as address, ethnicity, iwi,

etc.

Caregiver Details – this section is where all the details of the caregivers are displayed and recorded. This is a

link from the caregiver‟s EHR so that the information does not need to be entered twice. There may be a link

to more than one caregivers‟ EHR, and on the first visit the Plunket Nurse needs the ability to add more than

one caregiver. The type of information is general information such as address, ethnicity, iwi, etc. [Editor‟s

note: This item probably belongs on a different screen.]

Child Health Assessment – this section contains all the information from the physical assessment of the baby

And where relevant to the child‟s health:

Maternal Health Assessment – this section contains all the relevant information from the mother and

information regarding the pregnancy, birth and past parenting experience

Paternal Health Assessment – this section contains all the relevant information from the father and their

previous parenting experience

Family Health Assessment – this section contains all the relevant information regarding the family that

may affect the health and wellbeing of the child, including siblings. Siblings will have a separate EHR so

this should link to the siblings‟ EHRs.

Other information on the main screen will include a list of active Clinical, system and Hazard Alerts, with the

ability to add further alerts as they often come out of discussion during this conversation.

See the clinical data dictionary for the details of the information collected

1



3 How

Accessed


The Client Summary Screen.

The Client Contact Summary.

1






Most of the information will be selected through a drop down facility, however for some items free text entry

needs to be available.

In the Family Health Assessment there is a section on how information will be used – in the future this section

may require a signature from rather than a yes/no choice.

The ability to populate the relevant Weight, Height and Head Circumference information on to the relevant

charts.

1



9.3.3 Well Child Core Contact

v3

Plan

Educational

Anticipatory

Guidance

Referrals /

recommendationsOutcomes

Assessment Analysis

ABC1234 Address: 12 Davis Grove, Davidstown, Auckland

PlunketPlus 30/04/2010Well Child Core ContactChild's Name Dave Davis DoB 16-Sep-09 NHI

Each of the above will take the Plunket user to a different page and each page will have a different format butthe pages can be completed in any orderas each page is completed with all mandatory data it will "grey out"the requirements for each component will vary with ageeach goes through

Down this side will be decision support material depending on the topic under discussion.


Caregiver view

Physical Assessment

Support Links

General health

wellbeingParenting

Developmental Assessment SafetyScreening



Well Child – Core Contact

1 Description

and Purpose

This screen supports the Plunket Nurse when conducting a Core Contact.

The screen has links to sub-screens or tabs, all of which display information from the client‟s EHR and the

relevant Service Delivery Plan for Client Event.

The screen also:

Provides prompts to take all the necessary actions for the particular Core Contact.

Accepts entry of data.

Decision support.

The actual information needed to be collected will differ for which contact as each Core Contact is based on the

child‟s expected development at particular ages. This is based on the Well Child Tamariki Ora Framework.

9.3.3.1 1

2 Information

Displayed

Details shown on the screen (and its sub-screens) will alter depending on which Core Contact is applicable. It will

include:

Identification and contact details of the client

Caregiver view – free text section, plus a drop down to identify who has attended the assessment.

Physical Assessment

Developmental Assessment

Parenting

General Health wellbeing

Screening

Support Links

Safety

The individual items are identified in the first section of the clinical data dictionary.

On the right is a panel that will display the list of decision support links that are relevant to the topics that the

Plunket Nurse has open.

9.3.3.2 1



3 How

Accessed

The Plunket Nurse can access this screen from:



Well Child Health History.


9.3.3.3 1






Only Plunket Nurses undertaking a Well Child Contract contact is able to complete the data in this section

Only allow information from this section be read by staff undertaking a Well Child Contract contact

As each of the required components of the Core Contact are complete the top tabs change colour to highlight

(or otherwise indicate) to the Plunket Nurse that section has been completed. This will then also indicate to

the Plunket Nurse the topics that still need to be completed.

If all required sections are not completed then the Core Contact becomes an Additional Contact.

Flexibility to move from section to section in no particular order as the parents/caregivers will be leading the

flow of the conversations that occur.

The ability for the Plunket Nurse to work by topic including the assessment, analysis, plan of action to occur at

the contact including education or anticipatory guidance, referrals and recommendations.

During and at the end of the contact the Plunket Nurse will also record any agreed outcomes


charts.

9.3.3.4 1



9.3.4 Additional Contact – Face to Face

v3

Educational

Anticipatory

Guidance

Referrals /

recommendationsOutcomes

Assessment Analysis Plan


PlunketPlus 30/04/2010Additional Contact - face to face Child's Name Dave Davis DoB 16-Sep-09 NHI

If is a referral from a core contact then the text written by the Plunket Nurse will appear here which details the reason for the referral.If a particular subject for which decision support has been developed (and by inference a system of recording) then that will present.Referrals and recommendations would need to be able to be made so these links would need to be made.If a Plunket Nurse is doing the contact then she would be able to make Assessments / analysis calls and have access to the tools to do that along with the ability to refer and recommend. A Health Worker (by access permissions) would not. Down this side will be

decision support material depending on the topic under discussion.

A Health Worker would be able to record the non analytical content of the contact and make internal referrals and recommendations. An external referral would need to go via the case manager.


Caregiver view

Support Links

General health

wellbeing

ParentingSafety Assessment



Additional Contact – Face-to-Face

1 Description

and Purpose This screen will be completed by any Service Delivery Staff Member.

The actual information needed to be collected will differ for which contact as it is based on the needs for that

actual contact.

It may be a very general contact or it could be for only one specific topic – eg breastfeeding.

1

2 Information

Displayed

The groups of information to be displayed in this section will be finalised during the design phase. Currently the

information on the prototype is very much a draft idea.

Identification and contact details of the client.

Caregiver view – free text section, plus a drop down to identify who has attended the assessment

Safety.

Parenting.

General Health wellbeing.

Support Links.

Assessment.

The individual items are identified in the first section of the clinical data dictionary.

To the right side is the decision support that is relevant to the topics that the Service Delivery Staff member has

open.

1

3 How

Accessed




Well Child Health History.


1









flow of the conversations that occur.

The ability for the Service Delivery Staff member to work by topic including the assessment, analysis, plan of

action to occur at the contact including education or anticipatory guidance, referrals and recommendations.

During and at the end of the contact the Service Delivery Staff member will also record any agreed outcomes.


charts.

1



9.3.5 Group Contact

Adult Name Child Name

v3

16-Sep-09 12 Davis Grove, Davidstown, Auckland

ABC1235

ABC1236

ABC1237

ABC1238

PlunketPlus 30/04/2010Group Contact - Parenting Education / Antenatal Education

Child dob

Location for this groupDate of this Group contact Davidstown Family Centre30-Apr-10

NHI Address

somewhere1

somewhere2

somewhere3

somewhere4

another 27

ABC1234

ABC1248

ABC1249

ABC1242

ABC1243

ABC1244

ABC1245

ABC1246

ABC1247

ABC1240

ABC1241

ABC1239

another 25

another 26

somewhere5

somewhere6

somewhere7

somewhere818-Oct-09

20-Sep-09

24-Sep-09

28-Sep-09

2-Oct-09

6-Oct-09

10-Oct-09

14-Oct-09

somewhere9

somewhere10

somewhere11

somewhere12

somewhere13

somewhere1411-Nov-09

15-Nov-09

22-Oct-09

26-Oct-09

30-Oct-09

3-Nov-09

7-Nov-09

Topics coveredPersonnal Comments

needs to contact PN

Attended?

Anna Davis

an other 1

an other 2

an other 3

an other 4

an other 5

an other 6

an other 7

an other 8

an other 9

an other 10

an other 11

an other 12

an other 13

an other 14

an other 15

another 24

another 19

another 20

another 21

another 22

another 23

Attended?

Dave Davis

another 16

another 17

another 18

another 28

another 29

another 30 somewhere15

Group Opening Page

basket weavingnutritionbreastfeedingcar cleaningchiropodistsbodysurfing

Programme Completed

Close



Group Contact – Parenting Education/Antenatal Education

1 Description

and Purpose This screen is designed to support group activities, so that staff do not need to enter the same information into

every individual client record.

1

2 Information

Displayed


Identification of the group

NHI

Identification of the Adult client

Identification of the Child client

Attendance

Topics covered

Personal comments section where if a comment is to go against one client not all attending clients

Programme completed

The topics for the individual programmes are identified in the clinical data dictionary section entitled Parenting

Education topics and Antenatal Parenting Education Programme.

1

3 How

Accessed

A Scheduled Contact in their diary. 1




The ability to access and update any information displayed.

The ability to make add a new group.

The ability to print the details of the clients expected to attend the group.

The ability to mark present those that attended.

The ability then to populate the EHR of clients who have attended with information regarding the group

session.

The ability to take individual comments against a client and populate only that client‟s EHR.

The ability to populate information such as name, address etc from an NHI or locating an NHI from a name,

address and DOB.

The ability to discontinue a client following the completion of a programme.

1



9.3.6 Contact – Volunteer Home Visit

drop downs or new screens caused by clicking the above

Referral will show what the PN wrote

task - for the volunteer to list what they did.

and so on

v3


PlunketPlus 30/04/2010Volunteer Home VisitingChild's Name Dave Davis DoB 16-Sep-09 NHI

History Opening Page

Referral ConnectionsParenting

ConversationTask




1 Description

and Purpose This screen is for volunteers who are undertaking home visiting. This is a new programme currently being

designed by Plunket.

1

2 Information

Displayed


Identification and contact details for clients

Referral - is a copy of the referral to the volunteer to see the client under the home visiting programme

Tasks – there will be variety of tasks list that the volunteer may undertake at each visit – these are listed in

the clinical data dictionary

Parenting conversations – this section will be mainly free text however there will be topic headings that the

volunteer can mark

Connections are community agencies that the volunteer has connected the volunteer with.

1

3 How

Accessed



The Client Contact Summary Screen.


1







flow of the conversations that occur

The ability to make recommendations or referrals to other community groups

1



9.3.7 PAFT

Clicking on the above will bring up information / input forms.

v3


PlunketPlus 30/04/2010PAFT - Parents as First TeacherChild's Name Dave Davis DoB 16-Sep-09 NHI

History Opening Page

Referral Group ContactHome VisitEnrolment

Information



Parents As First Teachers (PAFT)

1 Description

and Purpose This screen shot is based on the PAFT contract and PAFT staff will need to be involved in the actual design of the

final page. PAFT is a specific contract which Plunket has with the Ministry of Social Development

1

2 Information

Displayed




Referral - is a copy of the referral to PAFT

Enrolment information

Home visit information

Group Contact Information

The individual items are identified in the clinical data dictionary section entitled Parents as First Teachers.

1

3 How

Accessed



The Client Contact Summary Screen.


1








1



9.3.8 B4 School Check

v3


PlunketPlus 30/04/2010B4 School CheckChild's Name Dave Davis DoB 16-Sep-09 NHI

Within each of these sections there is information to collect and the ability to do a referral.



Child Health Questionnaire PEDS Check

Immunisation Check

Growth Check

Dental Check

SDQ Assessment

Send summary to

MOH



B4 School Check

1 Description

and Purpose

This screen shot is based on the B4 School Check contract and staff will need to be involved in the actual design

of the final page. B4 School Check is a specific contract which Plunket has with the Ministry of Health. In Plunket

only Plunket Nurses undertake the B4 School checks

1

2 Information

Displayed




Child Health Questionnaire

Dental Check

Growth Check

Immunisation Check

PEDS Check

SDQ Assessment

Send summary to MOH

The individual items are identified in the clinical data dictionary section entitled B4 School Check.


open.

1

3 How

Accessed


The Client Summary Screen

The Client Contact Summary Screen

A Scheduled Contact in their diary

1











charts

Some of the sections are specific assessments which the staff need to complete. Examples of this are the

PEDS check and SDQ assessment. Both have a number of questions that are asked of the caregiver and

others involved with the care of the child. The Nurse scores the answers on a summary sheet. This section

will need the ability for the nurse to enter the information directly to the questions or be able to accept a

scanned copy of the parents answers if they have completed it prior to the contact.

The ability to “Send summary to the MOH” of agreed information from our system to the Ministry of Health

System.

1



9.3.9 PPNAP

v5

Plunket Post-Natal Depression ProgrammePlunketPlus 14/05/2010ABC1234 Address: 12 Davis Grove, Davidstown, Auckland Client Name Anna Davis DoB 16-Sep-09 NHI

Assessment broken into History, Risk factors

Individual Contact to current symptoms , progress



Referral to PPNAP

Sharing information

consent

Group Contact

Individual Contact

Assessment Discharge



Plunket Postnatal Depression Programme (PPNAP)

1 Description

and Purpose

This screen shot is based on the PPNAP contract and PPNAP staff will need to be involved in the actual design of

the final page. PPNAP is a specific contract which Plunket has with various DHBs throughout the country.

1

2 Information

Displayed




Referral to PPNAP - is a copy of the referral to PPNAP

Assessment

Individual Contact

Group Contact

Sharing information consent

Discharge

The individual items are identified in the clinical data dictionary section entitled Plunket Postnatal Depression

Programme.


open

1

3 How

Accessed


The Client Summary Screen

The Client Contact Summary Screen

A Scheduled Contact in their diary

1








Flexibility to move from section to section in no particular order

1


10 Standards Compliance Requirements

This section introduces Plunket‟s requirements for PlunketPlus to

comply with various standards.

Several areas of standards are outlined here, with reference to

further details that are specified throughout the remainder of the

document.

-

Overview Plunket supports initiatives that work towards interoperability

and appropriate access to data throughout the New Zealand

health sector.

To meet these aims, Plunket places importance on ensuring that

PlunketPlus complies with the relevant standards. These are a

combination of legislation, codes of conduct, published standards

and guidelines, all of which are referred to generically in this

document as “standards”.

The current standards that Plunket is aware of are listed below,

in arbitrary groups. Documentation for most of these standards

is available in the public domain; for those that are not, copies

are included in the RFP package.

Application of these standards is referenced throughout the

requirements sections of this document.

Plunket will also be interested in considering any additional

relevant standards that software providers may suggest.

Software providers are asked to include in their response to this

section whether their proposed solution:

Does already comply with each standard listed

Does not currently comply but could be made to comply

and what would be involved in achieving this

Cannot comply.

Software providers are requested to respond to all references to

standards throughout this section and the following

requirements sections, even although this may result in some

repetition.

-

1 Standards in

the Health

Sector

Uptake of health information standards has not been consistent

or complete across the New Zealand health sector.

There is a range of de facto, approved and emerging standards

that PlunketPlus will need to work with.

Software providers are expected to provide evidence that they

are familiar with these standards and the various initiatives

around the evolution of these.

Plunket‟s requirements for compliance with specific health sector

standards are detailed in the following sections.

1



2 Privacy

Standards

Plunket‟s privacy requirements for PlunketPlus are outlined here

and defined in Section 13.1 on page 271.

-

a) Health Information Legislation

The system is required to comply with the:

Health Information Privacy Code 1994 (HIPC).

Privacy Act 1993.

Official Information Act 1982.

Health Practitioners Competence Assurance Act 2003.

1

b) Health Information Standards

The system is required to comply with the:

Health Network Code of Practice 2002 (HNCOP).

New Zealand Health Network Security Policy for General

Practitioners and other Health Professionals.

HISO8 Health Information Security Framework (HISF),

formerly known as the Authentication and Security Standard.

1

c) Health Information Guides

The system should be consistent with the materials set out in:

The draft paper under development by the Office of the

Privacy Commissioner titled “Guidance Material on the

Extraction of Patient Data from General Practitioners' Practice

Management System Computers”.

The IPAC (GPNZ) security policy for general practice.

2

3 Data

Standards

Plunket‟s requirements relating to data are outlined here and

defined in Section 11.4 “How Plunket will Store the Data” on

page 123 and Section 12.6 “Interoperability with Other Systems”

on page 243.

-

a) Terminology

The system must store data in a way that complies with the

terminologies recognised in New Zealand, or in some way

achieve the same effect:

SNOMED

The New Zealand Government has obtained a licence for

SNOMED to be used in information systems throughout the

New Zealand health sector.

Nursing Terminology

Plunket wishes to adopt a standard nursing terminology for

the data in PlunketPlus and for data authorised for sharing.

Plunket‟s detailed requirements for a nursing terminology are

specified in Section 11.4 “How Plunket will Store the Data”

1

8 HISO: Health Information Standards Organisation, the information standards approval authority for the New Zealand health sector.



on page 123.

Software providers are requested to show how their system will

support these terminologies.

b) Ethnicity

The system must comply with:

HISO Ethnicity Data Protocols for the Health and Disability

Sector.

Please note that this is not the same as the Statistics New

Zealand Ethnicity Standard.

1

c) Geographic

The system must comply with:

NZ Post geographical postal address file (GeoPAF).

Critchlow‟s GeoStan.

Statistics New Zealand Mesh Blocks, annual pattern and

census based.

1

4 Interopera-

bility

It is essential that PlunketPlus has interoperability with other

data stores and systems in Plunket and throughout the New

Zealand health sector.

The principles Plunket is adopting for interoperability are:

Client Health Information will be shared only under the most

stringent of privacy and security conditions, detailed in

Section 13.1 “Privacy” on page 271.

All electronic transfer of Client Health Information with

external organisations will be transmitted through the secure

New Zealand health network and, if by email, using SEEMail.

Any Client Health Information sent to or received from

external organisations will be processed through:

“Transfer of Care” messaging, detailed in Section 12.6

“Interoperability with Other Systems” on page 243.

The future Kidslink, NIR9 and other “Interoperability with

External Systems” functionality described in Section

12.6.3 on page 262.

PlunketPlus will access external reference systems to obtain

or validate data, for example the National Health Identifier

(NHI) managed by the Ministry of Health.

Limited interoperability with internal Plunket systems is

planned. In concept, PlunketPlus will generally act as the

“master” with the other systems obtaining data from it and

providing data to it. PlunketPlus will not access or update

those other systems.

Plunket‟s requirements for interoperability are outlined here and

specified in detail in Section 12.6 “Interoperability with Other

Systems” starting on page 243.

-

9 NIR: National Immunisation Register.



a) Security, Authentication

The requirements for security of access to PlunketPlus from

within Plunket, detailed in Section 13.2 on page 277, also apply

to all access between PlunketPlus and all other Plunket systems.

PlunketPlus must work with:

Microsoft Active Directory (AD).

Microsoft Forefront Identity Manager (FIM).

There will be no access to PlunketPlus from any systems external

to Plunket. Any incoming data for PlunketPlus will be processed

by Transfer of Care messaging or manually.

Clients‟ access to the PlunketPlus Portal will be managed by a

PlunketPlus Security Mechanism, described in Section 13.2 as

“Non-Plunket Access”.

1

b) Transfer of Care

Transfer of Care interoperability requirements are specified in

Section 12.6.1 on page 243.

The current approved standards in use are:

HISO Referrals, Status and Discharges (RSD).

Health Level 7 (HL7).

GP2GP10 (in development).

PlunketPlus will need to work with these standards for a period,

then with any relevant successive versions or new standards

adopted in the New Zealand health sector.

1

c) Terminology

Any data that is authorised for sharing must conform to agreed

standards to ensure meaningful interoperability.

Plunket requires the system to support the following

terminologies:

SNOMED.

A standard nursing terminology.

Software providers will need to show how their system will

support such terminologies.


specified in Section 11.4 “How Plunket will store the data” on

page 123

1

d) Other Plunket Systems

Plunket wishes to adopt a standard approach to interoperability

between PlunketPlus and other Plunket systems:

Business systems.

Microsoft Office.

1

10 GP2GP: From General Practitioner to General Practitioner.



Software providers are requested to propose an approach to

achieving this, in a manner that conforms to any appropriate

industry and health sector standards.

Plunket‟s functional requirements for interoperability with other

Plunket systems are detailed in Section 12.6.2 on page 257.

e) Health Sector and Government Agency Systems

PlunketPlus is required to implement standards for

interoperability with various New Zealand health sector systems

in addition to Transfer of Care.

These systems are:

Identification Registers

Register Defined in Ministry of Health

documents

National Health Index

(NHI)

NHI Best Practice Guidelines

Health Practitioner Index

(HPI)

HPI Code Set.

HPI Data Set.

Sector Repositories

Register of GPs in PHOs

Kidslink

NIR

B4 School Check

Safe Medications

e-Pharmacy

Generic interoperability

Plunket‟s requirements for interoperability with these systems

are detailed in Section 12.6.3 “Interoperability with External

Systems” on page 262.

1

5 Technology

Standards

Plunket‟s technology requirements are defined in Section 13.14

on page 293.

1

6 Methodol-

ogy

Standards

Plunket requires the software provider to conform to a number

of methodology standards, which are detailed in the RFP

document, not this requirements specification.

1



11 Data Requirements

Plunket has identified its data requirements from:

Its existing paper-based records

Its POND database

The Well Child Tamariki Ora Schedule, which is the basis of

Plunket‟s Well Child service delivery contract with the Ministry of

Health

Service delivery requirements beyond those represented by

Plunket‟s current systems

Service delivery Standards of Practice and other guidelines

Strategic requirements.

Plunket sees its clients‟ Electronic Health Record (EHR) at the heart

of the new system and has created a conceptual high-level data

model to show its requirements in terms of data entities, entity

relationships and attributes.

This requirements specification assumes the existence of the EHR

database.

The data requirements set out in this section are structured into:

Overarching Data Requirements in Section 11.1 on page 84

Conceptual Data Model 11.2 90

This comprises a context diagram and several subject-area

entity-relationship diagrams, with explanatory text.

Future Data Volumes 11.3 122

How Plunket will Store the Data 11.4 123

Retention Disposal and Archiving of Data 11.5 125

Further extensive data requirements details are set out in a number

of tables in Appendix B.

This data requirement definition is intended as an indicative design

of the data structure and content, for the purpose of clarity of

Plunket‟s intent with its EHR and as a tool for evaluation of

proposals. Plunket expects that proposals may meet these data

requirements in a manner that has some differences with this

specification, and will consider these as long as the intent is met.

Note: The term “entity” used throughout this document is a data

modelling term, with the meaning defined in the Glossary, not the

term that Plunket Staff use to describe their organisational units.



11.1 Overarching Data Requirements

1 PlunketPlus

Database

and EHR

Plunket intends to have an Electronic Health Record (EHR) for

each client, which will be populated as relevant for each child

client and adult client.

Plunket has used the term EHR in this document to refer to the

envisaged PlunketPlus database, which will contain client data

and other data.

Access to data in the EHR will be tightly controlled, with any

user11 able to see only the parts of the EHR that are relevant to

them and their purpose. The requirements for access control are

described in:

Section 13.1 “Privacy” on page 271,

Section 13.2 “Security” on page 277

Section 13.4 “Access to Plunket and Client Information” on

page 283

Who Can Access What Matrix in Appendix D.

Identifiable data from the EHR (containing for example the

name, address, NHI or other data indentifying a specific

individual) will not be shared with other organisations. The only

exceptions are:

Access to some parts of the EHR will be shared with selected

caregivers, such as a child‟s parents. This requirement is

described in:

Section 12.5 “PlunketPlus Portal” on page 240.

Who Can Access What matrix in Appendix D.

Some data from a client‟s EHR may be included as part of a

referral to another provider. This requirement is described in:

Section 12.6.1 “Transfer of Care” on page 243.

EHR data that has been de-identified or aggregated will be

available for some analysis and reporting purposes. This is

described in the reporting sub-sections of Section 13 “Non-

Functional Requirements” starting on page 271.

-

a) Client-Centric

The EHR is to be client-centric. Plunket‟s focus is on the child

and family, with each individual person encompassed in the

model as an individual client.

1

b) EHR as the Single Client Record

The EHR is to be the single record for the client (and available to

all authorised Plunket staff as appropriate).

1

c) Client Relationships

The EHR must be able to record all the relevant relationships

1

11 User: Any person who uses PlunketPlus.



between the client and others who have an active participation

in the care of the child, for example parents, grandparents,

siblings and other caregivers, who will also be entered into the

database as clients.

d) Access and Update Any Time, Anywhere

Plunket Service Delivery Staff must be able to access and update

their client‟s EHR before, during and after a client contact, using

a mobile computer. This may occur in any location using mobile

telecommunications.

1

e) Online and Offline

Plunket Service Delivery Staff must be able to use the system in

”online” and ”offline” modes, with access to the client‟s EHR at

all times.

1

f) Automatic Upload

Information captured into the EHR while offline must be

automatically synchronised with the main EHR database at the

first opportunity.

1

g) Area Data on Mobile Computer

The mobile computers to be used by Service Delivery Staff are

to hold a replicated and synchronised copy of the EHR data for

all the clients in the Plunket Area where that staff member

works.

Data for clients outside that area will, by default, not be stored

on a mobile computer.

1

h) Access within Branch

In the normal course of their work, Service Delivery Staff may

access the EHR of only the clients in their own Plunket Branch.

The exception is PlunketLine Service Delivery Staff, who will

have the right of access to all clients.

When a Service Delivery Staff member needs to access the EHR

of a client from another Branch in the same Area, they will use

the “break-glass” access method.

1

i) Break-Glass Access to Other-Branch Clients

For the cases where Service Delivery Staff need to access the

EHR of a client from another Branch in the same Area,

PlunketPlus will require them to first enter a reason for this

access.

PlunketPlus will then allow the access and raise a System Alert

to advise their Clinical Leader of the break-glass incident.

1

j) Break-Glass Access to Other-Area Clients

For the cases where Service Delivery Staff need to access the

EHR of a client from outside their Area, and therefore not held

1



on their mobile computer:

The other-area client‟s EHR may be accessed and updated

only when the mobile computer is online; and

PlunketPlus will require them to first enter a reason for the

access and raise a System Alert to advise the Clinical Leader

in both of the areas of the break-glass incident.

2 Data

Dictionary

Plunket requires that the EHR accommodates all the details

described in the Data Dictionary included in Appendix B.

1

3 Data

Standards

Plunket wishes to ensure consistency with health sector

standards when storing and sharing its EHR data.

Additional details of the requirements around standards for data

are described in:

Section 11.4 “How Plunket will store the data” on page 122

1

4 Data

Flexibility

Plunket requires PlunketPlus to have flexibility of data

definitions, so that the system can adapt to meet changing

needs over time.

An example of the need for future change is the current review

of Well Child population health data by the Ministry of Health.

This is likely to result in a need to add further data entities and

attributes to the PlunketPlus database.

Further, Plunket frequently enters into new contracts for service

delivery and these will all need to be set up in PlunketPlus.

Plunket understands that exercising this requirement can have

significant impact.

Set out here are the areas of flexibility that Plunket will need,

irrespective of how this is accomplished, followed by a request

for software providers to propose options for meeting this

requirement.

-

a) Add Data Entities

Plunket requires the system to allow for additional data entities

to be added when necessary.

1

b) Add Data Entity Relationships

Plunket requires the system to allow relationships to be added

between data entities.

1

c) Add Attributes (Fields)

Plunket requires the system to allow for additional data

attributes (fields) to be added when necessary.

1

d) Define Attribute Characteristics

Plunket requires the system to allow for the characteristics of

each data attribute (field) to be defined. For example length and

data type.

1



e) Define Attribute Edit Rules

Plunket requires the system to allow edit rules to be associated

with each data attribute. Examples include:

ranges of valid date values for date fields

allowed values for numeric fields

value must exist in any related table.

1

f) Domain Values (Stored Value Lists)

Plunket requires the system to utilise domain values (often

known as stored value lists or code lists) that:

Define lists of values for selected attributes (fields)

Optionally limit values entered into an attribute to only those

stored as domain values.

1

g) Change Data Entity, Attribute, Characteristic and

Domain Value Details

Plunket requires the system to allow the definitions of data

entities, relationships, attributes, characteristics, edit rules and

domain values to be altered when necessary.

1

h) Database Administrator Functions

Plunket requires the system to allow Plunket‟s Database

Administrators and no-one else to add or change data entities,

relationships, attributes, characteristics, edit rules and domain

values.

1

i) Audit Trail of Changes

Plunket requires that there is an automated audit trail of all

additions and changes to data definitions, with facilities to view,

analyse and report on the contents of this audit trail.

1

5 Data

Flexibility

Options

Please detail the options for meeting the flexibility requirements

above, taking into account:

-

a) Changes at Short Notice

The need to implement changes to data definitions at relatively

short notice.

1

b) Preserve Integrity of Existing Data

The importance of preserving the integrity of data already in the

database.

1

c) Preserve Relational Integrity and Normalisation

Achieving relational integrity and normalisation when entities

and attributes are added or changed.

1

d) Cost-Effective 1



A cost-effective approach to achieving the flexibility.

e) Non-Proprietary

The approach to achieving the required flexibility will not

unreasonably lock Plunket into a particular technology or

provider.

1

6 Data Inter-

operability

Plunket intends that PlunketPlus will be highly interoperable with

other service delivery support systems and databases within

Plunket and throughout the New Zealand health sector and will

be standards-based.

The requirements around interoperability are described in:

Section 12.6 “Interoperability with Other Systems” on page 243.

-

7 Integration

with Active

Directory

Plunket will be moving to role-based authentication as part of

the migration to a new Standard Operating Environment (SOE)

this year. This will require a redevelopment of the Active

Directory (AD) environment and the implementation of Microsoft

Forefront Identity Manager (FIM) 2010 to manage role-based

network credentials and information for Plunket staff.

-

a) Integration with Active Directory

The PlunketPlus application suite will need to be AD and then

FIM aware to leverage the greatest level of inter-operability.

Please provide details of this integration.

1

b) Data in Active Directory

Please describe exactly how PlunketPlus will interact with Active

Directory (or FIM) to avoid duplication of data entry and

maintenance for person data that may be required in AD (or

FIM) and PlunketPlus.

1

8 Audit and

History

PlunketPlus will record important information about Plunket

clients and the Plunket services they have used. As such it is

important that PlunketPlus maintains a complete history of

changes and an audit of who made them.

-

a) History

PlunketPlus must be able to present to the user a full history of

all changes to records within PlunketPlus. PlunketPlus must be

able to present a record as it appeared at a given point in time.

This includes records that have been “deleted” by the user. Note

that this is a logical delete, in other words the data is retained,

marked as deleted as defined in Section 11.4 “How Plunket will

Store the Data” starting on page 123.

Describe how PlunketPlus will provide history as described

above.

1



b) Audit

All access and changes to EHR data recorded in PlunketPlus must

identify the user who viewed or printed the data, or made the

change, and when this occurred. Such audit details must be

recorded on all records including history records and a facility

must be available to view the audit data through queries and

reports.

1

c) Access to History and Audit

This information will not be visible by default, however it can be

selected for viewing by any user with the access rights detailed

in the Who Can Access What Matrix in Appendix D.

1

d) Alerts for Inappropriate Access to Data

Plunket places importance on the privacy of data and would

benefit from a facility that identifies inappropriate access to data

beyond that described above as break-glass access.

Software providers are invited to propose solutions to meeting

this requirement.

1

9 Maintenance

of Reference

Data Tables

and

Templates

Plunket requires facilities for PlunketPlus Administrators to set

up and alter templates and reference data tables.

Examples include:

Contract

Contract Event Template

Template Action

Service Delivery Plan for Client Event.

Changes to these are subject to the same audit trail

requirements as changes to data definitions.

1



11.2 Conceptual Data Model

Overview Plunket has set out a high-level view of its data requirements in

a conceptual data model, represented by a context diagram and

seven supporting Entity-Relationship Diagrams (ERDs).

These requirements are set out on the following pages.

-

Notation The lines between the data entity boxes describe the relationship

and use the notation:

EventContact

A Contact is a type of Event

Plunket Area Plunket Branch

Reading left to right: “Each area is made up of one or more

Branches”.

Reading right to left: “Each Branch can belong to only one Area”.

EventClient

Reading left to right: “A client may have zero, one or many

Events”.

Reading right to left: “Every Event must have at least one client

and may have many clients”.

ClientClient Health

Information

Reading left to right: “A Client Health Information item belongs

to one and only one client”.

Reading right to left: “A client can have zero, one or many Client

Health Information items”.

Event guidesSDP for Client

Event

Reading left to right: “An Event may be guided by one Service

Delivery Plan (SDP) for Client Event, or none”.

Reading right to left: “An SDP for Client Event may guide one

event, or none”.

-



Mapping of

Context

Diagram

ERD Pages Context Diagram Entities

Person and Organisation Client


Organisation

Plunket Organisation Organisation

Plunket Group Organisation

Person Organisation

Client Client

Person Organisation

Event Event

Client


Contracts and Service

Delivery Plans

Contract for Service

Event

Client


Client Health Information

and Actions

Event

Client


-

Requirement Plunket's requirements for the structure of the PlunketPlus

database are shown in the seven diagrams on the following

pages and the accompanying descriptions.

Details are to be confirmed as part of the design phase.

-

Overlap There is an inevitable overlap of descriptions across this Data

Requirements section and the functional and non-functional

Requirements sections.

All descriptions should be read in combination. Any

inconsistencies will be resolved during the design phase.

-



11.2.1 Context Diagram

To simplify the data model Plunket has identified 6 major subject areas PlunketPlus must manage data for. The diagram below shows the 6 major

subject areas and the high-level relationships between each. The following sections provide more detailed requirements for each subject area.

Person Organisation

This is a way of grouping entities with similar attributes.

For example clients, Service Delivery Staff and

Organisations may all have phone numbers, addresses

and emails.

Client

Data that describes the client themselves and their

relationships to other clients.

Event

Data that describe events that have happened or will

happen to a client (eg contact, referral etc).

Plunket Service Delivery Staff

Data that describe people who deliver Plunket‟s services

(eg nurses, Car Seat Rental Scheme staff, volunteer

facilitators etc).

Organisation

Data that describes Plunket itself (eg Area, Branch, sub-

Branch, address and relationships with other

organisations) and other organisations (eg The Ministry

of Health, MSD etc).

Contract for service

Data that describes the contract and the service offered

under that contract.

Client

Plunket

Service

Delivery staff

Contract for

ServiceOrganisation

Event

Belongs to

Involves

Is related to InvolvesFunds

and guides

Is related to

Person

Organisation

Is a

Is a

Is a

mk21



11.2.2 Person and Organisation

Plunket interacts with a number of different types of people and organisations and requires that PlunketPlus manages common information about all

of them in a consistent manner regardless of whether they are a client, Service Delivery Staff, Plunket Branch or a DHB. The diagram below

describes the different types of People and Organisations Plunket deals with and the common characteristics they all share.

Plunket

Management

and

Administration

Client

Organisation

Plunket Service Delivery staff

Phone Type

Address

Phone Person Organisation Address Email

relationship / roleIdentifier (e.g. NHI,

employee # etc)

Person Organisation

primary

Person

Person Name

Person Name Type

Organisation

Organisation Name

Oganisation Name Type

Person Organisation

Child Client

Volunteer

Plunket Nurse

Plunket Service

Delivery staff

Client

Health Worker

Plunket Care

Delivery staff

Registered

Nurse

Karitane

Karawhina

Adult Client

Volunteer

Funded

Position

ID Type

SDP (Service

Delivery Plan)

for Client Event

relationship type

secondary

Contact

CHI (observed,

measured)

Event

Postal Address

Person

Organisation

Physical

Address

Common

mk21

PAFT staff

B4 School

Coordinator

PPNAP staff

Caregiver

Other Adult

Client

Plunket

Administrators

Plunket

Management

Management

and

Administration

Area Managers

Volunteer Service

Leaders

Clinical

Leaders

National Office

CHI = Client

Health Information



Entity Description/Requirement Rank

1 Person and

Organisation

ERD

Plunket requires the PlunketPlus database to support the entities and relationships shown in this ERD. 1

2 Person

Organisation

The Person Organisation entity represents all of the different types of people and organisations Plunket deals with

and wishes to record information about.

-

a) Uniqueness

Whenever a user attempts to add or amend a Person or Organisation, PlunketPlus must check that no record with

similar characteristics exists and prompt the user if a potential duplicate is found. If potential duplicates are found

PlunketPlus must list the most likely matches first.

1

b) People

When checking for duplicate people PlunketPlus will check at least the following attributes:

Identifier – Check any identifiers such as NHI number, HPI number, Plunket employee number in the case of

Plunket staff.

Name – Check using current name plus any aliases or historical names.

Date of Birth – Check using exact match plus where the month and day have been transposed.

Gender

1

c) Organisation

When checking for duplicate organisations PlunketPlus will check at least the following attributes:

Identifier – Check any identifiers commonly used in the New Zealand Health sector.

Name – Check using legal name, trading name plus any other names or aliases.

1

d) Merge

Where Plunket identifies that 2 people or organisations are actually the same entity, PlunketPlus must allow a

PlunketPlus System Administrator to merge the 2 entities to form a new Person or Organisation.

Related information such as events, Client Health Information and service delivery plans must be copied from

the slave record to the new master. The slave information should then be hidden from view, accessible only

1




by a PlunketPlus Systems Administrator.

For information, such as address, phone numbers etc, that do not make sense to overlap, PlunketPlus must

allow the user to select the records to be copied to the new master.

PlunketPlus must perform the merge in such a way that it allows a user to easily unmerge the Person or

Organisation at a later date.

e) Unmerge, Split

Where Plunket identifies that a Person or Organisation is actually 2 separate identities, PlunketPlus must allow a

PlunketPlus System Administrator to split information about the Person or Organisation into 2 different entities.

PlunketPlus must allow the user to determine which attributes and related information from the original entity

are copied to the two new entities.

PlunketPlus must perform the split in such a way that it allows a user to easily remerge the Person or

Organisation at a later date.

1

f) Master Registers

Master registers such as the NHI or HPI often perform merge/split operations. Where PlunketPlus is informed this

has happened PlunketPlus will create a System Alert for a user to authorise the update to be performed on the

PlunketPlus database.

1

g) Deactivation

PlunketPlus must allow a PlunketPlus System Administrator to deactivate a Person or Organisation who has been

created in error. This will mark the record as inactive and hide it from general searches. A PlunketPlus System

Administrator will be able to “reactivate” a Person or Organisation deactivated in error.

1

h) Communication

PlunketPlus records multiple different means of communicating with a Person or Organisation. PlunketPlus must

record which specific address, phone number or email is the Person or Organisations preferred means of

communication. See below for specific requirements on addresses.

1

3 Address a) Maintain Two Address Types

Plunket requires PlunketPlus to have the facility to maintain addresses for all People and Organisations. There are

1




two main types of address:

Physical Address – A physical location e.g. house, flat, apartment etc

Postal address – An address recorded for the purpose of delivering mail.

b) Unique list of Physical Addresses

PlunketPlus must maintain a list of all unique physical addresses ever entered into the database as shown by the

Address entity in the diagram above. The system must allow analysis of events that occur at a given physical

address.

1

c) Master list of addresses

PlunketPlus will look up a new physical address for a Person or Organisation against a suitable master list such as

the NZ Post GeoPAF, Critchlow‟s GeoStan or equivalent list of unique New Zealand addresses and link the Person

or Organisation to that address and to the meshblock.

1

d) Meshblocks

Each physical address stored must include the meshblock to allow the address to be included in different

geographic areas such as Plunket Branch or Sub-Branch, Territorial Local Authorities (TLAs), District Health

Boards (DHBs) and Census Area Units (CAU) deprivation decile.

The meshblock can be mapped to Plunket‟s Branch or sub-Branch by tables available from Plunket and the

meshblock can be mapped to TLAs, DHBs and CAU using the “Atlas of Socioeconomic Deprivation in New Zealand

NZDep2006” from the website of the Ministry of Health.

See http://www.moh.govt.nz/moh.nsf/indexmh/dhb-maps-and-background-information-atlas-of-socioeconomic-

deprivation-in-nz-nzdep2006).

1

e) Postal Addresses

Postal address attributes must conform to New Zealand Post standards for mail delivery.

1

http://www.moh.govt.nz/moh.nsf/indexmh/dhb-maps-and-background-information-atlas-of-socioeconomic-deprivation-in-nz-nzdep2006

http://www.moh.govt.nz/moh.nsf/indexmh/dhb-maps-and-background-information-atlas-of-socioeconomic-deprivation-in-nz-nzdep2006




f) Valid From/To Date

All addresses must have a valid_from_date and valid_to_date to show when the address was valid while

associated with the Person or Organisation.

1

4 Identifier a) Sector Identifiers

The health sector has a number of sector identifiers used to identify different types of People and Organisations.

Examples include the National Health Index (NHI) number, the Health Practitioners Index (HPI) number etc.

PlunketPlus must be able to manage the association of different identifiers with a Person or Organisation and

ensure that that identifier is not in use by another Person or Organisation.

1

b) New Identifier Types

PlunketPlus must allow Plunket to create a new Identifier Type

1

c) Identifier Uniqueness

PlunketPlus must check that an identifier is not currently in use by another Person or Organisation before

associating it with a Person or Organisation

1

d) Valid From/To Date

PlunketPlus must include a valid_from_date and valid_to_date to show when an identifier was associated with a

Person or Organisation.

1

5 Relationship a) Recursive Relationships

Plunket requires PlunketPlus to provide a facility that allows a Person or Organisation to be related to another

Person or Organisation. This requirement applies to people (e.g. clients, Plunket staff, paid and unpaid) and

organisations (e.g. Plunket and Plunket Branches, PHOs, DHBs etc) and relationships between any pair of these

as set out below.

1

b) Relationship Types

PlunketPlus must allow Plunket to create new types of relationships.

1




c) Valid From/To Dates

PlunketPlus must record when the relationship began and ended.

1

d) Adult Child Relationships

PlunketPlus must allow for additional information to be captured about Adult Child relationships such as:

That a mother had one child by caesarean birth (but perhaps not her other children).

That a mother smoked during the pregnancy for one child and not for another.

The mother had postnatal depression during her last pregnancy which may affect all her children.

1

6 Person Plunket captures information about many different types of people including: -

a) Client

Client data is to be stored for:

Each child whose care is being managed by Plunket, whether part of the Well Child programme or not.


Each parent of the child, biological or otherwise.

The legal guardian(s) of the child.

Other people who have active participation in the care of the child who are:

- Other family members, biological or otherwise;

- Whānau

- Other people.



See section 11.2.5 on page 106 for more information about clients.

1

b) Plunket staff, paid and unpaid

A person who works for Plunket in a paid or voluntary capacity.

1




c) Client & Plunket staff, paid and unpaid

Plunket staff, paid and unpaid may also be clients and Plunket staff, paid and unpaid may be a paid employee and

a volunteer. Plunket requires that each person occurs once and once only in PlunketPlus. They can have multiple

roles and logon IDs related to those roles. For example a Plunket Nurse working as a volunteer (and logged in as

such) would have no access to the clinical information relating to clients. Inappropriate use of IDs would be dealt

with by “break-glass” controls and reporting. See Section 13.1 “Privacy” for more information on “break-glass”.

1

d) Plunket Staff Types

PlunketPlus must be able to accommodate and identify Plunket Staff in the various roles set out in Section 6 “Key

Plunket Concepts and Definitions” starting on page 15 under the sub-heading Plunket Staff.

Additional Staff Types can be added in the future.

1

e) Donors

Plunket will not capture any information in PlunketPlus that identifies a person as a donor of funding or resources

to Plunket.

1

7 Person Name a) Multiple Names

PlunketPlus must allow multiple names to be captured for a person. A Person may have more than one name

active at a time, but only one legal name.

See Appendix B for a list of attributes for Person Name.

1

b) Name Types

PlunketPlus must allow for different name types that can be added by Plunket if required.

1

c) Preferred Name

PlunketPlus must allow the selection of a name a Person prefers to be known as from a list of active names.

1

d) Valid From/To Date

PlunketPlus must have valid from/to dates to show when the name was applicable to the person.

1




8 Organisation

Name

a) Multiple Names

PlunketPlus must allow multiple names to be captured for an organisation. An Organisation may have multiple

names active at a time but only one legal name. See Appendix B for a list of attributes for Organisation Name.

1

b) Name Types

PlunketPlus must allow for different name types that can be added by Plunket if required.

1

c) Valid From/To Date

PlunketPlus must have valid from/to dates to show when the name was applicable to the organisation.

1



11.2.3 Plunket Organisation

Plunket is made up of over 500 sub-Branches that are grouped into 112 Branches which are grouped into 18 areas (19 including PlunketLine). Each

area has its own administration and employs its own staff. Each sub-Branch may have no, one or multiple clinics.

The diagram below graphically describes the Plunket organisation structure.

Organisation - Plunket

Plunket Area

DHBPlunket Family

Centre

Territiorial

Authority

Royal New

Zealand

Plunket Society

Plunket Organisation

Person Organisation

Relationships between Plunket

Organisations will be handled by

the relationship / role tables

External Organisation

mk21

Plunket Clinic

and

Plunket Bus

Plunket

sub-Branch

Plunket

Branch




1 Plunket

Organisation

ERD


2 Plunket

Structure

Plunket is made up of over 500 sub-Branches that are grouped into 112 Branches, which are grouped into 18

areas (19 if you include PlunketLine).

Each area has its own administration and employs its own staff.

Each sub-Branch can have one or more clinics.

-

a) Changes to Plunket Structure

Plunket requires a system that allows for changes in the Plunket Area, Branch and sub-Branch structure and the

structures of TLAs and DHBs over time. Plunket assumes that the system will utilise the relationship functionality

described earlier.

1

b) Historical view

Plunket must be able to see a history of the Plunket organisation structure.

1

c) Events

A client‟s events must be linked to the sub-Branch that was associated with that client at the time of the event, ie

if the sub-Branch has been replaced the user should see the sub-Branch as it was at the time of the event and

the sub-Branch it was replaced by.

1

3 Plunket Area Plunket must be able to map geographic areas such as meshblocks to Plunket Areas, Branches and sub-Branches. 1



11.2.4 Plunket Group

A Plunket Group is one or more people who meet on a regular basis facilitated by one or more Plunket People. The purpose of a Plunket Group is to

offer support to its members in different ways depending on the type of group. Plunket requires PlunketPlus to help manage membership and

facilitation of groups. The diagram below describes the main entities required to manage Plunket Groups.

Organisation - Plunket Groups

Plunket Service

Delivery Staff

Person

Person

Organisation

Organisation

Plunket group

Group Additional

Contact

Contact

Event

PEPE group

PIN group

Coffee group

Play group

Other group

Client

relationship / role

Group relationship

must have

(business rule)

may have

(business rule)

may include one or more facilitators

(business rule)

Facilitator

Group Member

Advisor

Coordinator

mk21

PEPE = Plunket‟s Parenting

Education Programme

PIN = Plunket in

Neighbourhood Group

Group Faclitator

Non - Plunket

person

If there are facilitators at

least one must be a


A co-facilitator may be from

an external Organisation

External

organisation




1 Plunket

Group ERD


2 Plunket

Group

a) Plunket Group Organisations

A Plunket Group is a type of Organisation and shares all of the characteristics of Organisations as described in

section 11.2.2 such as name, contact information (email, phone, address etc). Please confirm that your system

can create groups in this way.

1

b) Multiple Group Types

PlunketPlus must be able to accommodate multiple different types of group.

1

c) Add New Groups

PlunketPlus must allow new groups to be easily added.

1

d) Plunket Group Information

Plunket will need to record information specific to Plunket Groups.

1

3 Group

Relationship

The Group Relationship entity links groups to the people who are part of the group. There are different types of

relationships. All of the requirements of a standard Relationship also apply to Group Relationships. Please refer

to section 11.2.2 for details.

PlunketPlus must allow various relationships with Plunket Groups.

-

a) Facilitator Relationship

Facilitator – Must be a Plunket Service Delivery Staff.

1

b) Group Member Relationship

Group Member – May be a client but could be any Person.

1

c) Plunket Group Relationships 1




PlunketPlus must be able to associate a Plunket Group with one or more Plunket Organisations (e.g. Plunket Sub-

Branches, Clinics etc).

4 Group

Additional

Contact

Plunket requires PlunketPlus to capture information about each of the people attending or participating in a group

meeting, where these people are clients, caregivers, Plunket Service Delivery Staff, or other providers (eg a GP).

Please explain how your system would facilitate this.

1



11.2.5 Client

A client is a person to whom Plunket delivers its services. The client will be a child, a caregiver or another person (see definition on the next page).

As a client is a type of Person (in this model), the client entity has the characteristics and requirements detailed in section 11.2.2, “Person and

Organisation”. The diagram below describes specific requirements relating to clients.

Client

Client

Demographics

SDP for Client

Event

CHI (observed,

measured) and Action

Taken

guides

PersonPerson

Organisation

Plunket Nurse

Service Delivery

staff

OrganisationPlunket

Organisation

Event

Child Client Adult Client

Each Child Client has only one case manager at a time

but may have several over a period. The diagram shows

the main relationship. The history will need to show all

Case Managers.

relationship / role

Adult Child

relationship

Business ruleBusiness rule

Primary Caregiver

(e.g. mother)

Other Caregiver

(e.g. grandmother)

ContactContract Event

Template

guides

The same Plunket nurse is a case manager for

child client and manages the SDP for Client.

An Adult Client may also have a Case Manager

SDP = Service Delivery Plan

WCTO = Well Child Tamariki Ora

CHI = Client Health Information

mk21

Caregiver

Adult Client




1 Client ERD Plunket requires the PlunketPlus database to support the entities and relationships shown in this ERD. 1

2 Client a) Client Person

A client is a type of Person and must share all of the characteristics of People described in section 11.2.2

“Person and Organisation”.

Specifically, client data is to be stored for:

Each child whose care is being managed by Plunket, whether part of the Well Child programme or not.




Other people who have active participation in the care of the child who are:

- other family members, biological or otherwise;

- whānau

- other people.



1

b) Case Manager Plunket Nurse

Child clients may have a Plunket Nurse assigned as the Case Manager. This is mandatory for Well Child Tamariki

Ora clients.

Adults receiving certain Plunket services may also be assigned a Case Manager.

1

c) SDP (Service Delivery Plan) for Client Event

The SDP for Client Event defines the actions to be taken and Client Health Information to be observed,

measured or recorded at a planned Event, such as a Core Contact. These may be defined by a Contract Event

Template, a Plunket Nurse (the Case Manager), other Service Delivery Staff, or a combination of these. Only the

Plunket Nurse can update the SDP for Client Event for Well Child Core Contacts.

1




d) Client Health Information

Client Health Information is anything measured or observed about a client that affects their health or Plunket‟s

care of the client. Examples include:

Development

Growth

Hearing

Mental health

Nutrition including breastfeeding and other nutrition determinants

Parenting

1

e) Adult Child Relationship

The Service Delivery Plan must identify the Adult Child relationship the Service Delivery Plan should be viewed

in the context of. For example a mother with postnatal depression should have her Service Delivery Plan linked

to the affected children.

1

3 Demographics a) Capture and Maintain Demographic Data

PlunketPlus must be able to capture demographic information about clients and maintain a history of changes to

demographics over time.

1

b) Ethnicity Data Protocols for the Health and Disability Sector

PlunketPlus must capture at least level 2 Ethnicity Data Protocols for the Health and Disability Sector. Note that

this is different to the Statistics New Zealand Ethnicity Standard.

1

c) Synchronisation

PlunketPlus must allow Plunket to keep the ethnicity codes they use synchronised with the latest codes issued by

HISO.

1

d) Iwi and Hapu

Where the client has declared themself to be Maori, PlunketPlus will allow Plunket to record all the Iwi the client

1




affiliates with and based on Iwi, the relevant Hapu.

4 Adult Child

Relationship

A critical piece of information for Plunket is the Adult Child Relationship, of which there may be many instances

for a child. PlunketPlus must extend the generic Relationship requirements described in section 11.2.2 as

follows:

-

a) Single Adult to Single Child Relationship

An Adult Child Relationship must involve a single child client and a single adult client.

1

b) Multiple Adult-Child Relationships

Each Adult and Child may have many different Adult Child Relationships

1

c) Types of Adult-Child Relationships

PlunketPlus must support 3 types of Adult Child Relationships (Primary Caregiver, Other Caregiver and Legal

Guardian) with the ability to add additional types if required.

1



11.2.6 Event

An Event is anything that has already happened, or will happen, in relation to a client. Examples include Contacts, Referrals, Scheduled Contacts etc.

Events may involve at least one client and at least one Plunket Service Delivery staff but can involve multiple of each (e.g. group Contact). Plunket

requires a system that helps manage client events including reacting when an expected event does not occur when scheduled. The diagram below

describes the data requirements relating to events.

Event

Event

Contact Outgoing Referral

Core

Face to Face

Additional

Telephone

Additional

Group Additional

PlunketLine Call

non-clinical contact

Video Call (e.g.

WebCam)

LMC

GP/Practice

Self

Car Seat Rental

Service

Ante-Natal Group

Kidslink

Other

Other Follow UpSchedule Next

ContactIncoming Referral

date / time

Plunket Sub-

Branch

to CYF

to various agencies

to Plunket

OrganisationPerson

Organisation

Service Delivery

StaffClient

Person

guides

from Plunket

Place of Contact

SDP for Client

Event



LMC = Lead Maternity Carer

mk21

Person

Organisation

Physical Address

Plunket Branch

The event

belongs to the

client who is

enrolled with a a

branch or sub-

branch

A face to face contact may

take place at a clinic, family

centre or somewhere else

which may belong to a

different branch or sub-

branch to which the client is

enrolled in

Non - Plunket

person

External

organisation

TXT conversation




1 Event ERD Plunket requires the PlunketPlus database to support the entities and relationships shown in this ERD. 1

2 Event As described above, an Event is something that has happened or is scheduled to happen to a client or clients. The

following requirements apply to all types of events

-

a) Event – Attributes

Examples of the attributes PlunketPlus must record about an event:

Date and time the event occurred or is scheduled to occur.

Type of event.

Clients and Plunket Service Delivery Staff (s) involved.

Plunket Sub-Branch(es) involved in the event. (The event, especially if it is a group contact, may take place in

the rooms of one sub-Branch but belong to another. The child client may be enrolled with another. All will

need to be recorded along with their relationship to the event.)

1

b) Rules

Plunket must be able to define in the workflow system, logic that determines subsequent workflow actions.

Example:

If, for a Scheduled Core Contact, a client and caregiver do not attend then the event status is set as ANK

(Appointment not Kept) and a workflow action is initiated for the Area Administrator role to schedule a new

Core Contact.

1

c) Service Delivery Plan for Client Event

When recording an Event, PlunketPlus must allow the Service Delivery staff to amend the client‟s Service Delivery

Plan for Client Event.

1




3 Contact A contact is a type of Event and occurs when a client and Service Delivery Staff interact in some way. This may

be at a visit by the Plunket Service Delivery staff to the client‟s home, a phone call, group contact, call to Plunket

Line, video call (webcam), etc. Please refer to Appendix B “Clinical Dictionary” for specific contact attributes.

Any contacts where the client and a Plunket Service Delivery staff are at the same physical location must record

the Place of Contact. This could be the address of the Plunket Clinic or the clients address etc.

Any other contact must record the type of contact, for example a PlunketLine call.

1

4 Schedule

Next Contact

This entity stores data about scheduling the next contact.

This data may be stored in the diary, the workflow system, or elsewhere in PlunketPlus, or in a combination of

these places.

The relationships defined in this model will ensure that the data is related to the appropriate client, Service

Delivery Staff, and Service Delivery Plan for Client Event, and that the data can be viewed in any of these

contexts.

-

a) Schedule Contact

PlunketPlus must allow the user to schedule a contact at a later date.

1

b) Plunket Service Delivery staff

PlunketPlus must record the Plunket Service Delivery staff scheduled to be present at the Scheduled Contact.

1

5 Referral to

Plunket

a) Capture Incoming Referral

PlunketPlus must capture the referral of a client, or clients, from an external party to Plunket.

1

b) PHO

GP or GP Practice – PlunketPlus must record the Primary Health Organisation (PHO) a GP practice belongs to

using the relationship structure described in the section 11.2.2.

1




c) Internal Referral to Other Plunket Service

Plunket Referrals – PlunketPlus must allow Plunket to refer to another Plunket service or a specific individual role

within Plunket.

1

6 Referral from

Plunket

PlunketPlus must allow Plunket to refer a client to an external agency such as CYF, a hospital, GP, an NGO etc or

an internal service such as a Volunteer PEPE course.

1



11.2.7 Contracts and Service Delivery Plans

Plunket enters into contracts with a number of different organisations whereby Plunket is contracted to provide specific services. A contract may

result in a Contract Event Template being created which specifies the events that must occur for a client as part of the contract and the Client Health

Information that must be observed or measured at each event. When an Event occurs PlunketPlus must link the event back to the relevant contract

to allow Plunket to report the performance of each contract. The diagram below summarises the high level data requirements relating to contracts.

Contracts and Service Delivery Plans

Contract

Volunteer

Ministry of Health

Contract

DHB Contract

MSD Contract

Person

Organisation

Contract Event

Template

Organisation

Other

Client

Person

SDP for Client

Event

And other types

depending on

Service

Template Action




Plunket Nurse /RN

Under the WCTO contract the same

Plunket nurse is a case manager

for The child client and manages

the Service Delivery Plan for Client

Action TypeTemplate Core 1-8

if WCTO Service

mk22

SDP (Service

Delivery Plan) for

client

Service Delivery

staff

Measure CHI

Discuss/ ask CHI

Observe CHI




General Comment An overview of Contracts and Service Delivery Plans is provided under the respective sub-headings on

page 21 in Section 6 “Key Plunket Concepts and Definitions” and in the diagram at the end of that section.

-

1 Contracts and

Service

Delivery Plans

ERD


2 Contract A contract is agreed between external organisations and Plunket, where Plunket is contracted to provide

specified services. A contract could also be with an internal organisation, for example a Plunket Branch

sponsoring a parenting education course. Currently Plunket‟s largest contract is the Well Child Contract

with the Ministry of Health.

-

a) Recording of Events linked to Contract

PlunketPlus must be able to record contacts (events) provided within different contracts.

1

b) Creation of new Contracts in PlunketPlus

Plunket must be able to set up new contracts in PlunketPlus.

1

3 Contract Event

Template

a) Contract Event Templates for each Contract

Each Contract Event Template defines one event (e.g. a particular Core Contact) that should occur as part

of the contract. It may comprise multiple Client Health Information details to be observed and Actions to

be taken at that event.

There will be different Contract Event Templates depending on the contract. These will provide a

framework under which each visit occurs – therefore for those working under the Well Child Contract the

framework is based on the Well Child Tamariki Ora Template and individual Needs Assessment Level; for

volunteers it will be based on the service that they are providing, eg a support group or volunteer home

visiting, which will highlight the type of activities they will undertake around the home.

The system needs to be flexible so Plunket can add Contract Event Templates as and when required, as

Plunket usually enters into two to three new contracts a year, each of which will require different Contract

Event Templates.

1




b) Defining the Contract Event Templates

PlunketPlus must allow multiple Template Actions to be combined in different ways to make Contract

Event Templates. These may be combined into an SDP for Client Event based on the age of the child client

(as in Well Child), the course a client may be enrolled on (for example an Antenatal course) or some other

to be defined factor.

1

c) Linking Events to the Contract Event Template

When an event occurs PlunketPlus should link the event to the SDP for Client Event and therefore the

Contract(s) that caused the event to occur or under which the event is funded.

1

4 SDP for Client

Event

This data entity holds the actions that inform the Service Delivery Staff what they are expected to do at

the Event.

This will be one or more:

Take a measurement.

Observe something.

Discuss and ask questions.

Information gathered as a result is recorded in the Client Health Information entity and the Action Taken

entity.

-

a) Information in the SDP for Client Event

SDP for Client Event defines the actions to be taken, to be recorded at a specific Event. These may be

from a Contract Event Template, a Plunket Nurse, or other Service Delivery Staff depending on the

contract. Only a Plunket Nurse is authorised to update any information in the Core Contact part of the

SDP for Client Event.

1

b) Contract determined Actions

PlunketPlus must allow multiple actions to be taken from multiple Contract Event Templates depending on

the contracts under which the client is enrolled.

1




c) Case Manager determined Actions

PlunketPlus must allow Case Manager Plunket Nurses to define actions for others to perform, for example

asking a Health Worker to discuss breastfeeding.

PlunketPlus must allow a Service Delivery Staff member to add actions to the SDP for Client Event during

the contact.

This could happen:

During the contact.

While preparing for the contact.

While identifying follow up actions for the next contact.

1

5 SDP for Client SDP for Client is the collection of all Service Delivery Plan for Client Events for the client. 1

6 Template

Action

A Template Action is an action that is set to happen at a contact for a client and is determined by a

Contract.

PlunketPlus must allow Plunket to create and add Template Actions.

1

7 Action Type a) Action Types Requried

Each Template Action must have a specified Action Type

Action types so far defined are

Measure Client Health Information CHI

Observe CHI

Discuss /ask CHI

1

b) Create New Action Types

PlunketPlus must allow Plunket to create new Action Types.

1



11.2.8 Client Health Information and Actions

These data entities hold information that the Service Delivery Staff record in the system in relation to what has actually occurred at the Event.

Client Health Information (CHI) and Actions

Person

Organisation

Contract Event

Template

Event

Client

Person

SDP for Client

Event

Has a

guides

Belong

to

Collected at

Contact

Text /Description

Measurement

Value From List



Action Taken

Service Delivery

Staff

Performed at

performs

records

SDP (Service

Delivery Plan) for

client

mk21

CHI (observed,

measured, discussed)

Measure CHI

Discuss/ ask CHI

Observe CHI




General

Comment

Actions Taken and Client Health Information recorded at an Event are guided by the Service Delivery

Plan for Client Event.

An actual Action Taken may result in Client Health Information being recorded in one or more Client

Health Information occurrences.

The recording of Client Health Information must be the result of an Action Taken.

-

1 Client Health

Information

and Actions

ERD


2 Client Health

Information

Client Health Information is information about a client. Examples include:

Development

Growth

Hearing

Mental health

Nutrition including breastfeeding and other nutrition determinants

Parenting

-

a) Client Health Information for One Client

Client Health Information must belong to one and only one client.

1

b) Client Health Information from One Contact

Client Health Information must be captured at, or as a result of a single contact.

1

c) Client Health Information per Contact

The system must create a new instance of Client Health Information each time it is observed or

measured e.g. confirming that a child is still living in the same house as a smoker.

1




d) Client Health Information Attributes

The system must be able to collect different attributes for each different type of Client Health

Information. See the data dictionary for the attributes of the types of Client Health Information

identified to date.

1

e) Add Client Health Information and Attributes

The system must be able to add new types of Client Health Information and new attributes for it.

1

f) Measurements

Measurements need to be in predefined standard units. Plunket is unsure as to if it is better to select a

measurement from a list or input as a number so PlunketPlus will need to be flexible on this.

1

g) Text / Descriptions

Some information will need to be input as text and stored as such. Plunket want as much data entry as

possible to come from drop down lists or tick boxes to help the Service Delivery Staff and to allow

complex reporting.

1

h) Value From list

When recording Client Health Information the Service Delivery Staff should be able to select answers

from a drop down list.

1




3 Action Taken Actions Taken at an Event are guided by the Service Delivery Plan for Client Event. This data entity

stores the record that the actual actions have been taken during a contact.

There may be Actions Taken that are not in the Service Delivery Plan for Client Event so these need to

be added.

Types of Action Taken currently defined

Measure CHI

Observe CHI

Discuss / ask CHI

-

a) Add Action Taken

The system must provide functionality to add a pre-defined Action Taken to the SDP for Client Event.

For example a Plunket Nurse may decide to weigh a child at an Additional Contact. This may not be in

the Service Delivery Plan for Client Event but it is an Action Taken that is already in the system.

1

b) Add new Action Taken

The system must provide functionality to add a new Action Taken that has not previously been defined.

For example a Service Delivery Staff member may discuss fumigation of a child‟s room that is not a

defined Action Taken and It needs to be recorded.

1



11.3 Data Volumes - Future

Plunket has used its current volumes and its knowledge of its

business and anticipated growth to estimate the data volume

requirements for the time that PlunketPlus is commissioned.

-

1 Future Data

Volumes

Plunket requires that PlunketPlus accommodate the following

estimated volumes:

750,000 to 1,000,000 contacts per year with increases on

this number each year.

750,000 enrolled clients (this allows for recording details of

parents and other key caregivers – this would be once all

areas throughout the country are on the system).

120,000 to 150,000 new clients per year (approx 55,000 to

60,000 new baby cases, and then the first time parents and

other first time caregivers).

120,000 to 150,000 clients will be discontinued per year;

these records will be retained in PlunketPlus for a period.

1,500 Plunket Staff will require access – most of these will be

mobile remote connections

200 Plunket volunteer staff increasing to 5,000 over time

500 Plunket sub-branches

110 Plunket branches

19 Plunket areas (including PlunketLine)

12 Plunket regions

21 DHBs (this number is subject to change)

81 PHOs (this number is subject to change)

3000 General Practitioners

2875 Midwives

73 Local Territorial Authorities

Other Plunket system interacting with PlunketPlus will generate

data in PlunketPlus. The volumes shown below will be moderated

to some extent as a number of clients will already exist in

PlunketPlus.

PlunketLine which will be expected to have 100,000+

contacts per year

Car Seat Rental Scheme which may have 30,000+ contacts

per year

Both these systems will have clients that are not enrolled with

other Plunket Services.

1

2 Future

Growth

PlunketPlus must be able to accommodate unanticipated growth

in data volumes without disruption to services.

Software Providers should document the systems and operating

limits comprising their proposed solutions.

1



11.4 How Plunket will Store the Data

This section defines:

Nursing Terminology data standards and requirements.

Database requirements.

-

1 Nursing

Terminology

Plunket‟s client-facing operations are predominately nursing

practice. Therefore Plunket wishes to store its EHR data in a

manner consistent with nursing practice and terminology.

This will be achieved by adopting a suitable nursing terminology

standard. An example is the Omaha System.

The benefits of implementing a recognised nursing terminology

standard are:

Measurement and reporting on outcomes.

Improvements in care and Well Child outcomes.

Organisational efficiencies, resulting in more focus on care

delivery.

Interoperability with other health providers.

Measurement of population health outcomes.

Clarity of interpretation of information within and between

organisations.

Plunket understands that adopting such a nursing terminology is

likely to introduce some fine-tuning changes to Plunket‟s nursing

practices.

-

a) Support a Nursing Terminology

PlunketPlus must store data in the EHR in a manner compliant

with the nursing terminology that Plunket selects.

1

b) Recommend a Nursing Terminology

Plunket would like software providers to recommend a nursing

terminology that has international clinical recognition and is

oriented to child health and wellbeing, parenting and community

health outcomes.

Plunket may or may not adopt the recommended terminology.

2

c) Describe How the Recommended Nursing Terminology

is Implemented

Plunket would like software providers to describe how the

nursing terminology they recommend is implemented in their

product.

2

d) Describe How any Nursing Terminology would be

Implemented

Plunket would like software providers to describe how a nursing

terminology selected by Plunket would be implemented in their

product.

1



2 Relational

Database

Plunket has a number of requirements around the database

technology that is used, and the way it is used by the system.

-

a) Relational Database

Plunket requires that PlunketPlus and its EHR are implemented

on an industry-standard enterprise-grade relational database

product.

Software providers are asked to name the database software

product, along with versions supported by their system.

1

b) Implementation of Entity Relationships

Software providers are requested to show how PlunketPlus

utilises the relational functions of the database software to

implement the entity relationships along the lines set out in the

conceptual data model in Section 11.2 on page 90.

1

c) Relational Integrity

Software providers are requested to show how the integrity of

the entity relationships set out in the conceptual data model in

Section 11.2 on page 90 is managed and protected.

1

d) Field-level Access Rights

Plunket would prefer that the database can support field-level

access rights, or similar, in order to comply with the “Who Can

Access What” matrix.

Please explain how this will work and the implications.

Plunket will consider alternate solutions for meeting this

requirement.

2

e) Entity-level Access Rights

If the database cannot support field-level access rights, Plunket

requires it to support entity-level access rights or similar, in

order to comply with the “Who Can Access What” matrix.

Please explain how this will work.

1

f) Record Locking

The database software must lock individual records when a user

has it open for update.

Please explain how this will work, including options for

“pessimistic locking”, “optimistic locking” and similar.

1

g) Field-level Locking

Field-level locks are preferred.

Please explain how this could work and the implications.

2



h) Logical Delete

Plunket requires that all functions that delete data:

Make the data logically deleted.

Retain the data in the database, marked as deleted.

Provide the ability for a PlunketPlus Administrator to view the

deleted data and determine who deleted it and when.

1

i) Retain Previous Versions of Data

The database must retain and make available the previous

contents of all records when they are updated.

1

j) Checkpoint / Restore

The database software must include functions that allow for

situations where any rollback or restore are necessary.

1

k) Database Flexibility

Flexibility of the database is required. Please explain how this

will be achieved, options available and the relative merits and

costs of the options.

1

l) Database Synchronisation

Plunket expects PlunketPlus to operate in offline mode when

telecommunications to the remote mobile computer device are

not available and then synchronise offline updates with central

PlunketPlus system.

Please explain how these processes will be achieved.

1

11.5 Retention, Disposal and Archiving of Data

The current Plunket information retention and disposal policy is

oriented for the current paper-based system.

With the introduction of PlunketPlus, Plunket intends to review

this policy. Therefore it is important that the system has options

for how it retains and disposes of information.

Under the Health (Retention of Health Information) Regulations

1996 the client‟s records need to be retained for a minimum of

10 years from the last contact. Currently this is when Plunket

disposes of its paper records. Plunket may decide to retain

electronic health records longer than 10 years. There are a

variety of options including collating the data, de-identifying the

data or deleting all data after 10 years. The system has to be

flexible to allow for these or other options.

The expectation is that when a child reaches the age of five,

dies, moves overseas or is transferred to another service

provider, the electronic health record will be moved to archive.

1



However it will be important to be able to quickly ascertain that

the record is archived, as the client may decide to return to

another Plunket Service and we do not want a double-up of the

records.

Another area where Plunket intends to establish policy is when a

child becomes a parent. For this specification we are working on

the premise that a new record is commenced when a child client

reaches the age when they may become a parent client. The

current view is that their child record is not relevant to their

parenting; however this may change once Plunket has examined

the implications of the options, so the system needs some

flexibility around this.

Plunket will also determine policy regarding parent and caregiver

access to their child‟s record via the PlunketPlus Portal in

conjunction with the retention and disposal policy. The system

must cope with options that could include different retention

periods for various categories of data for a client.



12 Functional Requirements

The functional requirements are structured into:

Workflow

Decision Support

To-Be Processes

Overall Swimlane Flowchart

Individual To-Be Processes

PlunketPlus Portal

Interoperability with Other Systems

Changes to Other Systems

Business Rules

Supplementary information is included in the Appendices.

12.1 Workflow Requirements

Overview Plunket is expecting PlunketPlus to assist its Service Delivery

Staff to follow through on tasks or “actions” with a variety of

methods:

A “message board” for each Plunket Staff member that lists

all alerts, workflow actions and other messages for that

person to act on.

Prompts to advise and remind Plunket Staff that alerts or

actions have been added to their message board.

Prompts about overdue actions.

Escalation when a scheduled action is nearly due and no-one

appears to be dealing with it.

Escalation when actions have not been undertaken.

Monitoring and reporting to enable management at all levels

to have a view of overall performance, with drill-down as

appropriate to enable remedy where necessary.

Plunket has described its requirements in this section for an

integrated workflow system to deliver these functions.

These workflow requirements are described generally in this

section, starting with the concept of the message board.

Process-specific workflow requirements are documented

throughout the To-Be Process descriptions in later sections.

Plunket accepts that the system functionality to meet these

requirements could be delivered by a workflow system, a

decision support system, some other form of system, or a

combination of these.

-



1 Workflow

System

Plunket requires PlunketPlus to incorporate a workflow system as

an integral part of its functionality.

Please identify and describe this system.

1

2 Workflow

Function-

ality

The functionality of the workflow system must operate in a

manner consistent with industry best practice to deliver process

definition, process flow and process control functions.

Please describe how the workflow system will operate, how it

integrates as part of the overall PlunketPlus system, and what

makes it consistent with industry best practice.

1

3 Workflow

Standards

Please describe any standards with which the workflow system

complies.

1

4 Workflow

Roles

Workflow roles that must be supported by the workflow system:

Workflow Initiator. A person in this role enters an action

into the system.

An example is a Plunket Nurse who, during the course of a

client contact, identifies follow-up actions.

The Workflow Initiator is the person who initiates an action

and is not specifically referred to as a Workflow Initiator in

this document.

The Workflow Initiator can also be the system itself, where a

process can initiate an action.

Workflow Monitor. People in this role keep track of actions

as they progress through their workflow life-cycle.

An example is an Area Administrator who regularly checks to

see that actions have people assigned to them, actions are

being processed and backlogs are not building up.

Workflow Director. People in this role redirect or delegate

actions.

Examples are Plunket Nurses, Clinical Leaders and Managers

who assess actions and decide on any changes or additions.

Workflow Administrator. The people within Plunket who

are responsible for setting up and maintaining the variable

aspects of the workflow system. They will also monitor the

operation of the system and the status of action queues and

escalations. This is a technical role that also requires

expertise in Plunket‟s clinical and operational processes.

1



12.1.1 Message Board

Plunket envisages a concept whereby all Clinical Alerts, System

Alerts, Workflow Actions, Workflow Escalations and other

messages including email are displayed on some form of

integrated message board for a person.

The message board is to be the default view for all Plunket Staff

when they log on to PlunketPlus and should include a number of

productivity and prioritisation features.

Plunket accepts that this functionality could be provided by

Microsoft Outlook, which will be used by all Plunket staff. If this

is the case, system providers should respond to each

requirement accordingly, along with the necessary explanation

of how this would be implemented.

-

1 Message

Board

Facility

Plunket requires PlunketPlus to include a message board facility.

Please describe how your solution would provide this.

1

2 Types of

Content

The message board needs to display a number of different types

of content.

Please explain how the following types of content are

accommodated:

-

a) Clinical Alerts

This is a message containing information about a situation that

requires priority action by a Plunket Nurse, eg child protection

issues, and is initiated either manually or by PlunketPlus.

1

b) System Alerts

A message raised by PlunketPlus about a situation where some

action is required by a Plunket Staff member, and is initiated

either manually or by PlunketPlus.

1

c) Workflow Actions

Tasks waiting for action by a Plunket Staff member, initiated

either manually or by PlunketPlus

1

d) Escalations

An escalation is a message that something needs attention as it

has not been attended to as expected.

1

e) Personal Prompts

A reminder entered by a Plunket Staff member for themselves.

1



f) Email

Email in the person‟s Outlook inbox that has not been read yet,

and a summary of the number of read and unread emails for the

person.

1

g) Other

The message board should be capable of including other forms

of content in the future.

2

3 Display of

Content

a) User-Friendly Display

The message board must display in a user-friendly layout, with

the various forms of content clearly showing.

1

b) Highlighting

In particular the following should always appear at the top

(hence always visible by default) with appropriate highlighting:

Clinical Alerts.

Escalations.

Overdue items.

Items coming due.

1

4 Select and

Invoke

The message board must open any item when that item is

clicked.

1

5 Prompts a) Generate a Prompt

Under the following circumstances, PlunketPlus must generate a

prompt for the person or persons involved:

A Clinical Alert is generated.

A System Alert is generated.

A workflow action has reached its reminder date and time.

An escalation is generated.

A personal prompt reaches its due date and time.

Other circumstances in future.

1

b) Display a Prompt

Prompts will be sent to Plunket Staff in one or more of the

following ways:

Pop-up on their computer screen.

Cellphone txt message.

And perhaps other messaging facilities in the future.

The preferred option and necessary contact details will be

recorded in the PlunketPlus database for each Plunket Staff

1



member.

6 Invoking the

Message

Board

The message board must display on the Plunket Staff members

screen in the following ways:

-

a) Default View

The message board must always be the default view when a

Plunket Staff member logs on to PlunketPlus.

1

b) Always running in the Background

The message board must always be running for every person

logged on while they are logged on to PlunketPlus, in the

background if the person is using another function or has

minimised it.

It is noted that Plunket Staff will not want clients to see the

message board so they would minimise the message board prior

to or during a contact.

1

c) Starting the Message Board Manually

There must be ways to activate and display the message board

manually, if for any reason it has stopped running.

1

7 Offline Mode a) Using the Message Board in Offline Mode

Plunket expects the PlunketPlus message board to operate in

offline mode when telecommunications to the remote mobile

computer are not available and then synchronise offline updates

with the central PlunketPlus system.

Please explain how these processes will be achieved.

1

12.1.2 Actions

1 Define

Action

Template

The workflow system must include functionality for Workflow

Administrators to define and change standard actions in the

system, and all the details associated with each standard action

including default timeframe for completion of the action.

These standard actions will be used as templates; when an

action is initiated, it will be based on the appropriate standard

action template.

1

2 Action

Initiation

Actions will be initiated by events that occur in numerous

processes. The workflow system must be able to accept one or

more triggers to initiate actions from any process.

1



3 Manual

Initiation

A function must be provided to enable any Plunket Staff to

create a workflow action manually at any time. Generally this

will be text in nature, assigned to a Plunket Staff member or

role, usually with a due date and to appear on the message

board of the recipient(s).

1

12.1.3 Persons

1 Person The workflow system must provide the ability to store

information about each Plunket Staff member and their role, and

also about each external provider and their staff who play a role

in Plunket‟s processes.

Please describe how this works.

1

2 Person

Integrated

with

PlunketPlus

Database

There is a very strong preference that the workflow system

accesses the PlunketPlus database to retrieve and update

information about people, whether internal or external, and does

not store such data separately.


2

3 Person

Integrated

with Active

Directory

All access to the workflow system must be managed by Microsoft

Active Directory (AD) or Microsoft Forefront Identity Manager

(FIM).


There is further discussion of AD and FIM in Section 13.2

“Security” on page 277.

1

12.1.4 Roles

1 Role The workflow system must provide the ability to define roles and

store information about each role.

These are functional person roles, such as Plunket Nurse,

Kaiawhina and many others, and also workflow management

and administration roles.

A person may have one or more roles.


1

2 Role

Integrated

with

PlunketPlus

Database


accesses the PlunketPlus database to retrieve and update

information about roles, whether internal or external, and does

not store such data separately.


2



3 Role

Integrated

with Active

Directory


accesses Active Directory or Forefront Identity Manager to obtain

and use the role or roles for a person.


2

12.1.5 Availability

1 Resource

Availability

PlunketPlus must have access to information about each Plunket

Staff member‟s availability and be able to use this information to

support workflow functions.

1

2 Resource

Availability

from

Plunket

Presence

Plunket is planning to implement corporate systems that record

the current and future availability of each Plunket Staff member.

It is intended that this will include presence details.

This functionality would be implemented in a Microsoft Exchange

environment.

The workflow system will need to access Plunket‟s corporate

system to obtain the necessary availability information about

each Plunket Staff member.

1

12.1.6 Assignments

1 Default

Assignment

The workflow system must provide the ability to assign each

action to a default person or role.

In other words, when an action is initiated it will be

automatically assigned as defined in the particular action

template.

A null is an acceptable option for the default assignment in an

action template.

2

2 Multiple

Assignments

When multiple people participate in a single event, this may be

treated in the system as a separate action for each person, with

all the resulting multiple actions associated through a single

event record.

This is further explained as part of the data requirements in

Section 11 starting on page 83.

2

3 Assignment

by Business

Rule

The workflow system must allow the default assignment to be

automatically changed when a business rule applies.

An example is where an incoming electronic referral will be

automatically assigned to an Area Administrator role (generic)

or a Plunket Nurse (specific) to schedule a contact, depending

on the Plunket area and whether the relevant flag is set

accordingly. See this process defined in “Scheduling First

Contact in Section 12.8.2 “Specific Business Rules” on page

1



267.

4 Override

Assignment

The assignment of a person or role to an individual occurrence

of an action can be changed by:

Another authorised person taking over the action.

A person who has the role of Workflow Monitor, Workflow

Director or Workflow Administrator.

1

5 Assignment

of Role-

Based

Action

When an action is assigned to a role, the system must generate

a prompt to advise all persons in that role that the action has

been assigned. Any person in that role may pick up the action.

This should be totally automated; a person should be able to

see all the actions for their role (which is usually shared by

other people) and when that person picks up the action then

the system should automatically assign it to them so that it is

no longer a pending role-based assignment.

Note that roles will normally (but not always) be applicable to a

geographic or functional part of Plunket. For example the role

“Area Administrator – Pukekohe” is a different role to “Area

Administrator – Haast”.

2

6 Automatic

Re-

assignment

When an action is assigned to a person, the workflow system

should check the person‟s availability and, if the person is not

available at the time required for the action (eg on leave or

booked for a meeting or contact), automatically re-assign the

action to another suitable and available person or return an

error message.

2

7 Prompt on

Assignment

When the workflow system makes an assignment of an action

to one or more persons or roles, the system must generate a

prompt to advise them that they are now required to undertake

that action.

Prompts to roles must be sent to all people in that role.

1

8 Prompt on

Change of

Assignment

When an assignment is changed for any reason, the system

must generate a prompt for:

The new person or role that the action is now assigned to.

The person or role that no longer needs to undertake the

action.

1

9 Action

Completion

There may be cases when completion of an action is the trigger

for the next action to be initiated and assigned.

In such cases, the workflow system must have a mechanism for

recognising that the action has been completed, and it must

initiate the necessary next action or actions, along with the

appropriate assignments and prompts.

1



10 External

Notifications

Notifications to external people are NOT treated as workflow

notifications, as they are handled through the Referral

processes.

12.1.7 Reminders

Plunket has requirements for reminders, as set out in this

section.

There is some commonality with the “prompts” requirement

specified above as part of the message board.

The exact operation of reminders will be clarified during the

design phase.

-

1 Reminders For every action initiated, the system must provide the ability to

set up one or more reminders, each with a date, time and

destination.

It should be also be possible for a Plunket Service Delivery Staff

member to set up a reminder for anything, even where there is

no workflow system action involved.

Each reminder, when its date and time eventuates, must be sent

to the person concerned.

1

2 Automatic

Reminders

The system must automatically create reminders for actions that

require this, based on a setting in the action templates.

1

3 Manual

Reminders

A person must be able to set up their own reminders:

Based on information in an action assigned to that person.

Based on information the person inputs.

These requirements both apply; they are not alternatives.

1

4 Update

Reminder

A person who is the subject of a reminder must have facilities to

update it.

Other duly authorised people must also be able to update it.

1

5 Reminder

Medium

The workflow system must have the ability to send a reminder to

a person by one or more of a number of optional methods.

Examples include pop-up on a screen, an email or a txt

message.

6 Reminder

Preference

The workflow system must allow the preferred medium for

receiving reminders to be set for each person.

This includes internal Plunket people and external people such as

clients and other health care provider people.

Part of this requirement is the ability to store the necessary

1



details for a person, such as mobile phone number, email

address, and any other type of contact details that might

become prevalent in the future.

7 Reminder

Data in

PlunketPlus

There is a strong preference that the reminder data such as

email addresses and phone numbers for clients, Plunket people

and external care providers be stored in the PlunketPlus

database.

2

8 Reminders

by Pop-Up

The reminders generated by the workflow system should appear

as a “pop-up” message on the computer monitor of the person

being reminded.

2

9 Reminders

by Email

The reminders generated by the workflow system should be sent

as an email to the person being reminded.

Note that a person may have multiple email addresses and the

reminder should go to all of these.

2

10 Reminders

by Txt

The reminders generated by the workflow system should be sent

as a txt message to the person being reminded.

2

11 Reminders

by other

means

Other means of reminding people are welcomed for evaluation. 2

12 Reminders

to Clients

Plunket‟s requirement for reminders includes reminders to

clients about upcoming Plunket contacts.

Such client reminders will be sent by one or more methods as

described above; the pop-up or prompt mechanisms do not

apply for client reminders.

1

12.1.8 Escalations

1 Escalations An escalation is a message that something needs attention as it

has not been attended to as expected.

If a person does not attend to an action assigned to them within

the required timeframe, the workflow system is required to raise

an escalation to the person or role defined as the next escalation

point.

1

2 Escalation

Tables

The workflow system must provide a method of defining

escalations, and tables (or similar) that allow a hierarchy of

escalations.

1



3 Trigger an

Escalation

The workflow system must provide functions to trigger an

escalation from various situations.

Examples include:

An action that must be attended to by a certain date (and

optionally time) does not have a person assigned to it by the

selected number of days prior.

An action that must be attended to by a certain date (and

optionally time) was not attended to.

An escalation was not attended to, so the next level

escalation is triggered.

1

12.1.9 Other Workflow Requirements

1 Tags A client may be tagged so that any activity relating to that client

can be brought to the attention of the Case Manager Plunket

Nurse or Clinical Leader, for example a child in a vulnerable

family.

The system must provide the ability for a Plunket Nurse or

Clinical Leader to “tag” a client and the system should then send

them system alerts when any activity occurs for that client.

1

2 Logging The workflow system must keep a log of all activities relating to

all actions, and this must be available for immediate online

access by Workflow Monitors, Workflow Directors and Workflow

Administrators.

The access should include search, sort, extract and save, and

print. Optionally a filter feature would be useful too.

1

3 Monitoring The workflow system must provide facilities for Workflow

Monitors, Workflow Directors and Workflow Administrators to

monitor activity in the system online.

This should include being able to see summaries of queue sizes

for actions and escalations, with some form of drill-down to

locate and remedy bottlenecks, backlogs or other problems in

the day-to-day operation of the system.

1

4 Reporting Online reporting is required, so Plunket management and

Workflow Monitors, Workflow Directors and Workflow

Administrators can save and optionally print summaries and

optionally selected details of the status and performance of the

total workflow system and details of actions, assignments,

prompts, reminders and escalations.

1

5 System

Setup

The workflow system must provide facilities for Workflow

Administrators to access and manage the control parameters of

the system and to test changes without risk of impacting on the

1



production environment.

6 Workflow

Process

Configura-

tion – User

Interface

Workflow configuration should be defined through a user

interface that can be readily used by Workflow Administrators.

2

7 Workflow

Process

Configuratio

n – Business

Rules

The workflow system must provide functionality for Workflow

Administrators to configure business rules into the system.

1

8 Other Some workflow systems can provide functionality richer than

described above.

Plunket welcomes any additional or more sophisticated

functionality and will evaluate this along with the structured

requirements set out above.

2

12.2 Decision Support Requirements

Plunket requires PlunketPlus to provide decision support information

to Service Delivery Staff, which will primarily be used during the

course of client contacts.

The decision support information will be clinical advice about the

specific health, care and wellbeing needs of a client, and will be

delivered in two distinct ways:

Through system-generated links and prompts related to Service

Delivery Plan for Client Event details for the specific contact for a

specific client.

Through a library function, where Service Delivery Staff can look

up articles on topics.

There is some overlap between these requirements, Plunket‟s

workflow requirements set out in Section 12.1 on page 127 and the

business rules functionality set out in the section above.



12.2.1 Decision Support – Service Delivery Plans

This function will provide Service Delivery Staff with client-

specific automated prompts and links to relevant information

during the course of their client contact.

-

1 Links to

Service

Delivery

Plan

PlunketPlus must bring together situation information from:

The Service Delivery Plan for Client Event specific to this

client and contact

Client Health Information observed at this contact and

previous contacts.

These factors will determine the clinical advice that the

PlunketPlus decision support function makes available to the

Service Delivery Staff.

1

2 In-Line

Advice

For each item that a client‟s service delivery plan lists for

attention during a specific contact, the system will show one or

more buttons (or links) against each item that, if pressed, bring

up relevant clinical information about the item and how to go

about observing, measuring, treating, discussing and recording

it.

Plunket envisages that the buttons or links would appear down

the right side of the client contact screen, changing as the

Plunket Nurse moves from one action or Client Health

Information detail to the next.

See the screen mock-ups in Section 9.3 “Screen Displays and

Data Entry” starting on page 49.

This functionality is similar to the concept of context-specific

“help” facilities offered in some computer systems.

The clinical information may be presented in a pop-up style of

presentation, while not fully obscuring the client‟s details.

1

3 Reminder

Prompts

The system must display prompts to the Service Delivery Staff

during the course of the contact if there are any items scheduled

for attention that have not yet been addressed.

These items may be sourced from the current contact, or be left

over from a previous contact.

The purpose of this requirement is to ensure that the contact

has been completely fulfilled and all necessary information

recorded.

1



4 Clinical

Alerts

There are a variety of Clinical Alerts that the decision support

function will need to raise and these will need to be defined by

Plunket‟s Clinical Team. It is expected that these Clinical Alerts

will include items such as:

If key development cues have not been marked present at

key ages, then a Clinical Alert appears asking the Plunket

Nurse whether this has been missed or does a referral need

to be generated. The Plunket Nurse may decide to override

this, and will need to clearly identify the reason for the

override.

If the Needs Assessment Level changes between visits,

however none of the key Client Health Information has

changed, then a Clinical Alert appears asking if the new

Needs Assessment Level is correct. The Plunket Nurse may

decide to override this and will need to clearly identify the

reason for the override.

If the child has been referred to CYF a Clinical Alert should be

generated to advise the Case Manager Plunket Nurse.

1

5 Content

Source

Plunket will source and maintain the content for the PlunketPlus

decision support function.

Some of this may be obtained from external sources. If so, this

will be under Plunket‟s control.

1

6 Content in

SharePoint

Plunket wishes to use Microsoft SharePoint on its servers to

store the content required for the PlunketPlus decision support

function.

-

a) Access SharePoint

Please describe how PlunketPlus will dynamically utilise the

decision support content from SharePoint.

1

b) Online and Offline Modes

Please explain how PlunketPlus will access the required decision

support content from a mobile computer that can be online or

offline from the Plunket network.

1

c) Synchronise Content

In the case that the decision support content is stored on the

mobile computer as well as Plunket‟s servers, please describe

how this content will remain synchronised.

1

12.2.2 Decision Support – Clinical Advice

Plunket will be establishing a library of clinical information that

Service Delivery Staff will access for clinical advice.

This will be stored in SharePoint on Plunket‟s servers and will be

independent of PlunketPlus.

-



12.3 To-Be Process Flowchart

The swimlane flowchart on the following page represents an

overview of Plunket‟s main care delivery processes.

These are designed as the required processes for the future and

colloquially known as “To Be” processes.

Each process in the diagram is described in a rectangular box

and in the following pages there are descriptions and more

detailed flowcharts.

-

Explanation of

Symbols

The overview swimlane diagram entitled „Plunket Contact with

Client – To Be‟ has several different coloured rectangular boxes

and each represents a process.

The reasons for the colours of the boxes and the different styles

of lines are explained below.

The four bands represent:

Automated (PlunketPlus)

Management and Administration


External Providers.

The “to-be processes” represented by the rectangular boxes lie

between lines or on lines. If a box lies between lines it is a

process that is performed by that role. If a box lies on a line it

may be performed by either or both roles. For example only

Service Delivery Staff can attend contacts but both

Administration and Service Delivery Staff can receive Incoming

Communications.

Core Contact

(Plunket Nurse)

The blue boxes denote processes that are the

main focus of service delivery.

Incoming

Communication

White boxes generally relate to supportive

administrative processes.

Plunket Nurse

responds to

Clinical Alert

Red boxes relate to Clinical Alerts

Set Up Scheduled

Contact

Grey boxes relate to scheduling and reminders

-



Lines:-

Letters in circles

Incoming

Communication

Cfind a corresponding arrow and letter to find

where it came from or goes to

Raise Clinical

Alert

C

1 PlunketPlus

Support for

Flowchart

Plunket requires PlunketPlus to support the processes described

in the overview flowchart on the next page and in the detailed

pages that follow.

1

may follow

must follow



Plunket Contact with Client – To BeM

an

ag

em

en

t o

r

Ad

min

istr

atio

nP

lun

ke

t S

erv

ice

De

live

ry S

taff

Exte

rna

l

Pro

vid

er

Au

tom

ate

d

Incoming Referral

(Electronic)

Schedule Contact

by Area

Administrator

(preferred)

Reminders to

Clients

Incoming Referral

(Manual)

Core Contact

(Plunket Nurse)

Additional Contact

(any SD staff)

Make Referrals or

CYF Notification

Action Referral

Outgoing Referral

or

CYF Notification

Make

Recommendations

Identify Follow-up

Actions and

update SDP

Incoming

Communication

Schedule Next

Contact

Set Up Scheduled

Contact

Referral Feedback

(Manual)

Enrolment

(if necessary)

Schedule Contact

by Service

Delivery Staff

Prepare for

Contact

Other non-contact

Action

Update EHR

CMPN responds

to request for

Client Information

Case Manager

Plunket Nurse

updates EHR

Referral Feedback

(Automated)

Advise referral

outcome

Raise Clinical

Alert

Plunket Nurse

responds to

Clinical Alert

A

A

B

B

C

C

Discontinuation

v14

Prepare SDP for

next Client Event

CMPN = Case Manager Plunket Nurse


C

C



12.4 To-Be Processes

The “To-Be Processes” defined in this section each explain in detail a

process in the overview swimlane diagram above.

Each process is detailed in a table then represented in a swimlane

diagram. Together these describe in detail the functionality that

Plunket wishes to implement.

On the right hand side of the tables are boxes that the text refers to

so the reader can relate the text to the diagram.

These processes are closely related to workflow functionality and the

entities described in earlier sections.

Please note that further details of some processes are described

within other sections of this document.

Explanation of

Symbols

The swimlane diagrams in the following pages use various symbols,

which are described here by way of example.

Lines:

Boxes:

Is a function –

something

happens

Denotes a function – something happens

Is a question?

Answer yes or

no

Denotes a question, with the answer is

yes or no.

Is a terminator

starting or ending

a process

Is a terminator starting or ending a

process and unless it says “End” or

“Start” will tell you which process comes

next or came before.

Other colours refer

to Processes

defined elsewhere

Boxes that are not green refer to other

processes defined in other swimlane

diagrams.

or this one

this oneThis process may be

followed by

Process 1

Process 2

Or both

of them

Swimlanes:

Each diagram has a number of horizontal “lanes” in order to show

which organisation, role or person undertakes the processes in

their lane.

-

may follow

must follow



Where a process box spans two lanes, this signifies that this

process can be undertaken by either of the lanes it spans.

Example of

Symbols

An example is provided below to demonstrate the use of these

symbols. It assumes that the process of sending the invite and

acceptance is complete.

-

Coffee Meeting – White or Black

Yo

uM

e

I invited you for

coffee and you

accepted

Do you turn

up?

I get angry and

sulk - End

no

I ask you if you

want white or

black coffee

yes

Did you say

white?

I go get milk from

the fridge and put

milk in cup

yes

I pour coffee into

cup an give you

cup

no Start talking



12.4.1 Incoming Referral

Incoming referrals are a request from another organisation or

another Plunket service for Plunket to take some action with a

client.

Currently all referrals arrive manually, and even those received

by email are treated as manual.

Plunket is planning to receive electronic system-to-system

referrals once this data transfer function is delivered in

PlunketPlus and once other organisations have developed the

matching electronic processes in their systems.

This section describes two processes:

Incoming Referral (Electronic)

Incoming Referral (Manual)

Technical requirements for electronic referrals are specified in

Section 12.6.1 “Transfer of Care” on page 243.

-

1 Incoming

Referral

Electronic

Please explain how this process will be implemented in the

system

1


Brief

Description

Plunket receives an electronic data file that contains a

referral and information about a child and parent(s).

Trigger The electronic message is received by PlunketPlus from

an external agency. For example:

From midwives system

From General Practitioner system.

Or an internal workflow action from within Plunket

might be generated, and come up for action as an

incoming referral, eg:

From PlunketPlus internal referral

From PlunketLine or Car Seat Rental Scheme

From Plunket online registration via a future

function that may be developed on the Plunket

website (self referral).

External system

generates file for

Plunket

Outgoing Referral

or

CYF Notification

Actors External agencies systems.

Kidslink (system at Counties Manakau DHB)

Midwives (need names of both here)

General Practitioner systems

And more

Plunket‟s new PlunketPlus system

Inputs Same as trigger



What

Happens

PlunketPlus receives an electronic message that relates

to a client who is being referred to Plunket. It may

come from a Lead Maternity Carer, a General

Practitioner, an antenatal group, Plunket‟s Car Seat

Rental Scheme, the parent themselves via the website

or another Plunket Nurse.

PlunketPlus sends an acknowledgment to referrer. At

other points through the setting up of contacts and at

the completion of the first contact other progress and

acknowledgement messages are sent.

The referrer could also be a Plunket Nurse referring to

a volunteer group such as PEPE or a coffee group,

hence the need to decide if it is a WCTO12 referral or

not.

PlunketPlus checks for duplicate referrals. There will be

some duplicate referrals that PlunketPlus can recognise

and merge automatically, others that will be less clear

and will require manual intervention. For every case

where duplicates are detected, PlunketPlus must raise

a System Alert to the appropriate Administrator.

It is easy to identify exact duplicates (NHI numbers for

example) but there are “fuzzy” duplicates that may

need careful checking (twins with the same first initial

for example). This will have to be another manual

process.

If it is a WCTO referral a Case Manager must be

assigned, following the process specified in Section

12.8.2 “Specific Business Rules” on page 267.

The data will be added or merged into the client‟s EHR

in PlunketPlus, with a “pending” status until the Plunket

Nurse validates the data at the next contact.

Initiate workflow action for Area Administrator and

place on their message board.

If it is a late WCTO referral, then a Clinical Alert needs

to be sent to the Case Manager so she can arrange a

first contact to take place as soon as possible.

First

acknowledgement

sent to referrer

Is it a WCTO

referral?

Raise

System

Alert

Manage Merge

Manage possible

Duplicates

Assign case

manager

Is it a late

referral?

Raise Clinical

Alert

Outputs Depending on the business rule specified under

“Scheduling First Contact” in Section 12.8.2 “Specific

Business Rules” on page 267, details of the referral will

be sent to either the Plunket Nurse in whose area the

client lives so she can establish contact (see Schedule

Contact by Service Delivery Staff) or more commonly

an Administrator (see Schedule Contact by Area

Administrator (preferred)).

Details (to be defined) will also be sent to the Clinical

Leader(s).

Schedule Contact

by Area

Administrator

(preferred)

Schedule Contact

by Service

Delivery Staff

Refer to volunteer

or other service

12 WCTO: Well Child Tamariki Ora, the name of the main contract between Plunket and the Ministry of Health for services.




Plu

nke

tPlu

sA

rea

Ad

min

istr

ato

r

Plu

nke

t Se

rvic

e D

eliv

ery

Staf

f

Exte

rna

l

Syste

m

Is client in

system?

Possible

Duplicate?

Has Case

Manager

already been

assigned?

Conflicting

entries? Is it a WCTO

referral?

Manage Merge

Manage Merge

Merge Records

Add to

PlunketPlus Data

No

Yes

Yes

NoYes

No

No

Refer to volunteer

or other service

Yes

BR – does CD

staff make

appointment?

No

YesMerge Records

Assign case

manager

Outgoing Referral

or

CYF Notification

External system

generates file for

Plunket

no

YesIs a contact

needed?

End

no

Is it a WCTO

referral?

yes

noFirst

acknowledgement

sent to referrer

yes

Is it a late

referral?no

yes

Manage possible

Duplicates

Schedule Contact

by Area

Administrator

(preferred)

Schedule Contact

by Service

Delivery Staff

v5

Note:

WCTO = Well Child/ Tamariki Ora

BR = Business Rule

CD staff = Care Delivery Staff

SD staff = Service Delivery Staff

Raise Clinical Alert

Incoming

communication

Plunket Nurse

responds to

Clinical Alert

Raise

System

Alert

Raise

System

Alert

Raise

System

Alert



2 Incoming

Referral

Manual


system

1


Brief

Description

Plunket receives a communication from an outside party

that a client wants to enrol with the Well Child Tamariki

Ora Service or one of the other services.

Trigger Could be one (or more of the following):

Fax

Telephone Call

Chance meeting (face-to-face or self referral)

Face to Face

Meeting with

Parent / Child

Incoming Fax /

forms / letter /

Email

Incoming

Telephone Call

(not Plunketline)

Actors The referrer (client or external organisation)

Plunket Administration Staff or Service Delivery Staff

PlunketPlus


What

Happens

Preferably a referral is received by the Area Office. The

area office enters as much information into PlunketPlus

as possible from the form or phone call to cut down on

the time that the Service Delivery Staff takes at the first

contact.

If the referral is a chance meeting with a client the

Plunket Nurse needs to be able to add the new client into

the system at once or at a later date or she needs to be

able to forward the form to the Area Office.

While the data is being entered (and this may be after a

contact has been made) PlunketPlus checks for duplicate

referrals. When a duplicate is detected, the Plunket Staff

member will check the consistency of the data and add

the relevant data to the system.

It is easy to identify exact duplicates (NHI numbers for

example) but there are “fuzzy” duplicates that may need

careful checking (twins with the same first initial for

example).

If it is a WCTO referral a Case Manager must be

assigned, following the process specified in Section

12.8.2 “Specific Business Rules” on page 267.

The data will be added or merged into the PlunketPlus

Raise

System

Alert

Manage Merge

Manage possible

Duplicates

Assign case

manager



system.

If it is a late WCTO referral, then a Clinical Alert needs to

be sent directly to the Case Manager so she can arrange

a first contact to take place as soon as possible.

Is it a late

referral?

Raise Clinical

Alert

Outputs Depending on the client‟s address and business rules set

up by the Plunket area, details of the referral will be sent

to either the Plunket Nurse in whose area the client lives

so she can establish contact (see Schedule Contact by

Service Delivery Staff) or more commonly an Areas

Administrator (see Schedule Contact by Area

Administrator (preferred)).

Details (to be defined) will also be sent to the Clinical

Leader (s).

Schedule Contact

by Area

Administrator

(preferred)

Schedule Contact

by Service

Delivery Staff

Refer to volunteer

or other service




Plu

nke

tPlu

sA

rea

Ad

min

istr

ato

r

Plu

nke

t Se

rvic

e D

eliv

ery

Staf

f

Th

e

Re

ferr

er

Collects as much

data as possible to

enter into

PlunketPlus

Copy information from

FAX / email into

PlunketPlus or Transpose

information from phone call

into PlunketPlus while caller

is on line

Manage

Merge

Manage

Merge

Face to Face

Meeting with

Parent / Child

Incoming Fax /

forms / letter /

Email

Incoming

Telephone Call

(not Plunketline)

No

Yes

Yes

Yes

Yes

no

yes

Merge RecordsIs it a WCTO

referral?

Has Case

Manager

already been

assigned?

Is client in

plunketPlus?

Is a contact

needed?

Refer to volunteer

or other service

BR – does CD

staff make

appointment?

Possible

Duplicate?

Assign case

manager

End

Merge Records

No

Conflicting

entries?

Is it a WCTO

referral?

yes

no

no

no

Add to

PlunketPlus Data

yes

yes

no

no

Manage possible

Duplicates

V5

Schedule Contact

by Area

Administrator

(preferred)

Yes

Is it a late

referral?no

Note:


BR = Business Rule



Incoming

communication

Schedule Contact

by Service

Delivery Staff

Raise

System

Alert

Raise

System

Alert

Raise

System

Alert

Raise Clinical

Alert

Plunket Nurse

responds to

Clinical Alert



12.4.2 Schedule Contact

Scheduling contacts by using an electronic diary system is a very

important part of PlunketPlus. Currently Service Delivery Staff

carry an old fashioned diary.

Contacts can be scheduled by Service Delivery Staff for

themselves, or they can be scheduled by Area Administrators or

other Service Delivery Staff.

In urban areas it is envisaged that generally Area Administrators

will be able to save the Service Delivery Staff time by scheduling

the contacts. In rural areas local knowledge may be an

important factor so Plunket Nurses may need to schedule their

own contacts.

PlunketPlus needs to be flexible enough to allow both; see

“Scheduling First Contact” in Section 12.8.2 “Specific Business

Rules” on page 267 for some further information,

This section is set out under two headings:

Schedule Contact by Area Administrator

Schedule Contact by Service Delivery Staff

-

1 Schedule

Contact by

Area

Administra-

tor


system.

1

Schedule Contact by Area Administrator

(Preferred)

Brief

Description

Area Administrators schedules a contact for a Service

Delivery Staff member.

Trigger A workflow action has been initiated for the Area

Administrator role and it could be from:

A referral, manual or electronic.

The Reminder process.

An Incoming Communication.

Incoming Referral

(Electronic)

Incoming Referral

(Manual)

Reminders

Incoming

Communication

Actors Area Administrator, PlunketPlus, Service Delivery Staff,

caregiver


What

Happens

An Area Administrator views their message board for

pending actions and selects an action to schedule a

contact between a Service Delivery Staff member and a

client.

PlunketPlus displays a screen that shows a summary of

data collected on the client and any relevant related



Caregivers to date via the referral system along with the

Plunket Nurse whom a business rule dictates will be the

Case Manager. If a business rule dictates that the first

contact is done by a Health Worker (perhaps for ethnic

reasons) then their details are brought up as well.

The Area Administrator calls the client and if the

caregiver answers the phone the administrator engages

the caregiver in conversation and reviews data collected

so far and adds any that may be volunteered during the

conversation. This may include notes about preferred

times of availability.

The Area Administrator and caregiver agree a time and

date when the contact can take place.

If a time for the contact cannot be established or the

Caregiver does not answer then the action is added back

into the message board with a record of the attempt to

schedule a contact.

If a predetermined number of attempts have been made

to schedule a contact then the administrator sets up a

time and date for an Unscheduled Contact by the

designated Service Delivery Staff member.

Also, if a predetermined number of attempts have been

made to schedule a contact then a System Alert is

generated for the Clinical Leader for the Area.

Usually confirmation will not need to be made by the

Service Delivery Staff. Plunket requires a business rule

to be set up that indicates whether a particular Service

Delivery Staff member wants to confirm contacts

scheduled by other people, or not. If so, PlunketPlus

generates the necessary confirmation message.

If the Plunket Nurse cannot confirm the contact best

practice would be for her to reschedule the contact

herself.

PlunketPlus notifies

Admin that referral has

been received and no

appointment has been

confirmed. Provides

information such as

name, phone Number

etc of Client and

details of the SD staff

and her diary.

Calls Adult Client with

data windows open for

SD staff Diary and

client details already

entered.

Caregiver

answers?

Time and date

for first

appointment

established?

Has maximum

# of attempts

been made ?

Makes time for

unscheduled

contact in SD staff

diary

Scheduled

contact OK?

SD staff

reschedules?

Outputs A Scheduled Contact. Confirm scheduled

contact

Set Up Scheduled

Contact



Schedule Contact by Area Administrator (Preferred)

Are

a

Ad

min

istr

ato

rA

du

lt C

lien

tP

lun

ke

t S

erv

ice

D

eliv

ery

Sta

ffP

lun

ke

tPlu

s


Admin that referral has


appointment has been

confirmed. Provides

information such as

name, phone Number

etc of Client and

details of the SD staff

and her diary.

Calls Adult Client with

data windows open for

SD staff Diary and

client details already

entered.

Caregiver

answers?

Conversation.

Establish relationship.

Reviews demographic

data already received.

Additional

information

gathered?

Record

Information

Confirm scheduled

contact

Yes

Update Client

Record

Yes

Is

Administrator

trusted updater

of SD staff

diary?

Scheduled

contact OK?Yes

Incoming Referral

(Electronic)

Incoming Referral

(Manual)

Incoming

Communication

Add referral back

into Message

Board with record

of attempt

Time and date

for contact

established?

no

Has maximum

# of attempts

been made ?

Set Up Scheduled

Contact

v5

Makes time for

unscheduled

contact in SD staff

diary

no

no

yes

No

yes

no

Note:


BR = Business Rule



Yes

Is it a first

appointment?no

yes

NoSD staff

reschedules?

Schedule Contact

by Service

Delivery Staff

yes

Reminders



2 Schedule

Contact by

Service

Delivery

Staff


system.

1


Brief

Description

Service Delivery Staff schedules their own contact in

response to an Incoming Referral or an Incoming

Communication that is not a referral.

Trigger One of

An Incoming Referral (manual or electronic) that has

been routed through PlunketPlus and sent on to the

Service Delivery Staff member.

An Incoming Communication directly to an Area

Administrator or Service Delivery Staff member.

An automated Clinical Alert.

Incoming Referral

(Electronic)

Incoming Referral

(Manual)

Incoming

Communication

Plunket Nurse

Respond to

Clinical Alert

Actors Administrator, PlunketPlus, Service Delivery Staff,

caregiver.

Inputs Same as trigger.

What

Happens

A referral has been routed through the Incoming Referral

process in PlunketPlus and a workflow action initiated for

a specific Service Delivery Staff member that appears on

their message board.

Plunket Nurse selects a client and the screen will show a

summary of data collected on the child and caregiver to

date via the referral system. If a business rule dictates

that the first contact is done by a Health Worker (perhaps

for ethnic reasons) then their details are brought up as

well.

The Plunket Nurse calls the client and if the caregiver

answers the phone engages the caregiver in conversation

and reviews data collected so far and adds any that may

be volunteered during the conversation.

The Plunket Nurse finds a time and date when the contact

can take place (and in the case of a Health Worker doing

the first contact then a contact for the first Core Contact)

and agrees the time with the caregiver.

If a time cannot be agreed or the caregiver does not

answer the phone then the client is added back into the

“to do” list with a record of the attempt.

If a predetermined number of attempts have been made

to make a contact then the Plunket Nurse sets up a time


SD staff via Message

Board that referral has


scheduled contact has

been confirmed.

Provides information

such as phone

numbers etc.

Calls client with data

windows open for SD

staff diary and client

details already

entered.

Adult Client

answers?

Conversation.

Establishes

relationship.

Reviews demographic


Time and date

for contact

established?

Adds client back

into “to do” list with

record of attempts.



and date for an Unscheduled Contact.

Also, if a predetermined number of attempts have been

made to make a contact then a System Alert is generated

for the Clinical Leader for the Area.

If the contact is agreed upon then the Plunket Nurse

confirms the contact and it is set up in PlunketPlus in the

Plunket Nurse‟s diary and the scheduling system that will

send out reminders to clients.

Has maximum

# of attempts

been made ?

Makes time for

unscheduled

contact in diary

Confirm

Scheduled

Contact

Outputs A Scheduled Contact. Set Up Scheduled

Contact




Se

rvic

e D

eliv

ery

Sta

ffA

du

lt C

lien

tA

rea

Ad

min

istr

ato

rP

lun

ke

tPlu

s


SD staff via Message

Board that referral has


scheduled contact has

been confirmed.

Provides information

such as phone

numbers etc.

Calls client with data

windows open for SD

staff diary and client

details already

entered.

Adult Client

answers?

Conversation.

Establishes

relationship.

Reviews demographic


More information

gathered?

Time and date

for contact

established?

Record

Information

Confirm

Scheduled

ContactYes

Update Client

Record

Yes

No Yes

Incoming Referral

(Electronic)

Incoming Referral

(Manual)

Incoming

Communication

Plunket Nurse

Respond to

Clinical Alert

Adds referral back

into Message

Board with record

of attemptSet Up Scheduled

Contact

Has maximum

# of attempts

been made ?

no

no

yes

v5

Note:


BR = Business Rule



Makes time for

unscheduled

contact in diary



12.4.3 Client Transfer

This section describes the required processes for transferring

clients from one Plunket Area to another when they move to a

new address, or from one Case Manager Plunket Nurse to

another for any reason.

There are two versions of this process:

Client Transfer, relocation.

Client Transfer to new Case Manager Plunket Nurse.

The process of transferring to an External Provider is explained

in Section 12.4.26 “Discontinuation from a Plunket Service” on

page 235.

-

1 Client

Transfer,

Relocation


system

1

Client Transfer – Relocation

Brief

Description

A client moves from one Plunket Area to another

Plunket Area or within a Plunket Area. In the case of

the Well Child Tamariki Ora Service a different Case

Manager Plunket Nurse needs to be assigned or a

decision made that they can stay with their old Case

Manager Plunket Nurse.

For other services decisions need to be made by the

Service Delivery Staff responsible for the Service as to

the action taken.

Trigger Client tells any Plunket Staff at a contact or by phone,

txt or email. Client decides to

move

Actors Client


Area Administrator

Clinical Leader

PlunketPlus


What

Happens

The Plunket staff member who receives the Incoming

Communication will enter details into PlunketPlus

which will need to include the new address.

For the Well Child Tamariki Ora Service or where a

Case Manager Plunket Nurse has been assigned:

The system will generate a workflow action for

the Case Manager Plunket Nurse to verify the

request. This may involve checking that the

client no longer lives at an address or calling to

discuss the move with the adult client.

If PlunketPlus can verify the new address then

Incoming

Communication

Other non-contact

Action

PlunketPlus

identifies all

Services in which

client is enrolled

Initiates workflow

action for CMPN

„old‟ location



PlunketPlus will initiate a workflow action for

the appropriate Clinical Leader. If PlunketPlus

cannot verify the address then the PlunketPlus

will initiate a workflow action for the Area

Administration role in the new location. The

Area Administrator will then initiate a workflow

action for the appropriate Clinical Leader. If the

new address cannot be verified then a transfer

cannot take place.

Once the client has been assigned a new Case

Manager Plunket Nurse the new Case Manager

Plunket Nurse is prompted by workflow actions

to deliver appropriate services and the Case

Manager Plunket Nurse from the old location is

informed that the client now has a new Case

Manager Plunket Nurse.

PlunketPlus will cancel any Scheduled Contacts

in the old location.

The only exception to the cancelling of

Scheduled Contacts is if the client has moved a

short distance and, in the referral process, the

Clinical Leader has assigned the same Case

Manager Plunket Nurse to maintain a continuity

of service.

For a Service where there is no Case Manager Plunket

Nurse:

PlunketPlus will put an entry on the message

board for the role responsible for the service in

the new Plunket Area (if the service exists in

that Area).

PlunketPlus will put an entry on the message

board for the role responsible for the service in

the „old‟ Plunket Area advising them of the

change of address.

The Service Delivery Staff can then take

appropriate action.

CMPN verifies

request

Approves

transfer?

Can new

address be

verified?

Assigns different Case

Manager Plunket

Nurse

Cancel any

existing scheduled

contacts for old

location

CMPN „old‟ and

„new‟ informed of

completion of

transfer

Initiates workflow

action for Area

Administrator role of

„new‟ Plunket Area

PlunketPlus puts entry

on message board for

the role responsible

for the Service in the

„new‟ and „old‟ area.

Service coordinator

make appropriate

response

Outputs The client is transferred to one or more of:

A service in a different Area.

A different Case Manager Plunket Nurse for a

service.



Client Transfer – RelocationC

linic

al

Le

ad

er

Clie

nt

Plu

nke

tPlu

sA

rea

A

dm

inis

tra

tor

Se

rvic

e

De

live

ry S

taff

Client decides to

move

Incoming

Communication

Other non-contact

Action

Will include

new address

v5




Note:


BR = Business Rule

For a service without a CMPN

Initiates workflow

action for Clinical

Leader responsible for

„new‟ address

Assigns different Case

Manager Plunket

Nurse

Initiates workflow

action for Area



Contacts „old‟

or „new‟ Area

Initiates workflow

action for CMPN

„old‟ location

PlunketPlus puts entry

on message board for

the role responsible

for the Service in the

„new‟ and „old‟ area.

PlunketPlus identifies

all Services in which

client is enrolled then

for each service...

For a service with a CMPN

Service coordinator

make appropriate

response

Can new

address be

verified?

yes

no

Cancel any

existing scheduled

contacts for old

location

CMPN „old‟ and

„new‟ informed of

completion of

transfer

Initiates workflow

action for Area



yes

yes

End

Identifies

Clinical Leader

responsible for

new address?

no

CMPN verifies

request

Approves

transfer?no



2 Client

Transfer to

new Case

Manager

Plunket

Nurse


system.

1

Client Transfer to New Case Manager

Plunket Nurse

Brief

Description

A Case Manager Plunket Nurse resigns or changes

roles or responsibilities. A new Case Manager

Plunket Nurse needs to be assigned to multiple

clients.

Trigger A Case Manager Plunket Nurse resigns or their roles

or responsibilities change. A CMPN Resigns

or changes roles /

responsibilities

Area management

reorganise case

load distribution

Actors Adult client.

Case Manager Plunket Nurse.

Area Administrator.

Clinical Leader.

PlunketPlus.


What

Happens

The relevant Clinical Leader will need to reallocate

clients to other Case Manager Plunket Nurse(s) who

will take over the duty of care and brings up the

relevant PlunketPlus administration screen listing all

the clients for that Case Manager Plunket Nurse.

This will enable bulk reassigning of all clients or

groups of clients by use of check-boxes with the

ability to select all, by street, by branch or deselect

single clients or groups of clients that are to be

transferred to another Plunket Nurse.

If a Case Manager Plunket Nurse has been made

inactive in the system then a System Alert will be

sent to the relevant Clinical Leader if the Case

Manager Plunket Nurse still has clients assigned.

After the reallocation there will be existing

Scheduled Contacts that will need to be checked as

to the ability of the new Case Manager Plunket

Nurse to complete them.

PlunketPlus will initiate a workflow action on the

Message Boards of the Area Administration role for

each of the contacts that need rescheduling.

PlunketPlus provides

case load report with

clients grouped by

postcode / mesh block

Clinical Leader

reallocates case

loadwith the help of

PlunketPlus

Area Administrator

phones client to

reschedule scheduled

contacts and inform

client of the changes



Area Administrators will be given a time period and

maximum number of attempts to reschedule. If

they cannot make contact then a System Alert will

be raised in PlunketPlus for the new Case Manager

Plunket Nurse to deal with.

If no new time is required for the new Case

Manager Plunket Nurse then the client will be sent

details by their preferred means of communication

informing them of the change in Case Manager

Plunket Nurse.

PlunketPlus sends

message to client

informing them of

CMPN change by the

client‟s preferred

means of

communication –

letter, text, Email.

PlunketPlus records

attempt and maintains

Area Administrator

Message Board

Sufficient

attempts

made?

Raise System

Alert

Outputs All affected clients have a new Case Manager

Plunket Nurse. Transfer complete



Client Transfer - Plunket InitiatedA

rea

Ad

min

istr

ato

r

Ad

ult

Clie

nt

Plu

nke

tPlu

sC

linic

al L

ea

de

rC

ase

Ma

na

ge

r

Plu

nke

t N

urs

e

A CMPN Resigns

or changes roles /

responsibilities

PlunketPlus provides

case load report with

clients grouped by

postcode / mesh block

Clinical Leader

reallocates case

loadwith the help of

PlunketPlus

PlunketPlus checks for

schedule conflicts if

cases allocated to

existing CMPN or new

CMPN who works

different days.

Is there a

schedule

conflict?

PlunketPlus sends

message to client

informing them of

CMPN change by the

client‟s preferred

means of

communication –

letter, text, Email.

PlunketPlus records

attempt and maintains

Area Administrator

Message Board

Sufficient

attempts

made?

Area Administrator

phones client to

reschedule scheduled

contacts and inform

client of the changes

Was client

contacted?

no

yes

no

yes

yes

Area management

reorganise case

load distribution

Transfer complete

Raise System

Alert

v5




Note:


BR = Business Rule



12.4.4 Incoming Communication

Plunket receive many types of communication by phone, fax,

letter, email, txt, word of mouth etc. This will continue.

This process describes all Incoming communications, including

emails, and excluding referrals or electronic Visit Summary from

GP.

-

1 Incoming

Communicat

ion


system.

1

Incoming Communication

Brief

Description

An incoming communication arrives that requires human

intervention.

Trigger An incoming communication arrives, by phone, letter,

fax, email, txt, word of mouth, observation from:

a Client

a Plunket Staff member

an External Provider

any person or organisation.

Action Referral

External Provider

contacts Plunket

SD staff or Plunket

Administration

Client contacts

Plunket SD staff or

Plunket

Administration

Actors Plunket Service Delivery Staff

Area Administrators or Area Management

Client

External Provider

Other organisations

Other people

Inputs The message that triggered the process

What

Happens

The message is received and, as it is a request or

observation or the communication of a fact and is not

overtly automatic, human intervention is required. The

default Plunket Staff receiving the communication will

be an Area Administrator unless it is specifically

addressed to a Service Delivery Staff person or concerns

clinical requests such as a CYF Notification. The person

receiving the communication will then need to direct the

request or take an action.

Examples:

1. A client calls to say they have changed address –

depending on where to this could trigger an

„update files‟ process or a „client transfer – client

initiated‟ process.

2. A manual advice from an external provider in

relation to a referral from Plunket.



(Note that referral feedback is handled in a

separate process.)

3. CYF contacts the Clinical Leader requesting

information about a child. This triggers the

process Case Manager Plunket Nurse responds to

Request for information‟.

4. A client contacts the Area Office and wants to

view their Plunket record. This triggers a

„Request for Information‟ process.

5. Another provider calls to say a particular client

has requested that they take over the provision

of the WCTO service. This triggers a

Discontinuation process.

6. A client cancelling a Scheduled Contact.

7. The death of a client.

8. A change of caregiver.

9. Client doesn‟t want a Plunket Service.

10. A complaint.

11. A neighbour phones with concern about a child.

12. A communication about an at-risk teenager being

pregnant.

13. Housing New Zealand calls to say a family has

absconded and they want the new address.

14. A GP‟s Practice Nurse calls with concerns about a

child or adult.

Outputs The output could be a contact, scheduling a contact, the

updating of records or dealing with a request for

information or another non-contact action.

Core Contact

(Plunket Nurse)

Additional Contact

(any SD staff)

Case Manager

Plunket Nurse

updates EHR

Other non contact

action

Update EHR

Additional Contact

(any SD staff)

Raise Clinical

Alert

Schedule Contact

by Service

Delivery Staff



Incoming CommunicationA

du

lt C

lien

tP

lun

ke

tPlu

sA

rea

Ad

min

istr

ato

r

Exte

rna

l

Pro

vid

er

Plu

nke

t Se

rvic

e D

eliv

ery

Staf

f

Action Referral

Client contacts

Plunket SD staff or

Plunket

Administration

External Provider

contacts Plunket

SD staff or Plunket

Administration

Plunket staff

makes decisions

as to what to do

with the

communication

Update EHR

Case Manager

Plunket Nurse

updates EHR

Additional Contact

(any SD staff)

Other non contact

action

Core Contact

(Plunket Nurse)

Schedule Contact

by Area

Administrator

(preferred)

v5

Note:


BR = Business Rule



Schedule Contact

by Service

Delivery Staff

SD staff calls /

sends message to

say she is

unavailable

Referral Feedback

(Manual)

Referral Feedback

(Automated)

Raise Clinical

Alert

CMPN responds

to request for

Client Information



12.4.5 Contact

Plunket has defined two kinds of contact. Core Contact and

Additional Contact.

A Core Contact is part of the Well Child Tamariki Ora schedule

contract. There are currently eight successive Core Contacts that

must be conducted for every child, each with specific

measurements, observations and topics to be discussed. See the

section Contract Event Templates in the Appendix on page 356

for more detail.

An Additional Contact is any other contact between Plunket

Service Delivery Staff and a client:

Core Contact.

Additional Contact.

Core Contact at Kohanga Reo and Early Childhood Centres.

-

1 Core Contact Please explain how this process will be implemented in the

system.

1

Core Contact

Brief

Description

A Plunket Nurse has a Core Contact with a child

client and caregiver (adult client).

Trigger PlunketPlus detects a scheduled upcoming Core

Contact and the process “Prepare for Contact”

has been completed.

Prepare for

Contact

Actors Plunket Nurse

Child client

Caregiver (adult client)

Inputs The client‟s Electronic Health Record (EHR)

Plunket Nurse‟s diary

The Service Delivery Plan for Client Event (this

includes the appropriate details from the WCTO

schedule)

Other reference material deemed necessary by

the Plunket Nurse

What

Happens

Unless the client has responded negatively to

the automated reminder, the Plunket Nurse will

attend the contact.

If both client and caregiver do not turn up or are

not at home the Contact Status of the Event

data entity is set as ANK (Appointment not Kept)

if it was a Scheduled Contact and NAH (Not at

Home) if not.

The system will generate a workflow action for

the Plunket Nurse or Area Administrator role to

schedule a new contact.

Workflow action

generated for SD

staff or Area

Administrator to

schedule new

contact



If only one of the caregiver and client are

present then it cannot be a Core Contact and

must be changed to an Additional Contact.

Examples of the above:

A mother left her child with her sister and

turned up at the clinic to discuss

breastfeeding instead of having a Core

Contact.

A mother left the child at home with her

aunty. The Plunket Nurse carries out the

physical assessment but cannot ask or

discuss issues with the main caregiver.

If it is a first contact then the child client needs

to be enrolled and the details of the caregiver

collected.

If the Plunket Nurse has not done “Prepare for

Contact” prior to attending the contact, then the

Service Delivery Plan for Client Event must be

prepared by pulling down the appropriate

Contract Event Template and customising it as

necessary.

The Plunket Nurse conducts the Core Contact

using the “Service Delivery Plan for Client Event”

and recording the necessary measurements,

observations and topics discussed in the Client

Health Information and Action Taken data

entities. This will include any items additional to

those in the Service Delivery Plan for Client

Event that come up.

The system is assisting the Plunket Nurse to

identify whether the Core Contact is complete by

visual prompts on the screen. See this described

in Section 9.3 “Screen Displays and Data Entry”

on page 49.

The Plunket Nurse may fully complete the Core

Contact while in the presence of the client, in

which case the system will allow the Plunket

Nurse to “close” the contact (which sets the

appropriate flag in the Event entity).

If for any reason it is not possible to fully

complete the Core Contact while in the presence

of the client, the Plunket Nurse is required to

have entered sufficient free text notes to allow

completion of the required data later that day.

The system is not required to validate that

the free text notes have been entered.

All the required Core Contact data must be

entered by midnight on the day of the

contact, at which time the system will

automatically close the event. If all the

required Core Contact data has not been

entered, the system will close the event as

an Additional Contact. No further data can be

entered against this event unless authorised

by the relevant Clinical Leader, as described

Additional Contact

(any SD staff)

Enrolment (if

nessecary)

Plunket Nurse checks

demographics and contact

details and facilitates

contact according to the

needs of the client and the

Service Delivery Plan for

Client Event.

The Plunket Nurse will

record the details of the

contact.

Have all required

Actions been

completed?

PlunketPlus

display shows

which Actions are

not complete

Record Contact as

Core Contact



in “Core Contact Closure” in Section 12.8.2

“Specific Business Rules” on page 267.

Once a Core Contact has been closed, and if the

client‟s EHR shows that consent for this has

been given, PlunketPlus generates a Visit

Summary and sends it to the client‟s GP.

If a Plunket Nurse cannot complete the actions

required for the Core Contact then the contact

will be recorded as an Additional Contact.

If the Plunket Nurse does not schedule a

replacement Core Contact at the time then

PlunketPlus will initiate a workflow action for the

Case Manager Plunket Nurse to schedule a

replacement Core Contact.

If a Scheduled Contact takes place and the

“Prepare for Contact” process was not

undertaken first, PlunketPlus must automatically

generate a system alert to the relevant Clinical

Leader.

Record Contact as

Well Child

Additional Schedule a

replacement Core

Contact

Outputs During the contact (as either Core or Additional) the

Plunket Nurse identifies the follow-up actions. This

should include scheduling the next Core Contact and

any other follow up.

Identify Follow-up

Actions and

update SDP

Notes This does not include Kohanga Reo contacts and

contacts done in early childhood centres that do not

require the primary caregiver to be present.



Core Contact (excludes Kohanga Reo and Early Childhood centres)

Plu

nke

t N

urs

eC

lien

tP

lun

ke

tPlu

s

PlunketPlus sends

reminders to client

Prepare for

Contact

Event contact

status set as

ANK

Enrolment (if

nessecary)

Is it a first

Scheduled

Contact?

yes

Plunket Nurse checks

demographics and

contact details and

facilitates contact

according to the needs

of the client and the

Service Delivery Plan for

Client Event.

The Plunket Nurse will

record the details of the

contact.

no

Have all required

Actions been

completed?

PlunketPlus

display shows

which Actions are

not complete

no

Is PN able to

complete

Actions?

yes

yes

Record Contact as

Core ContactRecord Contact as

Well Child

Additional

no

Identify Follow-up

Actions and

update SDP

The follow up actions

will usually include

scheduling next

contact, making

recommendations,

referrals etc so see

the swimlane

diagrams for those

processes.

Additional Contact

(any SD staff)

v5

Note:


PN = Plunket Nurse

NAH = Not at Home

ANK = Appointment not Kept

Workflow action

initiated for Area

Administrator role

to schedule new

Core Contact

Is it a

scheduled

contact

Event contact

status set as

NAH

yesno

Schedule a

replacement Core

Contact

Attending at Clinic

or at home out of

Child and

Caregiver

both attend

one of the Two attend

no one attends



2 Additional

Contact


system.

1

Additional Contact

Brief

Description

A Service Delivery Staff member has a contact

with a client

Trigger Either of these:

PlunketPlus detects a scheduled upcoming

Additional Contact and the process

“Prepare for Contact” is complete.

This could be by phone, video call (eg

webcam), face to face or group face to

face.

A client is met by chance (e.g. client walks

into a family centre or a Car Seat Rental

Scheme office).

An incoming phone call from a client to a

Service Delivery staff member.

Prepare for

Contact

Client turns up at Clinic /

Plunket Bus / another

Client‟s home, car seat

rental office or it is an

incoming phone call from

a client

Actors Service Delivery Staff

Child client (perhaps)

Adult client


Service Delivery Staff diary

The Service Delivery Plan for Client Event (if

relevant)

Other reference material deemed necessary

by the Service Delivery Staff

What

Happens

For a scheduled Additional Contact, unless

the client has responded negatively to the

automated reminder, the Service Delivery

Staff will attend the contact.

If the client does not turn up or is not at

home the Contact Status of the Event data

entity is set accordingly. The system will

generate a workflow action for a Service

Delivery Staff member or the Area

Administrator role to schedule a new

contact.

If it is an Unscheduled Contact then the

Service Delivery Staff will need to be able

to access client‟s EHR.

If it is the first contact for this client, then

the Service Delivery Staff member will

undertake the Enrolment process.

If the Plunket Nurse has not done “Prepare

for Contact” prior to attending the contact,

then the Service Delivery Plan for Client

Is it a

scheduled

contact

Workflow action

initiated for Area

Administrator role

or SD staff to

schedule new

contact

Is it a first

Scheduled

Contact?



Event must be prepared by pulling down

the appropriate Contract Event Template

and customising it as necessary.

Service Delivery Staff conduct the

Additional Contact using the appropriate

Service Delivery Plan for Client Event and

recording the relevant measurements,

observations or topics discussed in the

Client Health Information data entity.

If the Additional Contact is a Group

Contact, the Service Delivery Staff member

hands out the list produced earlier in the

Prepare for Contact process and clients

mark their attendance and any changes to

contact details. Or the Service Delivery

Staff member checks attendance in some

other way.

The Service Delivery Staff member enters

those details on the “Additional Group

Contact” screen.

The Service Delivery Staff member “ticks”

those who attended and topics covered.

For individual comments or changes, the

Service Delivery Staff member opens a

client‟s EHR to record these.

When the Service Delivery Staff member

closes the contact, all details are updated

into the EHRs of all clients who attended.

If the end of the programme or course has

been reached, the Service Delivery Staff

member will use the “Programme

Completed” function on the screen to

Discontinue all the clients.

Enrolment (if

nessecary)

Service delivery staff

checks demographics and

contact details and

facilitates contact

according to the needs of

the client and the Service

Delivery Plan for Client

Event.

The service delivery staff

will record the details of

the contact.

Record Contact as

Additional by service and

details of the contact

against the client or, if it is

a group contact, details of

the contact against all

clients.

Outputs Completion of the Additional Contact is

recorded in each client‟s EHR. Identify Follow-up

Actions and

update SDP



Additional ContactP

lun

ke

t S

erv

ice

De

live

ry S

taff

Clie

nt

Plu

nke

tPlu

s

PlunketPlus

Scheduled Contact

triggers reminders to

Client

Prepare for

Contact

Enrolment (if

nessecary)

Is it a first

Scheduled

Contact?

yes Service delivery staff

checks demographics and

contact details and

facilitates contact

according to the needs of

the client and the Service

Delivery Plan for Client

Event.

The service delivery staff

will record the details of

the contact.

no

Record Contact as

Additional by service and

details of the contact

against the client or, if it is

a group contact, details of

the contact against all

clients.

Identify Follow-up

Actions and

update SDP

The follow up actions

will usually include

scheduling next

contact, making

recommendations,

referrals etc so see

the swimlane

diagrams for those

processes.

Client turns up at Clinic /

Plunket Bus / another

Client‟s home, car seat

rental office or it is an

incoming phone call from

a client

no

Is it a

scheduled

phone call?

Does Adult

Client answer?

yes

yes

no

Record

attempt

v5

Note:


BR = Business Rule

yesno

Event contact

status set as

NAH

Is it a

scheduled

contact

Event contact

status set as

ANK

Workflow action

initiated for Area

Administrator role

or SD staff to

schedule new

contact

NAH = Not at Home

ANK = Appointment not Kept


Attending at Clinic

or at home out of

Child and

Caregiver

no one attends

one or both attend



3 Core Contact

at Kohanga

Reo and

Early

Childhood

Centres

Core Contacts undertaken at Kohanga Reo and Early Childhood

Centres will be different to other Core Contacts as all the

components of the Core Contact do not occur at the same time.

The Plunket Nurse will undertake the components in three steps,

i.e. the parent questionnaire forwarded by the Kohanga Reo and

Early Childhood Centre, the physical assessment and the follow-

up discussion by phone with the parent.


system.

1

Core Contact at Kohanga Reo and Early

Childhood Centres

Brief

Description

A Plunket Nurse conducts the Physical Assessment part of

a Core Contact with a child client at a Kohanga Reo or

Early Childhood Centre. At a later time the Plunket Nurse

will complete the Core Contact by phone with the caregiver

(adult client).

Trigger A Plunket Nurse schedules a contact to visit a Kohanga Reo

or Early Childhood Centre.

Actors Plunket Nurse

Child client

The Head teacher of a Kohanga Reo or Early Childhood

Centres

Caregiver (adult client)


Plunket Nurse‟s diary

The Service Delivery Plan for Client Event (this includes the

appropriate details from the WCTO schedule)

Other reference material deemed necessary by the Plunket

Nurse

The completed information form from the caregiver

What

Happens

The Plunket Nurse has a planned visit to see a group of

child clients at a Kohanga Reo or Early Childhood Centre.

The Area Administrator sends blank information forms to

the Head teacher of the Kohanga Reo or Early Childhood

Centre.

Prior to the visit the Head teacher of the Kohanga Reo or

Early Childhood Centre sends out information form to the

caregivers of the children attending.

The Head teacher of the Kohanga Reo or Early Childhood

Centre collects the completed information forms and

either keeps them until the Plunket Nurse visits or sends

them to the Plunket Nurse.

Prior to the visit or before the first contact of the visit the

Plunket Nurse will prepare for the contact. With the help

PN provided with

returned

information forms

of Child Clients

Prepare for

Contact

Is it a first

appointment

?

Enrolment (if

necessary) using

details from

permission form



of the search function in PlunketPlus she will find the

EHRs belonging to the child clients. If a child does not

have an EHR then she will create one from the details on

the completed information form. If the child is not

enrolled in the Well Child Tamariki Ora Service then she

will enrol the child.

If the Plunket Nurse has not done “Prepare for Contact”

prior to attending the contact, then the Service Delivery

Plan for Client Event must be prepared by pulling down

the appropriate Contract Event Template and

customising it as necessary.

She will see the child clients one at a time but only if the

caregiver has signed the completed information form.

If the client does not turn up to a Kohanga Reo or Early

Childhood Centre and the Plunket Nurse is expecting to

see them due to the returned completed information

form then the Contact Status of the Event entity is set to

ANK (Appointment Not Kept).

The system will initiate a workflow action for the Plunket

Nurse to schedule a new contact.

If it is a first contact then the child client needs to be

enrolled and the details of the caregiver taken from the

completed information form.

The Plunket Nurse conducts the Physical Assessment

elements of Core Contact with the child client using the

“Service Delivery Plan for Client Event” and recording the

necessary measurements and observations in the Client

Health Information data entity.

PlunketPlus will recognise the place of contact and enable

the completion of the contact by telephone at a later

date. The system will initiate a workflow action for the

Plunket Nurse to make the follow up call.

The Plunket Nurse conducts the remaining elements of

Core Contact with the caregiver (adult client) by phone

using the “Service Delivery Plan for Client Event” and

recording the necessary measurements, observations

and discussion topics in the Client Health Information

data entity.

The system is assisting the Plunket Nurse to identify

whether the Core Contact is complete by visual prompts

on the screen. See this described in Section 9.3 “Screen

Displays and Data Entry” on page 49.

The Plunket Nurse may fully complete the Core Contact

while on the phone to the caregiver (adult client), in

which case the system will allow the Plunket Nurse to

“close” the contact (which sets the status of the

appropriate attribute in the event entity).

If for any reason it is not possible to fully complete the

Core Contact while in on the phone to the client, the

Plunket Nurse is required to have entered sufficient free

text notes to allow completion of the required data later

that day.

The system is not required to validate that the free

text notes have been entered.

Does Child

Client

attend?

PN provided with

returned

information forms

of Child Clients

Workflow action

generated for SD

staff or Area

Administrator to

schedule new

contact

PN completes the

Physical

Assessment

elements of the

WCTO schedule.

For example

measuring height

and checking

vision according to

the SDPCE

Plunket Nurse

calls Caregiver

Does PN

make contact

in time?

PN works through

remainder of

WCTO schedule

discussion topics

with caregiver

according to the

SDPCE

Has PN covered

all three strands of

the WCTO

schedule?

PlunketPlus sends

Prompt to PN that

schedule is not

complete

Is PN able to

complete

schedule?

Record Contact as

WCTO Additional

Record Contact as

appropriate Core

Contact



All the required Core Contact data must be entered

by midnight on the day of the phone call contact with

the caregiver (adult client), at which time the system

will automatically close the event. If all the required

Core Contact data has not been entered, the system

will close the event as an Additional Contact. No

further data can be entered against this event unless

authorised by the relevant Clinical Leader, as

described in “Core Contact Closure” in Section

12.8.212.8.2 “Specific Business Rules” on page 267.

If the Plunket Nurse fails to make contact by phone

with the client‟s caregiver or another method within a

certain timeframe then the system will close the

event as an Additional Contact.

Outputs During the contact (as either Core or Additional) the

Plunket Nurse identifies the follow-up actions. This should

include scheduling the next Core Contact and any other

follow up.

Identify Follow-up

Actions and

update SDP

Notes This is the only case when a Core Contact may be

completed on a day later than the initial contact.

A development to this process will be that the

caregiver is able to complete the information /

permission form on line.

The phone contact could be completed by a face to

face contact or a Video Call instead.



Core Contact at Kohanga Reo and Early Childhood centres

Ca

reg

ive

r

(Ad

ult

Clie

nt)

He

ad

tea

ch

er

of K

R /E

CC

Plu

nke

t N

urs

eC

hild

Clie

nt

Plu

nke

tPlu

s

PN makes

appointment with

KR/ECC to visit to

do Core Contacts

and provides

blank information

forms to be

completed by

Caregivers

Prepare for

Contact

Enrolment (if

necessary) using

details from

information form

Is it a first

appointment

?

PN completes the

Physical

Assessment

elements of the

WCTO schedule.

For example

measuring height

and checking

vision according to

the SDPCE

Has PN covered

all three strands of

the WCTO

schedule?

PlunketPlus sends

Prompt to PN that

schedule is not

complete

Is PN able to

complete

schedule?

Record Contact as

appropriate Core

Contact

Identify Follow-up

Actions and

update SDP

v1

Note:


PN = Plunket Nurse

SDPCE = Service Delivery Plan for Client Event

SD staff = Service Delivery staff

KR / ECC = Kohanga Reo or Early Childhood Centre

Distributes and

collects completed

and signed

information forms

Plunket Nurse

calls caregiver

Does PN

make contact

in time?

PN works through

remainder of

WCTO schedule

discussion topics

with caregiver

according to the

SDPCE

yes

Record Contact as

WCTO Additional

PN provided with

returned

information forms

of Child Clients

Does Child

Client

attend?

no

yes

yes

noyes

yes

no

no

no

Workflow action

generated for SD

staff or Area

Administrator to

schedule new

contact

Event contact

status set as ANK



12.4.6 Prepare for Contact

Before a contact a Plunket Service Delivery Staff member needs

to prepare. This process explains how PlunketPlus will assist with

that.

-

1 Prepare for

Contact


system.

1

Prepare for Contact

Brief

Description

Plunket Service Delivery staff prepare for a

meeting with a client.

Trigger A Scheduled Contact with a client is due.

Actors PlunketPlus


Client

Inputs The Service Delivery Staff member‟s calendar.

The client‟s Electronic Health Record (EHR)

Relevant Contract Event templates

What

Happens

Several different aspects of the data are required

when preparing for a contact.

When a Service Delivery Staff Member prepares

for a contact they must be able to access the

client‟s EHR to review previous contacts, any

clinical or hazard alerts that they need to be

aware of, previous referrals or recommendations

that need to be followed up.

As a result of reviewing the above they may

change the next Service Delivery Plan for Client

Event to ensure the correct care for the client is

planned.

They also need to access the EHR of those who

have a relationship with the client – i.e. a sibling

as they may need to undertake a contact

regarding the sibling as well as the client for

whom the contact is scheduled.

In the case of a Group Contact the Service

Delivery Staff Member needs to be able to print

off a copy of those expected to attend with their

contact details. This will be passed around in the

Group Contact for clients to change any relevant

details and note presence of those attending.

Some resource material may need to be printed

from the Plunket Library for client information

before any contact.

If a Contact Event Template exists for the

PlunketPlus lists upcoming

Scheduled Contacts In the SD

staff diary. The calendar will

provide the SD staff with links

to the Client‟s EHR and links

to those who have a

relationship with the Client. It

will also provide details of the

Contract Event Template (if

one exists).

Is it a Group

Contact?

SD Staff able to

print list of

expected

attendees

SD staff checks their diary

prior to contact. Prompts,

alerts and history (with drill

down) will enable staff to make

suitable preparation. (See

scenarios)

Creates Service Delivery

Plan for Client event using

relevant Contact Event

Templates and own

Professional judgement



contact then it will be made available to the

Service Delivery Staff Member so they can create

a Service Delivery Plan for Client Event. If

anything extra needs to be covered then a blank

Contract Event Template can be drawn down to

enable the extra Actions Taken to be added.

The Service Delivery Staff can also create or add

to a Service Delivery Plan for Client Event.

Outputs Information to facilitate a contact. Core or Additional

Contact

Notes If it is a „chance‟ contact then no preparation

will have been possible – for example a client

walking into a Family centre. The Plunket

Nurse / Health Worker will still need to be

able to access the client‟s records and other

information as above.



Prepare for ContactP

lun

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erv

ice

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live

ry S

taff

PlunketPlus detects

an upcoming

Scheduled Contact

PlunketPlus lists upcoming

Scheduled Contacts In the SD

staff diary. The calendar will

provide the SD staff with links

to the Client‟s EHR and links

to those who have a

relationship with the Client. It

will also provide details of the

Contract Event Template (if

one exists).

SD staff checks their diary

prior to contact. Prompts,

alerts and history (with drill

down) will enable staff to make

suitable preparation. (See

scenarios)

Core or Additional

Contact

v5

Note:





EHR = Electronic Health Record

Is it a Group

Contact?

no

SD Staff able to

print list of

expected

attendees

yes

Creates Service Delivery

Plan for Client event using

relevant Contact Event

Templates and own

Professional judgement



12.4.7 Enrolment

Clients need to be enrolled with a service to receive that service.

A client can be enrolled by many different Service Delivery Staff.

This process explains how Plunket sees this happening.

-

1 Enrolment Please explain how this process will be implemented in the

system.

1

Enrolment

Brief

Description

A client may enrol with one or more Plunket

services.

For example, a child might be enrolled in the

Plunket Well Child Tamariki Ora service.

While the caregivers of that child would be

entered into PlunketPlus as a related client, they

would not be enrolled in relation to Well Child.

A caregiver may however be enrolled as a client

in a Parenting Education or PPNAP service.

Basic common information for all clients is name,

address, date of birth and NHI where relevant.

Further information will be dependent on the

particular service.

A person may be first entered into PlunketPlus

during the initial engagement, for example when

there has been an initial approach and a first

contact is being scheduled. This is not enrolment.

Or a person may be first entered into PlunketPlus

as a result of an incoming referral (eg from an

LMC). This will result in a rich set of data in the

system for the client; however this is still not

enrolment.

Enrolment occurs during the first clinical contact

by Service Delivery Staff and may be face-to-face

or, in the case of PlunketLine, by telephone.

The enrolment process collects and records

further information, pertinent to the particular

service, relates the client to a particular contract

and creates the first Service Delivery Plan for

Client Event.

Trigger The first contact is in progress.

Or, at a subsequent contact, it is evident that the

enrolment was not fully completed previously.

Has client

been fully

enrolled in

service?

Actors Client


PlunketPlus



Inputs Information from caregiver

The client‟s EHR from PlunketPlus

Contract Event Template in PlunketPlus

What

Happens

During the contact, PlunketPlus requires data

to be entered for enrolment purposes (along

with other data relating to the contact).

As part of this process, Service Delivery Staff

will select the appropriate service. This action

will cause PlunketPlus to generate a Service

Delivery Plan for Client Event based on the

relevant Contract Event Template and any

other information entered.

PlunketPlus will automatically set the client‟s

status to “enrolled” for the particular service

once all the required data has been entered.

In the case where the Service Delivery Staff

member is unable to obtain all the data

required for enrolment, PlunketPlus will

remind the Service Delivery staff member to

obtain the missing data at the next contact.

Are details of client

already in system

under a different

service?

Reminder

generated for SD

staff depending on

the Service

Delivery Plan for

Client Event

SD staff collects

necessary enrolment data

for service and enters into

PlunketPlus

Outputs The client is enrolled or partially enrolled.

Service Delivery Plan for Client Event. It is

this data entity that records which service or

services the client is enrolled for.

Client Enrolled

Client „partially‟

enrolled subject to

more data being

collected



Enrolment (if necessary)P

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erv

ice

De

live

ry

Sta

ff

Core contact

(Plunket nurse)

Additional Contact

(any SD staff)

Prepare for

Contact

Has client

been fully

enrolled in

service?

Is it a Core

contact?

SD staff collects

necessary enrolment data

for service and enters into

PlunketPlus

Has all necessary

data been

collected for

enrolment?

Reminder

generated for SD

staff depending on

the Service

Delivery Plan for

Client Event

no

yes

no

noEnd – back to

contactyes

yes

Is it possible to

collect all

necessary

data?

yes

Client „partially‟

enrolled subject to

more data being

collected

no

Client Enrolled

Are details of client

already in system

under a different

service?

Fetch existing

data for clientyes

v5CD staff = Care Delivery Staff


Note:


BR = Business Rule

Client added to list

of partially enrolled

clients to be

followed up by SD

staff at next contact

no



12.4.8 Identify Follow-up Actions and Update Service Delivery Plan

A need has been identified at a contact. This process describes

how Plunket sees the need being addressed.

-

1 Identify Follow-

up Actions and

Update Service

Delivery Plans


system.

1

Identify Follow-up Actions and Update Service Delivery Plan

Brief

Description

After or during a contact the Service

Delivery Staff in consultation with the

caregiver will decide on what will happen

in the next Service Delivery Plan for Client

Event.

Trigger A contact takes place. Core Contact

(Plunket Nurse)

Additional Contact

(any SD staff)

Actors Plunket Service Delivery Staff

PlunketPlus

Client

Inputs Contact

Information from client

Service Delivery Plan for Client Event

Prompts from the Decision Support

function.

What

Happens

During a contact the Service Delivery

Staff member, in partnership with the

client or their caregiver(s), will be

deciding on the best course(s) of

action to improve the health outcomes

for the client. The course of action

could involve arranging the next

contact, referring the client to another

Plunket service or another health

provider or community agency for

further care, recommending a course

of action or, in the case of a client

being referred to them, reporting back

to the referrer. In all cases the Service

Delivery Staff will prepare the next

Service Delivery Plan for Client Event,

even if there are to be no more

Scheduled Contacts for that client.

DiscontinuationOther non-contact

Action

Advise referral

outcome

Make Referrals or

CYF Notifications

Make

Recommendations

Schedule Next

Contact

Prepare SDP for

next Client Event

Outputs An action or actions are decided upon

and documented and the appropriate

processes triggered.

The next SDP for Client Event.



Identify Follow-up Actions and update SDP

Plu

nke

tPlu

sC

lien

tP

lun

ket

Serv

ice

Del

iver

y St

aff

Core Contact

(Plunket Nurse)

Additional Contact

(any SD staff)

Using Professional judgement and the

SDP for Client Event the SD staff

make decisions in partnership with

client or their caregiver(s) as to the

type(s) of follow up required

Schedule Next

Contact

Make

Recommendations

Make Referrals or

CYF Notifications

Advise referral

outcome

Other non-contact

Action

Results in one or more of

Has next

contact been

scheduled?

Yes

Is SD staff the

Plunket Nurse

case

manager?

Is next contact

still OK?

yes

no

no

End

no

yes

YesIs it a WCTO

contact?

Must happen

Are more

contacts

required?

no

yes

no

Discontinuation




Note:


BR = Business Rule

Prepare SDP for

next Client Event



12.4.9 Schedule Next Contact

Plunket requires that at each contact the next contact is

scheduled if one is needed. This process explains how Plunket

see this happening.

-

1 Schedule

Next

Contact


system.

1

Schedule Next Contact

Brief

Description

A Plunket Service Delivery Staff member schedules the

next contact.

Trigger At the conclusion of a contact the next contact should

be scheduled (unless the child is approaching five

years of age or a course of contacts (PEPE or PAFT for

example) has come to an end.

Identify Follow-up

Actions

Actors Service Delivery Person

Client

PlunketPlus

Inputs The Service Delivery Staff diary

The Service Delivery Plan for Client Event

Information from the client

What

Happens

Whenever a Service Delivery Staff member has a

contact with a client, the next contact with Plunket

should be discussed unless no more are to be

scheduled.

If it is a Plunket Nurse contact with a client the

date of the next Core Contact should be set or

confirmed.

A Plunket Nurse may also schedule Additional

Contacts for a Health Worker and the client.

If the current contact is a Group Contact (and not

the last meeting) then the next date should be

confirmed.

If a Health Worker has been doing an Additional

Contact then they can check to see if the client has

a next Core Contact or Additional Contact

scheduled with the Plunket Nurse and get

confirmation from the client that the Scheduled

Contact is still OK. If no next contact has been

scheduled or it is not OK for the client then the

Health Worker should set up a tentative Scheduled

Contact. The Plunket Nurse will confirm.

Is a next

contact

required for

this service?

Is contact still

convenient?

Has a next

contact been

scheduled?

Establish tentative

time (subject to

confirmation) for

contact using

other SD staff‟s

diary.

Outputs A contact has been scheduled and the process “Set up

Scheduled Contact” triggered. Set Up Scheduled

Contact



Schedule Next ContactP

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lien

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lun

ket

Serv

ice

Del

iver

y St

aff

Core Contact

(Plunket Nurse)

Identify Follow-up

Actions and

update SDP

Additional Contact

(any SD staff)

Is a next

contact

required for

this service?

Has a next

contact been

scheduled?

Is contact still

convenient?

yes

yes

no

no Establish date and

time for contact

Establish tentative

time (subject to

confirmation) for

contact using

other SD staff‟s

diary.

Set Up Scheduled

Contact

no

End

Yes

noIs it a contact

for someone

else?

yes

v5

Note:


BR = Business Rule





12.4.10 Make Referrals or CYF Notifications

A Plunket Service Delivery Staff may decide that making a

Referral or a CYF Notification is an appropriate follow up action.

This process explains how Plunket sees this happening.

The system interoperability requirements are specified in Section

12.6.1 “Transfer of Care” on page 243.

-

1 Make

Referrals or

CYF

Notifications


system.

1

Make Referrals or CYF Notifications

Brief

Description

A Service Delivery Staff member decides to make a

Referral or CYF Notification.

Trigger A contact with the client and as above based on

professional judgement, Service Delivery Plan for

Client Event and involvement from client.

Identify Follow-up

Actions

Actors Caregiver


PlunketPlus

Clinical Leader

External agencies

Inputs Professional judgement, Service Delivery Plan for

Client Event and input from client.

What

Happens

PlunketPlus will include functionality to assist

Service Delivery Staff to generate a referral

quickly and easily. This will include context-

sensitive drop-down lists that include only items

relevant to the clinical context and the

geographic locality. For example, if making a

referral while in the nutrition screen, the drop-

down list will include only lactation consultant

and other relevant services, whether internal or

external, and only for the local geographic area.

The system will provide another drop-down list

to enable selection of the reason for referring.

There should be the ability to add notes as to

why the client is being referred if the drop down

list does not provide enough detail.

PlunketPlus will then provide onscreen a form

appropriate to the agency the client is being

referred to, pre-populated with all the relevant

details from the client‟s EHR. For example if it is

a CYF notification then a form acceptable to CYF

will be shown (see example in Appendix C).

If it is a Referral or Notification to an external

From a list SD

Staff selects

reasons as to why

they are making a

R/N and to whom

they are sending it

PlunketPlus

produces and

populates specific

R/N form with as

much data as

possible (dates,

address, NHI etc)



agency then approval must be obtained from

either the Case Manager Plunket Nurse or, in

the case of a CYF Notification, the Clinical

Leader. Workflow actions will be sent.

The Process “Outgoing Referral or CYF

Notification” is triggered to send the Referral or

CYF Notification to the correct recipient.

Workflow action

client sent to case

manager to

approve

Is referrer the

CMPN?

Is it a CYF

Notification?

Workflow action sent to

Clinical Leader for

approval and ownership

reasons with copy to

Clinical Advisor

Outputs The Process “Outgoing Referral or CYF Notification

is triggered

Outgoing Referral

or

CYF Notification



Make Referrals and CYF NotificationsC

linic

al

Le

ad

er

Plu

nke

tPlu

sC

lien

tP

lun

ke

t S

erv

ice

De

live

ry

Sta

ff

Core Contact

(Plunket Nurse)

Additional contact

(any SD staff)

Does one or more

R/N need to be

made?

From a list SD

Staff selects

reasons as to why

they are making a

R/N and to whom

they are sending it

yes

PlunketPlus

produces and

populates specific

R/N form with as

much data as

possible (dates,

address, NHI etc)

SD staff completes

form with additional

text (if needed)

Is it an internal

R/N?

Endno

Is it a CYF

Notification?

Outgoing Referral

or

CYF Notification

Is referrer the

CMPN?no yes

no

Workflow action

client sent to case

manager to

approve

no

Does case

manager

approve?

yes

Workflow action sent to

Clinical Leader for

approval and ownership

reasons with copy to

Clinical Advisor

yes

no

Is it a CYF

Notification?

no

yes Another R/N? no

Is it a referral?

no

yes

Plunket Nurse

discusses

Notification with

Clinical Leader

yes

v5

Note:





R/N = Referral or Notification

Schedule Next

Contact

Identify Follow-up

Actions and

update SDP

Plunket Nurse

only

yes



12.4.11 Advise Referral Outcome

Plunket may have had a referral from an outside agency or a

Plunket Nurse may have referred a client to a Health Worker.

This process describes how the feedback or the

acknowledgement is triggered.

-

1 Advise

Referral

Outcome


system.

1

Advise Referral Outcome

Brief

Description

When a contact has taken place as a result of an

incoming referral, whether from an external

organisation or another Plunket service, PlunketPlus

will send a feedback message to the referrer

advising the outcome of the contact.

Trigger A Plunket Service Delivery Staff member completes

a contact that resulted from a referral. Identify Follow-up

Actions

Actors Client


PlunketPlus

Outside organisation

Inputs Referral and Contact

What

Happens

A contact has resulted from an incoming

referral.

The Service Delivery Staff member may write a

summary of the referral outcome in the Client

Health Information and Action Taken data

entities during the contact. PlunketPlus will send

the summary to the referrer, along with relevant

Client Health Information (CHI) details, via

“Process Feedback”.

Example 1: A referral from an LMC results in a

child being enrolled at the first contact. In this

case the task that needs to happen is an

enrolment - no special forms or data. On

completion a note something like “Thank you for

referring Jimmy Smith and his family to Plunket.

He is now successfully enrolled with Plunket and

his Plunket nurse is Mary Jones.”. This will be

sent depending on the computer systems (or

not) of the midwife.

Example 2: Jimmy Smith (and his mother) have

been referred to a Plunket breastfeeding expert

by Anna, a Plunket Nurse. The Plunket Nurse

would have added the appropriate Client Health

Information and Actions Taken data into the

Is the contact

the result of a

referral?

The SDP for Client Event

will have guided the SD

staff through the contact.

The actions taken and

Health Information will

have been recorded in

PlunketPlus

The SD staff member may

write a summary of the

referral outcome in the


and Action Taken data

entities during the Contact.



client‟s EHR and raised a referral. When the

breastfeeding expert completes the ensuing

Additional Contact PlunketPlus generates the

necessary outgoing referral outcome

information.

Outputs Process feedback (Future) or (Interim) is triggered

and the referrer informed. Referral Feedback

(Automated)

Referral Feedback

(Manual)



Advise Referral OutcomeP

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erv

ice

De

live

ry S

taff

Core Contact (Plunket

Nurse)

Identify Follow-up

Actions and update

SDP

Additional Contact

(any SD staff)

Is the contact

the result of a

referral?

End

no

yes

The SDP for Client Event

will have guided the SD

staff through the contact.

The actions taken and

Health Information will

have been recorded in

PlunketPlus

The SD staff member may

write a summary of the

referral outcome in the


and Action Taken data

entities during the Contact.




Note:


BR = Business Rule

yesIs it an Internal

referral?

Does the

referrer have

interoperability

with

PlunketPlus?

Referral Feedback

(Automated)

Referral Feedback

(Manual)



12.4.12 Make Recommendations

A Service Delivery Staff member may decide that a verbal

prompt may be enough of a follow up. For example “It‟s time

you signed up for a kindergarten”. This process explains how

Plunket sees this happening.

-

1 Make

Recommend

-ations


system.

1

Make Recommendations

Brief

Description

A Service Delivery Staff member makes

recommendations

Trigger A Service Delivery Staff member in partnership with

the caregiver or client decides to verbally recommend

certain course(s) of action.

Identify Follow-up

Actions and update

SDP

Actors Service Delivery Staff

Caregivers

Clients

PlunketPlus

Inputs Professional judgement of Service Delivery Staff

Service Delivery Plan for Client Event

Information from client and caregiver

What

Happens

During a contact, Service Delivery Staff in

partnership with the caregiver or client decides to

verbally recommend certain course(s) of action.

The advice given depends on the Service Delivery

Plan for Client Event, the age of the client and the

professional judgement of the Service Delivery

Staff.

Outputs The recommendations and the reason for making

them are recorded in PlunketPlus.



Make RecommendationsP

lun

ke

tPlu

sC

lien

tP

lun

ke

t S

erv

ice

De

live

ry S

taff

Core Contact (Plunket

Nurse)

Identify Follow-up

Actions and update

SDP

Additional contact (any

SD staff)

The recommendations and the reason for

making the recommendations are recorded in

PlunketPlus

end

v5

Note:


BR = Business Rule



A service delivery staff in partnership with the

caregiver or client decides to verbally

recommend certain course(s) of action.



12.4.13 Action Referral

This process explains how Plunket sees external providers

reporting back after Plunket has made a referral to them.



-

1 Action

Referral


system.

1

Action Referral

Brief

Description

An external provider advises Plunket their feedback

on the outcome of the action they have taken in

response to the referral from Plunket.

Trigger External provider receives from Plunket an outgoing

Referral or CYF Notification.

Outgoing Referral

or

CYF Notification

Actors External provider

Client


What

Happens

The external provider receives a referral or CYF

Notification from Plunket.

The external provider actions the referral.

The external provider provides Plunket with

their feedback on the outcome of the action they

have taken in response to the referral from

Plunket.

If both Plunket and the External Provider are

equipped for electronic interoperability, then the

feedback will come that way.

If the external provider does not have

interoperability with Plunket they will need to

provide manual feedback within the timeframe

set in the PlunketPlus workflow system. If this

does not happen, then PlunketPlus will raise a

System Alert for the person who made the

referral.

The external

provider receives

the referral

Is there

interoperability

between external

provider and

Plunket?

Is there

interoperability

between external

provider and Plunket?

Outputs The feedback (a report or acknowledgement) is

received by Plunket. Referral Feedback

(Manual)

Referral Feedback

(Automated)



Action Referral

Exte

rna

l

Pro

vid

er

Plu

nke

tPlu

s

Plu

nke

t

Se

rvic

e

De

live

ry

Sta

ff

Outgoing Referral

or

CYF Notification

The external

provider receives

the referral

Is there

interoperability

between external

provider and

Plunket?

yes

System Alert

v5

SD staff follow up

Note:


BR = Business Rule



End yes

Are all

necessary

communication

s complete?

Referral Feedback

(Automated)

Referral Feedback

(Manual)

no

no



12.4.14 Other Non-Contact Action

This process describes how a Plunket Staff member takes some

action relating to a client, that is not covered by other

processes.

-

1 Other Non-

contact

Action


system.

1

Other Non-Contact Action

Brief

Description

A Plunket Staff member takes some action relating to a

client that is not covered by other processes.

Trigger An Incoming Communication

A follow-up from a contact

Or something else.

Incoming

Communication

Identify Follow-up

Actions and

update SDP

Actors A Plunket Staff member.

Inputs The trigger, or other inputs.

What

Happens

A Plunket Staff member takes some action relating to a

client, that is not covered by other processes.

These actions may include

Raising a Clinical Alert due to an Incoming

Communication or as a result of a contact

Discontinuing a client in one or more Services due to

an Incoming Communication or as a result of a

contact

Raise Clinical

Alert

Discontinuation

Outputs Some other action takes place that is recorded, for

example:

Corrections or updates to the client‟s EHR.

An attachment is made to the client‟s EHR such as an

email or a document.



Other non-contact ActionP

lun

ke

tPlu

sA

rea

Ad

min

istr

ato

r

Plu

nke

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erv

ice

De

live

ry

Sta

ff

An action is

required that is not

defined by other

processes

v5

Note:


BR = Business Rule



Identify Follow-up

Actions and

update SDP

Incoming

Communication

Raise Clinical

Alert

Discontinuation



12.4.15 Outgoing Referral or CYF Notification

This process explains how PlunketPlus will route Referrals and

CYF Notifications.



-

1 Outgoing

Referral or

CYF

Notification


system.

1

Outgoing Referral or CYF Notification

Brief

Description

The Outgoing Referral or CYF Notification is routed to

the correct place using the communications method

appropriate to the particular external provider for

external Referrals and an electronic Referral for

internal Referrals.

Trigger A Plunket Service Delivery Staff member makes

Referral or CYF Notification. Make Referrals or

CYF Notification

Actors PlunketPlus

Inputs The Outgoing Referral or CYF Notification

What

Happens

The Referral or CYF Notification is made.

PlunketPlus will then decide how to send the

Referral or CYF Notification depending on the

preferred means of communication details in the

PerOrg record for the third party.

CYF Notifications will be sent to CYF using the RSD

standard.

Internal Referrals will be sent electronically from

PlunketPlus to itself.

Send R/N by best

method -

interoperability by

preference

Outputs One of:

Electronic referral, using the RSD standard.

Email.

Fax.

Letter.

Incoming Referral

(Electronic)

Action Referral



Outgoing Referral or CYF Notification

Exte

rna

l

Pro

vid

er

Plu

nke

tPlu

s

Plu

nke

t

Se

rvic

e

De

live

ry

Sta

ff Make Referrals or

CYF Notification

Is it an internal

Outgoing

Referral?

Incoming Referral

(Electronic)

Action Referral

v5

Note:


CYF = Child, Youth and Family



R/N = Referral or Notification

noyes

Send R/N by best

method -

interoperability by

preference



12.4.16 Case Manager Plunket Nurse Responds to a Clinical Alert

After a Clinical Alert has been raised by PlunketPlus the Case

Manager Plunket Nurse needs to respond. This process explains

how.

-

1 Plunket

Nurse

Responds to

Clinical Alert


system.

1

Case Manager Plunket Nurse Responds to

Clinical Alert

Brief

Description

The Case Manager Plunket Nurse responds to the Clinical

Alert.

Trigger A Clinical Alert has been raised. Raise Clinical

Alert

Actors PlunketPlus

Case Manager Plunket Nurse

Client


What

Happens

The Case Manager Plunket Nurse receives notification

of a Clinical Alert for action. This will be in relation to

a particular client assigned to that Case Manager

Plunket Nurse.

PlunketPlus adds this Clinical Alert to the Message

Board for the Case Manager Plunket Nurse.

The Case Manager Plunket Nurse responds to the

Clinical Alert in an appropriate way. It may be by

scheduling a contact leading to a Scheduled Contact,

a phone call, or an Unscheduled Contact.

If the contact is scheduled but does not happen then

the Clinical Alert needs to be added back into the

Message Board.

If the contact did take place but the Clinical Alert was

not resolved then the Clinical Alert needs to be added

back into the Message Board and the attempt to

resolve recorded in the Action Taken data entity in

the client‟s EHR.

The workflow system will hold a rule for the

maximum number of attempts to resolve the Clinical

Alert. Any breach of this rule will raise a workflow

escalation to the Clinical Leader.

Clinical Alert for

Client added to

CMPN‟s Message

Board

Does the

CMPN plan a

contact

Additional Contact

(Plunket Nurse

face to face or

telephone)

Core Contact

(Plunket Nurse)

Clinical Alert

removed from

Message Board

Schedule Contact

by Plunket Nurse

(esp rural areas)

Contact added to

scheduled

contacts and alert

removed from

Message Board



Is Clinical Alert

Resolved?

Has maximum

number of

attempts been

made?

System Alert sent

to Clinical Leader

with details

Outputs The Alert is acted upon.



Case Manager Plunket Nurse Responds to Clinical Alert

Clin

ica

l

Le

ad

er

Plu

nke

tPlu

sC

ase

Ma

na

ge

r P

lun

ke

t N

urs

e

Clinical Alert for

Client added to

CMPN‟s Message

Board

Does contact

take place?

Attempt to resolve

is recorded

Contact added to

scheduled

contacts and alert

removed from

Message Board

End

Schedule Contact

by Plunket Nurse

(esp rural areas)

Core Contact

(Plunket Nurse)

Additional Contact

(Plunket Nurse

face to face or

telephone)

Does the

CMPN plan a

contact

Additional

contact?

Yes

Is Clinical Alert

Resolved?

no

no

yes

no

no

yes

yes

Clinical Alert

removed from

Message Board

Raise Clinical

Alert

no

Has maximum

number of

attempts been

made?

System Alert sent

to Clinical Leader

with details

yes

V5

Note:


BR = Business Rule






12.4.17 Case Manager Plunket Nurse Responds to Request for Client Information

From time-to-time a Plunket will receive a request from an

organisation or an individual for information about a client.

These are the responsibility of the Case Manager Plunket Nurse

for the client. This process explains the process for the Case

Manager Plunket Nurse to follow.

-

1 Plunket

Nurse

Responds to

Request for

Client

Information


system.

1

Case Manager Plunket Nurse

Responds to Request for Client

Information

Brief

Description

A Case Manager Plunket Nurse receives a request

for client information and takes appropriate

action.

Trigger An Incoming Communication requesting client

information. Incoming

Communication

Actors Area Management and Area Administrators.


Inputs The trigger and data from PlunketPlus.

What

Happens

The request is forwarded to the Case Manager

Plunket Nurse for the particular client.

The Case Manager Plunket Nurse prepares the

response, using information from the client‟s

EHR and advice from the Clinical Leader.

If the request is from CYF, or has legal

implications, the Case Manager Plunket Nurse

forwards the draft response to the Clinical

Leader for approval. The Clinical Leader

approves the response, and after any

necessary discussion and changes, sends it to

the requestor and enters the appropriate data

into the client‟s EHR.

If the request is not from CYF and there are

no legal implications, the Case Manager

Plunket Nurse sends the response to the

requestor and enters the appropriate data

into the client‟s EHR.

In the absence of the Case Manager Plunket

Nurse, the Clinical Leader is responsible for

completing the response in the required

IS CMPN

available?

Case Manager

Plunket Nurse

prepares response

Does request

need approval?

If the request is from CYF, or

has legal implications, the

CMPN forwards the draft

response to the Clinical

Leader for approval.

The Clinical Leader approves

the response, after any

necessary discussion and

changes, sends it to the

requestor and enters the

appropriate data into the

Client's EHR.



timeframe. In the absence of the CMPN,

the Clinical Leader is

responsible for completing the

response in the required

timeframe.

Outputs Response to the requestor, with a copy recorded

in PlunketPlus against the client‟s EHR. Response to the

requestor, with a copy

recorded in

PlunketPlus against the

Client's EHR



Case Manager Plunket Nurse Responds to Request for Client Information

Are

a

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linic

al L

ea

de

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lun

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tPlu

sC

ase

Ma

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ge

r P

lun

ke

t

Nu

rse

A request for

Client information

is received and

addressed to the

Plunket Nurse

The Clinical Leader approves

the response, after any

necessary discussion and

changes, sends it to the

requestor and enters the

appropriate data into the

Client's EHR.

IS CMPN

available?

Case Manager

Plunket Nurse

prepares response

If the request is from CYF, or

has legal implications, the

CMPN forwards the draft

response to the Clinical

Leader for approval.

In the absence of the CMPN,

the Clinical Leader is

responsible for completing the

response in the required

timeframe.

Does request

need approval?

Response to the

requestor, with a copy

recorded in

PlunketPlus against the

Client's EHR

Incoming

Communication

v5

Note:


BR = Business Rule




A request for

Client Information

is received by the

Area Office

Area Administrator

forwards request

to CMPN

PlunketPlus forwards

request to Clinical

Leader

no

yes



12.4.18 Case Manager Plunket Nurse Updates EHR

A Case Manager Plunket Nurse is prompted to add clinical

information to a client‟s EHR. This process explains how the

EHR is updated.

-

1 Case Manager

Plunket Nurse

Updates EHR


system.

1

Case Manager Plunket Nurse Updates

EHR

Brief

Description

A Case Manager Plunket Nurse receives some

clinical information and updates the relevant client‟s

EHR.

Trigger Incoming Communication. Incoming

Communication

Actors PlunketPlus.



What

Happens

A Case Manager Plunket Nurse receives clinical

information from any internal or external source,

that needs to be added to a client‟s EHR.

This may have been sent directly to the Case

Manager Plunket Nurse, or it may have been

sent to the Area Office and an Area

Administrator has scanned and forwarded it.

Examples of clinical information received

include:

An email from a client.

A visit summary from the client‟s GP.

A letter from a dentist to say he has

examined a child‟s teeth.

Incoming referral feedback from an external

provider or other Plunket service is handled in

the process “Referral Feedback”.

The Case Manager Plunket Nurse will attach the

email or other correspondence to the client

record and may add some notes to the EHR for

interpretation as well.

The Case Manager Plunket Nurse may identify

that further action is required and will follow the

appropriate process.

Area Administrator

scans and / or

forwards

communication

A Case Manager

Plunket Nurse

receives clinical

information from any

internal or external

source, that needs to

be added to a Client's

EHR.

The Case Manager

Plunket Nurse will

attach the email or

other correspondence

to the client record

and may add some

notes to the EHR for


Outputs The client‟s EHR has been updated.

Further action(s).



Case Manager Plunket Nurse Updates EHR

Are

a

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istr

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lun

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tPlu

sC

ase

Ma

na

ge

r

Plu

nke

t N

urs

e A Case Manager

Plunket Nurse

receives clinical

information from any

internal or external

source, that needs to

be added to a Client's

EHR.

The Case Manager

Plunket Nurse will

attach the email or

other correspondence

to the client record

and may add some

notes to the EHR for


v5

End



Note:


BR = Business Rule

Incoming

Communication

Area Administrator

scans and / or

forwards

communication



12.4.19 Referral Feedback

Plunket receives feedback from an external provider or a Plunket

service with details of the outcome of their action in response to

a referral from Plunket.

Although such feedback will be automated as much as possible

in the future, all referral feedback will be handled manually in

the interim.

Even when this process becomes automated, there will always

be some referral feedback that will be handled manually.

This section is set out under two headings:

Referral Feedback – Manual.

Referral Feedback – Automated.

-

1 Referral

Feedback

- Manual


system.

1

Referral Feedback – Manual

Brief

Description

Referral feedback from an external provider or any

Plunket service is forwarded to the Case Manager

Plunket Nurse, who assesses the information, decides

whether any actions need to occur and inputs the

information to the client‟s EHR.

Trigger The feedback from completion of a contact that

arose from an internal referral.

The feedback from an external provider who has

completed a Plunket-initiated referral or CYF

Notification.

Advise referral

outcome

Action Referral

Actors PlunketPlus.


Area Administrator.


What

Happens

The referral feedback is received by the Case

Manager Plunket Nurse:

Emailed from an Area Administrator, who has

scanned it if necessary.

Directly by email or on paper.

The Case Manager Plunket Nurse assesses the

referral feedback.

The Case Manager Plunket Nurse initiates any

necessary actions.

The Case Manager Plunket Nurse adds the

The referral feedback

is received by the

Case Manager

Plunket Nurse

The Case Manager

Plunket Nurse adds /

attaches the

necessary data to the

Client's EHR.

Do any

documents

need

scanning?



necessary data to the client‟s EHR.

The Case Manager Plunket Nurse attaches any

electronic referral feedback document to the

client‟s EHR.

The Case Manager Plunket Nurse will send any

paper referral feedback to the Area Office for the

Area Administrator to scan and add to the client‟s

EHR.

CMPN assesses the

referral feedback and

adds notes as

necessary

Does feedback

need acting

upon?

Raise Clinical

Alert

Plunket Nurse

responds to

Clinical Alert

Outputs Any necessary actions are initiated.

Data from the referral feedback is added to the

client‟s EHR.

The incoming referral feedback document is added

to the client‟s EHR.



Referral Feedback (Manual)

Se

rvic

e

De

live

ry

Sta

ff

Are

a

Ad

min

istr

ato

r

Ca

se

Ma

na

ge

r

Plu

nke

t N

urs

e

Exte

rna

l

Pro

vid

er

Plu

nke

tPlu

s

Action Referral

Does feedback

need acting

upon?

yes

Raise Clinical

Alert

The referral feedback

is received by the

Case Manager

Plunket Nurse

Plunket Nurse

responds to

Clinical Alert

v5




Note:



CMPN assesses the

referral feedback and

adds notes as

necessary

The Case Manager

Plunket Nurse adds /

attaches the

necessary data to the

Client's EHR.no

Do any

documents

need

scanning?

Scans and

attaches

document to

Client‟s EHR

yes

Endno

Advise referral

outcome



2 Referral

Feedback

- Automated


system.

1

Referral Feedback - Automated

Brief

Description

Electronic referral feedback from an external

provider or any Plunket service is received by

PlunketPlus, then automatically associated with the

relevant client‟s EHR. A System Alert is sent to the

relevant Case Manager Plunket Nurse, who assesses

the information, decides whether any actions need

to occur and authorises the addition of the incoming

referral feedback to the client‟s EHR.

Trigger Electronic feedback from completion of a contact

that arose from an internal referral.

Electronic feedback from an external provider

who has completed a Plunket-initiated referral

or CYF Notification.

Advise Referral

Outcome

Action referral or

Discharge

Actors PlunketPlus.


PlunketPlus Administrator.


What

Happens

The Case Manager Plunket Nurse receives a

System Alert advising that the referral feedback

has arrived and needs to be processed.

The System Alert may be clicked if the Case

Manager Plunket Nurse is able to process the

referral feedback straight away.

Or, the Case Manager Plunket Nurse clicks the

relevant item on the message board when

convenient.

PlunketPlus brings up the client‟s summary EHR

and the human-readable information from the

referral feedback.

The Case Manager Plunket Nurse assesses the

referral feedback.

The Case Manager Plunket Nurse initiates any

necessary actions.

The Case Manager Plunket Nurse adds any

necessary notes to the client‟s EHR.

The Case Manager Plunket Nurse authorises

PlunketPlus to import into the client‟s EHR the

data fields and human-readable information

from the referral feedback.

PlunketPlus receives

feedback and generates a

System Alert for the Case

Manager Plunket Nurse

The Case Manager

Plunket Nurse authorises

PlunketPlus to import into

the Client's EHR the data

fields and human-readable

information from the

referral feedback.

CMPN assesses the

referral feedback and adds

notes as necessary

Does feedback

need acting

upon?

Raise Alert

Outputs Any necessary actions are initiated.

Any Case Manager Plunket Nurse notes are



added to the client‟s EHR.

Data and the human-readable information from

the referral feedback are added to the client‟s

EHR.



Referral Feedback (Automated)

Se

rvic

e

De

live

ry

Sta

ff

Ca

se

Ma

na

ge

r

Plu

nke

t N

urs

e

Exte

rna

l

Pro

vid

er

Plu

nke

tPlu

s

Action Referral

Advise Referral

Outcome

PlunketPlus receives

feedback and generates a

System Alert for the Case

Manager Plunket Nurse

The Case Manager

Plunket Nurse authorises

PlunketPlus to import into

the Client's EHR the data

fields and human-readable

information from the

referral feedback.

no

Raise Alertyes

Does feedback

need acting

upon?

Plunket Nurse

Responds to alertEnd

v5

Note:


BR = Business Rule




CMPN assesses the

referral feedback and adds

notes as necessary



12.4.20 Raise Clinical Alert

PlunketPlus alerts the Case Manager Plunket Nurse to take

action relating to a particular client. This process explains how

Plunket see this happening.

-

1 Raise

Clinical Alert


system.

1


Brief

Description

A Clinical Alert is raised when a Plunket Staff member

to PlunketPlus identifies a situation that requires

priority action by a Plunket Nurse, eg child protection

issues.

Trigger A Clinical Alert may have been generated by:

Any Plunket Staff processing an Incoming

Communication.

A Service Delivery Staff member processing

another Non-Contact Action following a contact.

A Case Manager Plunket Nurse processing a

Referral Feedback.

Or PlunketPlus identifying an un-actioned Clinical

Alert.

Incoming Referral

(Manual)

Referral Feedback

(Manual)

Other non-contact

Action

Incoming

Communication

Referral Feedback

(Automated)

Incoming Referral

(Electronic)

Actors PlunketPlus.

Inputs Same as triggers.

What

Happens

PlunketPlus displays:

A prominent icon on every PlunketPlus screen that

the Case Manager Plunket Nurse views.

All Clinical Alerts for a Case Manager Plunket

Nurse, on their message board, prominently

highlighted.

PlunketPlus provides facilities for the Case Manager

Plunket Nurse to click the Clinical Alert on the

message board, which will result in PlunketPlus

displaying the details of the Clinical Alert and any

relevant client‟s EHR details.

Each Clinical Alert will remain on the message board

until it is resolved in the process “Case Manager

Plunket Nurse Responds to Clinical Alert”, which is

also where any necessary escalation occurs.

PlunketPlus helps

CMPN by providing

links to the Client‟s

EHR and other

information

PlunketPlus makes

CMPN aware, in

several ways, that a

Clinical Alert has been

raised



Outputs The message board for the Case Manager Plunket

Nurse, kept up to date with all un-actioned Clinical

Alerts.

Plunket Nurse

responds to

Clinical Alert




Ca

se

Ma

na

ge

r

Plu

nke

t N

urs

e

Are

a

Ad

min

istr

ato

rP

lun

ke

tPlu

s

Referral Feedback

(Automated)

Referral Feedback

(Manual)

Plunket Nurse

responds to

Clinical Alert

v5

Note:


BR = Business Rule




Incoming

Communication

PlunketPlus helps

CMPN by providing

links to the Client‟s

EHR and other

information

Other non-contact

Action

PlunketPlus makes

CMPN aware, in

several ways, that a

Clinical Alert has been

raised

Incoming Referral

(Manual)

Incoming Referral

(Electronic)



12.4.21 Reminders to Clients

Sending reminders to clients about Scheduled Contact times is a

very important part of PlunketPlus. This process describes how

the reminders will be sent and responses processed.

-

1 Reminders

to Clients


system.

1

Reminders to Clients

Brief

Description

PlunketPlus sends reminders of upcoming Scheduled

Contacts to clients and processes their responses.

Service Delivery Staff will know of the upcoming contact

from their diary, so do not need to be sent a reminder.

Trigger Date of a Scheduled Contact.

The reminder period chosen by the client and

recorded in their EHR.

PlunketPlus

detects a reminder

needs to be sent

Actors PlunketPlus.

Client.

Area Administrator.

Inputs Same as triggers.

What

Happens

A reminder becomes due for sending to a client. This

is based on:

The date of the Scheduled Contact for which the

reminder was set up.

The reminder period chosen by the client. This

should have been determined by Service Delivery

Staff during the first contact or subsequently. In

the absence of a client-set value, the default is

three business days.

The client may choose two reminder periods for

example one week then one day before for

electronic reminders. It would be impractical to

send a letter reminder one day before.

PlunketPlus generates and sends the reminder to the

client. The reminder format and method of sending

will depend on the details chosen by the client and

recorded in their EHR. It will be one or more of:

Microsoft Outlook reminder.

Email.

Txt message.

Phone call.

Letter.

Fax.

The necessary contact details are obtained from the

PlunketPlus

generates and

sends the

reminder by the

Client‟s preferred

method

Does client

respond?

Is it a positive

response?

Response statue

= null

Response status =

positive

Appointment

Cancelled. Alert

sent to SD staff

and admin

Is response

Electronic?

Does client

require 2nd

reminder?



client‟s EHR. If any are missing and a meaningful

reminder cannot be sent to a client, then the default

will be a phone call.

A phone call or letter reminder to a client will be

achieved by:

PlunketPlus sends a workflow action to the local

Area Administrator role.

An Area Administrator makes the phone call to

remind the client of the upcoming contact, or

prints and posts the letter.

A fax would be automatically generated and sent

electronically by PlunketPlus.

If the client responds electronically in a way that

PlunketPlus can interpret in the affirmative, it will

record this against the Scheduled Contact.

If the client responds electronically in a way that

PlunketPlus can interpret in the negative (any

response that is not affirmative is assumed to be

negative), PlunketPlus will:

Cancel the contact.

Delete any associated pending reminders for

Service Delivery Staff.

Send a workflow action to the local Area

Administrator role to undertake another “Schedule

Contact by Area Administrator” process.

Make an entry in the client‟s EHR that all this has

happened.

An Area Administrator will manually process any client

responses to the reminder as an “Incoming

Communication” when PlunketPlus cannot process it

automatically. For example:

a free-form email

a phone call or voice message

an electronic response that contains errors, which

should result in a System Alert raised

automatically by PlunketPlus.

If the client does not respond to the reminder, it is

assumed the contact will go ahead as scheduled.

An Area Administrator will process any workflow

action where the client has responded in the negative,

and undertake the “Schedule Contact by Area

Administrator” process.

At any time the Service Delivery Staff member will be

able to see in their diary the status of reminders to

clients and any client responses.

Note that the diary entry will also indicate whether

there are any hazard alerts pertaining to the client or

the address (eg dogs on the property or concerns

about family violence). Service Delivery Staff will be

able to click to view these.

Client record

available in

calendar of SD

staff



Reminders must not be sent to any discontinued

client. Although the Discontinue Client processes

should have removed all Scheduled Contacts,

reminders and Clinical Alerts for that client,

nonetheless the Reminder process should check the

client‟s status to ensure that the client is not

discontinued before proceeding.

PlunketPlus must send reminders to clients only

during socially acceptable hours, which the

PlunketPlus Administrator should set system-wide. By

default these hours should be 08:00 to 20:00 for

weekends and public holidays, and 07:00 to 20:00 on

other days.

Outputs A reminder is sent to the client about their upcoming

Scheduled Contact, with a copy to the Clinical Leader if

the client is tagged accordingly.

A Scheduled Contact is:

Updated with a confirmation from the client, or

Cancelled and an Area Administrator advised to

reschedule it.

Prepare for

Contact

Schedule Contact

by Area

Administrator

(preferred)



Reminders to ClientsA

du

lt C

lien

tA

rea

Ad

min

istr

ato

rP

lun

ke

tPlu

s

PlunketPlus

detects a reminder

needs to be sent

Does client

require 2nd

reminder?

PlunketPlus

generates and

sends the

reminder by the


method

PlunketPlus

detects a 2nd

reminder needs to

be sent

yes

Does client

respond?no

Is it a positive

response?

Response status =

positive

yes

Response statue

= null

yes

Appointment

Cancelled. System

Alert sent to SD

staff.

no

yes

Does client

respond?

Is it a positive

response?

Response statue

= positive

Response status =

null

no

yes

no

Client record

available in diary

of SD staff

Prepare for

Contact

no

v6

Note:


BR = Business Rule



PlunketPlus

generates and

sends the

reminder by the


method

Schedule Contact

by Area

Administrator

(preferred)



12.4.22 Set Up Scheduled Contact

This process explains how Scheduled Contacts will be set up in

the PlunketPlus diary for Service Delivery Staff and Clients.

-

1 Set Up

Scheduled

Contact


system.

1

Set Up Scheduled Contact

Brief

Description

PlunketPlus sets up a Scheduled Contact in the

diary of the Service Delivery Staff member and

sends a Scheduled Contact message to the client.

Trigger The processes:

Schedule Contact by Service Delivery Staff.

Schedule Contact by Area Administrator.

Schedule next Contact.

Schedule Contact

by Area

Administrator

(preferred)

Schedule Contact

by Service

Delivery Staff

Schedule Next

Contact

Actors PlunketPlus.

Inputs The diary for the Service Delivery Staff member.

Details of the new Scheduled Contact.

What

Happens

PlunketPlus sets up each Scheduled Contact in

the diary for the relevant Service Delivery Staff

member.

While setting up the contact in one of the

“Schedule Contact” processes, PlunketPlus will

support the process with the normal electronic

diary functions such as displaying free time. This

functionality will most probably be provided to

PlunketPlus by Microsoft Outlook.

Once the contact is set up in the diary for the

Service Delivery Staff member, the system will

automatically generate a Scheduled Contact

message and send it to the client using the

communication details and preferences from the

client‟s EHR.

If the contact has been set up by a person

other than the Service Delivery Staff member

attending the contact, then the status of the

contact in the diary will be:

“Confirmed” if the person setting it up has

the delegated right to set up confirmed

contacts for that Service Delivery Staff

member.

Was Contact

scheduled by SD staff

delivering contact?

Was Contact

scheduled by a

person with delegated

rights?

PlunketPlus create

workflow action for

SD staff on

Message Board to

confirm

SD staff

confirms?

Confirmation message

sent to Client by

preferred means



“Tentative” if the person does not.

If the Service Delivery Staff member does not

want the Scheduled Contact then she must

reschedule herself. PlunketPlus will generate a

workflow action for the service Delivery staff

member on their Message Board.

Message sent to

client saying

someone will be in

touch to arrange

new contact.

Workflow action

generated for SD

staff to reschedule

Contact

Outputs Scheduled Contact advice to client.

A confirmed or tentative contact in the diary for the


Send Reminders



Set Up Scheduled Contact

Plu

nke

t S

erv

ice

De

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taff

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a

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Schedule Contact

by Area

Administrator

(preferred)

Schedule Contact

by Service

Delivery Staff

Schedule Next

Contact

Was Contact

scheduled by SD staff

delivering contact?

yes

Was Contact

scheduled by a

person with delegated

rights?

no

yes

SD staff

confirms?

Workflow action

generated for SD

staff to confirm

no

yes

Confirmation message

sent to Client by

preferred means

Send Reminders

Message sent to

client saying

someone will be in

touch to arrange

new contact.



Note:


BR = Business Rule

Workflow action

generated for SD

staff to reschedule

Contact

no



12.4.23 Update Records

This process explains how an Area Administrator receives some

information and updates a client‟s EHR.

-

1 Update

Records


system.

1

Update Records

Brief

Description

An Area Administrator receives some information

and updates a client‟s EHR.

Trigger Incoming Communication. Incoming

Communication

Actors PlunketPlus.

Area Administrator.

Inputs Incoming information.

The client‟s EHR.

What

Happens

An item of information relating to a client

arrives in the Area Office on paper, by phone,

fax or email.

If it is a referral response describing the

outcome of a Plunket-generated referral, or if

it contains any clinical information, an Area

Administrator will:

scan any non-electronic information

attach all the electronic information to the

client‟s EHR

manually input a synopsis of any

telephone or in-person conversation

and PlunketPlus generates a System Alert

to the relevant Case Manager Plunket

Nurse.

The resulting human-readable information is

visible to any Plunket Staff viewing the

client‟s EHR, but not formally accepted into

the EHR until the Case Manager Plunket

Nurse has completed the “Referral Feedback”

process.

In all other cases the Area Administrator:

updates the relevant details in the client‟s

EHR, and

PlunketPlus generates a System Alert to

the relevant Case Manager Plunket Nurse.

Is it a referral

response or

contains Clinical

data?

Area Administrator

may add data in

various formats to the

Client‟s EHR subject

to acceptance by

CMPN

PlunketPlus generates

a System Alert to the

relevant Case

Manager Plunket

Nurse.

Case Manager

Plunket Nurse

completes “Referral

Feedback” process

and accepts the

addition to the EHR

The Area

Administrator updates

the relevant details in

the Client's EHR



relevant Case

Manager Plunket

Nurse.



Outputs A client‟s EHR has been updated and a System

Alert raised for the Case Manager Plunket Nurse.

Case Manager

Plunket Nurse

reviews changes



Update RecordsA

rea

Ad

min

istr

ato

rP

lun

ke

tPlu

sC

ase

Ma

na

ge

r

Plu

nke

t N

urs

e

The Area

Administrator updates

the relevant details in

the Client's EHR

no

Case Manager

Plunket Nurse

reviews changes



relevant Case

Manager Plunket

Nurse.

v5

Note:


BR = Business Rule




Is it a referral

response or

contains Clinical

data?

Incoming

Communication

Area Administrator

may add data in

various formats to the

Client‟s EHR subject

to acceptance by

CMPN



relevant Case

Manager Plunket

Nurse.

Case Manager

Plunket Nurse

completes “Referral

Feedback” process

and accepts the

addition to the EHR

yes



12.4.24 Connecting Client to Other Plunket Services

At any contact, a Service Delivery Staff member informs the

clients about other relevant Plunket services, records the client‟s

response and arranges services as appropriate.

This process is not on the main To Be Process Flowchart as it is

part of other processes.

-

1 Connecting

Client to

Other

Plunket

Services


system.

1

Connecting Client to Other Plunket

Services

Brief

Description

A client expresses an interest in receiving services

other than Well Child Tamariki Ora.

Trigger One of:

Any client contact.

An Incoming Communication.

A self Referral via the Plunket website

Any Contact (Core

or Additional)

Incoming

Communication

Incoming Referral

or Notification

(Electronic)

Actors PlunketPlus.

Client.

Plunket Staff.

Inputs Discussion between Plunket Staff and the client.

What

Happens

When ringing a client to schedule the first

contact, the Plunket Staff member may discuss

the range of Plunket services available that

could offer support.

During a contact, Service Delivery Staff will

discuss with the client the range of Plunket

services available that could offer support.

An Incoming Communication might include an

enquiry about Plunket services or a request for a

particular Plunket service.

A client may use a Plunket website facility to

make contact about a service; this will be

handled as another type of Incoming

Communication.

The Plunket Staff member must record in the

client‟s EHR the services discussed.

If the client expresses interest in any of the

services, the Plunket Staff member will:

Inform the client that some of their

Discuss other

services with Adult

Client during

phone call

Discuss other

services with Adult

Client at contact

Client expresses

interest via

website

The Plunket Staff

member must record

in the Client's EHR the

services discussed.



information will be shared with those

services.

Record in the client‟s EHR each of the

services the client wishes to receive.

For every service where the client has expressed

an interest, PlunketPlus will place an entry on

the message board for the role responsible for

that service in the local area.

When convenient, a service coordinator (who is

a Plunket Volunteer) will view the message

board for their service and ring each of the

clients.

Depending on what each client decides to do,

the service coordinator may:

Provide information.

Enrol the client for the service.

Undertake the “Schedule Contact” process

for the upcoming service, whether individual

or group.

Inform Client of the need

to share data with other

service and record in EHR

the services the Client

wishes to receive

PlunketPlus puts entry on

message board for the

role responsible for the

service in the local area.

Service

coordinator rings

each of the

Clients.

Outputs A client receives information on the services

they ask about.

A contact is scheduled.

Service

coordinator make

appropriate

response



Connecting Other Plunket Services

Are

a

Ad

min

istr

ato

rP

lun

ke

tPlu

sP

lun

ke

t S

erv

ice

De

live

ry

Sta

ff

Note:


BR = Business Rule

Any Contact (Core

or Additional)

Client expresses

interest via

website


SD staff = Service Delivery Staffv5

Discuss other

services with Adult

Client at contact

Incoming Referral

or Notification

(Electronic)

Incoming

Communication

Discuss other

services with Adult

Client during

phone call

The Plunket Staff

member must record

in the Client's EHR the

services discussed.





wishes to receive

Does the Client

express

interest in any

Service?

PlunketPlus puts entry on

message board for the

role responsible for the

Service in the local area.

End





wishes to receive

Service

coordinator rings

each of the

Clients.

no

yes

Service

coordinator make

appropriate

response



12.4.25 Unplanned Service Delivery Staff Absence

When Service Delivery Staff are unexpectedly away, for example

unwell, their Scheduled Contacts need to be rescheduled.

This process is not on the main To Be Process Flowchart as it

may occur at any time.

-

1 Unplanned

Service

Delivery

Staff

Absence


system.

1

Unplanned Service Delivery Staff

Absence

Brief

Description

A Service Delivery Staff member is unexpectedly

not available due to illness or unplanned leave. All

Scheduled Contacts and any items on their message

board due for action all need to be reassigned or

rescheduled.

Trigger A Service Delivery Staff member is not available and advises their Area management

or Administrators.

Area Office finds out a service Delivery Staff member is not available.

A Service Delivery

staff is sick /

unavailable

Area Office finds

out SD staff is

unavailable

Actors PlunketPlus


Area Management and Administration

Client


What

Happens

Any Service Delivery Staff member who is

sick or otherwise unexpectedly unavailable will inform their manager or an Area

Administrator.

Or the Area Office can become aware that a Service Delivery Staff member is

unexpectedly absent.

The person‟s Manager will decide the

approach, which could be any combination of:

Reassign some or all of the Scheduled Contacts and actions to another available Service Delivery Staff member.

Reschedule some or all of the Scheduled Contacts and actions to another date and

SD staff calls /

sends message to

administration

Are there any

scheduled Contacts

that need

rescheduling?

Manager decides on

approach depending

on staffing /geography



time.

The manager will either:

Reassign and reschedule, or

Ask an Area Administrator to do this.

The manager may

delegate to an

administrator or

reschedule or reassign

contacts herself

Outputs Scheduled Contacts and actions are either

reassigned or rescheduled.



Unplanned Service Delivery Staff Absence

Ma

na

ge

me

nt o

r

Ad

min

istr

atio

nP

lun

ke

tPlu

s

Plu

nke

t

Se

rvic

e

De

live

ry S

taff

A Service Delivery

staff is sick /

unavailable

v5



Note:


BR = Business Rule

SD staff calls /

sends message to

administration

Area Office finds

out SD staff is

unavailable

Manager decides on

approach depending

on staffing /geography

The manager may

delegate to an

administrator or

reschedule or reassign

contacts herself

Are there any

scheduled Contacts

that need

rescheduling?

yes

Endno



12.4.26 Discontinuation from a Plunket Service

A client will be Discontinued from a service for a variety of

reasons, depending on the details of the particular contract.

This process describes the circumstances and processing for

Discontinuation of a client from a service.

-

1 Discontinua-

tion from a

Plunket

Service


system.

1

Discontinuation from a Plunket Service

Brief

Description

When a client ceases participation in a Plunket

service, they are “Discontinued” from that service.

Trigger Any one of:

A client moves overseas.

A client dies.

A client completes the programme for a service.

In the case of the Well Child service the client is

discontinued at the end of the service (which is

currently five years of age) or if they transfer to

another Well Child provider.

A client decides to discontinue a service (except

in the case of Well Child).

For some other Plunket services, the client is

discontinued when reaching five years of age.

A Client has

transferred to

another WCTO

provider

A Client reaches a

specific age

A Client reaches a

time limit for a

Service

A Client moves

overseas

A Client dies

A Client decides to

discontinue a

Service

A Client

Completes a

Service „Actors‟ PlunketPlus

External Agencies


Area Administrator or Area Management


What

Happens

Any Plunket Staff member may become aware

that a client has changed circumstances that

require the client to be Discontinued from one or

more Plunket services.

A client has died or moved overseas:

An Area Administrator opens the client‟s EHR on

the administration screen, sets the status of

each service to “Discontinued” and enters the

reason and the date of Discontinuance.`

A Client dies

A Client moves

overseas



If the reason for the discontinuance is that the

client has died, PlunketPlus must generate a

System Alert to the Case Manager Plunket Nurse

or the Service Delivery Staff member

responsible for coordination of the service for

that client.

A client completes the programme for a service.

For a group programme, the Service Delivery

Staff member responsible for the programme

enters the “Programme Completed” details and

PlunketPlus sets the status for this service to

“Discontinued” for each client.

For an individual programme, where only one

client is involved at any one time, the Service

Delivery Staff member opens the client‟s EHR on

the administration screen, sets the status of

each service to “Discontinued” and enters the

reason and the date of Discontinuance.

A Well Child client is at the end of the

programme, which is currently when they reach

the age of five years.

PlunketPlus automatically changes the status of

the Well Child service for this client to

“Discontinued” and enters the date and reason.

If the client‟s EHR shows that the client or their

caregiver has previously given consent,

PlunketPlus initiates a workflow action for the

Case Manager Plunket Nurse for that client,

advising that a client GP Summary needs to be

completed and sent to the client‟s GP.

The Case Manager Plunket Nurse opens their

message board, selects this action and enters

any necessary additional information into the

client GP Summary that PlunketPlus has pre-

populated with standard information.

PlunketPlus sends the client GP Summary to the

client‟s GP.

A Well Child client has transferred to another

Well Child provider and the new provider has

requested a copy of the client‟s notes

The Incoming Communication is attached to the

client‟s EHR by the Plunket Staff member who

received it. If necessary, incoming documents

are scanned or notes of phone calls are entered.

PlunketPlus initiates a workflow action for both

the Case Manager Plunket Nurse and the

relevant Clinical Leader, requesting approval for

the transfer.

Either the Case Manager Plunket Nurse or the

Clinical Leader (whichever actions it first) checks

that the client has agreed to the transfer, then

Area Administrator

sets Service

status to

Discontinued and

enters reason

A Client

Completes a

Service

Is it a group

programme

completion?

SD staff sets

Service status to

Discontinued and

enters reason

A Client reaches a

specific age

Does a

summary need

to be sent to

the GP?

Send Client

summary to GP

Send any

appropriate

Systems Alerts

A Client has

transferred to

another WCTO

provider

Workflow request

for approval sent

to CMPN and CL.

Check: has

Client

requested

transfer?

Incoming

Communication

arrives from

another WCTO

provider

requesting copy of

Client‟s notes.

Staff member

attaches request

to EHR



approves the transfer. Once it is approved, it is

removed from the message board of both.

If the client had not agreed to the transfer, the

Case Manager Plunket Nurse or Clinical Leader

will initiate a workflow action for an Area

Administrator to follow this up and then route

the outcome back.

Once the transfer is approved, PlunketPlus

initiates a workflow action for the Area

Administrator role.

The Area Administrator:

Opens the client‟s EHR on the administration

screen, sets the status of the Well Child

service to “Discontinued” and enters the

reason and the date of Discontinuance.

Produces the Well Child Provider Summary

pdf report for the client and sends it to the

new provider. This report contains only the

common information and Well Child details.

Information about caregivers or any other

services is not included.

A client decides to discontinue a service for

some reason.

The client advises a Plunket Staff member that

they no longer want a service.

Note that a client cannot discontinue their

participation in the Well child service; they can

only transfer to another Well Child provider.

The Plunket Staff member opens the client‟s

EHR (if they have access rights) and enters a

note and initiates a workflow action for the

person responsible for coordination of that

service for this client.

If the Plunket Staff member does not have

access rights, they advise by phone or email the

person responsible for coordination of the

service for that client.

The Service Delivery Staff member responsible

for coordination of the service for that client

opens the client‟s EHR on the administration

screen, sets the status of the service to

“Discontinued” and enters the reason and the

date of Discontinuance.

The client is enrolled in a service that has a time

limit.

Some services have various criteria that

determine the end of the service for the client

and who needs to be advised. These will be set

in the Contract and Contract Event Templates.

When these criteria are met, PlunketPlus

automatically changes the status of the service

for this client to “Discontinued” and enters the

Follow up to report

back tp CMPN or

CL

Approve Transfer

Discontinues

Client and sends

Client Transfer

Report to new

provider

A Client decides to

discontinue a

Service

SD staff sets

Service status to

Discontinued and

enters reason

A Client reaches a

time limit for a

Service

Send any

appropriate

Systems Alerts

SD staff

responsible for

Service informed



date and reason, and generates any necessary

System Alerts as required by the Contract Event

Template.

Outputs A client is discontinued from the relevant service

or services.

A client summary is sent to the GP when

appropriate.

A copy of the relevant details from the client‟s

EHR is sent to the other Well Child provider.

Discontinuation

from Service

recorded in EHR



Discontinuation from a Plunket Service

Clin

ica

l

Le

ad

er

Ca

se

Ma

na

ge

r

Plu

nke

t

Nu

rse

Se

rvic

e

De

live

ry

Sta

ff

Clie

nt

Are

a

Ad

min

istr

ato

rP

lun

ke

tPlu

sv5

Note:


CL = Clinical Leader




A Client reaches a

specific age

A Client has

transferred to

another WCTO

provider

A Client decides to

discontinue a

Service

A Client reaches a

time limit for a

Service

A Client

Completes a

Service

Discontinuation

from Service

recorded in EHR

Discontinues

Client and sends

Client Transfer

Report to new

provider

Incoming

Communication

arrives from

another WCTO

provider

requesting copy of

Client‟s notes.

Staff member

attaches request

to EHR

Workflow request

for approval sent

to CMPN and CL.

Check: has

Client

requested

transfer?

Approve Transfer

yes

Follow up to report

back tp CMPN or

CL

no

Does a

summary need

to be sent to

the GP?

e.g. -WCTO at

5 years

Send Client

summary to GP

Send any

appropriate

Systems Alerts

yes

no

Is it a group

programme

completion?

e.g. a PEPE

course

SD staff sets

Service status to

Discontinued and

enters reason

no

SD staff enter

Programme

Completed details

yes

SD staff

responsible for

Service informed

Client Informs

Plunket Staff

Area Administrator

sets Service

status to

Discontinued and

enters reason

A Client moves

overseasA Client dies



12.5 PlunketPlus Portal

1 PlunketPlus

Portal

Plunket requires PlunketPlus to include a PlunketPlus Portal that

its clients can use to access their own EHR details and add to or

update these.

In reality it will usually be the parent or primary caregiver who

accesses their child‟s EHR through the PlunketPlus Portal.

There will be limits on exactly who can use the PlunketPlus

Portal and exactly what data can be accessed, updated or added

through the PlunketPlus Portal.

In concept, the PlunketPlus Portal will be the modern version of

the well-known Plunket Book that has been a hallmark of many

babies‟ life history in New Zealand.

The key principle behind the EHR being open to parent and

caregiver clients is that Plunket works in partnership with

families. Plunket brings expert knowledge regarding Well Child

Health, while the parents and caregivers bring expert knowledge

regarding their child. Therefore the entire EHR should be

available to them, with the exception of certain sensitive

information for example family violence and child protection as

detailed in the “Who Can Access What” matrix in Appendix D.

1

2 Access to

PlunketPlus

Portal

The PlunketPlus Portal is to be accessed by Plunket‟s clients,

using their own (or somebody else‟s) computer, connecting

through the public internet.

1

3 Access

Rights to

PlunketPlus

Portal

a) PlunketPlus Client Access Security

Plunket clients will not be registered in Plunket‟s Active

Directory, or its successor Forefront Identity Manager, so

PlunketPlus will need to include an alternative method of

authorising access to the PlunketPlus Portal.

This requirement is listed in Section 13.2 “Security” on page

277, under the topic “Non-Plunket Access”.

-

b) Who Can Access What

A strict privacy protocol will determine exactly who can use the

PlunketPlus Portal.

This requirement is detailed throughout Section 13.1 “Privacy”

starting on page 271, and in the “Who Can Access What” matrix

in Appendix D.

-

c) Automated Password Reset

Due to the large number of Plunket clients, Plunket requires that

PlunketPlus includes a secure client-initiated automated

password reset service so that clients can ask for a password

prompt or password reset.

1



4 Information

in the

PlunketPlus

Portal

The exact information available through the PlunketPlus Portal

will be decided at a future date.

In principle, the entire EHR should be available, with the

exception of certain sensitive information, for example family

violence or child protection information.

In principle, the information available in the PlunketPlus Portal is

expected to be along the lines of:

Client‟s basic identifying, addresses and other contact

details, including alternate contacts.

Family members and other caregivers.

Name and contact details for the client‟s current Plunket

Nurse and other Plunket Service Delivery Staff and groups

that the client has engaged with.

The client‟s GP and other providers, and any particular

people at those organisations.

Demographics.

Client Health Information recorded over time.

The client‟s service delivery plan, which will include

components from the contract event template such as date

ranges for future contacts.

Plunket recommendations and referrals.

Any information from other providers (especially GPs) where

the system has flagged that the provider has agreed their

information can be shown to the client.

Information that the client or caregiver may have entered

themselves.

The availability of individual data items will be controlled by the

“Who Can Access What” matrix in Appendix D.

The system will also need a method for flagging each provider to

signify whether or not information provided by the provider can

be made available for display to the client through the Portal.

1

5 Managing

Content

As part of the screen design, the portal will also contain static

information that applies to all clients. Examples are:

Introductory and explanatory text.

Notices that Plunket can change from time-to-time.

Plunket requires a method for the PlunketPlus Administrator to

maintain this static information.

The static information must include a warning to clients that any

material they enter in “their” parts of the Portal will not

necessarily be seen by their Plunket Nurse for some time, and

give them information about how to make contact with Plunket.

1



6 Functional-

ity in the

PlunketPlus

Portal

The functionality available in the PlunketPlus Portal will be

finalised at a later date.

In principle, the functions are expected to be along the lines:

Update own address and contact details.

Add own observations about the child‟s progress.

Display heights and weights in graph form, based on the UK

WHO code weight and height charts.

Complete developmental questionnaires relevant to age of

child, prior to Service Delivery Staff visit.

Future consideration might be given to functionality such as:

Contact Plunket Service Delivery Staff.

Chat with other members of local groups.

Add a limited number of photographs of the child, for

example one at each birthday. A standard format will be

required.

2

7 Technical

Points

a) PlunketPlus Portal Performance

The PlunketPlus information and client application will have to

optimised to support web-delivery speeds to ensure nominal

performance.

1

b) PlunketPlus Portal Timeout

There will need to be a “time-out” capability within PlunketPlus

in case records are not closed correctly either due to lost

communications between the central PlunketPlus systems and

the client‟s PC or the client fails to close-down their session

correctly which could lead to records being locked open.

1



12.6 Interoperability with Other Systems

Over time, Plunket anticipates introducing various forms of

interoperability between PlunketPlus and other systems, internal and

external.

Plunket wishes to support the use of common technology industry

standards and also standards developed specifically for the health

sector in New Zealand and around the world. It is important to

Plunket that PlunketPlus and the environment it operates in conform

to those standards to the optimal degree.

Foremost amongst those standards is a nursing terminology, which

will be the foundation for interoperability by potentially enabling any

organisation and their systems to interpret data in the same way.


specified in Section 11.4 “How Plunket will Store the Data” on page

123.

In this section, Plunket‟s interoperability requirements are set out

under:

Transfer of Care

Interoperability with Other Plunket Systems

Interoperability with External Systems.

First there is a brief overview to describe transfer of care, to ensure

clarity of meaning in the context of Plunket‟s requirements.

It is noted that Plunket does not currently consider it would have a

requirement to implement interoperability for e-Labs or e-Pharmacy,

although e-Pharmacy might become a requirement at a future date.

12.6.1 Transfer of Care

Overview The concept of “Transfer of Care” is to ensure continuity of care

for a client when multiple parties are involved in the provision of

that care.

There are various protocols, standards and systems in place

throughout the New Zealand health sector to support Transfer of

Care and a sector initiative is currently examining ways to

improve these, initially from a clinical perspective.

The components of Transfer of Care pertinent to PlunketPlus are

those with a focus on the safe sharing of relevant client

information.

Plunket Transfer of Care

Plunket has several cases where selected information for

specific clients will need to be transferred electronically in the

future:

Referrals

One party makes a referral to request another party to

provide an element of care to a client.

-



The referral request is usually accompanied by the relevant

information from the client‟s EHR.

Plunket makes referrals to a range of third parties and to

other Plunket services.

A referral to CYF is known as a “CYF Notification”.

Plunket receives referrals from various sources, mainly LMCs

at present, and in future may receive referrals from other

parties.

Visit Summaries

PlunketPlus will send the summary of each Core Contact to a

client‟s GP, if the client has given consent for this.

A client‟s GP may send Plunket a summary of the GP‟s

consultation with the client.

Discontinuance

When a client ceases participation in a Plunket service, they

are “Discontinued” from that service.

Note that Plunket does not discharge its clients; instead it

has the concept of Discontinuance.

For all services, a client is Discontinued when they:

move overseas, or

die.

For the Well Child service, a client is also Discontinued when

they:

reach five years of age, or

transfer to another Well Child provider.

For some other services, a client is also Discontinued when

they:

decide to leave the service for some reason, or

reach five years of age, or

complete the programme for that service.

A client is never fully Discontinued; they are Discontinued

from individual services.

The client‟s EHR details for each service are retained

following Discontinuation.

When a client has been Discontinued from all services, their

EHR is retained for a period, as described in Section 11.5

“Retention, Disposal and Archiving of Data” on page 125.

When a client is Discontinued from the Well Child service on

reaching five years of age, PlunketPlus will send a summary

of the client‟s EHR to the client‟s GP, if the EHR shows that

the client or their caregiver has previously given consent for

this.

If a client has been Discontinued due to transferring to

another Well Child provider, PlunketPlus will send a summary

of the client‟s EHR to the new provider if requested by the

new provider and approved by the client or their caregiver.



The workflow requirements for each of the above processes are

detailed in Section 12.4 “To-Be Processes” starting on page 144.

Referrals, Discharges and Status Reports in the Health

Sector Today

Currently, a referral is a standard health sector message that

requests a third party health or care delivery provider to

undertake some action in relation to a particular client.

Most commonly known to the public are referrals by GPs to

specialists.

Once the third party has seen the client, it is normal practice for

the third party to advise the referring party that the consultation

has taken place and what the outcome was.

Where the referral is to a hospital-based inpatient service, the

hospital takes over responsibility for care of the client during

their stay there. When the hospital has completed the client‟s

treatment and sends them home, there is a formal discharge

process where the hospital ends its responsibility of care and

creates a standard discharge message back to the referring

party.

For hospital-based outpatient services, there is usually a similar

regime although the hospital is not necessarily assuming full

responsibility for the client. Not all outpatient services issue

discharges.

The third party may issue status reports from time-to-time, so

that the referring party is kept informed about progress. The

referring party may also ask the third party for a status report.

Sometimes the status report is called a status update.

In the cases where the third party does not issue discharges, a

status report may be issued instead once the treatment is

complete.

Note that Plunket does not discharge its clients; instead it has

the concept of Discontinuance, described above.

Traditionally referrals, status reports and discharges have been

written on paper and sent to the other party. Over the years the

majority of these have been computerised, although still output

onto paper. For many years it has been common practice to

send them from one party to the other by fax, and more

recently by email.

A few years ago the New Zealand health sector developed and

agreed formal standards for electronic referrals, status reports

and discharges. The idea was that when a clinician made a

referral, their system would generate a pre-formatted electronic

message with machine-readable content which would be

automatically transmitted to the other provider‟s system, which

would in turn be able to automatically enter the incoming

referral into their system. Similarly the third party‟s system

would be able to send status reports and discharges

electronically with machine-readable content.

In practice it has transpired that it is necessary to accompany



machine-readable content with a human-readable version. This

is usually accomplished by including a pdf document as one of

the components of the message.

The standards cover a broad range of transactions and protocols

relevant to referrals, discharges and status reports, including

automatic technical acknowledgements and activity-based status

reports.

There has been relatively slow uptake of these standards,

possibly due to practice differences or the resources required to

retrofit them to existing systems. Nonetheless there are

examples of successful implementations between some DHBs

and some GPs.

Plunket intends to utilise these interoperability standards and

processes for outgoing and incoming referrals where the third

party is also able to process these, then in due course upgrade

to future versions or replacements of these standards and

processes.

GP Notes Transfer

A health sector project known as GP2GP has been under way for

some time, to implement a facility for electronic transfer of a

client‟s notes from one GP‟s system to another.

The document “GP2GP Implementation Guide v0.3” describes

this facility.

It is understood that the first release of the system is being

prepared for later in 2010.

Plunket may find that GP2GP is suitable to fulfil its requirements

for the cases described above:

Visit Summaries,

Discontinued clients

in which case Plunket may investigate whether it is appropriate

for PlunketPlus to utilise GP2GP. Alternately, it may transpire

that RSD is suitable for these purposes.

Transfer of Care in the Health Sector in Future

The National Health IT Board and the Clinical Leadership Group

are working on a review of the clinical processes for transfer of

care.

This review may result in changes to the processes and

information involved in transfer of care.

The implication is the possibility of substantial change to, or

replacement of, the standards for referrals, status reports and

discharges, and potentially GP2GP.

Plunket will expect the PlunketPlus software provider to stay

abreast of this initiative and to be prepared to upgrade the

system to work with any emerging developments in this area.



1 Standards a) HISO RSD Standard

Plunket requires PlunketPlus to confirm to the official New

Zealand standard for Referrals, Status and Discharges (RSD),

which is defined in three documents issued by HISO:

Messaging Standard 10011.2 v2.1

Business Process 10011.1 v1

Implementation Guide 10011.3 v3

These documents can be seen at www.hiso.govt.nz on the

“Standards Approved” page.


1

b) GP2GP Design Specification

Plunket requires PlunketPlus to be able to conform to the design

specifications for GP2GP, in the event that Plunket utilises this

service.

Please explain how this be achieved.

1

c) GP2GP Standard

Plunket requires PlunketPlus to be able to conform to a GP2GP

standard once that is adopted by HISO.

Please explain how this will be achieved.

1

d) XML

Plunket requires PlunketPlus to generate referrals in xml.

Please explain how this will be achieved.

1

e) HL7

Plunket requires PlunketPlus to utilise HL7 for transfer of care

messaging.


1

f) Web Services

Plunket may need to utilise Web Services for transfer of care

messaging in some instances.


1

g) SNOMED

Plunket requires PlunketPlus to support the use of SNOMED,

with any New Zealand localisation.


1

http://www.hiso.govt.nz/



h) Nursing Terminologies

There are multiple nursing terminologies in use in the health

sector globally, although none have been adopted in New

Zealand to date.

Plunket intends to select a nursing terminology and will require

that to be implemented in PlunketPlus, as detailed in Section

11.4 “How Plunket will Store the Data” on page 123.

Plunket also requires PlunketPlus to utilise the selected nursing

terminology for the data in transfer of care messages.


1

i) e-GIF

Plunket requires PlunketPlus to conform to e-GIF standards, to

ensure interoperability with the government agencies that are

not part of the health sector.


1

j) Updates to Standards

The provider of PlunketPlus must commit to updating the system

to conform to any future changes approved for transfer of care

standards.


1

2 Outgoing

Referrals

The types of outgoing referrals from Plunket are:

Referral to a GP or their practice.

Notification to Child, Youth and Family (CYF), a service of the

Ministry of Social Development.

Referral to various services within any New Zealand DHB,

eg paediatrician, dental, hearing testing, vision testing,

specialised service and developmental services.

Referral to government agencies such as Housing NZ, Work

and Income.

Referral to organisations with government contracts, such as

Family Start, PAFT.

Referral to social or community organisations such as other

Well Child Providers, Barnados, City Mission, Women‟s

Refuge.

Potentially, a referral to any other government or non-

government agency or organisation in the future.

Referral to another service within Plunket, such as:

- Plunket Kaiawhina

- Community Karitane

- Family Centre

- Lactation Consultant

- Parenting Education

- Support Groups

- Car Seat Rental Scheme

- PNNAP

- PAFT

-



- Volunteer Home Visiting Programme.

This section sets out the technical requirements for the

processing of outgoing referrals.

The workflow processes for creating and sending referrals are

described in Section 12.4.10 “Make Referrals and CYF

Notifications” on page 188.

a) Generate Outgoing Referral

PlunketPlus must generate an outgoing referral record when

triggered to do so at the appropriate point in the workflow.

1

b) Outgoing Referral Types

PlunketPlus must generate the referral in a format specific to

each referral type:

To a GP.

To CYF.

To a DHB service.

To various government agencies.

To organisations that have contracts with government

agencies.

To social and community organisations.

To a generic organisation for a generic service.

To Plunket.

The exact format of each referral type will need to be

determined during the design phase.

The formats will be decided with the relevant organisation. An

example of a Word template currently used for notifications to

CYF is included in Appendix C.

Note that in the case of a DHB service, the format will depend

on which DHB service the referral is directed to.

This function must be flexible so that changes can be made to

the format and content of each referral type and new referral

types can be added.

1

c) Localisation Defaults

When a referral is created, the system must automatically

default to the local location of the particular service, and

populate the referral accordingly with person name, local

organisation name, address and contact details.

2

d) Override Localisation Defaults

The system must allow the Service Delivery Staff creating the

referral to override the default location details.

1



e) Despatch Type

The despatch type for each third party will be one of:

Electronic:

An RSD message, using either HL7 or Web Services.

A GP2GP message, using either HL7 or Web Services.

An email with a pdf attached:

via SEEMail for CYF Notifications

via the New Zealand Health Network for all others.

A fax with a pdf attached.

A printed document for manual despatch.

PlunketPlus must generate referrals in the format appropriate to

the despatch type for that third party.

1

f) Addressee

The system must provide an easy-to-use function for the

Service Delivery Staff to select the referral addressee from the


1

g) Enter Addressee

In the case where the referral addressee is not already in the

PlunketPlus database, the system must provide a means for the

Service Delivery Staff to input a new addressee into the

PlunketPlus database, or alter an existing addressee‟s details,

without having to leave the referral process.

1

h) Additional Addressees

The system must provide the ability to enter multiple

addressees, for example a “cc” to the client‟s GP.

1

i) Populate the Outgoing Referral

The system must populate all the required fields of the outgoing

referral record:

In accordance with the applicable RSD and nursing

standards.

From the data in the PlunketPlus database.

By requesting the Service Delivery Staff to provide any

required data that is not already in the database.

1

j) Despatch the Referral - Electronic

If the despatch type is electronic, send the referral electronically

following the RSD or GP2GP standards and Plunket‟s

telecommunications technology facilities.

1

k) Despatch the Referral – Email

If the despatch type is email, generate an email using Plunket‟s

standard email system and with the referral as a pdf embedded

or attached so that the recipient is able to read and print it. Also

1



retain a copy, associated with the client‟s EHR.

Note that email within the New Zealand health sector is

transported through the secure New Zealand Health Network.

Note that email to New Zealand government agencies outside

the NZ health sector is transported by SEEMail.

l) Despatch the Referral – Fax

If the despatch type is fax, generate a fax using Plunket‟s

electronic gateway and retain a copy associated with the client‟s

EHR.

2

m) Despatch the Referral – Paper

If the despatch type is paper, generate a printed referral which

a Plunket Area Administrator will send by mail. Retain an

electronic version of the referral associated with the client‟s

EHR.

1

n) Despatch the Referral – Internal Plunket Referrals

Internal referrals must be processed using the same standards

and processes as all other outgoing referrals, except:

They will not be transmitted out to the Health Network or

any other external service (as these incur costs for

transmission).

They will instead be routed directly to the input side of

PlunketPlus.

On arrival at the input side of PlunketPlus, they will then

commence processing as an incoming referral.

1

o) Print Referral at Contact

For all forms of outgoing referral, the system must provide a

facility to print a copy for the client.

Service Delivery Staff are expected to have a small portable

printer available along with their mobile computer. The model

and specification of printer will change over time.

The printing function must be able to cope with a variety of

printer specifications.

1

p) Retain Record of Referral

For all referrals sent, a record of the referral must be retained in

the client‟s EHR.

1

q) Request Status Report

The system must provide a function so that Service Delivery

Staff can generate a request to the third party for a status

report.

2



r) Outgoing Referral Responses

PlunketPlus must be able to receive, process and respond to all

incoming messages relating to outgoing referrals, as defined in

the RSD standards.

These responses, including incoming status reports, must be

routed to the appropriate process or person as defined in

Section 12.4.19 “Referral Feedback” on page 210.

1

s) Overdue Referral Responses

PlunketPlus must generate a Clinical Alert for the client‟s Case

Manager Plunket Nurse when RSD responses have not been

received in cases where:

There has not been an acknowledgment of receipt of

Plunket‟s outgoing referral after one business day.

A referral Feedback has not been received after the period

set by the Case Manager Plunket Nurse when generating the

outgoing referral.

1

3 Incoming

Referrals

Incoming electronic referrals may arrive from:

Midwives, to advise Plunket of a new client

GPs

The parent or caregiver of a child (this is a “self-referral”)

Other government agencies or NGOs.

Other organisations in future.

Plunket, when it is known as an internal referral, for services

such as:

- Plunket Antenatal Education

- PlunketLine

- others, for Well Child Services if client not already enrolled.

Where a referral arrives by email or fax, or on paper, there is a

manual process to enter the necessary information into

PlunketPlus. All self-referrals will be handled this way too.

-

a) Receive Incoming Referral

PlunketPlus must be able to receive incoming electronic

referrals, which will follow the RSD standard.

1

b) Input Manual Incoming Referral

PlunketPlus must provide a mechanism to manually input a

referral that has arrived on paper, by email, fax or in person.

In additional, all incoming documents and emails that are part of

the referral must be scanned and attached to the client‟s EHR.

1

c) Route Incoming Referral

The system should automatically initiate a workflow action

based on the incoming referral, as defined in Section 12.4.1

“Incoming Referral” on page 146.

2



d) Incoming Referral Responses

PlunketPlus must be able to generate, process and otherwise

respond to referral messages as defined in the RSD standard.

1

e) Update the EHR with Incoming Referral Data

PlunketPlus must automatically attach the incoming referral to

the relevant client‟s EHR, in a “pending” status.

The NHI or name and date of birth and fuzzy logic is the basis

for matching.

This will ensure:

The referral is visible to Service Delivery Staff who access

the client‟s EHR (the embedded pdf content will aid

interpretation).

No data is formally accepted into the client‟s EHR until it has

been clinically reviewed.

If PlunketPlus cannot automatically match the incoming referral

to an existing client, it will automatically generate a client as set

out below.

1

f) Formally Accept Pending Referral

PlunketPlus must provide a facility for the Case Manager Plunket

Nurse for the client to formally approve the incoming referral

data and to update the client‟s EHR accordingly to change the

status from “pending” to “accepted”.

Generally this would occur during the first contact.

1

g) Create Client from Incoming Referral

It will often be the case that an incoming referral from an LMC is

Plunket‟s first advice of a new client, hence that client is unlikely

to be in PlunketPlus already.

This situation will also apply in future to incoming referrals from

any source.

PlunketPlus must generate a client record in this situation, based

on information in the incoming referral. The client will have a

“pending” status along the same lines as for the referral as

described above. The process for assigning an NHI will need to

be agreed during the design phase.

This requirement applies to electronic and manual referrals.

1

h) Formally Accept Pending Client

PlunketPlus must provide a facility for the Case Manager Plunket

Nurse for the client to formally approve the new client record

and to update the client‟s EHR accordingly to change the status

from “pending” to “accepted”.

PlunketPlus must also provide facilities for the Case Manager

Plunket Nurse to redirect the incoming referral to a different

client‟s EHR if the one automatically matched or created is

incorrect, and to mark any incorrect automatically created client

1



as deleted.

Generally this would occur during the first contact.

4 Discontinue

Client

The circumstances and workflow processes for Discontinuing a

client are specified in Section 12.4.26 “Discontinuation from a

Plunket Service” on page 235.

This process assumes that GP2GP will be used for sending

Discontinuation messages. Other protocols or standards such as

RSD and e-GIF may be used; this remains to be decided.

Currently there are two types of Discontinuation notes transfer

message envisaged:

Client GP Summary.

Well Child Provider Summary.

The interoperability requirements that flow from Discontinuing a

client are:

-

a) Generate Client GP Summary to GP

Generate a client GP Summary for the client‟s GP.

Initiate a workflow action for the client‟s Case Manager Plunket

Nurse.

Provide facilities for the Case Manager Plunket Nurse to review

the generated summary and add any free-text notes.

The format and content of the client GP Summary will be defined

during the design phase.

The client GP Summary is to be produced in human-readable

format in a pdf document and, once GP2GP is in use, also in

machine-readable format.

1

b) Send Client GP Summary Manually

Provide a straightforward facility for the appropriate Plunket

Staff member to send the client GP Summary to the GP by one

of the following methods:

Email.

Fax.

Paper.

This manual method will be used in all cases until such time as

GP2GP is in use.

Once GP2GP is in use, the manual method will continue to be

used for GPs who are not on GP2GP.

1

c) Send Client GP Summary Automatically

Once GP2GP is in use, send the Client GP Summary to the GP

using the GP2GP facilities for GPs where the Despatch Type set

in PlunketPlus for that GP shows that the GP is on GP2GP.

1



d) Retain Record of Client GP Summary

PlunketPlus must retain a copy of each client GP Summary

produced, as part of the client‟s EHR and showing the details of

when it was produced and who it was sent to.

1

e) Generate Well Child Provider Client Summary

Generate a client Summary for the client‟s new Well Child

provider.

There is no requirement for this summary to be reviewed before

it is sent.

The format and content of the Well Child Provider Client

Summary will be defined during the design phase.

1

f) Send Well Child Provider Client Summary Manually

Provide a straightforward facility for the appropriate Plunket

Staff member to send the Well Child Provider Client Summary to

the new provider by one of the following methods:

Email.

Fax.

Paper.

This manual method will be used in all cases until such time as

electronic interoperability is in use.

Once electronic interoperability is in use, whether GP2GP, RSD,

e-GIF or similar, the manual method will continue to be used for

Well Child providers who do not have electronic interoperability.

1

g) Send Well Child Provider Client Summary

Automatically

Once electronic interoperability is in place, send the Well Child

Provider Client Summary using the appropriate protocol based

on the Despatch Type set in the PlunketPlus record for that

provider.

1

h) Retain Record of Well Child Provider Client Summary

PlunketPlus must retain a copy of each Well Child Provider Client

Summary produced, as part of the client‟s EHR and showing the

details of when it was produced and who it was sent to.

1

5 Visit

Summary

to GP

PlunketPlus will send a summary of each Core Contact to a

client‟s GP, if the client‟s EHR shows that the client or their

caregiver gives consent or has previously given consent for this.

The Visit Summary will be generated and sent automatically

when the Case Manager Plunket Nurse closes the Core Contact.

The format of the Visit Summary will be determined during the

design phase.

The Visit Summary will be sent using the appropriate method:

A GP2GP or RSD message, depending which has been

1



decided as the protocol and if the GP‟s record in PlunketPlus

shows that the GP can receive these.

Email or system-generated fax in other cases, depending on

the details in the GP‟s record in PlunketPlus.

A record of the outgoing Visit Summary must be retained in

PlunketPlus.

6 Visit

Summary

from GP

A client‟s GP may send Plunket a summary of the GP‟s

consultation with the client.

This is to be treated as an incoming status report in the RSD

protocol and added to the client‟s EHR with a “pending” status.

A workflow action must be initiated for the Case Manager

Plunket Nurse to review the incoming summary, accept it into

the client‟s EHR and take any other necessary actions.

1

7 All Referrals For all referrals, discharges and status messages: -

a) View Status of Messages and Responses

The system must provide a facility for PlunketPlus

Administrators to view all the “technical” RSD messages

associated with a given outgoing referral.

1

b) Audit Reports

PlunketPlus must maintain audit logs of all incoming and

outgoing RSD and Transfer of Care messages and provide

facilities to view, search, analyse and print details, lists and

summaries from these.

1



12.6.2 Interoperability with Other Plunket Systems

Overview Plunket intends that the PlunketPlus database will become the

single central repository of all client-oriented data across all

parts of the organisation.

At the heart of the database will be the EHR for each client.

While other Plunket systems will hold their own data and this

may include some specific client data, in time those systems will

all access the EHR as the authoritative repository of Plunket

clients‟ data.

The EHR will need to be available to Plunket‟s other systems,

and some of those systems will also update the EHR.

In addition, some Plunket systems may be authorised to invoke

certain PlunketPlus functions.

Plunket has decided that PlunketPlus will not access other

Plunket systems; the interoperability will be one-way only.

This section sets out the requirements for interoperability

between PlunketPlus and other approved13 Plunket systems.

Section 12.7 “Changes to Other Systems” on page 267 sets out

in broad terms the changes that will be needed in other Plunket

systems to enable them to access the EHR.

-

1 Single

Mechanism

a) Common Mechanism

Plunket would prefer a single mechanism for interoperability,

which could be used by any other approved Plunket system to

access the PlunketPlus EHR and invoke PlunketPlus functions.

2

b) Flexible and Extensible

The interoperability mechanism should be flexible and extensible

so that it can be used by any other approved Plunket system,

once that system is adapted to use it.

2

c) Interoperability Approval Matrix

The interoperability mechanism should provide a mechanism for

a PlunketPlus System Administrator to define:

What interoperability functions are approved for each Plunket

system.

What type of access to which type of data is approved for

each Plunket system.

This needs to operate at a sufficiently granular level as set out in

the “Who Can Access What” matrix described on page 272.

2

2 Authentic-

ation and

Security

The full set of security requirements is defined in Section 13.2

“Security” on page 277.

Authentication and security for users accessing PlunketPlus

functions and data through the interoperability mechanism must

1

13 The PlunketPlus business owner will authorise access to PlunketPlus by other systems.



meet the same requirements.

3 PlunketLine PlunketLine is a call centre operated by Plunket and staffed by

Plunket Nurses, who will be authorised to access client EHR

details in PlunketPlus.

The PlunketLine system is required to have the following

interoperability with PlunketPlus. It is understood that these

requirements will need deeper definition at the time of

development and implementation.

-

a) Client Search

A PlunketLine operator needs to be able to access a PlunketPlus

client‟s data during a call. The PlunketLine system will need to

invoke a search so that the operator can identify which

PlunketPlus client is the subject of the call.

1

b) Create new Client

If the client is not already in PlunketPlus, PlunketPlus must set

up a new client in every case (except where the caller has

requested anonymity) with such data as PlunketLine has

available to it.

1

c) Display Full Client Details

Provide all client details including EHR information to the

PlunketLine system, for display to the operator.

1

d) Update Client Details

Update PlunketPlus client details with updates from PlunketLine.

For example, the client might advise a new address or additional

phone number.

Also generate a System Alert to the Case Manager Plunket Nurse

who will review each change to see if there are any implications,

for example a change address may lead to a change of Area and


1

e) Additional Contact

Record in PlunketPlus all the information necessary for the

process Additional Contact.

1

f) Identify Follow-up Actions


process Follow-up Actions.

1

g) Make Recommendations


process Recommendations

1

h) Make Referral

Record in PlunketPlus all the information necessary for Make

1



Referral.

4 Car Seat

Rental

Scheme

The Car Seat Rental Scheme system (CSRS) is required to have

the following interoperability with PlunketPlus:

-

a) Client Search

A Car Seat Rental Scheme administrator needs to be able to

access a PlunketPlus client‟s data. CSRS will need to invoke a

search so that the CSRS administrator can identify the

appropriate PlunketPlus client.

1

b) Create new Client

If the client is not already in PlunketPlus, the Car Seat Rental

Scheme administrator can ask CSRS to instruct PlunketPlus to

set up a new client, with such data as is available to CSRS.

1

c) Display Relevant Client Details

PlunketPlus should make available client information relevant to

CSRS, as dictated by the Who Can Access What Matrix.

1

d) Update Relevant Client Details

Update PlunketPlus client details with updates from CSRS. For

example, the client might advise a new address or additional

phone number.

Also generate a System Alert to the Case Manager Plunket Nurse

who will review each change to see if there are any implications,

for example a change address may lead to a change of Area and


1

e) Add or Change Car Seat Details

Update PlunketPlus client Car Seat Rental Scheme details with

updates from CSRS.

1

5 Human

Resources

Currently Plunket does not have a Human Resources (HR)

system. The Datacom system is used for payroll and other

products are used for point solutions.

The payroll system holds details of all Plunket staff and paid

volunteers. There is an intention to record all volunteers in the

future.

-

a) Employee Number in PlunketPlus

When a Plunket Staff member is set up in PlunketPlus, their

Plunket employee number must be recorded in PlunketPlus.

The Plunket employee number will be the key in PlunketPlus that

enables future interoperability between the HR system and

PlunketPlus.

1

b) Initial Bulk Employee Load 1



PlunketPlus will need to accept a bulk load of Plunket Service

Delivery Staff details, which will be used to populate the

PlunketPlus database early in the implementation process.

c) Employee Search

An HR administrator needs to be able to access the data of

Plunket Staff members in PlunketPlus. PlunketPlus must accept a

call from the future HR system that invokes a search so that the

HR administrator can identify the appropriate PlunketPlus

records.

1

d) Add New Plunket Staff

If a Plunket Staff member is not already in PlunketPlus, then

PlunketPlus must accept a call from the future HR system to set

up a new Plunket Staff member in the PlunketPlus database,

with such data as is available to the HR system.

1

e) Changes to Plunket Staff Details

PlunketPlus must accept calls from the future HR system to

update Plunket staff details in PlunketPlus with updates from the

future HR system, whenever any relevant information is changed

in the HR system. For example, a change of address or an

additional phone number.

1

f) Staff or Volunteer Leave Plunket

When a Service Delivery Staff member leaves Plunket, and this

is recorded in the future HR system, PlunketPlus must accept a

call from the HR system to alter the status of the person in

PlunketPlus and in particular the roles and access authority for

the person in PlunketPlus.

1

6 Member

Card System

Plunket‟s new web-based system is currently adding to Plunket‟s

records of its volunteers.

This will be used as an input to initially populate the Service

Delivery Staff details in PlunketPlus, which should be able to

accept this.

The longer term strategy of a relationship between the Member

Card system and PlunketPlus will be clarified at a future date.

2

7 Fundraising

System

Plunket uses the Raiser‟s Edge system supplied by Blackbaud Inc

to support its fundraising activities.

It is noted that while there may be people registered in this

system who may also be registered in PlunketPlus, Plunket

currently does not require interoperability between these two

systems.

Nonetheless there is a potential requirement for interoperability

in the future, in which case PlunketPlus may need to hold in the

EHR the unique ID key by which the person is identified in

Raiser‟s Edge.

3



8 Microsoft

Office

PlunketPlus must provide integration with Microsoft Office

software as follows:

-

a) Generate Letter from Template and EHR

The workflow and to-be processes require letters to be

generated.

The PlunketPlus must:

Bring up the appropriate Microsoft Word template, depending

on the reason for the letter.

Automatically populate the letter with data from the EHR

relevant to the purpose of the letter.

Allow the Service Delivery Staff to alter and add information,

according to the purpose of the letter.

Provide the ability to address the letter to multiple

addressees.

It is anticipated that business rules will be developed to govern

the content of these letters.

1

b) Despatch Generated Letter

PlunketPlus must provide mechanisms for despatching the letter

to each addressee:

Email.

Fax.

On paper.

1

c) Save Generated Document

The generated letter must be saved as part of (or linked to) the

client‟s EHR, including the method of despatch and the date and

time of despatch to each addressee.

1

d) Insert Emails into Client‟s EHR

PlunketPlus must allow emails to be inserted into (or linked with)

a client‟s EHR.

1

e) Save Attached Documents into Client‟s EHR

PlunketPlus must allow any documents to be inserted into (or

linked with) a client‟s EHR.

1

9 Generic

Microsoft

Interopera-

bility

Plunket requires the generic ability for PlunketPlus to be able to

utilise the interoperability functions of Microsoft products.

1

10 Other

Internal

Systems

Plunket does not currently have other systems that may require

interoperability with PlunketPlus.

Plunket does require that PlunketPlus has a mechanism for

achieving interoperability with other systems that it may

implement in the future.

1



12.6.3 Interoperability with External Systems

Most of Plunket‟s day-to-day interoperability with external

systems will be managed through the Referrals, Discharges and

Status Reports processes, as described above.

The Plunket expects to achieve interoperability in the future with

external systems, including the following.

-

1 NHI The National Health Index (NHI) system is New Zealand‟s

master index of all people who have been involved with a New

Zealand health provider. Most people in New Zealand are very

likely to have an NHI number and in some cases might have

more than one.

The Ministry of Health describes14 interfaces to the NHI as:

Hospitals, doctors‟ practices and other health organisations

including Plunket can connect their information systems to the

NHI through application program interfaces (APIs). An API is a

documented interface that provides a clean and simple way of

interacting with a software application. The APIs for the NHI are

network services that allow users to carry out tasks such as:

creating a new NHI number for a patient

looking up information such as a patient‟s name, address,

date of birth or ethnicity

updating a patient‟s information

searching for a patient‟s information using a close

approximation of the spelling of their name and an

approximate age.

Refer to the Ministry of Health document:

“NHI Best Practice Guidelines”.

-

a) API Access to the NHI from within PlunketPlus

Plunket would achieve operational efficiencies if PlunketPlus has

a built-in interface to NHI functionality.

Please describe your system‟s interface to the NHI, if any.

3

b) Cost to Provide API Access to the NHI

If your solution does not already include API interfaces to the

NHI, please describe what would be involved in providing this.

Please also provide the cost information for this requirement in

the relevant part of your RFP response.

3

14 The description given here is taken from the Ministry of Health website and modified to reference Plunket.



c) Look up NHI

Please describe the functionality provided from within the

system to look up and search for NHI records.

3

d) Create NHI


system to create new NHI numbers.

3

e) Update NHI


system to update information on individual NHI records,

including cases of duplicates and merging.

3

f) Access the NHI through the Health Network

Please describe how the system utilises the Health Network to

access the NHI.

3

g) Secure Access to the NHI

Please describe the how the system handles the Ministry of

Health NHI access requirements for authentication, authorisation

and audit logging.

3

2 HPI The Ministry of Health operates the Health Practitioner Index,

which has the principal purpose of uniquely identifying health

practitioners and holding that information in a central, national

database for use by the New Zealand health and disability

sector.

The HPI uniquely identifies health practitioners, practitioner

organisations (employers) and facilities (the physical address

where the health care takes place) in three separate indexes.

Plunket anticipates that in future Plunket nurses and facilities

may be entered in the HPI, in which case there will be benefits

from ensuring PlunketPlus can connect to it.

Refer to the Ministry of Health documents:

HPI Code Set.

HPI Data Set.

-

a) Access to HPI from within PlunketPlus

Does your solution include an interface to the HPI?

3

b) Cost to Provide Access to the HPI

If your solution does not already include API interfaces to the

HPI, please describe what would be involved in providing this.

Please also provide the cost information for this requirement in

the relevant part of your RFP response.

3



3 Sector

Repositories

There has been a movement in the New Zealand health sector to

implement shared repositories for various purposes, so that

certain elements of a person‟s health information are available

for access by all their care providers.

Please describe your approach to implementing connectivity with

such shared repositories.

1

4 Register of

GPs in PHOs

Plunket requires to have available in PlunketPlus the PHO to

which a GP is currently part of.

If this is available as an online look-up facility, PlunketPlus

should access it.

Otherwise, PlunketPlus must be able to look up a table stored on

a Plunket server, and facilities to update or replace the table

from time to time.

This requirement should be implemented in such a way that it

fits the Person and Organisation structure described in Plunket‟s

conceptual data model.

1

5 Kidslink The Kidslink service of Counties Manukau DHB provides

information to Plunket on all children they have seen who have

said they are Plunket Well Child clients.

Kidslink is a Well Child & Immunisation electronic event

database that enables the sharing of Well Child core event and

immunisation data for children aged between 0 and 5 years of

age, and who have provided consent to be on the Kidslink

programme.

The data is provided by and shared between Well Child providers

including Plunket and General Practitioners.

There is electronic interoperability between Kidslink and

Plunket‟s POND system that includes:

A two-way electronic interface system between Counties

Manakau / West Auckland and POND for child clients born on

and post 21 January 2002.

POND registration of new baby cases from Kidslink.

POND update of demographic data from Kidslink, for Well

Child checks and immunisation events.

Automatic POND update of Well Child core visits from POND

to Kidslink, identified by a match of the Domicile code for a

specified DHB, or partial DHB. Plunket sends completed Well

Child tasks, not declined tasks.

An electronic inbox (the Exception form) that receives text

files.

HL7 secure message standard protocol.

The existing interoperability is shown in the following diagram.

-



a) PlunketPlus Interoperability with Kidslink

The functionality currently provided between POND and Kidslink

must be provided between PlunketPlus and Kidslink as from the

time that Plunket commences using PlunketPlus in locations that

include clients in the Counties Manukau DHB area.

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6 NIR Plunket has a future requirement for interoperability with the

National Immunisation Register (NIR) that is operated by the

Ministry of Health.

The NIR is described by MOH as:

The NIR is a computerised information system that has been

developed to hold immunisation details of New Zealand

children.

The purpose of the NIR is to assist New Zealand to improve

its immunisation rates. Improved immunisation coverage will

offer individual protection against vaccine-preventable

diseases and protection for the community against recurring

epidemics.

The NIR enables authorised health professionals to quickly

and easily find out what vaccines a child has been given (this

includes children whose family has shifted to another area or

changed healthcare providers). This will help to make sure

immunisations are given at the appropriate time.

The Register will also provide a more accurate record of

immunisation coverage rates – regionally and nationally. This

will enable better programme planning to target populations

with the lowest immunisation rates.

Plunket‟s interoperability requirements are:

-

a) Receive NIR Messages about Missed Immunisations

The NIR provides lists to Plunket of children registered as

Plunket Well Child clients who have missed a scheduled

immunisation.

Plunket requires that, when NIR is able to send electronic

3

MATERNITY

UNITKIDSLINK

DATABASE

EVENT

SYSTEM

WELL CHILD

PROVIDER

PlunketGPsOther

POND [PMS]

Receives: new registrations [NBCs]

demographic updatesvia

Exception/InboxNew RegistrationsUpdates

Overdues [option]via Healthlink

via JADEgateway

Consent

letter

OPT-OFF

PLUNKET

WELL CHILD

CORE CHECK

WC CORE CHECK[message trigger]

[filterd by DoB and domicile code]

Auto generated via Jade --> Healthlink

Daily E-dumpNBCs



messages of missed immunisations, PlunketPlus will

automatically process these as Incoming Communications, add

the information to the child-client‟s EHR in a pending status and

raise an action for the Case Manager.

b) Access NIR for Immunisation Details

Plunket requires that PlunketPlus has a facility to access the NIR

in real-time when a Care Delivery Staff member has a client‟s

EHR open, then display the relevant details. This should occur

automatically when the client‟s EHR is opened.

There should also be a facility for the Care Delivery Staff to

refresh this information.

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c) Advise NIR of Plunket Immunisation

There are occasions when a Plunket Nurse administers an

immunisation. This is to be handled in PlunketPlus as an action

from the event template, with the result to be recorded as Client

Health Information.

The requisite information about the immunisation is to be

automatically transmitted to the NIR.

3

7 B4 School

Check

Plunket has a contract to deliver B4 School Check services, for

which data must be entered into a Ministry of Health system.

Plunket requires that PlunketPlus interact with that system, to

avoid double-handling by Service Delivery Staff.

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8 Safe

Medications

Work is currently in progress to develop and implement sector-

wide facilities that will enable New Zealand health and care

providers‟ systems to reference standard, up-to-date details of

medications.

Plunket requires that PlunketPlus is ready to interact with this.

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9 E-Pharmacy While Plunket does not have a current reason to engage in the

e-Pharmacy facilities being developed in the New Zealand health

sector, this may become a requirement in future.

Please explain how this would be addressed.

3

10 Other

Government

Agencies

Plunket foresees that there are likely to be future requirements

for PlunketPlus to interoperate with various government

agencies in the future, in areas outside the scope of the

standard health sector interoperability standards and facilities.

To achieve this, it is likely that adherence to e-GIF standards will

be necessary.

Please explain how this would be addressed.

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11 Generic

Facility

Plunket prefers that a standard approach is taken to provide

interoperability with external systems. This should be used to

meet the specific requirements identified here and other

potential interoperability requirements in the future.

Please describe how this would be addressed.

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12.7 Changes to Other Systems

Plunket will plan to make changes to its other systems in order

to achieve the required interoperability with PlunketPlus.

This will take place across a potentially extended timeframe.

The systems that will require such changes include:

PlunketLine

Car Seat Rental Scheme

HR

IQ4Bis

-

12.8 Business Rules

12.8.1 Business Rule Functionality

There are a number of situations where a business rule will be

necessary to determine the process flow.

Some of these cases will be handled by the workflow

functionality.

There are other cases that require a method of specifying logic

and data conditions.

The system should include a table-based facility (or similar) that

Plunket can use to specify business rules for various

functionality.

2

12.8.2 Specific Business Rules

1 Core Contact

Closure

Under the Well Child contract, it is necessary that the Plunket

Nurse undertakes all the actions and records all the Client Health

Information prescribed in the contract event template before the

record of the contact can be closed, otherwise it becomes an

Additional Contact.

-

a) Incomplete Core Contact

The system must keep the status of a Core Contact event as

“incomplete” until all the requirements of the contract event

template are satisfied.

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b) Completed Core Contact

The system must set the status of a Core Contact to “complete”

when all the requirements of the contract event template are

satisfied by midnight on the day of the contact.

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c) Same-Day Core Contact Requirement

If all the requirements of the core contract event template are

not satisfied by midnight on the day of the contact, then the

record of the contact must be closed (no further data entry

allowed) and it becomes an Additional Contact instead of a Core

Contact.

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d) Clinical Leader Override

Only a Clinical Leader may update the data in a Core Contact

once it is closed, and the system must require an explanation to

be recorded.

So if a Plunket Nurse has a genuine reason to complete the Core

Contact after the day of the contact, she must ask her Clinical

Leader to enter an authorisation code to allow the Plunket Nurse

to enter the data.

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2 Scheduling

First Contact

Each Area needs the ability to set the business rules around who

can make the first contact, eg Area Administrator, Plunket Nurse

or both. The business rule will include who will be assigned to

the workflow action to make the contact. In most cases this will

go to the Area Administrator and if the Plunket Nurse is to

schedule the contact then the administrator will reassign the

workflow action to the Plunket Nurse.

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3 Client ERD Business Rules around when Client Health Information from one

person affects other people with whom they have a relationship.

An example of this is when a child has chickenpox. A note needs

to go into the records of the siblings living in the same house

that they have been exposed to chickenpox. But other Client

Health Information details may only relate to the one person.

The details of each of these will be worked through during the

design phase.

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4 Organisation

ERD

Key business rules will need to be established to define which

roles can be facilitators for which programmes and also what

type of client can attend certain groups. The details will be

worked through during the design phase.

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5 Letter

Template

The business rules around letters will depend on the contract

and the role of the person within that contract. Under the Well

Child Tamariki Ora contract Health Workers should not be able to

write a letter to a client‟s GP. While under the Volunteer Home

Visiting contract a volunteer would be able to write a letter of

introduction for a client around key community agencies such as

budgetary advice. The individual details of these contracts will

be worked through during the design phase.

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6 Tags A client may be tagged so that any activity relating to that client

can be brought to the attention of the Case Manager Plunket

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Nurse or Clinical Leader.

The most common need for a tag is where there may be child

safety concerns.

There will be two tags that can be set:

The Case Manager tag. This will result in PlunketPlus

generating a System Alert to the client‟s Case Manager

Plunket Nurse for every activity against that client, including

any access to the client‟s EHR by any other Plunket Staff.

The Clinical Leader tag. This will result in PlunketPlus

generating a System Alert to the client‟s Case Manager

Plunket Nurse‟s Clinical Leader for every activity against that

client, including any access to the client‟s EHR by any other

Plunket Staff.

A Case Manager Plunket Nurse can set the Case Manager tag for

any client assigned to them. If the Case Manager tag is set, the

Case Manager Plunket Nurse can optionally also set the Clinical

Leader tag for that client.

A Clinical Leader can set the Clinical Leader tag for any client

assigned to a Case Manager Plunket Nurse who reports to them.

This enables the Clinical Leader to monitor activity in a client‟s

EHR, without the Case Manager Plunket Nurse receiving the

System Alerts.

7 Multiple

Case

Managers

It is possible that a client may be enrolled with more than one

service that requires a Case Manager Plunket Nurse.

While the data model allows for this, Plunket has a business rule

that a single Case Manager Plunket Nurse must be assigned to

each service. No client may have more than one Case Manager

Plunket Nurse.

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8 Assign Case

Manager

When enrolling in a service that requires a Case Manager a client

is assigned a Case Manager Plunket Nurse (see Section 12.4.1

“Incoming Referral” on page 146).

If a client is relocating (moving house) or a Case Manager

Plunket Nurse resigns or changes duties then a different Case

Manager Plunket Nurse needs to be assigned (see Section 12.4.3

“Client Transfer” on page 158).

The Clinical Leader role in an Area is responsible for the

assignment of Case Managers.

Each area will have a policy for assigning clients to Case

Manager Plunket Nurses on the basis of the physical address of

the client.

When assigning the Case Manager PlunketPlus will suggest the

Plunket Nurse according to the policy above. The Clinical Leader

will take into account the Plunket Nurse‟s case load, the ethnicity

of the client and other factors and either confirm the suggested

assignment or assign another Plunket Nurse.

In a case where a client relocates only a short distance the

Clinical Leader may decide to keep the same Plunket Nurse to

ensure continuity of care.

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9 Other Other requirements for business rules are touched on elsewhere

in the detail of this specification document, and others are likely

to be identified during the design and implementation phases,

and in the future.

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13 Non-Functional Requirements

Non-functional requirements describe the environment that Plunket

requires PlunketPlus to operate within.

System providers should explain in their proposals how their solution

will meet each of these requirements.

13.1 Privacy

It is accepted practice in the New Zealand health sector to share

relevant details of a person‟s health information, when

appropriate to that person‟s health situation.

Plunket requires the PlunketPlus system to support the provision

of this data and subscribes to the principle of “safe sharing” to

ensure that the privacy of the client‟s information is respected.

This is consistent with the 12 rules of the Health Information

Privacy Code.

This section of the specification sets out Plunket‟s requirements

around the privacy of client information.

-

1 Basic

Principles

Plunket requires that PlunketPlus will meet these basic

principles:

All information and data about a client must be treated as

confidential to the client.

Each client must have given informed consent for sharing

their health information before it is shared and this consent

will be recorded in PlunketPlus. This can only be overridden

for child protection reasons.

It will be explained to Plunket clients that their information

will be shared within Plunket, subject to strict privacy rules.

Plunket Nurses and Plunket Health Workers and their specific

Clinical Leaders have the right of full access to all the data of

clients in the same Plunket Branch. They can use the “break

glass” mechanism (described below) for full access to all the

data of clients outside their Branch.

Area Managers and Clinical Advisors have the right of full

access to all the data of all clients.

Plunket expects to share client information appropriately with

external parties in the event of an emergency, where

reasonable risk exists.

1

2 Break Glass

Mechanism

PlunketPlus will provide a break-glass mechanism for cases

where Plunket Service Delivery Staff in one Plunket Branch need

to access the data of a client associated with a different Plunket

Branch.

The break-glass mechanism is required to:

Ask the Service Delivery Staff member to enter the reason

for accessing the other-branch client.

Generate a System Alert to the relevant Clinical Leader,

1



advising the details of who has accessed what and when, and

the reason.

PlunketPlus must also provide facilities for analysing and

reporting on all break-glass incidents.

Note that PlunketLine Service Delivery Staff have rights to

access all clients, they are not limited to a Branch or Area.

3 Client

Consent

a) Initial Client Consent

As part of the enrolment process and during the first contact,

the Plunket Service Delivery Staff will brief the client about

information privacy and sharing, according to Plunket‟s standard

policy, and record in PlunketPlus that the briefing was given, the

material handed to the client, and that the client understood the

briefing.

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b) Client Records Consent Themselves

It is desirable to have the option for clients to personally indicate

on the PlunketPlus mobile computer that they have understood

and given their consent to the prescribed sharing of their

information.

3

c) Additional Services Consent

At any time, any Plunket Service Delivery Staff may recommend

that the client utilises additional services. In the cases where

client information must be shared with an external service, the

Plunket Service Delivery Staff must obtain the client‟s specific

agreement to share that specific information.

Recording the recommendation in PlunketPlus is Plunket‟s record

that the client‟s consent was obtained.

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d) Share Information Without Consent

It is permissible to share the information without the client‟s

prior consent in cases where the child or Plunket Service

Delivery Staff are at risk.

The system must require the Plunket Service Delivery Staff to

record that this situation has occurred and the reasons for it.

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e) Additional Access Consent

At any time, the Legal Guardian of a client may authorise the

Plunket Nurse or their Clinical Leader (and no-one else) to open

access to the client‟s information by certain other people. The

Plunket Nurse actions this in PlunketPlus, in accordance with the

business rules in “Who Can Access What” below. The system‟s

recording of such actions is Plunket‟s record of the client‟s

consent.

1

4 Who Can

Access What

Plunket requires that PlunketPlus provide role-based access

control following the principles set out in this requirement.

There are several broad categories of people who can access a

1



client‟s information:

Client


Other Plunket Staff

The groupings of information that can be shared, according to

roles and permissions, are:

All data

De-identified data

Contact details

Demographic information

Staff diary

Special confidential information, such as adoption details

which are visible only to the National Clinical Advisor.

Child safety issues

Information hidden by default, unless specifically unhidden

for a specific person by the Plunket Nurse

The Volunteer part of the client‟s Service Delivery Plan

The remainder of the client‟s Service Delivery Plan

Client Health Information, including matters raised by a

caregiver

Plunket Hazard Alerts

Outcomes.

The matrix in Appendix D shows a preliminary set of access

permissions based on these categories and groupings.

During the design phase, each intersection of categories and

groupings in the matrix, the type of access will need to be

indicated:

None

Read only

Add

Update

Delete (although this is a logical delete only).

The matrix will also be used to control which PlunketPlus

functions can be invoked by other approved Plunket systems.

The aim is to have such a matrix in PlunketPlus, or some

equivalent function, that the PlunketPlus Administrator will

maintain.

Plunket will be obtaining legal advice concerning various detailed

aspects of the matrix and may alter the matrix accordingly.

Plunket intends to fully develop the details of the matrix during

the solution design and configuration phase, once a solution has

been selected.



5 All Access to

be Logged

a) Log All Access

Plunket requires that PlunketPlus logs all access to the system,

including details of who accessed it, what they accessed, what

they added or changed, what they emailed, faxed, copied or

printed and the date and time.

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b) View, Analyse and Report on Access Log

Plunket requires functionality for PlunketPlus Administrators to

view, analyse and report on the PlunketPlus access log.

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6 How Plunket

Will Share

Data

a) Access to Plunket and Client Information

Plunket intends to provide access to information in its systems,

including PlunketPlus, through a variety of devices connected in

a number of ways. This requirement is detailed in section 13.4

“Access to Plunket and Client Information” on page 283

In summary:

Examples of devices are desktop and laptop personal

computers and tablet-type devices. The latter are a

significant requirement, as these will be used by Service

Delivery Staff to work with PlunketPlus all day, every day.

Examples of connectivity are local area networks that form

part of the Plunket wide area network, VPN or similar remote

access over various secure and public networks including

mobile communications networks.

In addition, Plunket wishes to provide browser-based access

from personal computers used by parents and other

caregivers, and by individuals in organisations such as GPs

and hospital clinicians.

Plunket requires that its privacy requirements for client

information will be upheld across these devices and connectivity

options.

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b) Provision of Client Information

Other means of sharing Plunket and client information to

external organisations, as defined elsewhere in this document,

are:

Referrals

Data extracts

Reports

In all these methods client information is extracted from the

PlunketPlus system and sent to external parties.

Plunket requires that the information provided by these methods

is subject to:

The access rules set out in the “Who Can Access What”

matrix.

The protocol for external organisations, as below.

1



7 Protocol for

External

Organisa-

tions

Client information provided by Plunket to external organisations

is safeguarded through a variety of mechanisms:

Every health care provider is required to observe the Health

Information Privacy Code 1994 (HIPC) and subsequent

amendments. The code comprises clauses 1-7 and rules 1-12

and is inter-linked with the Privacy Act 1993.

Usually health care providers will have their own privacy

obligations as well, which in some cases are more stringent.

Plunket may provide client information to:

The New Zealand Police

The Child Youth and Family service of the Ministry of

Social Development

Organisations contracted to undertake assessments on

behalf of CYF

Coronial Services

Mortality Review Committees.

If subject to subpoena, this information may comprise the

full client record or part of it, excluding any information

specific to caregivers depending on who is requesting the

information.

If in the event of an emergency Plunket will provide the

information relevant to the circumstances of the emergency.

These agencies are bound by legislation to safeguard the

client information appropriately.

The legal representative of a person or organisation not

covered by the HIPC may request client information. Plunket

will only provide what it deems suitable and only in response

to a subpoena from the appropriate legal representative.

In cases where Plunket is asked to provide client information

to any other organisation (or part of the above organisations

eg within CYF) or person, Plunket will be guided by its Client

Privacy Policy and will make a judgement accordingly.

Plunket requires PlunketPlus to be able to produce appropriate

reports to meet these needs.

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8 De-

Identified

Client

Information

Plunket requires the ability to produce de-identified client

information for research, statistical and performance reasons.

1

9 Aggregated

Client

Information

Plunket requires the ability to produce aggregated client

information for research, statistical and Plunket Staff

productivity performance reasons.

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10 Reference

Standards

The following standards are relevant to the sharing of health

information:

The Health Information Privacy Code 1994 (HIPC)

The Privacy Act 1993

The Official Information Act 1982

The Health Network Code of Practice 2002 (HNCOP)

The New Zealand Health Network Security Policy for General

Practitioners and other Health Professionals

HISO “Health Information Security Framework” (HISF),

formerly known as “Authentication and Security Standard”

The draft paper under development by the Privacy

Commissioner titled “Guidance Material on the Extraction of

Patient Data from General Practitioners' Practice

Management System Computers”. This has relevance to

Plunket‟s requirements as the issues are similar.

The IPAC (GPNZ) security policy for general practice.

Plunket requires the PlunketPlus system to adhere to these

standards and prospective system providers are asked to

describe the extent to which these standards are met by their

system, and how.

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13.2 Security

Plunket has security requirements that will safeguard

PlunketPlus and the information in it from:

inappropriate access

loss in the event of technical or environmental mishap.

This security topic does not cover requirements for protection

against virus, hacking or similar threats, as this is provided by

Plunket‟s technology infrastructure.

-

1 Plunket

Internal

Access

For the purpose of this section “Plunket Internal Access”, the

people who need access to PlunketPlus are those defined in the

table headed “Plunket Staff, paid and unpaid” in Section 6 “Key

Plunket Concepts and Definitions” starting on page 15.

These requirements apply whether the Plunket Internal Access

is from internal or external devices.

Methods of access are discussed in Section 13.4 “Access to

Plunket and Client Information” on page 283.

Access rules are set out in the “Who Can Access What Matrix”

in Appendix D.

-

a) PlunketPlus User Accounts

PlunketPlus must have a unique user account for every user of

the system, whether internal or external. For clients and

external care providers, this requirement may be met by

associating the necessary attributes with the person in the

Person/Organisation structure defined in Plunket‟s conceptual

data model.

Please describe how this would work.

1

b) Microsoft Active Directory: Integration

PlunketPlus is required to integrate with the directory service in

place at Plunket, which will initially be Microsoft Active Directory

(AD), followed by a migration to Microsoft Forefront Identity

Manager (FIM).

Please describe the features of the integration and how it

works.

1

c) Microsoft Active Directory: Users in AD or FIM

Every Plunket Internal Access user of PlunketPlus must exist as

a user in AD or FIM.

1

d) Microsoft Active Directory: Users not in AD or FIM

PlunketPlus must not allow Plunket Internal Access by any user

1



not in AD or FIM.

Every Plunket Internal Access user must be successfully logged

on through AD or FIM and duly authorised to access

PlunketPlus before they are allowed to access PlunketPlus.

e) Microsoft Active Directory: Authority to Access

PlunketPlus

Plunket would prefer that PlunketPlus obtains information from

AD or FIM as to whether a Plunket Internal Access user may or

may not access PlunketPlus.

2

f) Microsoft Active Directory: Roles

Plunket would prefer PlunketPlus to utilise Plunket Internal

Access user roles from AD or FIM, although this is not

mandatory.

2

g) User ID and Password

Every Plunket Internal Access user of PlunketPlus must have

their own unique User ID and password.

Plunket‟s policies will require people to use only their own User

ID and to keep their password secure and confidential to

themselves.

Pass-through access from AD or FIM does not over-rule this

requirement; every legitimate PlunketPlus user must still have

a unique PlunketPlus account.

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h) Two-Factor Authentication

Plunket may introduce two-factor authentication.

Please explain any implications to PlunketPlus.

1

i) Do Not Allow “Remember Password”

The system must not allow users to get the system or their

computer to remember their PlunketPlus password.

Note that this requirement may be delivered from two

platforms:

AD or FIM for Plunket Staff.

A PlunketPlus function for accessing the PlunketPlus Portal.

1

j) Password Reset

PlunketPlus must NOT have a self-help password reset

mechanism.

Plunket‟s policies require that Plunket Internal Access users

contact the Plunket service desk in the event a password needs

1



to be reset.

k) Password Expiry

Password expiry periods will be set by Plunket in accordance

with Plunket policies. If PlunketPlus does not utilise AD or FIM

to meet this requirement, it must provide this function itself.

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l) Account Deactivation – Automatic

When a user account is deactivated in AD or FIM, Plunket

prefers that the PlunketPlus account will be automatically

deactivated too.

2

m) Account Deactivation - Manual

A facility must be provided for the PlunketPlus Administrator to

deactivate a user account in PlunketPlus.

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n) Retain History for Deactivated Account

The system must retain all data pertaining to a deactivated

account.

Only the PlunketPlus Administrator should have access to this

data.

1

o) Role Based Access

PlunketPlus is required to control access to each function and

each type of data for each user in accordance with the “Who

Can Access What” matrix defined in this document.

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p) Systems Administrator Access to PlunketPlus System

and Data

Technology systems administrators must not by default have

the ability to access or use the PlunketPlus system or data.

This type of access must be provided through a very specialised

system administrator account and all access through this

account must be logged and audited.

Specialist support access for PlunketPlus is described in the

“Who Can Access What” matrix.

Please describe how this would work.

1



2 Non-Plunket

Access

Clients will be provided with Non-Plunket Access to PlunketPlus

from outside the Plunket network, through the PlunketPlus

Portal.

Usually these clients will be the parent or primary caregiver of a

child.

These people will not be known to Plunket‟s internal network

management system and will not have logon credentials or

other information in AD or FIM.

-

a) PlunketPlus Security Mechanism

PlunketPlus must provide a security and mechanism to manage

access to the system by authorised Non-Plunket Access people

who are not eligible for Plunket Internal Access.


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b) Administration of PlunketPlus Security Mechanism

There is potential for a high administrative over-head to

register and maintain user accounts for Non-Plunket Access

users.


1

3 Mobile

Computers

Plunket will establish an appropriate hardware security model

for its mobile computers, possibly including options such as

BIOS passwords, tokens or other forms of multiple-

authentication, data-at-rest and data transmission encryption.

Please describe how the PlunketPlus system can support these

or other forms of protection for PlunketPlus data stored on the

mobile computer, including the local replicated copy of the EHR

database and decision support material, email and other data.

1

4 Inter-

System

Access

Internal Plunket system-to-system access will be regulated by

the security policies enacted on the Plunket network.

The security requirements stated in this section also apply to

system-to-system access to PlunketPlus.

Please describe how this will work.

1

5 Backup and

Restore

a) Backup and Restore Facilities

Backup and restore facilities must be available for the

PlunketPlus system and for the configurations and data held in

it.

This must include:

Automated backups at predetermined scheduled times.

Selective record restore.

Full database restore.

1



Full system restore.

Multiple levels and cycles of backup.

Audit reports of the success and integrity of backups.

Facilities to validate backups to ensure they have worked

properly and that the backed-up data is able to be restored.

System Alerts when backups have not functioned properly

as scheduled.

b) Integration with Plunket Technology Infrastructure

Integration with the Plunket‟s planned technology infrastructure

would be advantageous, specifically:

Integration with the NETApp FAS 2020 unified storage

capability (backups, synchronisation and data recovery).

Integration / support of Plunket‟s Virtualisation environment

(full system recovery).

2

6 Disaster

Recovery

Capability

a) Disaster Recovery Facilities

The system must include facilities and processes to quickly

rebuild the system and its databases quickly, in the event of a

severe or total loss to the system or the environment it is

operating in.

This will need to comply with return-to-service objectives that

will be determined as part of Plunket‟s service level

agreements.


1

b) Integration with Plunket Technology Infrastructure

Integration with the disaster recovery functions of Plunket‟s

planned technology environment is essential.


1



13.3 The Health Network

The New Zealand Health Network forms part of the national

framework for the secure and private collection and sharing of

electronic health information within the Health and Disability

Sector.

It consists of a group of services provided by multiple

telecommunications organisations, governed by the Ministry of

Health and subject to well-documented rules.

The governance of the Health Network regulates the sharing of

patient medical information between healthcare organisations.

Access to the network is via accredited network provider

gateway and interconnection services.

The Health Network is used by a high percentage of general

practices and by other health sector organisations as a means of

connecting to common services and each other, as known

organisations within a secure environment.

Plunket must comply with the New Zealand Health Network

security policies and standards for the processing, storing and

sharing of client contact and clinical information both within its

internal network environment and inter-connections with other

Health providers.

Details about the Health Network can be found at:

http://www.moh.govt.nz/moh.nsf/indexmh/healthnetwork-

infopack

and in particular at:

http://www.moh.govt.nz/moh.nsf/pagesmh/8806/$File/NZHNsec

urity.pdf

-

1 External

Plunket

Communic-

ations

Plunket‟s interoperability requirements will result in PlunketPlus

exchanging information with other systems, internally and

externally.

In addition to all other relevant standards and security

requirements, Plunket requires that communications with health

provider organisations external to Plunket are carried through

the Health Network.

1

2 Mobile

Communic-

ations

Plunket‟s mobile computer devices will have connectivity only

with Plunket‟s internal network (even for access to the internet).

The requirement to connect through the Health Network does

not cover this scenario, nor does the Health Network currently

have any accredited providers of mobile connectivity.

-

http://www.moh.govt.nz/moh.nsf/indexmh/healthnetwork-infopack

http://www.moh.govt.nz/moh.nsf/indexmh/healthnetwork-infopack

http://www.moh.govt.nz/moh.nsf/pagesmh/8806/$File/NZHNsecurity.pdf

http://www.moh.govt.nz/moh.nsf/pagesmh/8806/$File/NZHNsecurity.pdf



13.4 Access to Plunket and Client Information

Plunket requires PlunketPlus to provide access to Plunket and

client information through a variety of mechanisms:

Plunket owned personal computers within Plunket, used by

authorised Plunket Staff.

Plunket owned mobile computers used in the field, at home

and in the office by Plunket Service Delivery staff and some

Area Management and National Office staff.

Privately owned personal computers in the homes of Plunket

Service Delivery staff. This scenario will be common in the

case of Volunteers.

The systems used to access Plunket and client information could

be:

The PlunketPlus system running on Plunket personal

computers and mobile computers. This is sometimes known

as a “fat client”.

A web-based version of the PlunketPlus system that operates

through a suitable web browser, with appropriate security

measures.

A remote desktop approach may be appropriate; there are a

variety of technology solutions to provide this whether or not

it is provided by the PlunketPlus solution itself. This approach

is sometimes known as “thin client”.

In another category, clients will be able to access their own EHR

using the envisaged PlunketPlus Portal through the public

internet, from a web browser on any device anywhere, with

appropriate security measures.

Every person who accesses PlunketPlus in any of these ways is

required to have and use their own unique login account and

password in PlunketPlus, as defined in Section 13.2 “Security” on

page 277.

Access will be role-based, as set out in the “Who Can Access

What” matrix and as specifically authorised by the client and

their Plunket Nurse.

1



13.5 Reporting

PlunketPlus reporting will be split into three main areas and

there will be some overlap between them. These are:

1. Reporting for Operational reasons by Area, Branch, sub-

Branch and Service Delivery Staff member.

2. Aggregated Reporting for Senior Management and

Contract by Area DHB, TLA and Nationally.

3. General Reporting and Reporting By Individual Client.

Plunket sees reporting being as graphical as possible with

reports produced on screen with the ability to print if needed.

-

13.6 Operational Reporting Requirements

Plunket requires reporting to support the operation and

improvement of its service delivery, with the significant example

of the Well Child Tamariki Ora contract.

This includes reporting services by area, branch, sub-branch and


This will cover both key outcome measures and service delivery.

-

1 Key

Outcome

Reporting

Below are examples of Key Outcome Reporting for Plunket.

Please explain how your proposed solution will perform this kind

of reporting.

We will be collecting data on the age at which children start

solids and we will want to be able to look at age by ethnic

group, age by Plunket area, age by deprivation, age by

Plunket Nurse and so on. We will want to compare the ages

for each nurse / branch to area key outcomes and national

key outcomes. For example we may see that the average

age for Maori starting solids in Mangere is 116 days in

comparison to Maori in Counties Manakau in comparison to

Maori nationally and all in Counties Manakau and all

Nationally.

We will be collecting data on Family Violence screening. We

will need to know the number and or percentage screened,

the number of those who were screened who had a positive

response and of those who responded positively what action

was taken. Again this will need to be compared nurse to

Branch to Area etc.

We will be collecting data on smoking in homes and exposure

to smoke. As above, if there is a positive response then we

will ask more questions as to who in the family smokes.

Again this will need to be compared nurse to Branch to Area

etc.

1



2 Service

Delivery

Reporting

Below are examples of Service Delivery Reporting for Plunket.


of reporting.

We currently have a “Cores due report” that a nurse can run

to find children who are due a Core Contact before a future

date. As the nurse have paper diaries they have to manually

check through the list to see who they need to contact. We

hope to change practice and get contacts scheduled for Core

Contacts so we would want either to ignore those with

contacts booked or flag them in some way. The aim would be

to have no clients who do not have a Scheduled Contact. The

Clinical Leaders would need a report to show all children in

the area with a Core Contact due in a certain time period. It

would show those with contacts and those without. The

report, which would have links to information about the

clients, by buttons may look like this

but once we have got systems up and running we will no

doubt want to change things as we get to know the

capabilities of new system better , perhaps by filtering by

ethnicity or deprivation. We will need the ability to change

these reports within Plunket, and quickly.

As a main part of the new Well Child Contract we need the

ability to measure performance by area, branch, sub-branch,

DHB, nurse and other parameters. So we may want to see

something like the following:

This is a much more standard type of reporting and it relies

on being able to cut and dice data for different views –

maybe replacing the Dep Band by nurse name or sub

branches by branch.

Our current operational reporting covers the following and

can be viewed by Deprivation, Area, Branch, Sub Branch,

DHB, nurse and other dimensions. The volunteer reporting is

covering all the services offered that are not WCTO or other

DHB funded contracts.

1.1. Contacts with targets 2007 - 2008



2.1. Core 1 contacts

1



2.2. Family centre contacts

3.1. Referral date vs contact date

3.2. Level of Service - From engagement

3.3. Level of Service - Core 1 onwards

4.1. Contacts by month

4.2. Nurse Report by month

5.1. Volunteer Report by month

6.1. Breastfeeding Percentage Report

6.2. Breastfeeding Report

6.3. Immunisation Report by month

6.4. Smoking Report by month

6.5. CDC Report by month

The current volunteer reporting for Auckland City looks like

this.

And can be viewed by ethnicity and other dimensions. We

need the ability to build reports similar to this from the new

database – either directly or from a data warehouse. The

ability to drill down to see those who attended the Owairaka

Playgroup compared to those who were enrolled is a

potentially useful function.



13.7 Aggregated Reporting Requirements

1 KPI

Reporting

Plunket requires various forms of aggregated reporting, with

options for sorting, totalling and presenting the results.

As well as key outcome reporting on a National level and

comparing Plunket Area to Plunket Area we need to count

contacts and clients.

An example is the MOH Well Child Contract Monthly KPI

reporting:

This is the highest level of aggregated reporting and involves

performance against targets.

For the quarterly reporting we need to be able to report by DHB

and include other measures such as Breastfeeding statistics,

Smoking statistics and more.

We report slightly differently to Senior Management but topics

follow the same themes and this time split by Plunket area.


of reporting.

1



13.8 Individual and General Reporting Requirements

1 Reporting

By

Individual

Client

This kind of reporting will allow data by individual client to be

compared to aggregated data from the larger population.

A good example of this would be a growth chart that compares

the growth of a child client to the New Zealand Population and

others with the same ethnic profile.


of reporting.

1

2 General

Reporting

With the implementation of PlunketPlus, Plunket will be

collecting data electronically much more than ever before.

We will need to be able to report on a number of criteria, such

as:

by individual client

by mothers

by fathers

by other caregivers

by all child clients

by sub groups of child clients

by individual Service Delivery Staff member

by individual clinical leader

by individual group

by area, branch, sub-branch

by DHB, Territorial Authority

by Care Delivery component

by key health outcome

by contract, contact type

by ethnicity (different levels)

by deprivation

by age of child

by age of caregiver

by date of contact, week of contact, month of contact

by quarter, year

by other specified period

by type and place of referral, incoming and outgoing

and by anything we record.

Reporting needs to be flexible and new reports need to be able

to be generated “in house”.


of reporting.

1



13.9 Reporting - General

1 Report

Generator

Plunket requires a report generator function for Plunket‟s

business intelligence analysts to use which will allow them to

access, manipulate, sort and summarise data from the


Please describe the report generator functionality proposed to

work with PlunketPlus.

1

2 Data

Warehouse

Plunket is prepared to consider implementing a data

warehousing facility if this is recommended by the PlunketPlus

software provider.

Please describe any recommendations in this area.

2

13.10 System Availability and Performance

1 System

Availability

Plunket requires PlunketPlus to have a high level of availability,

so that it is able to be used by Service Delivery Staff during their

normal hours of operation, which are 7:00 am to 9 pm Monday

to Friday and 7 am to 5 pm on Saturday, excluding national

public holidays.

Plunket recognises that the required offline capability for mobile

devices will provide local availability outside those hours.

There is a further requirement for PlunketLine Service Delivery

Staff to access PlunketPlus 24/7. Please explain options for

achieving this.

Software providers are requested to comment on the availability

performance of their proposed system and provide evidence that

will be validated during Plunket‟s reference checking.

1

2 System

Performance

Plunket requires that PlunketPlus operates with sufficient speed

so that Service Delivery Staff do not experience any delays

waiting for the system to respond.

Software providers are requested to advise the optimal

technology infrastructure requirements to achieve this and to

comment on the response performance of their proposed system

and provide evidence that will be validated during Plunket‟s

reference checking.

1

13.11 User Devices

Plunket has undertaken a pilot project to investigate the needs

and options for computer devices suitable in the working

environment of its Service Delivery Staff.

-



The key findings of the pilot included:

A full-screen computer is required. PDA and telephone

devices are not acceptable as their screens are not

sufficiently large.

A tablet-style computer is required. Fold-out devices such as

laptops, notebooks and netbooks are too cumbersome in

practice.

The device must not have any protruding or removable

components, as anything protruding is vulnerable to damage.

Also young children are prone to grabbing such items.

To meet the requirement for full-time connectivity to the

Plunket network, mobile communications capability must be

provided without protruding components such as a modem.

There are various devices available that meet these

requirements and the marketplace is developing rapidly in this

area currently.

Plunket will embark on a procurement process for devices once it

has selected the software solution for PlunketPlus.

Given Plunket‟s intention to progressively implement

PlunketPlus, the devices will probably be procured on a

progressive basis too. This will allow Plunket to benefit from the

anticipated evolution of this technology.

Please explain how your solutions to the following points will be

achieved.

1 Mobile

Device

a) Operate on a Mobile Device

PlunketPlus must operate on a mobile computer device such as

that described above.

1

b) Touch Screen

PlunketPlus should be able to be used with touch screen

technology.

2

c) Future Technology Changes

PlunketPlus must operate on successive new devices as the

technology advances.

1

d) Operating System

Please name and describe the operating system that PlunketPlus

can operate under, on such a mobile device.

1

e) Standby Mode

PlunketPlus must be able to deal with the device being put into

standby (or similar) mode then resume immediately and without

issues when the device is reactivated.

1



f) Online and Offline

PlunketPlus must continue operating without interruption or

issues whether online or offline from the Plunket network and

when this connectivity changes from one state to the other, no

matter how frequently.

1

g) Change of Connectivity Type

PlunketPlus must continue to operate with minimal interruption

to service when its connectivity with Plunket‟s servers changes

between connectivity types, for example from one to another of

mobile communications, Wi-Fi, physical LAN cable.

1

h) Unexpected Shutdown

PlunketPlus must cope with unexpected shutdown of the device

and resume operation without issues when the device is running

again.

1

i) Replication and Synchronisation

PlunketPlus must be able to replicate and synchronise specified

components with master data on Plunket servers, for example:

EHR data for the database subset stored on the device.

Lookup tables.

Replication and starting or stopping replication must not

interfere with or delay the operation of PlunketPlus.

PlunketPlus must make clear to users when there are pending

replication or synchronisation tasks waiting.

1

j) Software Updates

PlunketPlus software changes must be able to be applied on the

mobile device with minimal technical expertise and minimal

interruption to service.

1

k) Security

As well as the security requirements specified elsewhere in this

document, PlunketPlus must support device and operating

system security features.

1

13.12 User Interface

Plunket has set out its preliminary thinking on screen layouts

and functionality in Section 9.3 “Screen Displays and Data Entry”

on page 49.

General user interface requirements are specified as follows.

-

1 Ease of Use PlunketPlus must be easy for Service Delivery Staff to use, for

example:

1



Consistent screen layouts.

Consistent navigation scheme.

Consistent layout, appearance and naming of buttons, tabs

and other components that appear on multiple screens.

Intuitive to use.

Fonts and colours that provide sufficient differentiation for all

users, including those with impaired vision.

Large content, necessary for Service Delivery Staff who:

are of all ages (vision can change with age)

are under pressure in a busy family home situation, when

there is little time to pore over a computer screen

may have large fingers (particularly relevant if touch

screen technology is being used).

Large content, to aid in showing information to clients.

2 Data Entry To aid Service Delivery Staff enter information, PlunketPlus must

offer features such as:

Not data-entry intensive.

Fields should automatically pre-populate when the data is

available.

Drop-down boxes.

Drop-down box functionality that ensures only relevant

content is displayed, relating to the current context, with

minimal need for scrolling to select.

Type-ahead.

Optional means of input, depending on the hardware

available or preferred by the user.

1

3 Help PlunketPlus must provide a “help” function for Service Delivery

Staff to use when they require assistance in using the system.

1

4 Search PlunketPlus must include a search function to assist Service

Delivery Staff to find items of content in any part of the

database or system functionality.

1

13.13 Change Management

Plunket recognises that introducing PlunketPlus throughout the

organisation will have significant impact on staff and the way

that they carry out their duties.

A separate workstream has been established to manage this

change, and it will run alongside the successive phases of the

PlunketPlus procurement and implementation.

-



13.14 Technology Infrastructure Requirements

Software providers are invited to show in this section the degree

to which their system will operate in Plunket‟s future technology

environment.

Plunket‟s planned technology environment is described in

Section 7.5 on page 28.

Any non-compliance will not necessarily disqualify a system that

otherwise significantly meets Plunket‟s requirements. Plunket is

prepared to consider adjusting its technology environment to

support such a system.

-

1 WAN Infra-

structure

Please describe how your system would operate within this

environment.

1

2 Systems

Infra-

structure

a) Virtualisation


environment.

1

b) Server Operating Environment (SOE)


environment.

1

c) Directory Services


environment.

1

d) Web and Firewall


environment.

1

e) Messaging


environment.

1

f) Collaboration Services


environment.

1

g) Database


environment.

1

h) Anti-Virus


environment.

1



i) Software Update Management


environment.

1

3 Operations

View

Please document your proposed PlunketPlus solution at an

Operations View level; identifying technology infrastructure

components, their inter-actions with each other and an estimate

of size and power requirements.

1

4 PC Infra-

structure


environment.

1

5 Health

Network

Please describe how your system will work with the New Zealand

Health Network.

1

6 SEEMail Please describe how your system will work with SEEMail. 1

7 Transfer of

Care

Please describe how your system will work with the various

standards and health sector facilities relating to Transfer of Care.

This requirement has a focus on the technology infrastructure

aspect, unlike the functional requirements described earlier in

this document.

1

8 Business

Continuity,

Disaster

Recovery


environment.

1

9 Instances Plunket requires PlunketPlus to be set up and operate in multiple

instances simultaneously, to provide separation of development,

testing and training activities from production.


environment.

1

10 Automated

Regression

Testing

Plunket requires automated regression testing facilities.

Please describe the automated regression testing facilities that

will be provided to support PlunketPlus and explain how this will

be used.

1

11 Back-end

Hardware

Please describe the back-end hardware requirements for their

PlunketPlus solution, detailing:

Server hardware requirements.

Storage hardware requirements.

Networking hardware requirements (WAN, LAN and Data

Centre).

1



13.15 Implementation Approach

13.15.1 General Implementation Approach

Plunket will be implementing PlunketPlus in a staged manner,

over a period of at least two years and perhaps as long as five

years.

This will most likely be along the lines of implementing the

system a function at a time, location by location.

Plunket is including its full requirements for the system in this

requirements specification. Evaluation of proposals will be for the

whole system.

The commercial and contractual aspects relating to this

approach are detailed in the RFP document and the proposed

contractual agreement with the software provider.

-

1 Implement

Functions

in Steps

The PlunketPlus provider must be prepared to implement the

functions of the system in a series of functional steps.

Please state the approach you would take to achieving this.

1

2 Implement

Location by

Location

The PlunketPlus provider must be prepared to progressively

implement the system one or more geographical and

organisational locations at a time.

Please state the approach you would take to achieving this.

1

3 Full System The PlunketPlus provider must propose the full system that

meets Plunket‟s entire requirements specification, on the

understanding that it will be progressively implemented in steps

and locations over an extended period.

1

13.15.2 A Possible Sequence of Functional Steps

1 Priority Plunket‟s preferred implementation priorities are:

Well Child Contract and services

Basic reporting

Other services

Full reporting

Internal integration

Incoming LMC referrals

Outgoing referrals

Decision support

Client portal (although preferred earlier if practical)

All the rest, maybe phased too

Plunket welcomes software provider suggestions on the

1



components of the implementation steps that will generally align

with these priorities.

An initial internal assessment has resulted in Plunket drafting a

potential implementation sequence, set out as a series of

deliverables in four steps.

These four steps are included in the Pricing Tables included in

the RFP documentation and are not repeated here.

2 Possible

Step 1

Plunket considers that the components listed for Step 1 are all

essential in order for Service Delivery Staff to conduct the

majority of their client contacts without carrying all the

paraphernalia necessary to operate partly on the new system

and partly on the old system.

These components comprise the majority of the EHR and the

system functionality, which implies that Step 1 would be large,

complex and costly.

Plunket will welcome suggestions from software providers on

ways to reduce the scope of Step 1 while still enabling Service

Delivery Staff to carry out their duties without additional burden.

1

3 Stages of

Roll-out

The roll-out of the system will be location by location throughout

the organisation. The order of the locations is yet to be decided;

however it will be important that we use the lessons from each

roll-out to benefit the next area due for roll-out.

Plunket expects some overlap, with an implementation sequence

that could be something like:

1

Location

1

2-3

4-10

11-24

Step 1

Step 1

Step 1

Step 1

Step 2

Step 2

Step 2

Step 2

Step 3

Step 3

Step 3

Step 3



13.16 Data Migration

Plunket has data in existing systems that will need to be

migrated into PlunketPlus.

Details will need to be worked out during the design phase;

some initial requirements are specified as follows.

Please comment on each of these requirements.

-

1 Client Data Client data is currently stored in POND and in the distributed

paper PHR records.

-

a) POND – Current Clients

Data relating to current clients is held in POND.

This client data needs to be transferred from POND into

PlunketPlus as part of the progressive PlunketPlus roll-out.

POND data consists of numeric values and these do not translate

to the PlunketPlus data dictionary.

Plunket requires the POND data to be stored in PlunketPlus as

one pdf document for each active client, the format to be

agreed.

Plunket Staff will be able to view this pdf from within the client‟s

EHR screen displays and will manually interpret the numeric

values.

It is important while there are two systems running and reports

are required from both systems that contacts and clients do not

get double counted. A possible solution is that information is

moved from one system to another therefore it is only in one

place, or as information is moved to PlunketPlus it remains in

POND, deactivated.

1

b) POND – Non-Current Clients

There is no requirement to migrate the data of inactive clients

from POND to PlunketPlus.

-

c) Client PHR Data

The current Plunket Health Record for each client is held on

paper in the applicable Area Office.

Plunket does not intend to back-capture PHR information as data

in PlunketPlus.

Plunket does plan to scan each client‟s PHR during the

progressive roll-out and attach the scanned image to the client‟s

EHR in PlunketPlus.

Plunket Staff will be able to view this pdf from within the client‟s

EHR screen displays.

1



2 Plunket

Staff Data

Ideally an extract from the payroll system can be obtained and

used to initially populate the Plunket Staff data in PlunketPlus.

1

3 Volunteer

Data

Plunket has determined that it is not appropriate to utilise the

Volunteer data held by Plunket‟s marketing department.

Volunteer data will be manually loaded during the course of

commissioning PlunketPlus in each area.

1

13.17 System Support

1 System

Support

Plunket will require the software provider to provide support of

PlunketPlus once it is operational.

Software providers are requested to propose a support model for

Plunket‟s consideration.

Details of the support will be worked out with potential software

providers at the appropriate time during the procurement

process.

1

13.18 Training

1 Train the

Trainers

Plunket intends to adopt a “train the trainers” approach, where

the software provider will train selected Plunket Staff to

understand and use PlunketPlus.

Those Plunket Staff will then become trainers, who will train

others in the course of the progressive roll-out.

The train-the-trainers approach would be modular, aligned to

the implementation steps outlined above.

Software providers are requested to describe how they will

deliver this.

1



14 Appendix A: Plunket Organisation Chart



15 Appendix B: Data Dictionary

Plunket has set out in this appendix all the information it has

available about the data entities required in PlunketPlus, including

the required attributes and relationships.

These details are set out under four sub-headings:

Clinical Dictionary

Entities and Attributes

Mapping Attributes to Clinical Dictionary

Contract Event Templates – Well Child Contract

Plunket intends this information to inform software providers of the

scope and variety of the data requirements, and recognises that

implementation details will need to be agreed as part of the design

phase.

15.1 Clinical Dictionary Overview This section of the data dictionary defines the various required elements of

client information that will be collected through observations, measurement and discussion at the client contact.

The elements of the Clinical Dictionary will change as existing contracts are reviewed and new contracts are added. For example, the Well Child Tamariki Ora contract with the Ministry of Health is currently under review.

Other changes will come about as a result of evidence changing practice and from reviews with Plunket staff.

This dictionary is currently set up in the sequence of the current Plunket recording system. It is recognised this will change with the introduction of PlunketPlus.

To support the requirement for “Client‟s Own Language” in Section 9.3 “Screen Displays and Data Entry” on page 49, it will be necessary for the database to store the additional language words associated with the English words where this is needed. Details will need to be worked out during the design phase.

15.1.1 Client Contact

Client Contact

Adult Only When the purpose of the contact is only related to the health needs of the adult or family/whānau, rather than directly to the child/ren. This should only be used when the child‟s health is not the direct focus or purpose of the contact. The child‟s NHI should still be used for recording these contacts to connect the contact to the caregiver of the child. Field Type: tick box

Age The age of the child/Tamariki when the core or additional contact was completed, calculated against the birth age. This will be automatically populated from the information in the system.



Anticipatory guidance Provides the family/whānau with evidence based information on what to expect on both the child/Tamariki‟s current and the next developmental stage. Includes parenting practice and adjustment to child/Tamariki rearing and development. Anticipatory guidance is relationship based and educative, taking cues and evidence based knowledge into the future for the child‟s benefit. Examples “Ways to encourage crawling” / “ways to encourage language” / “developmental play options”. Field Type: alpha

Appointment Not Kept (ANK)

Client did not keep a mutually agreed, previously arranged, scheduled contact. Field Type: dot.

Attachment These categories are still to be confirmed

Breastfeeding See Nutrition section in client contact

Caregiver attending with child (new)

State the name and relationship of the person who is attending the visit and takes responsibility for the child on this occasion - it may be more than one person. Field Type: Drop down: Mother; Father; Grandparent; Nanny; Aunty/Uncle; Sibling; Other.

Caregiver's View Summary of the essence of what you listened to from the caregiver‟s view of the child/Tamariki and of parenting, to elicit the perceptions expressed and gain understanding. This subjective data is accepted as it is given. It is not interpreted to mean anything other than what was expressed. An example of some entries is: “No concerns with child‟s growth and development, family enjoying new baby”. Name the caregiver giving the information e.g. mother, nanny, or grandparent. On full assessment, it is possible to have contradictory findings. Analysis will be necessary once an assessment is completed. Field Type: Free text

Child's age at contact The age of the child client when the core or additional contact was completed. This is usually written in: weeks and days up to 6 months of age i.e. 5 6/7 = 5 weeks and 6 days; thereafter in months and weeks i.e. 6 2/52 = 6 months and 2 weeks or 6½ months; or in years and months i.e. 2 2/12 = 2 years and 2 months. It indicates the chronological age of the child and is used as a reference point for health assessments compared with predicted development. It is collected by default as it is derived from date of birth and contact date. Field Type: numeric

Child's Health Statement of the general wellbeing of the child/Tamariki; physical, emotional, social and environmental. Field Type: Drop down: Well; illness – drop down to include asthma, hips, undescended testes, ill health, dental health issues, infectious disease, allow room for comment. Also room for general comments

Complexity of need The mix of factors that are protective or increase risk for vulnerable families. Complexity influences decisions made. The more the complexity, the less certainty about how the family/whānau interacts, accesses necessary resources, accept responsibility for child/Tamariki care, or responds to health problems. Families who may have long-standing life problems may be less predictable, even unreliable in terms of their health seeking behaviour. Complex situation have the potential to threaten the safety of the child/Tamariki. A family/whānau with a child/Tamariki who has a congenital abnormality may have increased complexity at first, but one year on when effective support structures are in place. The complexity may reduce as their coping strengths increase. The extent of complexity may be influenced by poverty, or a health condition in the child/Tamariki or family/whānau. It can be difficult to establish which element impacts on the child/Tamariki the most, as the whole situation is “complex”. However, the more complex the situation, the greater the need to improve family life for children with appropriate and timely interventions. Field Type: alpha

Contact Type Identifies the type of contact being made – core (C) or additional (A). All contacts are either core or additional.



Core: Contact between a Plunket Nurse and a child client, which occurs with adult consent. Core contact includes all three aspects of the Tamariki Ora schedule. The adult or delegated caregiver must be an active participant during the planned health care activity. Core contacts relate to specific ages/development stages of child. The total number of Core Contacts completed by Plunket Nurses cannot exceed 8 between the ages of 4 weeks and 5 years. Core contacts relate to specific ages/developmental stages of the child/Tamariki as per the Well Child Framework. The computer will automatically work out the Core Contact due by date of birth

Additional: Contact provided by a Plunket staff member for the adult/child client who is formally enrolled with Plunket. An additional contact may be funded by the core/main contact or by another source. It is "additional" to the age related core contract for specific interventions planned at the core contract. Field Type: Alpha. Validation: C- Core, A- Additional.

Core Contact Completed

A Core Contact is completed when all requirements in the Service Delivery Plan for Client Event are completed.

Counselling/ emotional support

A helping process with the aim not to change the person but to enable them to use the resources they have access to for coping with life situations. Emotional support focuses on problems and feelings and ways to support parents in learning to cope in a positive way. It includes encouragement, reinforcement and enablement as a result of active listening, from a strengths based perspective. “Encouraged with feeding choices”/ “reflected on feelings about being a parent” / “supported to continue to breastfeed”. Field Type: alpha

Date This is the date on which the contact took place. It will be recorded according to SNOMED requirements around recording. Field Type: date

Dental Health The categories for this still have to be confirmed, it is assumed it will be based on Lift the Lip

Dental Enrolment Record date of any referral or recommended enrolment to the dental therapist after 12 months of age. Using SNOMED format for dates, next visit a reminder comes up to see if they have accessed the dental service yet, this will continue until it is ticked.

Designation The designation of the staff member undertaking the contact. This will be automatically completed by the sign on for the person accessing the computer.

Development Progress Assess developmental progress using Plunket Developmental Surveillance Profile (Royal New Zealand Plunket Society, 1998). This will need to be developed as part of the decision support basing the information of evidence based assessment such as Plunket developmental surveillance profile, PEDs and/or Sheridan. Will include physical development, communication development, behaviour development, exploration development. In the meantime this section should be free text until the decision support has been developed. Descriptors/examples. Document key-skills acquisition, e.g. “mutual gaze”, “sitting and pivoting”. Field Type: Until the tool has been finalised - drop down: Progressive within normal range; Progressive outside normal range: development delayed (please specify). Anticipatory Guidance/education - free text. Referrals/Recommendations: drop down with list of relevant services for development you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to development - with other added as a last option with specify reason.

Drugs/Alcohol The categories for this still have to be confirmed.

Early Childhood Education enrolment

Is the child enrolled in some form of early childhood education - if yes what type of service Kindergarten, preschool, daycare, home programme,



PAFT, crèche, other - please state

Employee Number and name

The employee number allocated to the Plunket staff member carrying out the client contact/care delivery. There are five boxes to complete. If you have a 4 digit number put 0 in the first box, for example: 2875 becomes 02875; 366 becomes 00366. The staff member prints their name. Field Type: numeric/text. Validation: Codes used in staff table as developed.

Family wellbeing Inquire as to family/whānau experience and circumstances including adjusting to this child/Tamariki within their family/whānau circumstances. Field Type: free text

Family Violence screening (new)

Field Type: Drop down – screening question asked – yes/no. From yes – answer Yes/no. If yes - advice provided (to be free text)/referral or recommendation to. If no do you have concerns yes/no (free text). From no answer to first question – reason why not asked. Anticipatory Guidance/education – free text. Referrals/Recommendations – Drop down with list of relevant services for family violence (including notification to CYF) you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to family violence including notification to CYF – with other added as a last option with specify reason.

Funding Indicates the funding source for the service contract. The Well Child/Tamariki Ora service contract includes core and additional contacts in the universal programme. Other service contracts may provide resource for additional contacts. A funding source must be provided to code for the correct service contract. Field Type: numeric. Validation: As per reference table

Group Comprises of 2 or more adult participants. A number of services are provided in a group setting, for example parenting education (solids/sleep talks). Field Type: marked box

Growth Weight measured using certified scales on the correct surface, for the naked weight of infant. May be in a singlet and undies for children over 1 year, though these must be lifted in observing the child during examination. Head circumference is taken at the largest diameter – occiput-frontal axis, from three successive measurements using a non-stretch or paper tape. Length is measured using a broad board, or similar, with the infant positioned in the supine position, using the feet to push the board against. Height (once child can stand with feet positioned close together) is taken with the child/Tamariki positioned with no shoes on using a standard measuring tool. Record measurements on percentile graphs against accurate age. Field Type: drop down: Weight in kg; Length in cm; height in cm; head circumference in cm; Each of these will then go on and automatically populate the growth chart based on the UK WHO code growth charts. Drop down: Concerns – within normal range; Failure to Thrive; overweight; Other (please specific). Anticipatory Guidance/education – free text. Referrals/Recommendations: drop down with list of relevant services for growth you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to growth – with other added as a last option with specify reason.

Head Circumference See Growth

Health Determinants factors

Identified determinants of health that may have a negative or positive influence on the child/Tamariki‟s short or long-term health. The Well Child Framework lists the following three types of factors to be taken into account in decision–making regarding service intensity: The extent to which the identified needs have an impact on the health, wellbeing or safety of the child/Tamariki (dependency on family/whānau resilience); The extent to which the risk factors are likely to become significant problems in the near future (judged by the actual family/whānau circumstances); The extent to which successfully addressing a specific need depends upon the



resolution of other identified needs, e.g. other problems may not be able to be addressed until a drug or alcohol addiction has been treated (prioritising needs). Health determinants can be categorised in several different ways. In child health, Client Health Information can be groups as: 1. biological, e.g. prematurity; 2. social, e.g. family resilience; 3. environmental, e.g. housing; 4. cultural, e.g. health beliefs, values and knowledge. Descriptors Low birth weight infant; mother‟s age less than 18 years; low ability to cope with parenting demands; poor housing; poverty; unemployment/benefit; poor access to community services; lack of transport; little support in the home; health decisions not a priority; presence of family violence; history of child abuse; first time mother with premature twins. Field Type: Drop down with some and free text ability to add others,

Health Education Health education is one part of the larger concept of health promotion. Health information and learning experiences lead to voluntary adaptation of behaviour that is conducive to health of individuals, families, or communities. Health education represents health information plus change in behaviour, and can be achieved in many ways. Without demonstrated change in behaviour the intervention cannot be defined as health education – it would simply be health “information”. Giving out/sending information does not represent health education, and is of doubtful health benefit. Health education can be one-to-one, in groups or to wider communities. Examples “Agreed to introduce solids - provided with information on food choices”. The following contact would then comment under the entry nutrition; about appropriate infant feeding. These two entries indicate that health education did take place in a planned way, with no behaviour change, education cannot be claimed from any education given. Field Type: alpha

Health Promotion Health promotion also involves planned care. Specific interventions for the individual family/whānau need to be goal orientated. All families need to have encouragement and interventions that strengthen their own capacity to achieve wellness in both the short and longer term. Interventions most often involve teamwork and collaboration. Teamwork and interagency collaboration are relevant interventions when planned to meet assessed and agreed need. “Process-outcome” indicators require descriptive definition to share common understanding. In health promotion the “hows” in respect to health gain achievement can be difficult to document. Field Type: alpha

Health Promotion Recommendation - where

Interventions that result in the Plunket staff member verbally recommending a specific course of action in order for parents to enhance their own or children‟s health and wellbeing. Health promotion recommendations can be made face-to-face, by phone, and are then recorded. The recommendation places are grouped into like groupings. Options are not mutually exclusive. Field Type: alpha. Validation: Codes used in reference table.

Health Promotion Recommendation - why

Interventions that result in the Plunket staff member verbally recommending a specific course of action in order for parents to enhance their own or children‟s health and wellbeing. Health promotion recommendations can be made face-to-face, by phone, and are then recorded. Health promotion is to increase the client capability to “self-care”. Options are not mutually exclusive. Field Type: alpha. Validation: Codes used in reference table.

Health seeking behaviour

The ability of families to reach out to access health care spontaneously from their knowledge of their community. This level of skill is dependant on knowledge, judgement, family/whānau resources (e.g. telephone, transport), perceived barriers and confidence to reach services. The impact on the child/Tamariki‟s health and wellbeing is related to their dependency on adults to access services in a timely way, and the extent of need for direct supervision or reminders for preventative health care, such as immunisation. Field Type: Drop down: will attend, unsure of where to



go, reluctant to attend, unable to access due to resources, other (please state) - for each of these you can then add comment to the type of service you are talking about i.e. playgroup.

Hearing Surveillance Undertake screening questionnaire in the Well Child Tamariki Ora Health Book, Can Your Child Hear? Questions must be asked as they are written according to the age of the child/Tamariki. Check the family history and follow up any concerns raised by the parent. Field Type: drop down: hearing Screening questionnaire complete – yes; no. If yes then drop down to no concerns; concerns (please specify). If no then drop down to reason why not asked. Drop down: Concerns - no concerns, hearing concerns - suspected ear infection; suspected loss or impairment. Anticipatory Guidance/education - free text. Referrals/Recommendations - Drop down with list of relevant services for development you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to development - with other added as a last option with specify reason.

HPI HPI - Health Practitioner's Index - Is a unique identifier for health practitioners registered under the Health Practitioners Competencies Act. The HPI number has three components - Practitioner (registration number), Organisation and Facility. The HPI is being established through the MOH. For Plunket only a registered nurse will receive an HPI. Currently this is not being used but the system needs to have the facility for HPIs in the future.

Immunisation Provided Immunisation Provided - If Plunket does provide immunisation at any contact it needs to be recorded. (This is only under specific contracts) The information that needs to be recorded is the type of immunisation i.e. MMR, polio etc; the time the immunisation was given, the site of the immunisation and any reactions. Field - drop down with list of all immunisation, able to highlight more than one at a time. Time using the 24 hour clock. Drop down for the site of immunisation, batch number. Drop down with common reactions and text to add anything abnormal. An area in the future may be needed for signing for consents

Immunisation status The immunisation status of the child/Tamariki must be completed at each Core Contact. This information is useful to determine immunisation trends in areas. Field Type: Drop down: Complete (C) - All immunisations complete for age. Includes infant less than 6 weeks of age; Incomplete (I) - Immunisations not complete for age, or, when parents have made an informed decision to delay immunisation for whatever reason; Partial (P) - The purposeful exclusion of at least one component of the current immunisation schedule. This would include informed decision by the parents to withhold one component, and medical reasons such as known allergies to vaccines. Declined (D) - Informed decision made by parents not to immunise. This category includes when homeopathic immunisation regimes are used; Unknown (U) - Information about the child immunisation status is unable to be ascertained. Anticipatory Guidance/education – Free Text. Referrals/Recommendations – Drop down with list of relevant services for immunisation you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to immunisation – with other added as a last option with specify reason.

Length See Growth

Link to community support

Facilitation of support to parent/family/whānau through identification and access of appropriate, acceptable and available linkages to a range of community groups, ethnicity support groups, agencies, or social relationships. Field Type: Drop down: accessing playgroup; coffee mornings; other - please state.

Maternal health Summary of the mother‟s physical recovery and mental wellbeing in the postnatal period. To provide an opportunity to raise any issues arising from the mother‟s experience. Field Type: drop down for Postnatal Depression



screening (new) still to be developed. Drop down to the following: Attending to own rest, sleep and adequate nutrition yes/no. Accesses support and contact from extended family/whānau and friends yes/no. With ability to add comment to each of these. Anticipatory Guidance/education - free text. Referrals/Recommendations - Drop down with list of relevant services for development you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to maternal health - with other added as a last option with specify reason.

Needs Assessment Level

The assessment of health need is different to the level of risk, the level of intervention required, and family/whānau resilience. The analysis of health need is part of the health care process and recorded so that conclusions from client information are linked to the Service Delivery Plan. Analysis of health need is the reasoning or pathway that makes sense of the history, the observations made, and the clinical assessment undertaken for the benefit of the child/Tamariki. A sound analysis of need leads to relevant interventions for each particular family/whānau. All previous values must be retained along with the dates each was current. Low Need - Assessment identifies that the health needs of the child can be met by the parents. This group of parents requires a low level of intervention to maintain/improve child health, and can usually access the education and support they need from core contract visits and other sources; High Short Term Need - Assessment identifies health needs that are readily modified and require specific, usually short-term, interventions(s) to maintain and/or improve child health outcomes; High Long Term Need - Assessment identifies health needs that are enduring and require ongoing interventions, education and support. Achieving improvements is likely to take longer. Planning for involvement of other agencies or services in care may contribute to overall complexity." Field Type: Drop down.

Not At Home (NAH) An opportunistic call made to a client‟s home without a scheduled contact, with the person being sought not at home. Field Type: dot

Nutrition Summary of nutrition in relation to the developmental stage and age of the child/Tamariki, and family/whānau culture. Field Type: Drop down boxes for type of feeding, each will also have the ability to write any notes on issues/concerns. For each there will also be a drop down for advice provide – education/anticipatory guidance/referrals/recommendations.

Breastfeeding status of the infant/child must be collected at every Core Contact. Field Type: Drop down: Exclusive, the infant has never to the mother‟s knowledge, had any water, formula or other liquid or solid food. Only breast milk from the breast, expressed breast milk, and prescribed medicines have been given from birth; Full, the infant has taken breast milk only. No other liquids or solids, except a minimal amount of water or prescribed medicines, have been given in the past 48 hours (further drop down – water/medications (write medication in last 48 hours)); Partial; The infant/child has taken some breast milk and some infant formula or other solid food in the past 48 hours (further drop down: other nutrition needs;

Formula – drop down to amount, frequency and type/solids – frequency/other (please state)). Artificial feeding. The infant/child has had no breast milk, but has had alternative liquids such as infant formula, with or without solid food, in the past 48 hours. Drop down with ability to add amount, frequency and type of formula used.

Solids: drop down: Introduction of solids - add date of intro of solids (be able to pick an actual date or time period i.e. 12 November 2009 or 3 weeks ago). Drop down also for type of food – Stage 1, stage 2 and stage 3. Diet: drop down: Type – Normal, vegetarian, allergy (state what allergy), diabetic, prescribed nutrition, other (please state). Habits: drop down: Normal eater, fussy eater. Education: drop down: Info provided on nutrition requirements; Discussion on nutrition requirements; Strategies on feeding; Weaning discussed; Hazard of burns from heating formula in microwave discussed, Choking discussed. Other please state. Anticipatory Guidance:



drop down: advice on when to introduce solids; weaning; Strategies for upcoming development stages (state what). Referrals/Recommendations: drop down with list of relevant services for nutrition you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to nutrition – with other added as last option with specify reason.

Obtained data from surveillance/clinical assessment

Child health surveillance is the systematic and ongoing collection, analysis and interpretation of indices of child health, growth, and development in order to identify, investigate and where appropriate, correct deviations from predetermined norms. Surveillance includes assessing progress of previously identified health need, identified risks and strengths, and evaluation of planned intervention. It focuses on specific aspects of a child and family‟s health. It is the result of observation, examination, interviewing and listening and learning about the child/Tamariki‟s health and wellbeing over time. Field Type: text

Other Services involved Types of community care services currently accessed, other than Core Well Child Tamariki Ora. The distinguishing feature is that without these services it would be unlikely the family/whānau would cope as well. The services once identified are named in the PHR. This is important in deciding the extent of unmet need, and the overall goal for the service delivery plan. Some families will require care co-ordination in a formal way. Field Type: Drop down with groupings of types of organisation that can then drop down to specific organisations under those groupings, i.e. top level will be - Other health agencies, social welfare agencies, self-help groups, parenting education groups, next level may be Barnardos childcare, Early Childhood Education, Women‟s Refuge etc.

Parenting Practice Observe parent-child interaction and their ability to care for the child/Tamariki e.g. initiates communication, anticipates needs, attends to needs, holds eye contact, smiles at and talks to infant fondly. Field Type: drop down: Attentive; unresponsive; inappropriate approach to child/Tamariki‟s needs or feelings; overwhelmed; handles the infant roughly or without due care and fondness; interested in all aspects of child/Tamariki wellbeing. Link to the Manitoba risk assessment tool in this section. Anticipatory Guidance/education - free text. Referrals/Recommendations - Drop down with list of relevant services for parenting practice (including notification to CYF) you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to parenting practice including notification to CYF, links to social groups - with other added as a last option with specify reason.

Physical assessment and examination

Assess general appearance of the child/Tamariki, and then follow a head-to-toe direction for systematic physical assessment. This will need to be developed as part of the decision support basing the information of evidence based assessment such as Plunket developmental surveillance profile, PEDs, Well Child Schedule and/or Sheridan - this will need to include hips assessment, testes assessment, dental assessment. In the meantime this section should be free text until the decision support has been developed. Field Type: free text. Descriptors: Comment as indicated from findings outside normal range. Screens listed in the Well Child/Tamariki Ora National Schedule Handbook (Ministry of Health, 2002) at appropriate ages. Drop down: Concerns – no concerns, development delayed (please specify). Anticipatory Guidance/education: free text. Referrals/Recommendations: drop down with list of relevant services for development you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to development – with other added as a last option with specify reason.

Place Identifies where the contact either took place or was planned to take place. Drop down (only one to be recorded). Home: client‟s home address (place of residence), or, any visit at a home (any household); Clinic: Includes any building which is regularly used to hold Plunket clinics; Family Centre: Plunket Karitane Family Centre is a community base used for supporting



parenting practice; Marae: A Whānau-base - may or may not have a clinic/office facility; Kohanga Reo: Maori language nest; Early Childhood Centre: Preschool, play group, Play Centre, Kindergarten, Day Care; Bus: Mobile Clinic; Community Centre: Local community centres used for Plunket groups, playgroups etc; Toy Library; Phone: Using the telephone/fax as a means of communicating clinical information to a parent/caregiver including text messaging; Email: Using email as a means of communicating clinical information to a parent/caregiver; Other – please state. (Need to be able to add to this from where parenting activities occur). Field Type: Dropdown. Validation: Codes used in reference table.

Plunket location number

Identifies the Plunket identified location in the Area where the service is being provided. This may be a sub-branch, branch or Area number. This element is mandatory for reporting requirements. All Branch and Sub-branch codes map back to an area code. There are four boxes to complete. If you have a 3 digit number put 0 in the first box. 875 becomes 0875. Field Type: numeric. Validation: Codes used in reference table provided by Plunket.

Plunket volunteer activities

The staff member completes this field indicating that the parent/primary caregiver has/has not consented to their name being made available to volunteers. Field Type: Drop down: parenting education; support groups; playgroups; socialising; newsletters; volunteer information.

Privacy of Information Plunket staff member has discussed with the client regarding how, the purpose and who can access their information. By marking yes the staff member is stating that she believes that the client understands the information given. This is collected at the first contact under health information. But it also needs to be in the contact section as a reminder to speak to clients about this when undertaking referrals or providing information to other groups within Plunket. Field Type: current this is a tick box that privacy of information has been discussed. However in the future this may require a client signature dependant on Plunket Policy

Referral - Where Interventions that result in a formal written process to refer clients to a specific service, in order to access identified health and/or social resources. The referral places are grouped into like groupings. Options are not mutually exclusive. WHERE a referral is made represents the intention to access specific types of services in addition to the current service the client is receiving. Field Type: alpha. Validation: Codes used in reference table.

Referral - why Interventions that result in a formal written process to refer clients to a specific service, in order to access identified health and/or social resources. Referral is a specific, planned process usually undertaken with the client‟s informed consent. Key steps are: assessment of need; assessment of options; decision making; consent; documentation and evaluation. This item is marked when the referral is documented. Options are not mutually exclusive. Field Type: alpha

Recommendation These are interventions that result in the Plunket staff member verbally recommending a specific course of action in order to enhance the parent/caregivers or children health and wellbeing. Health promotion recommendations can be made face-to-face or via the phone, then are recorded. Field Type: There will be drop down boxes to where and reason for recommendation (need to add the drop down requirements here) for each type of concern see above in the flow of process recording.

Referral These are interventions that use formal written processes (electronic referral or hard copy), to refer clients to a specific service, or a number of selected services, in order to address identified health and/or social issues. There will be specifically designed referral forms for various purposes. Field Type: There will be drop down boxes to where and why reason for referral (need to add the drop down requirements here) for each



type of need. See above in the flow of process recording.

Relationship building Parent-attachment impacts on the development of relationships with the child/Tamariki, the family/whānau and social groups. Engagement and disengagement cues can be indicators of success or difficulty in building meaningful relationships. Relationship building is an indication that the family/whānau is able to develop positive behaviours for an enduring, affectionate bond between people. In particular, the extent of the ability to relate to the children impacts on the mental health of both child/Tamariki and adult. The positive ability to build relationships is a protective feature. Inability to build a healthy relationship with a child/Tamariki may increase the child/Tamariki‟s vulnerability for abuse. Examples A parent may spontaneously express satisfaction about their child/Tamariki and their life generally, which would suggest their ability to develop positive relationships. Alternatively, the parent may demonstrate antagonistic behaviour towards the child/Tamariki or a pet in your presence, which would suggest that aggressive behaviour may inhibit building positive relationships. Field Type: ? Parent ability to be perceptive of child's needs, yes/no; responsive to them, yes/no; flexible in this responsiveness yes/no; able to solve problems themselves yes/no

Anticipatory Guidance/education – Free Text. Referrals/Recommendations - Drop down with list of relevant services for attachment/parenting relationship you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to attachment/parenting relationship - with other added as a last option with specify reason.

Safety assessment This is a new section that we need to work with Plunket‟s Safety Advisor about but current thoughts are safety advice provided by age specific development so Drop down for car safety, water safety, burns, falls, bath safety, kitchen safety, driveway safety, home safety, poisons. For example at the core 1 visit

Child safety discussed? Yes – drop down to key injury areas:

car seat,

drowning prevention - keep hand on baby while bathing, don‟t leave baby in bath with older siblings, supervise around water at all times, pool compliance;

falls prevention - change baby on floor, don‟t leave baby alone on high surface, stair guard;

poisoning prevention - paracetamol – strength and dose, safe storage; prevention of burns - fire guard, cold water into bath first, don‟t hold baby and hot drink, no tablecloth;

safe sleeping environment

No – did not discuss (state reason for not discussing)

Signature The signature of the staff member undertaking the assessment. This will be automatically completed by the sign on for the person accessing the computer.

Smoking exposure Must be completed at each Core Contact. The codes are based on the question asked of the parent/caregiver. During the past 3 days did you or any other person smoke in places while your baby/child was there (e.g. home, car, friend‟s or relatives home, Marae, restaurant)? Field Type: Drop down: Yes - who and relationship to child. Drop down – stop smoking information offered; No; Unknown - did not ask (state reason for not asking); Refused to answer; Other (please state reason). Anticipatory Guidance/education: drop down - smoke free advice provided/no advice. Referrals/Recommendations – Drop down with list of relevant services for



smoking you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to smoking – with other added as a last option with specify reason.

Smoking in house Must be completed at each Core Contact. The codes are based on the question asked of the parent/caregiver. Is there anyone in your household who is a tobacco smoker? Field Type: Drop down: Yes - who and relationship to child. Drop down - smoke free information offered; No; Unknown - did not ask (please state reason for not asking); Refused answer; Other (please state reason).

Solids see nutrition

SUDI/Sleep Field Type: After each of the following drop down for sleep position and sleep environment should be the frequency - always, some times, occasionally - Drop down boxes for SUDI: Sleep position: Back; front; side (able to add comments to each i.e. with wedge, etc). Sleep environment: own cot in parents room; own cot in another room; bed sharing with parents; bed sharing with others (state who), space for comments; Other – please state. Drop down boxes for Sleep: no problems; up during the night but no issues; up during the night and causing concerns; sleeping during the day well; not sleeping during the day (more than one can be marked with the ability to add comments to each if needed). Anticipatory Guidance/education – drop down SUDI prevention information provided – back sleeping, bed sharing, face clear, smoking. Referrals/Recommendations – Drop down with list of relevant services for SUDI/sleep you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to SUDI/sleep – with other added as a last option with specify reason.

Summary/outcomes Health gains achieved as the result of the agreed plan of care. This includes what the parent(s) has been supported to do as a result of previous intervention(s)/Core Contact. There is additional space for further information if required such as: internal referrals, follow up actions as a reminder to staff, or more specific documentation. Field Type: Still need to sort how we do this. Do we have key words that we can use as drop down or do we just have free text?

Vision surveillance Undertake screening questionnaire in the Well Child/Tamariki Ora Health Book (Ministry of Health, 2002): Can Your Child See? Questions must be asked as they are written according to the age of the child/Tamariki. Check the family/whānau history and any concerns raised by the parent. Field Type: drop down: Vision Screening questionnaire complete - yes; no. If yes then drop down to no concerns; concerns (please specify). If no then drop down to reason why not asked. Drop down: concerns - no concerns; vision issues (please specify). Anticipatory Guidance/education – free text. Referrals/Recommendations: drop down with list of relevant services for vision you may refer a client to and click box to bring up relevant referral form, also list of key reasons for referral relevant to vision - with other added as a last option with specify reason.

Volunteering Question - would you like information on how you can help Plunket? Field Type: Drop down yes/no from yes then now, 6 months, 1 year, 1 year +

Weight See Growth

Whānau/ family carer support

Support provided to the child/Tamariki and family/whānau or caregiver by the extended family/whānau in whatever configuration that may be. It is actively encouraged by, and may be facilitated by, the Health Worker. It acknowledges the wider family/whānau‟s ability to care for themselves in meaningful ways. Field Type: Drop down: reports family supportive; minimal support from family; no support from family - then ability to add words to each of these.



15.1.2 Health History (Core 1)

Health History

(Core 1)

Apgar Score The score based on observations of heart rate, respiratory effort, muscle tone, reflex irritability, colour of infant at birth. Each item is given a score of 0, 1, or 2, and evaluation of all categories is made at 1 and 5 minutes after birth. Total score of: 0 to 3 represents severe distress, 4 to 6 signifies moderate difficulty, 7 to 10 indicate absence of difficulty in adjusting to extra-uterine life. These scores are taken at various time intervals and have different significance the longer the time interval from the birth time. An example would be a score of 7 @ 5 minutes is a concern while a score of 7 @ 1 minute followed by a 10 @ minutes is OK. The Apgar score reflects the general condition of the infant at birth. The Apgar score is affected by the degree of physiologic immunity, infection, congenital malformations, maternal sedation or analgesia, neuro-muscular disorders and birth trauma. The Apgar score is not a stand-alone tool. It does not interpret past events nor predict future events linked to the infant‟s eventual neurological or physical health. It is an indicator of infant health at birth only. Field Type: alpha/Numeric. Drop down 1 -10 @ 1 min and 5 min – this should automatically populate from the electronic referral from the midwife.

Birth Weight The first weight, in grams, of the infant at birth. Low birth weight is less than (<) 2500 grams at 38-42 weeks gestation for most ethnic groups. The full term infant has a gestational age of 38 – 42 weeks. The relationship between birth weight (and gestational age), and child/Tamariki mortality shows that the lower the birth weight, the higher the mortality rates. Increased morbidity has also been identified in infants and children who have low birth weight (and gestational age), therefore infants with low birth weight for their gestational age are at greater risk. Field Type: alpha/numeric. This should automatically populate from the electronic referral from the midwife.

Child's Family Medical History

The adult client is asked about the family medical history, specifically conditions listed. In general the history is confined to first-degree-relatives (parents, siblings, grandparents and their children). It is used to discover the potential existence of hereditary or familial diseases/or conditions in the infant and/or immediate family, as well as family habits that may impact on the child‟s health. For each of these a yes/no and then if yes the first degree relationship – some of this may be populated directly from midwives electronic referral – still to establish what information will be transferred.

Child's Family Medical History Hereditary Conditions, familial diseases and conditions

Genetic conditions/syndromes are usually classified as those produced by chromosome abnormalities, caused by a single mutant gene. E.g. albinism, cystic fibrosis, muscular dystrophy (Whaley & Wong, 1999, p.196).

Child's Family Medical History Asthma

Asthma is a chronic inflammatory disorder of the airways. It is estimated that 44% of NZ children will have some symptoms of asthma prior to age 15 years. Prevalence does not vary by ethnicity but hospitalisation rates for Maori children with respiratory illness are more than twice the rate of non-Maori children. Most children with asthma (75%) have a family history of infantile eczema, hayfever or asthma. The best indicator of whether a child will develop asthma is whether siblings have it. Drop down Yes/No, if Yes list who - mother, father, siblings, other

Child's Family Medical History Allergies

Allergic disorders occur as a result of an abnormal antigen-antibody response. Allergies include atopic dermatitis (eczema), seasonal allergic rhinitis (hayfever), food allergies and anaphylaxis. Almost 1 in 5 children suffer from an allergic disorder, resulting from an abnormal antigen-antibody response. Drop down Yes/No, if Yes list of whom - mother,



father, siblings, other

Child's Family Medical History Developmental Displacement of the Hip. (DDH)

DDH is a spectrum of disorders related to abnormal development of the hip that may develop at any time during foetal life, infancy and childhood. The term DDH is preferred over the traditional term CDH, as it also considers the relationship between dysplasia and stability. DDH covers the same range of hip problems as congenital dislocation of the hip (i.e. dislocation, subluxation and instability) but also includes poorly developed joints that may not actually dislocate and abnormalities determined after the newborn period. Children with untreated DDH can go on to develop significant pathology and disability – degenerative joint disease, loss of joint space, cyst formation and may have back pain, limb length inequality, knee deformity and pain, scoliosis, and gait abnormalities. The risk factors for DDH include family history, breech presentation, and deformities of the foot, first-born babies and oligohydraminios. Female infants are reported to have 4-6 times greater incidence than male infants. Drop down Yes/No, if Yes list who - mother, father, siblings, other

Child's Family Medical History Hearing Impairment

Hearing impairment is a general term used to indicate disability that may range in severity from mild to profound hearing loss. Hearing is a primary sensory pathway by which children normally develop speech and language. Hearing disorders can cause problems of speech, language and learning. It is essential therefore, that hearing loss in children be identified as early as possible and management planned. Hearing loss may commence prenatally, perinatally or postnatally. 40% of permanent childhood hearing impairment (PCHI) is due to environmental factors (e.g. premature birth, meningitis). The remaining 60% of cases are considered to be genetic, the largest category of PCHI being the isolated genetic mutation leading to non-syndromic deafness. Infants at increased risk of hearing impairment are those who have had: Admission to NNU; Birth weight <1500 grams; Perinatal infection - (cytomegalovirus, rubella, herpes, syphilis, toxoplasmosis and bacterial meningitis); Craniofacial abnormalities; Birth asphyxia; Chromosomal abnormalities; Very high jaundice levels; Family History of PCHI; Ototoxic drug. In the presence of these risk factors, the infant is referred directly to an audiology center for diagnostic assessment of hearing acuity. Drop down Yes/No, if Yes list who - mother, father, siblings, other

Child's Family Medical History Vision Impairment

Visual impairment is a general term that includes both mild to severe loss of visual acuity. Discovery of visual impairment as early as possible is essential to prevent further loss of vision and developmental delay. Infants at increased risk of visual impairment are those who have: Family history of squint, blindness, cataract, retinoblastoma, albinism or glaucoma; Congenital infections such as rubella, cytomegalovirus, toxoplasmosis, herpes or syphilis; Prematurity (gestation of 34 weeks of less) or birth weight < 1500 grams; Other developmental or neurological problems (e.g. cerebral palsy). In the presence of any of these risk factors, the infant must be referred directly to an ophthalmologist for diagnostic assessment of visual acuity. Field Type: Drop down Yes/No, if Yes list who - mother, father, siblings, other

Discharge Feeding Status

The feeding status of the infant, when transferred from, the Lead Maternity Carer (LMC). Breastfeeding: Exclusive: (E) The infant has never to the mother‟s knowledge, had any water, formula or other liquid or solid food. Only breast milk from the breast, expressed breast milk, and prescribed medicines have been given from birth; Full: (F) The infant has taken breast milk only. No other liquids or solids except a minimal amount of water or prescribed medicines, have been given in the past 48 hours; Partial: (P) The infant/child has taken some breast milk and some infant formula or other solid food in the past 48 hours; Artificial: (AF) The infant/child has had no breast milk, but has had alternative liquids such as infant formula, with or without solid food, in the past 48 hours. To establish the infant feeding method, or methods, as a baseline of feeding



status and parental goals. Field Type: alpha. Drop down Exclusive: (E), Fully: (F), Partially: (P), Artificial: (A). This should automatically populate from the electronic referral from the midwife.

Gestational Age The length of time, in weeks, of development of infant in utero. The full term infant has a gestational age of 38 – 42 weeks. This should automatically populate from the electronic referral from the midwife.

Jaundice Jaundice, characterised by a yellowish discolouration of the skin and/or sclera and nails, refers to an excessive level of accumulated bilirubin in the blood. This is termed hyperbilirubinanemia. Hyperbilirubinemia is always a significant finding and while it is common in the newborn and in most instances is relatively benign, it can also indicate a pathologic state. Jaundice that remains present at age 5 weeks must be referred to the GP for monitoring if it is not being already monitored. Field Type: alpha/numeric. Drop down Yes/No. This should automatically populate from the electronic referral from the midwife.

Medical follow up planned

Indicates whether the infant has been booked for medical follow up, and if so the specific health issue. Medical follow up signifies some problem in the neonatal period requiring monitoring. Information is relevant to planning on going care. Will also include the 6 week check by the GP. Specify reason and age for medical follow up. Field Type: alpha. Drop down – Yes/No, if yes specify reason and where to. This should automatically populate from the electronic referral from the midwife.

Metabolic Screen Indicates whether blood testing by heel prick and completion of the Guthrie Card by the LMC, has occurred. This is a screening test for a number of metabolic disorders. IEM (Inborn errors of metabolism) constitute a large number of inherited diseases caused by the absence or deficiency of a substance essential to cellular metabolism, usually an enzyme. Most IEM are characterised by abnormal protein, carbohydrate, or fat metabolisation. It is now possible to detect and screen for an increasing number of IEM. In New Zealand screening of all newborn infants is undertaken with parental consent after the second day of life, before feeding alters the metabolism, for some of the following diseases: Phenylkeonuria (PKU); Maple syrup urine disease (MSUD); Biotinidase deficiency; Cystic fibrosis (CF); Congenital hypothyroidism (CH); Galactosaemia; Congenital adrenal hyperplasia (CAH). If screening results are normal parents are not notified. Some results require repeat screening

Contact is made when results are outside the normal range so there can be appropriate follow up. Field Type: Yes/No if yes state problems

Universal Newborn hearing assessment undertaken

Drop down – Yes/N. and text for result

Neonatal Unit Admission

Indicates whether the infant was admitted to a neonatal unit, and if so the reason for admission and the length of stay in the unit. Neonatal admission signifies some problem in the neonatal period requiring intensive care. This may be relevant information in planning or coordinating on going care. Specify reason for admission, length of stay and planned pediatric follow-up. Field Type: alpha/numeric. Drop down – Yes/No. From Yes – reason (to be written), length of staff and planned follow-up. This should automatically populate from the electronic referral from the midwife.

Phototherapy Indicates that an infant has received phototherapy after birth as treatment for jaundice. Pathologic hyperbilirubinemia is treated with phototherapy with the primary goal of preventing Kernicterus, a neurological syndrome that occurs when the serum concentrations of bilirubin reach toxic levels. Phototherapy, using high density light in the visible spectrum, alters the structure of bilirubin to a soluble form for easier excretion. This form of



treatment requires careful monitoring during and following phototherapy. Field Type: yes/no. Drop down – Yes/No. This should automatically populate from the electronic referral from the midwife.

Pre-birth alcohol intake Specify number of drinks containing alcohol per day. Include comments about daily, weekly, monthly / binge drinking, how many drinks containing alcohol in this time, period of gestation that mother was drinking. Circle number of drinks containing alcohol. Alcohol is a significant risk factor for the development of congenital malformations in infants. Infants born with Fetal Alcohol Syndrome exhibit prenatal and postnatal growth deficiencies in height and weight. Also dysmorphic facial features and central nervous system involvement (e.g. cognitive impairment, irritability, hyperactivity, behavioural problems, and hypotonia), which become more defined with increasing age. Field Type: circle response None/1-2/3-4/>4 daily.

Pre-birth Smoking Specify number of cigarettes the mother smoked per day during this pregnancy. Smoking during pregnancy has significant effects on a child/Tamariki growth and development. These effects include, but are not limited to; decreased fetal growth, increased deliveries of low-birth-weight, preterm, and stillborn infant and a greater incidence of sudden infant death syndrome. Field Type: Drop down 0/ 1-9/ 10-19/ 20+ per day.

Transfer to Plunket weight

The weight, in grams, of the infant, at the time they are referred to Plunket by the Lead Maternity Carer (LMC). Accurate weights provide a baseline for the assessment of growth and risk factors. In normal development serial weights are indicators of child/Tamariki nutrition. Growth rates that fall 2 or more centiles may indicate the possibility of the presence of a medical condition or a child/Tamariki management problem. Normally the newborn loses up to 10% of the birth weight by 3-4 days of age because of loss of extra cellular fluid and meconium, as well as limited food intake, (especially breast-fed infants). This weight is usually regained within 10 to 14 days. Weight gains are usually 20 to 30 grams per day for the first 3 to 4 months, and have regained their birth weight by no later than 6 weeks after birth. Field Type: numeric.

Vitamin K Indicates whether the infant received vitamin K either orally or by intra muscular injection in the neonatal period (birth-6 weeks). The major function of vitamin K is to catalyse the synthesis of prothrombin in the liver, which is needed for blood clotting and coagulation. Normally vitamin K is synthesized in the intestinal flora. However, since the infant‟s intestine is sterile at birth and since breast milk contains low levels of vitamin K, the supply is inadequate for at least the first 3 to 4 days after birth. Therefore shortly after birth, vitamin K is administered as a single intramuscular dose, or in 3 oral doses, at birth, 7 days and 6 weeks, to prevent hemorrhagic disease of the newborn which cannot be reversed. Field Type: O/IM. Drop down – Yes – orally, IM - No. This should automatically populate from the electronic referral from the midwife.

BCG Vaccination The detail of this is still to be confirmed

15.1.3 Child Client record

Child Client record

Address/Kainga. The residential address where the primary caregiver lives with the child/Tamariki client. Includes house number, street name or rural address, suburb and town/city. Computer to automatically populate postcode information. Field Type: alpha

Child name: Family The family/whānau name (surname) of the child/Tamariki client noted at registration. Field Type: alpha. Validation: At least one alpha character



name/Whānau within field

Child name first/ingoa The first given name of a child/Tamariki client. Field Type: alpha. Validation: At least one alpha character within field

Child name Second or other names (allows the collections of the full name which is important for some families). Field Type: alpha. Validation: At least one alpha character within field.

Discontinued date from a service

The date the client was confirmed being discontinued from a service. Clients can only be discontinued for specific reasons depending on the contract. dd/mm/yyyy format. Field Type: Date

Date of Birth The birth date of the child/Tamariki client. It will be recorded according to SNOMED requirements around recording. Field Type: Date

Date of enrolment The date on which a client is first seen by Plunket Service Delivery Staff for a Service or when they receive clinical advice. This does not include visits to maternity units. Enrolment is used as one of the business rules for all reports. The enrolment date is electronically recorded by taking the first date the client receives clinical advice. Field Type: Date. Validation: The date of the first contact by a Plunket Service Delivery staff member, dd/mm/yyyy format.

Date of Referral Date that the referral was received by Plunket. Field Type: Date

Deprivation Score The score attributed to the geographical location where the child client lives, which indicates the level of socio-economic deprivation for a particular locality using a standard scale of 1 to 10 (10 being the most deprived). Field Type: Numeric. Validation: Geostan software which automatically allocates the correct Dep score to given addresses.

Domicile Code Statistics New Zealand Area Unit Code representing the client‟s residential address. A national automated domicile coding facility has been implemented on the NHI. The domicile code can be established from a comprehensive address.

Field Type: Alpha-numeric. Validation: Codes used in reference table available from NZHIS. Generated in POND using integrated Geostan software.

Email Email address of the primary caregiver/s – could be both mother and father. Field Type: alpha-numeric

Ethnicity The ethnicity of the child client as reported by the primary caregiver. Ethnicity should be self identified whenever possible, for children under 5 the views of the parent of the child‟s ethnicity are used. It should be updated if the self-identified affiliation changes on Primary Caregiver request. Plunket collects ethnicity using level 2 from HISO Health & Disability Sector Ethnicity Protocol. Field Type: Alpha-Numeric (Code and Name). Validation: Codes used in reference table.

Father The preferred name of the father (first and family name), the age and ethnicity as per previous ethnicity criteria. Record age in format agreed by SNOMED for age. For ethnicity of father the ability to put born overseas, born in NZ.

General Practitioner Family doctor, or General Practitioner (GP), providing primary health care for the child client. Field Type: alpha-numeric

General Practitioner Practice name

The name of the practice where the client‟s GP and PHO operates from may include Accident and Emergency Clinics/Centre. The GP practice is identified by the Primary Caregiver, but the chosen practice may change over time. If GP practice is not named, leave the space blank. Field Type: alpha-numeric



Hapu The Hapu of the child client as identified by the child‟s whānau or parents/caregiver. This information is primarily used by Plunket staff when relating to Maori clients. Hapu have specified tribal names, which are coded in POND. A full list of all Iwi and Hapu can be located in Appendix 2 of the Plunket Client Information System Instruction Booklet 2002. Field Type: Swapbox/Drop down list of the Iwi as per PCIS handbook – breakdown into geographical locations to assist.

Iwi The Iwi of the child client as identified by the child‟s Whānau/parents/caregiver. Iwi are groups of people who have common ancestral, geographical, historical or water/sea links, specific to Maori. This information is primarily used by Plunket staff when relating to Maori clients. Iwi have specified tribal names, which are coded in POND. A full list of all Iwi and Hapu can be located in Appendix 2 of the Plunket Client Information System Instruction Booklet 2002. Field Type: Field Type: Swapbox/Drop down list of the Iwi as per PCIS handbook – breakdown into geographical locations to assist.

Legal Guardian If parents are separated record legal guardianship situation, also need to identify if they are under CYF care (need to work on definitions of the type of CYF involvement).

Mother The preferred name of the mother (first and family name), the age and ethnicity as per previous ethnicity criteria. Record age in format agreed by SNOMED for age. For ethnicity of mother the ability to put born overseas, born in NZ.

National Health Index Number

The National Health Index identifier (NHI) of the child/Tamariki client usually issued at birth. This is the key link in the provision of health services to the client. The National Health Index number allocated to a NZ child as a health service user, usually allocated after birth at 1st contact with a health provider e.g. hospital, GP, Plunket. NHI remains the identifier for life, so care is required when NHI is allocated – only one code is necessary. The NHI cannot be deleted from the Ministry of Health national register. Field Type: 3 alpha; 4 numeric

New Baby Case Refers to all children under 12 months of age (by birth date) who enrol for Plunket services for the first time. Identifies that a new client is being enrolled with Plunket for the first time. This does not necessarily relate to births. Immigrants are also included as new baby cases if born outside New Zealand and the child is under 12 months of age. This will automatically be recorded in POND.

New Case Refers to all children over 12 months of age (by birth date) who enrol for Plunket services for the first time. Identifies that the new client is enrolled with Plunket for the first time. This does not necessarily relate to births. Immigrants are also included as new baby cases if born outside New Zealand and the child client is over 12 months of age. This will automatically be recorded in POND.

Parent/caregivers The parent/caregiver who has primary responsibility for the care and wellbeing of the child/Tamariki client. Some children have caregivers with legal authority for decisions about everyday care of the child/Tamariki, who may not be the birth parents. If the address is different to the child‟s this also needs to be recorded here i.e. shared custody etc. Other if required – details as for mother and father but also identifying relationship. Grandmother, grandfather, foster mother, foster father, aunty, uncle, step mother, step father and other (please specify) Field Type: Dropdown

Phone Telephone numbers for contacting the primary caregiver. Include the STD code. Collect home phone, cell phone and work phone if relevant, need at least 3 spaces if not 4, highlight preference (additional space for different phone numbers). Field Type: numeric

Plunket Referral The source from which the client was first referred to Plunket services.



Source Source of referral enables the monitoring and long term planning of service utilisation at an area, regional and national level. Identifying the source of referral to Plunket can be useful to highlight the interface with the community, and where networking and liaison should be improved for effective client care transfer. Field Type: Numeric. Validation: Codes used in reference table. Text to add actual name of person

Reason for discontinuation

The specified reason for discontinuation of Plunket services following enrolment. The reason why the child client is no longer using Plunket services. Includes, “left the country, deceased, transferred to another recognised Well Child provider, death by SIDS, reached 5 years of age. Lost to service or changed/new address unknown are not reasons for discontinuation. Field Type: Dropdown. Validation: Codes used in reference table.

Sex of Child The Primary Caregiver identified sex of the child client. Compliant with the NZ Health Information Service, gender type code. When this is indicated, the data should be updated as soon as possible, once sex/gender is defined. A very small number of children may be „sex unknown‟. Field Type: Dropdown. Validation: Codes used in reference table for PCIS.

Status The current status of the client in respect to the process of enrolment for Plunket services: Prospective - Potential recipient of Plunket services; Active - Current recipient of Plunket Well Child services; Discontinued Past recipient of Plunket Well Child services. When a child (client) is originally referred to Plunket services they are a “prospective” client. At this stage the administrator, or staff member, will collect minimal data so the Plunket Nurse can initiate contact. The family may already be using other Plunket services, such as renting a car seat. When the first contact for a service is accepted the client then becomes “enrolled” for that service – this means they have now been enrolled. “Discontinued” is used when a child client dies, reaches 5 years of age, or the Primary Caregiver chooses to stop using Plunket Well Child services and formally notifies Plunket of that decision. Field Type: alpha

15.1.4 Caregiver Client Record

Caregiver Client

Record

Alternative Adult

contact Name

An adult name as an alternative contact for the adult and/or child/Tamariki for occasions when it is difficult to trace the child/Tamariki or usual caregiver. This is useful information, to maintain contact for the period of the Well Child/Tamariki Ora Programme. This adult could be a friend, family/whānau member or neighbour named by the primary caregiver as a source of information about their whereabouts. Field Type: alpha. Note: In POND the alternate contact address is called “other”. The primary caregiver address is “usual”. First and last name required

Alternative Contact

Address

A second or alternative address where the Adult and/or child client may live at times. In some circumstances clients may stay with others, such as their other parent, a member of the extended family or friends. This is termed a visit and not a permanent change of address. An alternative contact address may also be used so that the adult and/or child/Tamariki client may be traced. This is useful information to maintain continuity of health care, and is used only with the Primary Caregiver‟s verbal consent. Field Type: alpha/numeric.

Alternative Contact

Phone Number

Alternative or second contact telephone number of the Primary Caregiver or alternative phone number of the adult contact. This is useful information to maintain continuity of health care, used only with the client‟s verbal consent. Field Type: Numeric.



Able to read English English reading level to newspaper. Field Type: Drop down – yes/no, if no then ability to record alternative.

Ability to

Communicate in

English

The ability of the primary caregiver to communicate using English as the common language. This is defined by being able to speak and understand everyday English. This information identifies disability (e.g. hearing impairment), and English as second language, as potential barriers to health care. If no, state the alternative communication method (e.g. fax messaging, interpreter required, etc.). The ability to communicate in English includes/excludes reading and writing. Field Type: tick box (The alternative communication method will need to be noted in the comments text area of POND).

Consent for client

summaries

Client has given consent for a summary to be sent to their GP after each Core Contact.

Date of Birth The date given as the date the Primary Caregiver was born. Documented as: If full date is known dd/mm/yyyy; If month and year are known 00/mm/yyyy; If only year is known 00/00/yyyy. Field Type: date.

Ethnicity The ethnicity of the primary caregivers as identified by themselves. Ethnicity should be self identified whenever possible. It should be updated if the self-identified affiliation changes (NZHIS, 1996a, p. 13) at the request of the Primary Caregiver. Plunket collects ethnicity using level 2 from HISO Health & Disability Sector Ethnicity Protocol. Field Type: Numeric.

Family

name/Whānau

The surname or family name of the Primary Caregiver. Field Type: alpha

First name/Ingoa The first name of the Primary Caregiver as provided by that caregiver – this should include the client‟s preferred name. The first name is recorded. Any other names are recorded under second name. Field Type: alpha. Validation: At least one alpha character within field.

First time parent An adult who is fulfilling a parent role for an infant for the first time and considers themselves to be a first time parent of an infant/child. It is parent choice whether the term “first time parent” is appropriate. Field Type: Tickbox.

Hazards Alert Indicates if there are any identified potential hazards to consider when home visiting. Existing hazards are identified. More than one factor may be recorded if “yes” is circled. Examples are substance abuse, violence, and geographical location. The identified hazards to staff likely to make a home visit should be realistically managed. Need drop down boxes – Yes/No. Under Yes list some of the hazards – uncontrolled dogs, violence, substance abuse, geographical location – then from there drop down: Uncontrolled dogs (space to record # of dogs and type) ring prior to visit: Do not visit at home; Other (Please write instructions). Violence: do not visit alone; Clinic contacts only; Other (please write instructions). Substance abuse: do not visit alone; Clinic contacts only; Other (please write instructions). Geographical location: (record the issue and write instructions) new. Field Type: dropdown/text

Dogs on Property

that are uncontrolled

Uncontrolled dogs are the most common hazard so far identified by staff. Uncontrolled dogs are dogs that eliminate/display any form of “aggression to home visitors (Uncontrolled is a definition). Comments can be added after “yes”. Note number, type and control issues. Field Type: text.

Languages spoken

at home

The language most preferred by the adult client for communication at home. This may be a language other than English, even where the adult client can speak fluent English. Drop down with list of languages, in the future it is hoped that the software may be able to translate key information and questions into the appropriate language.

National Health The National Health Index identifier of the child/Tamariki client‟s birth or



Index Number adoptive (not both) mother/caregiver. The NHI number remains the individual‟s health identifier for life. This is the key link in the provision of health services to all clients. The National Health Index number allocated to a NZ child as a health service user, usually allocated after birth at 1st contact with a health provider e.g. hospital, GP, Plunket. NHI remains the identifier for life, so care is required when NHI is allocated – only one code is necessary. The NHI cannot be deleted from the Ministry of health national register. Field Type: 3 alpha; 4 numeric

Parent/Caregivers

name

The parent/caregiver who has primary responsibility for the care and wellbeing of the child/Tamariki client. Some children have caregivers with legal authority for decisions about everyday care of the child/Tamariki, who may not be the birth parents. The first and family name should be recorded– as well as the name which they prefer to be called. Field Type: alpha.

Phone Number

(DAY)

Contact telephone number of the Primary Caregiver as primary carer of the enrolled child. Important contact information - include STD prefix/cellphone prefix. Landlines are preferable. Field Type: Numeric.

Phone Number

(evening)

Contact telephone number of the Primary Caregiver of the enrolled child during evening hours. Important contact information - include STD prefix. In most cases this will be the same as the Day time contact but may differ if the caregiver is working. Field Type: Numeric.

Phone Number

(mobile)

Mobile telephone number of the Primary Caregiver of the enrolled child. Important contact information - include prefix. Field Type: Numeric.

Primary Caregiver The adult who has primary responsibility for the care and wellbeing of the child. In the majority of cases this will be either the mother or father or both. However it may also be others including grandparents, foster parents – see relationship for the different possibilities. The fields to complete the details are individually listed. Field Type: alpha.

Requires interpreter Indicates whether or not the use of an interpreter is required to facilitate communication between the adult client and Plunket staff member. Field Type: Drop down – Yes/No

Second name The second name of the Primary Caregiver as provided by the caregiver. The second and any subsequent names are recorded here. Field Type: alpha. Validation: At least one alpha character within field

Street / Flat Number

and Name

The residential address at which the primary caregiver is living with the child client. Number: The house or flat number or unit of the client‟s home. For example, 3/345 for Flat 3, 345 xyz Street. Only the numbers and separators are recorded in this field; that is, 3/345 in this example. Street Name: The name of the street address of the child. For rural address the rapid number should be the preference. If this is not available then the Rural Delivery and Road Residence number can be used. Field Type: numeric, alpha. Validation: At least one character within field.

Suburb The suburb address of the child clients. Primary caregiver to provide rural delivery number when applicable. Field Type: alpha. Validation: At least one alpha character within field.

Town city The town or city address of the client. If possible use of the postcode is also helpful. Field Type: alpha. Validation: At least one alpha character within field.

15.1.5 Maternal Health (Core 1)

Maternal Health

(Core 1)

A number of these could be automatically populated from midwives electronic referral once agreement has been made



Antenatal and

Parenting Education

Mother and/or father‟s antenatal education in gaining formal or informal parenting information/knowledge. Drop down yes or no. If yes - Specify classes attended/or level of estimated knowledge.

Birth: normal,

epidural, caesarean

section and other

Whether the mother‟s labour was normal or abnormal, or an intervention (epidural, forceps delivery, caesarean section or general anaesthetic) was required. Field Type: Drop down – normal, epidural, caesarean section, other (please state).

Current medication To establish whether the mother is taking any medication, prescribed or self-administered. Field Type: Drop down - Yes/No, if yes space to record name of medication.

Contraception

Discussed

To establish whether the mother has had contraception options explained by LMC. Field Type: Drop down - yes/no. If no comment on actions taken

Mother's health after

birth

Mother‟s health after birth includes a number of topics listed in this section.


birth General

wellbeing

The period of 6 weeks following birth (the puerperium), involves a number of physiological and psychological changes for a mother adjusting to birth. Field Type: Drop down - well, unwell (state specify issues/concerns).


birth Vaginal loss

To record the amount and type of lochia, early identification of signs of infection or retained products. Field Type: Drop down - normal, offensive, heavy bleeding, pain (low back or abdominal) (can mark more than one).


birth

Perinatal/abdominal

The presence of sutures, either perineal or abdominal from obstetric intervention. Field Type: Drop down – yes/no If yes – episiotomy, abdominal, under each of these healing, not healing (state action being taken beside not healing)


birth Breasts and

nipples

To establish the health and comfort of the mother‟s breasts and nipples. Field Type: Drop down – comfortable, lumps, redness, pain and discomfort from the last 4 the ability to add notes regarding any treatment


birth Mental health

To assess the mother's emotional state. Field Type: Drop down - normal, blues, depression, psychosis. From the last 3 the ability to add notes around treatment or services being received. ?Drop down - PND screening questions (still to be designed).

Other comments

related to this birth

Drop down - Multiple births, other issues/concerns (please state)

Pre birth problems Has the mother experienced any health problems related to her own, or the baby‟s health during this pregnancy? Field Type: Drop down - yes or no. If yes allow addition of specify problems.

Previous

Breastfeeding

Problems

Mother‟s previous breastfeeding experience in terms of duration, confidence, and associated problems. Field Type: Drop down yes or no, if yes duration (add details), problems (add details).

Previous postnatal

depression

The mother reports having experienced postnatal depression. May be self reported PND or formal diagnosis by a professional. Field Type: Drop down yes or no, if yes allow addition of specify details regarding experience and intervention.

Previous pregnancy,

birth and postnatal

history

The mother‟s experience of any previous pregnancies, birth and postnatal period. Field Type: Drop down – 1, 2, 3 or more pregnancy, allow comment if pregnancies did not end in live birth.

Support person

Present at birth

Indicator of the type of support for the mother and in particular the involvement by the father. Field Type: Drop down – yes/no, if yes then father, parent, other (state relationship).



15.1.6 Paternal Health

This is a new section. Decision needs to be made on what Client Health Information is

to be collected regarding the father.

Whole new section to be designed.

Previous Experience Any previous experiences with fathering - may be biological or

other

General health Is his general health good, short term health problems, long

term problems

Mental Health Assess the father's emotional stated

Medications Is the father taking any medications, prescribed or self-

administered.

Smoking status Is the father a smoker yes/no

Disabilities List any disabilities

Drugs/Alcohol Abuse – if yes list type

15.1.7 Family data (Core 1)

Family data

(Core 1)

Ability to read

English

Indicates whether the Primary Caregiver can read simple English. Field Type: yes/no

Child's Primary

Health Care Provider

Family/whānau doctor, practice nurse, nurse practitioner or PHO providing health care for the child/tamariki, identified by the primary caregiver. Field Type: Drop down with list of PHOs, practices and GP's for the local area. One in each can be marked or all three drop downs can be marked. These are linked in the background, so if the mother chooses a GP the computer will identify the practice and PHO.

Community Support

Currently Accessed

by Parent(s)

Community support refers to the relationships the family/whānau has with others and the benefits that this brings to them and their community. Details the nature and scope of community support that is used by the parent(s) of the child/Tamariki e.g. Parents Centre, early childhood education, church groups. Field Type: Drop down – parent groups, church (drop down with list of local churches - very important for Pacific families), sporting groups, early childhood education and community agencies, ethnicity support group, others (please state).

Disabilities Are there any disabilities in the family that we should be aware of? Field Type: drop down yes/no, drop down with relationship i.e. mother, father, sibling, if yes then write actual disability.

Family Support

Currently Accessed

by Parent(s)

Caregivers

Details of the nature and scope of the family/whānau and extended family/whānau support that is available and acceptable to the parent(s) of the child/Tamariki. Field Type: Drop down – parents, neighbours, friends and others (state relationship). Can pick more than one. Drop down strong support, when asked only, no support.

Father's age The age of the father expressed in years. This can be derived from Primary Caregiver‟s year of birth, if the Primary Caregiver is the father. Implications for first time parent‟s status and needs. Field Type: numeric



Father's ethnicity Ethnicity should be self identified whenever possible. It should be updated if the self-identified affiliation changes on Primary Caregiver request. Field Type: alpha. Validation: Codes used in reference table. Reference: Using level 2 (amended) from NZ Standard Classification of Ethnicity, Statistics New Zealand, 1993. Ethnicity data protocols for the health and disability sector 2004 MOH Wellington.

Father's Name Preferred given name of the father. Necessary information to communicate with the father. Field Type: alpha

Father's

employment status

Occupation refers to the job, trade, profession, or type of work in which a person is employed for financial reward or as an unpaid worker. This can be useful to indicate the socio-economic situation of the family. Field Type: Drop down to include full time employment, part time employment, unemployed, Full time parent. Text.

Grandparent details Names of grandparents and their involvement within the family

Health information The staff member completes and signs this field indicating that the Primary Caregiver has been informed about the use and sharing of their health information that has been collected. Field type: Drop down Yes/No.

Income Does the parent feel their income meet their family needs. Are they receiving any benefits. Field Type: Drop down yes; no Drop down to include information on benefits.

Immigration Status The immigration status of the child - drop down (need to check legal terminology

Language Spoken at

Home

The language most preferred by the Primary Caregiver for communication at home. This may be a language other than English, even where the Primary Caregiver can speak fluent English. Language spoken at home is an important indicator of ethnicity, and is also considered to be a surrogate measure only for English language proficiency. Field Type: Alpha

Living Arrangements A parent or parents living arrangements, indicating opportunities for support available from cohabitants or not. Field Type: drop down: Lives with partner/spouse; Lives with family/friends - number living in house; Lives alone with children; Overcrowding, Not stated.

Lead Maternity Carer

(LMC)

The midwife and/or GP/specialist, responsible for the care of the mother during her pregnancy birth and postnatal period. Field Type: Drop down with list of LMCs for area and ability to add if not on the list

Marae If the client is of Maori ethnicity then this should be a drop down to ask there connection with the marae and a list of local marae's provided. This will allow us to look at issues related to their marae

Mother's age The age of the mother, in years. This can be derived from Primary Caregiver‟s year of birth, if the Primary Caregiver is the mother. Field type - Numeric

Mother's ethnicity Ethnicity should be self identified whenever possible. It should be updated if the self-identified affiliation changes on Primary Caregiver request. Field Type: alpha. Validation: Codes used in reference table. Reference: Using level 2 (amended) from NZ Standard Classification of Ethnicity, Statistics New Zealand, 1993. Ethnicity data protocols for the health and disability sector 2004 MOH Wellington.

Mother's name Preferred given name of the mother of the child client. Necessary information to correctly communicate with the mother. This may differ from the name provided in referral data. Field Type: alpha.

Mother's

employment status

The most recent employment situation of the mother. Occupation refers to the job, trade, profession, or type of work in which a person has been employed for financial reward or as an unpaid worker. Drop down to



include full time employment, part time employment, unemployed, fulltime parent Field Type: text.

Name and signature The staff member completing health history, this will come from a time/date stamp with staff members name automatically from the computer

Other persons living

in the house

Who else lives in the home? Field Type: Drop down able to add as many as required and beside each name list the relationship to the child and if they are responsible for providing care to the child.

Plunket Volunteer

notification

The staff member completes this field indicating that the parent/primary caregiver has/has not consented to their name being made available to volunteers. Field Type: Drop down: parenting education; support groups; playgroups; socialising; newsletters; volunteer information.

Requires interpreter Indicates whether or not the use of an interpreter is required to facilitate communication between the Primary Caregiver/client and Plunket staff member. Field Type: Drop down yes/no

Siblings The first and last names of` other children living with the whānau as brother and sister. Field Type: Drop down to be able to add as many as required and beside each relationship i.e. adopted, foster, step and half brothers and sisters, also DOB and gender of the siblings. For DOB use SNOMED format.

Significant

medical/health

issues in the family

Medical conditions or health issues that affect the child/Tamariki‟s parent(s) ability for/to parent(ing). Field Type: Drop down: None reported, Mental Health, Substance abuse, Abuse, Relationship issues, other.

Transport The type of transport commonly used by parent. Field Type: drop down: Unlimited use of own car; Limited use of car; Bus/taxi; Walks/cycles; Unstated; Dependant on others, appropriate car seat for child

Type of household Drop down - single parent, 2 parent, 2 parents and other children, multi-generational, other

Type of

dwelling/accommoda

tion

Type of dwelling or accommodation in which a child/Tamariki usually lives. The information collected is based on the home situation you see during the time of your visit. There should also be another field around the warmth of the home. Field Type: Drop down: House/flat owned; House/flat rented; Boarding house/motel; Caravan/tent/mobile home/boat; Special housing; Another family's house; Homeless; Not stated/inadequately described. New Drop down: Adequate warmth - yes; no. Number of changes of address in last year

Church If the client is of Pacific ethnicity then this should be a drop down to ask there connection with the church and a list of local churches provided. This will allow us to look at issues related to their church

15.1.8 Physical Assessment (Core 1)

Physical Assessment (Core 1)

Abdomen Describe the physical appearance and assessment by gentle palpation of the infant‟s abdomen. Inspect the contour of the abdomen. Field Type: drop down: Appearance – rounded; flat; Palpation – normal; masses (size, location, feel), feel (resists, cries, tenseness).

Age when physical

assessment

completed

The age of the Child Client at the time the physical assessment was completed. This is usually written in weeks and days, and indicates the chronological age of the child. Field Type: alpha/numeric

Birthmarks Describe the presence of birthmarks observed on the infant‟s skin. Field



Type: None observed. Present, type, colour, location and size.

Breasts and nipples Describe the presence and state of the infant‟s (male and female) breast tissue. Field Type: drop down: symmetrical and flat; asymmetrical; enlargement; discharge, supernumerary nipples.

Chest Describe the physical appearance of the infant‟s thorax and the respiratory status. Field Type: drop down: Chest appearance - symmetrical/asymmetrical; Respiratory rate - normal/ stridor/ wheeze/ in-drawing.

Date The date on which the complete physical assessment of the infant was undertaken. It is important that the date the physical assessment was completed is noted to ensure you have a baseline time for any changes that may have occurred and to confirm findings for the age of the infant. Field Type: alpha/numeric

Ears Describe the external appearance of the infant‟s ears. Field Type: Pinna - symmetrical/ asymmetrical; Hearing behaviour - responsive/unresponsive.

Eyes Describe the external appearance and function of infant‟s eyes. Field Type: drop down: Eyelids- symmetrical/ptosis; Cornea- clear/opaque; Pupils- round, equal, reactive to light/unequal/non-reactive; Iris - round and clear/not round and clear; Visual behaviour- fixing-following/not fixing-following; Strabismus (squint) - none observed/present.

Female genitalia Describe external appearance of the genitalia. Field Type: drop down: Labia - separated/fused; Discharge - normal (psuedomenstruation)/abnormal/blood/mucous/fecal; Skin tags - nil observed/ present.

Fontanelle Describe the appearance of the fontanelle. Field Type: drop down: Open flat and firm; bulging; tense; sunken; closed.

Head Shape Describe the general appearance of the infant‟s head shape. Field Type: drop down: symmetrical head shape; asymmetrical head shape - then describe location.

Hernia Describe the presence of hernia/s. Field Type: Drop down.

Hips Describe assessment made of the hips as a screening and surveillance process for developmental dysplasia of the hips (DDH). Field Type: drop down: Ortolani Barlow - dislocation/NAD; Classic signs – absent/present – Asymmetry of skin creases; Limitation of abduction; Limb shortening; Posture; Instability

Infant State Assess the general appearance of the infant. Field Type: Drop down: Alert and responsive; crying/irritable; unresponsive/drowsy.

Limbs Describe appearance and movements of the arms, hands, legs, and feet. Field Type: drop down: Arms and hands - length, symmetrical/asymmetrical; movement; normal range/limited; Feet and legs - length, symmetrical/asymmetrical; movement; normal range/limited; Digits - complete; extra digits; fusion of digits; normal range of movement.

Lip/ palate The Lip/palate is inspected for normal development. In a good light, inspect the hard and soft palates for any clefts. Field Type: drop down: Lips and palate intact; cleft.

Male genitalia Describe external appearance of the penis and scrotum. Field Type: drop down: Penis - normal/hypospadias/circumcised; Testes - descended/size/symmetry; Scrotum - normal/hydrocele/hernia; Urine flow - normal stream.



Muscle tone Observe symmetry and quality of muscle, development, tone and strength. Field Type: drop down Equal muscle development, tone and strength; unequal muscle development tone and strength; floppy; stiff/rigid.

Neck Describe the mobility of infant‟s head and alignment of neck in relation to the head and shoulders. . Field Type: drop down: Alignment - straight/torticollis; Movement - normal range.

Nose, mouth and

Mucosa

Describe the physical appearance of the infant‟s nose, mouth and mucous membranes. Field Type: Drop down: symmetrical; asymmetrical; mucous membrane, clear and pink; moving tongue; unable to move tongue.

Skin Assess the skin for colour, texture, and temperature. Field Type: drop down: Normal perfusion (pink) and smooth, pallor, cyanosis, jaundice (refer if persists at 5/52), dryness, rash.

Spine Describe appearance of infant‟s spine. Field Type: drop down: Straight and intact, scoliosis/spina-bifida/irregularity/sacral pit.

Subcutaneous

Tissue

Describes tissue turgor and the presence of subcutaneous fat. Field Type: drop down: Firm and elastic, lax, wasted, thin, well covered.

Sutures Describe the physical appearance of infant‟s sutures. Field Type: Drop down: Normal union; separated; fused; overlapping

Umbilicus Describe the state of the umbilicus. Field Type: drop down: Cord separated and clean, inflamed/discharge (serious, bleeding, purulent), granulation, hernia.

15.1.9 Parenting Education Topics

This information comes from the PEPE programme and lists the various components of each of the PEPE courses.

Parenting in the first six weeks

The role of the baby and parents

Parenting role models

Communication, crying and sleep

New Baby appearance

Bedding and sleep safety

Feeding

Bathing

Clothing

Nappies

Transporting Baby

Coping with change and challenges

Supports to aid adjustment

Returning to paid work

Immunisation



Parenting from 6 weeks to 1 year

Putting on your own oxygen mask

Physical wellbeing - sleep

Physical wellbeing - nutrition

Understanding your changing body (mums or becoming a new Dad

Who is there to help

Building your relationship with your baby

What sort of parent do you want to be

Your crying baby

Your colicky baby

Baby's sleeping and safety issues with sleeping

Your baby's head

Changing relationships - your relationship with your partner

Nutrition - breastfeeding

Changing relationships - your relationship with other adults

Changing relationships - your relationship with your children

Managing your relationship with health professionals

Keeping your baby safe

First aid - fevers and fits

First aid - burns, falls, choking, bad cuts, poisoning

First aid - CPR

Immunisation

When to call a health professional

Making decisions - dealing with conflicting advice

Nutrition - introducing your baby to solids

Your baby's first teeth

Managing infant behaviours positively

Returning to the work force

Babysitting

Childcare

When you are parenting against the odds - parenting alone

When you are parenting against the odds - when it all gets too much (PND)



Parenting from 1-2 years

Activity and rest

Nutrition and oral health

Safety

Environments for development

Toilet training

Positive responses to active behaviour

Parenting from 2-3 years

When you don't see eye to eye

The square screen

Activity and rest

Nutrition and oral health

Safety

Environments to help developments

Community supports

15.1.10 Antenatal Parenting Education Programme

Access to Maternity Services and Pregnancy Care

Antenatal providers and the role of health professionals

Complaints procedure

Physical changes during pregnancy

Pelvic floor

Maintaining a healthy pregnancy

Smoking, drug and alcohol use during pregnancy

When to seek help during pregnancy

Labour

Signs of labour

Stage one and two of labour

Induction of labour

Resources for labour

Involvement of partner or support person

Chemical pain relief



Birth Care and Baby Essentials

Third stage of labour

Assisted delivery

New Baby appearance

Post delivery

New born procedures

Essential items when preparing for baby

Breastfeeding

Breastfeeding

Baby friendly hospital initiative

Artificial feeding

Care Following Birth

Nappy options

Emotional responses in the postnatal period

Postnatal depression

Self Care postnatally

Sudden Infant Death Syndrome and Bedding

Well Child Service

Local emergency services

Parenting

Change and challenges

Different ways of parenting

Attachment

Crying baby

Information on community parent supports

15.1.11 Volunteer Support

Support groups

Date Date of support given



Group Name of group attended - free text. Type of group - playgroups, music groups, walking groups, special interest groups, coffee groups, PIN groups, toy library, puzzle library. Specialist Groupings - ethnicity groups - list to level 2 stats NZ, young parent groups, step-parents, parents of children with special needs, parents with special needs

Name attending A list of all those attending the group

Individual notes Notes of individuals that will populate their individual record

External speaker or special event

Free text

Venue List of local venues to appear as drop-down

Shared facilitation List of providers we may share facilitation of a group with

Facilitators name List of local Plunket facilitators with ability to add other names


Date of contact

Name of volunteer visitor

Drop down list from computer - the volunteer must be a registered Plunket volunteer

Length of time of visit Time in minutes

Source of referral Within Plunket, External to Plunket

Referral to another source

Within Plunket, External to Plunket

Connections to community agencies/support

Local support agencies

Issue for referral or connection

Tasks carried out while visiting

General Housework, Laundry, Cooking, Childcare,

Topics covered in general conversation

Positive parenting, financial literacy state other

15.1.12 Parent as First Teachers - PAFT

This is subject to change when programme reviewed

Assessment Interview

Most information from details already described in Health History, Child Client, Maternal health, Caregiver. The following is what is not already identified

PAFT team Drop down with list



PAFT Educator Drop down with list of local educators

Times for contact free test

Languages your family read

Drop down with common languages then text for others

Main language spoken in home

Drop down with common languages then text for others

Parents secondary education

# of years drop down

Are you still at school Mother and father both Yes/No

Did you gain a qualification at secondary school

Mother and father both Yes/No, then free test to right qualification

Do you have any other qualifications

Mother and father then free text to state

Do you read for pleasure

Mother and father - hardly ever, a little, quite a lot, one of my favourite pastimes

Did you attend any parenting or antenatal classes during this or previous pregnancies

Mother and father Yes/No

How did you find out about PAFT

Family/friends, PAFT parent educator, Family Start transfer, Other organisation - please specify

Do you have a Well Child Provider

Yes/No then text to state who

Are you planning to use other early childhood services (as well as PAFT)

Yes/No/don't know. If Yes - kindergarten, playcentre, childcare centre, kohanga reo, home-based care, playgroup, Nga puna kohnungahunga, Pacific Islands early childhood group, Correspondence School Early Childhood Section, Correspondence School Special Needs Section, Other - please specify

Are you planning to sue other parent support groups as well as PAFT

Other

Income bracket Less than $20,000, $20,000 - $24,999, $25,000 - $34,999, $35,000 - $50,000, more than $50,000

Was your baby born early

Yes/No then text to specify number of weeks early

How are you feeding your baby

breast, bottle, both

Other information Free Text



15.1.13 Plunket Postnatal Adjustment Programme

This is subject to change when programme reviewed

Assessment Interview

Most information from details already described in Health History, Child Client, Maternal health, Caregiver. The following is what is not already identified

Significant Partner Drop down for role, text for name

Supports -

Family/Whānau

Drop down and text

Obstetric History - Gravida, Parity

Drop down

Significant Factors Drop down for key (to be decided) and text for others

Childbirth experiences Drop down/text

Date referral received standard date text

Initial referrer Drop down for role, text for name

Assessment date/time

EPNDS scale (Edinburgh Postnatal Depression Score

Drop down with date of assessment. Need more than one

Permission to contact Yes/No - drop down by role and text for whom

Clients relationship with GP

Medication Drop down list of common medications and dosage to be developed, but need text to add more

Occupation

Maternity Leave Yes/No

Home Environment

Assessment -

Past Health History

Mental Client/Family

General health

Infant temperament

Interaction



(Mother/Baby)

Relationships: - family of origin, partner

Stressors - Current

Stressors - Functioning/Cares

Crisis Plan

Advocacy

Referrals

Special Needs

Potential as group member

Review Planned Date

15.1.14 Before School Checks

All the demographic and contact details is mentioned in the health history, client child, caregiver, family health below is the information not mentioned elsewhere.

Venue Free Text

Date Date

Name of person giving consent

Drop down for role, free text for name

Relationship Free Text

Contact Phone number

Address

Child Health Questionnaire

Health questionnaire complete

Yes/No - if yes then scanned into systems - yes/no

Any preconditions Yes/no then specify

Preschool name and location

Drop down of local with the choice of none

School to attend Drop down of local schools

GP & Medical Practice Drop down

Referral required Yes/No

If yes reason Drop down for common, then free text



Dental Check -

Progression of decay score 1-6

Enrolled in dental Service

Yes/No


If yes - referred to practitioner/service

Drop down

Growth Check -

Height drop down cm

Weight drop down kg


if yes - referred to practitioner/service type

Drop down

Immunisation Check -

Up to date in their immunisation

Yes/No/Partially/declined all immunisation

Menz B Yes/NO

Immunisation provided Yes/No if yes drop down for type

Referred for immunisation

Yes/No - if yes GP practice, immunisation outreach

Verified by Well Child Book

Yes/No

PEDS check - This is an assessment which needs to be entered into the system - what is listed below are the findings which should come automatically from the assessment

PEDS completed Yes/No

PEDS unshaded score(1-10)

PEDS shaded score (1-10)

PEDS pathway (A-E)


If yes, referred to practitioner/service type

Drop down

if no, list what information,

Drop down with key categories



recommendation if any were given

SDQ Check - This is an assessment which needs to be entered into the system - what is listed below are the findings which should come automatically from the assessment

SDQ completed by parent

Yes/No

Emotional symptoms score (1-10)

Conduct problems score (0-10)

Hyperactivity score (0-10)

Peer problems score (0-10)

Prosocial behaviour score (0-10)

Total difficulties score (0-40)

Impact score

SDQ teacher form completed

Yes/No/Not applicable

Emotional symptoms score (1-10)

Conduct problems score (0-10)

Hyperactivity score (0-10)

Peer problems score (0-10)

Prosocial behaviour score (0-10)

Total difficulties score (0-40)

Impact score

Referral required Yes/no and tick for sent copy to co-ordinator

If yes referred to practitioner

If no list what information, recommendations if any were given

Free text



15.2 Entities and Attributes This list details the attributes of the data entities as Plunket sees them with regard to the

Entity Relationship Diagrams in the Conceptual Data Model and the Clinical Dictionary.

These will need to be examined in more detail in the design phase.

It is recognised this could change depending on the solution chosen and changes

identified in the design and configuration stages.

It is also recognised this will change as the elements of the Clinical Dictionary, Contracts

and Contract Event Templates change.

ENTITY ATTRIBUTE TYPE

Client Health Information Abdomen list

Client Health Information Age (of child) in days number (days)

Client Health Information Age when physical assessment

completed

number (days)

Client Health Information Analysis of Health needs list

Client Health Information Antenatal and Parenting Education y/n

Client Health Information Antenatal and Parenting Education if

yes

string

Client Health Information Anticipatory guidance / education string

Client Health Information APEP 1 Antenatal providers and the role

of health professionals

y/n

Client Health Information APEP 1 Complaints procedure y/n

Client Health Information APEP 1 Maintaining a healthy

pregnancy

y/n

Client Health Information APEP 1 Pelvic floor y/n

Client Health Information APEP 1 Physical changes during

pregnancy

y/n

Client Health Information APEP 1 Smoking, drug and alcohol use

during pregnancy

y/n

Client Health Information APEP 1 When to seek help during

pregnancy

y/n

Client Health Information APEP 2 Chemical pain relief y/n

Client Health Information APEP 2 Induction of labour y/n

Client Health Information APEP 2 Involvement of partner or

support person

y/n

Client Health Information APEP 2 Resources for labour y/n

Client Health Information APEP 2 Signs of labour y/n

Client Health Information APEP 2 Stage one and two of labour y/n

Client Health Information APEP 3 Assisted delivery y/n

Client Health Information APEP 3 Essential items when preparing

for baby

y/n

Client Health Information APEP 3 New Baby appearance y/n

Client Health Information APEP 3 New born procedures y/n

Client Health Information APEP 3 Post delivery y/n

Client Health Information APEP 3 Third stage of labour y/n

Client Health Information APEP 4 Artificial feeding y/n

Client Health Information APEP 4 Baby friendly hospital initiative y/n

Client Health Information APEP 4 Breastfeeding y/n

Client Health Information APEP 5 Emotional responses in the

postnatal period

y/n

Client Health Information APEP 5 Local emergency services y/n

Client Health Information APEP 5 Nappy options y/n

Client Health Information APEP 5 Postnatal depression y/n

Client Health Information APEP 5 Self Care postnatally y/n

Client Health Information APEP 5 Sudden Infant Death Syndrome

and Bedding

y/n




Client Health Information APEP 5 Well Child Service y/n

Client Health Information APEP 6 Attachment y/n

Client Health Information APEP 6 Change and challenges y/n

Client Health Information APEP 6 Crying baby y/n

Client Health Information APEP 6 Different ways of parenting y/n

Client Health Information APEP 6 Information on community

parent supports

y/n

Client Health Information Apgar Score number

Client Health Information B4School - Any preconditions 1 y/n

Client Health Information B4School - Any preconditions 2 string

Client Health Information B4School - Dental Check -Enrolled in

dental Service

y/n

Client Health Information B4School - Dental Check -If yes -

referred to practitioner/service

list

Client Health Information B4School - Dental Check -Progression

of decay

number

Client Health Information B4School - Dental Check -Referral

required

y/n

Client Health Information B4School - Growth Check - Height list

Client Health Information B4School - Growth Check - if yes -

referred to practitioner/service type

list

Client Health Information B4School - Growth Check - Referral

required

y/n

Client Health Information B4School - Growth Check - Weight list

Client Health Information B4School - Health questionnaire

complete

y/n

Client Health Information B4School - If yes reason list

Client Health Information B4School - Immunisation Check -

Immunisation provided

y/n

Client Health Information B4School - Immunisation Check - Menz

B

y/n


Referred for immunisation

y/n

Client Health Information B4School - Immunisation Check - Up to

date in their immunisation

y/n


Verified by Well Child Book

y/n

Client Health Information B4School - PEDS check - if no, list what

information, recommendation if any

were given

list

Client Health Information B4School - PEDS check - If yes,

referred to practitioner/service type

list

Client Health Information B4School - PEDS check - PEDS

completed

y/n

Client Health Information B4School - PEDS check - PEDS pathway

(A-E)

list

Client Health Information B4School - PEDS check - PEDS shaded

score (1-10)

number

Client Health Information B4School - PEDS check - PEDS

unshaded score(1-10)

number

Client Health Information B4School - PEDS check - Referral

required

y/n

Client Health Information B4School - Referral required y/n

Client Health Information B4School - SDQ Check - Conduct

problems score (0-10)

number

Client Health Information B4School - SDQ Check - Conduct

problems score (0-10)

number




Client Health Information B4School - SDQ Check - Emotional

symptoms score (1-10)

number

Client Health Information B4School - SDQ Check - Emotional

symptoms score (1-10)

number

Client Health Information B4School - SDQ Check - Hyperactivity

score (0-10)

number

Client Health Information B4School - SDQ Check - Hyperactivity

score (0-10)

number

Client Health Information B4School - SDQ Check - If no list what

information, recommendations if any

were given

list

Client Health Information B4School - SDQ Check - If yes referred

to practitioner

list

Client Health Information B4School - SDQ Check - Impact score number

Client Health Information B4School - SDQ Check - Impact score number

Client Health Information B4School - SDQ Check - Peer problems

score (0-10)

number

Client Health Information B4School - SDQ Check - Peer problems

score (0-10)

number

Client Health Information B4School - SDQ Check - Prosocial

behaviour score (0-10)

number

Client Health Information B4School - SDQ Check - Prosocial

behaviour score (0-10)

number

Client Health Information B4School - SDQ Check - Referral

required

y/n

Client Health Information B4School - SDQ Check - SDQ

completed by parent

y/n

Client Health Information B4School - SDQ Check - SDQ teacher

form completed

list

Client Health Information B4School - SDQ Check - Total

difficulties score (0-40)

number

Client Health Information B4School - SDQ Check - Total

difficulties score (0-40)

number

Client Health Information BCG Vaccination to be defined

Client Health Information Birth Weight number (grams?)

Client Health Information Birth: normal, epidural, caesarean

section and other

list

Client Health Information Birth: normal, epidural, caesarean

section and other if other

string

Client Health Information Birthmarks 1 y/n

Client Health Information Birthmarks 2 if 1 = yes string

Client Health Information Breasts and nipples list

Client Health Information Caregiver's View string

Client Health Information Chest list

Client Health Information Child's Family Medical History Allergies y/n

Client Health Information Child's Family Medical History Allergies

if yes

list

Client Health Information Child's Family Medical History Asthma y/n

Client Health Information Child's Family Medical History Asthma if

yes

list

Client Health Information Child's Family Medical History

Developmental Displacement of the

Hip.

y/n


Developmental Displacement of the

Hip. if yes

list

Client Health Information Child's Family Medical History Hearing y/n




Impairment

Client Health Information Child's Family Medical History Hearing

Impairment if yes

list


Hereditary Conditions

y/n


Hereditary Conditions if yes

string

Client Health Information Child's Family Medical History Vision

Impairment

y/n

Client Health Information Child's Family Medical History Vision

Impairment if yes

list

Client Health Information Child's Health 1 ill y/n

Client Health Information Child's Health 2 illness list

Client Health Information Child's Health 3 string

Client Health Information Church 1 y/n

Client Health Information Church 2 list

Client Health Information Community Support Currently Accessed

by Parent(s)

list

Client Health Information Community Support Currently Accessed

by Parent(s) other

string

Client Health Information Complexity of need string

Client Health Information Contraception Discussed y/n

Client Health Information Counselling/ emotional support string

Client Health Information Current medication y/n

Client Health Information Current medication if yes string

Client Health Information Date date

Client Health Information Dental Enrolment y/n

Client Health Information Development Progress 1 list

Client Health Information Development Progress 2 - comment on

1

string

Client Health Information Development Progress 3 - referral or

recommendation

ref, rec or blank


recommendation to whom

list


recommendation why

list

Client Health Information Disabilities y/n

Client Health Information Disabilities if yes string

Client Health Information Discharge Feeding Status exclusive full

partial artificial

Client Health Information Drugs/Alcohol to be defined

Client Health Information Early Childhood Education enrolment 1 y/n

Client Health Information Early Childhood Education enrolment 2

if 1 = yes

list

Client Health Information Ears appearance list

Client Health Information Ears responsive y/n

Client Health Information Eyes 1 - eyelids list

Client Health Information Eyes 2 - cornea list

Client Health Information Eyes 3 - pupils shape list

Client Health Information Eyes 4 - pupils reactive list

Client Health Information Eyes 5 - iris list

Client Health Information Eyes 6 - visual behaviour list

Client Health Information Eyes 7 - strabismus list

Client Health Information Family Support Currently Accessed by

Parent(s) Caregivers

list

Client Health Information Family Violence 1 - screening asked y/n

Client Health Information Family Violence 2 - screening if yes or string




no

Client Health Information Family Violence 3 - Anticipatory

guidance / education

string

Client Health Information Family Violence 3 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Family Violence Screen string

Client Health Information Family wellbeing string

Client Health Information Female genitalia - discharge list

Client Health Information Female genitalia - labia list

Client Health Information Female genitalia - skin tags list

Client Health Information Fontanelle list

Client Health Information Gestational Age number (weeks)

Client Health Information Growth 1 head circumference number cm

Client Health Information Growth 2 length height number cm

Client Health Information Growth 3 weight number kg

Client Health Information Growth 4 Anticipatory guidance /

education

string

Client Health Information Growth 5 Concerns list

Client Health Information Growth 6 - referral or recommendation ref, rec or blank

Client Health Information Growth 7 - referral or recommendation

to whom

list

Client Health Information Growth 8 - referral or recommendation

why

list

Client Health Information Head Shape list

Client Health Information Head Shape - location string

Client Health Information Health determinant factors 1 list

Client Health Information Health determinant factors 2 string

Client Health Information Health determinant factors 3.... string

Client Health Information Health Education string

Client Health Information Health Need H (high) M (short

term high) L (Low)

Client Health Information Health Promotion Recommendation -

where

list

Client Health Information Health Promotion Recommendation -

why

list

Client Health Information Health seeking behaviour 1 list

Client Health Information Health seeking behaviour 2 1 = other string

Client Health Information Health seeking behaviour 3 service list

Client Health Information Hearing Surveillance 1 questionnaire

completed

y/n

Client Health Information Hearing Surveillance 2 1 = y concerns /no

concern

Client Health Information Hearing Surveillance 3 2 = concerns

specify

string

Client Health Information Hearing Surveillance 4 Anticipatory


string

Client Health Information Hearing Surveillance 5 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Hernia list




Client Health Information Hips list

Client Health Information Immunisation status 1 list

Client Health Information Immunisation status 2 Anticipatory


string

Client Health Information Immunisation status 3 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Income y/n

Client Health Information Infant State list

Client Health Information Jaundice y/n

Client Health Information Language Spoken at Home list

Client Health Information Language Spoken at Home if other string

Client Health Information Lead Maternity Carer (LMC) string

Client Health Information Limbs - arms and hands list

Client Health Information Limbs - feet and legs list

Client Health Information Limbs - digits list

Client Health Information Link to community support 1 list

Client Health Information Link to community support 2 if 1 =

other

string

Client Health Information Lip/ palate list

Client Health Information Living Arrangements - if situation =

other

string

Client Health Information Living Arrangements - number in house number

Client Health Information Living Arrangements - Other persons

living in the house

list

Client Health Information Living Arrangements - situation list

Client Health Information Male genitalia - penis list

Client Health Information Male genitalia - scrotum list

Client Health Information Male genitalia - testes list

Client Health Information Male genitalia - urine flow list

Client Health Information Maternal health 1 PND screen to be defined

Client Health Information Maternal health 2 - rest sleep nutrition y/n

Client Health Information Maternal health 3 - comment rest sleep

nutrition

string

Client Health Information Maternal health 4 - access whānau y/n

Client Health Information Maternal health 5 - comment access

whānau

string

Client Health Information Maternal health 6 - Anticipatory


string

Client Health Information Maternal Health 7 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Medical follow up planned y/n

Client Health Information Medical follow up planned if yes string

Client Health Information Metabolic Screen 1 y/n

Client Health Information Metabolic Screen 2 if 1 = yes string

Client Health Information Mother's health after birth Breasts and

nipples

list

Client Health Information Mother's health after birth Breasts and

nipples more info

string

Client Health Information Mother's health after birth General well / ill




wellbeing

Client Health Information Mother's health after birth General

wellbeing if ill

string

Client Health Information Mother's health after birth Mental

health

list

Client Health Information Mother's health after birth Mental

health

string

Client Health Information Mother's health after birth

Perinatal/abdominal

list

Client Health Information Mother's health after birth

Perinatal/abdominal more info

string

Client Health Information Mother's health after birth PND screen to be defined

Client Health Information Mother's health after birth Vaginal loss list

Client Health Information Muscle tone list

Client Health Information Name and signature

Client Health Information Neck - alignment list

Client Health Information Neck - movement list

Client Health Information Needs assessment same as health

need?

Client Health Information Neonatal hearing assessment

undertaken

y/n

Client Health Information Neonatal Unit Admission y/n

Client Health Information Neonatal Unit Admission if yes string

Client Health Information Nose, mouth and Mucosa - mouth

appearance

list

Client Health Information Nose, mouth and Mucosa - mucus

membrane appearance

list

Client Health Information Nose, mouth and Mucosa - nose

appearance

list

Client Health Information Nose, mouth and Mucosa tongue list

Client Health Information Nutrition 01 - Breastfeeding type exclusive full

partial artificial

Client Health Information Nutrition 02 Breastfeeding Anticipatory


string

Client Health Information Nutrition 03 - depending on nutrition 1

= full

list


= full

string


= partial

list


= partial

string


= artificial

list


= artificial

string

Client Health Information Nutrition 09 - introduction of solids date

Client Health Information Nutrition 10 - diet type list

Client Health Information Nutrition 11 - type of food list

Client Health Information Nutrition 12 - if Nutrition 11 = other string

Client Health Information Nutrition 13 - Habits list

Client Health Information Nutrition 14 - Education list

Client Health Information Nutrition 15 - Education if Nutrition 14

= other

string

Client Health Information Nutrition 16 - referral or

recommendation

ref, rec or blank

Client Health Information Nutrition 17 - referral or list





Client Health Information Nutrition 18 - referral or

recommendation why

list

Client Health Information Obtained data from surveillance/clinical

assessment

string

Client Health Information Other comments related to this birth string

Client Health Information Other information string

Client Health Information Other Services involved list

Client Health Information PAFT - Are you planning to use other

early childhood services (as well as

PAFT)

y/n

Client Health Information PAFT - Are you planning to use other

parent support groups as well as PAFT

list

Client Health Information PAFT - Did you attend any parenting or

antenatal classes during this or

previous pregnancies

y/n

Client Health Information PAFT - did you get a further

qualification 1

y/n

Client Health Information PAFT - did you get a further

qualification 2 if 1 = yes

string

Client Health Information PAFT - did you get a secondary school

qualification 1

y/n

Client Health Information PAFT - did you get a secondary school

qualification 2 if 1 = yes

string

Client Health Information PAFT - do you read for pleasure list

Client Health Information PAFT - How are you feeding your baby list

Client Health Information PAFT - How did you find out about PAFT list

Client Health Information PAFT - Income bracket list

Client Health Information PAFT - Other Well Child provider y/n

Client Health Information PAFT - Plan to use other services? 1 list

Client Health Information PAFT - Plan to use other services? 2 if 1

= other

string

Client Health Information PAFT - still at school y/n

Client Health Information PAFT - Was your baby born early y/n

Client Health Information PAFT - Years secondary education number

Client Health Information PAFT Child Milestone - Intellectual string

Client Health Information PAFT Child Milestone - Language string

Client Health Information PAFT Child Milestone - Motor string

Client Health Information PAFT Child Milestone - Social-Emotional string

Client Health Information PAFT Groups - Budgeting y/n

Client Health Information PAFT Groups - Cooking y/n

Client Health Information PAFT Groups - Music & Movement y/n

Client Health Information PAFT Groups - Outside visits y/n

Client Health Information PAFT Groups - Physical Activity i.e.

swimming

y/n

Client Health Information PAFT Groups - Toy Making y/n

Client Health Information PAFT Groups - Toys for under 1's y/n

Client Health Information PAFT Parent Handouts - Attachment &

Brain development

y/n

Client Health Information PAFT Parent Handouts - Born to Learn y/n

Client Health Information PAFT Parent Handouts - Direction to

build my pyramid

y/n

Client Health Information PAFT Parent Handouts - Food

categories

y/n

Client Health Information PAFT Parent Handouts - Food Guide

pyramid

y/n

Client Health Information PAFT Parent Handouts - Getting ready y/n




for your baby

Client Health Information PAFT Parent Handouts - How should I

feed my baby

y/n

Client Health Information PAFT Parent Handouts - My Pyramid y/n

Client Health Information PAFT Parent Handouts - Pre-natal care

- what to expect

y/n

Client Health Information PAFT Parent Handouts - Prepare for

older child

y/n

Client Health Information PAFT Parent Handouts - Rhymes/Songs y/n

Client Health Information PAFT Parent Handouts - This list is long

and all handouts will need to be on it

y/n

Client Health Information PAFT Parent Handouts - Understanding

Postpartum depression

y/n

Client Health Information PAFT Parent Handouts - Welcome to

PAFT

y/n

Client Health Information PAFT Parent Handouts - What's

happening with mum/dad

y/n

Client Health Information PAFT Parent Handouts - Your child's

Amazing brain

y/n

Client Health Information PAFT Parent Handouts - Your role as a

Parent

y/n

Client Health Information Paid employment

Client Health Information Parenting 3 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Parenting Ed <6 wk - Bathing y/n

Client Health Information Parenting Ed <6 wk - Bedding and

sleep safety

y/n

Client Health Information Parenting Ed <6 wk - Clothing y/n

Client Health Information Parenting Ed <6 wk - Communication,

crying and sleep

y/n

Client Health Information Parenting Ed <6 wk - Coping with

change and challenges

y/n

Client Health Information Parenting Ed <6 wk - Feeding y/n

Client Health Information Parenting Ed <6 wk - Immunisation y/n

Client Health Information Parenting Ed <6 wk - Nappies y/n

Client Health Information Parenting Ed <6 wk - New Baby

appearance

y/n

Client Health Information Parenting Ed <6 wk - Parenting role

models

y/n

Client Health Information Parenting Ed <6 wk - Returning to paid

work

y/n

Client Health Information Parenting Ed <6 wk - Supports to aid

adjustment

y/n

Client Health Information Parenting Ed <6 wk - The role of the

baby and parents

y/n

Client Health Information Parenting Ed <6 wk - Transporting

Baby

y/n

Client Health Information Parenting Ed 1-2 year - Activity and

rest

y/n

Client Health Information Parenting Ed 1-2 year - Environments

for development

y/n

Client Health Information Parenting Ed 1-2 year - Nutrition and

oral health

y/n




Client Health Information Parenting Ed 1-2 year - Positive

responses to active behaviour

y/n

Client Health Information Parenting Ed 1-2 year - Safety y/n

Client Health Information Parenting Ed 1-2 year - Toilet training y/n

Client Health Information Parenting Ed 2-3 year - Activity and

rest

y/n

Client Health Information Parenting Ed 2-3 year - Environments

to help developments

y/n

Client Health Information Parenting Ed 2-3 year - Nutrition and

oral health

y/n

Client Health Information Parenting Ed 2-3 year - Safety y/n

Client Health Information Parenting Ed 2-3 year - The square

screen

y/n

Client Health Information Parenting Ed 2-3 year - When you don't

see eye to eye

y/n

Client Health Information Parenting Ed 6w-1 ye - Baby's sleeping

and safety issues with sleeping

y/n

Client Health Information Parenting Ed 6w-1 ye - Babysitting y/n

Client Health Information Parenting Ed 6w-1 ye - Building your

relationship with your baby

y/n

Client Health Information Parenting Ed 6w-1 ye - Changing

relationships - your relationship with

other adults

y/n



your children

y/n



your partner

y/n

Client Health Information Parenting Ed 6w-1 ye - Childcare y/n

Client Health Information Parenting Ed 6w-1 ye - First aid -

burns, falls, choking, bad cuts,

poisoning

y/n

Client Health Information Parenting Ed 6w-1 ye - First aid - CPR y/n

Client Health Information Parenting Ed 6w-1 ye - First aid -

fevers and fits

y/n

Client Health Information Parenting Ed 6w-1 ye - Immunisation y/n

Client Health Information Parenting Ed 6w-1 ye - Keeping your

baby sage

y/n

Client Health Information Parenting Ed 6w-1 ye - Making

decisions - dealing with conflicting

advice

y/n

Client Health Information Parenting Ed 6w-1 ye - Managing

infant behaviours positively

y/n

Client Health Information Parenting Ed 6w-1 ye - Managing your

relationship with health professionals

y/n

Client Health Information Parenting Ed 6w-1 ye - Nutrition -

breastfeeding

y/n

Client Health Information Parenting Ed 6w-1 ye - Nutrition -

introducing your baby to solids

y/n

Client Health Information Parenting Ed 6w-1 ye - Physical

wellbeing - nutrition

y/n

Client Health Information Parenting Ed 6w-1 ye - Physical

wellbeing - sleep

y/n

Client Health Information Parenting Ed 6w-1 ye - Putting on your

own oxygen mask

y/n

Client Health Information Parenting Ed 6w-1 ye - Returning to y/n




the work force

Client Health Information Parenting Ed 6w-1 ye - Understanding

your changing body (mums or

becoming a new Dad

y/n

Client Health Information Parenting Ed 6w-1 ye - What sort of

parent do you want to be

y/n

Client Health Information Parenting Ed 6w-1 ye - When to call a

health professional

y/n

Client Health Information Parenting Ed 6w-1 ye - When you are

parenting against the odds - parenting

alone

y/n

Client Health Information Parenting Ed 6w-1 ye - When you are

parenting against the odds - when it all

gets too much (PND)

y/n

Client Health Information Parenting Ed 6w-1 ye - Who is there to

help

y/n

Client Health Information Parenting Ed 6w-1 ye - Your baby's

first teeth

y/n

Client Health Information Parenting Ed 6w-1 ye - Your baby's

head

y/n

Client Health Information Parenting Ed 6w-1 ye - Your colicky

baby

y/n

Client Health Information Parenting Ed 6w-1 ye - Your crying

baby

y/n

Client Health Information Parenting Practice 1 list

Client Health Information Parenting Practice 2 Anticipatory


string

Client Health Information Paternal Health to be defined

Client Health Information Paternal Health 1 Previous Experience 1 y/n

Client Health Information Paternal Health 1 Previous Experience if

1 = yes

string

Client Health Information Paternal Health 2 General health 1 list

Client Health Information Paternal Health 2 General health detail string

Client Health Information Paternal Health 3 Mental Health list

Client Health Information Paternal Health 4 Medications 1 y/n

Client Health Information Paternal Health 4 Medications if 1 = yes string

Client Health Information Paternal Health 5 Smoking status y/n

Client Health Information Phototherapy y/n

Client Health Information Physical assessment 1 string

Client Health Information Physical assessment 2 - WCTO Screen list

Client Health Information Physical assessment 3 - Physical

Assessment 2 = other

string

Client Health Information Physical assessment 4 - Anticipatory


string

Client Health Information Physical assessment 5 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Place 1 list

Client Health Information Place 2 when Place 1 = other string

Client Health Information Plunket volunteer activities list

Client Health Information Plunket Volunteer notification list

Client Health Information PPNAP Assessment - Advocacy string

Client Health Information PPNAP Assessment - Crisis Plan string

Client Health Information PPNAP Assessment - General health string




Client Health Information PPNAP Assessment - Infant

temperament

string

Client Health Information PPNAP Assessment - Interaction

(Mother/Baby)

string

Client Health Information PPNAP Assessment - Mental

Client/Family

string

Client Health Information PPNAP Assessment - Past Health

History

string

Client Health Information PPNAP Assessment - Potential as group

member

string

Client Health Information PPNAP Assessment - Referrals string

Client Health Information PPNAP Assessment - Relationships: -

family of origin, partner

string

Client Health Information PPNAP Assessment - Review Planned date

Client Health Information PPNAP Assessment - Special Needs string

Client Health Information PPNAP Assessment - Stressors -

Current

string

Client Health Information PPNAP Assessment - Stressors -

Functioning/Cares

string

Client Health Information PPNAP Assessment date/time date

Client Health Information PPNAP Childbirth experiences 1 list

Client Health Information PPNAP Childbirth experiences 2 string

Client Health Information PPNAP Clients relationship with GP to be defined

Client Health Information PPNAP Date referral received date

Client Health Information PPNAP EPNDS scale (Edinburgh

Postnatal Depression Score

list

Client Health Information PPNAP Home Environment string

Client Health Information PPNAP Initial referrer string

Client Health Information PPNAP Maternity Leave y/n

Client Health Information PPNAP Medication 1 y/n

Client Health Information PPNAP Medication 2 string

Client Health Information PPNAP Obstetric History - Gravida,

Parity 1

list

Client Health Information PPNAP Obstetric History - Gravida,

Parity 2

string

Client Health Information PPNAP Occupation string

Client Health Information PPNAP Permission to contact y/n

Client Health Information PPNAP Significant Factors 1 list

Client Health Information PPNAP Significant Factors 2 string

Client Health Information PPNAP Significant Partner 1 list

Client Health Information PPNAP Significant Partner 2 string

Client Health Information PPNAP Supports - Family/Whānau 1 list

Client Health Information PPNAP Supports - Family/Whānau 2 string

Client Health Information Pre birth problems y/n

Client Health Information Pre birth problems if yes string

Client Health Information Pre-birth alcohol intake list

Client Health Information Pre-birth Smoking list

Client Health Information Previous Breastfeeding Problems y/n

Client Health Information Previous Breastfeeding Problems if yes string

Client Health Information Previous postnatal depression y/n

Client Health Information Previous postnatal depression if yes string

Client Health Information Previous pregnancy, birth and postnatal

history

y/n

Client Health Information Previous pregnancy, birth and postnatal

history if yes

string

Client Health Information Privacy of Information y/n

Client Health Information Process Recording string




Client Health Information Recommendation list

Client Health Information Referral list

Client Health Information Referral - Where list

Client Health Information Referral - why list

Client Health Information Relationship building 1 list

Client Health Information Relationship building 2 - if relationship

building 1 = other

string

Client Health Information Relationship building 3 - Anticipatory


string

Client Health Information Relationship building 4 - Health

Promotion

string

Client Health Information Relationship building 5 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Safety assessment 1 y/n

Client Health Information Safety assessment 2 list

Client Health Information Safety assessment 3 reason for no on

1

string

Client Health Information Significant medical/health issues in the

family

list

Client Health Information Skin list

Client Health Information Smoking 1 - exposure list

Client Health Information Smoking 2 - exposure If Smoking 1 =

other

string

Client Health Information Smoking 3 - in house list

Client Health Information Smoking 4 - if Smoking 3 = other string

Client Health Information Smoking 5 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Spine list

Client Health Information Subcutaneous Tissue list

Client Health Information SUDI/Sleep 01 - position list

Client Health Information SUDI/Sleep 02 - environment list

Client Health Information SUDI/Sleep 03 - if SUDI/Sleep 2

environment = other

string

Client Health Information SUDI/Sleep 04 - sleeping at night list

Client Health Information SUDI/Sleep 05 - depends on

SUDI/Sleep 4

string


SUDI/Sleep 4

string


SUDI/Sleep 4

string


SUDI/Sleep 4

string


SUDI/Sleep 4

string

Client Health Information SUDI/Sleep 10 - Anticipatory guidance

/ education

list

Client Health Information SUDI/Sleep 11 - Anticipatory guidance

/ education

string

Client Health Information SUDI/Sleep 12 - referral or ref, rec or blank




recommendation

Client Health Information SUDI/Sleep 13 - referral or


list

Client Health Information SUDI/Sleep 14 - referral or

recommendation why

list

Client Health Information Summary/outcomes string

Client Health Information Support person Present at birth y/n

Client Health Information Sutures list

Client Health Information Transfer to Plunket weight number (grams?)

Client Health Information Transport list

Client Health Information Type of dwelling/accommodation list

Client Health Information Umbilicus list

Client Health Information Vision surveillance 1 list

Client Health Information Vision surveillance 2 - if Vision

surveillance 1 = other

string

Client Health Information Vision surveillance 3 - Anticipatory


string

Client Health Information Vision surveillance 4 - referral or

recommendation

ref, rec or blank



list


recommendation why

list

Client Health Information Vitamin K y/n

Client Health Information Volunteering list

Client Health Information whānau / family carer support 1 list

Client Health Information whānau / family carer support 2 string

date / time Date of Event (contact) date

Demographics Deprivation Score number

Demographics Domicile Code number

Demographics Ethnicity list

Demographics Ethnicity if other string

Email Email email address

Event Adult Only y/n

Event Caregiver attending with child (new) list

Event Contact age band list

Event Contact Type Core or KR Core or

Additional

Event Deprivation Score of child at time of

event

number

Event Designation (of CD staff) list

Event DHB of child at time of event list

Event External speaker or special event string

Event Funding list

Event Group y/n

Event Is Event Closed y/n

Event New Baby Case y/n

Event New Case y/n

Event Plunket location number number

Event Status List (ANK, NAH,

pending, complete,

rescheduled

Event Territorial Local Authority (TLA) of child

at time of event

list

Event was event prepared for y/n

Event Needs assessment at time of contact. list

Identifier Employee Number list




Identifier National Health Index Number alphanumeric

Person Ability to Communicate in English y/n

Person Able to read English y/n

Person Consent for GP summary y/n

Person Date of Birth date

Person Date of enrolment date

Person Date of referral date

Person Discontinued date date

Person Enrolled in service list

Person Event reminder period 1 number (days)

Person Event reminder period 2 number (days)

Person Event reminder sent by list

Person Expression of interest in Volunteer

activities

list

Person First time parent y/n/na

Person Hapu list

Person Hazards for staff y/n

Person Hazards for staff if yes string

Person Immigration status list

Person Iwi list

Person Language - Ability to read English y/n

Person Language - Requires interpreter y/n

Person Language - Requires interpreter if yes -

language

string

Person Languages spoken at home list

Person Languages spoken at home if other string

Person Preferred Method of contact list

Person Reason for discontinuation list

Person Reason for discontinuation if other string

Person Requires interpreter y/n

Person Requires interpreter if yes - language string

Person Sex list

Person Status list

Person Type of Client list

Person Type of Service Delivery Staff list

Person Organisation

Address

Deprivation Score number

Person Organisation

Address

DHB of address list

Person Organisation

Address

Dogs on Property that are uncontrolled y/n

Person Organisation

Address

Postcode number

Person Organisation

Address

Street / Flat Number and Name string

Person Organisation

Address

Suburb string

Person Organisation

Address

Territorial Local Authority (TLA) of

address

list

Person Organisation

Address

Town city string

Person Organisation

Physical Address

Hazards for staff y/n

Person Organisation

Physical Address

Hazards for staff if yes string

phone Alternative Contact Phone Number number

phone Phone number




phone Phone Number (DAY) number

phone Phone Number (evening) number

phone Phone Number (mobile) number

place of contact Contact Place list

relationship/role Relationship type list

The Entities below Will have attributes that mirror Client Health Information as

they cause the Client Health Information to be actioned / measured / recorded

Actions

SDP Template for Client

Contact Event Template

SDP Plan for Client

Template Action

Template Health Determinant

Types of relationships

1 is primary caregiver for

2 is alternate contact for

3 is caregiver for

4 is related to

5 is referee for

6 is Doctor for

7 is legal guardian for

8 is first time parent for

9 works for

10 volunteers for

11 is home sub branch for

12 is primary contact for

13 is area for x branch

14 is branch for sub -branch

15 is TA for sub- branch

16 is DHB for sub- branch

17 is a group that A attends

18 is PHO for doctor

19 is PHO for client

20 is father of

21 is mother of

22 is Case Manager for

23 is a Karitane

24 is a Kaiawhina

25 is a Registered Nurse

26 is a Plunket Nurse

27 Is a Plunket Administrator

28 Is a Plunket Manager /Clinical Leader

29 is a Plunket Volunteer

30 Is a Plunket Volunteer funded person

31 is a member of group

32 is a facilitator for group

33 is an advisor for group

34 is a sibling to



35 is an organisation that can facilitate

36 is a support agency in area

37 is a member of PAFT team

38 is a PAFT educator in area

38 is the Well Child provider for

and many more to be identified

Relationship Attribute

is a Plunket Nurse in area x can only be assigned clients for sub-branches x, y

and z

is a Plunket Nurse in area x can only be assigned clients for ethnicities a, b and c

is a Plunket Nurse in area x can only be assigned contacts for sub-branches x, y

and z

is a Plunket Nurse in area x can only be assigned contacts for ethnicities a, b and

c

is a Health worker in area x can only be assigned contacts for sub-branches x, y

and z

is a Health worker in area x can only be assigned contacts for ethnicities a, b and

c

is the mother of had a caesarean delivery for child a and not b



15.3 Mapping Attributes to Clinical Dictionary These charts show some examples of how the entity and attribute definitions in

Section 15.2 “Entities and Attributes” map to the descriptions in Section 15.1 “Clinical

Dictionary”.

Entity level 1Entity level

2Group type Description

Examples of

attributesfield Type Notes Concerning attributes (taken from Clinical dictionary)

Jaundice yes/ no Simple yes/ no

Neo-natal Unit

Admission 1yes/ no Simple yes / no

Neo-natal Unit

Admission 2text Explanation if 1 = yes giving reason for the admission

Neck drop down

Describe the mobility of infant‟s head and alignment of neck in

relation to the head and shoulders. . Field Type: drop down:

Alignment - straight/torticollis; Movement - normal range.

Limbs - Arms and

Hands

drop down can

select multiple

Limbs -Legs and

Feet

drop down can

select multiple

Limbs - Digitsdrop down can

select multiple

Lip/ palate

The Lip/palate is inspected for normal development. In a good light,

inspect the hard and soft palates for any clefts. Field Type: drop

down: Lips and palate intact; cleft.

Male genitalia -

penisdrop down

Male genitalia -

testesdrop down

Male genitalia -

scrotumdrop down

Male genitalia -

urine flowdrop down


birth Breasts and

nipples

drop down


birth Breasts and

nipples more info

text


birth General well-

being

drop down


birth General well-

being if ill

text

Pre birth problems yes/ no

Pre birth problems if

yestext

Birth: normal,

epidural, caesarian

section and other

drop down

Whether the mother‟s labour was normal or abnormal, or an

intervention (epidural, forceps delivery, caesarean section or general

anaesthetic) was required. Field Type: Drop down – normal,

epidural, caesarean section, other (please state).


birth Mental health 1drop down


birth Mental health 2text

Child's Family

Medical History

Vision Impairment 1

drop down can

select multiple

Visual impairment is a general term that includes both mild to severe

loss of visual acuity. Discovery of visual impairment as early as

possible is essential to prevent further loss of vision and

developmental delay. Infants at increased risk of visual impairment

are those who have: Family history of squint, blindness, cataract,

retinoblastoma, albinism or glaucoma; Congenital infections such as

rubella, cytomegalovirus, toxoplasmosis, herpes or syphilis;

Prematurity (gestation of 34 weeks of less) or birthweight < 1500

grams; Other developmental or neurological problems (e.g. cerebral

palsy). In the presence of any of these risk factors, the infant must

be referred directly to an opthalmologist for diagnostic assessment

of visual acuity. Field Type: yes/no

Child's Family

Medical History

Vision Impairment 2

text Explanation if 1 = yes giving history (text)

Data

that

is c

olle

cte

d w

hen a

child

enro

ls t

hat

rela

tes t

o t

he

birth

and t

he c

hild

‟s h

ealth a

t

birth

.

Data

that

is c

olle

cte

d o

ne

only

at

the f

irst

enro

lment

conta

ct

or

import

ed d

irectly

from

a r

efe

rral and v

erified/

expanded u

pon /

corr

ecte

d a

t

the f

irst

conta

ct

Once o

nly

Data

- a

t re

ferr

al or

firs

t conta

ct

Data

that

is c

olle

cte

d a

t th

e f

irst

core

conta

ct

by a

physic

al assessm

ent

conducte

d

by a

Plu

nket

Nurs

e.

Describe external appearance of the penis and scrotum. Field Type:

drop down: Penis - normal/hypospadias/circumcised; Testes -

descended/size/symmetry; Scrotum - normal/hydrocele/hernia; Urine

flow - normal stream.

To establish the health and comfort of the mother‟s breasts and

nipples. Field Type: Drop down – comfortable, lumps, redness, pain

and discomfort from the last 4 the ability to add notes regarding any

treatment

The period of 6 weeks following birth (the puerperium), involves a

number of physiological and psychological changes for a mother

adjusting to birth. Field Type: Drop down - well, unwell (state

specify issues/concerns).

Has the mother experienced any health problems related to her own,

or the baby‟s health during this pregnancy? Field Type: Drop down -

yes or no. If yes allow addition of specify problems.

Initia

l C

lient

Health I

nfo

rmation

- C

hild

once o

nly

data

at

firs

t conta

ct

Data

that

is c

olle

cte

d o

ne o

nly

at

the f

irst

enro

lment

conta

ct

(Core

1)

To assess the mother's emotional state. Field Type: Drop down -

normal, blues, depression, psychosis. From the last 3 the ability to

add notes around treatment or services being received. ?Drop down -

PND screening questions (still to be designed).

Data

that

is c

olle

cte

d w

hen

a c

hild

enro

ls t

hat

rela

tes

to t

he c

hild

and t

he

moth

er's h

ealth a

t birth

whic

h c

ould

repate

to o

ther

child

ren a

s w

ell

Data

that

is c

olle

cte

d w

hen a

child

enro

ls t

hat

rela

tes

to t

he b

irth

and t

he c

hild

‟s h

ealth a

t birth

whic

h m

ay

be s

upple

mente

d b

y r

ecord

s o

f sib

lings o

r m

ay

supple

ment

theirs

Describe appearance and movements of the arms, hands, legs, and

feet. Field Type: drop down: Arms and hands - length,

symmetrical/assymetrical; movement; normal range/limited; Feet

and legs - length, symmetrical/assymetrical; movement; normal

range/limited; Digits - complete; extra digits; fusion of digits; normal

range of movement.

Data

that

is c

olle

cte

d w

hen a

child

enro

ls t

hat

rela

tes t

o t

he c

hild

and t

he

moth

er's h

ealth a

t birth

.

Initia

l C

lient

Health I

nfo

rmation

- F

am

ily

Once o

nly

Data

- a

t re

ferr

al or

firs

t conta

ct

Data

that

is c

olle

cte

d o

ne o

nly

at

the f

irst

enro

lment

conta

ct

or

import

ed d

irectly f

rom

a r

efe

rral and

verified/

expanded u

pon /

corr

ecte

d a

t th

e f

irst

conta

ct

Initia

l C

lient

Health Info

rmation -

Well

Child

Initia

l C

lient

Health I

nfo

rmation

- M

oth

er

Once o

nly

Data

- a

t re

ferr

al or

firs

t conta

ct

Data

that

is c

olle

cte

d o

ne o

nly

at

the f

irst

enro

lment

conta

ct

or

import

ed d

irectly f

rom

a r

efe

rral and

verified/

expanded u

pon /

corr

ecte

d a

t th

e f

irst

conta

ct





Examples of


Child's Health 1 yes/ no

Child's Health 2drop down can

select multiple

Child's Health 3 text

Child's Health 4 text

Child's Health … text and enough space for comment on each health issue selected

Growth 1 weight drop down

Growth 2 - head

circumferencenumber

Growth 3 - length number

Growth 4 - concernsdrop down can

select multipleGrowth 5 -describe

concernstext

Growth 6 - describe

concernstext

Growth …. -describe

concernstext

Growth - 7+

Anticipatory

Guidence

text

Growth 8+ referrals

why

drop down can

select multiple

Growth 9+ referrals

where

drop down can

select multiple

Growth 10+

recommendations

where

drop down can

select multiple

Growth 11+

recommendations

why

drop down can

select multiple

Smoking 1 -

exposureyes/ no

Smoking 2 -

exposure If Smoking

1 = other

Smoking 3 - in

houseyes/ no

Smoking 4 - if

Smoking 3 = other

drop down can

select multiple

Smoking 5 - referral

or recommendation


or recommendation

to whom


or recommendation

why

Must be completed at each core contact. The codes are based on

the question asked of the parent/caregiver. During the past 3 days

did you or any other person smoke in places while your baby/child

was there (e.g. home, car, friend‟s or relatives home, Marae,

restaurant)? Field Type: Drop down: Yes - who and relationship to

child. Drop down - information offered; No; Unknown - did not ask

(please state reason for not asking); Refused answer; Other (please

state reason). Anticipatory Guidance/education: drop down - smoke

free advice provided/no advice. Referrals/Recommendations – Drop

down with list of relevant services for smoking you may refer a client

to and click box to bring up relevant referral form, also list of key

reasons for referral relevant to smoking – with other added as a last

option with specify reason.

Statement of the general well being of the child/Tamariki; physical,

emotional, social and environmental. Field Type: Drop down: Well;

illness – drop down to include asthma, hips, undescended testes, ill

health, dental health issues, allow room for comment. Also room for

general comments

Weight measured using certified scales on the correct surface, for

the naked weight of infant. May be in a singlet and undies for

children over 1 year, though these must be lifted in observing the

child during examination. Head circumference is taken at the largest

diameter – occiput-frontal axis, from three successive

measurements using a non-stretch or paper tape. Length is

measured using a broad board, or similar, with the infant

appropriately positioned in the supine position, using the feet to push

the board against. Height (once child can stand with feet positioned

close together) is taken with the child/Tamariki positioned with no

shoes on using a standard measuring tool. Record measurements on

percentile graphs against accurate age. Field Type: drop down:

Weight in kg; Length in cm; height in cm; head circumference in

cm; Each of these will then go on and automatically populate the

growth chart. Drop down: Concerns - within normal range; Failure to

Thrive; overweight; Other (please specific). Anticipatory

Guidance/education - free text. Referrals/Recommendations: drop

down with list of relevant services for growth you may refer a client

to and click box to bring up relevant referral form, also list of key

reasons for referral relevant to growth - with other added as a last

option with specify reason.

Must be completed at each core contact. The codes are based on

the question asked of the parent/caregiver. Is there anyone in your

household who is a tobacco smoker? Field Type: Drop down: Yes -

who and relationship to child. Drop down - smoke free information

offered; No; Unknown - did not ask (please state reason for not

asking); Refused answer; Other (please state reason).

Well

Child

Clie

nt H

ealth Info

rmation o

bserv

ed / r

ecord

ed a

t all

core

conta

cts





Examples of


Nutrition 1 -

Breastfeeding typedrop down

Nutrition 2

Breastfeeding

Anticipatory


text

Nutrition 3 -

depending on

nutrition 1 = full

drop down

Nutrition 4 -

depending on

nutrition 1 = full

text

Nutrition 5 -

depending on

nutrition 1 = partial

drop down

Nutrition 6 -

depending on

nutrition 1 = partial

text

Nutrition 7 -

depending on

nutrition 1 = artificial

drop down

Nutrition 8 -

depending on

nutrition 1 = artificial

text

Nutrition 9 -

introduction of solids

Nutrition 10 - diet

type

Nutrition 11 - type of

food

Nutrition 12 - if

Nutrition 11 = other

Nutrition 13 - Habits

Nutrition 14 -

Education

Nutrition 15 -

Education if Nutrition

14 = other

Nutrition 16 - referral

or recommendation


or recommendation

to whom


or recommendation

why

Summary of nutrition in relation to the developmental stage and age

of the child/Tamariki, and family/whanau culture. Field Type: Drop

down boxes for type of feeding, each will also have the ability to

write any notes on issues/concerns. For each there will also be a

drop down for advice provide – education/anticipatory

guidance/referrals/recommendations. Breastfeeding status of the

infant/child must be collected at every core contact. Field Type:

Drop down: Exclusive, the infant has never to the mother‟s

knowledge, had any water, formula or other liquid or solid food. Only

breast milk from the breast, expressed breast milk, and prescribed

medicines have been given from birth; Full, the infant has taken

breast milk only. No other liquids or solids, except a minimal amount

of water or prescribed medicines, have been given in the past 48

hours (further drop down – water/medications (write medication in

last 48 hours)); Partial; The infant/child has taken some breast milk

and some infant formula or other solid food in the past 48hours

(further drop down: other nutrition needs; Formula – drop down to

amount, frequency and type/solids – frequency/other (please state)).

Artificial feeding. The infant/child has had no breast milk, but has

had alternative liquids such as infant formula, with or without solid

food, in the past 48 hours. Drop down with ability to add amount,

frequency and type of formula used. Solids: drop down: Introduction

of solids - add date of intro of solids (be able to pick an actual date

or time period i.e. 12 November 2009 or 3 weeks ago). Drop down

also for type of food – Stage 1, stage 2 and stage 3. Diet: drop

down: Type – Normal, vegetarian, allergy (state what allergy),

diabetic, prescribed nutrition, other (please state). Habits: drop

down: Good eater, fussy eater. Education: drop down: Info provided

on nutrition requirements; Discussion on nutrition requirements;

Strategies on feeding; Weaning discussed; Hazard of burns from

heating formula in microwave discussed, Other please state.

Anticipatory Guidance: drop down: advice on when to introduce

solids; weaning; Strategies for upcoming development stages (state

what). Should we combined the education and anticipatory

guidance? Referrals/Recommendations: drop down with list of

relevant services for nutrition you may refer a client to and click box

to bring up relevant referral form, also list of key reasons for referral

relevant to nutrition – with other added as an last options with

specify reason.

We

ll C

hild

Clie

nt

He

alth

In

form

atio

n o

bse

rve

d /

re

co

rde

d a

t d

esig

na

ted

co

re

co

nta

cts

Plu

nket

see c

hild

ren f

rom

birth

to a

ge 5

. N

utr

itio

nal needs c

hange o

ver

the t

ime s

o w

e d

on't w

ant

to a

sk m

oth

ers

of

new

born

s a

bout

the s

olid

s t

heir c

hild

is g

ett

ing

nor

do w

e n

eed t

o a

sk a

bout

bre

astf

eedin

g o

nce a

child

is w

eened.

Develo

pm

ent

topic

s w

ill a

lso f

ollo

w t

his

patt

en a

s w

ill S

UD

I





Examples of

attributesfield Type

APEP 1 Antenatal providers

and the role of health

professionals

yes/ no

APEP 1 Complaints

procedure

yes/ no

APEP 1 Maintaining a healthy

pregnenacy

yes/ no

APEP 1 Pelvic floor

yes/ no

APEP 1 Physical changes

during pregnancy

yes/ no

APEP 1 Smoking, drug and

alcohol use during pregnancy

yes/ no

APEP 1 When to seek help

duing pregnancy

yes/ no

APEP 2 Chemical pain relief

yes/ no

APEP 2 Induction of labour

yes/ no

APEP 2 Involvment of partner

or support person

yes/ no

APEP 2 Resources for labour

yes/ no

APEP 2 Signs of labour

yes/ no

APEP 2 Stage one and two of

labour

yes/ no

APEP 3 Assisted delivery

yes/ no

APEP 3 Essential items when

preparing for baby

yes/ no

APEP 3 New Baby

appearance

yes/ no

APEP 3 New born procedures

yes/ no

APEP 3 Post delivery

yes/ no

APEP 3 Third stage of labour

yes/ no

Other ServicesA

nte

Nata

l C

ours

e C

lient H

ealth Info

rmation

Cours

e D

ete

rmin

ants

- A

dult

this

is a

bit lik

e a

curr

iculu

m -

and is it

covere

d o

r not.

Perh

aps n

ot

a h

ealth d

ete

rmin

ant



15.4 Contract Event Templates – Well Child Contract This section sets out the requirements for populating the Contract Event Templates for

the Well Child Tamariki Ora Contract. Plunket expects to work with the Software Provider

during the design phase to further define the details including the data type of each

attribute.

These templates are based on the requirements from each contract and what needs to

occur at each contact for the contract requirements to be met. Different contracts held by

Plunket have completely different requirements, and we need to ensure that the

components of the contract are met. Therefore Contract Event Templates will need to be

developed for each individual contract; however under some of the contracts each

individual contact will have differing requirements.

An example of this is the Well Child Tamariki Ora Contract where each contact has

different requirements and these are set out below.

For additional contacts in the Well Child Tamariki Ora Contract (and some other

contracts) templates will need to be developed for specific topics such as breastfeeding,

safety or sleep. The staff member will then be able to select the most appropriate

template when they see the client, if it was not already pulled down into the Service

Delivery Plan for Client Event. There will need to be a blank template for clients with

issues for which there is no template. Plunket needs the ability to continuously develop

the templates.

The following information is based on the 2002 Well Child Tamariki Ora Framework

Schedule as well as current Plunket practice based on policy and known changes to be

implemented during 2010 resulting from the review of the Well Child Tamariki Ora

Framework.

15.4.1 Well Child Core Contact 1 – Child 4-6 weeks

History including – Health History, Child Client Health Information, Maternal Client Health

Information, Paternal Client Health Information – see data dictionary for attributes.

Complete Physical Assessment of the baby – see data dictionary for attribute.

In particular for this age group the Health Protection and Clinical Assessment focuses on:

General observations

Weight

Head Circumference

Length

Hips

Hearing - questions

Vision – questions

Immunisation status

Development for age

Nutrition status

Family Violence screening

Safe sleeping

Testes (descended undescended)

Smoking environment



The Key Health Education and Promotion focuses on

Recognition of illness

Management of minor illness

Breastfeeding promotion

Maternal nutrition

Infant feeding

Contacts for emergency

SUDI prevention

CPR

Parenting Skills

Infant development

Immunisation

Smoke free environment

Caregivers stress and fatigue

Contraceptive advice

Community networking

Safe environment

Car seats

Fire safety

Falls

Bathing

Rights of child

Ensure resources

Collaboration with other providers

The Key Family or Whānau Care and Support focuses on:

Opportunity to discuss parental or whānau concerns

Listen and responds to whānau concerns

Review of psychological and environment circumstances including cultural support

Assessment of Postnatal Depression (Patient Health Questionnaire 3 - PHQ3)

Promote family or whānau support

Assessment of need for additional support for families

Crisis intervention

Assessment of parental relationship with child

Support groups and networks

15.4.2 Well Child Core Contact 2 – Child 6–10 weeks

If this is the first contact then the history and physical assessment in core 1 needs to be

undertaken.





Weight

Head Circumference

Length

Hips – only if it has been identified as a problem

Hearing - questions


Immunisation status

Development for age

Nutrition status


Safe sleeping

Testes (descended undescended) – only if it has been identified as a problem

Smoking environment

The Key Health Education and Promotion focuses on:




Maternal nutrition

Infant feeding


SUDI prevention

CPR

Parenting Skills

Infant development

Immunisation




Safe environment

Car seats

Fire safety

Falls

Bathing

Rights of child

Ensure resources











Crisis intervention



15.4.3 Well Child Core Contact 3– Child 10–16 weeks


undertaken.


PEDS assessment


Weight

Head Circumference

Length

Hearing - questions


Immunisation status

Development for age

Nutrition status


Safe sleeping


Smoking environment





Maternal nutrition

Infant feeding


SUDI prevention

CPR

Parenting Skills

Infant development

Immunisation






Safe environment

Car seats

Fire safety

Falls

Bathing

Rights of child

Ensure resources









Crisis intervention



15.4.4 Well Child Core Contact 4– Child 16 weeks to 8 months


undertaken.


PEDS assessment


Weight

Length

Hearing - questions


Immunisation status

Development for age

Nutrition status


Safe sleeping


Smoking environment







Maternal nutrition

Infant feeding


SUDI prevention

CPR

Parenting Skills

Infant development

Immunisation




Safe environment

Car seats

Fire safety

Falls

Bathing

Rights of child

Ensure resources









Crisis intervention



15.4.5 Well Child Core Contact 5– Child 8 – 14 months


undertaken.


PEDS assessment


Weight

Length/Height



Hearing - questions


Immunisation status

Development for age

Nutrition status



Smoking environment

Dental assessment for children over 12 months – Lift the Lip




Maternal nutrition

Infant feeding


CPR

Parenting Skills

Infant development

Immunisation




Safe environment

Car seats

Fire safety

Falls

Bathing

Home

Rights of child

Ensure resources








Crisis intervention





15.4.6 Well Child Core Contact 6 – Child 14-21 months


undertaken.


PEDS


Weight

Height

Hearing - questions


Immunisation status

Development for age

Nutrition status



Smoking environment

Lift the Lip



Infant feeding

Parenting Skills

Behaviour management

Toileting

Sleeping

Socialisation

eating

Immunisation


Education about child development

Play

Language

Safe environment

Home hazards

Water

Medicines, poisons

Hot water

Car Seat

Road



Sun

Safe home/neighbourhood

Safe playgrounds

Water safety/pool fencing

Bathing

Enrolment with dental service






Preschool involvement



undertaken.


PEDS


Weight

Height

Hearing - questions


Immunisation status

Development for age

Nutrition status



Smoking environment

Lift the Lip



Infant feeding

Parenting Skills


Toileting

Sleeping

Socialisation

eating

Immunisation





Play

Language

Safe environment

Home hazards

Water

Medicines, poisons

Hot water

Car Seat

Road

Sun


Safe playgrounds


Bathing










undertaken.


PEDS


Weight

Height

Hearing - questions


Immunisation status

Development for age

Nutrition status



Smoking environment



Lift the Lip



Infant feeding

Parenting Skills


Toileting

Sleeping

Socialisation

eating

Immunisation



Play

Language

Safe environment

Home hazards

Water

Medicines, poisons

Hot water

Car Seat

Road

Sun


Safe playgrounds


Bathing










16 Appendix C: CYF Notification Form

This is a four-page form, used for the Plunket outgoing referral process.

Referrals to CYF are known as CYF Notifications.



17 Appendix D: Who Can Access What Matrix

All data De-

identified

Data

Contact

details

Demo-

graphic

Contact

Dates

Special

Confidential

Child

Safety

Issues

Hidden by

Plunket

Nurse

Volunteer

part of

SD Plan

Rest of

Client's

SD Plan

Client's

Health

Info

Plunket

Hazard

Alerts

Outcomes

Clients and Client Representatives

Legal Guardian (usually parent)

Person under protection order O O O O O O Note 2

Other Primary Caregiver O O O O O O O O

Other caregivers approved by Legal Guardian O O O O O O O O

Limited Legal Guardian Note 2

External provider approved by Legal Guardian O O O O O O O O

Plunket Service Delivery Staff within Branch

Care Delivery Staff Note 8

Volunteers Note 8

Area Management and Area Administrators within Area

Area Managers Note 8

Clinical Leaders Note 8

Volunteer Service Leaders Note 8

Area Administrators Note 8

Plunket - Specialist PlunketPlus Technical Support Staff

PlunketPlus System Adminstrators

PlunketPlus Database Adminstrators

PlunketPlus Clinical Specialists

National Office

Clinical Advisors

Clinical Educators (only while working with staff)

Business Intelligence Analysts

Researchers - General

Researchers - Specific Projects Note 5

HR staff

Accounts Staff

IT Staff, including service desk and specialists Note 3

Other, with approval from Ethics Committee Note 6

Any not listed here

NOTES 1. By default, Child Safety Issues are hidden; only Plunket Nurse can unhide for a person.

means access allowed. 2. Plunket to seek legal advice about this requirement.

means access denied. 3. IT support staff are permitted to use their remote desktop mirror service to assist users, understanding that

O means access set at option of Legal Guardian this allows them to see and potentially operate PlunketPlus, however Plunket should have policies to preclude this.

This matrix shows who may READ which data. 4. Special confidential. For example, adoption details, visible only to National Clinical Advisor.

Permission to ADD or UPDATE data to be defined. 5. Only with specific approval from the Ethics Committee.

No data can be deleted, it can just be marked not current. 6. Access to only the specific data approved case-by-case by the Ethics Committee.

Capability needed to add further categories of data. 7. Any of the data categories across here can be hidden by the Plunket Nurse.

Access right for SYSTEM FUNCTIONS to be defined. 8. Access outside Branch or Area through the "break-glass" function.

Note 1Note 4 Note 7

DRAFT

See Notes at bottom.



18 Appendix E: Glossary

AD Microsoft Active Directory. This will be superseded by FIM.

Action The word “action” is used throughout this document in two

Plunket defined contexts, in the names of three to be

processes and as a generic term for doing something or

approving something.

The two Plunket defined contexts are:

Workflow actions – these are detailed in Section 12.1.2

on page 131. The system or a Plunket Staff member

can initiate workflow actions for themselves or other

Plunket Staff members.

The two data entities:

Template Action,

Action Taken and Actions to be Taken.

These define what is to happen and what has happened

at a contact and are detailed in Sections 11.2.7

“Contracts and Service Delivery Plans” on page 114

and 11.2.8 “Client Health Information and Actions” on

page 118.

The To-Be processes that use the work action are:

12.4.8 Identify Follow-up Actions and Update

Service Delivery Plan on page 184.

12.4.13 Action Referral on page 196.

12.4.14 Other Non-Contact Action on page 198.

Action in these instances is used as a term for something

to do.

Plunket has taken care to be consistent in the use of the

word “Action” throughout this document and would like the

reader to be aware of the different uses.

Administrator There are references several quite different administrator

roles throughout this document, each with a specific

definition.

Area Administrator

Staff in Plunket Area Offices who provide

administrative support to other Plunket Staff.

Database Administrator

A technical specialist with skills and experience in

database schemas and database management and

maintenance, with some familiarity in data modelling.

PlunketPlus System Administrator

A senior Plunket employee who is very familiar with

Plunket‟s operational and clinical practices, Plunket‟s

data and systems, and who is a specialist in the



detailed functionality and data of PlunketPlus.

This person might also be referred to as a “super user”.

Workflow Administrator

The people within Plunket who are responsible for

setting up and maintaining the variable aspects of the

workflow system. They will also monitor the operation

of the system and the status of action queues and

escalations.

Alerts Clinical Alert. This is a message containing information

about a situation that requires priority action by a Plunket

Nurse, eg child protection issues.

Hazard Alert. Information held in relation to a client or

address about possible risks to Service Delivery Staff, eg a

dangerous dog on the property.

System Alert. A message raised by PlunketPlus about a

situation where some action is required by a Plunket Staff

member.

Area Administrator Defined under Administrator, above.

B4 School Check Staff The B4 School Check programme is a nationwide

programme offering free health and development

assessments for four year olds and is delivered by Plunket

Nurses.

The B4 School Check staff aim to identify and address any

health, behavioural, social or developmental concerns

which could affect a child‟s ability to benefit from school.

Examples include hearing problems, nutrition issues or

communication difficulties.

Calendar The term “calendar” has sometimes been used in this

document when referring to “Diary”, which is defined

elsewhere in this glossary.

Case Manager The Service Delivery Staff member responsible for the

coordination of a service the client is receiving.

Case Manager Plunket

Nurse

The Plunket Nurse who is assigned as the Case Manager

for the client.

The Case Manager Plunket Nurse has responsibility and

accountability for ensuring that the client and family

receive the appropriate care and services.

This is mandatory for Well Child Tamariki Ora clients.

Adults receiving certain Plunket services may also be

assigned a Case Manager.



Client and Caregiver Plunket considers that each of these people is a client:

The child receiving Plunket services.




Other people who have active participation in the

care of the child who are:

- Other family members, biological or otherwise;

- Whānau

- Other people.

Each other child in the same family or place of

residence.


There are clear relationship linkages between child clients,

each child‟s caregivers and with other people.

Client Contact The core client contact is the heart of Plunket‟s service

delivery and it consists of a structured visit with the client,

who is generally a child and their mother or other

caregiver, usually in their family home or a Plunket clinic.

There are several other different types of client contact

and there are differing levels of information access or

collection requirements associated with each type.

The client contacts may be individual contacts (eg Plunket

Nurse with the caregiver and child), or they may be in

groups (eg several clients attending a parenting group). In

some cases they may take place by telephone or other

messaging services.

Contacts are usually scheduled; they can be unscheduled.

During every client contact, Plunket Service Delivery Staff

undertake the following actions:

Make and record measurements.

Make and record observations.

Discuss defined topics, record that the topic was

discussed and any information relevant to the topic.


(CHI)

Information that the Service Delivery Staff record in the

client‟s EHR determined during a Contact that is:

A measurement, or

An observation or conclusion, or

Topics discussed and any information relevant to that

topic.

The client‟s EHR contains other information that is not

Client Health Information, for example address, contact

details and demographics.



Contract Plunket has a number of contracts for provision of

services. The most significant of these currently is the

Ministry of Health contract for the Well Child service. Other

examples include PlunketLine and services funded by

volunteers, grants, donors or other government

departments such as MSD.

Each client contact needs to be carried out and recorded

against a contract to ensure the necessary actions are

taken and to enable effective reporting.

In the cases where services provided are not covered by a

funded contract, a contract will nonetheless be used to

define the service. This will enable Plunket to track and

report on such services.

CSRS The Car Seat Rental Scheme system.

CYF Child, Youth and Family, a service of the Ministry of Social

Development

Data Entity In data modelling, the data entity represents something

about which various items of information are stored.

For example, a “person” entity would hold the names and

date of birth of the person.

Database Administrator Defined under Administrator, above.

Design phase Plunket anticipates that its system procurement process

will include a detailed systems design phase as an early

activity prior to system configuration, testing and

commissioning.

DHB District Health Board

Diary The date and time based record of future and past

appointments and client contacts for each Service Delivery

Staff member.

There are also Diaries for resources, such as family

centres.

In Microsoft Outlook, this is called a calendar; to Plunket,

it is a Diary.

EDD Expected date of delivery.

EHR

Electronic Health Record

The EHR that Plunket intends to establish for each client.

See the full description on page 19.



Entity In this document, this generally means Data Entity; see

above.

ERD Entity Relationship Diagram, the data modelling term for

the diagrams used in the conceptual data model section of

this specification.

External Providers Plunket works with a number of different providers.

The majority of referrals to Plunket are from the Lead

Maternity Carers (LMCs) ie midwives. Other examples

include DHB services, GPs and PHOs.

Plunket refers clients to a wide range of services including

GPs, DHB services, Dental Services, Education Services,

NGOs and Government departments.

FIM Microsoft Forefront Identity Manager (FIM) is an Identity

Management toolset from Microsoft; Plunket will use FIM

to develop and maintain role-based policies across its

network and applications environment.

Follow-up During a client contact, Plunket Service Delivery Staff

usually identify one or more follow-up actions that are

required.

This may just involve scheduling the next client contact.

GP General Practitioner (Doctor).

GPNZ General Practice New Zealand, the new organisation

comprising IPAC and the General Practice Nursing Alliance.

Health Worker Health Workers are qualified paraprofessionals, who have

completed a Tamariki Ora certificate or equivalent. They

focus on enhancing family/whānau strengths and capacity,

to meet the needs of their children.

Health Workers work with families/whānau who have

children up to five years of age and deliver health

promotion, health education, health protection and illness

prevention concepts in their work. They work under the

delegation and direction of a Plunket Nurse in supporting

families with different needs.

There are two types of Health Worker:

Plunket Kaiawhina –Maori Health Workers who work

mainly with Maori Families

Community Karitane – work across all ethnicities

HISNZ Health Information Strategy for New Zealand.



HISO The Health Information Standards Organisation of New

Zealand, a unit of the Ministry of Health.

IPAC The Independent Practitioners Association Council of New

Zealand. IPAC has recently merged with the General

Practice Nursing Alliance to create GPNZ.

IT Information Technology.

Legal Guardian The person who has legal responsibility for making the

parental decisions for a child.

LMC Lead Maternity Carer; a midwife.

Meshblock Meshblock definition from Statistics New Zealand:

The meshblock is the smallest geographic unit for which

statistical data is collected and processed by Statistics New

Zealand. A meshblock is a defined geographic area,

varying in size from part of a city block to large areas of

rural land. Each meshblock abuts against another to form

a network covering all of New Zealand including coasts and

inlets, and extending out to the two hundred mile

economic zone. Meshblocks are added together to „build

up‟ larger geographic areas such as area units and urban

areas. They are also the principal unit used to draw-up and

define electoral district and local authority boundaries.

Mobile Computer It is envisaged that Plunket Service Delivery Staff will have

mobile computer devices that can access the EHR from

any location using mobile communications, such as client‟s

homes, maraes and pre-schools, and allow input or

updating of information.

Plunket also requires that these devices can access other

Plunket and non-Plunket systems, including the internet,

through Plunket‟s secure network.

When on Plunket premises where there is WAN

connectivity, the mobile computer should use the WAN

through either Wi-Fi or a fly lead.

Plunket‟s experience has indicated that the mobile

computer needs to be of the tablet style, or similar.

Details of the requirements for the mobile computer

devices are specified in Section 13.11 “User Devices” on

page 289.

These devices will be the subject of a separate

procurement process once the solution for PlunketPlus is

selected.

MOH Ministry of Health.



MSD Ministry of Social Development.

Needs Assessment Level Plunket Nurses carry out a “needs assessment” of each

client at every Contact, based on a number of observations

and the information in the client‟s EHR. This is an analysis

which results in determining a “needs assessment level” as

at the time of the Contact and helps the Plunket Nurse

decide any follow-up actions and changes to the client‟s

Service Delivery Plan.

The Plunket Nurse enters the Needs Assessment Level

code into the Client Health Information in the EHR as an

observation from that Contact. Over time, there will be

multiple Needs Assessment Level codes for each client, so

that trends can be noted and acted on.

While there is significant clinical rigour in determining the

Needs Assessment Level, there is no current requirement

for the system to support this process.

NGO Non Government Organisation.

NHI National Health Index.

NIR National Immunisation Register.

NZ New Zealand.

NZHIS New Zealand Health Information Service, a unit of the

Ministry of Health.

PAFT Staff Parents as First Teachers is an early childhood programme

which has a strong education focus. PAFT staff have an

education background and are usually qualified early

childhood educators.

The focus of PAFT staff is to provide parents with

information and support to become more confident in their

parenting role, making effective use of family, whānau and

wider networks.

PCIS Plunket Client Information System, the existing system for

collecting and scanning information into the current POND

database.

PEPE Parenting Education ProgrammE.

PHO Public Health Organisation.



PHR Plunket Health Record, which is paper-based.

PIN Plunket in Neighbourhood groups.

Plunket Kaiawhina Health Worker who works mainly with Maori families under

the direction and delegation of a Plunket Nurse.

Plunket Nurse A Plunket Nurse is a Registered Nurse with a current

practising certificate who has completed or is completing

further specialty training in the area of Well Child health

and community child and family/whānau health promotion.

The focus is on delivering a primary health care service

based on the Tamariki Ora Schedule (health promotion,

education, clinical assessment and whānau/family support)

to child clients aged birth to approximately 5 years, and

their whānau, families and caregivers.

Plunket Nurses work in a variety of community locations

including clinics, homes, Marae and early childhood centres

and have extensive knowledge of the communities they

work in.

Advanced assessment skills and knowledge of child health

and development enable Plunket Nurses to provide and co-

ordinate care, information, surveillance, and support

appropriate to the whānau/families situation.

PlunketPlus System

Administrator

Defined under Administrator, above.

POND Plunket Operational National Database, the existing legacy

system.

PPCIS Plunket Primary Client Information System, a former

working name for PlunketPlus.

PPNAP Staff Plunket Postnatal Adjustment Programme Staff work in

areas that provide a DHB funded service contract to

support mothers with mild-to-moderate postnatal

depression. This is undertaken both in group settings and

on a one to one basis.

RFI Request for Information.

RFP Request for Proposal.



Schedule As a noun: The Well Child Framework Tamariki Ora

Schedule.

As a verb: We schedule appointments and client contacts

into the diaries of Service Delivery Staff.

SDP

Service Delivery Plan

Plunket aims to establish an individual Service Delivery

Plan for each client. This will comprise all the Plunket

services and actions that are scheduled, or waiting to be

scheduled for that client.

See the full description on page 21.

Software Provider An organisation that could potentially provide the

PlunketPlus software or part of it.

In Plunket‟s Request for Proposal document, the term

“Respondent” refers to an organisation providing a

proposal in response to the RFP. The Respondent may be a

software provider or integrator and they may represent

other software providers in proposing an integrated

solution.

TLA Territorial Local Authority

User Any person who uses the computer system.

Volunteer Within Plunket there are two groups of volunteers.

Volunteers who choose to do unpaid work to help

Plunket achieve its vision. They work with clients either

in a group setting or on an individual basis such as

volunteer home visiting.

Paid staff who work in volunteer-funded programmes.

These activities include groups such as parenting

programmes, breastfeeding support and some family

centre services. These are classified in this document

as volunteer funded.

VPN Virtual Private Network

WCTO Well Child Tamariki Ora, the name of the main contract

between Plunket and the Ministry of Health for services.

Workflow Administrator Defined under Administrator, above.

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