Written by: Crystal Maertens

This article covers a topic that is part of Champ Software’s Expert Webinar series in which subject matter experts present on trending or urgent public health topics. Join our mailing list here to receive Expert Webinar invitations.

Kari Quilling, RN, BSN, Clinic Nurse Manager for Dunn County Health Department in Wisconsin, presented at the July 2024 Expert Webinar on streamlining reproductive health management using Champ Software’s Nightingale Notes EHR software. Kari has nearly two decades of experience in the nursing field. Her career has included supervising nursing programs and clinics for immunizations, community health, maternal child health, reproductive health, and harm reduction. You can view the full presentation recording here.

Dunn County Health Department has been using Champ Software’s EHR, Nightingale Notes, to document their public health work since 2018. Since the majority of the charting done at Dunn County Health Department is done in their reproductive health work, the health department decided to start implementing Nightingale Notes EHR customized forms, tabs, and reports in their reproductive health charting first. Kari Quilling’s presentation focused on how the health department has utilized that customization to streamline their reproductive health management through Nightingale Notes EHR.

Custom Fillable Forms

Kari Quilling began her presentation by sharing about managing fillable forms in the EHR across multiple platforms and customizing fillable forms for their reproductive health management work, specifically. 

Quilling explained, “If you have custom forms as part of your package, you can create your own forms to fit your clinic flow and assessment needs.” Fillable forms features in Nightingale Notes EHR that Dunn County Health Department has found beneficial include:

• Building custom forms from scratch
• Customizing the layout of the form
• Editing a form as clinic needs change over time
• Creating links for clients and providers to access forms
• Creating QR codes for clients and providers to access forms

Quilling shared the many ways Dunn County Health Department has leveraged the ability to create links and QR codes to access forms. The health department has published those links and QR codes on:

• The health department website 
• Flyers and brochures
• Tablets used in the clinic so clients can fill out forms at the clinic
• In texts or emails to clients (if a patient agreement is in place)
• Hard copy paper that is laminated (this is specific to QR codes) so a provider can quickly scan the QR code and use the form to chart a client interaction

Getting Started with Custom Fillable Forms

When getting started with custom forms, Quilling said she started from scratch, converting the health department’s paper forms. Another option is to have an existing form, created by another Nightingale Notes EHR user, copied to your health department’s database by Champ Software. Some health departments using Nightingale Notes EHR, may have created a custom form and then given permission for that form to be copied into other users’ databases. 

Quilling created a sample form for her audience, explaining her steps as she went. She added custom fields, choosing from options such as demographics, static text, blank line, horizontal line, file attachment, etc. 

When adding a field such as demographic, Quilling can choose what type of demographic fields she’s adding by clicking to select from a list of options: middle name, address, gender, cell phone number, etc. 

Quilling demonstrated adding a field for “home visit” and choosing to create a checkbox where one can select “yes” or “no.” Quilling also demonstrated that she could make fields required or not. After adding fields, Quilling can change the order.

Once Quilling has created her form, she can save and print it to see what the completed form looks like. If there’s anything she wants to change, she can go back and edit the form until it looks the way she wants. “So, if I go to our custom forms and I pick one for editing, if I go in there, I can change any of this information, the order of the information… so, I can move them up and down if I want to,” she explained. Quilling also noted she could copy existing forms and edit them to create a new form.

Using Fillable Forms for Clients

A client can then use their phone or tablet to access a fillable form by clicking the link or scanning the QR code. Quilling explained that the health department website has a ‘Patient Forms’ tab, “So, if they call to make an appointment, our front desk staff says, ‘You have the option of filling out these forms ahead of time,’ and then they go to this page and they click on the ones that they’re instructed to fill out. And this allows the patients to complete the forms on their own time, without feeling rushed, prior to their appointment.”

If a client hasn’t used the links on the website to fill out forms or prefers not to use (or does not have) their own phone or tablet to scan a QR code or access the form from the website, the health department provides tablets for client use while at the clinic, with the forms pre-loaded so the client can just click on the form and begin filling it out. Quilling noted, “We also chose to get tablets with S Pens so that folks can sign just as they would do on paper.”

Once a client has filled out a form, either through a link or QR code or by using a tablet at the clinic, the form populates within the Nightingale Notes EHR in a “Manage Custom Forms” section. From there, a Dunn County Health Department nurse can either match the form to an existing client or create a new client. If the form is filled out by an existing client, Nightingale Notes EHR will find and suggest existing clients whose names match the form and the nurse can select the correct match.

After the form is matched to an existing client or a new client, the form flows into the client’s individual chart. Quilling said, “We go through the forms with the clients or the patients when they are in clinic, make sure everything is filled out, and make sure that everything is filled out for our end.” After that, the form is saved as a PDF within the client’s chart so it can no longer be edited. 

Public health nurses also have the option to pull up a new custom form while charting during the client visit. Since the nurse is pulling up a form from within the client’s chart, the name and date of birth fields will auto-populate with the client’s details. 

Using Fillable Forms for Providers

Another use Dunn County Health Department has found for custom forms is to create custom forms for the providers. “So, since our provider is contracted and doesn’t come every day, we created custom provider forms. The provider scans the QR code or clicks the link on our clinic tablet and then just charts. The form’s then pulled into the patient’s chart and the provider does not need access to Nightingale Notes to chart.”

This is especially helpful since Dunn County Health Department doesn’t need to add an additional EHR software license for a contracted provider. 

Custom Tabs

Quilling then moved on to discussing another customization in Nightingale Notes EHR that has helped Dunn County Health Department streamline their Reproductive Health work: custom tabs. The client chart in Nightingale Notes EHR is divided into sections or “tabs” such as demographics, allergies, etc.

Nightingale Notes offers users the ability to also create their own custom tabs to collect data for a specific purpose in a central location, making it easy and convenient for providers and staff to locate and access the data. This offers users a way to customize the organization and grouping of some of the client data they collect or to collect data specific to their own needs.  

Examples of data Dunn County Health Department collects using custom tabs includes:

• Family Planning Annual Report (FPAR) 2.0 data
• Title X family planning data
• Data for other grant reporting
• Reproductive health data

Examples of data that is collected in the reproductive health custom tab includes:

• Insurance coverage and type
• Contact information
• Cytology history
• Date of last annual exam
• Date of last STI check or positive STI
• Birth control type
• Confidentiality notes
• General notes

Because Nightingale Notes EHR allows documentation of an individual, family, or community, tabs can be used to collect data for community events as well, using the community as a client.

Custom Reports

Nightingale Notes EHR offers a host of canned reports to its users. Quilling notes the benefits of also having the ability to create customizable reports in Nightingale Notes. “Do you need to know how many clients you’ve seen in a certain time frame? There’s a report for that. How about how many medications you’ve been – you have dispensed in the past quarter for STI treatment? There’s a report for that. And how many visits a certain patient has had in the last year? Yep, there’s a report for that too. So, for just about any information you need, that you can think of, a report can be built.” Quilling said.

Examples of custom reports that Dunn County Health Department has built include:

• Non-duplicated, newly enrolled reproductive health patients within a filterable time frame
• Grant specific reports
• STI treatment
• Clients by program
• Family Planning Annual Report (FPAR) 2.0
• Prenatal Care Coordination (PNCC) billing report
• Employee activities

Quilling explains that they use reports to track, among other things:

• Outcomes (“…we have a lot of outcomes we track,” Quilling notes.)
• Grant requirements
• Inventory
• Flu billing
• Documentation completed

“So you can just play around and build reports that pull from different parts of the chart,” Quilling explains. Quilling also says, “Reports are an important part of tracking quality improvement and patient care.”

The report builder allows Nightingale Notes EHR users to select the data they’d like to report on, set the filters they’d like to apply, choose a timeframe they’d like to report on, and also choose how they’d like to receive their results (e.g., Excel spreadsheet, PDF, etc.). 

And because Nightingale Notes EHR allows documentation of an individual, family, or community, reports can be pulled for data on individuals, families, or the community. This makes it possible to track outcomes at any level. 

The Scheduler and Customized Calendar Views

Quilling discussed how Dunn County Health Department uses the scheduler and customized calendar views in Nightingale Notes to manage appointments, streamline clinic operations, and enhance patient engagement.

She explained that there can be multiple calendar views created to keep programs and staff separate. “So I have a reproductive health calendar and a community health calendar,” Quilling said, describing the filtered scheduler views she uses. “… you can also set a chosen calendar to your default view and it will also combine calendars if needed,” she continued.

The scheduler allows users to customize colors, appointment types, and schedule recurring appointments. Appointments can easily be scheduled by clicking the “New Appointment” option or by clicking on a time slot in the calendar. 

“In our clinic, scheduling is not restricted to a certain few people. So, anyone, all of our employees that have Nightingale Notes access can easily schedule…,” Quilling explains, “This enhances patient engagement because they don’t have to wait to schedule if front desk staff is unavailable. And appointments can also be marked as completed, no-show, canceled, etcetera, right from the screen.” 

Features Quilling highlights:

• The schedule/calendar is printable (it can also be printed by day, so the provider can easily see a list of appointments for the day)
• There are different views (day view, week view, month view, list view)
• Views are filterable by program or staff and filtered views can be saved (for example, Quilling notes being able to see reproductive health appointments in a filtered view she’s saved)
• There is a free-text description field that allows users to add notes

In Conclusion

Quilling described the ease of getting started with Nightingale Notes EHR. “Once you get used to, you know, clicking where you need things and adding things, it’s pretty easy to use,” Quilling said. 

There is a tiered approach to onboarding, where a few staff at a time train to use the software. In addition, users meet with an onboarding specialist who will help determine what your most pressing needs are and users will onboard with those services and reports first. 

Nightingale Notes EHR also comes with a training database which allows users to practice or test customizations as they create them before taking those customizations live in the production database.

Quilling wrapped up her presentation by saying, “So, custom forms, tabs, reports, and scheduling all allow for streamlined patient care, efficient tracking, and are adaptable to growing and changing clinic needs. They’re also comprehensive and easy for all staff to use and break out of the traditional HR structures where things may be missed if not tailored to your specific need.”