Section 1 Introduction

High Performance Sport New Zealand uses a cloud based information management platform called Smartabase to collect, store and communicate health data within the High Performance sport environment.

The HPSNZ Electronic Health Record (EHR) is used exclusively by the Performance Health team for managing all medical, physiotherapy and massage information within HPSNZ and at Major Games such as the Olympics and Paralympics.

During the Games, all consultations (Medicine, Physiotherapy, Massage Therapy) must be documented in the EHR.

A consultation is considered to be any clinic based meeting with an Athlete or Support Staff Member where health related matters are discussed, advice is given or treatment provided. The intent of this intensive approach to record keeping is to ensure best practice management of the team member, to provide protection to the practitioner and team member through effective record keeping, and to support the collection of accurate data.

This user guide allows you to read through the guide at your own pace, jump to specific sections from the expandable left hand menu, or use the search function in the top menu bar.

Thank you

Section 2 AMS Permission

Every user of the HPSNZ Athlete Monitoring System (AMS) must be granted specific permission to use the system.

There are two main groups of AMS users:

  • Athlete use of the AMS is developed in partnership with the NSO and HPSNZ support staff. Athlete can only view their own data.
  • Support team use of the AMS is a function of their primary role at HPSNZ. Some support team members are only able to access their own data, while others (i.e. doctors, nutritionists, coaches, etc.) can access their own data and that of athletes

NOTE: Electronic Health Record (EHR) access is strictly controlled.

  • only users authorized by the HPSNZ Medical Lead can access medical records
  • only users authorized by the HPSNZ Therapies lead can access physiotherapy records

Your overall permissions include a combination of:

system permissions
basic Smartabase functionality such as entering data, creating reports, using dashboards, editing accounts, etc
data permissions
using specific forms to read, write or delete data, as well as linking to data or seeing that data on the calendar
user access
you need additional permission to read data for other users


2.1 Track & Trace

Every record viewed, edited, saved, printed and shared is logged by the core Smartabase security features. In the case of a suspected data breach, a full EHR audit is possible within 24 hours.

Together, these permissions keep data private and secure.

For assistance with your account, permissions or other questions, please contact Alan Carlsson

Section 3 Privacy

The HPSNZ AMS complies with all with relevant New Zealand legislation. Specifically:

  • Privacy Act 1993;
  • Official Information Act 1982;
  • Statistics Act 1975;
  • Health Information Privacy Code 1994

Other legislative requirements may apply to specific types of data.

Following the safe data principles promoted by Stats NZ, HPSNZ follows the five safes framework with your data:

SAFE PEOPLE
only practitioners and researchers who can be trusted to use the data appropriately and follow procedures
SAFE PROJECTS
all project have a high performance or statistical purpose and is in the interest of sport
SAFE SETTINGS
security arrangements prevent unauthorized access to the data
SAFE DATA
identifiers are removed before data is made available
SAFE OUTPUT
the statistical results produced do not contain any results that disclose individually identifiable information


Smartabase is also fully compliant with the 2018 European Union General Data Protection Requirements (GDPR). The GDPR addresses the protection of data belonging to European Union residents and is considered World Leading data security and privacy at this time.

3.1 External Connections

The EHR also connects with a number of external databases (i.e. ACC, Training Peaks, etc.) and has the capacity to connect to many others data sources.

If you have privacy or confidentiality questions, please contact the HPSNZ Privacy Officer Neena Ullal

Section 4 Quick Start

Let’s get you started in the EHR!

If at any time you want more detail on a workflow or an EHR feature, please follow up on the detailed section(s) of interest to you using the left hand menu.

The core consultation note workflow is identical for all Health team members:

  • Login
  • Select individual athlete
  • Enter Notes

4.1 Login

Open Google Chrome and go to https://hpsnz.smartabase.com/ams and enter your EHR credentials as requested.

Figure 1. EHR login screen

4.2 Select Athlete

To select the athlete for whom you are recording a consultation, first load the correct group of athletes then select your individual.

4.2.1 Group First

This group icon is on the right side of the top right menu bar. Click on this to select the group with the athlete you are looking for.

Figure 2. The EHR main menu showing what group you have loaded (highlighted in yellow below).

The NZOC group has two main sub-groups, ATHLETES and OFFICIALS. For athletes, you can narrow your choices by select NSO sub-groups.

Figure 3. Example of EHR Olympic Athlete NSO groups

4.2.2 Individual

Once you have the correct group loaded, use the left menu bar to select the athlete you want to record notes on. You can use either the search or drop down menu.

Once an athlete is selected, they are loaded in your main EHR window.

Figure 4. Main EHR window example for individual

4.3 Notes

During the Games, all consultations (Medicine, Physiotherapy, Massage Therapy) must be documented in the EHR.

A consultation is considered to be any clinic based meeting with an Athlete or Support Staff Member where health related matters are discussed, advice is given or treatment provided.

Consultations also include:

  • physiotherapy, massage therapy and medical consultations that occur in individual NSO Health Team settings within the Olympic Village.
  • any medical interventions,
  • diagnostic work-ups for injury or illness, or
  • other significant process provided at competition or training venues as part of a pre- or post- event review.

Consultations do not necessarily include:

  • field of play discussions that outside of the clinic or village environment, or
  • preparations that occur as part of a routine preparation or review of athletes.

Over and above these minimum expectations, Health team members may document consultations on an as needed basis, in any of the above scenarios.

The intent of this intensive approach to record keeping is to ensure best practice management of the team member, to provide protection to the practitioner and team member through effective record keeping, and to support the collection of accurate data.

Each health team discipline has a dedicated consultation note page:

  • Medical: Only accessible by medical team
  • Physiotherapy: accessible by medical and physiotherapy teams
  • Massage: accessible by medical, physiotherapy and massage teams

4.3.1 Medical Consultation

The medical workflow centers on the Consultation Notes and any linking all related injuries or illnesses.

Medical Consultation Notes are only accessible by the medical team

The top of the consultation notes shows an athlete’s Medical Alerts, Allergies, and both injury and illness availability status.

Figure 5. Medical Consultation Notes Summary Section

Use the first level of the grey menu bar to navigate through key workflows. For each key workflow, dependent workflows are available on the menu underneath.

4.3.2 Physiotherapy Consultation

The physio workflow centers on the Physiotherapy Treatment Notes and any linking all related injuries.

Physiotherapy Consultation Notes are accessible by the physiotherapy and medical teams

The top of the consultation notes shows an athlete’s availability status summary and all ongoing injury and illness from past 3 months.

NOTE date filters allow you to show longer period of time

Figure 7. Physiotherapy Treatment Notes with linking areas highlighted in yellow and notes areas highlighted in blue.

The main treatment notes section is where you link to all related injuries.

4.3.3 Massage Consultation

The massage workflow centers on the Massage Notes.

Massage Consultation Notes are accessible by the massage, physiotherapy and medical teams

Figure 8. Massage Treatment Notes with notes areas highlighted in blue and body map highlighted in green.


4.4 More Information

For full details on the EHR workflows please follow the link to your health area(s) of interest:


Section 5 Reference section

The following sections detail all of the data available in the full version of the EHR.

For Major Games, this section is for reference only. It isn’t necessary for using the EHR at the Games.

5.1 Medical

To be as efficient as possible, the NZ Olympic medical team has a simple note taking workflow. However, the full HPSNZ Electronic Health Record is available to assist with the informed decision making process.

The medical workflow centers on the Consultation Notes and any associated injuries or illnesses.

Consultation Notes

This form is where you record the details of a consultation as:

  • Presenting Complaints
  • History
  • Examination
  • Management

The Consultation Notes must be linked to all related injury and illness diagnoses.

Illness Record

The Illness Record is required for any disease, sickness or illness.

Injury Record

An Injury Record is required for any injury.


For existing Injuries and Illnesses, you simply need to link your Consultation Notes to, and update, existing records.

5.1.1 The Flow

The medical workflows all follow “The Flow”. If you follow the flow, every step will knit together like clockwork.

Figure 1. The Medical Flow

5.1.1.1 Ignoring the Flow

If you choose to ignore The Flow, data can go missing. This is often due to when one bit of data is recorded relative to another.

Please see the Section on Missing Related Data in the Smartabase Basics Section.

5.1.2 Major Games Workflow

5.1.2.1 Consultation Notes

The medical workflow starts with the consultation notes form. From here, you can track your consultation notes for injuries and illnesses. Your consultation notes must be linked to all related illnesses and injuries diagnoses.

The injury workflow is shared jointly with the physiotherapy team.

5.1.2.1.1 Illness record

An Illness record is created for every new and distinct illness an athlete presents with.

Each Illness Record must have a diagnostic OSIICS code.

Every time an individual is seen by a medical team member, their availability to train and compete based on the Illness must be updated. As such, each illness is tracked individually so that recovery is tracked on an illness by illness basis.

5.1.2.1.2 Injury Record

An injury is defined as damage or impairment to normal physical function as a result sudden of repetitive movement.

Each Injury must have a diagnostic OSIICS code associated.

An Injury record is created for every new and distinct injury an athlete presents with.

Every time an individual is seen by a medical or physiotherapy team member, their availability to train and compete must be updated on the Injury Record. As such, each injury is tracked individually so that recovery is tracked on an injury by injury basis.

5.1.3 Non-Major Games Workflow

In the EHR, you have access to the following additional workflows that may contain relevant information on an athlete.

5.1.3.1 Communications

Any medical letters, prescriptions, investigations etc. are recorded using specific workflow so that we can prepare professional quality communications with a consistent look and key content.

5.1.3.1.1 Medical Letters

1 select addressee (when applicable); 2 add specific content to communications; 3 update communication to prepare printing template; 4 input the unique letter id into the print template to ensure privacy and confidentiality of the communication; 5 select print

Medical Letters are printed using a dashboard enabled template. This dashboard requires a unique letter key created by the medical letter form upon saving the form.

5.1.3.1.1.1 Duplication

The duplication option, available through the left sidebar, allows you to recreate a letter as many times as you want without altering the original.

5.1.3.1.2 Prescriptions

The prescriptions tool allows you to build and print a prescription.

Prescriptions are printed using a dashboard enabled template. The prescription dashboard requires both the athlete name and the unique prescription key created upon saving the form to ensure the correct prescription is issued.

5.1.3.2 Investigations

5.1.3.2.1 Radiology Requests

The radiology request form prepare a radiology request for an MRI, Ultrasound, XRay, etc.

The Radiology Request is printed using a dashboard enabled template. This dashboard requires a unique key created by the form upon saving.

5.1.3.2.2 Pathology Request

The Blood Test Request prepares a laboratory pathology request for blood work, histology, biochemistry, etc.

The Blood Test Request is printed using a dashboard enabled template. This dashboard requires a unique key created by the form upon saving.

5.1.3.3 Periodic Health Evaluation

The HPSNZ periodic health evaluations form allows you to record a variety of Period Health Evaluation from a full Period Health Evaluation including Periodic Cardiac Evaluation with ECG through to a basic cardiac evaluation without ECG..

5.1.3.3.1 Medical Clinical Observations

This related event form records clinical observations such as heart rate, ventilation, blood pressure, vision, etc.

5.1.3.3.1.1 Anthropometry

Basic anthropometry data such as height, weight, limb lengths, girths, etc. is recorded in this form. The anthropometry data is shared with other APS disciplines (i.e. Nutrition, physiology, S&C) to minimize data redundancies and duplication of workflows.

5.1.3.4 Mental Health

The 21 question Depression, Anxiety and Stress screening tool DASS21 is available for routine mental health screening. There is an associated dashboard for visualisations.

5.1.3.5 Low Energy Availability Form

The Low Energy Availability Form (LEAF) screening tool is available to help assess Relative Energy Deficit Syndrome (RED-S) in female athletes.

5.1.3.6 Sport Concussion Assessment Tool

The Sport Concussion Assessment Tool (SCAT 5) is available in the EHR. The SCAT5 is a standardized tool for evaluating concussions designed for use by physicians and licensed health care professionals.

5.1.3.7 History

5.1.3.7.1 Medication

This PHE linked form records medications the athlete self-reports as having taken that are not recorded in the EHR prescription module.

5.1.3.7.2 Supplements

This PHE linked form records supplements the athlete self-reports as having taken. The supplement data is shared with the Nutrition Team to minimize data redundancies and duplication of workflows.

5.1.3.7.3 Medical Document Stores

All third party correspondence, radiology, lab results, etc. are saved as PDF files and following the HPSNZ document naming guidelines.

5.1.3.8 Physiotherapy Notes

All treatment notes are related documents.

5.1.3.8.0.1 Clinical Measures

Clinical measures are verified tools used by the physiotherapy team to assess the extent of an injury and its subsequent progress.

5.1.3.8.0.2 Return to Performance

A Return to Performance (RTP) plan identifies and tracks the clinical, functional, performance and psychological measures needed to assess the progress from treatment.

As a best practice, over the first three weeks of an injury, the lead therapist will identify five (5) assessments from each of the four measures they believe are best suited to the injury and track subsequent progress progress. The associated RTP dashboard visualizes the injury’s progress back to Fully Available

5.1.3.9 Clinic Management

There are a number of Clinic Management workflows used primarily by the Performance Health Operations Team to support the Health team.

5.1.3.9.1 Incident Form

This records the details on what happened to cause an INjury Record.

If an ACC claim is being submitted, the Incident Form is provides critical details for the claim.

5.1.3.9.2 Claim Record

The Claim record for Health Related Issue identifies whether it is ACC, Private or NIB.

If an ACC Claim is being submitted, the Claim Record must be completed in detail including work status, READ codes, etc.

5.1.4 Missing Data

As Smartabase is a relational data base, under certain circumstances it can appear that data goes missing. This is often due to when one bit of data is recorded relative to another.

Please see the Section on Missing Related Data in the Smartabase Basics Section.

5.2 Physiotherapy

The Major Games physiotherapy workflows in the EHR allow us to record our treatment notes as well as track the recovery process associated with either individual injuries or a particular incident. Combined, this allows us to make more informed decisions.

The physiotherapy workflows at Major Games are slightly simplified relative to those expected in daily practice:

Treatment Notes
This form is where you record the details of a treatment in SOTAP note format.
NOTE
DETAIL
SUBJECTIVE
What the athlete says is bothering them.
OBJECTIVE
Your professional observations (i.e. outcome measures)
TREATMENT
What treatment interventions you performed
ASSESSMENT
Your analysis of the various components of the assessment
PLAN
How the treatment is developed to the reach the goals or objectives
Health Related Issue
A Health Related Issue (HRI) records a musculoskeletal injury.
One or more HRI is linked to each Treatment Note
Incident Form
This records the details on what happened to cause a Health Related Issue. If an ACC claim is being submitted, the Incident Form is critical


HPSNZ clinical best practices for accurate note taking follows a chronological Flow from what happened through what you did.

5.2.1 The Flow

The core physiotherapy workflows all follow The Flow. If you follow the Flow, every step will knit together like clockwork.

Going against the Flow makes everyone’s lives harder, exposes you to making mistakes and having incomplete notes.

Figure 1. The Physiotherapy Flow

5.2.1.1 Ignoring the Flow

If you choose to ignore The Flow, data can go missing. This is often due to when one bit of data is recorded relative to another.

Please see the Section on Missing Related Data in the Smartabase Basics Section.

5.2.2 Major Games Workflow

5.2.2.1 Treatment Notes

Your Treatment Notes are where you record the details of a treatment in SOTAP note format. Your Treatment notes should link to all related data on the following:

5.2.2.2 Incident Form

This records the details on what happened to cause a Health Related Issue. If an ACC claim is being submitted, the Incident Form is critical

5.2.2.3 Health Related Issue

A Health Related Issue (HRI) is an injury resulting in damage or impairment to normal physical function as a result sudden of repetitive movement.

Each HRI must have a diagnostic OSIICS code associated with it.

Incidents resulting in multiple distinct injuries require multiple HRI records creating. Each HRI is linked to an Incident Form.

Every time an individual is seen by an HPSNZ medical or physiotherapy team member, their availability to train and compete on the HRI must be updated. As such, each injury is tracked individually so that recovery is tracked on an injury by injury basis.

One or more HRI is linked to each Treatment Note, either as new HRI(s) or to existing HRI(s).

5.2.2.3.1 New HRI

A new HRI requires detailed and accurate cataloging which takes time.

It must include the incident, associated diagnoses, a Claim Record, an HRI, Treatment Notes and Clinical Measures. This is the degree of detail expected for our Olympic, Paralympic and World Class athletes that allows us to make fully informed decisions, access better quality analytics, assess our workloads, etc.

5.2.2.3.2 Existing HRI

For an existing HRI, you simply need to link your Treatment Notes to the pre-existing relevant data (i.e. incident, claim, HRI, clinical measures, etc.)

5.2.3 Non-Major Games Workflow

In the EHR, you have access to the additional workflows that may contain relevant information on an athlete.

Claim Record
The Claim record for Health Related Issue identifies whether it is ACC, Private or NIB. ACC Claims must have a detailed Claim Record logged.
Clinical Measures
Clinical measures are verified tools used to assess the extent of an injury and its subsequent progress.
Return to Performance
A Return to Performance (RTP) plan identifies and tracks the clinical, functional, performance and psychological measures needed to assess the progress from treatment.
Radiology Request
prepare a radiology request.
Referral
write a clinical referral to a sports doctor or sports physician or other specialist.


5.2.3.1 Claim Record

The Claim record for Health Related Issue identifies whether it is ACC, Private or NIB.

ACC Claims must have a detailed Claim Record logged, including READ codes.

5.2.3.2 Clinical Measures

Clinical measures are verified tools used to assess the extent of an injury and its subsequent progress

5.2.3.3 Return to Performance

A Return to Performance (RTP) plan identifies and tracks the clinical, functional, performance and psychological measures needed to assess the progress from treatment.

As a best practice, over the first three weeks of an injury, select five (5) measures in each category you believe are best suited to this injury and track their progress. The associated RTP dashboard will visualize the injury’s progress back to Fully Available

5.2.3.4 Radiology Request

The radiology request allows you to prepare a referral for radiology linked to an HRI and a treatment note.

5.2.3.5 Referral

Write a clinical referral to a sports doctor or sports physician or other specialist

5.2.3.6 Medical Document Stores

All third party correspondence, radiology, lab results, etc. are saved as PDF files and following the HPSNZ document naming guidelines.

5.3 Massage

The massage workflows at Major Games are identical to those expected in daily practice:

Massage Notes
This form is where you record the details of a treatment in SOTAP note format.
NOTE
DETAIL
SUBJECTIVE
What the athlete says is bothering them.
OBJECTIVE
Your professional observations (i.e. tightness, imbalances, pain)
TREATMENT
What treatment interventions you performed
ASSESSMENT
Your analysis of the various components of the assessment
PLAN
How the treatment is developed to the reach the goals or objectives


Section 6 FAQ

6.1 What browser should I use?

Use Google Chrome or Mozilla Firefox to access Smartabase on your computer. Many other browsers are not supported due to security vulnerabilities.

6.2 Is there a mobile app?

Yes, free mobile apps are available in the Google Play or Apple store. See the section on the mobile apps for more details.

6.3 Can I use my iPad or tablet?

Yes! You can use a browser or the Smartabase Athlete app appropriate for your device. See the section on the mobile apps for more details.

6.4 How do I get my password?

To ensure your account security, you must request a password reset link using the automated password reset options available on the app or browser.

6.4.1 Mobile App

The password reset is available directly from the app login screen. A password reset link is sent to the email associated with your account.

  1. Select FORGOT PASSWORD at the bottom of the login screen.
  2. On the RESET PASSWORD screen, enter the SITE URL (hpsnz.smartabase.com/ams) and your email. Your email is case sensitive and should be in all lowercase. That is important!
  3. Then select SEND RESET LINK. That will show up in your email quickly. Click on the link in the email and set your new password.

IMPORTANT: your password must be at least 12 characters in length, and have at least one number, one upper case letter, one lower case letter and one special character. Your password is case sensitive.

  1. Return to the mobile login screen and enter the site URL, your username and your password. Follow the on-screen instructions for setting up a PIN number and facial recognition if supported by your mobile device.
  2. Return to the login screen and enter your username, then your password on the next screen and you are in!

6.4.2 Browser

After you enter your username, the password screen has a password reset link.

  1. Enter your username and email. The password reset is then sent to the email on file for your account.

IMPORTANT username and password are both case sensitive. Most emails are are recorded in your account as all lowercase.

  1. Once you request the reset, you will receive an email right away. Click on the link in the email and set your new password.

IMPORTANT: your password must be at least 12 characters in length, and have at least one number, one upper case letter, one lower case letter and one special character. Your password is case sensitive.

6.5 How do I reset my password?

See the section above on How do I get my password?

6.6 I never got my password reset

Add to your email contacts so the automated password message is not blocked by firewalls, flagged as junk mail, or caught in spam filters.

6.7 Yikes! That’s not my preferred email

If your email is incorrect, please send an email from that account or, if you can’t access that account, have your NSO contact HPSNZ with your new email.

6.8 Help! I can’t log in on my mobile device!

There are a few reasons you may not be able to log in. Here are the most common reasons the mobile app will not behave:

  • To keep your data safe, Smartabase needs a secure connection. Older and free wifi networks may not be secure. Turn off wifi and enable cellular data for the app to check if this is the problem.
  • Make sure you are using the Smartabase Athlete App, not the generic Smartabase App, Smartabase SmartSpeed App, Smartabase Kiosk App, etc.
  • Make sure you entered the correct url https://hpsnz.smartabase.com/ams

A common typo here is adding a blank space after the …/ams

Another common error is to use a \ instead of a /

  • Check your username and password are correct. Both are case sensitive
  • Make sure your mobile device is running the most recent OS. If not, update your device and restart your device
  • Make sure your Smartabase Athlete app is the most recent version. If not, update your app and restart your device.
  • Lastly, go old school, uninstall the Smartabase app and then reinstall it. This way, you are running the most recent OS on a fresh install of the most recent Smartabase app version