mobile, informed & connected tm t-2 electronic medical records in long term care october 8, 2007...
TRANSCRIPT
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MOBILE, INFORMED & CONNECTEDTM
T-2 Electronic Medical Records in Long Term Care
October 8, 2007
10:30am – 12:30pm
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© 2007 SigmaCare Slide 2
• Introductions
• What is an EMR?
• LTC Slow in Adopting EMRs and Perceived Barriers
• “Big Bang Benefits” of an EMR
• Valley View Case Study
• Simple Benefits that Impact More than Just Dollars
• Certification Process and Survival with an EMR
• Implementation & Adoption of an EMR
• Questions & Answers
Presentation Agenda
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© 2007 SigmaCare Slide 3
Learning Objectives
The participant will be able to:
• Define an EMR
• Explain similarities between paper record and EMR
• List 5 benefits of an EMR in a LTC facility
• Identify how an EMR affects the Certification Survey
• Identify truth behind perceived barriers when implementing an EMR
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© 2007 SigmaCare Slide 4
The IOM 2003 Patient Safety Report describes an EMR as encompassing:
– “a longitudinal collection of electronic health information for and about persons
– Immediate electronic access to person- and population-level information by authorized users;
– Provision of knowledge and decision-support systems that enhance the quality, safety, and efficiency of patient care and
– Support for efficient processes for health care delivery.”
What are Electronic Medical Records?
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© 2007 SigmaCare Slide 5
The 1997 IOM report “The Computer-Based Patient Record: An Essential Technology for Health Care” defines an EMR as:
“A patient record system is a type of clinical information system, which is dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care.
The central focus of such systems is clinical data and not financial or billing information.”
What are Electronic Medical Records?
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© 2007 SigmaCare Slide 6
The American Health Information Management Association defines three essential capabilities of an EMR:
1. To capture data at the point of care,
2. To integrate data from multiple internal and external sources, and
3. To support caregiver decision making.
What are Electronic Medical Records?
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© 2007 SigmaCare Slide 7
According to the February 2007 Report on Health Information Exchange in Post-Acute and LTC from the HHS Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy:
• Only 1% of SNFs adopting EMRs vs. Hospitals adoption rate at 18% and MD offices at 15%.
• Projected to increase in 5 years to 14% in SNFs, up to 41% in Hospitals, and up to 38% by MDs.
Adoption of EMRs in LTC
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© 2007 SigmaCare Slide 8
• Fear of the unknown; surveillance outcomes
• Differences in staffing patterns between acute and long term care
• LTC requires a multi-disciplinary “holistic” approach versus “disease-centric” approach in acute care
• Resources, training/re-training, turn-over rates
• Doubts in clinical usefulness and accuracies
• Financial burdens
Why the Different Adoption Rates?
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© 2007 SigmaCare Slide 9
Therapies
MedicalServices
Activities Dietary
Administration
Social Services
Nursing
Resident
• Comprehensive Level of Care
• Strict Regulations with State & Federal oversight
• Average LOS- months-years vs. days.
ALL Care Centered on Disease Process
ICD-9 Code
• Disease Focus
• Less oversight
• Short LOS- measured in days.
Models of Care in LTC vs. Acute Care
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© 2007 SigmaCare Slide 10
• Improve Quality Care
• Avoid Adverse Drug Events
• Improve Quality Measures
• Enhance Resident Safety
• Improve Operational Efficiencies and Reallocate Staff
• Increase Reimbursements
Objectives for Implementing EMRs
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© 2007 SigmaCare Slide 11
The real benefits one NYS Nursing Home realized upon implementation of a full EMR….
• Increased reimbursement• Pharmacy cost savings• Decrease in medication errors• Improved Quality of Care• Timely ability to gather data and run critical reports • Improved oversight of facility operations by leadership • Integration of tools with clinical intelligence• Clinician ease with timely access of resident records• Improved staff satisfaction• Improved survey compliance
Introduction to the Benefits of EMRs
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© 2007 SigmaCare Slide 12
• Goshen, NY
• 520 Beds
• 4 Buildings
• 15 Units
– Sub-Acute Rehabilitation
– Long Term
– Dementia/Alzheimer's
– Palliative Care
• Over 600 Employees
Valley View Case Study
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© 2007 SigmaCare Slide 13
• Less time on resident care due to inefficiencies
• Clinician and staff frustration high
• In danger of losing reference lab
• Inefficiencies resulted in an underlying concern for resident safety
Lost Revenue• Medicare billing inefficiencies
• Inaccurate data capture
Increasing Costs• Formulary non-compliance was resulting in
escalating drug costs
Inefficient Work Flow• Renewal process lengthy and error prone
• Difficult to manage off-hour admissions
• Cumbersome communication within facility
• Nursing staff mired in paperwork
Resident Safety Concerns• Difficult to manage quality with paper and
retrospective MDS data
• Incomplete or ambiguous orders
• DUR alerts missed or late
Business Issues
Business Issues
Valley View’s Business Issues
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© 2007 SigmaCare Slide 14
• Medication order renewal process
• Formulary updates, communication and control
• Facility communication and order data entry (telephone, ADT, etc.)
• Pharmacy communication and order data entry
• Resident identification, alert and room/bed assignment
* Through attrition
Additional EfficienciesAdditional Efficiencies
Direct Financial Benefit
Direct Financial Benefit
Business Processes Automated
Business Processes Automated
• 92% reduction in adverse drug events (from avg. of 2.81 per month to .23 per month)
• 9% additional time for over 200 employees (700 hours per week) to focus on direct resident care
• Reporting (resident safety, quality indicators, DUR, shift productivity, census)
• Compliance with State, Federal and accreditation audits, surveys and ad hoc requests
• 5 FTE Staff Reduction*• Medication savings • Renewal efficiencies• Efficiencies in formulary training• Consultation forms• Medicare billing improvement• Lab billing improvement
$ 250,000$ 262,000$ 120,000$ 8,000
$ 20,000$ 15,000
$ 10,000
Valley View’s Return on Investment
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© 2007 SigmaCare Slide 15
Survey process is an open book test:
• Each employee should know the survey tasks
Know how the EMR will interface with each survey task:
• Entrance – Practice preparing all reports that are expected upon the surveyors entrance into the facility
• Tour – Explain what surveyors are looking for during the tour phase of survey, medication pass observation.
Explain quick Do’s and Dont’s for staff:
• There is no regulation that states an employee must have an answer within a split second, “I’ll get back to you on that.”
• Don’t make up answers just in order to give an answer.
• If you are unfamiliar with a specific area of the EMR the surveyor is requesting that is not a deficiency.
Surveillance Process
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© 2007 SigmaCare Slide 16
Quality of Life Assessment
Contains 3 parts:– Resident interviews– Group interview– Family interview and resident
observation
Information Gathering During Survey
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© 2007 SigmaCare Slide 17
Medication Pass Observation
– 20-25 medication opportunities for error are observed.
– Error? An additional 20-25 opportunities for error are observed.
Information Gathering During Survey
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© 2007 SigmaCare Slide 18
Electronic Medication Administration Record (eMAR)Online Drug Reference Guide
While Observing the medication pass the surveyor will review:
• Every medication is given with 5 Rights,
• In accordance with physician orders & standards of practice.
• Focus on drugs with a high potential for Adverse Drug Reactions.
• Medication Nurse is aware of potential s/s that may be exhibited in a resident receiving a medication with a high potential for an ADR or those medications on the Beers List.
Medication Pass Observation
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© 2007 SigmaCare Slide 19
Quality Assessment & Assurance Review– To determine if there is a functioning QA
process which addresses concerns.
Abuse Prohibition Review– To determine if a facility has developed
and operationalized policies and procedures related to resident abuse.
Information Gathering During Survey
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© 2007 SigmaCare Slide 20
Abuse/Neglect Awareness & Prevention
Proper screening, training, identification, investigation, protection, reporting and response are key elements the surveyor will review every time they are on-site in accordance with the SOM.
What are the top 5 deficiencies cited?
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© 2007 SigmaCare Slide 21
Abuse/Neglect Awareness & Prevention
• Identify those residents that are at risk for abuse, neglect or mistreatment.
• Ascertain approaches for difficult to manage residents are incorporated into the Comprehensive Care Plan and the CNA’s plan of care.
• Hall coaching and support for those staff on units with harder to manage individuals.
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© 2007 SigmaCare Slide 22
• A nursing home survey is resident centered, not medical record centered.
• A NH survey starts with observation of the resident, the surveyor backs into the record to corroborate evidence.
• An EMR is a medical record, it replaces its paper predecessor.
• An EMR is less vulnerable to HIPAA related deficiencies than a paper medical record.
Facts about EMRs & the Survey Process
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© 2007 SigmaCare Slide 23
Facts about EMRs & the Survey Process
• Timely, accurate information during the survey process reduces staff frustration and stress in attempts to find misplaced forms and documentation.
• Compiling information and documentation for the IDR should be easier, more efficient with clear audit trails through the use of an EMR.
• No employee is required to know every answer when questioned, it is OK to remind staff they can say “I’ll get back to you on that”.
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© 2007 SigmaCare Slide 24
• Document, document and document the nursing process, changes in plans of care and the implementation process.
• Engage, educate and empower your staff to utilize every skill and embrace a new tool in providing QOC.
Empowering Your Staff
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© 2007 SigmaCare Slide 25
• Leadership
• Education & Culture Change
• Communication
• Demonstration
• Job-Based Training
• Support
Overcoming the Barriers to Adoption
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© 2007 SigmaCare Slide 26
Leadership Support
Optimum User Adoption & Customer ROI
Pre-Implementati
on
Pre-Implementati
onGo Live & Support
Go Live & Support
Peer Mentor & Training
Peer Mentor & Training
Change Management
Change Management
Implementing an EMR in LTC
Account Management
Account Management
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© 2007 SigmaCare Slide 27
• Workflow analysis and benchmarking
• Customize training based on workflow findings
• Develop customized assessment forms
• Order and Care Plan libraries
• Labor-Management Committee
• Hardware & network assessment and installation
• Integration testing and validation for billing, pharmacy, lab, radiology and hospital
Pre-Implementation
Pre-Implementati
on
Pre-Implementati
on
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© 2007 SigmaCare Slide 28
• Orientation and Engagement program
• Establish Peer Mentor program and training strategy
• Conduct and analyze readiness surveys
• Departmental meetings to get buy in demonstrate functionality
• Communicate training schedule and plan to staff and administration
• Change management programs across all three shifts
Change Management
Change Management
Change Management
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© 2007 SigmaCare Slide 29
• Schedule training for each discipline and department
• Peer Mentor training
• Setup classroom onsite with laptops, PDA’s and training materials
• Customized training for each discipline with small class sizes
• Onsite training for weeks for all three shifts and weekends
Peer Mentoring & Training
Peer Mentor & Training
Peer Mentor & Training
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© 2007 SigmaCare Slide 30
• Rollout phased in by unit to avoid disruptions to facility
• On-the-job user support for every shift including weekends
• Activation and verification for each module
• Vendor provides 24/7/365 phone and web-based customer support
• Account Manager monitors adoption and outcomes
Go-Live & Support
Go Live & Support
Go Live & Support
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© 2007 SigmaCare Slide 31
• Dedicated Account Manager to ensure on-going customer satisfaction
• Benchmarks to track and analyze metrics before, during and after the implementation:
– Resident Safety
– Training Satisfaction
– Usability and Adoption
– Resource Utilization
– Operating Costs & Reimbursement
Account Management
Account Management
Account Management
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© 2007 SigmaCare Slide 32
Utilizing Technology in health care facilities is no longer the future….
IT is TODAY!!!
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© 2007 SigmaCare Slide 33
Questions ?
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