FHCA 2014 Annual Conference & Trade Show

Transcription

1 FHCA 2014 Annual Conference & Trade Show CE Session #21 Polished Electronic Health Records Solutions Tuesday, July 8 7:00 to 8:30 p.m. Canary 3 Operations/Quality Improvement Upon completion of this presentation, the learner will be able to: outline the roles of the CIOC and NEC and the impetus for development of the white paper; differentiate between the current state of EMR in LTPAC and the functionality required for a robust Electronic Health Record; and articulate one's personal objectives when talking with a vendor/provider in regards to requirements related to EHR in LTPAC. Seminar Description: This session will review the white paper that was developed by the CIO Consortium and the Nurse Executive Council. This white paper calls attention to the need for an EHR that is patient-centered, comprehensive, intuitive, versatile and becomes a "one and done" product. The EHR should support coordination versus redundancy of patient care across internal and external settings and services. This session will conclude with a call to action for both providers and EHR vendors. Presenter Bio(s): Irene Fleshner, RN, MHSA, FACHE, serves in a part-time capacity as the Senior Vice President for Strategic Nursing Initiatives at Genesis Health Care. Prior to her current role, Irene spent 13 years with Genesis Health Care, most recently as the Senior Vice President for Clinical Operations. Irene speaks nationally on issues related to LTPAC. Donna Megrey is a consultant in the long term care profession. Her prior positions have included Vice President of Clinical Operations for National Health Care Associates and nurse executive with Sun Health Care. Donna has a number of years of LTPAC nursing experience and is a frequent speaker in the field. Renee Reber is the Senior Vice President of Clinical and Regulatory Compliance for Consulate Health Care. She holds responsibility for oversight of 200 plus facilities in 21 states. She is a frequent speaker at long term care conferences on a range of topics. In addition to her 20 years working in LTPAC, Renee spent several years working for a national software vendor.

2 POLISHED ELECTRONIC HEALTH RECORDS SOLUTIONS Irene Fleshner, RN, MHA, FACHE SVP, Strategic Nursing Initiatives, Genesis HealthCare Principal, Reno Davis & Associates, Inc. Renee Reber, RN, FCDONA, C-Ne SVP, Clinical and Regulatory Compliance Consulate Health Care Donna Megery, RN Long Term Care Nurse Consultant 1 SESSION OVERVIEW Review white paper developed by the CIO Consortium and the Nurse Executive Council. The EHR Based Solutions that LTPAC Providers Need Today White paper calls attention to need for EHR: Patient-centered, comprehensive, intuitive, versatile and a one and done product Support coordination versus redundancy across internal and external settings and services Conclude with a call to action for both providers and EHR vendors 2 1

3 BACKGROUND Who is the NEC? Fun Fact or Quote? Who is the CIO Consortium? CIOC/NEC Collaboration on EHR The EHR Based Solutions that LTPAC Providers Need Today CIOC & NEC finalized the whitepaper June 27, 2013 Technical whitepaper outlines key requirements and capabilities of a LTPAC system needed to support the LTPAC provider today, over the next 5-10 years, and into the future. 4 2

4 WHITE PAPER TOPICS & GOALS Core EHR Fundamentals still not in place, electronic paper system Workflow Support care delivery processes Interoperability Common language, elements, goals Transitions of care Economics Operational efficiencies Incentivize innovation and collaboration Call to Action CHALLENGES Regulatory Requirements HIPAA Increasing complexity and acuity of patients Explosion of information New payment models and provider relationships 3

5 THE GOOD OLD DAYS 7 EHR - HISTORY 1960 s Lockheed Unveils Clinical Data Management System Introduced in El Camino Hospital, Moutain View, CA Now known as - hospital information system Problem-Oriented Medical Record Introduced Dr. Larry Weed introduced the idea of recording patient information electronically to generate a record that would allow a 3 rd party to verify a diagnosis 1970 s VistA Initiated to Manage Veterans Health Data The start of government investments in VistA and clinical IT First Electronic Medical Record System Developed The Regenstreif Institute developed the 1 st electronic medical record. 8 4

6 EHR - HISTORY 1980 S VA health Information Software Declared Public Available to the public or private sectors Major hospitals in other countries adopt and modify VistA s information driven care model Dragon System Pioneers Voice Dictation Software Early voice recognition prototype Emergence of Low Cost PC s Spurs Wide Adoption Practice management functions moved computers billing and scheduling Case Mix Programs for Medicaid Reimbursement in Long Term Care 9 EHR - HISTORY 1990 s Emergence of the Word Wide Web Clinitec Sells Software to Convert Paper Records to EHR s Allscripts (Eclypsis Corporation) Founded EMR, CPOE and Revenue Cycle Management Health insurance Portability and Accountability Act HIPAA Software developers predict HIPAA will force a shift to EHR Veterans Health Administration Mandates Use of EHR s Allscripts Begins Focusing on Healthcare IT Launched electronic prescribing solution for physicians eclinical Works Started by Four Engineers and a Physician Ambulatory EHR systems Data Collection Long Term Care Infections Incident & Accident MDS First required electronic record with data submission regarding Medicare & Case-Mix 10 5

7 EHR - HISTORY 2000 s Emergence of Web-based Software EHR vendors begin to offer remote host options GE Acquires MedicalLogic and Millbrook 31 healthcare IT solutions President George Bush Promotes Adoption of EHR s Adopt standards for electronically transmitting W-rays, lab results and prescriptions CCHIT Certifies Electronic Health Record Systems VA and Kaiser Permanente Create CONNECT Moves US to national interoperability HITECH Act Passes 2009 stimulus package encourages switch to EHR by providing Medicaid and Medicare rebates 11 WE VE COME A LONG WAY BABY 12 6

8 EHR - TODAY 2010 s Apple ipad Spurs Widespread Use of Tablet Computers Physicians start to demand the same simplicity and convenience in the workplace ONC-ATCB Certification Program Created Meaningful use criteria for adoption of EHR s HHS Proposes Accountable Care EHR will play a key role in capturing patient data for sharing within the ACO 13 EHR - TODAY MDS EHR Physician Orders Progress Notes H & P Disciplinary Notes Nursing, Activities, etc. Vital Signs & Weights 14 7

9 WE STILL HAVE A LONG WAYS TO GO 15 EHR - TOMORROW Interoperability/Integration Greater connectivity Collaboration among providers Improve home-based health monitoring Use of mobile technology Sharing of data among partnering vendors Elimination of redundancy 16 8

10 HOW DO WE ACHIEVE VISION OF TOMORROW Long Term Care CIO Consortium (CIOC) and the Nurse Executive Council (NEC) joined forces to review & evaluate the state of software available to long term care and post acute industry regarding: Clinical Data Collection Clinical Documentation Electronic Medical Record Electronic Health Record 17 WHITE PAPER EVOLUTION Current software offerings do not meet the industry needs Develop the whitepaper Highlighting the issues Proposing specifics on strategic system offerings Encourage software vendors to compare their offerings to the strategies in the whitepaper Proposed meeting with CIOC & NEC to formulate and develop improvements to their systems 18 9

11 SELECTION OF AN EHR Conduct a needs assessment What do you want? What functionality do you want? What do you need? Review IT infrastructure Internal External Computers Connectivity File formats 19 EHR & WORKFLOW Workflow throughout the day CAN be captured in an electronic record: Physician Orders Medication Administration Notes Physician, Nurse, Dietary, Activities, SS, Rehab, etc. Assessments Physician, Nurse Dietary, Activities, SS, Rehab, etc. Tracking/Trending Reports 20 10

12 EHR & WORKFLOW Software needs to follow the workflow The industry does not need to adapt to the software no matter the setting SNF PAC Home Health Hospice HISTORICALLY WE HAVE ADAPTED THE WORKFLOW TO THE TECHNOLOGY. 21 A LINE IN THE SAND WE WILL NOT STAND FOR IT ANYMORE TECHNOLOGY WILL ADAPT TO THE WORKFLOW 22 11

13 WHO USES EHR CNA LPN RN ARNP MD PT OT ST RT Ect. 23 EHR & WORKFLOW Workflow & process changes TAKE ADVANTAGE OF TECJHNOLOGY TO AID PROCESSES 24 12

14 EHR & WORKFLOW Internal processes can be integrated within the technology (meet the regulation as well as workflow) Example Nursing Assessment Braden Scale Every week for 4 weeks then quarterly 25 BENEFITS OF EHR No more manual tracking Notification of missing assessment Who did the assessment Trending of assessment scores Etc. All of this at your fingertips 26 13

15 BENEFITS OF EHR No need to duplicate or have redundancy Enter information only once Information is available with only being entered once Manual auditing verifications made simple 27 EHR & INTEROPERABILITY Interoperability The ability to communicate/share data with others Lab Radiology Pharmacy Hospital ACO s 28 14

16 INTEROPERABILITY How do we communicate: Send Fax Receive Fax Send/Receive via ONC Direct Project Direct Provider Provider Transfer of Care Direct Provider Provider Shared Care Provider Consumer Health Information Exchange/Regional Health Information Exchange eprescribing and Medication Management Intra-Provider System Health Information Exchange Non-Standards Based Health Information Exchange Hybrid Health Information Exchange Standards based Exporting to PHR and/or Resident/Client Portal Interface with Hospital/Discharge System Interface to Consultant Pharmacy Systems 29 THE IDEAL INTEROPERABLE ENVIRONMENT Integration of online systems Secured online systems Optimized online systems 30 15

17 LTPAC CHALLENGES Rapidly changing regulatory and reimbursement environments Regulatory Changes SFF Program 5 Star Program Reimbursement Changes RAC s, MAC s and ZPIC s ACO and Managed Care Model This combination equals shrinking access to capital for healthcare IT 31 EHR CHALLENGES Rapidly changing LTC environment No longer one type of population in one setting Now includes diversified workforce at the center level: Nurses Admissions Case Managers Nutrition Services Discharge Planners Nurse Practitioner Business Office Physician Assistant Nurse Navigators Nursing Assistant Therapists Social Service Activities Psychological Services 32 16

18 EHR CHALLENGES Rapidly changing LTC environment Virtual Care Team involvement Clinical Consultant Physicians Specialists Mobile X-ray Pharmacy Community Services Home Care Services Acute Care Services Laboratory Testing ALL of these team members need accessibility and ease to utilize an intuitive EHR that provides effective tools and collaboration 33 EHR CHALLENGES The EHR and EMR MUST: Include and have the capability to expand as the environment changes Systems that support a secured and easy access to patient information Tools for collaboration include secured messaging, discussions, notes, computer conferencing and telemedicine Collaboration and accommodation of an expanded view for the patient s care team is key to the delivery of quality of care and successful transition to the next care setting The capability of integration and transmission of information to different EHR formats of hospitals and other partner systems is CRUCIAL 34 17

19 THE ENTERPRISE What should it look like? Consolidated model between clinical, operations, financial, compliance and technology across the continuum Consistently and initiatively apply clinical and business protocols, documentation, and practices Automation of payer transaction services by gathering pertinent information throughout the enterprise from interdisciplinary partners 35 THE ENTERPRISE What should it look like? Facilitate remote monitoring of system use and business practice delivery, compliance Provide insightful, consolidated reporting, analytics, and outcomes at all levels of the organization s hierarchy Feature comprehensive event capture, alertnotification, and management Identify the patient across settings and episodes of care 36 18

20 CONTINUUM Our patient population is not stagnant moves from one continuum of care to the other and at times back to the beginning Hospital LTPAC Home Back to the Beginning of the Continuum 37 KEY INTEGRATION POINTS To ensure clinically safe transfer to and from the LTPAC setting EHR and EMR must have: Timely access to current patient information Supports a variety of proprietary and nonstandard integrations with hospital and community-based systems and related health information exchanges (HIEs) or possibly not be chosen by a managed care organizations or ACOs

21 WHAT ARE THE KEY INTEGRATION POINTS FOR COLLABORATIVE PARTNERS? Patient Referral Referral, response, acceptance ADT-Patient Profile Admission, discharge, transfer Discharge Summary Physician, clinical notes, H&P, problem list, allergies, lab results, medications E-Pharmacy Orders, receipt, reorders, returns E-labs, Diagnostics Orders, results, images Payor Eligibility, benefits, authorization, claims, remittance advice 39 BI-DIRECTIONAL EXCHANGE The EHR must have the ability to fluctuate Directionally and bi-directionally within the network of an organization and the outside continuum The exchange must be fluid to allow real time information to be available and transmittable when an event occurs 40 20

22 THE CUSTOMER --YOU The Electronic Health Record (EHR) each LTPAC environment is given the daunting task of choosing and implementing an EHR that includes Once and done approach where information is recorded should obviate prior processes and downstream redundancies Picking the best of breed of EHR and EMAR and build interfaces and repositories to integrate and/or aggregate data at the enterprise level. 41 THE CUSTOMER --YOU The On-site Clinical Care Teams Clinicians rely on clinical care delivery processes (workflow) to provide care The care delivery is a systematic approach called care-delivery process. The steps of care process must occur sequentially if to be successful and effective Nursing process steps allows the patient to be cared for in a proven evidence based model i.e., comprehensive nursing assessment 42 21

23 THE CUSTOMER --YOU The importance of systematic care-delivery process is important because it removes the guess work, increases the likelihood of providing the correct and safe care, contributes to improved care quality, customer satisfaction, regulatory compliance, financial performance and reduced legal liability 43 THE CUSTOMER YOUR STAFF Similar to the clinical workflow of the EMR training of your staff (customer) is imperative Train sequentially as their delivery care process and workflow dictates Have the EMR work for your staff not for the EMR Allow for comments and criticisms Teach at their knowledge level not everyone is a smart phone!!! 44 22

24 THE CUSTOMER YOUR STAFF Use the tools and training sites the EHR has created for you as the trainer and learner Develop return demonstration examples to ensure understanding Make How to binders, help-desk numbers and super-users for each shift Apply the Train-the-Trainer Model Correspond frequently with the EHR company regarding concerns or questions you are having in the field Learn what the reports are telling you as the consumer does it make sense Ensure through your QAPI that the EHR incorporates clinicaldecision support intelligence that assists the interdisciplinary team both within the center and the virtual team 45 CONCLUSIONS Systems are critical enablers of the quality, process, and innovation Achieving positive quality and cost outcomes depend upon these systems. Evolving incentives are reconfiguring healthcare delivery for LTPAC evidence, data, and technology-enabled virtual care teams, population outcomes, transparency and accountability The LTPAC EHR requirements are similar and distinctive from other health care settings. EHR-lite is already too limiting 46 23

25 CALL TO ACTION ON COLLABORATION LTC Software vendors work with the Providers and Ancillaries Providers push the software vendors to the best solution Ancillary providers partner with the providers and cooperate your system development with those of the LTC software vendors Together we can make this happen QUESTIONS? THANK YOU 48 24

26 REFERENCES The Authority on Software Selection; History of Electronic Health Records; Houston Neal, Director of marketing, 1/10/13 McKnights Long Term Care News, March 2014, Vol. 35, No.3, How to do it: Implementing an EHR System ehr or Long Term and Post Acute Care: A Primer on Planning & Vendor Selection 2013, Leading Age Cast Report 49 25