Healthcare Information Systems Management Testing and Evaluation Session LT4, March 5, 2018 Gregory L Alexander PhD, RN, FAAN, Professor, University of Missouri, Sinclair School of Nursing Sue Shumate BS, RN, Health Information Coordinator, University of Missouri/Primaris 1
Conflict of Interest Gregory L Alexander Phd, RN, FAAN Sue Shumate BS, RN Contracted Research: Center for Medicare and Medicaid Services, Innovations Center Missouri Quality Initiative for Nursing Homes, Grant #1E1CMS331489 2
Agenda MOQI Model Systems Analysis Process Developing Use Cases to Guide Implementation Iterative Pilot Testing of Technology with Partners Policy and Standards Expected Benefits 3
Learning Objectives Define key differences between LTPAC and traditional healthcare provider organizations in the testing and evaluation of IT systems Summarize at least one insight an LTPAC provider gained from using analytics to guide their system testing and evaluation effort Identify CAHIMS testing and evaluation competencies LTPAC provider organizations should most closely watch 4
Please use blank slide if more space is required for charts, graphs, etc. To remove background graphics, right click on selected slide, choose Format Background and check Hide background graphics. Remember to delete this slide, if not needed.
MOQI Primary Project Goals Reduce avoidable hospitalizations via four aspects of APRN Care Coordination 1. Condition management 2. Early illness detection 3. INTERACT 4. End-of-life/Advanced care planning AND integrate health information technology into patient care processes 6
2018 MOQI Project Goals Reduce infections and hospitalizations related to infections through educational opportunities provided to nursing homes Increase and sustain use of INTERACT tools at fully engaged level Increase and enhance meaningful care conversations about serious illness and advanced care planning Increase use of bi-directional portals in all nursing homes Refine Quality Improvement processes for guidelines of Phase 2 billable conditions and feedback reports for billing Develop, test, and implement APRN feedback reports for preventable hospitalizations 100% of nursing facilities adoption of secure communication tools for texting and e-mailing Achieve and sustain the Phase 1 hospitalization rate below 1.10 7
HIT Intervention Promote the use of healthcare information technology (HIT) to improve the care of patients and communication among team members Pursue integration and interoperability of all aspects of technology solutions Train team members and nursing home staff regarding use of technology and workflow Lead evaluation of software/components to be used in technological solutions Systematic Feedback Reports to Users 8
IT Staffing Champions and Super Users Chief Operations Officer Executive Assistant Chief Nursing Officer Managers (Regional or Local) Chief Clinical Officer Business Office Manager Senior Vice President Benefits Coordinator Executive Director/Director (Regional or Local) Central Supply Clinical Information Systems/Technology Customer Service Representative Nursing Transitional Care Education Information Technology Technicians Environmental Services Network Administrators Social Services Scheduling Coordinator Health Information Management Systems Analyst Campus Director Clinical Services Community Relations Minimum Data Set Coordinator Quality Management Regional Consultant Medical Records 9
Stakeholder Partnerships HIE Mobile Services Training Hospice Project management Wound Provide feedback reports Radiology HIE Vendors Laboratory Manage Platforms Pharmacy Develop feedback Reports EMT and Paramedics Healthcare Facilities Medical Directors Office Nursing Homes SNF Technology consultants Administrators Professional Organizations and Societies Nursing staff Alzheimer s Association Social Workers Quality Improvement Org. Patients Research Team Caregivers Policy Advocates and Evaluation EMR vendors CMS Hospitals RTI Administrators ONC Nursing staff Patients Caregivers EMR vendors 10
Polling Question What is your primary organization and responsibility? A. Administrator B. Medical Provider/Staff C. Technology Consultant/Vendor D. Policy Advocate https://live.eventbase.com/polls?event=himss2018&polls=4311 11
Project Outcomes Achieve and sustain the hospitalization rate below 1.10 12
Key Results with RTI- Comparison Group 40% reduction in all-cause hospitalizations and 57.7% potentially avoidable hospitalizations reduced (p=.001); 54.1% all cause ED visits reduction and 65.3% potentially avoidable ED visits reduced (p=.001). 33.6% Medicare expenditures in all-cause reduced and 45.2% in potentially avoidable hospitalizations (p=.001); 50.2% Medicare expenditures in all-cause ED visits reduced and 59.7% potentially avoidable ED visits reduced(p=.001). Ingber, MJ, Feng, Z, Khatutsky, G, et al. Evaluation of the initiative to reduce avoidable hospitalizations among nursing facility residents: Annual report project year 4, February, 2017. Available at: https://innovation.cms.gov/files/reports/irahnfr-finalyrfourevalrpt.pdf. Accessed April 14, 2017. Centers for Medicare and Medicaid Services. Medicare Hospital Quality. 13
HIE Milestones and Outcomes 13 out of 16 NFs completed EHR implementation All 16 homes expected to be live by end of June 2018 502 secure texting discussions involving MOQI APRN All MOQI APRNs and 1/3 of NFs have secure texting 2,380 Direct Messages exchanged 4 th quarter 2017 100% HIE Participation in nursing home facilities 14
Systems Analysis Process Survey of NFs regarding technology infrastructure to develop NF capabilities list Evaluate technology for APRNs and NF capabilities Laptops, phones, tablets, printer/scanners Worked with NFs and their corporate IT to iteratively test connectivity and remedy deficiencies 15
Expected Benefits Connectivity to clinical support services» Pharmacy» Radiology» Laboratory» Hospice» Wound Care User centered satisfaction surveys of technology Tracking usage of HIE statistics 16
HIE Implementation Phase I IT Readiness Assessment: Electronic Interfaces: Direct CareMail and Bidirectional Portal CareView System Administrator Help Desk and Training 17
HIE Implementation Phase II: Use Case Development 18
HIE Implementation Phase III: User Feedback Semi Structured Interviews Help Desk Reports Usability Surveys HIE Usage Reports Training Webinars 19
HIE Implementation Process Phase III Non Emergent Scheduling appointments Laboratory Specimen Drawing Pharmacy Orders and Reconciliation Social Work Discharge Planning Admissions and Pre-Admissions Pharmacy Medication Reconciliation 20
Non Emergent Use Case: Scheduling Appointments 21
Non Emergent Use Case Laboratory Specimen (Antibiotic Administration) 22
Non Emergent Use Case: Admissions and Pre-Admissions (Part 1) 23
Non Emergent Use Case: Admissions and Pre-Admissions (Part 2) 24
Polling Question What Use Case is est Priority for Healthcare Partners A. Lab Specimen Drawing B. Scheduling Appointments C. Pharmacy Reconciliation D. Admission and Pre-Admission https://live.eventbase.com/polls?event=himss2018&polls=4312 25
Hospital and LTPAC Partnerships in HIE Keep in mind: There are two sides to every story 26
Building Partnerships, Organizational Learning, and Collaboration Hospitals Nursing Homes EHR Vendors HIE Organizations Design Specifications CCDs Versions Formatting Blocked Transmissions Opening Documents (user privileges) Incompatible Browsers Storage and Retrieval of Downloads 27
Discharge Paperwork for Acute Transfer 1. Face sheet (EMS needs) 2. Med rec 3. Rounding report 4. 3 days MD notes 5. Patient summary report 6. Advance directives/living will, if applicable 7. H&P (only for long distance transfers over 25 miles) 8. Patient transfer form (MD orders/nursing patient functional assessment) 9. Physician certification statement (for ambulance transfer only) (EMS needs) 10.Transfer and authorization form (for hospital-based NH or ED transfer to another hospital) 28
Goals of Transition of Care Safe transitions to post acute care levels Improve communication between providers Partnering to improve and reduce care transitions Benefits of collaboration will include: Decreased hospital length of stay and readmissions Appropriate active case management Decreased use of the emergency department Appropriate utilization of resources and ancillary services Improved patient and family satisfaction Improve results of quality measures 29
Challenges/Opportunities Develop custom reports Pull relevant PHI Pulling data from multiple applications Sending report takes multiple steps Limited users for CareMail in hospital setting Roll out new process to other hospitals after pilot 30
Potential Change(s) from Initiative Stakeholder (Groups) (n=49) Potential changes for Stakeholder Group(s) Impact (, Medium, Low) Greater Access to Information Addressing Errors More Timeliness Improved Accuracy Build Network/Partner Opportunities Transfer of Information Better Quality of Information Increased Patient Satisfaction Increased Family Satisfaction Correct Patient Information Seamless Patient Transitions Reduced Stress and Harm to Client Problem Solving Legal and Fiscal Activities Collaboration Early Identification Condition Change Greater Care Involvement Identification of Care Improvements Effectiveness of Care Regulatory Compliance Comprehensive Record Available Keep Residents Healthy Navigating Healthcare Processes Increased Accountability Healthcare Facilities Nursing Homes Administrators Nursing staff Social Workers Patients Caregivers EMR vendors Hospitals Administrators Nursing staff Patients Caregivers EMR vendors DON: Deep dive each admission DON: True picture of admission DON: Communicate findings w ith nurses and providers DON: Inputs orders ahead of time DON: Review s order for correctness Administrator: Fact finding (e.g. diagnosis, equipment) IT/Vendor Specialists: Assure information transfer Charge Nurse: Provide immediate care Please use blank slide if more space is required for charts, graphs, etc. Charge Nurse: Ensure patient info., orders, meds input accurately Admissions Coord.: Gathers disperses information to correct areas Physicians: Faster feedback, clarification, authorization Social Services: Evaluation: Care planning and advance directives Administrator: First contact (e.g. hospital and families) Social w orker: communication w ith family and hospital Physician: Involvement in challenging cases Executive Director: Document accurate resident evaluations To remove background graphics, right click on selected slide, choose Format APRN: Background Change agent and check Hide background APRN: Holistic graphics. view APRN: Sounding board for clinical questions Admissions Coordinator: Provide nursing w ith needed information Care Consultants: Consultations w ith patients, families, physicians Nursing: Using SBAR to communicate findings Administrator: Access to referral data IT: Getting information to facility IT: Process to assure data quality Remember to delete this slide, if not needed. Charge Nurse: Coordinates care w ith admissions coordinator Unit Nurse: Stability to the unit Social Worker: Support, buffer, comfort w hen family drama occurs Social Worker: Identifies solutions to problems QM/QI Nurse: Review resident risks, prevent illness Nurse Manager: Technology lead in EMR implementation Care Consultants: Maximizes use of encrypted IT/EHR Nurse Manager: Double check Admit, proper coding and auditing Home Health Aide: Identifying chore duties for client Social Worker: Identify equipment needs Social Worker: Notary w ork Physician: Better understanding of hospice services 31 Restorative Aide: Consultation Director of Education: Professionalism, appropriate care Medical Advisor: Connections betw een physicians and staff Medium Medium Medium Medium Medium Medium Medium Medium Medium Medium Medium Medium Low Low Low Low Low Low Low
Questions Gregory L Alexander PhD, RN Professor, University of Missouri MOQI HIT Lead Sue Shumate BS, RN Primaris Health MOQI Health Information Coordinator 32