Transcript Implementation and beyond…

Implementation and
Beyond…
How we became FOTO-genic at
Tomah Memorial Hospital
Tomah, Wisconsin
14TH ANNUAL OUTCOMES
CONFERENCE
April 5-6, 2014
Knoxville, TN
Nicole (Nikki) Rasmussen, PT, Cert. MDT
Conflict of Interest Disclosure
Nicole (Nikki) Rasmussen, PT, Cert.MDT
has no real or apparent conflicts of
interest to report.
Learning Objectives
• TMH FOTO-genic journey
• Development of a Documentation and
Reimbursement committee/FOTO “superuser”
• IT considerations /needs
• Rolling out of FOTO with patients/staff
• Lessons learned along the way: “Growing
pains” and “stuff we learned by the 2x4
method”
• Going forward, using the data, etc.
Tomah Memorial Hospital
• Rural western Wisconsin, about 10,000 in city
• Another 5,000 surrounding country; Industrial,
trucking, farming, schools, healthcare are main
employers in area.
• Critical Access (25 beds) including
Medical/Surgical , Swing Bed, and OB.
• 24 hour Emergency/Urgent Care services and
Walk-in clinic 7 miles north of town
• Ambulatory and inpatient surgery
• Broad range of outpatient services – Lab, MRI, CT,
Cardiac Rehab, Orthopedics, Plastic Surgery, Work
Conditioning, Outpatient PT, OT, ST, etc.
So, Where is Tomah?
TMH in Summertime!
TMH in Wintertime
TMH Rehab Department
• PT and OT/ST managers (2)
• 10 PT’s, 2 PTA’s, 3 OTR’s, 1 COTA, and
1 SLP-CCC
• 2 full time front office and 1 rehab aide
Our First Intro to FOTO
• Early 2000’s when it was paper entry,
decided against it in light of adding
burden to workload for much smaller
staff
• Late 2000’s when web based program
became an option, became much
more favorable. Clinical staff drove
some of the interest, with one involved
in EIM and one involved in MDT
Development of the Committee
Documentation Committee consists of:
 rehab managers
 two front line senior clinicians (PT’s)
 lead receptionist
 IT department head (invited as needed)
Weekly meetings (Wed morning 8 a.m.)
Documentation Committee
Roles and Duties
• Initially began as a way to develop
autocorrects for all staff to use in ReDoc but
evolved into so much more
• Troubleshoot ReDoc, FOTO, Say-It, MedHost or
other concerns within the realm of
documentation
• FOTO “super-user” - responsible for all updates,
changes, and training with FOTO
• Train all staff in FOTO updates, ReDoc
changes, G-codes, CMS or other insurance
changes that require updates or changes in
documentation
Documentation Committee
Roles and Duties
• Train newly hired staff one-on-one in
documentation expectations and software,
as part of the initial orientation. Competencybased with checklists.
• Perform ongoing training for current staff,
typically in small groups of 3-4
• Create annual competency reflecting current
changes in documentation, charges, high risk
potential as part of corporate compliance
• Development of marketing strategies using
outcomes data working with PR department
Documentation Committee
Roles and Duties
• Attend FOTO webinars and
conferences
• Contact with FOTO reps when
needed, which is often weekly,
especially early on
Roll-Out of FOTO
Roll-out of FOTO
• Began in the winter 2011-2012
• Committee sat down with the surveys,
looked at which optional surveys to
include, ongoing as new surveys are
brought forward
- Completed a lot of test patients
- Looked at surveys on screen as a
group, worked with IT and front
office
Roll-out of FOTO
• For patients began in spring 2012
• Initially started with shoulder patients
(both OT and PT see them)
• Worked out glitches, determined
scripting, increased patients’ comfort
with using technology
• Added foot and ankle next
• Then rolled out the whole body
Roll-out of FOTO
• Article for local newspapers, radio
advertising, and direct marketing to
MD’s
• Education of patients and the greater
community regarding what FOTO is,
why we are using it, and how it can be
of benefit
IT Considerations
• Equipment -Software as a service (SaaS)
infrastructure easy to implement – web browser – no
issues with system requirements
• Safety and security
• iPad vs. laptop kiosk in exam rooms vs.
provider laptop vs. home survey
• Wireless connection
• Email security/considerations
Why iPad vs. other tablets
• Apps for OT and Speech are available
on App Store and are used for some
patients (individual iTunes account for Rehab
department, installed by IT only)
• Easy: one home button, change size of
screen easily, compatible with other
equipment
• Many people are familiar with it
• Our environment needs to restart
printing service on occasion
Winner is iPad
• Connected to a public wifi –secure site (https)
• Enabled location service thru App store
(Where is my phone app)
• No patient data is stored
• Reception desk has three iPads (soon to be
five !)
• Charging station is under the desk, iPads kept
on desk between them and staff check them
out from desk if they take one.
• Reception desk area is secured when we are
not there
Procedures for FOTO at Intake
• Receptionists create patient in FOTO when
they schedule or shortly thereafter
• Ask therapist for assistance when needed in
choosing impairment, body area, or surgery
• Ask patients to come 30 min prior to
appointment time for hospital and PT
registration and intake process, explain
expected duration of time start to finish to the
patient (scripting)
• Assist patients in completing FOTO survey if
needed, offer private area
• Have used email feature with some patients
Procedures for FOTO at Intake
• Single page paper history form
• Reception obtains medications, PMH,
and last medical note from provider
offices via link or med record request
• Patient is given the iPad with their
survey ready to complete in rehab
services waiting area
Creature Comforts for Patients
Completing FOTO surveys
• Receptionists offer assistance, tell the
patients their names (scripting) “My
name is Jessie if you have any questions
while you work on the survey.”
• Coffee and water available in lobby
• Varying chair heights and widths
• iPad encased in Gumdrop, heavy duty
case, easy to hold, can be sanitized
• Compatible stylus also can be sanitized
• Reading glasses – can be sanitized
Our Patients Love Doing
FOTO Surveys!
Status Surveys
• When? Monthly, every ten visits, change in
status, prior to MD visit, PT/OT choice
• Therapist puts note on MedHost Scheduling
with “FOTO” in the visit notes. This prints on our
daily schedule and receptionists prepare
surveys in advance for that day’s cases who
need to complete FOTO. They explain to the
patient (scripting) about it, and is done prior
to staff seeing the patient that day
• We are given the printed survey in our boxes
to review details with the patient
Lessons Learned
a.k.a. “the 2x4 method”
Lessons Learned
• How to correctly use NPA
• How to speak with the patients to
encourage their participation in the
surveys (scripting)
• How to encourage staff to do the status
surveys and go over the scores and the
answers with the patients so they see how
we use the data.
• If the status survey is not done prior to
seeing the patient, it seems to get missed
Lessons Learned
• Share general data quarterly with
physicians and other referral sources
via email blast
• Share individual patient data with
patients themselves and their referring
provider
• Ongoing training via webinars, small
group training, individual training
• Small group training works best overall
Lessons Learned
• Getting the correct risk adjusted
parameters and the correct survey the
first time is critical!
• Ask if you don’t know!
• Use your FOTO rep as a resource! Speed
dial and email contact list
• Give it 12 months… just like total knees!
• Read your Release Notes
• Tell FOTO what you need – they are
awesome!
FOTO and ReDoc
• When ReDoc 7.8 came out, the
interface between FOTO and ReDoc
for generation of G-codes and severity
modifiers was a godsend
• We import the G-codes and severity
modifiers from FOTO into the ReDoc
note directly
• These two products interface readily
and save time on behalf of the
therapist
Documentation of FOTO scores
• We document in the functional section of the
ReDoc note the patient’s FOTO score,
average patient’s score and the FABQ score.
This is not an automatic population. We have
created shortcuts in Say-it and autocorrects in
ReDoc for the statements.
• We write this as: “FOTO score on 4/6/14 is x,
compared to y for patients with similar risk
adjusted parameters. Numbers closer to 100
indicate higher degree of function.”
Documentation of FOTO scores
• Include the FABQ in same area
• “Fear Avoidance Belief about Activity
is: x – elevated. Numbers closer to 100
indicate higher degree of fear or
avoidance of activity.”
• Incorporate a FOTO score into a goal
FORWARD!
• Not just the state motto of Wisconsin
• Quarterly emails to our local physicians
and referral sources with data highlights
• Use for staff appraisals as means to
highlight skills and consideration of
continuing education opportunities (we
do not use punitively)
• Colorful, fun bulletin board in lobby with
our data
Moving Forward Still
Be assured that implementing and using
FOTO is an ongoing work in progress and
not everything works perfectly the first
time. Sometimes you have to reevaluate, change, and modify your
plan. (Sound familiar?)
And Beyond…
Implementing FOTO is…
fun
exciting
challenging at times
an ongoing learning opportunity
but, mostly rewarding… to see your
data reflect what you know you already
do!
Time for Q & A
Nikki Rasmussen, PT, Cert.MDT
[email protected]
Tomah Memorial Hospital
www.tomahhospital.org