Transcript T-1 Electronic Medical Records - American Health Care Association

MOBILE, INFORMED & CONNECTED
TM
T-2 Electronic Medical Records
in Long Term Care
October 8, 2007
10:30am – 12:30pm
Presentation Agenda
• 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
© 2007 SigmaCare
Slide 2
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
© 2007 SigmaCare
Slide 3
What are Electronic Medical Records?
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 populationlevel 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.”
© 2007 SigmaCare
Slide 4
What are Electronic Medical Records?
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.”
© 2007 SigmaCare
Slide 5
What are Electronic Medical Records?
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.
© 2007 SigmaCare
Slide 6
Adoption of EMRs in LTC
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.
© 2007 SigmaCare
Slide 7
Why the Different Adoption Rates?
• 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
© 2007 SigmaCare
Slide 8
Models of Care in LTC vs. Acute Care
• Disease Focus
Nursing
Social
Services
Therapies
• Less oversight
• Short LOS- measured in days.
ICD-9 Code
Resident
Medical
Services
Administration
ALL Care
Centered on
Disease Process
Activities
Dietary
• Comprehensive Level of Care
• Strict Regulations with State & Federal oversight
• Average LOS- months-years vs. days.
© 2007 SigmaCare
Slide 9
Objectives for Implementing EMRs
• Improve Quality Care
• Avoid Adverse Drug Events
• Improve Quality Measures
• Enhance Resident Safety
• Improve Operational Efficiencies
and Reallocate Staff
• Increase Reimbursements
© 2007 SigmaCare
Slide 10
Introduction to the Benefits of EMRs
The real benefits one NYS Nursing Home realized upon
implementation of a full EMR….
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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
© 2007 SigmaCare
Slide 11
Valley View Case Study
• Goshen, NY
• 520 Beds
• 4 Buildings
• 15 Units
– Sub-Acute Rehabilitation
– Long Term
– Dementia/Alzheimer's
– Palliative Care
• Over 600 Employees
© 2007 SigmaCare
Slide 12
Valley View’s Business Issues
Business Issues
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
© 2007 SigmaCare
• 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
Slide 13
Valley View’s Return on Investment
Business Processes
Automated
• 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
© 2007 SigmaCare
Direct Financial
Benefit
Additional
Efficiencies
• 92% reduction in adverse
drug events (from avg. of
• 5 FTE Staff Reduction* $ 250,000
2.81 per month to .23 per
• Medication savings
$ 262,000
month)
• Renewal efficiencies
$ 120,000
• Efficiencies in
$
8,000 • 9% additional time for over
formulary training
200 employees (700 hours
• Consultation forms
per week) to focus on
$ 20,000
direct resident care
• Medicare billing
$ 15,000
improvement
• Reporting (resident safety,
• Lab billing
$ 10,000
quality indicators, DUR,
improvement
shift productivity, census)
• Compliance with State,
Federal and accreditation
audits, surveys and ad hoc
requests
Slide 14
Surveillance Process
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.
© 2007 SigmaCare
Slide 15
Information Gathering During Survey
Quality of Life Assessment
Contains 3 parts:
– Resident interviews
– Group interview
– Family interview and
resident observation
© 2007 SigmaCare
Slide 16
Information Gathering During Survey
Medication Pass Observation
– 20-25 medication
opportunities for error are
observed.
– Error? An additional 20-25
opportunities for error are
observed.
© 2007 SigmaCare
Slide 17
Medication Pass Observation
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.
Electronic Medication
Administration Record
(eMAR)
Online Drug Reference
Guide
© 2007 SigmaCare
• 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.
Slide 18
Information Gathering During Survey
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.
© 2007 SigmaCare
Slide 19
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?
© 2007 SigmaCare
Slide 20
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.
© 2007 SigmaCare
Slide 21
Facts about EMRs & the Survey Process
• 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.
© 2007 SigmaCare
Slide 22
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”.
© 2007 SigmaCare
Slide 23
Empowering Your Staff
• 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.
© 2007 SigmaCare
Slide 24
Overcoming the Barriers to Adoption
• Leadership
• Education & Culture Change
• Communication
• Demonstration
• Job-Based Training
• Support
© 2007 SigmaCare
Slide 25
Implementing an EMR in LTC
Leadership Support
PreImplementation
Change
Management
Peer Mentor &
Training
Go Live &
Support
Account
Management
Optimum User Adoption
& Customer ROI
© 2007 SigmaCare
Slide 26
Pre-Implementation
• Workflow analysis and benchmarking
PreImplementation
• 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
© 2007 SigmaCare
Slide 27
Change Management
• Orientation and Engagement program
Change
Management
• 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
© 2007 SigmaCare
Slide 28
Peer Mentoring & Training
• Schedule training for each
discipline and department
Peer Mentor &
Training
• 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
© 2007 SigmaCare
Slide 29
Go-Live & Support
• Rollout phased in by unit to avoid
disruptions to facility
Go Live &
Support
• 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
© 2007 SigmaCare
Slide 30
Account Management
• Dedicated Account Manager to
ensure on-going customer satisfaction
Account
Management
• Benchmarks to track and analyze
metrics before, during and after the
implementation:
– Resident Safety
– Training Satisfaction
– Usability and Adoption
– Resource Utilization
– Operating Costs &
Reimbursement
© 2007 SigmaCare
Slide 31
Utilizing
Technology in
health care
facilities is no
longer the
future….
© 2007 SigmaCare
IT is
TODAY!!!
Slide 32
Questions ?
© 2007 SigmaCare
Slide 33
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TM
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212-268-4242
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