ehr in long term care: are you ready?
DESCRIPTION
EHR in Long Term Care: Are you ready?. What is EHR?. EHR – Electronic Health Record Also known as EMR – Electronic Medical Record Capturing Resident Health Information electronically Usually encompasses Billing data Data elements typically include: ADL documentation - PowerPoint PPT PresentationTRANSCRIPT
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EHR in Long Term Care: Are you ready?
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EHR – Electronic Health Record Also known as EMR – Electronic Medical
Record Capturing Resident Health Information
electronically Usually encompasses Billing data Data elements typically include:
ADL documentation Clinical Documentation CPOE eMAR and eTAR
What is EHR?
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EHR in LTC began with MDS MDS established a standard “data set” for all
residents Established a standard comparison between
facilities This “data set” was the early start to quality
measure reporting Mandatory Electronic transmission of MDS
data began in 1998
The “Beginning”
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Large variation of EHR MDS and Care Plan ADL documentation tools RUG Analysis Lab websites Pharmacy website X-ray/diagnostic websites Full Clinical documentation EHR Integration to Billing Software Most EHR are a “hybrid” EHR and Paper chart
The “Present”
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Full integration of billing/financial and clinical Electronic exchange of data to ACO’s Electronic exchange of data to other providers
Pharmacy Laboratory Mobile Diagnostic Acute Care Hospital
Having a truly “paperless” chart Family portals MD portals Barcoding RFID tracking
The “Future”
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Standard data for multi site organizations Real time data 672/802 Data reporting – replace spreadsheets No more “bad handwriting” Clean MAR and TAR “Force” data entry Reduce errors
The “Good”
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Workflows and prompts Alerts Tracking/Trending - QAPI Audit “from your desk” Point of Care Documentation Decrease “filing” of paper records Reduce “clutter at desk” Transparency
More “Good”
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Transparency Standard data – change in process Mobility – device type Learning curve Cost IT support internal IT support external Change Perception of families
The “Bad”
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Perception of Management Security of network Security of devices “Dirty data” Interfaces Nursing vs. Billing Back up plan “Not me” syndrome
More “Bad”
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Server/Database Cost Maintenance Flexibility Custom reporting
Web or Cloud Decreased Flexibility Data retrieval Decreased Cost Maintenance
Server/Database vs. Web or Cloud
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Key Stakeholder Who are they? How to get their input?
Budget What is goal of stakeholders? What is goal of “front line”? Current Technology State Growth
Evaluation
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Initial costs Maintenance costs Support services Training services Hardware requirements “Bells and whistles” Server/Database Web or Cloud
Product
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Phased Approach Phase 1 – MDS and Care Plan Phase 2 – ADL documentation Phase 3 – Clinical documentation Phase 4 – CPOE and eMAR/eTAR Phase 5 – Integration/data exchange
Implementation
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People Support from the Top down Get their buy in Stay positive in front of others
Process, process, process “Software/computers” will NOT fix bad
practices/process Know and document current process Document process change
The “Keys” to Change
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Evaluate, Evaluate, Evaluate Current state – BE HONEST Current process – BE HONEST What is company goal – BE REALISTIC What is staff goal – Get their input, don’t guess “Test run” of more than 1 potential application Budget “Deal breaker” vs. “Nice to have”
Secrets to Success
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Plan, Plan, Plan Dedicated project manager – not an “additional duty”
and not the “decision maker” Stages – phase 1, phase 2, phase 3 Identify “Super Stars” Document process – not just clinical Educate on process change in advance if possible Update policies in advance if needed Establish a “change board” or “decision board” Key stakeholders Establish deadlines and stick to them
Secrets to Success
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Test, Test, Test and Train, Train, Train Testing/training site “Super stars” input “Walk through” Train the Trainer Go Live within 2- 4 weeks of Training
Secrets to Success
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Patience Patience Patience Patience Patience More patience
Secrets to Success
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Communication, Communication, Communication Training dates Go Live dates Feedback to “change board” Key contacts for Go Live Key contacts post Go Live Process documents How to Guides
Secrets to Success
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Follow up, Follow up, Follow up Daily “checks” post Go Live Follow up with staff Discuss “Good” and “Bad” Positive feedback first “Kick off” party “Graduation” party
Secrets to Success
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Re-evaluate, Re-evaluate, Re-evaluate What is working What isn’t working Is there a better way or process Is this re-education On going re-education New employee training Competency checklist
Secrets to Success
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Questions