EHR in Long Term Care: Are you ready?

1. EHR in Long Term Care: Are you ready?

2. 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 • Clinical Documentation • CPOE • eMAR and eTAR

3. The “Beginning” 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

4. The “Present” 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

5. The “Future” • 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

6. The “Good” 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

7. More “Good” 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

8. The “Bad” Transparency Standard data – change in process Mobility – device type Learning curve Cost IT support internal IT support external Change Perception of families

9. More “Bad” Perception of Management Security of network Security of devices “Dirty data” Interfaces Nursing vs. Billing Back up plan “Not me” syndrome

10. Server/Database vs. Web or Cloud • Server/Database • Cost • Maintenance • Flexibility • Custom reporting • Web or Cloud • Decreased Flexibility • Data retrieval • Decreased Cost • Maintenance

11. Evaluation • 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

12. Product Initial costs Maintenance costs Support services Training services Hardware requirements “Bells and whistles” Server/Database Web or Cloud

13. Implementation • 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

14. The “Keys” to Change • 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

15. Secrets to Success • 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”

16. Secrets to Success • 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

17. Secrets to Success • 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

18. Secrets to Success Patience Patience Patience Patience Patience More patience

19. Secrets to Success • 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

20. Secrets to Success • 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

21. Secrets to Success • 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

22. Questions