digitizing the mobile_workforce_electronic_health_records_for_hospice

Digitizing the Mobile Workforce: Electronic Health Records for Hospice

AIIM 2011

George Zimmerman,St. Peters Healthcare Services

Brian LincolnXerox Corporation

The old problem – Information andApplication overload

Information (and paper) overload:Information (and paper) overload:Information (and paper) overload:Information (and paper) overload:

Healthcare workers spend almost twice as much spend almost twice as much spend almost twice as much spend almost twice as much time with documentstime with documentstime with documentstime with documents as in other industries (and 33% of information searches are unsuccessful). IDC, 2007

In a 2010 survey of healthcare providers, Forrester found over 50% of providers were still driven by over 50% of providers were still driven by over 50% of providers were still driven by over 50% of providers were still driven by paperpaperpaperpaper----based processesbased processesbased processesbased processes, and had not committed to an enterprise wide EMR.

Complexity of Complexity of Complexity of Complexity of HealthcareHealthcareHealthcareHealthcare

Many application areasMany application areasMany application areasMany application areas exist in a healthcare organization – EHR/EMR, patient management, health information management, education/training, diagnostics, billing, etc. etc.

Hospitals typically have a multitude of IT systemsmultitude of IT systemsmultitude of IT systemsmultitude of IT systems –•Multiple EHR/EMR•PACS•Lab systems•Payroll/Finance/Scheduling•Compliance•Patient Accounting•Specialized clinical systems – for ER, Pathology, Mental Health, Obstetrics, Hospice, etc. etc.

2011 Technology Challenge and Driver: ‘Meaningful Use’

•Healthcare providers striving to support:

• Electronic Medical Records (EMR)

• Health Information Exchange (HIE)

• Cross-provider Electronic Health Records (EHR)

•2009 American Recovery and Reinvestment Act (ARRA), HiTECH Act

• Accelerate EMR/EHR via incentive payments; but providers must also show “meaningful use” of EHR, meeting a matrix of objectives

Example ‘Meaningful Use’ requirements:

Compliance – Strong auditing and reporting

Participation in HIE networks

Cross-system coordination

Transmittal of prescriptions electronically

Quick patient access to records on request

Improved patient engagement, communication

Better process capabilities

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And the next frontier – Going Mobile

•Use of PDA devices, tablets, Web applications has exploded

In Healthcare: In Healthcare: In Healthcare: In Healthcare:

• New media tablets with better screen size and availability mean more effective use by physicians, clinicians

• Mobile tool must match the purpose – laptops, smart phones, wireless devices are acceptable for different clinical activities

• Security and compliance requirements are key

• Emerging mobile technologies give Healthcare providers new options for supporting Hospice workers and other mobile teams

GPS, 3G, Wi-Fi, Bluetooth all growing at over 40%

Internet Administrator/Webmaster, St. Peters Health Care Services

George Zimmerman George Zimmerman

Senior Product Line Manager, Xerox Corporation

Brian LincolnBrian Lincoln

• Who we are

• About Hospice

• Relationship to St. Peter’s

• Relationship to the area health care community

• Special Regulations regarding patient information

George Zimmerman George Zimmerman

Internet AdministratorInternet Administrator

St. Peters Healthcare ServicesSt. Peters Healthcare Services

� Manage Internet and Web Services at healthcare centers around Albany, NY.

� St. Peter’s Hospital recently became part of the Catholic Health East network extending along the entire eastern United States.

� I have been instrumental in implementing IT solutions and policy-setting to address regulatory guidelines related to HIPAA and JCAHO, disaster planning, and many other healthcare-related initiatives.

� I have advised and contributed best practices to many healthcarecenters across the nation.

• First founded by the Religious Sisters of Mercy in 1869 as St. Peter's Hospital, St. Peter's Health Care Services today provides New York's Capital Region with a comprehensive, integrated continuum of care.

• Hospital has 442 beds, 4,600 employees (currently merging with two additional acute healthcare systems).

• 25 Facilities with a wide range of programs and services, from birth to LTC.

• Member of Catholic Health East (CHE).

• Currently expanding our Acute care with a $250 million expansion.

• Regional announcement to merge with 3 upstate area healthcare systems, making us one of the largest in the region, expanding to 125 facilities,1,200 beds and 12,000 employees.

� The Community Hospice provides expert care to those who are very ill with any disease, plus help and support for their families. We show patients and their loved ones how to focus on the things that matter most, and we encourage them to set goals and embrace life.

� St. Peter’s Healthcare Services’ Web Services group provides critical infrastructure, network, application, and internet related support to help the foundation reach its goals.

� The Community Hospice is a non-profitserving 7 counties: Albany, Rensselaer, Columbia, Greene, Schenectady, Saratoga and Montgomery and employees approximately 500 staff.

� Of the approximately 8600 deaths last year, 39% were receiving hospice services.

� The Community Hospice set a record for “patients under care,” caring for average of 658 patients per day.

� Approximately 64% are homecare, 33% are residents of local nursing homes, and about 3% are hospital patients and receive inpatient hospice care.

� Services are provided at little or no cost to patients.

� Patients often keep their current doctors, and we work with them to ensure they are receiving the best care possible.

� The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy

Rule

Health information technology (health IT) involves the exchange

of health information in an electronic environment. Widespread use of health IT within the health care industry will improve the quality of health care, prevent medical errors, reduce health care costs, increase administrative efficiencies, decrease paperwork,and expand access to affordable health care. It is imperative that the privacy and security of electronic health information be ensured as this information is maintained and transmitted electronically.

� Community Health Accreditation ProgramCHAP is an independent, not-for-profit, accrediting body for community-based health care organizations. Created in 1965, CHAP was the first to recognize the need and value for accreditation in community-based care. CHAP is the oldest national, community-based accrediting body with more than 5,000 agencies currently accredited nationwide.

The dangers of not having document management:

• Don’t let HIPPA guidelines or JCAHO eat you up

� New compliance, disaster recovery initiatives required information to be available, accessible anywhere anytime :

� HIPAA PoliciesHIPAA PoliciesHIPAA PoliciesHIPAA Policies (frequent versions)

� Disaster/Emergency Preparedness ManualDisaster/Emergency Preparedness ManualDisaster/Emergency Preparedness ManualDisaster/Emergency Preparedness Manual

� New compliance, disaster recovery initiatives required information to be available, accessible anywhere anytime :

� HIPAA PoliciesHIPAA PoliciesHIPAA PoliciesHIPAA Policies (frequent versions)

� Disaster/Emergency Preparedness ManualDisaster/Emergency Preparedness ManualDisaster/Emergency Preparedness ManualDisaster/Emergency Preparedness Manual

St. Peters Background: St. Peters Background: St. Peters Background: St. Peters Background: Document Management Solutions to date

Diagnosis:Many Hospital-related documents to manage and keep up to date#1 – Key Challenges #2 - Benefits

� Administrative /Health Policies� Nursing Generic Standards Manual

� HR Personnel Policies & Forms� HIPAA, JCAHO Guidelines *� Emergency Preparedness *

� Pharmacy Policies & Formulary� Facilities documentation� Hospice documentation� IT Online Request forms

� IT Customer Support documents

Prescription:Centralized management of documents

across all hospitals, clinics

Document ManagementSystem

Other Document Managementapplications:

�Integrated Faxed Prescriptions to a secure repository

for review and fulfillment �Document Archiving

St. Peters Background: St. Peters Background: St. Peters Background: St. Peters Background: Document Management Solutions to date

� Polices , Procedures and forms – Now “Up to date”

� Printing cost savings – High volume printers downsized, huge paper $$$ savings

� IT cost savings – Email Inbox & Storage downsized

� Trash savings and Privacy – Less trash

� Quicker access to updated information – no more binders, nurses can read and text-search Nursing Manual instantly at desktops

� Employees can download HR Forms from Web - Massive reduction in printed forms

� Emergency Preparedness Manual – readily available

� Up-to-date HIPAA Guidelines are on-line

� Remote clinics and affiliates can access centralized documents from St. Peters’ intranet

� Hospice organization can share documents with International affiliates

� Polices , Procedures and forms – Now “Up to date”

� Printing cost savings – High volume printers downsized, huge paper $$$ savings

� IT cost savings – Email Inbox & Storage downsized

� Trash savings and Privacy – Less trash

� Quicker access to updated information – no more binders, nurses can read and text-search Nursing Manual instantly at desktops

� Employees can download HR Forms from Web - Massive reduction in printed forms

� Emergency Preparedness Manual – readily available

� Up-to-date HIPAA Guidelines are on-line

� Remote clinics and affiliates can access centralized documents from St. Peters’ intranet

� Hospice organization can share documents with International affiliates

#2 – Benefits #1 – Key Challenges

St. Peters Background: St. Peters Background: St. Peters Background: St. Peters Background: Document Management Solutions to date

• What Hospice does

• How services are delivered

• Administrative vs. Clinical Staff

• Overhead associated with process

� The Community Hospice provides round the clock medical services to terminal patients.

� Working with the patients directly in their homes, Hospice provides doctor visits, nursing care, comfort care, and emotional support when needed.

� Often our nurses and doctors will travel the 7 counties across cities and towns to provide services to patients.

� They must being everything needed for

care with them, as well

as be informed of the

patient’s diagnosis and

condition.

� The Community Hospice has both an administrative staff and clinical staff in order to help manage its patients.

� With patient information spread across both the office and the field, they are able to provide care seamlessly.

� Every day the Community Hospice deals with patient data and the need to have current information with them at a site.

� With a largely mobile workforce this information needs to be available nearly anywhere, secured, and as up to date as possible.

• Providing care remotely from outside the facility walls

• How to access records back at the office if needed

• Centralized Document Store

• Meaningful Use

• Security issues- the “open file on the car seat” problem

• Disseminating information to employees in the field

� Paper

� Land Lines

� Pagers

� Dial up Modems

� File Cabinets

� Medical Records Storage

� File Clerks

� Incentive Program for Electronic Health Incentive Program for Electronic Health Incentive Program for Electronic Health Incentive Program for Electronic Health RecordsRecordsRecordsRecords: Issued by the Centers for Medicare & Medicaid Services (CMS), this final rule defines the minimum defines the minimum defines the minimum defines the minimum requirements that providers must meet requirements that providers must meet requirements that providers must meet requirements that providers must meet through their use of certified EHR through their use of certified EHR through their use of certified EHR through their use of certified EHR technologytechnologytechnologytechnology in order to qualify for the payments.

� Standards and Certification Criteria for Standards and Certification Criteria for Standards and Certification Criteria for Standards and Certification Criteria for Electronic Health RecordsElectronic Health RecordsElectronic Health RecordsElectronic Health Records: Issued by the Office of the National Coordinator for Health Information Technology, this rule identifies the standards and certification identifies the standards and certification identifies the standards and certification identifies the standards and certification criteria for the certification of EHR criteria for the certification of EHR criteria for the certification of EHR criteria for the certification of EHR technologytechnologytechnologytechnology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

� Patient Data at risk

� HIPAA concerns

� Word of Mouth

� Postings

� Training Manuals

• Transforming paper-based process to electronic process

• Facilitating electronic document exchange with other health care providers and insurers

• Improves service delivery –support/information for field staff

• Improves productivity –Information always available when needed

• Easier to secure information

� Multi-Function Printers

� DocuShare

� HIXNY

Created through a unique collaboration

of health care providers and insurers, the purpose of HIXNY is to mobilize medical purpose of HIXNY is to mobilize medical purpose of HIXNY is to mobilize medical purpose of HIXNY is to mobilize medical information for the benefit of the information for the benefit of the information for the benefit of the information for the benefit of the patients that our member organizations patients that our member organizations patients that our member organizations patients that our member organizations serveserveserveserve. By improving health care delivery in our community, HIXNY will promote quality care and reduce costs. HIXNY provides a secure technology infrastructure and services to enable physicians, hospitals, health plans, and other health care providers to interact, share information resources, and conduct the business of healthcare in a collaborative manner.

� Tablets/Portables

� Cellular/Wifi

� GPS/CellTrak

� Education/Training

� SCCM Remote Support

� Point Sec

� BEZ Server

� VPN

� Drive Encryption

� Firewalls

• The technology chosen

• Streamlined workflows

• Reduced time required to maintain records

� DocuShare

� All in One Printers

� Blackberry PDAs

� AllScripts EHR System

� Mileage Tracking Automated

� Maps on Demand

� Voice Recognition

� Scanning

• Return on Investment

• Recommendations

• Summary

� Things you can’t Measure

� Soft cost

� Availability of information

� Joke- slide

Q&AQ&AQ&AQ&A

� Thank you!

George Zimmerman, IT Administrator, St. Peters Healthcare Services

gzimmerman@stpetershealth.orggzimmerman@stpetershealth.orggzimmerman@stpetershealth.orggzimmerman@stpetershealth.org

Brian Lincoln, Senior Product Line Manager, Xerox DocuShare

brian.lincoln@xerox.combrian.lincoln@xerox.combrian.lincoln@xerox.combrian.lincoln@xerox.com