ehr in long term care: are you ready?. ehr – electronic health record also known as emr –...

EHR in Long Term Care: Are you ready?

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?

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”

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”

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”

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”

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”

Transparency Standard data – change in process Mobility – device type Learning curve Cost IT support internal IT support external Change Perception of families

The “Bad”

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

More “Bad”

Server/Database Cost Maintenance Flexibility Custom reporting

Web or Cloud Decreased Flexibility Data retrieval Decreased Cost Maintenance

Server/Database vs. Web or Cloud

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

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

Product

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

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

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

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

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

Patience Patience Patience Patience Patience More patience

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

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

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

Secrets to Success

Questions