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Healthcare Information Systems Management—Testing and EvaluationSession LT4, March 5, 2018

Gregory L Alexander PhD, RN, FAAN, Professor, University of Missouri, Sinclair School of Nursing

Sue Shumate BS, RN, Health Information Coordinator, University of Missouri/Primaris

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Gregory L Alexander Phd, RN, FAAN

Sue Shumate BS, RN

Contracted Research: Center for Medicare and Medicaid Services, Innovations Center

Missouri Quality Initiative for Nursing Homes, Grant #1E1CMS331489

Conflict of Interest

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Agenda

• MOQI Model

• Systems Analysis Process

• Developing Use Cases to Guide Implementation

• Iterative Pilot Testing of Technology with Partners

• Policy and Standards

• Expected Benefits

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Learning Objectives

• Define key differences between LTPAC and traditional healthcare provider organizations in the testing and evaluation of IT systems

• Summarize at least one insight an LTPAC provider gained from using analytics to guide their system testing and evaluation effort

• Identify CAHIMS testing and evaluation competencies LTPAC provider organizations should most closely watch

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MOQI Primary Project Goals

• Reduce avoidable hospitalizations via four aspects of APRN Care Coordination

1. Condition management

2. Early illness detection

3. INTERACT

4. End-of-life/Advanced care planning

• AND integrate health information technology into patient care processes

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2018 MOQI Project Goals

Reduce infections and hospitalizations related to infections through

educational opportunities provided to nursing homes

Increase and sustain use of INTERACT tools at fully

engaged level

Increase and enhance meaningful care conversations about serious

illness and advanced care planning

Refine Quality Improvement processes for guidelines

of Phase 2 billable conditions and feedback reports

for billing

Increase use of bi-directional portals in all nursing homes Develop, test, and implement APRN feedback reports

for preventable hospitalizations

100% of nursing facilities’ adoption of secure communication tools

for texting and e-mailing

Achieve and sustain the Phase 1 hospitalization rate

below 1.10

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HIT Intervention• Promote the use of healthcare information technology (HIT) to

improve the care of patients and communication among team members

• Pursue integration and interoperability of all aspects of technology solutions

• Train team members and nursing home staff regarding use of technology and workflow

• Lead evaluation of software/components to be used in technological solutions

• Systematic Feedback Reports to Users

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IT Staffing Champions and Super Users Chief Operations Officer Executive Assistant

Chief Nursing Officer Managers (Regional or Local)

Chief Clinical Officer Business Office Manager

Senior Vice President Benefits Coordinator

Executive Director/Director (Regional or Local) Central Supply

Clinical Information Systems/Technology Customer Service Representative

Nursing Transitional Care

Education Information Technology Technicians

Environmental Services Network Administrators

Social Services Scheduling Coordinator

Health Information Management Systems Analyst

Campus Director Clinical Services

Community Relations Minimum Data Set Coordinator

Quality Management Regional Consultant

Medical Records

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Stakeholder PartnershipsHIE Mobile Services

Training Hospice

Project management Wound

Provide feedback reports Radiology

HIE Vendors Laboratory

Manage Platforms Pharmacy

Develop feedback Reports EMT and Paramedics

Healthcare Facilities Medical Directors Office

Nursing Homes SNF Technology consultants

Administrators Professional Organizations and Societies

Nursing staff Alzheimer’s Association

Social Workers Quality Improvement Org.

Patients Research Team

Caregivers Policy Advocates and Evaluation

EMR vendors CMS

Hospitals RTI

Administrators ONC

Nursing staff

Patients

Caregivers

EMR vendors

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Polling Question• What is your primary organization and responsibility?

A. Administrator

B. Medical Provider/Staff

C. Technology Consultant/Vendor

D. Policy Advocate

https://live.eventbase.com/polls?event=himss2018&polls=4311

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Project OutcomesAchieve and sustain the hospitalization rate below 1.10

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Key Results with RTI- Comparison Group• 40% reduction in all-cause hospitalizations and

• 57.7% potentially avoidable hospitalizations reduced (p=.001);

• 54.1% all cause ED visits reduction and

• 65.3% potentially avoidable ED visits reduced (p=.001).

• 33.6% Medicare expenditures in all-cause reduced and

• 45.2% in potentially avoidable hospitalizations (p= .001);

• 50.2% Medicare expenditures in all-cause ED visits reduced and

• 59.7% potentially avoidable ED visits reduced(p=.001).

Ingber, MJ, Feng, Z, Khatutsky, G, et al. Evaluation of the initiative to reduce avoidable hospitalizations among nursing facility residents: Annual report project year 4, February, 2017. Available at: https://innovation.cms.gov/Files/reports/irahnfr-finalyrfourevalrpt.pdf. Accessed April 14, 2017. Centers for Medicare and Medicaid Services. Medicare Hospital Quality.

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HIE Milestones and Outcomes• 13 out of 16 NFs completed EHR implementation

– All 16 homes expected to be live by end of June 2018

• 502 secure texting discussions involving MOQI APRN

– All MOQI APRNs and 1/3 of NFs have secure texting

• 2,380 Direct Messages exchanged 4th quarter 2017

• 100% HIE Participation in nursing home facilities

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Systems Analysis Process• Survey of NFs regarding technology infrastructure to develop NF

capabilities list

• Evaluate technology for APRNs and NF capabilities

– Laptops, phones, tablets, printer/scanners

• Worked with NFs and their corporate IT to iteratively test connectivity and remedy deficiencies

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Expected Benefits– Connectivity to clinical support services

» Pharmacy

» Radiology

» Laboratory

» Hospice

» Wound Care

– User centered satisfaction surveys of technology

– Tracking usage of HIE statistics

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HIE Implementation Phase I

• IT Readiness Assessment:

• Electronic Interfaces: – Direct “CareMail” and Bidirectional Portal “CareView”

• System Administrator

• Help Desk and Training

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HIE Implementation Phase II: Use Case Development

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HIE Implementation Phase III: User Feedback

Semi Structured Interviews

Help Desk Reports

Usability Surveys

HIE Usage Reports

Training

Webinars

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HIE Implementation ProcessPhase III

• Non Emergent

– Scheduling appointments

– Laboratory Specimen Drawing

– Pharmacy Orders and Reconciliation

– Social Work Discharge Planning

– Admissions and Pre-Admissions

– Pharmacy Medication Reconciliation

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Non Emergent Use Case:Scheduling Appointments

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Non Emergent Use CaseLaboratory Specimen (Antibiotic Administration)

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Non Emergent Use Case: Admissions and Pre-Admissions (Part 1)

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Non Emergent Use Case: Admissions and Pre-Admissions (Part 2)

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Polling Question• What Use Case is Highest Priority for Healthcare Partners

A. Lab Specimen Drawing

B. Scheduling Appointments

C. Pharmacy Reconciliation

D. Admission and Pre-Admission

https://live.eventbase.com/polls?event=himss2018&polls=4312

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Keep in mind: There are two sides to every story

Hospital and LTPAC Partnerships in HIE

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Building Partnerships, Organizational Learning, and Collaboration

Hospitals Nursing Homes EHR Vendors HIE Organizations

• Design Specifications

– CCDs

• Versions

• Formatting

• Blocked Transmissions

• Opening Documents (user privileges)

• Incompatible Browsers

• Storage and Retrieval of Downloads

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Discharge Paperwork for Acute Transfer1. Face sheet (EMS needs)

2. Med rec

3. Rounding report

4. 3 days MD notes

5. Patient summary report

6. Advance directives/living will, if applicable

7. H&P (only for long distance transfers over 25 miles)

8. Patient transfer form (MD orders/nursing patient functional assessment)

9. Physician certification statement (for ambulance transfer only) (EMS needs)

10.Transfer and authorization form (for hospital-based NH or ED transfer to

another hospital)

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Goals of Transition of Care• Safe transitions to post acute care levels

• Improve communication between providers

• Partnering to improve and reduce care transitions

• Benefits of collaboration will include:

– Decreased hospital length of stay and readmissions

– Appropriate active case management

– Decreased use of the emergency department

– Appropriate utilization of resources and ancillary services

– Improved patient and family satisfaction

– Improve results of quality measures

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Challenges/Opportunities• Develop custom reports

– Pull relevant PHI

• Pulling data from multiple applications

• Sending report takes multiple steps

• Limited users for CareMail in hospital setting

• Roll out new process to other hospitals after pilot

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Potential Change(s) from Initiative Stakeholder (Groups) (n=49) Potential changes for Stakeholder Group(s) Impact (High, Medium, Low)

Greater Access to Information

Addressing Errors

More Timeliness

Improved Accuracy

Build Network/Partner Opportunities

Transfer of Information

Better Quality of Information

Increased Patient Satisfaction

Increased Family Satisfaction

Correct Patient Information

Seamless Patient Transitions

Reduced Stress and Harm to Client

Problem Solving

Legal and Fiscal Activities

Collaboration

Early Identification Condition Change

Greater Care Involvement

Identification of Care Improvements

Effectiveness of Care

Regulatory Compliance

Comprehensive Record Available

Keep Residents Healthy

Navigating Healthcare Processes

Increased Accountability

Healthcare Facilities

Nursing Homes

Administrators

Nursing staff

Social Workers

Patients

Caregivers

EMR vendors

Hospitals

Administrators

Nursing staff

Patients

Caregivers

EMR vendors

DON: Deep dive each admission

DON: True picture of admission

DON: Communicate f indings w ith nurses and providers

DON: Inputs orders ahead of time

DON: Review s order for correctness 

Administrator: Fact f inding (e.g. diagnosis, equipment)

IT/Vendor Specialists: Assure information transfer

Charge Nurse: Provide immediate care

Charge Nurse: Ensure patient info., orders, meds input accurately

Admissions Coord.: Gathers disperses information to correct areas

Physicians: Faster feedback, clarif ication, authorization

Social Services: Evaluation: Care planning and advance directives

Administrator: First contact (e.g. hospital and families)

Social w orker: communication w ith family and hospital

Physician: Involvement in challenging cases

Executive Director: Document accurate resident evaluations

APRN: Sounding board for clinical questions

Admissions Coordinator: Provide nursing w ith needed information

Care Consultants: Consultations w ith patients, families, physicians

APRN: Change agent

APRN: Holistic view

Nursing: Using SBAR to communicate f indings

Administrator: Access to referral data

IT: Getting information to facility

IT: Process to assure data quality

Charge Nurse: Coordinates care w ith admissions coordinator

Unit Nurse: Stability to the unit

Social Worker: Support, buffer, comfort w hen family drama occurs

Social Worker: Identif ies solutions to problems

QM/QI Nurse: Review resident risks, prevent illness

Nurse Manager: Technology lead in EMR implementation

Care Consultants: Maximizes use of encrypted IT/EHR

Nurse Manager: Double check Admit, proper coding and auditing

Home Health Aide: Identifying chore duties for client

Social Worker: Identify equipment needs

Social Worker: Notary w ork

Physician: Better understanding of hospice services

Restorative Aide: Consultation

Director of Education: Professionalism, appropriate care

Medical Advisor: Connections betw een physicians and staff

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Medium

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Low

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Questions

• Gregory L Alexander PhD, RN

Professor, University of Missouri

MOQI HIT Lead

Sue Shumate BS, RN

Primaris Health

MOQI Health Information Coordinator