introduction to the hit toolkit for nursing homes presented by: mary ann leonard, rhia, crm, rac-ct...
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INTRODUCTION TO THE HIT TOOLKIT FOR NURSING HOMES
Presented By:Mary Ann Leonard, RHIA, CRM, RAC-CT Michelle Dougherty, MA, RHIA, CHP
AHIMA LTC Community
Spring Conference 2009
Atlantic City, New Jersey
Purpose of Toolkit
Kick start your HIT and EHR planning Formalize the process Reduce your cost Server as surrogate staff Achieve your HIT and EHR goals
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General term relating to any use of information technology in health care
Specific term referring to the information system applications collectively used by clinicians that support decision making at the point of care
Tool Kit Development
Based on: QIO DOQ-IT Resources for Physician Practices
BY Margret Amatayakul RHIA, CHPS, CPHIT, CPEHR, FHIMSS President, Margret\A Consulting, LLC Schaumburg, IL
FOR Aging Services of Minnesota,
Alliance Purchasing, and
MHHA Service Corporation
It was produced by Stratis Health (QIO) in MN
HIT vs. EHR
Health information technology (HIT): a general concept that describes the technology that supports management of health information for many purposes
Electronic health record (EHR): a specific system of applications and other elements that capture data from multiple sources for clinical decision support at the point of care wherever that may occur including promotion of health and wellness
Softwarethat directscomputerdevices
People to supportand usesystems
Policythat drivesadoption ofsystems
Hardwarethat enablessystem use
Processthat helpsachieveresults
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
Encompasses broader view of a health record moving from notion of a location for keeping track of patient care events to a resource with enhanced utility
Provides longitudinal (i.e. lifelong) access to events that may have influenced a person’s health. Virtual core of a health care delivery system information infrastructure
Merely automating the form, content, and procedures of current patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs
(Institute of Medicine, Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997)
EHR
Electronic medical record (EMR) sometimes refers to: Physician office EHR Hospital document imaging system Non-interoperable record of health-related information
EHR is term used by: Federal government Institute of Medicine (IOM) Health Level Seven (HL7)
• Primary organization to develop interoperability in health care information systems; adopts the term EHR system
Certification Commission for Healthcare Information Technology
EHR vs. EMR
Purposes of EHR
Improve quality of care: data availability, links to knowledge sources
Enhance patient safety: context-sensitive reminders/alerts, clinical decision support, automated surveillance, disease management, drug/device recall
Support health maintenance: preventive care and wellness - patient reminders, summaries, tailored instructions, remote evaluation, home monitoring
Increase productivity: data capture and reporting formats tailored to user, streamlined workflow support, patient-specific care plans and protocols
Purposes of EHR
Reduce hassle factors: improve satisfaction for clinicians, consumers, and caregivers - managing schedules, registration, referrals, medication refills, work queues, automatically generating administrative data
Support revenue enhancement: accurate and timely eligibility and benefits, cost-efficacy analysis, clinical trial recruitment, rules-driven coding support, accountability reporting/outcomes measures, contract management
Support predictive modeling: contribute to development of evidence-based health care guidance
Maintain patient confidentiality: as health information is securely exchanged among all stakeholders, including across the continuum of care and with individuals
GOALS
HIT Implementation Improve direct clinical care processes for
safety and quality of care Achieve greater efficiency and improve
use if resources Communicate across the continuum of
care Accelerate diffusion of knowledge and
reduce variability in access to care
GOALS
HIT Implementation Strengthen privacy and data protection Promote public health and preparedness Engage individuals in their health
maintenance and wellness efforts
GOALS
HIT Implementation in nursing facilities Improvement in reducing pressure ulcers
and use of restraints, and improving pain management
Targeted improvement in quality of care for residents
Heightened satisfaction by residents and their families for care provided in your home
Increased staff retention and consistent assignment of staff
GOALS
HIT Implementation in nursing facilities Support for MDS/RAP documentation and
triggers for interdisciplinary care planning Integrated orders and e-prescribing, full
electronic charting, and remote access to improve communications with providers
Automated services for privacy and security management
Enhanced coordination of care across the continuum
Tool Kit Organization: 3 Sections with 7 Stages
HIT TOOLKIT
PLANNING IS THE MOST IMPORTANT COMPONENT
FOR SUCCESSFUL IMPLEMENTATION OF THE
ELECTRONIC HEALTH RECORD
Plan Before Acting
Follow the HIT Toolkit for Nursing Homes guidance to: Assess readiness Plan
• People: engagement and communication• Policies and goal setting• Processes for efficiency and effectiveness
Perform thorough selection process• Understand total cost of ownership – you get what you pay for• Do not move forward without a clear roadmap
Implement well and monitor for effective use• Correct course where necessary• Celebrate successes all along the way
Consider health information exchange across the continuum of care with residents and their families as a key part of the roadmap
HIT TOOLKIT
PEOPLE, POLICY AND PROCESS ARE OFTEN
DESCRIBED AS CONTRIBUTING 80% TO THE
SUCCESS OF HIT IMPLEMENTATION
Instructions for Use:Your Dashboard
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Types of Tools Recorded WebExes
Short (15-20 minute) educational tools Walk through use of key tools Introduce key topics for your HIT team, EHR
steering committee, staff Stimulate team discussion
Survey forms, checklists, comparisons, charts, tip sheets, interview tools, rating forms, other tools
Sample job descriptions, policies and procedures, request for proposal, other model documents
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Tool Structure
Purpose Each tool begins with a brief statement of purpose
Instructions for Use Many tools include specific instructions for use Some tools are more informative than interactive and
may not need instructions for use Notes and illustrations
Some tools include notes to define terms, diagram a concept, or provide references
Tool Microsoft Word, PowerPoint, or Excel Hyperlinked Modifiable
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Purpose and Instruction
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Hyperlinks and Resources
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Examples and Illustrations
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Additional Example (eRx)
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
Tools in Excel
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EHR RoadmapDoctor’s Office Quality – Information Technology
This material is provided by Stratis Health, the Minnesota Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 8SOW-MN-1d1-05-20
Maintain
CDSS Maintenance
Patches
Upgrades
Hardware Upgrade & Maintenance
User Preferences
Improve
Disease Registries
Quality Outcomes
Patient Safety
Public Health
Surveillance
External Reporting
National Repository
Pay for Performance
Benefits Realization
Return on Investment
Provider & Patient Satisfaction
Continuity of CarePersonal Health Record
Select
Vendor of Choice
Due Diligence
Marketplace
Contracting
Financing
Approval to Buy
Code of Conduct
Request for Proposal
Plan
Migration Path
Timeline/Goals
Applications
Technology
Operations
Chart Conversion document
Organizing Your Efforts Document
Project Management
Change Management
Process Mapping document
Change Strategies
Requirements Specs
Business Case
Standards Reqmts
Technical Reqmts
Functional Reqmts
Benefits Expectations
LHIO, RHIO, NHIN
Assess
Landscape
Communication Plan
Readiness
Attitudes and Skills
Financial
I.T. System Inventory
I.T. Staffing
What is an EHR WebEx
Why EHR
Market Forces
MN EHR Activity
Overcoming Barriers
Myths & Realities
Tales from the Field
What is EHR
Implement
Issues Management
Guidelines
Process Improvement
Functional
Core Data Sets
Vocabulary
Turnover Strategy
Implementation Plan
Install
Hardware
Network
Software
Interfaces
Training
Support
Acceptance Test
Phase I – Go Live
Subsequent Phases
Data Conversion
Test Planning
Security
Access ControlsAudit Controls
Contingency Plan
Stress Test
Training Plan
Storage
Integration Test
Change Control
System Build
Tables/FilesTemplates/Reports
Data Modeling
System Testing
Unit Testing
What is an EHR PPT Pres
Documentation
Job Descriptions
Steering Committee
Organizing Your Efforts PPT Pres
Organizing Your Efforts WebEx
Process Mapping PPT Pres
Process Mapping WebEx
Chart Conversion PPT Pres
Chart Conversion WebEx
TOOLKIT ADOPT SECTION: ASSESS, PLAN & SELECT
Parts of the Toolkit: Adopt Tools to help you assess, plan for, and select HIT
and EHR Readiness assessments, project management aids goal setting tools instructions on current workflow and process
mapping support for understanding the HIT
marketplace, issuing a request for proposal, and conducting due diligence for selection and contract negotiation
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Parts of the Toolkit: Adopt
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Contents of Adopt - Assess section
•How to use the toolkit – webinar, power point and document
•HIT governance
•HIT vision and strategic planning – webinar, power point and document
•Communication plan
•HIT attitudes assessment
Parts of the Toolkit: Adopt
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Contents of Adopt - Assess section
•Computer skills survey
• Total Cost of Ownership (TCO)/Return On Investment (ROI)
•IT staffing inventory
•IT system inventory
•HIT security risk analysis and controls assessment
Parts of the Toolkit: Adopt
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Contents of Adopt - Assess section
•Contingency plan assessment
•Application interface inventory
•Financing resources
Parts of the Toolkit: Adopt
Content of Adopt – Plan Section HIT steering committee Meetings, agendas, minutes Clinical IT leadership Project management Project manager job description Goal setting Change management Workflow & process mapping – webinar,
power point and document Chart conversion planning
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Parts of the Toolkit: Adopt
Content of Adopt – Select HIT code of conduct Vendor selection – webinar, power point and
document Requirements analysis Request for proposals Request for proposal analysis Key differentiators
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Parts of the Toolkit: Adopt
Content of Adopt – Select Due diligence: demonstration plan Due diligence: site plan Due diligence: reference check plan Vendor choice Contract checklist
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TOOLKIT: UTILIZE SECTION – IMPLEMENT & EFFECTIVE USE
Parts of the Toolkit: Utilize
Tools for implementing and effectively using HIT and EHR
Guides project performance and issues management
Supports workflow and process improvement Assists system build, testing, and training Offers strategies for gaining value and
effectively using HIT and EHR components in documentation and clinical decision support
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Parts of the Toolkit: Utilize
Content of Utilize – Implement Project planning – document and excel Workflow and process improvement Policy and procedure checklist Forms and reports analysis Input device planning System build Change control
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Parts of the Toolkit: Utilize
Content of Utilize – Implement Clinical decision support Training plan Testing plan Roll out strategies Space planning Go live planning HIT technical security controls - excel
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Parts of the Toolkit: Utilize
Content of Utilize – Implement Implementation strategies for assessments Implementation strategies for Electronic
Document Management System (EDMS) and hybrid record risk management
Implementation strategies for physician documentation
Implementation strategies for Electronic Medication Administration Record (EMAR)
Ongoing system maintenance
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Parts of the Toolkit: Utilize
Content of Utilize – Effective Use Quality measurement reporting
improvement HIT adoption milestone results Monitoring SMART goal achievement Benefits realization HIT user satisfaction HIT resident satisfaction TCO/ROI assessment - excel
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TOOLKIT: EXCHANGE SECTION – READINESS & INTEROPERATE
Parts of the Toolkit: Exchange
Tools to assess your readiness for interoperating with other organizations supporting health care
Describes health information exchange goals and governance, architectures, data stewardship, technical interoperability issues, and personal health records
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Parts of the Toolkit: Exchange
Contents of Exchange – Readiness HIE readiness HIE goals and governance HIE technology
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Parts of the Toolkit: Exchange
Contents of Exchange – Interoperate HIE data stewardship HIE interoperability Policy and procedure for personal health
records
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Thank You and Questions
Contact:Mary Ann Leonard
Michelle Dougherty
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