Health Information Technology in Home Care and Hospice

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Health Information Technology

in Home Care and Hospice

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Outline

• Why adopting Health Information

Technology important

• The benefits of HIT in Home Care and

Hospice

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Why is HIT Important:

Adoption

• Hospitals:

1

– Having a basic EHR System

• 9.4% in 2008 – 44.4% in 2012

• Professionals

2

– Using any type of EHR:

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1.1% 3.1% 13.3% 24.2% 15.7% 37.7% 7.2% 3.2% 4.0% 6.1% 12.3% 46.3% 13.7% 6.6% 2011 Q2 2014 Q1

Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS

Closed loop medication administration

CPOE, Clinical Decision Support (clinical protocols)

Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside radiology

CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging, HIE capable

Ancillaries – Lab, Rad, Pharmacy – All Installed

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Change in Hospital EHR Adoption

from 2011 to 2014: US and Canada

-15 -10 -5 0 5 10 15 20 25

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7

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Why is HIT Important:

Care Coordination

• Requirements for hospitals and clinics:

– Summary of care and referral documents sent

electronically

– Electronic messaging

– Electronic Notes

– On-line access to patient information

– Electronic Access to lab results

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Elements of the Transfer of Care /

Referral Summary Document

• Patient name

• Demographic information • Referring or transitioning

provider's name and office contact information (EP only).

• Encounter diagnosis. • Reason for Referral (EP)

• Discharge instructions (Hospital Only).

• Problem List • Immunizations. • Medication list

• Vital signs

• Laboratory test results. • Procedures.

• Functional status, including

activities of daily living, cognitive and disability status.

• Care plan field, including goals and instructions.

• Care team including the primary care provider of record and any additional care team members beyond the referring or

transitioning provider and the

1

1

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Types of Data Exchange

• Direct

– Push

– One to one

– A mechanism to

securely transmit

encrypted patient

information to an

authenticated provider

via the internet.

– An Electronic FAX

• Query-based

– Push – Pull

– One to many

– Allows providers the

ability to query and

retrieve patient

information via a

secure connection with

other providers.

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Why is HIT Important:

Clinical Decision Support (CDS)

• A variety of approaches for delivering

clinical knowledge, and intelligently filtered

information, to clinicians and patients for

the purpose of improving healthcare

processes and outcomes*

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Types of CDS

• Alerts and reminders

• Drug-drug and Drug-allergy interactions

• Documentation forms or templates

• Situation-specific flow sheets

• Relevant data presentation

• Referential information

• Interactive sequential advice

• Order sets

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Why is HIT Important:

Quality Improvement

Minnesota

• …where all the

women are strong, all

the men are

good-looking, and all the

children are above

average

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To prove it, one needs data

• “If you can not

measure it, you can

not improve it.”

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Why is HIT Important:

Health Care Reform

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Total Accountable Care

Organizations

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Estimated ACO Covered Lives by

Hospital Referral Region

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What it can do for you

• Notification of patient admission and

discharge

• Rapid order request and transmittal

• Telemedicine and remote monitoring

• Ability to measure and document

performance

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Functionalities used by those

with only mobile devices

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Functionalities used by those

with only EHRs

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Functionalities used by those

with both EHRs & mobile devices

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The Stratis Health Toolkit

• Focuses on HIT functionality, people, policy, and

processes for success in the home health agency

environment

• Provide tools for each stage:

– Assessing your needs

– Planning a successful project

– Selecting an HIT product

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Emphasis is on Adopt Tools

33 (50% of all tools just to get

started!) 23 tools

10 tools

Number of Tools in Each Section

Adopt tools

Use tools

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Minimizing the Challenges depends on

Preparation

Choices, planning, and execution determine

extent of slide

Leadership and management determine how long

you’re in the valley of despair Implement EHR Possible Future

Pr

odu

ctiv

it

y

Little or No HIT

Good choices and management determine level of productivity and

satisfaction

Implemented and Supported

Slide derived from Dr. Norman Okamoro,

University of Hawaii Valley of

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One Caution

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Favorite Adopt Tools

Communication Plan

• Most important

single change

management

technique

• Gives examples of

type of

communication

• Provides a matrix

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Half Done!

Onward  Implement and Use!

• Vision  strong enough

• Leadership  in place

• Plans  set and communicated

• Management  demonstrated

• Choices  well made

• Execution  possible

Conditions set to move quickly

through the Valley of Despair

33 (50% of all tools just to get started!) 23 tools

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Favorite Use Tools

• Issues List

– Acknowledge that

there will be issues

– Provides a

consistent method to

track issues

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Favorite Use Tools

• Training Plan

– Helps with the

go-live planning

– Assures

everyone is

trained

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Favorite Use Tools

• Ongoing HIE Partner

Communications

– Focuses on one of

the key benefits of

HIT

– Helps identify and

resolve issues

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85% Done! Optimize

• System  working

• Staff  trained

• Clients  informed and

comfortable

• Exchange  enabled

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Optimize Tools

• By definition, for more experienced

organizations

• Optimization strategies, including:

– Telehealth

– Quality improvement

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Getting to e-Health –

Three Takeaways

• It’s about change – the biggest hurdle will

be changing the way people work

• Don’t look at puppies until you know what

kind of dog you want

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Overview - Document Table

The Overview Table gives a list of the documents (tools), available for viewing, in the Section.

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Understanding Experience Level

Use the Experience Level symbols to decide if a document is appropriate for your type of organization:

Skiers will recognize these symbols.

Everyone should consider all tools with a green circle.

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Accessing the Tools

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Using a Tool

All documents have these attributes:

1) Title

2) Overview: high level

explanation of the tool

3) Time needed: how long

you should expect to work with the tool

4) Suggested other tools:

associated or pre-requisite tools

5) How to Use: Tips on how

to use the tool

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Using More Tools

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In the Assess Section, Note the “View/Hide the

Overview tools” link. Click the link to gain

access to the documents in this section.

Follow the steps we’ve described to get the tools you want.

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It’s Easy

• Begin exploring and select one of the tools to start

• Experience level symbols help you find the tool

that matches your organization’s resources

• Time Requirements indicate level of effort

• Associated Tools help you find pre-requisites or

similar tools

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In Conclusion

• Change is

coming, do not

get left behind

• Begin the process

now

• Use the Stratis

Health Toolkit to

start your

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Stratis Health is a nonprofit organization that leads

collaboration and innovation in health care quality and safety,

and serves as a trusted expert in facilitating improvement for

Paul Kleeberg, MD, FAAFP, FHIMSS

Email:

pkleeberg@stratishealth.org

Ph: 952-853-8552

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