Health Information Technology
in Home Care and Hospice
Outline
• Why adopting Health Information
Technology important
• The benefits of HIT in Home Care and
Hospice
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:
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
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
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
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
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.
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*
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
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
To prove it, one needs data
• “If you can not
measure it, you can
not improve it.”
Why is HIT Important:
Health Care Reform
Total Accountable Care
Organizations
Estimated ACO Covered Lives by
Hospital Referral Region
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
Functionalities used by those
with only mobile devices
Functionalities used by those
with only EHRs
Functionalities used by those
with both EHRs & mobile devices
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
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
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 HITGood choices and management determine level of productivity and
satisfaction
Implemented and Supported
Slide derived from Dr. Norman Okamoro,
University of Hawaii Valley of
One Caution
Favorite Adopt Tools
Communication Plan
• Most important
single change
management
technique
• Gives examples of
type of
communication
• Provides a matrix
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
Favorite Use Tools
• Issues List
– Acknowledge that
there will be issues
– Provides a
consistent method to
track issues
Favorite Use Tools
• Training Plan
– Helps with the
go-live planning
– Assures
everyone is
trained
Favorite Use Tools
• Ongoing HIE Partner
Communications
– Focuses on one of
the key benefits of
HIT
– Helps identify and
resolve issues
85% Done! Optimize
• System working
• Staff trained
• Clients informed and
comfortable
• Exchange enabled
Optimize Tools
• By definition, for more experienced
organizations
• Optimization strategies, including:
– Telehealth
– Quality improvement
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
Overview - Document Table
The Overview Table gives a list of the documents (tools), available for viewing, in the Section.
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.Accessing the Tools
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
Using More Tools
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.
