Successful Implementation of Electronic
Health Records In Your Community:
From Vendor Selection, Training of Staff
To Full Streamlined Execution
By Nikkei Concerns
Randi Saeter – Seattle Keiro Administrator
Jessica Giron – Seattle Keiro Director of Nursing Services Lisa Waisath – Nikkei Manor Assisted Living Manager
Nikkei Concerns (NC) is a health & wellness nonprofit organization, celebrating its 40th anniversary in 2015, who provides key services for Asian seniors in the Pacific Northwest.
Seattle Keiro Rehab/Skilled Nursing ‐1976
Kokoro Kai Senior Social Day Care ‐1978
Nikkei Horizons Continuing Ed. ‐1990
Nikkei Manor Assisted Living ‐1998
NC Transportation ‐2014
NC Club HCBS ‐2015
NC Catering & Meal Delivery ‐2015 We are committed to making every day the best day for our residents and
participants and strive to enhance their health/wellness, quality of life
and independence through our founding values of:
Respect, Trust, Kimochi (compassion), Quality of Life, and Family
NC has expertise in serving & “brand” awareness of the Asian population including:
►Japanese
►Chinese
►Korean
►Vietnamese
WHO WE ARE
• Randi Saeter, RD MBA
– Seattle Keiro Administrator • Jessica Giron, RN
– Seattle Keiro Director of Nursing Services • Lisa Waisath, BA
– Nikkei Manor Assisted Living Manager
Other members on the team:
Ibtissam Davis – Support Services Director Mark Smith – IT Consultant
Tina Masuda Draughon – CFO Financials
Analyn Mingaracal – Health Information Manager
Objectives
• You will gain a greater understanding of how to successfully
implement an E.H.R. system in your skilled nursing facility (SNF) or assisted living facility (ALF)
• You will gain a greater understanding of what is required in terms of IT infrastructure, software selection, training of staff, and implementation of the system
Electronic Health Records – A necessity?!
• What are your organization’s IT needs now vs the future? • Over 15,600 skilled nursing facilities in the U.S. – 228 in
Washington State in 2012
• Over 36,000 assisted living facilities in the U.S. – 483 in Washington State in 2014
Project Timeline (input visual timeline)
• Started Research February 2013
• Launched training for Nursing and Activities staff – October 2014 • Entered Physician’s Orders into the new system & old system –
October 2014
• Launched MDS – last week of November 2014 • Launched Financials – December 1, 2014
• Started building Care Plans for Restorative/Nursing and Activities before going “live” on POC
• Launched Clinical Modules for Seattle Keiro SNF – January 2015 • Launched Clinical Module for Nikkei Manor AL TBD
Research
• LeadingAge CAST (http://www.leadingage.org/ehr/search.aspx)
– SNF and AL mainly
• Indepth analysis of service offerings
– NTT Data
– Answers on Demand – Pioneer ACMS – American Data – American Health Tech – Lintech Comet
– Answers Certified E.H.R – PointClick Care
Research
• Webdemos
– Ease of navigation – Userfriendliness
– Interface Capabilities – Pharmacy, Hospital, Xray, Lab, etc. – Interact
• Site visits
– See it in action
• Cost analysis
Project Budget
• IT Infrastructure
– Hardware selection
• Software Requirement
– Clinical and administrative modules
• Training & Implementation
– Professional data migration & input assistance – Professional training assistance
– Preparation of staff – Timelines
IT Infrastructure
• Needs assessment of each building
– Access Points for WiFi – how many and where?
• Kiosks (detailed specifications/variety of options to accommodate staff and ease of use) • Med Carts • Desk Tops • Cell phones • Tablets • Laptops
– Secured & Adequate Bandwidth WiFi • Added a 2ndprivate wireless network
• Capacity
IT Infrastructure
– Backup Generator– Backup Network
• Cloud Based vs. Hosted Server
• Second computer (e.g. in medical records) that backs up data every 15 minutes in case of an emergency
• Back up printer
Wall
mounted
Portable WOW
Station
• For assessments
IT Infrastructure
• Who owns the data • HIPAA Concerns
Copy machine and
scanner for
documents –
“Misc”
• H&P
Software Requirements
• Upgraded to Windows 8
• Clinical and Administrative Modules
– What are your needs?
– Configuration: What are you currently using on paper? Gather all forms you would like to continue using – what is working and what is not?
– Phasing in modules vs “everything all at once” – Physicians orders, Emar/Etar, PointofCare
– What do you need first? – What can come later? • ThinkANew
– Imported 18 months MDS – Imported Financials
Training and Implementation
• What piece of the E.H.R. do you launch first/last? • Our experience
– Clinical: Physicians’ orders, MDS, Care plans imported and built first
– All P.O.s in by 11/1/2014, MDS started one week prior to 12/1/2014
– Business office: Go Live 12/1
– MDS must be fed in to be able to bill
Work with each discipline on assessment forms (UDAs – User Defined Assessments)
– Build your own or purchase forms from your vendor
– Build your PointofCare as soon as possible: What do you want your nursing assistants and activities staff to document on?
Training
• Webbased or inperson?
We had concerns about the ability of our staff based on our staff’s needs assessment
1. Have you used EHR before? Which company? 2. Are you intimated by computers?
3. Do you consider yourself a beginner, moderate, or expert user?
IMPORTANT TO PAY FOR THE TRAINING
• Pay for the highest level that your organization can afford • Targeted Superusers
Training
• Configuration
– Superusers need to truly know how to configure the system, e.g., create a care plan library and how care plans will link to the pointofcare
• Superusers: Identify staff who are enthusiastic about learning and teaching other staff (navigation, troubleshooting, configuration)
• Training by department
– Classroom computer lab (10 desktops) – Example of training schedule
– We only had staff come in for training on sections they needed to be trained on – Finance training was separate
Implementation
• Go Live was 01/20/2015 for the nursing department
– All clinical modules except eMar/eTar – Assessments were gradually phased in
– Policies & procedures in place for approving/signing physician’s orders
– Still using paper T.O.s (only change is entering order into the system)
– A nurse or medical records will enter an order, but a nurse is required to approve the order before it is finalized
– Standing orders need to be updated and included in the standing orders library specific to your facility
– Recaps: Crucial that physician’s orders are uptodate
– Superusers present and always available to assist during Go Live
– Most common issue was having to reset passwords
Implementation
• User roles
– Determine who will needs access to what (e.g., surveyors do not need to have access to your whole system – determine what areas in “read only”) – Very time consuming process
– Request your training company to assist or other facilities to share types of roles
– Consultants /Physicians/ARNPs – Should you allow external access?
– Able to access system using the private/secure network with own work/secure computer (internal use only)
Implementation
• eMar/eTar
– Go Live at Seattle Keiro SNF 06/16/2015
– Preparation: Superusers / Managers watched web demo – Training of staff: 2 hours of classroom time for each LN – Sandbox training available 24/7
• Rehab Optima
– Therapy module: Go Live TBD
• Lab and XRay Company
– TBD
Medication Cart
Laptops
On
going training
• All new staff receive training by DNS / Superuser
• Current staff may get refreshers at scheduled training times with manager’s permission
Evaluation
• Managers are encouraged to regularly check % POC tasks completed (by shift)
– Are staff charting “as they go” or at the end of shift?
– Parameters for alerts: Implement and evaluate according to your own protocols (e.g. BM, weight change, PO intake)
– Custom alerts in addition to your Stop And Watch alert
• Solicit feedback from staff and monitor compliance
– Any concerns/suggestions for improvement
– E.g., we changed the meal monitor documentation based on staff feedback – E.g., catheter use: had to build a custom task for monitoring output of catheter
Recommendations
• Plan for more time • Plan your resources • One last look
• Know what you need and want for the future
• Completely understand how much you will be charged upfront and monthly
Summary
• A larger project than first anticipated
• Worth having a project management team with extensive involvement from Super users
• A larger budget than first anticipated
• Research may take longer than expected, but worth it in the end • Having staff “buyin” proved to be instrumental in a successful
implementation
• Pay for the most training your organization can afford & keep the training site active
Questions?
Randi Saeter – Seattle Keiro Administrator
Jessica Giron – Seattle Keiro Director of Nursing Services
Lisa Waisath – Nikkei Manor Assisted Living Manager
