The Future of Technology in Long
Term Care
Lisa Mitchelson, TEF
Ralmetha Brooks, Bronx Center
Louis Gonzalez, Bronx Center
Stephanie Telfer, Bronx Center
Traci Jersen, 6N Systems, Inc.
David Finkelstein, VCNY
In today’s workshop….
•
Introduction
•
Overview of Electronic Medical Records
1. Bronx Center Presenters
2. Village Care Presenters
•
Labor Management Collaboration
•
Questions and Answer
Bronx Center
Why an
EMR?
Introduction to EMR
• Staff reaction to EMR
• Adjustments
• Celebration
• Survey (Preparation and Results)
• Where we are now
.
Innovation: Impact of EMR
• Creation of new
union position
• Assist all departments
with software and
equipment
• Orientate C.N.A.’s in
using EMR/PDA as
needed
• Monitor C.N.A.
documentation
C.N.A./Tech Support
6:00am-11:00am
9:00pm-11:00pm
C.N.A
11:00pm-7:00am
C.N.A
7:00am-3:00pm
C.N.A
3:00pm-11:00pm
Maintenance and Accountability of
Equipment
Labor And Management Working
Together
Bronx Center Tag Team
C.N.A. Backup Support
•
Provide on site support to the C.N.A.’s
•
Peer Mentor to staff with EMR tasks and
updates to system
•
Report system problems
•
Communication with the
DNS/Administrator/Tech support
•
Monitor C.N.A. documentation and give
Getting Started….
UNDERSTANDING THE EMR
Presented by David Finkelstein & Traci Jersen
The Business Case for EMR? “Fog is Fatal”
Currently, there exists a “fog of information” – preventing information from flowing to the point of need efficiently, leading to poor outcomes and inefficient care.
HIT can support greater transparency of actions and outcomes that enable alignment of financial incentives
and reimbursements with quality outcomes.
Lifting the fog can lead to…. • Quality Improvement • Financial Improvement • Employee Satisfaction
Source: Report to the National Commission for Quality Long Term Care - Essential but Not Sufficient: Information Technology in Long Term Care as an Enabler of Consumer Independence and Quality Improvement. Bearing Point, Inc. September 24, 2007
Quality Improvement
• To truly gain return on investment and fully benefit from an EMR, an organization must adopt the workflow and decision support technology embedded in the EMR.
Improve completeness of documentation, accuracy of documentation, legibility, use evidence based tools
Compiles and analyzes documentation Intelligently disseminate information, tasks and control process C.N.A Documentation of
Nutritional Status
System identifies risk for skin breakdown based upon nutritional status
Dietary is notified. High protein diet/supplement added to prevent skin breakdown
Pressure Ulcer prevention
Financial Improvement
• Improvement in RUGS Scores
• Reduced Medical Errors/Falls
• Savings in Increased Staff Efficiencies
• Prevention Measures/Reduced
Hospitalizations
Standard Workflow : Communication Gaps
Standard Workflow : Communication Gaps
All documentation
scattered, paper‐based
Clinicians wait to access
paper charts Statisticsare done andmanually reports
•Less time for patient care
•Loss of critical statistical and quality data
•Time spent on administrative paperwork
•No process improvement
Information not
communicated
effectively
P
roject Management
• Assemble a project team
• Project team must define the value outcomes
The key to a successful EMR implementation is having a clear definition of what you want the EMR to accomplish and making decisions throughout the process that support that goal.
Define Value Outcomes and then…..
Workflow Analysis and Redesign
Hardware Selection and Installation/Facility Modification
Software Configuration
Dealing with Paper/Merging the Old and the New
Training
Feedback mechanisms/Weekly Reporting
Roll-Out
Communication of the Benefits of the EMR
Different departments want different things
Meet with all stakeholders early, and continue the discussions. Use a facilitator in order to help prioritize what is the best decision for all involved.
Basic Computer Training
Some staff may be uncomfortable moving from paper to a computer
Review systems to make sure they will be user-friendly, with good customer and online support. Offer additional basic computer training.
Broaden the Scope of the Project Beyond Technology
The intent is NOT to recreate your existing paper process electronically
Thoroughly document and understand your current processes
Find your bottlenecks and look for areas of improvement
Challenge your traditional processes
Functionality
• Link functionality with project goals
• Beware of “The Big Bang” Theory
• Focus on how technology accomplish what
the process requires?
• Does the functionality allow for process
improvement and modification?
Example
Reduce hospitalizations through identifying and preventing short
Reduce hospitalizations through identifying and preventing short termterm illnessesillnesses inin
residents residents Identify Value Identify Value Outcome Outcome Reduce Short Reduce Short Term Illnesses Term Illnesses Develop Process Develop Process Define Process Define Process for identifying for identifying
risk factors for
risk factors for short term short term illness illness Illness Illness Detection Tool Detection Tool
Fall Risk Tools
Fall Risk Tools Other Other Prevention Prevention Features Features
Can the technology
Can the technology
accomplish what the process
accomplish what the process
requires?
ROI Indicators / Categories
• Resident / Client Information Management
• Clinical Protocol Management
• E-prescribing and eMAR / Medication
Reconciliation
• Medical Records Management
• Staff Satisfaction
• Increased Reimbursement
Realizing Value – Success
Metrics
• Understanding an organization’s culture
– What is our current IT expense and success rate?
• Aligning expectations
– What are the top 3 things we can realistically expect from this investment?
• Developing management strategies
– Benchmarking, feedback loops, metrics development
• Implementing ROI Reporting
– Reduce burden of manual reporting and enable rapid-cycle quality improvement
• Continual improvement
Worker Satisfaction and
Retention
• Including staff in the change process will
promote buy-in, trust, and create a team
approach to care practices.
• The labor management committee will be a
forum for all disciplines to share ideas and
will assist in the transition phase.
Labor-Management
Relationships
•
Establishing a labor management committee to
engage the staff in the change process. (Plan a kick
off party to introduce the new technology, schedule
staff orientations on all shifts to provide information
and allow the staff to ask questions, schedule
product demonstrations to allow the staff to interact
with the equipment prior to the training
implementation).
•
Information sharing: the committee members can
create slogans, promotional materials to post
throughout the home to generate excitement about
the new technology. The committee can be a
method for communicating to the staff and to
receive feedback from the staff.
Challenges and Concerns
• Fear of new technology (Address the concerns of staff
members that are not comfortable with the computer). Plan to have additional classes to allow staff to practice on new
system until they have a comfort level.
• Literacy (The new system should be user friendly: picture
icons, layman terms, system should mirror the documents staff are familiar with).
• Language (The new system should be user friendly: picture
icons, terms that are easy to read, system should mirror the documents staff are familiar with).
• Alerts on system that are color-coded should be consistent
(Resident alerts, to prompt the staff for action to be taken for a resident (example): Turning and positioning to reordering
Challenges and Concerns
• Allow a time period from dual systems (paper and system) to the
“go live” phase.
• Inform the staff at all levels, of any changes made to the new
technology, provide an in service once changes have occurred.
• Policies and procedures should be reviewed prior to installation
to assure they are in alignment with the new technology.
• Be open-minded when staff address concerns about the system.
• The staff should be made aware that the new technology is not
a monitoring system of the staff but an efficient way to document and access information.
Next Steps…
• What’s your take?
