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Healthcare Information Systems Management—Testing and EvaluationSession LT4, March 5, 2018
Gregory L Alexander PhD, RN, FAAN, Professor, University of Missouri, Sinclair School of Nursing
Sue Shumate BS, RN, Health Information Coordinator, University of Missouri/Primaris
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Gregory L Alexander Phd, RN, FAAN
Sue Shumate BS, RN
Contracted Research: Center for Medicare and Medicaid Services, Innovations Center
Missouri Quality Initiative for Nursing Homes, Grant #1E1CMS331489
Conflict of Interest
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Agenda
• MOQI Model
• Systems Analysis Process
• Developing Use Cases to Guide Implementation
• Iterative Pilot Testing of Technology with Partners
• Policy and Standards
• Expected Benefits
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Learning Objectives
• Define key differences between LTPAC and traditional healthcare provider organizations in the testing and evaluation of IT systems
• Summarize at least one insight an LTPAC provider gained from using analytics to guide their system testing and evaluation effort
• Identify CAHIMS testing and evaluation competencies LTPAC provider organizations should most closely watch
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MOQI Primary Project Goals
• Reduce avoidable hospitalizations via four aspects of APRN Care Coordination
1. Condition management
2. Early illness detection
3. INTERACT
4. End-of-life/Advanced care planning
• AND integrate health information technology into patient care processes
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2018 MOQI Project Goals
Reduce infections and hospitalizations related to infections through
educational opportunities provided to nursing homes
Increase and sustain use of INTERACT tools at fully
engaged level
Increase and enhance meaningful care conversations about serious
illness and advanced care planning
Refine Quality Improvement processes for guidelines
of Phase 2 billable conditions and feedback reports
for billing
Increase use of bi-directional portals in all nursing homes Develop, test, and implement APRN feedback reports
for preventable hospitalizations
100% of nursing facilities’ adoption of secure communication tools
for texting and e-mailing
Achieve and sustain the Phase 1 hospitalization rate
below 1.10
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HIT Intervention• Promote the use of healthcare information technology (HIT) to
improve the care of patients and communication among team members
• Pursue integration and interoperability of all aspects of technology solutions
• Train team members and nursing home staff regarding use of technology and workflow
• Lead evaluation of software/components to be used in technological solutions
• Systematic Feedback Reports to Users
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IT Staffing Champions and Super Users Chief Operations Officer Executive Assistant
Chief Nursing Officer Managers (Regional or Local)
Chief Clinical Officer Business Office Manager
Senior Vice President Benefits Coordinator
Executive Director/Director (Regional or Local) Central Supply
Clinical Information Systems/Technology Customer Service Representative
Nursing Transitional Care
Education Information Technology Technicians
Environmental Services Network Administrators
Social Services Scheduling Coordinator
Health Information Management Systems Analyst
Campus Director Clinical Services
Community Relations Minimum Data Set Coordinator
Quality Management Regional Consultant
Medical Records
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Stakeholder PartnershipsHIE Mobile Services
Training Hospice
Project management Wound
Provide feedback reports Radiology
HIE Vendors Laboratory
Manage Platforms Pharmacy
Develop feedback Reports EMT and Paramedics
Healthcare Facilities Medical Directors Office
Nursing Homes SNF Technology consultants
Administrators Professional Organizations and Societies
Nursing staff Alzheimer’s Association
Social Workers Quality Improvement Org.
Patients Research Team
Caregivers Policy Advocates and Evaluation
EMR vendors CMS
Hospitals RTI
Administrators ONC
Nursing staff
Patients
Caregivers
EMR vendors
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Polling Question• What is your primary organization and responsibility?
A. Administrator
B. Medical Provider/Staff
C. Technology Consultant/Vendor
D. Policy Advocate
https://live.eventbase.com/polls?event=himss2018&polls=4311
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Project OutcomesAchieve and sustain the hospitalization rate below 1.10
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Key Results with RTI- Comparison Group• 40% reduction in all-cause hospitalizations and
• 57.7% potentially avoidable hospitalizations reduced (p=.001);
• 54.1% all cause ED visits reduction and
• 65.3% potentially avoidable ED visits reduced (p=.001).
• 33.6% Medicare expenditures in all-cause reduced and
• 45.2% in potentially avoidable hospitalizations (p= .001);
• 50.2% Medicare expenditures in all-cause ED visits reduced and
• 59.7% potentially avoidable ED visits reduced(p=.001).
Ingber, MJ, Feng, Z, Khatutsky, G, et al. Evaluation of the initiative to reduce avoidable hospitalizations among nursing facility residents: Annual report project year 4, February, 2017. Available at: https://innovation.cms.gov/Files/reports/irahnfr-finalyrfourevalrpt.pdf. Accessed April 14, 2017. Centers for Medicare and Medicaid Services. Medicare Hospital Quality.
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HIE Milestones and Outcomes• 13 out of 16 NFs completed EHR implementation
– All 16 homes expected to be live by end of June 2018
• 502 secure texting discussions involving MOQI APRN
– All MOQI APRNs and 1/3 of NFs have secure texting
• 2,380 Direct Messages exchanged 4th quarter 2017
• 100% HIE Participation in nursing home facilities
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Systems Analysis Process• Survey of NFs regarding technology infrastructure to develop NF
capabilities list
• Evaluate technology for APRNs and NF capabilities
– Laptops, phones, tablets, printer/scanners
• Worked with NFs and their corporate IT to iteratively test connectivity and remedy deficiencies
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Expected Benefits– Connectivity to clinical support services
» Pharmacy
» Radiology
» Laboratory
» Hospice
» Wound Care
– User centered satisfaction surveys of technology
– Tracking usage of HIE statistics
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HIE Implementation Phase I
• IT Readiness Assessment:
• Electronic Interfaces: – Direct “CareMail” and Bidirectional Portal “CareView”
• System Administrator
• Help Desk and Training
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HIE Implementation Phase II: Use Case Development
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HIE Implementation Phase III: User Feedback
Semi Structured Interviews
Help Desk Reports
Usability Surveys
HIE Usage Reports
Training
Webinars
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HIE Implementation ProcessPhase III
• Non Emergent
– Scheduling appointments
– Laboratory Specimen Drawing
– Pharmacy Orders and Reconciliation
– Social Work Discharge Planning
– Admissions and Pre-Admissions
– Pharmacy Medication Reconciliation
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Non Emergent Use Case:Scheduling Appointments
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Non Emergent Use CaseLaboratory Specimen (Antibiotic Administration)
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Non Emergent Use Case: Admissions and Pre-Admissions (Part 1)
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Non Emergent Use Case: Admissions and Pre-Admissions (Part 2)
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Polling Question• What Use Case is Highest Priority for Healthcare Partners
A. Lab Specimen Drawing
B. Scheduling Appointments
C. Pharmacy Reconciliation
D. Admission and Pre-Admission
https://live.eventbase.com/polls?event=himss2018&polls=4312
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Keep in mind: There are two sides to every story
Hospital and LTPAC Partnerships in HIE
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Building Partnerships, Organizational Learning, and Collaboration
Hospitals Nursing Homes EHR Vendors HIE Organizations
• Design Specifications
– CCDs
• Versions
• Formatting
• Blocked Transmissions
• Opening Documents (user privileges)
• Incompatible Browsers
• Storage and Retrieval of Downloads
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Discharge Paperwork for Acute Transfer1. Face sheet (EMS needs)
2. Med rec
3. Rounding report
4. 3 days MD notes
5. Patient summary report
6. Advance directives/living will, if applicable
7. H&P (only for long distance transfers over 25 miles)
8. Patient transfer form (MD orders/nursing patient functional assessment)
9. Physician certification statement (for ambulance transfer only) (EMS needs)
10.Transfer and authorization form (for hospital-based NH or ED transfer to
another hospital)
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Goals of Transition of Care• Safe transitions to post acute care levels
• Improve communication between providers
• Partnering to improve and reduce care transitions
• Benefits of collaboration will include:
– Decreased hospital length of stay and readmissions
– Appropriate active case management
– Decreased use of the emergency department
– Appropriate utilization of resources and ancillary services
– Improved patient and family satisfaction
– Improve results of quality measures
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Challenges/Opportunities• Develop custom reports
– Pull relevant PHI
• Pulling data from multiple applications
• Sending report takes multiple steps
• Limited users for CareMail in hospital setting
• Roll out new process to other hospitals after pilot
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Potential Change(s) from Initiative Stakeholder (Groups) (n=49) Potential changes for Stakeholder Group(s) Impact (High, Medium, Low)
Greater Access to Information
Addressing Errors
More Timeliness
Improved Accuracy
Build Network/Partner Opportunities
Transfer of Information
Better Quality of Information
Increased Patient Satisfaction
Increased Family Satisfaction
Correct Patient Information
Seamless Patient Transitions
Reduced Stress and Harm to Client
Problem Solving
Legal and Fiscal Activities
Collaboration
Early Identification Condition Change
Greater Care Involvement
Identification of Care Improvements
Effectiveness of Care
Regulatory Compliance
Comprehensive Record Available
Keep Residents Healthy
Navigating Healthcare Processes
Increased Accountability
Healthcare Facilities
Nursing Homes
Administrators
Nursing staff
Social Workers
Patients
Caregivers
EMR vendors
Hospitals
Administrators
Nursing staff
Patients
Caregivers
EMR vendors
DON: Deep dive each admission
DON: True picture of admission
DON: Communicate f indings w ith nurses and providers
DON: Inputs orders ahead of time
DON: Review s order for correctness
Administrator: Fact f inding (e.g. diagnosis, equipment)
IT/Vendor Specialists: Assure information transfer
Charge Nurse: Provide immediate care
Charge Nurse: Ensure patient info., orders, meds input accurately
Admissions Coord.: Gathers disperses information to correct areas
Physicians: Faster feedback, clarif ication, authorization
Social Services: Evaluation: Care planning and advance directives
Administrator: First contact (e.g. hospital and families)
Social w orker: communication w ith family and hospital
Physician: Involvement in challenging cases
Executive Director: Document accurate resident evaluations
APRN: Sounding board for clinical questions
Admissions Coordinator: Provide nursing w ith needed information
Care Consultants: Consultations w ith patients, families, physicians
APRN: Change agent
APRN: Holistic view
Nursing: Using SBAR to communicate f indings
Administrator: Access to referral data
IT: Getting information to facility
IT: Process to assure data quality
Charge Nurse: Coordinates care w ith admissions coordinator
Unit Nurse: Stability to the unit
Social Worker: Support, buffer, comfort w hen family drama occurs
Social Worker: Identif ies solutions to problems
QM/QI Nurse: Review resident risks, prevent illness
Nurse Manager: Technology lead in EMR implementation
Care Consultants: Maximizes use of encrypted IT/EHR
Nurse Manager: Double check Admit, proper coding and auditing
Home Health Aide: Identifying chore duties for client
Social Worker: Identify equipment needs
Social Worker: Notary w ork
Physician: Better understanding of hospice services
Restorative Aide: Consultation
Director of Education: Professionalism, appropriate care
Medical Advisor: Connections betw een physicians and staff
High
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High
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High
Medium
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Low
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Questions
• Gregory L Alexander PhD, RN
Professor, University of Missouri
MOQI HIT Lead
Sue Shumate BS, RN
Primaris Health
MOQI Health Information Coordinator