Health Information Technology in Home Care and Hospice

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1 Health Information Technology in Home Care and Hospice Paul Kleeberg, MD, FAAFP, FHIMSS CMIO Stratis Health VNAA Midwest Regional Meeting June 18, 2014

2 Outline Why adopting Health Information Technology important The benefits of HIT in Home Care and Hospice The Stratis Health Homecare HIT toolkit 2

3 Why is Health Information Technology Important? 3

4 The Need for HIT 4

5 Why is HIT Important: Adoption Hospitals: 1 Having a basic EHR System 9.4% in % in 2012 Professionals 2 Using any type of EHR: 18% in 2001 => 78% in ONC Data Brief #9, Mar 2013: 2. CDC NCHS Data Brief Number 143, Jan

6 2011 Q Q1 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 1.1% 3.1% +210% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 4.0% 13.3% +333% Closed loop medication administration 6.1% 24.2% +297% CPOE, Clinical Decision Support (clinical protocols) 12.3% 15.7% +27% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside radiology 46.3% 37.7% -19% CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging, HIE capable 13.7% 7.2% -47% Ancillaries Lab, Rad, Pharmacy All Installed 6.6% 3.2% -50% All Three Ancillaries Not Installed 10.0% 5.6% -44% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 5439 N =

7 Change in Hospital EHR Adoption from 2011 to 2014: US and Canada Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 CA US

8 Meaningful use is progressive

9 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 Electronic Data exchange with patients and other providers 9

10 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 Medication allergy list. Smoking status 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 receiving provider. 10

11 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. Web Search 11

12 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* Making the right thing to do the easiest thing to do * Paraphrased from: Osheroff, M. D., et al. Improving outcomes with clinical decision support: an implementer's guide. (2012). 12

13 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 Protocols and Pathways Automatic dose calculators 13

14 Why is HIT Important: Quality Improvement Minnesota where all the women are strong, all the men are goodlooking, and all the children are above average But how do we know 14

15 To prove it, one needs data If you can not measure it, you can not improve it. William Thomson (Lord Kelvin) Lecture on "Electrical Units of Measurement" (3 May 1883) paraphrased 15

16 Why is HIT Important: Health Care Reform Moving away from an episodic, fee for service payment approach and towards a coordinated model that is focused on delivering high-quality, low-cost care across the continuum of care. 16

17 Total Accountable Care Organizations Source: Leavitt Partners Center for Accountable Care Intelligence, Accessed March 12,

18 Estimated ACO Covered Lives by Hospital Referral Region Source: Leavitt Partners Center for Accountable Care Intelligence, Accessed March 12,

19 19

20 Benefits of HIT 20

21 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 Improved medication reconcilliation 21

22 Home Health and Hospice use of HIT, 2007 Resnick, Helaine E., and Majd Alwan. "Use of health information technology in home health and hospice agencies: United States, 2007." Journal of the American Medical Informatics Association 17.4 (2010):

23 Functionalities used by those with only mobile devices Home health and hospice care agencies with mobile technology, by functionality used Resnick, Helaine E., and Majd Alwan. "Use of health information technology in home health and hospice agencies: United States, 2007." Journal of the American Medical Informatics Association 17.4 (2010):

24 Functionalities used by those with only EHRs Home health and hospice care agencies with electronic health records, by functionality used Resnick, Helaine E., and Majd Alwan. "Use of health information technology in home health and hospice agencies: United States, 2007." Journal of the American Medical Informatics Association 17.4 (2010):

25 Functionalities used by those with both EHRs & mobile devices Home health and hospice care agencies with both electronic health records and mobile technology, by functionalities used Resnick, Helaine E., and Majd Alwan. "Use of health information technology in home health and hospice agencies: United States, 2007." Journal of the American Medical Informatics Association 17.4 (2010):

26 HIT is a must 26

27 The Stratis Health Toolkit 27

28 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 Implementing your product Maintaining your investment Optimizing your processes with the new technology 28

29 Methodology: 3 Sections 6 Steps Adopt Assess Plan Select Use Implement Maintain Optimize Optimize Toolkit has tools for each of these steps 29

30 Emphasis is on Adopt Tools Number of Tools in Each Section 10 tools 23 tools 33 (50% of all tools just to get started!) Adopt tools Use tools Optimize tools 30

31 Productivity Minimizing the Challenges depends on Preparation Implemented and Supported Little or No HIT Implement EHR Leadership and management determine how long you re in the valley of despair Good choices and management determine level of productivity and satisfaction Choices, planning, and execution determine extent of slide Valley of Despair Possible Future Slide derived from Dr. Norman Okamoro, University of Hawaii Time 31

32 One Caution Beware of Puppies! 32

33 Favorite Adopt Tools Communication Plan Most important single change management technique Gives examples of type of communication Provides a matrix that you can use 33

34 Favorite Adopt Tools Due Diligence Helps you analyze vendor responses Allows you to compare apples to apples Provides a matrix that you can use 34

35 Half Done! Onward Implement and Use! 10 tools 23 tools 33 (50% of all tools just to get started!) 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 35

36 Favorite Use Tools Issues List Acknowledge that there will be issues Provides a consistent method to track issues Give you a matrix so you can get started 36

37 Favorite Use Tools Training Plan Helps with the go-live planning Assures everyone is trained Provides a matrix for you to use for planning 37

38 Favorite Use Tools Ongoing HIE Partner Communications Focuses on one of the key benefits of HIT Helps identify and resolve issues Give you a matrix so you can get started 38

39 85% Done! Optimize 10 tools 23 tools 33 (50% of all tools just to get started!) System working Staff trained Clients informed and comfortable Exchange enabled You re part of the e-health world! 39

40 Optimize Tools By definition, for more experienced organizations Optimization strategies, including: Telehealth Quality improvement Clinical decision support 40

41 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 A strong implementation of an OK product is better than a poor implementation of a great product 41

42 Step by Step Instructions On Using the Toolkit 42

43 Getting Started 1) On the home page, read the intro text, or just get going. 43

44 Overview Scroll down to the Overview Section In the Overview Section, Click View to gain access to the documents in this section. 44

45 Overview - Document Table The Overview Table gives a list of the documents (tools), available for viewing, in the Section For each tool in the section, you ll find a description of its: Tool Name Use Purpose (Action Inform) 4 Experience Level or 45

46 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. Larger organizations and those with more IT experience may want to use tools with marked with the blue square or the black diamond. 46

47 Accessing the Tools To use a tool, click the link. 47

48 Using a Tool All documents have these attributes: 1 Title 1) 2) 2 Overview: high level explanation of the tool 3) 3 Time needed: how long you should expect to work with the tool 4) 4 Suggested other tools: associated or pre-requisite tools 5) 5 How to Use: Tips on how to use the tool 6) Body of the tool 6 48

49 Using More Tools Go back to the home page and scroll down to the Assess Section.Or select another section if you are farther along 49

50 Using More Tools continued 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. 50

51 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 How to Use lets you understand what you ll need to do with the tool 51

52 Final thoughts 52

53 In Conclusion Change is coming, do not get left behind Begin the process now Use the Stratis Health Toolkit to start your transformation 53

54 Contact Information: Paul Kleeberg, MD, FAAFP, FHIMSS Ph: 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 people and communities. Prepared by Stratis Health, the Medicare Quality Improvement Organization for Minnesota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 9SOW-MN

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