The Future of Technology in Long Term Care

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1 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

Gonzalez, Bronx Center Stephanie Telfer, Bronx

2 In today s workshop. Introduction Overview of Electronic Medical Records 1. Bronx Center Presenters 2. Village Care Presenters Labor Management Collaboration Questions and Answer Evaluation of Workshop

3 Bronx Center Why an EMR?

4 Why an EMR? Introduction to EMR Staff reaction to EMR Adjustments Celebration Survey (Preparation and Results) Where we are now

5 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

6 Coverage on All Shifts 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

7 Maintenance and Accountability of Equipment

8 Labor And Management Working Together

9 Bronx Center Tag Team Stephanie And Louie

10 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 feedback to staff

11 Technology and Long Term Care Getting Started.

12 Business Model UNDERSTANDING THE EMR Presented by David Finkelstein & Traci Jersen

13 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

care. HIT can support greater transparency of actions and outcomes that enable alignment of financial incentives and reimbursements with quality outcomes.

14 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

Improve completeness of documentation, accuracy of documentation, legibility, use evidence based tools Compiles and analyzes documentation

15 Financial Improvement Alignment of financial incentives and reimbursements with quality outcomes Improvement in RUGS Scores Reduced Medical Errors/Falls Savings in Increased Staff Efficiencies Prevention Measures/Reduced Hospitalizations

Scores Reduced Medical Errors/Falls Savings in Increased

16 Employee Satisfaction Standard Workflow : Communication Gaps All documentation scattered, paper based Clinicians wait to access paper charts Statistics and reports are done manually Information not communicated effectively Less time for patient care Loss of critical statistical and quality data Time spent on administrative paperwork No process improvement

manually Information not communicated effectively Less time for patient care Loss of

17 Project 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.

implementation is having a clear definition of what you want the

18 Project Management 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

Installation/Facility Modification Software Configuration Dealing

19 Change Management 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

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.

20 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?

21 Example Reduce hospitalizations through identifying and preventing short term illnesses in residents Identify Value Outcome Develop Process Can the technology accomplish what the process requires? Reduce Short Term Illnesses Define Process for identifying risk factors for short term illness Illness Detection Tool Fall Risk Tools Other Prevention Features

22 ROI Indicators / Categories Resident / Client Information Management Clinical Protocol Management E-prescribing and emar / Medication Reconciliation Medical Records Management Staff Satisfaction Increased Reimbursement Use of Evidence Based Medicine

23 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 Developing new goals, strategies and tactics

24 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.

25 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.

26 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 medications).

27 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.

28 Next Steps What s your take? Any Questions?

The Future of Technology in Long Term Care

The Future of Technology in Long Term Care Lisa Mitchelson and Scott White, TEF Traci Jersen, 6N Systems Ellen Flaherty, VCNY David Finkelstein, VCNY In today s workshop. Introduction Overview Electronic