Landscape of HIT in US Skilled Nursing Market

Transcription

1 Landscape of HIT in US Skilled Nursing Market MHA Conference Presented by: Dave Wessinger, CTO

2 Topics PointClickCare Highlights Market Drivers / Key Priorities Current State of the Union Integrated Medication Management (IMM) IMM Status Update Checklist to Get Moving What s Coming?

3 About PointClickCare PointClickCare Launched 2000 Senior Management Core Business Employees 750 Founder Owned and Operated (CEO,CTO, EVP) Software and Services designed for the LTPAC market Customer Base Assisted Living Growth 9,000 long-term care centers #1 Market Share in the US and Canada 1,600 facilities. Dedicated R&D investment for market launch in X faster than nearest competitor Active Residents 995,000 Retention Rate 99.92%

4 Our LTPAC Mission Deliver a robust, fully integrated EHR that improves quality outcomes for customers by driving costs down through process efficiency creation.

5 Customer Demographics Top 10 Chains Regional Mid-Size Small/Independents More than 9,000 LTPAC facilities 9 of top 10 chains 50% of mid-sized chains Fastest growing in the independent market

6 Our AL Customers Top Assisted Living Chains More than 1,600 AL facilities 12 of the top 40 AL chains Fastest growing in the Senior Living market

7 The Market is Consolidating 2500 Net US SNF Customer Gain/Loss ( ) Growing 31x Faster than our nearest competitor PCC Vendor A Vendor B Vendor C Vendor D 90 Other Accumed

8 Market Drivers / Key Priorities

9 Key Drivers for LTC HIT Reduce Hospital Readmissions Census, Census, Census Cost containment in face of reimbursement cut-back o Professional Staff efficiencies; desire to eliminate time consuming error-prone manual processes and redirect staff to providing quality care Regulatory Concerns o HIPPA HITECH o Meaningful Use pressure ACOs information needs/requirements Litigation Risk Avoidance

10 Factors That Raise Risk Multiple complex health issues Increased documentation demands Complex medication regimens Resident physiological changes Legibility issues with handwritten paper charts

11 Key Themes Achieving better outcomes by enabling providers to work smarter together Connecting those involved in the person-centric care delivery process Operational efficiencies reducing costs, doing more with less Better information supporting better decision-making on care

12 HIT Priorities Today - Connecting Connecting those involved in the personcentric care delivery process o Secure Conversations o Practitioner Engagement o Hospitals ACOs HIEs Interoperability o Meaningful Use Approved Technology o Family & Friends Access

13 HIT Priorities Today Operational Efficiencies Operational efficiencies reducing costs, doing more with less o Centralized administration o Improve the Medication Management Processes o Integrated Lab and Radiology Results o Integrated Devices (weights & vitals) o Mobility documentation captured as services are provided o Workload estimating o Automation

14 HIT Priorities Today Better Information Better information supporting better decision-making on care o Embedded clinical protocols / decision support i.e. einteract o Quality Improvement Processes such as QAPI o Embedded analytics o Enterprise Dashboards o Population Health Management

15 Deeper Dive einteract Practitioner Engagement Interoperability

16 einteract

17 What is INTERACT? INTERACT ( Interventions to Reduce Acute Care Transfers ) is a quality improvement program designed to improve the care of nursing home residents by: o Preventing conditions from becoming severe enough to require hospitalization through early identification and assessment of changes in resident condition o Managing some conditions in the NH without transfer when this is feasible and safe o Improving advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents

18 einteract workflow Stop and Watch Nursing Alert(s) Intelligent Assessment / Care Paths No=fy Physician Advanced Care Planning? SBAR Transfer? CCD / Transfer Form Revise Care as necessary

19 Practitioner Engagement

20 Background Said they would use mobile EHR functions Customized, simplified versions of charts Apps optimized for touchscreen Physicians chose iphone over Android Would integrate tablets

21 Practitioner Engagement Market Drivers Need for up-to-date access to relevant clinical data to support better clinical care decisions by practitioners Time-consuming and error-prone manual paper signature processes Compliance risks Need to support meaningful use requirements for eligible providers Reduction in preventable readmissions

22 Practitioner Engagement Priority Features o Secure Conversations o Order Signature Management o Simplified Chart Access o Physician Encounters and Monthly reviews o eprescribing and Voice Dictation

23 Interoperability

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25 Complex Workflow support Sustainability?? All Unique

26 Health Information Exchange Health Informatio Exchange Health Information Service Providers KISS principle Clearing House Secure Limited workflow Identity verification Health Informatio Service Providers Clearing House Direct Integration Direct Integration

27 Standardized Low Maintenance Sustainable Tx fees

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29 Current State of the Union

30 EHR Adoption Model for Sustainability Interoperability Physician Engagement Orders Management Advanced Clinical Documentation Point of Care Documentation Basic Electronic Health Record (EHR) Mandatory

31 PointClickCare EHR Adoption ROI 1. Reduced Returns to Hospital 2. Increased RUGs Reimbursement 3. Improved Quality Care 4. Reduced Med Errors 5. Improved DSO 6. Reduced Operational Costs

32 Scorecard Top Level View

33 Today s Reality Stage Name What s Typically Included 1 Mandatory ADT, MDS, Medical Diagnoses Typical SNF Investment $15,000 to $25,000 Per 120 bed facility SNF Market Adoption 100% 2 Basic EHR Basic Assessment, Care Plans Weights & Vitals, Advanced MDS, Therapy Documentation & Integration $35,000 to $45,000 Per 120 bed facility 94% 3 Point of Care Documentation Observations, Alerts, Tasks /Flow Sheets $50,000 to $60,000 Per 120 bed facility 49% 4 Advanced Clinical Documentation Comprehensive Assessments, Progress Notes, Embedded Workflow, Clinical Protocols (INTERACT), Order Entry, Paper or emar $25,000 to $35,000 Per 120 bed facility 79% 5 Orders Management Order Integration (pharmacy, lab, diagnostic), Formulary Management $30,000 to $60,000 Per 120 bed facility 10% 6 Physician Engagement 7 Interoperability Physician electronic signatures, eprescribing, Physician Portal HIE, PHR, Hospitals, EHR Repositories Still being evaluated <2% Still being evaluated <2%

34 Key Challenges in Driving Adoption Access to funding (infrastructure, implementation, and on-going maintenance) Grants often driving spending decisions; not always in the best interest of the SNF Change Management Expanding to the unknown (resistance to change) Industry Noise Being taken down rabbit holes (HIEs here today, gone tomorrow) Lack of standardization on key processes

35 Integrated Medication Management Improving the Medication Management Process

36 A Closed Loop Medication Management Solution

37 Closed Loop Medication Management Medica=on Receipt Process Facility ADT ADT Capture Informa=on Physician Order Entry Medica=on Review Pharmacy Order Reconcilia=on Pharmacy Dispensing System Dispensing AdjudicaCon Process Clearing House

38 Focus on Standardized Workflows Facility Dispense Medication Therapeutic Interchanges Telephone/Verbal Orders Refill Requests Pharmacy New Order Prescriber New Orders

39 Bi-directional Solution in a Nutshell Transmits physician order info to and from the pharmacy Securely accessed over the Web Real-time accuracy and dependability Easily manage the entire order lifecycle Supports therapeutic interchanges and complex orders Streamlined medication administration processes

40 Method for Obtaining Orders Today Communication Method 14% 1% Physician Entered 44% Phone Written 41% Verbal

41 Practical Approach

42 Frequent Obstacles Aging technology Non-standard processes (manual processes developed and tweaked over decades) Manage Change o Nurses not familiar with order entry process; resistance to change Funding of Capital Cost Investment for technology/devices to support emar Industry noise

43 Status update for Integrated Medication Management

44 How Do We Prioritize Pharmacies? Dispensing system integration testing completed Opportunity to serve greatest number of existing customers Length of Enrolment in the Exchange Program Configuration / Processes have been tested Commitment to rollout

45 Status of Dispensing System Integration Beginning work on NCPDP transition - will likely cause some disruption in our broader rollout strategy Frameworks: Completing 5 pharmacy pilot on Framework HL7 interface - multiple buildings each. 4 pharmacies live QS/1: Vendor Certification completed. Final testing being completed with first pilot pharmacy. Two others starting testing HBS & RNA: some testing has been completed

46 Changes in Motion to Improve Certification Process Improved documentation; creating a Playbook by Dispensing System Development of a Fast Track program; for pharmacies utilizing a tested model Additional resources to support UAT/Pilots Initiating Pharmacy Census in Advance option

47 Checklist to Get Moving

48 What Can You Do? Become an Exchange Partner Option to move ahead with Census / ADT interface (can move more quickly than full orders interface) Start Certification testing Requires testing environment Fixed set of test cases + any additional recommended by pharmacy (6-8 weeks, 60 hours) Opportunity to document pharmacy best practice for filling orders / handling certain scenarios User Acceptance Testing (1-2 weeks, 15 hours) Work with initial pilot home to do a mock go-live using real-world data Total of four pilots to test different go live scenarios (e.g. customer already running emar vs Order Import) (4 months)

49 Things to keep in mind Most successful implementations have pharmacies that embrace and support their customers through the transition What will be required to support integration effectively 24/7? Standardized processes ensure systems can talk well together and achieve consistent results Training for your pharmacy staff Resources need for managing and troubleshooting HL7 / SCRIPT messages Do not underestimate the amount of work involved to support and maintain a scalable solution

50 What s Coming

51 What s Coming? Assisted and Senior Living models Clearinghouse models Physician eprescribing adoption Intelligent sensors Leveraging Standards to support Interoperability (NCPDP, CCD/ CDA)

52 Questions?