Successful Implementation of Electronic Health Records In Your Community: From Vendor Selection, Training of Staff To Full Streamlined Execution

Transcription

1 Successful Implementation of Electronic Health Records In Your Community: From Vendor Selection, Training of Staff To Full Streamlined Execution By Nikkei Concerns Randi Saeter Seattle Keiro Administrator Jessica Giron Seattle Keiro Director of Nursing Services Lisa Waisath Nikkei Manor Assisted Living Manager Nikkei Concerns (NC) is a health & wellness non profit organization, celebrating its 40 th anniversary in 2015, who provides key services for Asian seniors in the Pacific Northwest. Seattle Keiro Rehab/Skilled Nursing 1976 Kokoro Kai Senior Social Day Care 1978 Nikkei Horizons Continuing Ed Nikkei Manor Assisted Living 1998 NC Transportation 2014 NC Club HCBS 2015 NC Catering & Meal Delivery 2015 We are committed to making every day the best day for our residents and participants and strive to enhance their health/wellness, quality of life and independence through our founding values of: Respect, Trust, Kimochi (compassion), Quality of Life, and Family NC has expertise in serving & brand awareness of the Asian population including: Japanese Chinese Korean Vietnamese Filipino 1

2 WHO WE ARE Randi Saeter, RD MBA Seattle Keiro Administrator Jessica Giron, RN Seattle Keiro Director of Nursing Services Lisa Waisath, BA Nikkei Manor Assisted Living Manager Other members on the team: Ibtissam Davis Support Services Director Mark Smith IT Consultant Tina Masuda Draughon CFO Financials Analyn Mingaracal Health Information Manager Objectives You will gain a greater understanding of how to successfully implement an E.H.R. system in your skilled nursing facility (SNF) or assisted living facility (ALF) You will gain a greater understanding of what is required in terms of IT infrastructure, software selection, training of staff, and implementation of the system 2

3 Electronic Health Records A necessity?! What are your organization s IT needs now vs the future? Over 15,600 skilled nursing facilities in the U.S. 228 in Washington State in 2012 Over 36,000 assisted living facilities in the U.S. 483 in Washington State in 2014 Project Timeline (input visual timeline) Started Research February 2013 Launched training for Nursing and Activities staff October 2014 Entered Physician s Orders into the new system & old system October 2014 Launched MDS last week of November 2014 Launched Financials December 1, 2014 Started building Care Plans for Restorative/Nursing and Activities before going live on POC Launched Clinical Modules for Seattle Keiro SNF January 2015 Launched Clinical Module for Nikkei Manor AL TBD 3

4 Research LeadingAge CAST ( SNF and AL mainly In depth analysis of service offerings NTT Data Answers on Demand Pioneer ACMS American Data American Health Tech Lintech Comet Answers Certified E.H.R PointClickCare Research Web demos Ease of navigation User friendliness Interface Capabilities Pharmacy, Hospital, X ray, Lab, etc. Interact Site visits See it in action Cost analysis Get some quotes up front 4

5 Project Budget IT Infrastructure Hardware selection Software Requirement Clinical and administrative modules Training & Implementation Professional data migration & input assistance Professional training assistance Preparation of staff Timelines IT Infrastructure Needs assessment of each building Access Points for WiFi how many and where? Kiosks (detailed specifications/variety of options to accommodate staff and ease of use) Med Carts Desk Tops Cell phones Tablets Laptops Secured & Adequate Bandwidth WiFi Added a 2 nd private wireless network Capacity Cabling the building 5

6 IT Infrastructure Backup Generator Backup Network Cloud Based vs. Hosted Server Second computer (e.g. in medical records) that backs up data every 15 minutes in case of an emergency Back up printer Wall mounted Kiosk 6

7 Portable WOW Station For assessments For meetings & care conferences 7

8 IT Infrastructure Who owns the data HIPAA Concerns Copy machine and scanner for documents Misc H&P Lab & X Ray Reports Consult notes from external providers 8

9 Software Requirements Upgraded to Windows 8 Clinical and Administrative Modules What are your needs? Configuration: What are you currently using on paper? Gather all forms you would like to continue using what is working and what is not? Phasing in modules vs everything all at once Physicians orders, Emar/Etar, Point of Care What do you need first? What can come later? Think A New Imported 18 months MDS Imported Financials Training and Implementation What piece of the E.H.R. do you launch first/last? Our experience Clinical: Physicians orders, MDS, Care plans imported and built first All P.O.s in by 11/1/2014, MDS started one week prior to 12/1/2014 Business office: Go Live 12/1 MDS must be fed in to be able to bill Work with each discipline on assessment forms (UDAs User Defined Assessments) Build your own or purchase forms from your vendor Build your Point of Care as soon as possible: What do you want your nursing assistants and activities staff to document on? Managers started using UDAs first for ~ a week to help work out any glitches 9

10 Training Web based or in person? We had concerns about the ability of our staff based on our staff s needs assessment 1. Have you used EHR before? Which company? 2. Are you intimated by computers? 3. Do you consider yourself a beginner, moderate, or expert user? IMPORTANT TO PAY FOR THE TRAINING Pay for the highest level that your organization can afford Targeted Super users Training Configuration Super users need to truly know how to configure the system, e.g., create a care plan library and how care plans will link to the point of care Super users: Identify staff who are enthusiastic about learning and teaching other staff (navigation, troubleshooting, configuration) Training by department Classroom computer lab (10 desktops) Example of training schedule We only had staff come in for training on sections they needed to be trained on Finance training was separate Keep the Sandbox! 10

11 Implementation Go Live was 01/20/2015 for the nursing department All clinical modules except emar/etar Assessments were gradually phased in Policies & procedures in place for approving/signing physician s orders Still using paper T.O.s (only change is entering order into the system) A nurse or medical records will enter an order, but a nurse is required to approve the order before it is finalized Standing orders need to be updated and included in the standing orders library specific to your facility Recaps: Crucial that physician s orders are up to date Super users present and always available to assist during Go Live Most common issue was having to reset passwords Implementation User roles Determine who will needs access to what (e.g., surveyors do not need to have access to your whole system determine what areas in read only ) Very time consuming process Request your training company to assist or other facilities to share types of roles Consultants /Physicians/ARNPs Should you allow external access? Able to access system using the private/secure network with own work/secure computer (internal use only) 11

12 Implementation emar/etar Go Live at Seattle Keiro SNF 06/16/2015 Preparation: Super users / Managers watched web demo Training of staff: 2 hours of classroom time for each LN Sandbox training available 24/7 Rehab Optima Therapy module: Go Live TBD Lab and X Ray Company TBD Medication Cart Laptops 12

13 On going training All new staff receive training by DNS / Super user Current staff may get refreshers at scheduled training times with manager s permission Sandbox always available 13

14 Evaluation Managers are encouraged to regularly check % POC tasks completed (by shift) Are staff charting as they go or at the end of shift? Parameters for alerts: Implement and evaluate according to your own protocols (e.g. BM, weight change, PO intake) Custom alerts in addition to your Stop And Watch alert Solicit feedback from staff and monitor compliance Any concerns/suggestions for improvement E.g., we changed the meal monitor documentation based on staff feedback E.g., catheter use: had to build a custom task for monitoring output of catheter Recommendations Plan for more time Plan your resources One last look Know what you need and want for the future Completely understand how much you will be charged up front and monthly Scheduling & Training Super users ASK QUESTIONS don t be afraid! That s their job 14

15 Summary A larger project than first anticipated Worth having a project management team with extensive involvement from Super users A larger budget than first anticipated Research may take longer than expected, but worth it in the end Having staff buy in proved to be instrumental in a successful implementation Pay for the most training your organization can afford & keep the training site active Questions? Randi Saeter Seattle Keiro Administrator Rsaeter@nikkeiconcerns.org Jessica Giron Seattle Keiro Director of Nursing Services Jgiron@nikkeiconcerns.org Lisa Waisath Nikkei Manor Assisted Living Manager Lwaisath@nikkeiconcerns.org 15