Moving your Facility to an Electronic Medical Record 1
Table of Contents Paper vs Electronic The Pros and Cons Page 3 Considerations As You Move Ahead Page 10 Infrastructure Page 14 Your Current Software System Page 27 Funding the Change Page 31 Your Staff Page 34 Other Electronic Options Page 39 Implementation Review Page 43 Conclusion Page 46 2
What is an EMR? A computerized medical record created in an organization that delivers care in: Hospitals Physician offices Long term or residential care facilities Usually part of a local health information system that allows: Storage Retrieval Modification of records 3
The Good News You are not starting from scratch. Your resident face sheets and MDS records are computerized now. This gives you the basis of an EMR, even if other records (notes, vitals, clinical assessments, etc.) are still on paper. Start with this partial EMR, and add computerized elements over time. Even a partial electronic record provides a central source of demographic information that flows into the MDS, MARs and care plans.. 4
The Bad News Your facility s infrastructure (hardware, wireless network) might not support a complete electronic record. You have staff who might be resistant to the change. Using paper records requires collecting, recording and maintaining resident information multiple times. Records that are partially on paper and partially electronic are harder to access and integrate. 5
Paper Based Records Pros: Familiarity: this is what we know how to do Accessibility: no need for the PC to power up, no passwords Low cost 6
Paper Based Records Cons: Requires so much storage space Limited accessibility Hard to share, hard to integrate for a complete picture Repetition of data gathering Transcription errors Poor legibility 7
Electronic Medical Records Pros: Reduce workload and duplication Standardize the information recording process Improve resident care and safety Increase time spent with residents Reduce errors by making the chart information clear and legible Improve survey results and reduce deficiencies Store larger records with extensive patient histories Use a standardized interface, such as HL7, to share information 8
Electronic Medical Records Cons: Additional costs for new or more hardware and software Staff might be resistant to change Staff will have additional educational needs IT support will be required System reliability must be constantly monitored 9
What s Next? You ve reviewed the advantages and disadvantages of converting to an electronic record, and you have decided to start implementation at your facility. What should you consider next? 10
Administrative Concerns Administrative and Management Support for the Project Encouragement and support must start at the top. Administration has to be involved: Show that they are committed to the project Promote the change as a positive step for the facility 11
Front Line Leadership A comprehensive project like this must have a champion. Or a team of champions! Certain staff members will be naturals for this role. Leaders will have: A comfort level with technology Be open to change Have the vision to see that this is the right direction for the facility A committee (perhaps all department heads) should be formed to: Collaborate on the transition schedule Keep staff informed of the progress Promote the benefits of change 12
Capital Budget To ensure proper funding, consider the cost of: Purchasing and installing new equipment Installing a wireless network Purchasing additional software Additional staff training Work with your IT and software providers for accurate estimates 13
Your Infrastructure IT Support You will need IT professionals to help you through the process. Do you have your own IT department? Are you affiliated with a hospital or management group that will provide IT services for you? Can you contract services from a local IT company? 14
Server (for software installed at the facility) Pro - Gives you more control over your data Con Requires newer equipment and backup protocols Considerations Review the condition of your server and consider its: Available memory and systems currently installed Age and reliability Review your server s current operating system Windows 2008, 2011, 2012 these are current operating systems Windows 2003 consider an upgrade Consider remote access capabilities, (i.e., RDP or VPN connections) 15
Internet Connectivity (for software hosted by the provider or 3 rd party) Pro - Eliminates the need for a newer server, reducing your capital outlay Pro The hosting company handles backups and software upgrades Pro Older workstations are usually sufficient Con Your data is held in a separate location Considerations Is your internet connection reliable? Is your facility s bandwidth sufficient? This will be dependent on the number of concurrent users Your software provider will have minimum specifications Ask your Internet Service Provider to help you 16
Review Workstation Availability Are they conveniently located? Are they accessible to staff on 2 nd and 3 rd shifts? Are there enough workstations to eliminate waiting time? Consider Workstation Mobility Desktop PCs are almost always necessary. Can you add mobile laptops or tablets? Do carts on wheels make sense at your facility? Are wall-mounted kiosks a good choice? 17
Wireless Network Add a wireless connection to your computer network for mobile charting. This is not the same as wireless for your residents to access the internet. You ll need reliable connectivity. Confirm that the mobile workstations stay connected to the network throughout the facility. Confirm that you have stable connections for quick response time. Slow systems = decreased utilization 18
Reliable Backup Procedures in the Facility This is only necessary if you host the software on your own server. You cannot attach too much importance to this topic. If your server goes down, your backup files will contain your only resident records. Back up all resident files at least daily, using a different tape or disk every day for 7 days. Use 3 additional tapes or disks for the 3 previous Fridays. On the 8 th day, overwrite the 1 st day s backup and start over, re-using the previous week s tapes day by day. Take the last backup off-site every night. Review the integrity of last night s backup every morning. 19
Cloud Backup Options If you host your own data, contracting with a company that provides cloud backup is a great option. They will: Help you decide which directories and files must be backed up Establish the back up routine Schedule the backup to occur at least daily (consider multiple times a day) Monitor the success of the backup for you Keep all your backed up files in a secure, HIPAAcompliant location Work with you if file restoration is necessary 20
Redundant Power Source A constant, reliable power source is critical. Backup generators should be connected to your server(s) to avoid downtime. Staff access to a computer every shift, every day is vital. 21
Scanners Scanners are used to convert your current paper records to an electronic format. Use stand-alone scanners or a copier/printer with scanning capability. Connect the scanner to your network. Save documents in a PDF or jpg format and attach to the individual resident s record. You can sub-contract this project for history records. 22
Document Management System Used with a scanning system This feature might be built-in to your software, or you can contract with a 3 rd party. Allows you to securely save records on your network. Resident records are saved with the user s name, the date and time. Specify a secure location on the network to keep PHI safe. Only authorized users can move individual records. Records cannot be edited after saving, but can be inactivated if saved incorrectly. Use addendums to make changes and attach to the original. 23
Laser Printers Ensure that: Printers are conveniently located for staff use. They are accessible after normal business hours for 2 nd and 3 rd shifts. The facility has enough printers. The printers are not Inkjets or Desk jets. 24
Hand-Held Devices Consider: Are these types of units a feasible alternative for your staff s use? Is the screen size sufficient for daily use? What about the fragility of the units? What if they are misplaced, taken home accidently or even stolen? 25
Safeguarding Protected Health Information Safe use and dissemination of protected health information (PHI) is critical to your facility s reputation. Ensure secure user access to the system. Assign a Super User System Administrator. Each user must have their own unique User ID and Password. Software menu security will be driven by User ID. How will you store patient data collected on PDAs? Consider a secure in-house wireless network. Don t store PHI on a mobile device. Send secure real-time transactions to the server. Establish a written facility policy. 26
Your Current Software Features of your Software System Are you using your system to its full potential? What software features do you have? What features do you pay for, but don t use? 27
Internal Communication Enhancements to the current programs are released regularly by your vendor. Who understands and publicizes the newest options in your system to your staff? Does IT install software updates? Do they forward information about enhancements and fixes to the users? 28
Current Software Use Which features of your current software are being used regularly? Only face sheet and MDS information (because they are required)? Is there any plan in place to implement more features? Care Plans, based on triggered CAAs Progress notes, stored by type of note, discipline, user, date and time Resident activities Resident inoculations Clinical assessments Calendar of events 29
Reporting Options Do the staff have a good understanding of the reporting options available? QA reporting based on MDS, Care Plans, Medications, Diagnosis Survey Reporting CMS 672 and 802 Reports Unresolved Conditions based on the last 2 MDS records Customizable reporting options 30
Funding the Change Efficiencies Integrating to increase accuracy and reduce duplication. Better coordinated processes to produce financial benefits. More time with residents improves: Your facility s customer service Resident, family and staff satisfaction Word of mouth referrals Overall reputation Census 31
Integration Benefits Clinical observations imported into the MDS Result: Higher RUGs, or at the least, more accurate RUGs Therapy details imported into the MDS and the billing system Result: Accurate supporting documentation Result: Increase accuracy of claims and reimbursement MDS records integrated with the billing system Result: Bill with the submitted MDS Result: Submitted RUGs match billing details 32
Reimbursement If you submit a Medicaid Cost Report, capital expenditures for equipment and software and the programming portion of the monthly fee can be considered in the calculation of Fixed Costs. Check with your accountants for more information. American Recovery and Reinvestment Act (ARRA) Skilled and long-term care nursing facilities are included in the HITECH (Health Information Technology for Economic and Clinical Health) definition of health care provider, but there is no financial incentive plan in place for these facilities yet. 33
Your Staff Resistance to the Change It is very common for staff to resist the change from paper to electronic record. Why? People don t like change! 34
Other Questions to Consider Do you have staff with no computer experience? Have you found that some of the staff have experience, but are still uncomfortable with technology in the workplace? Do you anticipate that since staff have always used paper records they just won t want to change? Has there been good direction from management to help everyone understand the need for a change? Have any incentives been offered to help staff embrace the change? 35
Staffing Keys to a successful implementation: Willing and able frontline staff Staff who are comfortable with computer technology can help others adjust Start on a unit with the most flexible and interested staff When hiring look for those candidates who: Have taken HIT (Health Information Technology) classes Have worked with other EMR systems in previous jobs Are experienced with computer technology 36
Encourage your staff Assign a technology champion, cheerleader, or super user for each unit. Involve staff in the process and decision-making as much as possible. Allow collaboration between Clinical and IT early in the conversion process. Use fun incentives to encourage faster implementation. Bring in pizza for the best shift Provide a coffee and donut break for the best unit Give a gift certificate to the best user 37
What training opportunities are available to your facility? Users Manuals Update memos can the user access these from the system? FAQ documentation Software vendor s newsletters Other vendor-created electronic communications Vendor s website Webinars Workshops On-site training Train-the-trainer sessions 38
Other Electronic Options Consider other options for increasing the capabilities of your current electronic record. 39
Electronic Medication Administration If your software doesn t have this feature, you can use a 3 rd party vendor. Laptops with extended life batteries mount to the med and treatment carts. Wireless network in the facility for med/treatment cart mobility. Bar code labels on the meds and treatments identify each item and link it to the resident. Bar code scanners on each cart allow users to scan each med or treatment before administration to ensure accuracy and timeliness. An electronic interface to the pharmacy can be used to send new orders and re-orders. 40
Point of Care Systems If your software doesn t have this feature, you can use a 3 rd party vendor. Point of Care workstations, tablets or wall-mounted kiosks are used to record assistance to resident and observations about residents as they occur. Can be easier to use than hand-held devices. Staff can give residents their full attention. Observations are recorded as they happen, not at end of shift. More observations are recorded every shift. Staff can t see previous responses to the same task. Compliance with required observations is easy to track. 41
Interfaces Use interfaces to link information between and among vendors: Pharmacy or medical supply charges imported into your billing system Therapy charges imported into your billing system Therapy days and minutes imported into your MDS Resident care observations imported into your MDS Resident admits and discharges between software systems 42
Implementation Review Go modular Consider a phased-in implementation. Add software features one or two at a time as you see that staff is ready to learn something new. Start with the best users or the best unit. Reward them to encourage progress. 43
Other Recommendations Review your current workflow. Consider changes to your current processes to achieve greater efficiency. Consolidate forms to avoid duplications. Try to avoid TIHWADI. This is how we ve always done it! 44
Plan Your Training Work with your software vendor to prepare installation and training agendas. Schedule training time when staff are not performing their regular duties or arrange for someone else to cover the shift. Take advantage of small groups, hands-on, webinars and train-the-trainer sessions. Consider off-site training, so staff can stay focused on learning. See if your vendor is able to provide an off-site training location. Post the upcoming implementation and training schedules in advance and ask staff to evaluate the training they receive. 45
In Conclusion With ongoing adoption of the system by all departments and disciplines within the facility, you will be able to achieve your goals for improved clinical and financial outcomes. Use the technology to your staff and residents advantage. Improve the quality of required documentation. Reduce staff time spent on duplicate documentation. Increase accuracy and improve survey results. Ensure appropriate reimbursement for the good work you do every day. Increase the amount of time staff is able to spend with residents. Enhance your residents quality of care and quality of life. 46
Offered by Lynne Hammond Director of Marketing and Sales 207-474-7122 lynne@hi-techsoftware.com Thank you! 47