Helen M. Simpson Rehabilitation Hospital Leveraging IT to Coordinate Care Transitions All speakers have completed commercial bias disclosure forms and do not have any conflicts of interest
Disclosures It is the policy of Corexcel and IMNE to ensure fair balance, independence, objectivity, and scientific rigor in all programming. In compliance with the American Nurses Credentialing Center (ANCC) and the Accreditation Council for Pharmacy Education (ACPE), it is the policy of Corexcel and IMNE that faculty disclose all financial relationships with commercial interests over the past 12 months. Corexcel s provider status through the ANCC and IMNE s provider status through the ACPE, are limited to educational activities. Corexcel, IMNE, ANCC and ANCC do not endorse commercial products.
Objectives Understand the importance of continuity of care as patients transition across care settings. Discuss the clinical documentation process and compliance standards for a rehab setting. Discuss ways in which IT can support clinical documentation in a rehab setting. Share examples of how IT supports a coordinated approach to care delivery in a rehab setting.
Presenters Melissa Gillis, OTR/L MPA Administrative Director, Physical Medicine and Rehabilitation and Rehabilitation Hospital Cynthia Brown, RN, BSN, MS Director of Clinical Informatics Jenny L. Morris, RN, BSN Clinical Informatics Specialist
Disclosures It is the policy of Corexcel and IMNE to ensure fair balance, independence, objectivity, and scientific rigor in all programming. In compliance with the American Nurses Credentialing Center (ANCC) and the Accreditation Council for Pharmacy Education (ACPE), it is the policy of Corexcel and IMNE that faculty disclose all financial relationships with commercial interests over the past 12 months. Corexcel s provider status through the ANCC and IMNE s provider status through the ACPE, are limited to educational activities. Corexcel, IMNE, ANCC and ANCC do not endorse commercial products.
Objectives Understand the importance of continuity of care as patients transition across care settings. Discuss the clinical documentation process and compliance standards for a rehab setting. Discuss ways in which IT can support clinical documentation in a rehab setting. Share examples of how IT supports a coordinated approach to care delivery in a rehab setting.
PinnacleHealth Harrisburg, Pennsylvania Non-profit healthcare system in Central Pennsylvania since 1873 Healthcare network includes four campuses, Family Care practices, specialty practices, outpatient surgery and Imaging centers, PinnacleHealth-Fox Chase Regional Cancer Center, Inpatient and Outpatient care, Home Health and Hospice services. 591 licensed beds 55 bed Rehab Hospital Primary service area includes 550,000 people in a five-county area Annual Statistics Surgeries: 23,000 (in our hospitals) Emergency Department Visits: 58,000 Births: 5,000 Employees: 4,500 Medical Staff: 800 active and courtesy staff
Impetus for Change CMS Regulatory Changes 2010 IRF-PPS Administrative Efficiency and Compliance Physician and Therapy adoption of IT Clinical Process Quality
Innovation via CMS SURPRISE! October 15, 2009 Inpatient Rehabilitation Facility-Prospective Payment System (IRF-PPS) Strong Documentation Requirements highlight regulatory changes for 2010 Effective January 1, 2010
Premises of Changes Areas of Discussion Attending Physiatrist demonstrates active involvement in Pre-Admission Process Must approve patients for admission Pre-Admission Assessment becomes part of Medical Record Post Admission Assessment 24 hours after admission Admission H&P is not enough Must demonstrate that interdisciplinary team has been part of initial itial communication Interdisciplinary Plan of Care 72 hours after admission Existing Interdisciplinary Team Conference Form meets standards Must demonstrate interdisciplinary involvement and oversight by physiatrist Documentation by Team Interdisciplinary Focus is important Must demonstrate rehab nursing and therapies are communicating among a all shifts.
Documentation Opportunities Post Acute Care Coordinator moves to EMR on Acute Therapist documentation within EMR on Acute and then Inpatient Rehab Nursing documentation re-design to meet inpatient rehabilitation needs. All time stamped encounters needed for regulatory compliance are posted in EMR Interdisciplinary Plan of Care in Weekly Team Conference within EMR Use of Electronic Signatures by team
Rehab Approval Process Automated the Post Acute Care Coordinator (PACC) assessment PACC nurse notifies physician via consult Physician completes approval on-line Resource center is notified via the tracking board to initiate the insurance approval process Resource center auto faxes a system generated report to the insurance provider
Tracking Board
Rehab Report
Admission to Rehab Hospital Facilitate transition of care from acute care to the rehab hospital Sharing of historical information between therapy disciplines Prompts to complete required nursing documentation Decrease documentation time charting the shift and admission assessments so that Nursing can focus on functional assessment documentation
Facilitating Transition of Care
Rehab Clinical Summary
Shared Historical Information
Worklist: Required Documentation
Abbreviated Nursing Assessments
Functional Assessment Consistency across disciplines with functional assessment Correlation between therapy and nursing documentation and the functional level Accurately reflects functional ability Clinician providing the care completes the documentation Easily view the trend of patient s s functional level
Plan of Care/Team Conference To facilitate coordination of care utilizing the interdisciplinary plan of care: Shared Problem List and Outcomes Nursing assigns medical mgmt problems Therapy assigns functional problems Communication between disciplines Physician approval of Plan of Care Review of plan at Team Conference
Physician Alert to Review Plan of Care
Team Conference
Regulatory Requirements Charge for service at the point of care Automatic calculation of therapy units Real Time display of therapy hours. Summary of Care Document upon Discharge from Rehab
Total Therapy Time
Summary of Care
Outcomes of Project Clinical Process Quality Streamlined Audit of patient encounters including timeliness Standardized procedures for therapist initial evaluation on Acute and Inpatient Rehab. Functional documentation algorithm embedded in EMR Clinical Outcomes Consistent tracking of 3 hour rule and reasons for missed therapy Two deficiency free certification surveys through Joint Commission in past 18 months
Outcomes of Project: Review by Contracted Auditor
Future Plans Physician documentation of H&P and progress notes in Soarian Explore replacing the current system with Soarian in the outpatient rehab sites Continue to enhance documentation and processes to comply with regulatory changes
Questions?
Download the Free Chapter Chapter 2 PinnacleHealth: Leveraging Documentation and Embedded Workflow Technology to Coordinate Care across a Health System Part of the new series, Technology in the New World of Healthcare, from Siemens Healthcare. www.usa.siemens.com/techseries2013
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