INTRODUCTION TO THE HIT TOOLKIT FOR NURSING HOMES Presented By: Mary Ann Leonard, RHIA, CRM, RAC-CT Michelle Dougherty, MA, RHIA, CHP AHIMA LTC Community Spring Conference 2009 Atlantic City, New Jersey

Purpose of Toolkit Kick start your HIT and EHR planning Formalize the process Reduce your cost Server as surrogate staff Achieve your HIT and EHR goals 2 General term relating to any use of information technology in health care Specific term referring to the information system applications collectively used by clinicians that support decision making at the point of care

Tool Kit Development Based on: QIO DOQ-IT Resources for Physician Practices BY Margret Amatayakul RHIA, CHPS, CPHIT, CPEHR, FHIMSS President, Margret\A Consulting, LLC Schaumburg, IL FOR Aging Services of Minnesota, Alliance Purchasing, and MHHA Service Corporation It was produced by Stratis Health (QIO) in MN

HIT vs. EHR Health information technology (HIT): a general concept that describes the technology that supports management of health information for many purposes Electronic health record (EHR): a specific system of applications and other elements that capture data from multiple sources for clinical decision support at the point of care  wherever that may occur  including promotion of health and wellness Software that directs computer devices People to support and use systems Policy that drives adoption of systems Hardware that enables system use Process that helps achieve results Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

Encompasses broader view of a health record  moving from notion of a location for keeping track of patient care events to a resource with enhanced utility Provides longitudinal (i.e. lifelong) access to events that may have influenced a person’s health. Virtual core of a health care delivery system information infrastructure Merely automating the form, content, and procedures of current patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs (Institute of Medicine, Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997) EHR

Electronic medical record (EMR) sometimes refers to: Physician office EHR Hospital document imaging system Non-interoperable record of health-related information EHR is term used by: Federal government Institute of Medicine (IOM) Health Level Seven (HL7) Primary organization to develop interoperability in health care information systems; adopts the term EHR system Certification Commission for Healthcare Information Technology EHR vs. EMR

Purposes of EHR Improve quality of care: data availability, links to knowledge sources Enhance patient safety: context-sensitive reminders/alerts, clinical decision support, automated surveillance, disease management, drug/device recall Support health maintenance: preventive care and wellness - patient reminders, summaries, tailored instructions, remote evaluation, home monitoring Increase productivity: data capture and reporting formats tailored to user, streamlined workflow support, patient-specific care plans and protocols

Purposes of EHR Reduce hassle factors: improve satisfaction for clinicians, consumers, and caregivers - managing schedules, registration, referrals, medication refills, work queues, automatically generating administrative data Support revenue enhancement: accurate and timely eligibility and benefits, cost-efficacy analysis, clinical trial recruitment, rules-driven coding support, accountability reporting/outcomes measures, contract management Support predictive modeling: contribute to development of evidence-based health care guidance Maintain patient confidentiality: as health information is securely exchanged among all stakeholders, including across the continuum of care and with individuals

GOALS HIT Implementation Improve direct clinical care processes for safety and quality of care Achieve greater efficiency and improve use if resources Communicate across the continuum of care Accelerate diffusion of knowledge and reduce variability in access to care

GOALS HIT Implementation Strengthen privacy and data protection Promote public health and preparedness Engage individuals in their health maintenance and wellness efforts

GOALS HIT Implementation in nursing facilities Improvement in reducing pressure ulcers and use of restraints, and improving pain management Targeted improvement in quality of care for residents Heightened satisfaction by residents and their families for care provided in your home Increased staff retention and consistent assignment of staff

GOALS HIT Implementation in nursing facilities Support for MDS/RAP documentation and triggers for interdisciplinary care planning Integrated orders and e-prescribing, full electronic charting, and remote access to improve communications with providers Automated services for privacy and security management Enhanced coordination of care across the continuum

Tool Kit Organization: 3 Sections with 7 Stages Adopt Assess Plan Select Utilize Implement Effective Use Exchange Readiness Interoperate

HIT TOOLKIT PLANNING IS THE MOST IMPORTANT COMPONENT FOR SUCCESSFUL IMPLEMENTATION OF THE ELECTRONIC HEALTH RECORD

Plan Before Acting Follow the HIT Toolkit for Nursing Homes guidance to: Assess readiness Plan People: engagement and communication Policies and goal setting Processes for efficiency and effectiveness Perform thorough selection process Understand total cost of ownership – you get what you pay for Do not move forward without a clear roadmap Implement well and monitor for effective use Correct course where necessary Celebrate successes all along the way Consider health information exchange across the continuum of care with residents and their families as a key part of the roadmap

HIT TOOLKIT PEOPLE, POLICY AND PROCESS ARE OFTEN DESCRIBED AS CONTRIBUTING 80% TO THE SUCCESS OF HIT IMPLEMENTATION

Instructions for Use: Your Dashboard 17

Types of Tools Recorded WebExes Short (15-20 minute) educational tools Walk through use of key tools Introduce key topics for your HIT team, EHR steering committee, staff Stimulate team discussion Survey forms, checklists, comparisons, charts, tip sheets, interview tools, rating forms, other tools Sample job descriptions, policies and procedures, request for proposal, other model documents 18

Tool Structure Purpose Each tool begins with a brief statement of purpose Instructions for Use Many tools include specific instructions for use Some tools are more informative than interactive and may not need instructions for use Notes and illustrations Some tools include notes to define terms, diagram a concept, or provide references Tool Microsoft Word, PowerPoint, or Excel Hyperlinked Modifiable 19

Purpose and Instruction 20

Hyperlinks and Resources 21

Examples and Illustrations 22

Additional Example (eRx) Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

Tools in Excel 24

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TOOLKIT ADOPT SECTION: ASSESS, PLAN & SELECT

Parts of the Toolkit: Adopt Tools to help you assess, plan for, and select HIT and EHR Readiness assessments, project management aids goal setting tools instructions on current workflow and process mapping support for understanding the HIT marketplace, issuing a request for proposal, and conducting due diligence for selection and contract negotiation 28

Parts of the Toolkit: Adopt 29 Contents of Adopt - Assess section How to use the toolkit – webinar, power point and document HIT governance HIT vision and strategic planning – webinar, power point and document Communication plan HIT attitudes assessment

Parts of the Toolkit: Adopt 30 Contents of Adopt - Assess section Computer skills survey Total Cost of Ownership (TCO)/Return On Investment (ROI) IT staffing inventory IT system inventory HIT security risk analysis and controls assessment

Parts of the Toolkit: Adopt 31 Contents of Adopt - Assess section Contingency plan assessment Application interface inventory Financing resources

Parts of the Toolkit: Adopt Content of Adopt – Plan Section HIT steering committee Meetings, agendas, minutes Clinical IT leadership Project management Project manager job description Goal setting Change management Workflow & process mapping – webinar, power point and document Chart conversion planning 32

Parts of the Toolkit: Adopt Content of Adopt – Select HIT code of conduct Vendor selection – webinar, power point and document Requirements analysis Request for proposals Request for proposal analysis Key differentiators 33

Parts of the Toolkit: Adopt Content of Adopt – Select Due diligence: demonstration plan Due diligence: site plan Due diligence: reference check plan Vendor choice Contract checklist 34

TOOLKIT: UTILIZE SECTION – IMPLEMENT & EFFECTIVE USE

Parts of the Toolkit: Utilize Tools for implementing and effectively using HIT and EHR Guides project performance and issues management Supports workflow and process improvement Assists system build, testing, and training Offers strategies for gaining value and effectively using HIT and EHR components in documentation and clinical decision support 36

Parts of the Toolkit: Utilize Content of Utilize – Implement Project planning – document and excel Workflow and process improvement Policy and procedure checklist Forms and reports analysis Input device planning System build Change control 37

Parts of the Toolkit: Utilize Content of Utilize – Implement Clinical decision support Training plan Testing plan Roll out strategies Space planning Go live planning HIT technical security controls - excel 38

Parts of the Toolkit: Utilize Content of Utilize – Implement Implementation strategies for assessments Implementation strategies for Electronic Document Management System (EDMS) and hybrid record risk management Implementation strategies for physician documentation Implementation strategies for Electronic Medication Administration Record (EMAR) Ongoing system maintenance 39

Parts of the Toolkit: Utilize Content of Utilize – Effective Use Quality measurement reporting improvement HIT adoption milestone results Monitoring SMART goal achievement Benefits realization HIT user satisfaction HIT resident satisfaction TCO/ROI assessment - excel 40

TOOLKIT: EXCHANGE SECTION – READINESS & INTEROPERATE

Parts of the Toolkit: Exchange Tools to assess your readiness for interoperating with other organizations supporting health care Describes health information exchange goals and governance, architectures, data stewardship, technical interoperability issues, and personal health records 42

Parts of the Toolkit: Exchange Contents of Exchange – Readiness HIE readiness HIE goals and governance HIE technology 43

Parts of the Toolkit: Exchange Contents of Exchange – Interoperate HIE data stewardship HIE interoperability Policy and procedure for personal health records 44

Thank You and Questions Contact: Mary Ann Leonard Michelle Dougherty 45