Electronic Health Records (EHRs): Selection and Evaluation Scott Code, Aging Services Technology Manager, LeadingAge CAST, Washington, DC

Session Objectives Explore the analytic tools, clinical decision support systems and interoperability certification functionalities of the CAST EHR Selection Matrix. Hear about new EHR products for physicians who practice in long-term and post-acute care settings. Discuss case studies of aging services providers who are implementing EHRs to drive quality initiatives in their organizations.

Speakers Scott Code, Aging Services Technology Manager, LeadingAge CAST, Washington, DC Carl Goodfriend, CIO, ProviNet Solutions, Tinley Park, IL Larry Carlson, CEO, United Methodist Homes, Neptune, NJ Dusanka Delovska-Trajkova, CIO, Westminster Ingleside, Washington, DC

EHR Whitepaper

Overview of the Whitepaper Overview of Purpose of WhitepaperDefinitions: EHR, EMR, PHR and HIEPlanning for and Implementing an EHR System Assess Plan Select Components of EHR Selection Matrix

Portfolio Updates New Selection Matrix Elements ICD-9 and ICD-10 coding capabilities Different types of certifications Analytic Tools Clinical Decision Support Systems (CDSS) KLAS Research Rating

Online EHR Selection Tool

CAST EHR Selection Tool Demo

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Electronic Health Records (EHRs): Selection and Evaluation Carl Goodfriend, CIO, ProviNet Solutions

ProviNET’s Philosophy… Technology as a way of life – Staff are more receptive to change as it applies to Technology – Routine & Reliable IT Services – End users can concentrate on operational issues without concerns about availability, access or rekeying.

ProviNET Solutions Successful Strategies for implementing an EMR: – Knowing your starting point – Knowing your desired end point – Creating a road map – Identifying strengths and weaknesses for achieving success How does this fit your overall IT strategy in the short and long term? Where is your organization in the process?

Successful Strategies for implementing an EMR: – Know your starting point: Conduct an IT assessment: Internal audit Bring in a 3 rd party to perform assessment Get input for staff

Key areas to consider with Assessment: Technology: Review current Information Systems capabilities including hardware components, software applications, network infrastructure, telecommunication infrastructure and other low-voltage systems. Review internal audit control risks and procedures

Specific infrastructure items to consider Technology: Optimal bandwidth for your communities Gigabit network within the community Wireless technologies (Resident and business) Point of care devices deployed for EMR Cloud computing vs. self hosting Health information Exchanges (HIE’s)

Key areas to consider with Assessment: Human Capital: Review the existing IT staffing capabilities. Review existing Technology Support Structure and compare to future support needs. Look for natural champions from within or outsource to trusted solutions partner. Evaluate the staff needed to carry out the plan. Evaluate the critical need for 24/7 support.

Specific Support items to consider Human Capital: More sophisticated Management oversight Helpdesk and call center support End user technical support End user software specific support & Training Engineering support Custom development/integration Analysts

Key areas to consider with Assessment: Operations: Assess Information Systems capabilities to determine functional requirements and gaps. Inventory and review existing applications. Review strategic Information Systems goals including reporting capabilities, current and future integration points. Develop your own wish lists.

Specific Operational items to consider Operations: Typical IT Dept will need to manage these systems: , desktop, workstations Mobile device deployment Point of care devices for nurses, CNA’s, therapists, etc. Life Safety systems (Nurse call, wander, security) Phone systems/cell phones Telehealth deployments Connectivity to hospitals, physicians, labs, pharmacies & HIE Resident cable television and internet access

Taking control of the results Once the assessment is complete. – Create your own short and long term IT strategy Budget accordingly Monitor to stay on track Include decision makers and key users

Where are you in the process?

2013 LZ 100 TECHNOLOGY SURVEY

2013 LZ 100 Technology Survey

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Electronic Health Records (EHRs): Selection and Evaluation Larry Carlson, CEO, United Methodist Homes

United Methodist Homes of New Jersey Decision to migrate to a new EMR Process of making the product selection Implementation experience

Current Situation SNF only Nursing assessments Nursing notes Kiosks for ADL tracking No EMAR, ETAR, Physician Order Entry

Evaluated the limitations of our current EMR product Flow of medical record was arduous Potential to document in areas that did not flow to the MDS Limited ability to customize – “one size fits all” – Care plans – Admissions and general observations Difficulty to navigate the medical record Limited support State surveyors were unhappy with difficulty of product Refused to work with ancillary vendors to integrate data flow

Identified the needs that are important for a new EMR Integration and interface with ancillary software such as: Disease Management, Adverse Event Tracking, MDS Scrubbing, Therapy, Pharmacy, Financial Flow of medical record for ease of documentation and understanding Ability to customize Care Plan library – with person-directed living applicability Ease of documenting skin issues Assessments that push quality data to populate the MDS, track scheduling dates (falls, pain, cognition, balance, PHQ9 and BIMMS) Notifications and alerts to nurses and aides regarding resident care Efficient and effective quality assessments not only for nursing, but ancillary teams – that can be customized to support best practice.

Important needs (cont.) Kiosks – icons that are easy to understand Potential for Physician integration of documentation vs current paper method Efficient and effective EMAR, ETAR and Physician Order Entry system Financial integration that flows from face sheet: insurances, Medicare days etc. Potential education of families/residents (pop-up training videos) EMR tools that could be applied on devices such as an IPad for ease of use Robust Training from software provider

Committee to screen potential products and recommend to senior leadership  DONs  MDS expert  Educator  People who had worked with the current EMR  Those who had worked with other EMRs  People who could be considered spokespersons for the nursing associates who would be utilizing the product Reviewed four EHR Products using the LeadingAge EMR selection tool Narrowed down to two using the ProviNET comparative selection tool  General Overview presentations by each  Site visits with end users  Reference Checks  Recommendation and decision

What we like about our new EMR Fully integrated Customizable Look and feel is that of a paper medical record All Product lines: SNF and AL as well as capability for growth into community based services and hospice

Implementation One year process – five communities – all product lines – all modules 1 st community – design/build – Go Live Two teams: clinical and financial Hardware Assessment o Wireless Network o Laptops o Kiosks Training hardware Assistance from ProviNET to help with ramifications of implementation decisions Customization of all forms, assessments and clinical tools Development of systems process work-flow(s) Data input – Super-users Training of end users

Lessons learned from the implementation Process Need consistent trainers from the software vendor Availability of trainers in between site training for questions in real time Guidance from ProviNET was invaluable to make good decisions at the macro level Put enough time between building rollouts to allow for and ensure system is working properly Cushion budget for staffing patterns and overtime to replace for training and roll- out Allow for the time-delay due to financial side closing before rollout out of a second building

Links to Case Study: _of_New_Jersey_and_ProviNET.aspxhttp:// _of_New_Jersey_and_ProviNET.aspx ces/ProviNet-UMHNJ.pdf Larry Carlson, President & CEO United Methodist Homes of New Jersey

Health Information Exchange Improves Care Coordination Dusanka Delovska-Trajkova CIO, Westminster Ingleside

Ingleside at King Farm One of three affiliates of Westminster Ingleside Opened March 2009 Located in Rockville, Maryland Continuing Care Retirement Community 245 Independent Living apartments, 32 Assisted Living, 45 Comprehensive Care beds

Ingleside at King Farm Project Improving Transitions of Care With Health Information Exchange – Connect disparate systems for exchange of continuity of care documents (CCDs), including laboratory and radiology results – IKF embraced Encounter Notification System (ENS), MD HIE web portal and DIRECT messaging

Project Partners Maryland HIE – Chesapeake Regional Information System for our Patients (CRISP) ZaneNet – MD state designated organization Answers on Demand (AOD) – EHR provider Radiation Physics – radiology partner Quest Diagnostics – lab partner Ingleside at King Farm Medical Director Ingleside at King Farm Team

HIE in Practice IKF - Labs / Rad / CCD Interface AOD / CPC Tiani 1. Patient Demographic Match - Publish CCD 2. Radiation Physics Push to AOD + Publish to HIE 3. Quest Push to AOD + Publish to HIE HL-7 / CCD HL-7 HL-7 / CCD

Results

Percentage of lab results received electronically – 93%

Challenges Implementation of EHR in house competed with the HIE implementation CRISP changed directions to not push labs and rads to third party EHRs Due to competing projects of the lab provider, IKF had to switch labs Integrate data workflow and healthcare workflow in-house Treatment relations limit queries

Benefits & Impacts Clinical – Streamlined access to resident medical history – Improved resident transitions from/to hospitals – Improved quality measures, such as reduced hospital readmissions, reduced medication errors, etc. – Fewer errors and delays in treatment – More accurate follow-up – Decreased wait time for referrals Financial – Reduced costs for fewer duplicate tests – Reduced operating costs Safety and security – Data access – Data integrity Improved communication between all care providers due to access to data => improved care coordination and resident satisfaction

Lessons Learned Teamwork is the key – Internal team – External groups Follow consistent work and schedule Create group and individual education sessions for residents and family members Be patient Change does not come easy for the user Communicate early and often

Next Steps Piloting Encounter Notifications to family members Include ADT feed – in progress Expand HIE to other two affiliates – In progress at Ingleside at Rock Creek, DC Work with our institutional pharmacy to add list of medications to HIE Add advance directives to HIE Add Personal Health Records (PHR)

Questions?