EHR in Long Term Care: Are you ready?

 EHR – Electronic Health Record  Also known as EMR – Electronic Medical Record  Capturing Resident Health Information electronically  Usually encompasses Billing data  Data elements typically include:  ADL documentation  Clinical Documentation  CPOE  eMAR and eTAR What is EHR?

 EHR in LTC began with MDS  MDS established a standard “data set” for all residents  Established a standard comparison between facilities  This “data set” was the early start to quality measure reporting  Mandatory Electronic transmission of MDS data began in 1998 The “Beginning”

 Large variation of EHR  MDS and Care Plan  ADL documentation tools  RUG Analysis  Lab websites  Pharmacy website  X-ray/diagnostic websites  Full Clinical documentation EHR  Integration to Billing Software  Most EHR are a “hybrid” EHR and Paper chart The “Present”

 Full integration of billing/financial and clinical  Electronic exchange of data to ACO’s  Electronic exchange of data to other providers  Pharmacy  Laboratory  Mobile Diagnostic  Acute Care Hospital  Having a truly “paperless” chart  Family portals  MD portals  Barcoding  RFID tracking The “Future”

 Standard data for multi site organizations  Real time data  672/802  Data reporting – replace spreadsheets  No more “bad handwriting”  Clean MAR and TAR  “Force” data entry  Reduce errors The “Good”

 Workflows and prompts  Alerts  Tracking/Trending - QAPI  Audit “from your desk”  Point of Care Documentation  Decrease “filing” of paper records  Reduce “clutter at desk”  Transparency More “Good”

 Transparency  Standard data – change in process  Mobility – device type  Learning curve  Cost  IT support internal  IT support external  Change  Perception of families The “Bad”

 Perception of Management  Security of network  Security of devices  “Dirty data”  Interfaces  Nursing vs. Billing  Back up plan  “Not me” syndrome More “Bad”

 Server/Database  Cost  Maintenance  Flexibility  Custom reporting  Web or Cloud  Decreased Flexibility  Data retrieval  Decreased Cost  Maintenance Server/Database vs. Web or Cloud

 Key Stakeholder  Who are they?  How to get their input?  Budget  What is goal of stakeholders?  What is goal of “front line”?  Current Technology State  Growth Evaluation

 Initial costs  Maintenance costs  Support services  Training services  Hardware requirements  “Bells and whistles”  Server/Database  Web or Cloud Product

 Phased Approach  Phase 1 – MDS and Care Plan  Phase 2 – ADL documentation  Phase 3 – Clinical documentation  Phase 4 – CPOE and eMAR/eTAR  Phase 5 – Integration/data exchange Implementation

 People  Support from the Top down  Get their buy in  Stay positive in front of others  Process, process, process  “Software/computers” will NOT fix bad practices/process  Know and document current process  Document process change The “Keys” to Change

 Evaluate, Evaluate, Evaluate  Current state – BE HONEST  Current process – BE HONEST  What is company goal – BE REALISTIC  What is staff goal – Get their input, don’t guess  “Test run” of more than 1 potential application  Budget  “Deal breaker” vs. “Nice to have” Secrets to Success

 Plan, Plan, Plan  Dedicated project manager – not an “additional duty” and not the “decision maker”  Stages – phase 1, phase 2, phase 3  Identify “Super Stars”  Document process – not just clinical  Educate on process change in advance if possible  Update policies in advance if needed  Establish a “change board” or “decision board”  Key stakeholders  Establish deadlines and stick to them Secrets to Success

 Test, Test, Test and Train, Train, Train  Testing/training site  “Super stars” input  “Walk through”  Train the Trainer  Go Live within 2- 4 weeks of Training Secrets to Success

 Patience  More patience Secrets to Success

 Communication, Communication, Communication  Training dates  Go Live dates  Feedback to “change board”  Key contacts for Go Live  Key contacts post Go Live  Process documents  How to Guides Secrets to Success

 Follow up, Follow up, Follow up  Daily “checks” post Go Live  Follow up with staff  Discuss “Good” and “Bad”  Positive feedback first  “Kick off” party  “Graduation” party Secrets to Success

 Re-evaluate, Re-evaluate, Re-evaluate  What is working  What isn’t working  Is there a better way or process  Is this re-education  On going re-education  New employee training  Competency checklist Secrets to Success

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