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HIT ToolkitVisioning and Strategic

Planning for HIT in

Home Health

Sponsors:


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Sponsored by Aging Services ofMinnesota and its subsidiary, AlliancePurchasing for use by home health

agencies in Minnesota

Produced by Stratis Health

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HIT Toolkit for Home Health


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Presenter Margret Amatayakul

RHIA, CHPS, CPHIT, CPEHR, FHIMSS

President, Margret\A Consulting, LLC

Schaumburg, IL

Independent consultant, who focuses on achieving value fromelectronic health records, HIPAA/HITECH, and health informationexchange. Developer of tools in Toolkit

Adjunct faculty College of St. Scholastica, Duluth, MN, mastersprogram in health informatics

Founder and former executive director Computer-based PatientRecord Institute, associate executive director AHIMA, associateprofessor University of Illinois

Active participant in standards development, former HIMSS BOD,and co-founder of and faculty for Health IT Certification

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Stratis Health

Stratis Health is a nonprofit organization that leadscollaboration and innovation in health care qualityand safety, and serves as a trusted expert infacilitating improvement for people and communities

Stratis Health works toward its mission throughinitiatives funded by federal and state governmentcontracts, and community and foundation grants,including serving as Minnesotas Medicare QualityImprovement Organization (QIO)

Stratis Health operates the Health InformationTechnology Services Center for health careorganizations seeking to use health informationtechnology in support of their clinical transformation


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Envision . . .

HIT vs. EHR vs. EMR

Purposes of EHR

Conceptual model of technical concepts

Data vs. information; repository vs.

warehouse

HIT to support home health functions Strategizing to progress toward the vision

Agenda


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Envision . . . Referral management that reduces hassles of

exchanging information for new patients

Field staff Guided in completing applicable assessments,

without repetition of data entry

Use easy-to-use tools to record visit information

Dashboard for clinicians and managers withalerts and key indicators, such as census,incidents, incomplete data, and quality

Support for exchange of information across thecontinuum of care

Physicians able to provide oversight, signorders electronically, and receivereimbursement records


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HIT vs. EHR

Health information technology (HIT): a general conceptthat describes the technology that supports management of healthinformation for many purposes

Electronic health record (EHR): is a specific set of

applications that provide an electronic record of health-related informationon an individual including patient demographic and clinical healthinformation, such as medical history and problem lists, and has capacity toprovide clinical decision support, support physician order entry, capture andquery information relevant to health care quality, and exchange electronichealth information with and integrate such information from other sources(Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009)

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.


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Encompasses broader view of a health record

moving fromnotion of a location for keeping track of patient care events to aresource with enhanced utility

Merely automating the form, content, and procedures of currentpatient records will perpetuate their deficiencies and will be

insufficient to meet emerging user needsInstitute of Medicine:

Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997

Longitudinal collection of electronic health information for and aboutpersons; immediate electronic access to person- and population-level information by authorized, and only authorized, users;

provision of knowledge and decision-support that enhance thequality, safety, and efficiency of patient care; and support of efficientprocesses for health care delivery

Key Capabilities of an Electronic Health Record System, 2003

EHR


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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, including in HITECH

Institute of Medicine (IOM)

Health Level Seven (HL7)

Primary organization to develop interoperability in health care informationsystems; adopts the term EHR system

Certification Commission for Healthcare InformationTechnology (CCHIT)

EHRvs. EMR


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Purposes of EHR Improve quality of care: data availability, links to knowledge sources

Enhance patient safety: context-sensitive reminders/alerts, clinical decisionsupport, automated surveillance, disease management, drug/device recall

Support health maintenance: preventive care and wellness - patientreminders, 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

Reduce hassle factors: improve satisfaction for clinicians, consumers, andcaregivers - 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, accountabilityreporting/outcomes measures, contract management

Support predictive modeling: contribute to development of evidence-basedhealth care guidance

Maintain patient confidentiality: as health information is securelyexchanged among all stakeholders, including across the continuum of careand with individuals


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Technical Concepts

CDR

CDS

EMAR

Human-computerinterface

Processor

Operations

BillingCharges

Storage

LIS

O/E

POCCDWOASIS

MD

Human-computerinterface

CCR/

CCDPHR

Scanning


HIE

RIS

R-ADT/

Census

P.H.

MSW

DME


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Glossary of Terms

CCR/CCD Continuity of care record/document standard data content/transmission to send for referrals

CDR Clinical data repository database optimized for processing patient transactions, e.g., posting vital signs

CDSS Clinical decision support system software that processes discrete data according to logical rules toprovide reminders and alerts

CDW Clinical data warehouse database optimized for translational data analysis, e.g., data mining

CPOE Computerized provider order entry system that provides CDS at the point of order entry

Discrete (or structured) data = individual values of data that are entered via templates and which are computable; e.g., patientblood pressure; lab result; name of medication; in contrast to unstructured scanned images, narrative notes, dictation

EDMS Electronic document management system document imaging, email, efax, and other digital document

(e.g., dictation) storage and retrieval

E-MAR/BC-MAR Electronic medication administration record (forms)/bar-code MAR for positive patient identification

eRx Electronic prescribing system supports drug selection & transmits prescription to retail pharmacy

Human computer interface = data entry devices, such as workstations, tablets, slates, speech recognition, personal digitalassistants (PDAs), and smart phones

LIS Laboratory information system that manages operations of a clinical laboratory

O/E Order entry system used by nursing staff to transcribe handwritten orders

PACS Picture archiving and communication system for x-rays and other clinical images

POC Charting Clinical documentation at the point of care, using clinical practice guidelines/critical pathways and CDS

PHR Personal health record patient contributed data in many forms

PMS/HIS/PFS Practice management system/Hospital information system/patient financial services applications foroperations, e.g., scheduling, admitting, billing, etc.

RIS Radiology information system that manages operations of a radiology department

HIT Toolkit



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Data vs. InformationCDR vs. CDW

H&P

Patient ID

Height

Weight

Labs

Patient ID

Test

Result

Orders

Patient ID

Drug

Dose

Data

Warehouse

Pt1 ht

wtdose

outcome

Pt2 ht

wt

dose

X% Outcome

Structured data for

Analytical Processing

and Data Mining

Structured data

to provide

clinical decision support

Patient ID +Lab Test

Height

Weight Drug & Dose

Data Repository

DKB

+ Result


Alert

Unstructured

informationinformation


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Home Health Functions

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Strategies for HIT

Do you consider a migration path?

To acquire product, do you build upon your

existing vendor, add to, or rip and replace? How do you participate in a corporate-wide

roll out of EHR?

How do you gain user adoption and achieve

your goals? What are the risks?


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Migration PathTimeline Current Phase I Phase II Phase N

Goals

Applications:

- Financial/

Administrative

- Operational- Clinical

Technology

- Database

- Network &

Infrastructure

- Interfaces

Operations

- People

- Policy

- Process


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Potential Paths

1. Non-clinical systems, e.g., email, schedulingsystem first

2. Scanning system for paperless environment

(perhaps or not at all)3. Web-based, on-demand products for OASIS data

capture

4. EHR phased in by modules, e.g., integratedOASIS assessment, visit documentation, EMAR or

BC-MAR, patient report card5. Participation in a health information exchange

(HIE) organization


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Acquisition Strategies

Build upon your existing product financial/administrative system

Determine if your incumbent vendor offers an EHR component and

include in mix of vendors to consider

If your incumbent system does not have an EHR, your choices are

to add or replace

Adding to your existing financial/administrative system with a

different EHR product means:

You may get a more clinically-oriented product

You will require an interface (requiring HL7 compliance)

Replacing your existing financial/ administrative system may

seem like an extraordinary expense, but . . . May be the only alternative (other than sneaker-ware)

Could provide ROI benefits sufficient to overcome cost differential

as many vendors are integrating products so incremental cost is

very low


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Corporate Roll-Out

Corporate roll-outs do not give individualfacilities much options, but . . . If a corporation is in the process of selection, join its

selection committee

Evaluate products against your real-life experience

In addition . . . Your agency may need modifications to whatever

product is acquired, so review product thoroughly

Your agency will have to address work flow andprocess changes, training, introduction to patientsand physicians, optimization strategies for effectiveuse


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Gain User Adoption EHRs are new for everyone, so engage

everyone in understanding the EHR project Learn together

Set goals together

Start using the computer together Find drug information online Review practice guidelines online

Find information for clients online

Encourage clients to get a PHR online

Study work flows and processes as performed todayto share ah ha moments

Reassure everyone that this is a joint effort


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Mitigating Risk Build a team of field staff who meet virtually to discuss

EHR

Create a communication plan and communicate earlyand often

Engage a physician champion who can guide andsupport

Evaluate remote connectivity With physicians (but monitor physician attendance in facility)

With hospitals for referral management

Contact local surveyors and make the case for EHRs

with them Get their commitment to support your EHR efforts

Find Web sites that will help your staff learn aboutcomputers and gain computer skills


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Plan Before Acting

Follow the HIT Toolkit for Home Health 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 ofcare with clients and their families as a key part of the roadmap


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Contact:

Stratis Health

2901 Metro Dr., Suite 400Bloomington, MN 55425

952-854-3306

1-877

-787

-2847

(toll free)www.stratishealth.org

For More Support

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Documents

1.1Visioning_and_Strategic_Planning_000