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6/2/2010
1
LET’S TELL THE TRUTH ABOUT POINT-OF-CARE TECHNOLOGY
Tim RowanTim RowanEditor
Home Care Technology Report
Home Care Alliance of Massachusetts 2010 Spring ConferenceCo
nnec
t
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SWITCHING FROM PAPER TO Truth #1:
COMPUTERS HAS BOTH PROS AND CONS
THE PROS AND CONS OF POINT-OF-CARE
Plus side: Forces a much more
thorough assessment, increases accountability
Down side: Requires thorough,
carefully planned training. Requires investmentincreases accountability
Should lead to a more complete care plan
Reinforces the clinical-financial link
Provides management with more and better patient data
Requires investment Does not, nor has it ever
been intended to, increase clinician productivity.
Increases the size of the HIPAA risk if a theft or loss should occur.
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POINT-OF-CARE AUTOMATION Truth #2:
IS NOT ABOUT LAPTOP COMPUTERS
THE MANY FACES OF POINT-OF-CARE
Platforms: Laptop PC
Notebook PC
Tablet PC
Vendors:
Advanced Answers on Demand Allscripts AugustSystems CareAnyware CareCentric CareFactsCareKeeper CareVoyant CareWatch CernerCompliance & Billing Solutions ContinuLinkDataLogic Software Inc. Delta Health TechnologiesDial N Document Fastrack Health Care Systems
Netbook
PDA
Smartphone
Cell Phone
Patient’s Phone
Optical Mark Recognition Scanning
Dial N Document Fastrack Health Care SystemsFocal Point Systems Great Lakes MicroSystems,Inc. Hann's On Software Healthcare Automation IncHealthcare Synergy Healthcarefirst HealthMedXHealthWare HealthWyse Home Advantage HomeCare SOS Homecare Homebase HomecareInteractive Horizon Healthware Kinnser SoftwareLewis Inc. McKesson Meditech NDSI OMS2 ProcuraProData Professional Computer Consultants, Inc.Progresa Sandata Sansio Select Data StratisBusiness Systems Suncoast Solutions ThornberryLtd
TRUTH #3
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Point-of-Care systems do not, nor
have they ever been intended to, y ,
increase clinician productivity.
[AUDIENCE VOTE]Truth #4:
[ ]
TRUTH #4 = ?
An Analogy
What matters more?What matters more?A. Garmin brand?
B. TomTom brand?
C. Magellan brand?
D. Or…
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Arriving at your niece's wedding on time.
TRUTH #4 = ?
Another AnalogyWhat matters more?
A. Selecting between Dell and Fujitsu andA. Selecting between Dell and Fujitsu and Panasonic laptop PCs?
B. Selecting between Allscripts/Lewis/HealthWyse/Delta/etc.?
C. Or…
Patient improves, episode cost comes in under payment.
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IS THIS TRUTH #4?
Software is pretty much all the same.
Anything is better than paper.
Just find one you can afford.
OR IS THIS TRUTH #4?
BRAND SELECTION MATTERS
ALL SOFTWARE IS NOT CREATED EQUAL
“YOU HAVE ARRIVED AT YOUR DESTINATION”
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YES! BRAND MATTERSTruth #4:
REMEMBER THIS LIST?
Somewhere in here is the software company referenced in that letter.
Advanced Answers on Demand Allscripts August Systems CareAnywareCareCentric CareFacts CareKeeper CareVoyant CareWatch CernerCompliance & Billing Solutions DataLogic Software Inc. Delta HealthCo p a ce & g So ut o s ata og c So t a e c e ta ea tTechnologies Dial N Document Fastrack Health Care Systems FocalPoint Systems Great Lakes MicroSystems, Inc. Hann's On SoftwareHealthcare Automation Inc Healthcare Synergy HealthcarefirstHealthMedX HealthWare HealthWyse Home Advantage Home Care SOSHomecare Homebase Homecare Interactive Horizon Healthware KinnserSoftware Lewis Inc. McKesson Meditech NDSI Procura ProData Inc.Professional Computer Consultants, Inc. Progresa Sandata SansioSelect Data Stratis Business Systems Suncoast Solutions Thornberry
TRUTH #4, COROLLARY A:
Reproducing a paper form on a laptop
screen is not the point of point of carescreen is not the point of point-of-care
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TRUTH #4, COROLLARY B:
The purpose of point-of-care systems is to
make nursing practice better. Intelligent
software not only checks your OASIS
assessment for accuracy but uses it:
1) To build your plan of care
2) To prompt for the creation of complete
nursing notes at every visit
TRUTH #4, COROLLARY C:
Assessment accuracy trumps purchase price
1) How much does a PoC system cost if it helps
achieve 10% - 15% higher average payments?
2) How much does a PoC system save if it is
virtually unusable in the home?
TRUTH #4, COROLLARY D:
Accurate documentation provides
audit protection:
Care plans and visit notes that are built
directly on assessments are extremely
difficult for auditors to criticize.
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THE “POINT OF CARE” Truth #5:
IS LOCATED INSIDETHE PATIENT’S HOME
TWO CRITICAL REASONS NOT TO CHART AT HOME AFTER A
FULL DAY OF VISITS
1. The finite human memory
2. Computers in cars = HIPAA Security risk
TRUTH #5 – COROLLARY A
OASIS accuracy degrades by the minute from patient’s home to nurse’s home.p
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SIS Consistency Between Clinicians in a Training Settingmparison of 400 Class Attendees over Three Years
rage Decrease in Accuracy Among the Groupsument Imm2 Hours Post A4 Hours Post Assessment
93.0% 78.8% 62.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
93.0%
78.8%
62.0%
Document Immediately 2 Hours Post Assessment 4 Hours Post Assessment.0%
10.0%
20.0%
30.0%
40.0%
TRUTH #5 – COROLLARY B
On average, 80% - 90% of all automated OASIS corrections result in a higher payment. The typical “Medicare Discount” is 10% - 15%.
Source:
Acucare Health Strategies
Healthcare Systems Solutions (The Analyzer)
Home Health Gold
Outcome Concept Systems (OCS)
PPS Plus
Strategic Healthcare Programs (SHP)
MEDIOCRE DOCUMENTATION IS EXPENSIVE
80%
90%
100%
0%
10%
20%
30%
40%
50%
60%
70%
RHHI Standard Acceptable Battle Area Guaranteed Failure
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YOU ARE UNDER ATTACK
• RHHI• QIC• ALJ
• MAC• ZPIC• RAC
• FBI • DEA
The rate of attack is on the increase.
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H.E.A.T. STRIKE FORCE CITIES
March 2007 MiamiMay 2008 Los Angeles
December 2009 Baton Rouge Tampa Brooklyn Los Angeles
March 2009 DetroitNovember 2008 (covert)
May 2009 (revealed) Houston
Brooklyn
MANAGEMENT’S CONTRIBUTION TO POINT-OF-CARE DOCUMENTATION
Why do clinicians say they prefer not to bring a laptop into the home? Have you asked?
Too heavy Screen too small, too dim Short battery life Too long to boot up Barrier between me and patient Too slow to enter documentation
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TRUTH #5 - COROLLARY C
Laptop Thefts and HIPAA Headaches: Mobile PCs do get lost and stolen.
MISSING DATA COSTS
What does a breach of Protected Health Information cost a HIPAA Covered Entity?
Cash You must notify every affected patient
Cost of mailing alone can be astronomical
Reputation It will hit the newspapers
Referrals will be impacted
TWO APPROACHES
As in personal health maintenance, you must approach a potential security breach in two ways:
1. ___________________
2. ___________________
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PREVENTION
What are your agency’s written policies regarding company-owned equipment?
PC / PDA i d l l t it PCs / PDAs are insured, company replaces lost items
Company supplies one PC / PDA per person; employee replaces lost units
Two or three lost units is cause for dismissal
Other?
PREVENTION
Never leave it in the car, even at home If you must leave it in the car, hide it Computer bags that look like computer bags
are as attractive to thieves as exposedare as attractive to thieves as exposed laptops
CURE
Absolute Software’s “CompuTrace”
• www.absolute.comS ft k l hidd i BIOS• Software kernel hidden in BIOS
• GPS
• Auto-erase programs and data
• Reveal user IP address
• Versions for laptops, PDAs, smart phones
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CURE
Spatial Networks’ “Geodexy”www.geodexy.com
Automated Personnel Location with Emergency Distress Functionality• Any cell phone• Single button alerts up to 5 people• Constant GPS transmitter
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SKIMPING ON TRAINING Truth #6:
COSTS MANY TIMES MORE THAN IT SAVES
THE ACCURATE ASSESSMENT
Revenue matches cost of treating the patient Payment less likely to be denied
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Payment less likely to be denied Therapy frequency less like to be questioned Full supply reimbursement
Outcomes: paper matches reality
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INITIAL OVER-ASSESSMENT
Revenue exceeds cost of treating the patient Revenue exceeds what RHHI and CMS accept Therapy exceeds medical necessity
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Therapy exceeds medical necessity Full supply reimbursement Patient appears worse than s/he really is
Outcomes: you are working miracles, but only on paper
INITIAL UNDER-ASSESSMENT
Cost of treating the patient exceeds payment RHHI quietly allows you to keep underpayment Therapy provided may be inadequate for patient need
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Supply costs may exceed reimbursement Patient appears better than s/he really is
Outcomes: on paper, your services are making people worse
TRUTH #6 – COROLLARY A:CLINICAL PERFORMANCE AFFECTS FINANCIAL PERFORMANCE
Your Goals:
Q lit O t
Your vulnerabilities:
OASIS bj ti it
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Quality Outcomes Market Prominence Financial Stability Happy:
Payers Surveyors Patients
OASIS subjectivity Inadequate training Favorite Answers
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TRAINING’S IMPACT ON COSTS
Accurate OASIS Assessments:
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Visit count better matches payment Fraud accusations, denied payments: reduced Employee satisfaction: increased Employee turnover: decreased
TRAINING’S IMPACT ON REVENUE
Accurate OASIS Assessments:
Increased payment 80%-90% of the time
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Increased payment 80% 90% of the time Patient outcomes on paper match actual
outcomes Improved patient satisfaction Improved referral source satisfaction
TRUTH #6 – corollary BThe “Let’s all try harder” pep talk is the most popular and least effective strategy in the history of the world. Let’s see how well it has been working in home care by seeing what it has done for hospitalization rates.
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Hospitalization rates, March, 2006 – Sept. 2008:
Total Agencies:
6,830
Reduced hospitalization
Increased Hospitalization
Stayed the same
Number of agencies
3,247 2,700 883
Rate of change 4.1% 3.9% 0%
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HOW NOT TO TRAIN ADULT PROFESSIONALS
Shotgun Approach: Mandatory Saturday Workshop, Donuts Provided
Productivity issue: pulling clinicians out of the field Goodwill issue: wasting their time Efficiency issue: how to re-train absentees (and
there will always be some) Effectiveness: 95% of your staff is probably already
accurate 95% of the time
HOW TO TRAIN ADULT PROFESSIONALS
Ockham’s razor:Pluralitas non est ponenda sine necesitate
Identify individuals with: Bad habits Misunderstandings Favorite answer syndrome
Target train one clinician on one OASIS question 10-15 minutes Tremendous affect on your HHC averages
TO APPLY OCKHAM’S RAZOR
You Need To Know:
What to trainWhom to train
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Whom to train Whom to leave alone How often to train Whether your training is working How to adjust your training topics on the fly
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MANAGEMENT’S QUALITY ANALYSIS TOOLS
Goal:
Assessment performance and patient outcomes parsed by individual
Options: (in order of preference)
1. Use your current software application’s features:
a) Associate QA reviews with each clinicianparsed by individual
clinicianb) Track errors, deduce
misunderstandings and bad habits
2. Use your application with an interface to a 3rd-party OASIS / QI vendor
3. Use 3rd-party OASIS / QI vendor standalone
TRUTH #6 – COROLLARY C
If some can do it, all can do it.
If some, but not most, of your clinicians are near where they should be then you know it is possible to hit the mark you set.
Target your training programs toward those who need specific assistance with specific issues.
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TRUTH #6 – COROLLARY D
Managers: if it’s not them, it’s you.
Once you have drilled down and assessed each individual clinician’s documentation skills, and all of them have OASIS and other quality issues, honestly answer this question. Is your problem with: A – Your clinicians as individuals? B – Your agency’s operations, policies, and procedures?
If you find that no clinicians hit the mark, if the same issues are common to all of your clinicians, what do they all have in common?
You!
Be willing to examine agency operations.It might not be your clinicians. It might be you!
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LET’S TELL THE TRUTH ABOUT POINT-OF-CARE TECHNOLOGY
Tim RowanTim RowanEditor
Home Care Technology Report
Home Care Alliance of Massachusetts 2010 Spring ConferenceCo
nnec
t
Share
Innovate
