TechnologyandLearningintheHomeHealthCareSettingJUDITHARNESON,RN,MSPARTNERSHEALTHCAREATHOME

AnIntroductiontoPartnersHealthCareatHome• Establishedin2000withmerger

of27VNAs

• 800+employees(~500clinicians,80homehealthaides)

• 4branchoffices

• Averagedailycensus 3,700

• Annualadmissions 27,000

• Visitsperyear 470,000

PartnersHealthCare

Brigham&Women’s/FaulknerHospitals

MassachusettsGeneralHospital

NorthShoreMedicalCenter

Newton-WellesleyHealthCareSystem

PartnersContinuingCare

Brigham&Women’sHospital

Brigham&Women’sPhysiciansOrganization

FaulknerHospital

TheGeneralHospitalCorporation

MassachusettsGeneralPhysiciansOrganization

McLeanHospitalCorporation

TheMGHInstituteofHealthProfessions

MGHHealthServicesCorporation

NorthEndCommunityHealthCommittee

SalemHospitalNorthShoreChildren's

Hospital

UnionHospital

CharterProfessionalServicesCorporation

Newton-WellesleyHospital

NeWell MedicalDeliveryOrganization

NWHCharitableFoundation

SpauldingRehabilitationNetwork

• SpauldingRehabHospitalBoston

• SpauldingRehabHospitalCambridge

• SpauldingHospitalforContinuingMedicalCareCapeCod

• SpauldingNursingandTherapyCenterNorthEnd

• SpauldingNursingandTherapyCenterWestRoxbury

• SpauldingOutpatientCenters

PartnersHealthCareatHome

ClarkHouseatFoxHillVillage

DanaFarber/PartnersCancerCareTwoPhysiciansAppointed

byPartnersPartnersCommunityPhysician’s

Organization(PCPO)

Martha’sVineyardHospital

NantucketCottageHospital

CooleyDickinsonHospital

StaffLearningChallengesinHomeCare

• Workforcedispersedduringtheworkday;fieldcliniciansmaygodayswithoutgoingtoanoffice

• Tightproductivityexpectationsforfieldstaff(patientvisits/day),andsomealsohaveextensivedriving

• Impromptutrainingsessionsareoftenimpossible

• Evenscheduledsessionsrequireadditionaldriving,decreasedproductivity

• Lessface-to-faceinteractionwithmanagersandco-workersthaninafacility• Lessinformalknowledgetransmission

• Lessopportunityfortransmissionofnorms&expectations

TheHealthStreamLearningManagementSystem

LearningManagementSystems(LMS)permitremoteaccessviatheinternet,provideonlinelearningmodules,includetrackingandreportingfunctions

HealthStream istheLMSusedthroughoutthePartnersnetwork

TheHealthStreamLearningManagementSystemHealthStream istheLMSusedthroughoutthePartnersnetwork

Libraryoflearningmodules

• Widevarietyoftopics(clinical,safety,compliance,administrative)

• Foravarietyofaudiences(nurses,therapists,aides,officestaff,allemployees)

• MajorityareHealthStream-authored

• Somecreatedbyothervendors

• Somecreatedin-housebyPartnersstaff

UseofHealthStream inPartnersHealthCareatHome

Orientation

• Allnewemployeescomplete17standardmodulesduringtheirfirst90daysofemployment

• Fieldcliniciansalsocompleteanadditional16modulesnecessaryfortheirrole

AllNewEmployeesBackSafetyCorporateCompliance:AProactiveStanceCulturalCompetence:BackgroundandBenefitsCulturalCompetence:ProvidingCulturallyCompetentCareDiversityintheWorkplaceElectricalSafetyEmergencyPreparednessFireSafetyGeneralSafetyHandHygieneIdentifying&AssessingVictimsofChildAbuse&NeglectIdentifying&AssessingVictimsofDomesticAbuseIdentifying&AssessingVictimsofElderAbuse &NeglectInfectionControlSexualHarassmentintheWorkplaceWorkplaceViolencePHEHIPAA

NewCliniciansAdvanceDirectivesMedicalEthicsPatientRightsPersonalProtectiveEquipmentPreventingPatientFallsTuberculosisDrivingSafetyinHomeCareHomeCareBasicsHomeHealthCoveredServicesMedicationSafetyinHomeCareOASIS-C:RoombyRoomOASIS-C:BeyondtheBasicsRecipeforEffectiveDocumentationHomeCareofthePatientwithAdvancedHeartDisease:ManagementAdvancedPainManagementinHomeCareandHospice:AssessmentProfessionalBoundariesinHomeCare

Tocompleteallofthesemodulesrequiresalotoftime(modulesaverageanhoureach).

• Modulescanbedoneathomebutareconsideredworktime.

• In-personorientationclassesmayendat2or3.

• Daysinfieldwithpreceptormayhavedown-timefornewemployee.

• ManagersmayscheduleblocksoftimefornewemployeetofinishHealthStream assignment.

Particularchallengesnotedforhomehealthaides

UseofHealthStreaminPartnersHealthCareatHome

HealthStream maystillbeunder-utilizedforlearningoutsideoforientation,butuseisincreasing.

• Annualmandatorycompliancetraining

• Annual“ActiveShooter”video

• Updatesforcliniciansonimportantchangesmadetodocumentationsoftware

• Preparationforupcomingchangestoregulations

• Electiveorassignedlearningonclinicaltopics

UseofHealthStream inPartnersHealthCareatHome

OnlineLearningModules,TraditionalandBeyond

Instructionaldesignisarelativelynewbutmaturingfield.

Increasingattentiontotryingtomakee-learningeffective:

• Concrete

• Relevant

• Interactive

OnlineLearningModules,TraditionalandBeyond

“Gamification”

WithfundsfromtheCommonwealthCorporation,wedevelopedpalliativecaremodulesin-houseforusethroughoutPartnersContinuingCare

• Concrete – usecases(fictional,butrealistic)topresentcontent

• Relevant – informationandcasesaredirectedatanaudiencewhoworkinthepost-acutecaresetting(homecare,SNFs,LTACs,andinpatientrehab)

• Interactive – Eachtopichasatleastoneuserinteraction

OnlineLearningModules,TraditionalandBeyond

ACoupleofQuickSamples

http://zebr.as/2oiSTXw

http://zebr.as/2oqxzga“Preventing,Identifying,andManagingDelirium”

“WhatIsPalliativeCare”

TechnologyandLearningOutsideoftheLMS

• Webinars

• Smartphones

• Videotransmissionoftalkstodifferentoffices

• Startbuttonresources

• PartnersHandbook

InteractiveEducationalSessioninFourLocations

Start-ButtonResourcesPHH-Specific

• PracticeGuidelines

• DocumentationGuidelines

• PoliciesandProcedures

• MiscellaneousResources

Partners-Wide

• PartnersHandbook

UpToDateOnlinemedicalresource

Expertphysiciansineachfieldupdatearticlesregularlyasnewresearchcomesout.

Thereisalimited,freeversion,butPartnersHealthCareSystemhaspurchasedaccessforallofitsemployees.

Samplesituation:goingouttoadmitanewpatienttohomecare;referralpaperworklistsprimarydiagnosisashepatocellularcarcinoma

ChangingCultureGettingthetechnologyinplaceisonlythebeginning.Otherpiecesoftheprocesscomeevenslowerandharder.

• Imaginingwhatitpossible,notjustassumingthatwe’llkeepdoingwhatwe’vealwaysdone

• Accommodatingnewlearningapproachesintheflowofourworkday,workweeks

• Makinglearnersawareofopportunities

• Shiftinglearnerhabitsforseekinginformation