Development of Home Health Care Solution Using

EHRSamir Sawli, CPHIMS,RN

Designing and building a Home Health Care solution using EHR is a unique project which will entail the following phases

Introduction

Planning Execution Closure

Main modules to be developed Actionable Dash Board to enable quick access

and actions on the go The dashboard must be mobile view compatible Orders & Results to support automated Computer

Physician Order Entry for all care related orders Pre-completed notes to facilitate more time

efficient documentation Electronic Immunizations record Additional modules to support electronic

prescription, standardized coding and referalls.

Solution Proposed, EHR

Strategic Objective

Incidence and Stats

International Standards

Business Requirements

Planning phase starts with a full review of the need of the project taking into consideration the following factors:

Strategic importance of this service for your organization, and how it fits within the strategy of health care plans of your country.

Incidence and statistics of home health patients identified by existing health care providers governmental and private.

Identifying and review of international standards of Home Health care example Joint Commission International (JCI).

Understand and review your local business requirements which includes the unit structure and operation needs( how many beds, clinics, appointment slots, slot duration for new case and follow up, staff requirements, management of information, access security and reports, staffing model

1. Planning

Write Project Charter which includes Project Plan Identify stake holders including physicians, nurses, IT analysts and

training support staff. Identify councils needed to provide input to the project including clinical

user council, electronic documentation council, orders and clinical decision support councils.

Identify design and implementation team writing terms of reference, meeting frequency, quorum and decision making mechanism.

Communication and status report plan Risks Issues Cost Deliverables Interfaces Requirements capturing through interviews and literature, then

analyzing the requirements, identify gaps, system analysis, architecture deign, workflow diagrams, interface requirements, interoperability, device connectivity,

Project Planning

Project ExecutionExecution

Design

Build

Test

Train

Go live

1. Design This stage involves the documentation of the

development of a solution to the new system. A prototype may be used to help clarify the solution to the participant. System design tools can also be used to explain the solution, for example; context diagrams, data flow diagrams, decision trees, decision tables, data dictionaries, storyboards.

2. Build: This stage involves the acquisition of information technology and making it operational. Additionally, decisions are made on how the new system will be implemented. An implementation plan is developed setting out clearly: support for the participants of the new system through training,

3. Test, include unit testing, integration testing for 2 cycles using test scripts to capture faults, issues and flow. HP ALM tools can be used to facilitate this process

4. Training involves, curriculum design, e-learning content, classroom plan and user manuals. This phase must enhance user adoption and change management

5. Go live includes: conversion, user support, issue logging and fix mechanism as well as maintenance and updates

Design Considerations for EHR Setup design workshops with the design teams

Setup Health care providers access roles and policies taking into consideration who can view and do what within the CIS system

Review EHR security access policies as such patients must have strict EHR access

Design charting forms to be used by providers and referral specialists

Design and plan decision support into CPOE module as such patients may be put on Psychotropic medications. The objective of decision support is to promote patient safety using rules and alerts.

Design advanced directives and consents taking into consideration that such patients might be unable to make care related decisions.

Design care giver forms taking into consideration that such patients have a family care provider partnering with Sidra care teams

Design order care sets to ease placement of orders based on evidence based practice and clinical pathways

User interface, must be user friendly Rules enabled decision support orders must be

employed to maintain patient safety against “e-Iatrogenesis” refer to harm introduced as a result of conversion to electronic records.

interoperability, we refer to the ability to communicate and exchange data among different systems with precision and accuracy. Interoperability includes referrals, continuity of care documentation, e-prescription, and PACS

Build Interface using interoperability methodologies

Build Considerations

E-learning curriculum development Classroom with at the elbow roamers curriculum Computer Based Training Development of train domain and training scenarios

along with associated data and results Simulation of integrated care approach role based

training Provision of manuals and on page help files Training of instructors Super user training User adoption workshops Apply Change management strategies Plan for on the unit support and through IT support

Training Considerations

Access to the system from remote location and on the go using mobile and static devices

Privacy and Security of information, using security token or vpn is common for portal access from outside

Development of Prototype, then trialing it for 6 month Partnering with patient and family care provider is a must Tele Communication using electronic and mobile devices Collaboration with local authorities to streamline communication,

connectivity, safety and continuity of care Telecommunication Local health care centers Paramedics

Equipment tracking: equipment may be used on patients at home example IV pump, how to connect and track the equipment?.

Close the loop of referral specifically notification of the consultant.

Key Factors To Be taken Into Consideration

Complete closure documentation Measure ROI in terms of process

improvement, patient and user satisfaction Measure Quality of solution provided,

incidence reports, medical errors avoided

Project Closure

Questions or comments are welcomed

Thank youssawli@yahoo.com