Healthcare Information Systems Management—Testing and Evaluation Session LT4, March 5, 2018 Gregory L Alexander PhD, RN, FAAN, Professor, University of Missouri, Sinclair School of Nursing Sue Shumate BS, RN, Health Information Coordinator, University of Missouri/Primaris

1 Conflict of Interest

Gregory L Alexander Phd, RN, FAAN

Sue Shumate BS, RN

Contracted Research: Center for Medicare and Medicaid Services, Innovations Center Missouri Quality Initiative for Nursing Homes, Grant #

2 Agenda

• MOQI Model • Systems Analysis Process • Developing Use Cases to Guide Implementation • Iterative Pilot Testing of Technology with Partners • Policy and Standards • Expected Benefits

3 Learning Objectives

• Define key differences between LTPAC and traditional healthcare provider organizations in the testing and evaluation of IT systems

• Summarize at least one insight an LTPAC provider gained from using analytics to guide their system testing and evaluation effort

• Identify CAHIMS testing and evaluation competencies LTPAC provider organizations should most closely watch

4 Please use blank slide if more space is required for charts, graphs, etc.

To remove background graphics, right click on selected slide, choose “Format Background” and check “Hide background graphics”.

Remember to delete this slide, if not needed. MOQI Primary Project Goals

• Reduce avoidable hospitalizations via four aspects of APRN Care Coordination 1. Condition management 2. Early illness detection 3. INTERACT 4. End-of-life/Advanced care planning

• AND integrate health information technology into patient care processes

6 2017 MOQI Project Goals

Reduce infections and hospitalizations related to infections through Systematically increase and enhance meaningful care educational opportunities provided to nursing homes conversations through advanced care planning

Increase use of IT bidirectional portals in all nursing homes 100% of nursing facilities’ adoption of secure communication tools for texting and e-mailing

Increase and sustain use of INTERACT tools at fully engaged level Develop and implement Quality Improvement process for guidelines of Phase 2 billable conditions

Develop and refine feedback reports to include Phase 2 billing Achieve and sustain the Phase 1 hospitalization rate below 1.10

7 HIT Intervention • Promote the use of healthcare information technology (HIT) to improve the care of patients and communication among team members • Pursue integration and interoperability of all aspects of technology solutions • Train team members and nursing home staff regarding use of technology and workflow • Lead evaluation of software/components to be used in technological solutions • Systematic Feedback Reports to Users

8 IT Staffing Champions and Super Users Chief Operations Officer Executive Assistant Chief Nursing Officer Managers (Regional or Local) Chief Clinical Officer Business Office Manager Senior Vice President Benefits Coordinator Executive Director/Director (Regional or Local) Central Supply Clinical Information Systems/Technology Customer Service Representative Nursing Transitional Care Education Information Technology Technicians Environmental Services Network Administrators Social Services Scheduling Coordinator Health Information Management Systems Analyst Campus Director Clinical Services Community Relations Minimum Data Set Coordinator Quality Management Regional Consultant Medical Records

9 Stakeholder Partnerships

HIE Mobile Services Training Hospice Project management Wound Provide feedback reports Radiology HIE Vendors Laboratory Manage Platforms Pharmacy Develop feedback Reports EMT and Paramedics Healthcare Facilities Medical Directors Office Nursing Homes SNF Technology consultants Administrators Professional Organizations and Societies Nursing staff Alzheimer’s Association Social Workers Quality Improvement Org. Patients Research Team Caregivers Policy Advocates and Evaluation EMR vendors CMS Hospitals RTI Administrators ONC Nursing staff Patients Caregivers EMR vendors

10 Polling Question • What is your primary organization and responsibility?

A. Administrator B. Medical Provider/Staff C. Technology Consultant/Vendor D. Policy Advocate

https://live.eventbase.com/polls?event=himss2018&polls=4311

11 Project Outcomes Achieve and sustain the hospitalization rate below 1.10

12 Key Results with RTI- Comparison Group • 40% reduction in all-cause hospitalizations and • 57.7% potentially avoidable hospitalizations reduced (p=.001); • 54.1% all cause ED visits reduction and • 65.3% potentially avoidable ED visits reduced (p=.001).

• 33.6% Medicare expenditures in all-cause reduced and • 45.2% in potentially avoidable hospitalizations (p= .001); • 50.2% Medicare expenditures in all-cause ED visits reduced and • 59.7% potentially avoidable ED visits reduced(p=.001).

Ingber, MJ, Feng, Z, Khatutsky, G, et al. Evaluation of the initiative to reduce avoidable hospitalizations among nursing facility residents: Annual report project year 4, February, 2017. Available at: https://innovation.cms.gov/Files/reports/irahnfr-finalyrfourevalrpt.pdf. Accessed April 14, 2017. Centers for Medicare and Medicaid Services. Medicare Hospital Quality13. HIE Milestones and Outcomes • 13 out of 16 NFs completed EHR implementation – All 16 homes expected to be live by end of June 2018

• 502 secure texting discussions involving MOQI APRN – All MOQI APRNs and 1/3 of NFs have secure texting

• 2,380 Direct Messages exchanged 4th quarter 2017

• 100% HIE Participation in nursing home facilities 14 Systems Analysis Process • Survey of NFs regarding technology infrastructure to develop NF capabilities list

• Evaluate technology for APRNs and NF capabilities – Laptops, phones, tablets, printer/scanners

• Worked with NFs and their corporate IT to iteratively test connectivity and remedy deficiencies

15 Expected Benefits – Connectivity to clinical support services » Pharmacy » Radiology » Laboratory » Hospice » Wound Care – User centered satisfaction surveys of technology – Tracking usage of HIE statistics

16 HIE Implementation Phase I • IT Readiness Assessment:

• Electronic Interfaces: – Direct “CareMail” and Bidirectional Portal “CareView”

• System Administrator

• Help Desk and Training 17 HIE Implementation Phase II: Use Case Development

18 HIE Implementation Phase III: User Feedback

Semi Help Desk Usability HIE Usage Training Structured Reports Surveys Reports Interviews Webinars

19 HIE Implementation Process Phase III

• Non Emergent – Scheduling appointments – Laboratory Specimen Drawing – Pharmacy Orders and Reconciliation – Social Work Discharge Planning – Admissions and Pre-Admissions – Pharmacy Medication Reconciliation

20 Non Emergent Use Case: Scheduling Appointments

21 Non Emergent Use Case Laboratory Specimen (Antibiotic Administration)

22 Non Emergent Use Case: Admissions and Pre-Admissions (Part 1)

23 Non Emergent Use Case: Admissions and Pre-Admissions (Part 2)

24 Polling Question • What Use Case is Highest Priority for Healthcare Partners

A. Lab Specimen Drawing B. Scheduling Appointments C. Pharmacy Reconciliation D. Admission and Pre-Admission

https://live.eventbase.com/polls?event=himss2018&polls=4312

25 Hospital and LTPAC Partnerships in HIE

Keep in mind: There are two sides to every story

26 Goals of Transition of Care • Safe transitions to post acute care levels • Improve communication between providers • Partnering to improve and reduce care transitions • Benefits of collaboration will include: – Decreased hospital length of stay and readmissions – Appropriate active case management – Decreased use of the emergency department – Appropriate utilization of resources and ancillary services – Improved patient and family satisfaction – Improve results of quality measures27 Discharge Paperwork for Acute Transfer 1. Face sheet (EMS needs) 2. Med rec 3. Rounding report 4. 3 days MD notes 5. Patient summary report 6. Advance directives/living will, if applicable 7. H&P (only for long distance transfers over 25 miles) 8. DA-124C (mandated for new patients) 9. Patient transfer form (MD orders/nursing patient functional assessment) 10.Physician certification statement (for ambulance transfer only) (EMS needs) 11.Transfer and authorization form (for hospital-based NH or ED transfer to 28 another hospital) Building Partnerships, Organizational Learning, and Collaboration Hospitals Nursing Homes EHR Vendors HIE Organizations

• Design Specifications – CCDs • Versions • Formatting • Blocked Transmissions • Opening Documents (user privileges) • Incompatible Browsers • Storage and Retrieval of Downloads 29 Challenges/Opportunities • Develop custom reports – Pull relevant PHI • Pulling data from multiple applications • Sending report takes multiple steps • Limited users for CareMail in hospital setting • Roll out new process to other hospitals after pilot

30 Potential Change(s) from Initiative Stakeholder (Groups) (n=49) Potential changes for Stakeholder Group(s) Impact (High, Medium, Low) Greater Access to Information Healthcare Facilities DON: Deep dive each admission High Addressing Errors Nursing Homes DON: True picture of admission High More Timeliness Administrators DON: Communicate findings with nurses and providers High Improved Accuracy Nursing staff DON: Inputs orders ahead of time High Build Network/Partner Opportunities Social Workers DON: Reviews order for correctness High Transfer of Information Patients Nursing: Using SBAR to communicate findings Medium Better Quality of Information Caregivers Administrator: Access to referral data Medium Increased Patient Satisfaction EMR vendors Administrator: Fact finding (e.g. diagnosis, equipment) High Increased Family Satisfaction Hospitals IT/Vendor Specialists: Assure information transfer High Correct Patient Information Administrators IT: Getting information to facility Medium Seamless Patient Transitions Nursing staff Please useIT: blank Process to assureslide data qualityif more Medium Reduced Stress and Harm to Client Patients Charge Nurse: Coordinates care with admissions coordinator Medium Problem Solving Caregivers space is requiredCharge Nurse: Provide for immediate charts, care High Legal and Fiscal Activities EMR vendors Charge Nurse: Ensure patient info., orders, meds input accurately High Collaboration graphs,Admissions Coord etc..: Gathers disperses information to correct areas High Early Identification Condition Change Unit Nurse: Stability to the unit Medium Greater Care Involvement To removePhysicians: background Faster graphics,feedback, clarification, authorization High Identification of Care Improvements Home Health Aide: Identifying chore duties for client Low Effectiveness of Care right clickSocial on Worker: selected Identify slide, equipment needs Low Regulatory Compliance choose “FormatSocial Background” Worker: Support, and buffer, check comfort when family drama occurs Medium Comprehensive Record Available “Hide backgroundSocial Worker: graphics Identifies solutions”. to problems Medium Keep Residents Healthy Social Worker: Notary work Low Navigating Healthcare Processes Social Services: Evaluation: Care planning and advance directives High Increased Accountability QM/QI Nurse: Review resident risks, prevent illness Medium Physician: Better understanding of hospice services Low Remember to deleteAdministrator: this slide, First contact if not (e.g.needed. hospital and families) High Social worker: communication with family and hospital High Restorative Aide: Consultation Low Physician: Involvement in challenging cases High Nurse Manager: Technology lead in EMR implementation Medium Executive Director: Document accurate resident evaluations High APRN: Sounding board for clinical questions High Director of Education: Professionalism, appropriate care Low Admissions Coordinator: Provide nursing with needed information High Care Consultants: Consultations with patients, families, physicians High Care Consultants: Maximizes use of encrypted IT/EHR Medium Nurse Manager: Double check Admit, proper coding and auditing Medium APRN: Change agent High APRN: Holistic view High Medical Advisor: Connections between physicians and staff Low Questions

• Gregory L Alexander PhD, RN Professor, University of Missouri MOQI HIT Lead

Sue Shumate BS, RN Primaris Health MOQI Health Information Coordinator

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