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Choosing and Implementing an Electronic Nursing Information System in a Home Health Organization

Choosing and Implementing an Electronic Nursing Information System in a Home Health Organization. Michael Lees, M.D. OHSU BMI 512 Winter 2008.

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Choosing and Implementing an Electronic Nursing Information System in a Home Health Organization

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  1. Choosing and Implementingan Electronic Nursing Information Systemin a Home Health Organization Michael Lees, M.D. OHSU BMI 512 Winter 2008

  2. “Making strides in the clinical documentation process can result in significantly faster billing and more complete reimbursement for Healthcare facilities…To maximize reimbursement, a facility’s clinical documentation must be fast, accurate, and thorough.” (Rehm 2007 p. 8) Why convert to an electronic nursing information system? A Guideline for Implementing an electronic Nursing Information System (NIS)

  3. Choosing a vendor and Implementation of a electronic NIS • Purpose of the Project: • To implement an electronic Nursing Information System to show measurable improvement in the quality of patient care as reflected in standard quality indicators and to improve reimbursement from third party payers by: • Improving Accuracy of Documentation • Improving Completeness of Documentation • Decreasing Time to Finish Documentation

  4. Traits of a successful project • One project managers who manages the team • Executive support and sponsorship • Objectives are well defined • Project is on time and budget • Team commitment and cohesiveness • No conflicts with other projects or resources • The project is fun (Brady 2000)

  5. An Overview of the Scope of the Project System Implementation Strategy (Brady 2000, p35) 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  6. System Implementation Strategy (Brady 2000, p35) 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  7. All stakeholders need to be represented at all stages of planning and preparing for the eventual use of the NIS {Nurses, Physical Therapists, Occupational Therapists, Social Workers, Administration, Clerical Workers} (Fullerton 2006) The Clinical Champion “This individual has to be willing to put in a lot of extra, typically uncompensated, hours doing research and management tasks.” (Adler 2005 p2)

  8. System Implementation Strategy (Brady 2000, p35) 2 Clarify your goals 1 Identify your decision makers. 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  9. Consider the expected results from and requirements for a Nursing Information System

  10. Referral Source (Hospital, physician’s office) Intake- Obtains and records Demographics, Diagnosis, Orders Obtain H&P, Consultations, Operative notes, Lab and test results, Discharge summary for the main chart Review of intake data Appropriate Referral Referral denied and referral source notified No Yes Shadow chart created at home office for filing of loose papers Referral accepted and sent to scheduler for assignment based on territory and service Scheduler sends voice mail to appropriate providers Providers check voice mail Primary Service- Opens Case Provider drivesto home office *** Secondary service- Start of care Providers gather required documents and supplies from office Provider attempts to verify orders with referring source if unclear Providers gather copies of medical records obtained at intake Provider drives to patient’s location Provider gathers required and appropriate clinical information during evaluation of the patient Information recorded on proper forms- may occur at the point-of-contact or later in the day Provider attempts to contact referring physician if a change in patient condition or if plan of care needs to be modified Providerdrivesto home office to submit forms to be filed in the patient’s chart Completed chart on file Provider responsible for missing or incomplete forms is sent voice mail Chart reviewed for completeness Provider responsible for missing or incomplete formsdrives to home office to correct the deficiency Missing or incomplete forms present Billing claims submitted from completed chart Provider checks voice mail and learns of deficiency

  11. System Implementation Strategy (Brady 2000, p35) 3 Write a request for proposal 1 Identify your decision makers. 2 Clarify your goals 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  12. REQUEST FOR PROPOSAL (RFP) OUTLINE A request for proposal that follows an outline like the one below will tell prospective vendors what they need to know about your practice to provide you with useful information about their products, and it will help to ensure that the responses you receive can be more easily compared. I. Cover letter II. Introduction and selection process III. Background information about your practice a. Size and location b. Current practice management system and any EHRs c. Current computer hardware d. Current network information IV. Your practice's desired EHR functionality (prioritized) V. Vendor information a. Company history b. Number of employees (separate numbers for sales, support, research and development, and management) c. Financial statements d. History of their EHR product e. List of all current EHR users and list of users similar to your practice in size and type (including how long they've been using the software and, ideally, what version they're using currently) VI. Product description a. How it performs the functions described in section IV b. Other functions it performs c. Product brochures, etc. d. Software versions and release dates VII. Hardware and network requirements VIII. Customer maintenance and support IX. Vendor training X. Implementation plan XI. Interface history and capabilities XII. Proposed costs and payment schedule XIII. Warranties XIV. Sample contract http://www.aafp.org/online/en/home/publications/journals/fpm/fpmtoolbox.printerview.html

  13. System Implementation Strategy (Brady 2000, p35) 4 Selecting the RFP recipients 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  14. Where to find prospective Nursing Information Vendors 1. Literature, trade shows, and Internet search; 2. Initial site reference calls and visits secured through informal networking or a literature search; 3. Development of a request for information (RFI); 4. market analysis; 5. Development of a request for proposals (RFP); 6. Initial product demonstrations; 7. Development of vendor and product requirements against which the various products can be compared and scored; 8. Reference calls; site visits to organizations that have experience with the product, talking with both information technology personnel and end users. Rosebaugh (2004 p232)

  15. System Implementation Strategy (Brady 2000, p35) 5 Review the RFPs and narrow the field 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  16. Resources for evaluation of electronic health records systems • http://www.rheumatology.org/products/coding/03emr_ack.asp • 2. http://www.himss.org • 3. http://www.elmr-electronic-medical-records-emr.com • 4. http://www.medrecinst.com/conferences/tepr/index.asp • 5. http://www.centerforhit.org • Adler (2005)

  17. System Implementation Strategy (Brady 2000, p35) 6 Attend vendor demonstrations 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  18. EHR DEMONSTRATION RATING FORM You can download a PDF version of this form. 76 year old female discharged from hospital after exacerbation of congestive heart failure. History of diabetes, hypertension, coronary artery disease status post drug eluting stents, ischemic cardiomyopathy, and atrial fibrillation. Medications include metoprolol xl 50mg once daily, coumadin 5mg once daily, lisinopril 20mg twice daily, insulin 70/30 30 units before the morning meal and 20 units before the evening meal, clopidogrel 75mg once daily, furosemide 80mg once in the morning http://www.aafp.org/fpm/20050200/55howt.html#box_b

  19. Provider usage What percent of your providers use the EHR? What functions do most/all of your providers use? Do your providers still dictate? What has been the most frustrating thing about the EHR for the providers? What has been the best thing? How much individual physician customization is there? Are you happy with the templates? Were they pre-loaded? How do they get modified? Have you saved money? Have you broken even? Does electronic prescribing work? Does e-faxing work? How have patients responded to the system? Can your physicians access the system from home? How do they do this? Implementation & hardware Did the implementation go smoothly? How long did it take? Do you have a wide area network (WAN)? How much bandwidth is used? Was the EHR preloaded with CPT and ICD-9 codes? Was it preloaded with formularies? What hardware do the physicians use? What hardware do the medical assistants use? If you are using a wireless network, how well does it work? How much of the paper chart did you scan or input into the EHR? How did you do it? Do you still use paper? If paperless, how long did that take? Background How many physicians/nurse practitioners/physician assistants are in your group? How many office sites do you have? What year did you go live? What practice management software do you use? How many interfaces do you have with the EHR? Training & support How long does it take a physician to become fully trained/efficient in using the EHR? How long does it take a medical assistant to be trained? What kind of support system did you set up for the EHR? How many full-time support people are required? Have you been happy with the upgrades and support? Do you have an EHR committee? An IT medical director? Are physician “champions” involved in the maintenance, training and upgrading of your EHR? Satisfaction Would you buy this system again? What would you do differently? System Implementation Strategy (Brady 2000, p35) 7 Check references 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  20. System Implementation Strategy (Brady 2000, p35) 8 Rank the vendors 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  21. System Implementation Strategy (Brady 2000, p35) 9 Conduct site visits 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  22. System Implementation Strategy (Brady 2000, p35) 10 Select a finalist 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  23. System Implementation Strategy (Brady 2000, p35) 11 Solidify organizational commitment 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 12 Negotiate a contract Adler 2005

  24. What is duration of contract What occurs when contract ends What role will the vendor have Request that the vendor’s source code be placed in escrow Clarify circumstances of access to the code Consider using a lawyer with software contract experience System Implementation Strategy (Brady 2000, p35) 12 Negotiate a contract 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment Adler 2005

  25. Roll out the new system System Implementation Strategy (Brady 2000, p35) 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  26. Roll out the new system System Implementation Strategy (Brady 2000, p35) 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  27. Roll out the new system System Implementation Strategy (Brady 2000, p35) 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 5 Review the RFPs and narrow the field 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract Adler 2005

  28. Closing Thoughts Choosing and implementing a Nursing Information System to convert a paper-based patient record to an electronic one is a time consuming task. Methodically working through the process is important to the ultimate success of the project. Having the right people involved to not only to help select but also to promote the system is a proven benefit. (Fullerton 2006) System Implementation Strategy (Brady 2000, p35) “To thrive, a home care agency must see automation as an opportunity…” (Rosebaugh 2004 p. 228) 1 Identify your decision makers. 2 Clarify your goals 3 Write a request for proposal 4 Selecting the RFP recipients 6 Attend vendor demonstrations 7 Check references 8 Rank the vendors 9 Conduct site visits 10 Select a finalist 11 Solidify organizational commitment 12 Negotiate a contract 5 Review the RFPs and narrow the field Adler 2005

  29. References: (Adler 2005) Kenneth G. Adler, MD, MMM, How to select an Electronic Health Record System, Family Practice Management, February 2005 Vol.12, No2 http://www.aafp.org/fpm/20050200/55howt.html (Baron 2005) Richard J. Baron, M.D., Electronic Health Records: Just around the Corner? Or Over the Cliff? Ann Inter Med. 2005:143:222-226 (Brady 2000) Maureen Brady, RN, MBA (2000) Clinical Informatics Chicago, IL Healthcare Information and Management Systems Society (Fullerton 2006) Cliff Fullerton, MD, Lessons learned from pilot site implementation of an ambulatory electronic health record Proc (Bayl Univ Med Cent) 2006; 19:303-310 (Rehm 2007) Christopher Rehm, MD, Making Billing Strides by Improving Clinical Documentation For The RecordJune 11, 2007Vol. 19 No. 12 P. 8 http://www.fortherecordmag.com/archives/ftr_06112007p8.shtml (Rowley 2005) Robert Rowley, MD, Practicing Without Paper Charts: One Clinic’s Experience Family Practice Management, February 2005 (Rosebaugh 2004) David L. Rosebaugh, BS, MURP Getting Ready for the Software in Your Future Home Health Care Management & Practice/ April 2004 / Volume 16, Number 3, 228-234 DOI: 10.1177/1084822303259877 http://hhc.sagepub.com.liboff.ohsu.edu/cgi/reprint/16/3/228

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