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The Value of HIE to Prevent Avoidable Hospitalizations in - - PowerPoint PPT Presentation
The Value of HIE to Prevent Avoidable Hospitalizations in - - PowerPoint PPT Presentation
The Value of HIE to Prevent Avoidable Hospitalizations in Post-Acute Care- The MOQI Model February 6, 2018 Nursing Informatics Symposium Demonstrate Nursing Value through Health Information and Technology Monday, March 5 l 8:00am-4:30pm PT
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Demonstrate Nursing Value through Health Information and Technology
Monday, March 5 l 8:00am-4:30pm PT
Learning Objectives:
- Discuss how to reduce clinician burden with effective and efficient
documentation
- Explore how nurses can use predictive analytics to drive value
- Outline innovative uses of telehealth and how it affects care coordination
- Explore how to manage a cyberattack from an operational perspective
- Share best practices and engage and network with colleagues
Nursing Informatics Symposium
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Nursing Impact on Quality Care Delivery
Wednesday, March 7 l 4:00pm-5:00pm PT
Reception to follow immediately 5:00pm-6:00pm PT
Speakers: Nancy Beale, Vice President, Clinical Systems and Integration, NYU Langone Health Marie (Kim) Jordan, Senior Vice President, Patient Care Services & CNO, Lehigh Valley Health Network Michelle R. Troseth, Co-Founder, MissingLogic, LLC, President, National Academies of Practice
New at HIMSS18: Nursing Informatics Roundtable & Reception
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Gregory L. Alexander PhD, RN Professor, University of Missouri MOQI HIT Lead Sue Shumate BS, RN Primaris Health MOQI Health Information Coordinator
Speakers
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Objectives
- Recognize critical stakeholders in an HIE network in a post-acute nursing
home setting to prevent avoidable hospitalizations
- Describe value propositions for stakeholders in an HIE network in post-acute
care nursing homes
- Identify processes of care crucial for achieving value propositions in an HIE
network to prevent avoidable hospitalizations
- State potential solutions to common barriers to HIE in post-acute care
- Construct some strategies using health IT in care delivery to help attain value
propositions and prevent avoidable hospitalizations
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- Introduction of Missouri Quality Improvement Model
- Goals of MOQI Project
- Implementation Process
- Use Cases
- Stakeholder Analysis
- Strategies for Health IT adoption
Presentation Outline
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MOQI Model
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- Reduce avoidable hospital transfers via four aspects
- f APRN Care Coordination
- 1. Condition management
- 2. Early illness detection
- 3. INTERACT
- 4. End-of-life/Advanced care planning
- AND integrating health information technology
into patient care processes
MOQI Project Goals
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- 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
Health Information Technology Intervention
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- IT Readiness Assessment
– HIT assessment; provide homes with scanners, computers and other IT equipment
- Electronic Interfaces
– 220 mailboxes
- (DON, Nursing Staff, Social Services, APRN/Medical Directors)
- System Administrator
– Identify-proofed, key staff are identified and assigned mailboxes
- Help Desk and Training
MHC CareMail Implementation Process: Phase One
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- Work Flow Observations
– Focused on behaviors associated with communication and documentation strategies
- Identify NON-EMERGENT Use Cases for HIE Use
– Scheduling appointments – Laboratory specimen drawing – Pharmacy orders and reconciliation – Social Work discharge planning – Admissions and pre-admissions – Pharmacy medication reconciliation
Appl Clin Inform 2015; 6: 248–266 http://dx.doi.org/10.4338/ACI-2014-12-RA-0113
MHC CareMail Implementation Process: Phase Two
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Non Emergent Use Case: Scheduling Appointments
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Non Emergent Use Case Laboratory Specimen (Antibiotic Administration)
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Non Emergent Use Case: Admissions and Pre-Admissions (Part 1)
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Non Emergent Use Case: Admissions and Pre-Admissions (Part 2)
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- Maintenance and Ongoing Training
– Semi-structure interviews: validated six use cases – Help desk reports – Usability survey – HIE e-mail use reports – Ongoing webinars – Building user network
MHC CareMail Implementation Process: Phase Three
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Building Stakeholder Engagement
- St. Louis Regional LTPAC Technology Summit
October 2017
Time Activity Topic 9:00am – 9:15am Welcome Who and Why: Teams for today 9:15am – 10:30am Session 1 What are our value propositions? 10:45am – 12 noon Session 2 What processes of care help achieve our value? 12:30pm – 1:45pm Session 3 How does health technology contribute? 2:00pm – 3:15pm Session 4 What strategies can we apply to successfully achieve our value? 3:15pm – 3:30pm Wrap-Up Let’s continue as teams for tomorrow
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Stakeholder Feedback on MOQI Outcomes: Change in Hospitalization Rates
- 10 of 16 facilities had reductions in hospital
admissions
- Lots of variability
– Simply noise – Don’t over compensate – Shift in outcome – Multiple causes? “Trying harder” is not sustainable – Shift in process – A new normal
- Process Changes
– APNs on site – Review all hospitalizations for root cause – Address causes Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative Marilyn J. Rantz, Lori Popejoy, Amy Vogelsmeier, Colleen Galambos, Greg Alexander, Marcia Flesner, Charles Crecelius, Bin Ge, Gregory Petroski http://dx.doi.org/10.1016/j.jamda.2017.05.027
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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 Quality.
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Stakeholder Engagement
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Potential Changes from Initiative Healthcare Facility Staff
Potential Change(s) from Initiative Stakeholder (Groups) (n=49) Potential changes for Stakeholder Group(s) Impact (High, Medium, Low)
Greater Access to Information Addressing Errors More Timeliness Improv ed Accuracy Build Network/Partner Opportunities Transf er of Information Better Quality of Information Increased Patient Satisfaction Increased Family Satisfaction Correct Patient Information Seamless Patient Transitions Reduced Stress and Harm to Client Problem Solv ing Legal and Fiscal Activities Collaboration Early Identification Condition Change Greater Care Involvement Identif ication of Care Improvements Ef f ectiveness of Care Regulatory Compliance Comprehensive Record Available Keep Residents Healthy Nav igating Healthcare Processes Increased Accountability Healthcare Facilities Nursing Homes Administrators Nursing staff Social Workers Patients Caregiv ers EMR v endors Hospitals Administrators Nursing staff Patients Caregiv ers EMR v endors DON: Deep dive each admission DON: True picture of admission DON: Communicate findings with nurses and providers DON: Inputs orders ahead of time DON: Reviews order for correctness Nursing: Using SBAR to communicate findings Administrator: Access to referral data Administrator: Fact finding (e.g. diagnosis, equipment) IT/Vendor Specialists: Assure information transfer IT: Getting inf ormation to facility IT: Process to assure data quality Charge Nurse: Coordinates care with admissions coordinator Charge Nurse: Provide immediate care Charge Nurse: Ensure patient info., orders, meds input accurately Admissions Coord.: Gathers disperses information to correct areas Unit Nurse: Stability to the unit Phy sicians: Faster feedback, clarification, authorization Home Health Aide: Identifying chore duties for client Social Worker: Identify equipment needs Social Worker: Support, buffer, comfort when family drama occurs Social Worker: Identifies solutions to problems Social Worker: Notary work Social Serv ices: Evaluation: Care planning and advance directives QM/QI Nurse: Review resident risks, prevent illness Phy sician: Better understanding of hospice services Administrator: First contact (e.g. hospital and families) Social worker: communication with family and hospital Restorative Aide: Consultation Phy sician: Involvement in challenging cases Nurse Manager: Technology lead in EMR implementation Executive Director: Document accurate resident evaluations APRN: Sounding board for clinical questions Director of Education: Professionalism, appropriate care Admissions Coordinator: Provide nursing with needed information Care Consultants: Consultations with patients, families, physicians Care Consultants: Maximizes use of encrypted IT/EHR Nurse Manager: Double check Admit, proper coding and auditing APRN: Change agent APRN: Holistic view Medical Adv isor: Connections between physicians and staff High High High High High Medium Medium High High Medium Medium Medium High High High Medium High Low Low Medium Medium Low High Medium Low High High Low High Medium High High Low High High Medium Medium High High Low
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- Reviewing CCD content and structure with each
stakeholder
- Ensuring hospitals updated directory with NF direct
addresses
- Creating Direct addresses for NF staff
- Training NF staff on accessing CCD
- Launching bi-directional CCD pilot
Strategies for Using Health Information Technology
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HIE CCD Example—hospital
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HIE CCD Example—Nursing Facility
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HIE CCD Example—Nursing Facility
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- Conducted Pilot: Delmar Gardens North to Christian NE Hospital
– Christian NE utilized EHR with no integrated Direct messaging – Delmar Gardens North not yet live with EHR
- Scanned transfer documents
– Paper transfer packet still sent with EMS
Testing Exchange with Partial EHR Systems
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- Conducted Pilot: Festus Manor to Jefferson Mercy Hospital
– Jefferson Mercy utilizes EHR with integrated HIE – Festus Manor utilizes EHR with no integrated Direct messaging
- Web based Direct Messaging--CareMail
– Paper transfer packet still sent with EMS
Testing Exchange with Complete EHR Systems
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Questions
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