Summary
Goals: Seeking an opportunity in administrative healthcare where I can utilize what I have learned through education and life-long experiences.
I would like to use knowledge of healthcare management, health law, leadership in healthcare administration, medical care organization, and public healthcare policy. Studied analysis, planning, design, and management of healthcare institutions and organizations. Built focus on achieving quality patient care through increased efficiency and accessibility. Used Care MedX (an electronic medical record system) and trained other staff members on how to use the system properly.
• Effectively researched and analyzed an electronic medical records implementation at a long-term care facility for a case study. Implementation was managed in stages due to fiscal restraints.
• Researched health care system of the state of Indiana, including Medicaid, waivers, Indiana Senate Bill 327, Children’s Health Insurance Program, and managed care and single payer systems.
• Assessed technical and organizational requirements for developing electronic medical records, including client/server applications, vendor selection, implementation, and training.
Specialties: Project Management, Case Studies, Quantitative/ Qualitative Analysis, Customer Service, Inventory Control, Staff Management, Information Systems
1. Created by Tom Kukulka
Graduate Capstone
Thursday, November 5, 2009
2. Introduction
This is a case study that explores the process of
implementing a hybrid clinical electronic medical
record (EMR) system at a long-term care (LTC) facility
An extensive interview was conducted, with an
administrative supervisor
There were several questions asked, answers were
provided, and an analysis was given.
A conclusion was drawn based on what was found in
the case study
3. Weaknesses of Paper-based Record
System
Illegible handwriting
Uncertain and incomplete data
Data fragmentation
Easily misplaced data
Data difficult to transfer or copy
Costs increases with larger office space, having a file clerk
on payroll, and use of transcription services
Health information kept at different locations not available
at time of care (negative outcome and even possible death)
Records could end up in wrong hands and not be
confidential
4. Advantages of an EMR system
A single consolidated record
Accessibility from anywhere and anytime
Readability
A report generator
Information completeness and decision support
Access to external knowledge
Ability to sum up the result of certain treatment
Faster more efficient diagnosis and treatment
More face time with resident and family
Privacy and confidentiality concerning patient record
Enter data only once not for every form
5. EMR system barriers
Costs
Lack of technology expertise
Software difficulties (lack of interoperability)
The unwillingness to invest in systems with vague
financial rewards
Physicians’ resistance to change
Human factors and staff training
6. Why 50% of EMR projects “fail”?
Selection of the EMR system was based on wrong
criteria for that particular facility
Planning is so important as well as adequate training
and support from entire staff
7. Implementation Success
Staff acceptance
Willingness to use the system
Must have high-level of end-user satisfaction, which is
the result of being designed to meet that facility’s
needs
8. Definition of Long-term care (LTC)
Long-term care is“…care provided in a licensed nursing
facility that offers 24-hour nursing supervision and a
range of comprehensive medical, personal, and social
services coordinated to meet the physical, social, and
emotional needs of chronically ill or disabled
individuals” (Cherry, Carter, Owen, &
Lockhart, 2008).
Individuals are referred to as residents who are
admitted to a LTC facility and generally reside in the
facility for several months to several years.
9. EMR in Long-Term Care Facilities
Demand for LTC will increase
Facilities have resident population age 65 and over
Improve quality of care by spending more face-time
Reduce costs
10. Adoption of EMR System
Large national LTC chains and regional networks are
starting to adopt the EMR system
Small privately owned LTC facilities generally avoid
Clinical EMR systems altogether
11. Sources of Funding
Local, state, or federal government
Insurance industry
Pharmaceutical industry
Several electronic sources are available:
www.foundationcenter.org
Funding implementation in LTC facilities remains
quite limited
12. EMR System - Automatic Alerts
Vital signs
Incomplete documentation and critical elements of
medication administration
Due dates for scheduled appointments
Routine labs and immunizations
13. Computerized Provider Order Entry
(CPOE)
Is an application physicians use to write orders using the
system (Robles, 2009).
Physicians see alerts concerning medications at the time of
order entry, which forces them to make decisions then and
there
Computer decision support system (CDSS) is built into the
CPOE system, which provides: assistance with diagnosing a
resident’s condition, assistance in determining proper drug
dosage, specific reminders to administer preventive
services to certain residents at a specific time…….
CDSS can perform drug-drug interaction checks, drug
laboratory checks, drug allergy checks.
14. Beneficiary of EMR system
Long-term care facilities could be significant
beneficiaries of the EMR development if their unique
characteristics and needs of their facilities are
considered in the development of the system
(Oatway, 2004)
15. Health Insurance Portability
Accountability Act (HIPAA)
The HIPAA needed to be updated to include medical
privacy as a result of an increase in EMRs
Long-term care facilities have to meet all HIPAA
requirements
Federal privacy protection standards called “HIPAA
Privacy Rules” were established during former
President Clinton’s Administration . These were for
privacy of personal health information (PHI) of all
Americans (Longley, n.d.)
16. Medical Center Physician EMR
Implemented system-wide
Accessible 24 hours a day
Information include: medical
history, medications, any residents
problems, allergies, vaccinations and lab data
embedded by outside vendors (Wilt & Muthig, 2008)
17. Clinical EMR System
Implemented in 2007 system-wide
There was a need for a more care-based, resident
focused system
Used by assisted living facilities (ALFs) and skilled
nursing facilities (SNFs) as well rehabilitation and
home health
18. Implementation Challenges at
Health System
One challenge encountered was the integration of the
Clinical EMR system with the already existing Medical
Center Physician EMR system
Another challenge was automating the capture of the
Minimum Data Set (MDS) documentation that was
required by Centers for Medicaid and Medicare
Services.
19. Conclusion
There are many benefits that the implementation of the
Clinical EMR system brought to long-term care facility:
fewer documentation errors, more face time with residents
and their families, ability to flag any work not done on a
previous shift, increase revenue from Medicaid
reimbursements, lower staffing and operation costs, and
physician order reconciliation would also be reduced
Certain barriers were overcome by the facility (Integration
of the 2 systems) and (Automating capture of MDS
documentation which had to match assessment forms that
were filled out)
Training was very important so that staff could get
comfortable using the Clinical EMR system
Human factors would include: staff members unfamiliarity with computers or perhaps their fear of a computer, staff members’ resistance to change, and lower education levels for CNAs. Staff training barriers involved the quality of the training programs, the costs and hours involved, the need for training of temporary and on-call staff and outside entities such as consultants and the need for on-going training.
Transfer information to or from a LTC facility is normally written. However documentation could end up missing, illegible or not complete. Direct person-to-person communication is often seen as the standard means to communicate, but there are lag times in reaching providers or incomplete information may be given.
An important advantage that an EMR system provides for a LTC facility is its ability to introduce evidence-based guidelines to the user ordering or charting medications, helping both the physician and nurse with proper assessment, care planning, and treatment
Long-term care facility residents taking medications in several categories including: anticoagulants, antipsychotics, diuretics, and antiepileptic have been identified as being at high risk for experiencing preventable adverse drug events.
These EMRs are accessible 24 hours a day both on-site and remotely. Information available in the Medical Center Physician EMR included: medical history, medications, problems, allergies, vaccinations and laboratory data embedded by outside vendors (Wilt & Muthig, 2008). Interfacing the Clinical EMR system with the Medical Center Physician EMR required further standardization of data dictionaries and clinical terms (Wilt & Muthig, 2008). There was also a need for adjustments to ensure that information entered in the Medical Center Physician EMR would display correctly on the Clinical EMR. A system-wide conversion to standard processes for resident admissions, policies and charting forms, as well as discharges and transfers also took place (Wilt & Muthig, 2008). All needed data for the MDS had to match all assessment forms that were filled out.