Medxforms, Inc

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Medxforms, Inc
Transforming Long Term Care
Medxforms Inc. helps nursing homes improve
quality of care by reducing the burden paperwork
places on time, morale, communication, and the
balance sheet.
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What the Government Wants
Govt Enforcement
Holistic Approach
Individualized Care Plan
The methodology has teeth.
MDS Assessment
Quality of Care
Highest level of functioning possible.
RUG-III scores
Initial Assesment. Establish baseline
MDS values drive Reimbursement.Case Mix
Resource Utlitization Group scores.
Quality of Life
Maintain sense of individuality.
Triggers RAPs
QMS/Quality Indicators
MDS values trigger any of 18 RAP areas.Resident
Assessment Protocols (RAPs)guidance/best
practice for each area.
QI scores are published for all nursing homes.
Data is publically available through Medicare
site.
Interdisciplinary Team
Collaborative Model
Team collaboratively collects and shares
information. Team combines clinical competence,
observa-tional skills, and assess-ment expertise.
State Surveyors
Develop Care Plan
State Medicaid surveyors inspect for
deficiencies, issues citations, and write
reports. Deficiency reports are published and
publically available. Care Plan must promote
individualized quality of care quality of life.
Documentation in residents record must support
care plan.
ChargeNurse
Activities
Individualized care plan must address all
triggered RAPs. Instructions and measurable
goals for each item addresed in care plan
Social Work
Dietician
Implement. Document. Evaluate.
Implement care plan. Measure, document, and
evaluate daily. Reassess when changes warrant.
Therapist
CNA
Pharmacy
Families
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How Vendors Responded
Back Office Software
Limited Collaboration
More Paper Forms
RestorativePrograms
Vital Signs
I/O Sheets
90 DayCycle
Care Plan
Handwritten Notes
Flow Sheets

In hospitals, rehabs, nursing homes
computers have the traditional province of
clerical and back office staff.
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Medxforms, Inc. Addresses the Issues in this Box
Back Office Software
Limited Collaboration
More Paper Forms
RestorativePrograms
Vital Signs
I/O Sheets
90 DayCycle
Care Plan
Handwritten Notes
Flow Sheets

In hospitals, rehabs, nursing homes
computers have the traditional province of
clerical and back office staff.
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Medxforms, Inc. -- Our Approach
For each role on the interdisciplinary team
Interdisciplinary Team
documents
Identify
ChargeNurse
ADON
how info is collected
Analyze
who consumes information
Social Work
Dietician
Families
working sessions
Listen
journal notes
Activities
Therapist
MDS Coord
workflow
Certified Nurse Assistants (CNAs) are a key
member of the interdisciplinary care team. CNAs
spend more time with individual residents than
any other team member. They are primary
providers of both physical and emotional care.
user-centered design
Inform
performance support
Solution
collaborative systems
Read more about it
point of care devices
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Medxforms, Inc. -- An Example
For each role on the interdisciplinary team
formal
documents
Identify
informal
how info is collected
Analyze
who consumes information
working sessions
Listen
journal notes
workflow
contextual design
Inform
performance support
Solution
CNAs use formal documents, such as flow sheets to
collect information about residents.
Structurally, formal documents often mirror the
structure of the underlying database.
collaborative systems
point of care devices
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Medxforms, Inc. -- An Example
For each role on the interdisciplinary team
Crib Sheet
formal
documents
Identify
informal
how info is collected
Analyze
who consumes information
Informal Narrative
Better check on him later.
Harry is not feeling well this morning.
working sessions
Listen
journal notes
CNA 1
CNA 2
workflow
contextual design
Inform
performance support
Solution
Formal documents do not fit well with CNAs
workflow. In actual practice, CNAs use make
-shift devices, such as crib sheets, and informal
narratives, such as hallway conversations, to
track resident state.
collaborative systems
point of care devices
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Medxforms, Inc. -- An Example
For each role on the interdisciplinary team
A paper flow analysis
formal
documents
Identify
informal
how info is collected
Analyze
who consumes information
working sessions
Listen
journal notes
workflow
When the relationship between time, formal and
informal documents, and the residents record is
analyzed, the inefficiencies and disconnects
become clear.
contextual design
Inform
performance support
Solution
collaborative systems
point of care devices
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Medxforms, Inc. -- An Example
For each role on the interdisciplinary team
Consumer Model
formal
documents
Identify
50
informal
Information
how info is collected
Analyze
who consumes information
50
Minimum Data Set
working sessions
Listen
journal notes
workflow
contextual design
Inform
performance support
The Minimum Data Set, along with triggers RAPs
drive both a residents care plan and Medicaid
reimbursement. CNAs produce 50 of the MDS data
elements that drive reimbursement. Every other
member of the interdisciplinary team collects and
further processes CNA data.
Solution
collaborative systems
point of care devices
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Medxforms, Inc. -- An Example
For each role on the interdisciplinary team
formal
documents
Duplication Too much copying, and
recopyingInformation on forms not organized
around way I work Information not integrated
Updating in one place does not update another
Disconnected from Kardex/Care Plan Scales
Numbers Confusing. Carried forward from shift
to shift Limited Number of Observations Cannot
capture changes during shiftCan only input what
forms ask Lack history/context -- Difficult to
reference or update preferencesNo summary
informationEspecially after 3-day
absence Performance support --Include
instructions on hardware devicesInclude
instructions on restorative care plansAllow
pictures to document wound/care progress
Identify
informal
how info is collected
Analyze
who consumes information
working sessions
Listen
journal notes
workflow
When interviewed or job shadowed CNAs identify
a wealth of things theyd like to change to make
things better.
contextual design
Filter
performance support
Solution
collaborative systems
point of care devices
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Medxforms, Inc. -- An Example
For each role on the interdisciplinary team
formal
documents
Identify
informal
how info is collected
Analyze
who consumes information
working sessions
Listen
Journal notes
workflow
user-centered design
Observations made during on-site visits recorded
in a project journal
Filter
performance support
Solution
collaborative systems
point of care devices
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Medxforms, Inc. -- An Example
For each role on the interdisciplinary team
formal
documents
Shift Report
Identify
A.M. Care
Breakfast
Feed resident breakfast Pick up tray Document
food and fluid intake Document calories consumed
Team review Shift Report Nursing Notes Get a
sense of how resident did on previous
shift Sometimes too clinical. Verbally share
care-related info in hallway with other CNAs
Help resident out of bed Set up clothes and wash
up Dress up Comb hair Special programs,
sometimes
informal
how info is collected
Do special programs when time permits
Analyze
who consumes information
Answer call lights in between times
working sessions
Listen
Journal notes
Database
workflow/database
user-centered design
Filter
performance support
Solution
Map information to shift tasks where it can be
collected at point of care as part of nartural
workflow.
collaborative systems
point of care devices
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A Better Approach. Part 2. Use Technology to
Support Way People Naturally Work
Crib Sheets
Pocket PC
Magic Paper. CNAs carry crib sheets, 3 x 5
slips of paper onto which they jot down data as
they do their work.
Paper Point of Care. CNAs carry crib sheets, 3
x 5 slips of paper onto which they jot down data
as they do their work.
Shift Reports
Tablet PC
A better clipboard. Tablet PCs work just like a
clipboard, only better.
Natural Interlocution Charge Nurses put blank
shift report forms into clipboards. They confer
with the CNAs on their wing at end of
shift. Maintaining eye contact, they jot down
summaries and instructions based on CNA feedback.
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A Concrete Example.
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Use Case. Harry Miller A.M. Care.

Typical Day vs. Today
Harry is a longtime resident of the Newton
Center. He is 89 years old and is generally in
good health. Harry lives in room 125A on the 200
Wing.
Typical Day

• Up at 500 Hes usually first on wing for a.m.
  care
• Good mood Talkative in the morning. Smiles.
• Independent Alert. Seldom confused. No ADL
  cueing or set up.
• Program Ambulation program. Recovering from
  broken hip
• Eating H-a-t-e-s scrambled eggs. Otherwise
  good appetite
• Usually continent Call light at night to help
  to the bathroom. No chuks.

Harry Miller Hes a sweetheart.
Today

• Harry has come down with the flu.
• Becky discovers a 2o fever.
• Disoriented. Wet the bed last night.
• Diarrhea. No vomitting. Possibly dehydrated?
• Refused to eat breakfast. Drinks only a little
• Keeps asking for ice cream

Becky Johnson C.N.A.

• Floater CNA
• Off for three days
• 1st time on 200 Wing
• Hates paperwork
• Numbered scales confuse
• No time to consult Kardex
• On the job for 2 months
• Works independently

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• Becky logs into her Pocket PC.
• Charge has already completed assignment sheet
  for 200 Wing

Comments

• Becky works independently.
• She does Harrys a.m. care first.
• Clicks the Harry link to get to Harrys home
  page

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• This page contains links to all items in the
  flow sheet and collector sheets
• The last 24 hours.. section gives Becky an
  idea what to expect
• Harry slept well the night before. He is just
  now coming down with the flu
• Becky clicks AM Care to record information she
  notices as she gets Harry out of bed.

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• The AM Care page tells whats normal for Harry
  Miller in the morning.
• It is important that Becky notice and record any
  changes
• The TODAY column gives Becky access to change
  pages
• Harry is normally independent. But today he
  requires Set Up help for Bed Mobility.
  Transfer. Grooming.

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• Becky checks off Set Up Help for Bed Mobility,
  Transfer, and Grooming.
• To refresh her memory, she clicks the VIDEO link
  to view a short video that gives examples of what
  is meant by set up help only

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• Becky notices that Harry feels warm
• She return to Harrys home page
• And clicks the Temp link

Comments

• Becky takes Harrys temperature.
• She refers to the last five temps to see if his
  temp is elevated today.
• Becky is concerned. This is not a typical day.
• She returns to Harrys home page

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• Becky clicks the link Write a Note to the
  Charge Nurse
• On the note screen, she handwrites a brief
  description of Harrys day.
• Later in the hallway, she informs the charge
  nurse of Harry situation
• They will discuss further during end of shift
  report.

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• The Charge Nurse sits with the CNAs on the 200
  Wing
• She uses the Tablet PC Shift Report screens to
  review each resident with the CNA
• The buttons to the right of Harrys picture
  recap the information collected by the CNA during
  the shift.
• The red dot indicates that information is either
  missing or otherwise requires attention
• Beckys note about Harry appears in the window
  below Harrys picture
• The Charge Nurse reviews missing or not sure
  items with Becky.
• She clarifies and reinforces information that
  Becky learned at a recent training session.
• Becky noted not sure for several ADLs. After
  talking with her, the Charge Nurse uses the
  Tablet PC screen to update the ADLs to Limited
  Assist.

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• Harrys situation is cause for concern.
• The Charge Nurse has already taken steps to make
  sure Harry does not dehydrate. And she is
  monitoring Harrys temperature
• She uses the Shift Report to note changes in
  Harrys condition
• She clicks the flag to Highlight Harrys entry
• During incoming shift report, she refers to her
  notes.
• Flagged documents are carried forward to the
  CNAs Pocket PC, as we will see later.

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• While discussiong Harry, Becky mentions that
  Harry likes ice cream
• The Charge Nurse sends dietary a note asking if
  it OK to give Harry a milkshake.

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• The other CNAs mention that they have not seen
  Harrys daughter, Mrs. Foley.
• Mrs. Foley visits frequently and has asked to be
  informed of changes to Harrys condition
• The Charge Nurse sends a note to the Social
  Worker asking her to give Mrs. Foley a call.

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• Becky, who is getting to know Harry a little
  bit, mentions that Harry loves Lassie the
  centers resident dog.
• The Charge Nurse sends the Activities Director a
  note Can an activity aide bring the dog buy?

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Use Case 1. Harry Miller A.M. Care.

Typical Day vs. Today
Comments

• The Charge Nurse briefs the incoming 2nd shift
• Sally McCarthy listens carefully, but the
  meeting is running long and the 2nd shift is
  short-staffed.
• Sally logs into her Pocket PC. She has Harry
  tonight. Something she wasnt sure of at the
  shift change meeting.
• She sees a yellow hightlity next to Harrys
  name.
• Harrys home page has a highlighted summary of
  the Charge Nurses comments.

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Exhinbit A. Newton Center Timeline
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