Debbie McQuay

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Implementation and Benefits of an Electronic
Health Record

• Citizens Memorial Healthcare

• Debbie McQuay
• Director of Quality Improvement
• Information Systems Steering Committee Member
• Long Term Care Implementation Team Member

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About UsCitizens Memorial Healthcare 25 Years

• 5 Long Term Care / 1 Residential Care 588
  Beds
• 74 Acute Care Beds / ICU / Outpatient / ASC
• Emergency Room / Ambulance Services
• 19 Clinics
• Home Care Services / Hospice
• Davies Award 2005
• Most Wireless/ Most Wired 2005 2007

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Project Infocare Vision

• Citizens Memorial Healthcare will implement
  Meditech to enable a patient to enter anywhere
  into our continuum of care and have a personal
  identity that is maintained across that
  continuum.
• Physicians and other caregivers will have access
  to all of that patients medical information
  within the healthcare system.
• Health care providers will be able to document
  efficiently within the software system. Providers
  will be able to spend more time with their
  patients. Time will be spent providing patients
  with that human touch of care, rather than spent
  completing forms and paperwork.
• We will realize the benefit of our investment of
  time, talent and money in Meditech by enabling
  Citizens Memorial Healthcare to become a
  technologically advanced health care organization
  that is poised to grow to meet demand and offer
  new services to our current patients and to the
  community at large.

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Project Infocare Timeline

• 2000 IS Strategic Planning
• 2001 Vendor Search Selection
• 2002 Implementation Began
• 2003 September MDS Care Plans
• 2004 February 1st First LTC (110 bed)
• 2005 Feb All 5 LTC/SNF - Implemented
• 2006 July Residential Care
• 2007 Jan BMV Completed Aug 2007

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Project Infocare Costs

• Total Project 6,000,000
• Software (Meditech other)
• Computers and network structure
• Staff implementation time benefits
• Travel training costs
• LTC Costs 650,000
• 130,000 per facility, or
• 1,365 per licensed bed

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Patient Centered
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Getting Started

• Team Diversity
• Clinical team included Administrators, DONs,
  Charge Nurses, Ward Clerks, Med Techs, MDS
  Coordinators
• Financial Team included Director of Finance,
  Billing Personnel, Business Office Clerks,
  Admissions Coordinators
• 6 month implementation schedule for
  Admissions/Billing, MDS and Care Plans (all
  facilities live at once)
• 1 year implementation for Physician Orders,
  Nursing Documentation, Electronic MAR (one
  facility at a time-21 day in-house live coverage
  by Team members)

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Training

• Initial Training Course
• RNs and LPNs 16 hours
• RMTs 12 hours
• C.N.As 8 hours
• Continued Education
• LTC Specialist provide continuing education
  through scheduled and requested in-services
• On Line Education HealthStream
• Challenge
• Some Staff Never Used a Computer

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Security Features

• We have the ability to tailor access levels to
  what is appropriate for a specific job class.
  This applies to both the parts of the system they
  can document in and the portions of the
  Electronic Medical Record that they have access
  to.
• Records are secure from falsification. All
  documentation is date and timed stamped.
• Tracking mechanism in place to track edits to
  documentation.

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Status Board

• Customize to display pertinent information by
  type of caregiver
• List of residents by location.
• Sort by any field.
• Provides critical info such as Resuscitation
  Status, new Lab results, Allergies, latest Vital
  Signs at a glance. Also specific treatments (like
  Accu-checks)
• Alerts caregivers of Medications or Interventions
  that are due
• Alerts caregivers to New Orders
• Physician Contact info available with one click.
  

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Worklist

• Provides an electronic To Do list
• Assessments built to our specifications.
• Ability to add descriptor text to assist
  clinicians
• Ability to attach our protocols or policies and
  procedures to individual assessments
• For easy access to click on view protocol

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View Protocol

• Assist care providers with meeting nursing care
  standards.

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POM (Physician Order Management )

• Benefits
• Increased Safety
• The orders are clear and concise.
• Orders are automatically checked against the
  residents allergy and adverse reaction
  information.
• Medications are checked for duplicate therapy and
  drug to drug interaction, as well as for food to
  drug interaction.
• Able to chose medications, Procedures, or I.V.s

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Labs

• Labs can be ordered for one time or set up for a
  routine basis. i.e. Every 30 days.
• Reports available to ease the difficulty of
  managing routine lab orders
• Use of Medication

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Medications

• Able to chose from thousands of medications 1st
  Data Bank
• Orders follow the Medication Rights
• Order is editable changes can be made to the
  start date, dose, frequency, etc.
• Dose instructions and comments can be entered

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eMAR(Electronic-Medication Administration Record
)

• Provides Detailed Information
• To improve efficiency and safety
• Start and Stop Dates
• List Trade and Generic name
• List dosage, route, and frequency.
• List when the medication was last given.
• List when the medication is next scheduled.
• Associated Data
• The user can access related information from
  nursing assessments and labs.
• Monograph
• Detailed information regarding the use of the
  medication.

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Monograph

• Provides information regarding medication such
  as
• Side effects
• Precautions
• Drug Interactions
• Missed doses
• Medical Alerts

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Why BMV Resident Safety

• BMV decreases errors
• Opportunity for errors
• 588 Residents / 10 meds per day / 5880 med per
  day
• 2,146,200 Meds per year
• Average Medication Error Rate 6
• What if we only have 1 21,462 errors per year
• 0.1 2146 Errors
• Noted through observation - Errors Prevented
• Wrong dose errors prevented
• Wrong medication errors prevented
• Wrong resident errors prevented

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BMVBedside Medication Verification

• BMV in LTC Gave Us Some Opportunities to be
  Creative
• Eleven Retail Pharmacies in 3 Counties
• Partners in Medication Safety
• Provided each pharmacy with the software and
  hardware to produce a bar code

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LTC BMV Improvements to Process

• Further Automated ordering process
• Order is placed in POM
• Fax is generated to the residents pharmacy
• The fax prints with the details of the medication
  including a bar code of the Rx number.

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BMV

• Hardware issues
• Not all Scanners are created the same.
• Power issues
• Battery management
• Power settings
• USB Port Issues
• Make sure that there are enough ports for all for
  the hardware

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EMR ( Enterprise Medical Record )

• Replaced paper chart
• Resident data stored in electronic form.
• Provides storage of all residents visits, LTC,
  Hospital, Clinics.
• Automatic, incremental tape backup every day
• Weekly back-up placed in hospital vault, as well
  as monthly and annual back-ups.
• 2006 Image Now Paper is all scanned into EMR

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Visits Panel

• With appropriate access, providers can view
  multiple visits within the organization.

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Notes

• Provides a listing of all notes that have been
  entered regarding the resident.
• Can selected by specific providers i.e. Nurses,
  Therapist, Social Services, etc.
• Notes can be viewed individually by clicking on
  the magnifying glass
• Notes can be sorted by date, provider, type, and
  text.

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Order History

• Provides a listing of all the orders placed on
  the resident.
• Can be sorted by category, procedure, status,
  etc.
• Can provide an audit trail regarding who placed
  the order, made edits, or discontinued the order.

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Allergies

• Provides a listing of the residents allergies.
• Shows the severity of each allergen.
• Allergies and Adverse reactions are checked
  against medications.
• Can view details of the allergies by clicking on
  the specific listing

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Summary

• Tabs on this screen include
• Providers
• Allergies
• Visit Specific Info
• Risk/Legal Info
• Diagnoses
• Contact Info
• Insurances
• Demographics

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Management Benefits

• Reports Vioxx Example
• Access from any computer in the organization
• Increase in documentation from direct care givers
• D.O.Ns and Administrators can easily monitor
  resident care.
• Status board management allows easy viewing of
  interventions or medications that are due.
• Reports are available for several medications.
  More efficient means of monitoring residents that
  receive psychotropic medications,
  antidepressants, etc.
• Reports available for resident interventions.
  Provides more effective way of tracking residents
  with specific needs such as Restorative Care

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Future Expansion

• Functionality to further streamline communication
  between facilities and the physician (2007-2008)
• PDA functionality will allow caregivers greater
  mobility (2008)
• Interface Vital Sign Machines with Computer
  System

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Challenges

• Staff who had never used computers
• Want to write on paper and transfer to chart
• Correspondence / Printing of Medical Record
• How to affix the Computers to the Med Carts -
  Velco
• COWS (Computers on Wheels) How many do we need?
  What kind of carts should we purchase?

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Wonderful Things

• Never have to look for a chart
• Never have to wait for someone to finish with a
  chart
• Can View from Anywhere
• Can Build Reports to Assist Caregivers
• Residents are Safer
• Support for Clinical Decisions