Enhancing EHR in LTPAC Settings Andy Petrovich Sarah Slocum Lo Long-Term rm a and Post ost-Acut cute Ca Care Healt lth I IT Spe peci ciali list sts February bruary 1 19, , 2019 1
Agenda ▲ Overview of the M-CEITA and LTPAC Group ▲ Investing in LTPAC EHRs ▲ Overview of Michigan LTPAC EHR Environment ▲ LTPAC EHR Challenges and Barriers ▲ LTPAC EHR Solutions: New Technical Assistance available for LTPAC settings ▲ Questions and Answers 2
Who is M-CEITA? THE TRIPLE AIM ▲ Michigan Center for Effective Information Technology Adoption (M-CEITA) 3 Improve patient experience ▲ One of 62 ONC Regional Extension Centers Improve population health Reduce costs (REC) providing education & technical assistance to primary care providers across the country ▲ Founded as part of the HITECH Act to Performance accelerate the adoption, implementation, and Measurement effective use of electronic health records Improve Ensure Improve Improve Engage Population Privacy (EHR) Care Quality, Patients And And Coordi- Safety & & Public Security ▲ Funded by ARRA of 2009 (Stimulus Plan) nation Efficiency Families Health Protections Meaningful Use ▲ Purpose: support the Triple Aim by achieving 5 Certified Technology Infrastructure overall performance goals 3
M-CEITA’s LTPAC Group ▲ The LTPAC group focuses specifically on enhancing the EHR and Health Information Exchange among Long Term Post Acute Care Settings. ▲ Focused on studying the Michigan health IT landscape for LTPAC providers and how to advance the use of EHR and health information exchange (HIE) in the LTPAC community Christy Colleen Sarah Andy Fareeha Avery Quintal Slocum Petrovich Shuttari 4
LTPAC providers are motivated to adopt health services technologies that will enable them to provide innovative care delivery models and position providers well for strategic partnerships in the future. 5
Investing in LTPAC EHR *adapted from healthit.gov 6
Key Opportunities in Quality Improvement ▲ Care Transitions ▲ Medication Management 7
Federal Factors Pa Past – Foc ocus s on on Elig igibl ble e Provid ider ers • HITECH Act • Incentive Funds Presen esent – Inc ncrea eased ed Flexi exibi bilit ity • LTPAC Inclusion • Interoperability Between Provider Types 8
Federal Initiatives CMS Considering Changes to Star Measures Value-Based Reimbursement Readmission Rates and Short- Term Rehab Measures 9
Value-Based Purchasing ure – Hos Measur ospital Readm dmis ission ons Quarterly & SNF's Score Payment Compared to Annual Incentives US Progress Reports 10
5 Star Changes ▲ New Survey Process ▲ Payroll Based Journal ▲ RUGS Risk Score 11
Readmission Rates and Short-Term Rehab Measures ▲ Value Based Purchasing Program – Readmissions ▲ CMS Revising Measure on Preventable 30-Day Readmission ▲ Short-Term Rehab (e.g. Mobility, Self-Care) 12
Regulatory – State of Michigan ▲ Goal is to improve coordination of care and transitions of care by promoting interoperability and connectivity at LTPAC facilities – Provide technical assistance (TA) to improve connectivity and interoperability – Benefit to vulnerable patient population – Meet changing patient expectations for seamless care delivery across continuum ▲ Certificate of Need process incentivize HIT investment 13
Linking HIT and Care Improvement - Louisiana ▲ Camelot Brookside Care Center – 120 bed SNF in Louisiana ▲ Upload vitals/weights immediately to EHR and used Telehealth ▲ Goal to reduce 26.3% hospital readmission rate in 2014 ▲ Intervention – 24/7 vitals monitoring post-hospital – Care protocol on all post-hospital residents – Proactive intervention (including weekends) on changes in condition ▲ Result = readmission rate down to 10.4% 14
Linking HIT and Care Improvement - Oklahoma ▲ Oklahoma pilot project – 5 LTPACS and 1 hospital, 20 month pilot during 2013 and 2014 ▲ ADT, Referral Management, Transition Document Exchange ▲ Realtime information on patient conditions – 98% Nursing Assistant compliance with daily patient assessments – 97% Patient satisfaction level – 78% lower 30 day readmission rate – 70% lower 30 day return to ED – 50% lower hospital readmission within 12 months 15
Patient Care and Patient Safety 16
17 LTPAC settings with robust EHR and HIE: Providers reportedly experience a positive impact on workflow for nursing staff and many nurses see EHR as an efficiency-enhancing tool. What is the Michigan LTPAC providers’ EHR experience ? 17
EHR Trends in Michigan LTPAC Facilities Implementation Utilization LT LTPAC EHR T R Tren ends Desired HIE Enhancements 18
LTPAC EHR Implementation ▲ Analyzed availability of EHR for LTPAC providers Implem lemen enta tati tion Utilization ▲ Most popular EHR platforms are Certified EHR LTPAC LT Technology (CEHRT) by the ONC EHR T Trend nds s ▲ LTPAC providers have modernized operations by Desired HIE Enhancements implementing EHRs 19
LTPAC EHR Implementation ▲ Results from 2018 Michigan LTPAC Survey 6% ▲ Higher adoption rates compared 13% EHR in entire organization to national trends EHR in some parts of the organization ▲ Implementation rates are Do Not Have EHR increasing, aligned with the 81% direction of broader healthcare industry 20
LTPAC EHR Utilization ▲ Analyzed EHR Utilization at LTPAC providers Implementation Uti tili lizati tion ▲ Once EHR systems are adopted, how they are LTPAC LT utilized varies EHR T Trend nds s ▲ Utilization rates and management of HIT Desired HIE Enhancements infrastructure closely linked 21
LTPAC EHR Utilization ▲ LTPAC facilities typically utilize only a few EHR functionalities ▲ Most commonly used function: medication management 22
LTPAC HIE Utilization ▲ Analyzed HIE at LTPAC providers Implementation Utilization ▲ Need to become interoperable with hospitals, clinics, and health systems to provide continuity of care and to be recognized as a preferred referral recipient by other providers LTPAC LT EHR T Trend nds s Desired HIE E Enhancements 23
LTPAC HIE Utilization ▲ Table highlights HIE activity at LTPAC facilities ▲ The table highlights that HIE is being utilized at a low/moderate level ▲ The most common exchanges being related to radiology reports, lab reports, exchanges between hospitals outside the system, and pharmacies. 24
LTPAC HIE Utilization ▲ LTPAC providers have engaged in HIE, more specifically for ADT with outside organizations ▲ Nearly 50% of SNFs and less than 2% of HHAs included in the query were participating in HIE through MiHIN, while about 45% of inpatient rehab and 15% of LTAC were participating. 25
LTPAC Desired Enhancements ▲ Analyzed LTPAC provider requests for EHR enhancements Implementation Utilization ▲ Most LTPACs selected various enhancements, if not all available offerings in the survey LTPAC LT EHR T Trend nds s ▲ Integrating patient data from external sources into EHR was most often sought Desired HIE Enhancements 26
LTPAC Desired Enhancements Improve ove Q Quality of of Incr crea ease P e Patien ient Prom omote O e Oper eration ions Patien ient C Care e Safety y Efficien iciency cy Integrat ating ng pat patient d dat ata a Manag Managing ng w workflow from e exte tern rnal sources i into to Medi edication m managem gemen ent chang hanges EHR Developi ping ng po policies and and procedu edures es f for managi ging g dat ata q a qual ality Manag Management of p pati tient t Utilizing ng d dat ata anal a analytics con onse sent HIE a agr greem eemen ents and d techni hnical al s suppo pport Integrat ating ng ph physician an Infras astructure r reliabi ability Outc tcome a alerts rts orders and and l labs abs and s d sec ecurity 27
LTPAC organizations in general have not reached a level of EHR utilization where their technology investment is fully integrated within their clinical operations. LTPAC providers are frustrated with the day-to-day experience of using their EHR 28
LTPAC EHR Adoption and Utilization Challenges Lack of La f Lack of T La f TA and Inc ncen entive e ▲ Environmental Scan identified Traini ning ng Programs ms various EHR adoption and utilization challenges ▲ Categorized issues into the La Lack of f Cos ost a and nd following themes Inter eroper operabi bility Rel eliabil bilit ity LT LTPAC EHR R Challen llenges es 29
LTPAC EHR Adoption and Utilization Challenges– Interoperability Lack of La f La Lack of T f TA and Inc ncen entive e ▲ Inte teroperability ty With thin Traini ning ng Programs ms Inter ernal al an and Exter ernal al sy systems – Would promote integration of patient data – Most sought after EHR La Lack of f Cos ost a and nd enhancement Inter eroper operabi bility Rel eliabil bilit ity – Would help manage physician LT LTPAC orders and lab orders EHR R Challen llenges es 30
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