Implementation and Benefits of an Electronic Health Record

1. 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

2. 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

3. 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 patient’s 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.

4. 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

5. 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

6. Patient Centered

7. Getting Started • Team Diversity • Clinical team included Administrators, DON’s, 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)

8. Training • Initial Training Course • RN’s and LPN’s 16 hours • RMT’s 12 hours • C.N.A’s 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

9. 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.

10. 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.

11. 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 Worklist

12. Assist care providers with meeting nursing care standards. View Protocol

13. 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

14. 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

15. 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

16. 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.

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

18. 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

19. 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

20. 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.

21. 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 BMV

22. 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

23. With appropriate access, providers can view multiple visits within the organization. Visits Panel

24. 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.

25. 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.

26. 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

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

28. Management Benefits • Reports – Vioxx Example • Access from any computer in the organization • Increase in documentation from direct care givers • D.O.N’s 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

29. 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

30. 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?

31. 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