In our last two posts, we have discussed the first five important questions to ask your current or potential EHR vendor. Today, we wrap up the series with the last few questions to consider.
6. How do you balance innovation, client needs and regulatory changes in your product?
Purchasing a software solution can be a substantial investment for any organization. Looking at the software provider’s ability to continue meeting organizational needs into the future will help ensure the investment has long-term value. Looking at the details behind the percent of staff or resources a software provider allocates to product development is an ideal way to gauge the likelihood the solution will keep the value. Further delving into exactly how a vendor addresses ongoing regulatory changes while also delivering continued product innovation will help as well. Asking about a recent regulatory change the industry has seen and how a vendor handled it is a perfect way to bring up the topic.
7. How do you assist novice or entry level users in becoming proficient quickly with the system?
Navigation is the one major issue new users face when trying to become proficient in a system. Asking a vendor how they address this key barrier is important. While training and reference materials are important, system interface and other tools can also assist with this need. Properly designed systems will create tools that allow a user to do nothing more than choose a process they want to complete within the system. If the system is designed appropriately, the solution should automatically navigate the user through the steps of the process they are completing and prompt them for the documentation or action needed.
8. What tools are available to the client to make system adjustments after implementation?
Even with proper detailed discovery, organizations will continue to grow and their needs will change with this growth. While a system can be designed with the intent to meet the needs of an organization at a specific point in time, no one can predict the exact future needs of a provider. To help ensure the solution will work in the long-term, investigate what tools and options are provided to make adjustments or changes in the future. If it is determined changes to forms or workflow within the system takes significant interaction from the vendor, budget expectations should be set with executive management to plan for these types of future needs. The ideal scenario is to find a product that provides clients the ability to make these types of changes with little to no vendor interaction.
If you would like more info, or would like to view a demo, please let us know!
8 Things to Ask Your Vendor
The process of selecting an appropriate software solution for long-term, home care, or rehab providers can be challenging. Evaluating system functionality is an important aspect in choosing the appropriate software for your organization. Evaluating your prospective vendor’s preparedness to address ongoing changes to industry regulations, the rapid pace of innovation, and an established goal of 2014 for EHR should be of equal importance in the selection process.
The evaluation of a potential partner’s ability to address these types of issues doesn’t have to be complicated. Asking the appropriate questions of your vendor candidates will help determine their focus and readiness for the issues facing long-term and post-acute care in today’s market. Eight questions are provided below that should always be asked of a potential software partner in an effort to determine their readiness to handle the future. These questions can serve as discussion points between care providers and vendors to ensure a like-minded approach to the issues facing long-term and post-acute care.
1. How will you support our organization if we want to be part of an ACO (Accountable Care Organization) or HIE (Health Information Exchange)?
As part of the Medicare Shared Savings Program, ACO’s are a required component made available within the healthcare market. ACO’s are voluntarily established entities that must service a minimum population of 5,000 people. They are made up of multiple care entity types that work together to care for the outlined population. ACO’s will receive and distribute shared savings from the combined approach and focus on quality care. Additionally, they will share in repayment of any losses incurred from serving the population. Sixty-five quality measures are in place to determine the savings or losses each ACO will create. These quality measures will determine whether the ACO has to reimburse losses or enjoy the benefits of creating savings.
Software solutions will play a crucial role for organizations electing to participate in ACO’s. More specifically, participation in a HIE will be at the center of this role. As individuals move through the care continuum, each organization’s software will need to have the ability to share information across care settings and with participants in the ACO. The following capabilities should be provided by the software vendor in support of ACO participation:
2. What steps are you taking to ensure your solution meets industry standards for a certified EHR?
- Continuity of Care Document (CCD) for transfer of care
- Ability to feed an ACO-wide EHR or HIE
- Support and utilization of an ACO Master Patient Index (MPI) for the population
- Ability to produce Quality Measures data as required
- Tracking and reporting on cost and utilization data
With the growth of information technology in healthcare, the need for solution accreditation has grown as well. Recently, the Certification Commission for Health Information Technology (CCHIT) has expanded its focus beyond acute care EHR solutions to include long-term and post-acute care EHR certification. Various solutions within the industry are considered EHRs; however, CCHIT certification standards now exist to provide validity to these EHR functionality claims.
Discussing details with EHR vendors regarding their certification plans is important. Certification of an EHR by CCHIT standards ensures more than 400 criteria are met. Certification serves as a starting point for any solution claiming to be an EHR. This can save organizations time and resources to investigate systems for these critical components allowing providers to focus on analysis of the solution in other areas.
Come back next week to see what other questions you need to ask.
The utilization of MDS 3.0 is set for October 1, 2010. The new assessment will bring significant changes to the way long-term care providers operate on a daily basis. While all of the changes within MDS 3.0 have been established to promote the highest quality of care, proper steps must be taken by providers to ensure the goal of MDS 3.0 is achieved.
Proper preparation for MDS 3.0 is critical. How a facility implements the MDS 3.0 will impact:
- Accuracy of the data that surveyors and third party medical record auditors review.
- Representation of the Quality of Care as impacted by the QI/QM and impact to 5 star rating.
- Appropriate reimbursement for the care provided in the facility.
The following can be utilized as a basic checklist of top 10 transition areas that should be addressed to properly prepare for MDS 3.0.
- Transition Leader in place with necessary skill set to manage a project this large. May need two individuals, one MDS, one RUG IV
- Facility Timeline for MDS 3.0 in place and public knowledge of timeline
- Resources Allocated: Budgetary (Educational costs, Hardware costs, Physical environment changes, Resource Manuals, will you need translators?)
- Resources Allocated: Personnel: workload?
- Involvement: Residents, Families, Providers, Staff, Consultants, Survey team. Do not forget the important role of the C.N.A.
- Communication Plan in place including marketing the new Tool: My Minimum Data, include all referral sources, providers, family and residents.
- Connect with your Project Manager or Customer Service Representative regarding plan to go live with current Vision release.
- Send your MDS Coordinator to classes on MDS 3.0; Business Managers to classes on RUG IV.
2. MDS 3.0 and Assessment Schedules
- Analyze the affects of coding changes, look-back periods, supportive documentation, and time to complete assessment as it impact assessment processes in place in facility.
- Vision set up plan developed and tested
- Vision testing of MDS, reports, and widgets
- Vision testing on ability to transmit to MDS Verification Software vendor
- Assign individuals to sections of the MDS include interviews
- Staff Education on the change (Depression scale, CAM, PUSH tool and interviews). Reserve at least hours in September devoted to this activity.
- Plan complete with scenarios to address Setting the Assessment Reference Date
- Education of Management staff on MDS widgets and reports to mitigate risk
- Where necessary changes made in General Orientation Educational materials.
- Communication Plan in Place regarding ARD selection, daily meetings set up to manage the process
- Update any touch screen forms that may have MDS 2.0 data on them, along with any other forms.
- Staff Identified to conduct interviews
- Modifications in Job Descriptions made to accommodate interviewing responsibilities and skill set
- Education in interviews
- Mock interviews conducted with a variety of resident conditions
- Alternate Interview Location Identified
- Accommodation Plan in Place for Residents with Hearing or Communication Needs, do you have a hearing amplification device?
4. Therapy Delivery System
- Determine how much concurrent therapy is currently being done. KNOW IT NOW!!! ADJUST where needed now.
- Change made in therapy delivery system as necessary, hours adjusted?
- MDS RUG Visualize on Home page of key staff members to monitor minutes.
- MDS RUG Utilization benchmarks established and on Home Page of key staff members
- Projections on Length of Stay in place and impact on discharge.
5. Restorative Program
- Seamless integration of restorative program with therapy.
- Programs assessed and revised as needed.
6. Clinical Documentation to Support MDS
- Documentation Program: Referral Management
- Documentation Program: Cognitive Management
- Documentation Program: Mood and Behavior Management including on-going assessment tools/flow sheets
- Documentation Program: Pain Management including on-going assessment tools/flow sheets
- Documentation Program: Bowel and Bladder Management
- Documentation Program: Skin Management including use of PUSH tool
- Documentation Program: Accident Prevention including Fall Risk Assessment
- Supportive Documentation: Assessments/Flow sheets/Clinical Notes/Benchmark Outcomes
- Update any policies that contain MDS 2.0 reference
- Education on Documentation.
7. Admission and Discharge Processes
- Workflow all existing processes
- Changes made where necessary with existing processes
- Plan in place to address Medicare Short Term Stay Residents
- Resident and family satisfaction surveys with the admission through discharge experience in place.
- Referral process in place with identified responsible person for each resident.
- Referral Networks in Place
- Necessary Equipment available for home going skill training
- Necessary Educational Resources available to staff, resident and families.
- Discharge Care Plan library addresses referral management.
- Organizational process for submission reviewed and changes made as needed to comply with new transition timelines.
- 14 day rule: Staff education on new submission criteria
- More than one person with the facility ID and password for MDS submission
- More than one person prepared to deal with rejected records/errors and new criteria for correction. Staff member has in-depth knowledge on reading validation reports, understanding how to identify and troubleshoot fatal errors.
- Process in place to deal with rejected records/errors and need for additional assessments.
10. QA Plan and Outcomes
- Survey Preparedness: Ready for surveys that do not rely on QM/QI but on 802/672 that are not matched to MDS 3.0.
- Benchmarks established for RUG Utilization and incorporated into MDS RUG Utilization Widget
- Vision Home Page: Set up for Managers with MDS RUG Utilization Widget, MDS Tracker, MDS At Risk Snapshot
- Conduct MDS 3.0 Mock Survey with team
- Outcome Measures: Avoiding Rehospitalization (will also need to define this for your organization)
- Outcome Measures: Referral Network
- Outcome Measures: Rehab Resident Outcomes and delivery (Are you discharge to a safe home environment). Outcome where possible linked to Avoiding Rehospitalization
- MDS Audits: Post analysis of MDS in terms of Setting the ARD Date "properly" (look back period capture, RUG capture)
- MDS Audits: % of MDS with resident interviews being conducts
- MDS Audits: Rule of 3 and monitoring use of 7
- MDS Audits: % of MDS with rejections or needing corrections
- MDS Audits: Depression Scoring
- RUG Utilization: Benchmarking Default days
HealthMEDX has provided a white paper on MDS 3.0 with more details on how to prepare for the transition and what it will mean for long-term care providers. The white paper can be accessed by clicking here.
The only constant these days is change. This is true for the long-term and post acute care (LTPAC) health information technology (HIT) industry as well. The recently enacted Patient Protection and Affordable Care Act (HR 3590, a.k.a. the healthcare reform bill) contained a number of sections relevant to our industry. At the HealthMEDX User Group last month, I provided an outline of the extensive changes that are in store for us. A few examples: Grants will be available for long-term care HIT best practices demonstration and adoption. Payment bundling demonstrations will begin and pay for performance (called value based purchasing by CMS) will move closer to implementation. The bill seems to favor shifting patients from institutional care to home and community based care. Look for consolidation and collaboration among post acute providers as a result.
A remnant from 2009's ARRA Stimulus bill is the required study and report on EHR payment incentives for providers not receiving other incentive payments. The Secretary of Health & Human Services (HHS) is due to provide this report to Congress in June. The LTPAC stakeholder industry is working with HHS to express the importance of adoption incentives for LTPAC providers.
The MDS 3.0 is set to implement in October, however it remains to be seen whether nursing home reimbursement will be driven from RUG-III or RUG-IV. The healthcare reform bill delayed RUG-IV to 2011, but industry groups are lobbying for implementation this October.
LTPAC EHR certification for is in full swing. The Certification Commission for Health Information Technology (CCHIT) LTPAC workgroup has been hard at work for the past year, co-chaired by yours truly. Criteria will consist of core elements (applicable to certified home health, nursing facilities, inpatient rehab facilities, hospice, long-term acute care hospitals) plus criteria specific to certified home health and nursing facilities. Pilot testing for the criteria was conducted in May with publication of the criteria and test script scheduled for June. Starting in July, LTPAC vendors may begin applications to certify their applications. HealthMEDX is planning to certify Vision this summer.
Finally, mark your calendars for the 6th annual LTPAC Health IT Summit at the Hyatt Regency Baltimore Inner Harbor on June 7 and 8. This is the only conference that specifically focuses upon LTPAC HIT. An Interoperability Showcase is included, giving participants the opportunity to see the latest technology initiatives to connect systems and applications. It is a great venue to network with LTPAC HIT thought leaders and to keep up-to-date on recent and future developments. More information on the Summit can be found at http://www.ahima.org/events/ltchitsummit/. HealthMEDX will demonstrate standards-based data exchange in the Interoperability Showcase and I will be speaking in a general session on EHR certification and data exchange standards.
See you in Baltimore.
Dan Cobb, CTO, HealthMEDX