Nine Ways to Maximize Adoption of Health Information Technology: Transforming Care in your Home Care Organization
By Cyndi Rizzitello
Over the last decade, health IT has greatly evolved. Lessons have been learned and best practices developed that can improve the chances of successful adoption. This, in turn, leads to better care and outcomes for patients. Successfully implementing health care technology solutions is critical for the viability of the home care industry. HIT ensures people receive high-quality care at lower cost, according to Patrick Conway, MD, Deputy Administrator for Innovation & Quality and Chief Medical Officer at the Centers for Medicare and Medicaid Services (CMS):
Health information technology is an important building block that enables delivery system transformation. It allows for the seamless health information exchange needed to improve care delivery, ensure patient safety, enhance clinical decision making, track patient outcomes, support payment for care quality, and more.
Dr. Conway makes it sound easy. But providers know otherwise if they have faced the challenges of selecting, planning, and implementing HIT solutions that can ultimately transform care delivery and clinical outcomes. It takes a coordinated, organization-wide effort to achieve success with HIT. And all of that work comes with a great financial cost — one that is not reimbursed by CMS.
Another obstacle is that not many easily embrace change. That’s one major reason why organizations struggle with adoption of anything new, not just HIT. Relying on the early adopters to help drag the laggards across the finish line is one effective strategy. But the bottom line is that achieving value with technology relates directly to an organization’s ability to integrate HIT into the daily clinical workflow.
So how successful has the home care industry been in adopting HIT? In 2014, the National Association for Home Care & Hospice (NAHC) surveyed agencies and found that 57.8 percent have point-of-care systems, and 89.9 percent have electronic back office systems. Among agencies with EMRs, 46.4 percent said their system met their needs; 8.5 percent said their system somewhat met their needs; 31.9 percent said their system did not meet their needs; and 13.2 percent were unsure.
This equates to half of all agencies expressing some level of dissatisfaction with their HIT. It also means that the 40 percent of agencies without a point-of-care solution, over 15 years after its inception, are still completing OASIS on paper. So how far have we really come since the age of the papyrus?
And why are clinicians still documenting OASIS on paper though home care is a data-driven industry with both clinical and financial requirements? What makes HIT so challenging? The high cost of hardware, software, and resources to manage it all is an obvious obstacle. CMS’s Meaningful Use incentives, which leave home care out of the mix of “eligible providers,” further burdens the industry to find funding on its own.
Now that we know about some of the challenges home care faces as it adopts and implements HIT, let’s dive into some strategies that can help ease the burden for those who have attained a degree of success with technology. How can you further maximize adoption to reduce costs and transform care?
You paid a lot of money for your EMR. And we know CMS sure did not reimburse you for it. So how can you avoid being one of those survey respondents that was less than satisfied with their EMR? You can start by boosting your adoption of HIT.
Foster an innovative culture. Start at the top where it’s most needed. Leadership that is well engaged in HIT initiatives sets the tone for a culture open to change and investment in resources that can lead to adoption of HIT and efforts toward clinical transformation. The right people will do the right thing if they have support from the top and autonomy to perform their jobs.
Invest in an IT software specialist or clinical informatics position. If you’ve made it far enough into an EMR implementation without a dedicated resource for clinical IT adoption, consider yourself lucky. This position is critical for ongoing efforts to clinically transform care by maximizing adoption. A good candidate may be clinical or non-clinical but extensive operational knowledge and leadership ability are requirements. This is a key position that needs the autonomy we have mentioned as well as good relationships with operational stakeholders in all departments.
The IT software specialist is a steward for change management. You cannot fully reap the benefits of a robust EMR without knowing its ins and outs. And you need a systems expert to achieve this. Your internal support mechanisms depend on this person. Keep in mind that software company support can tell you where to point and click but can’t tell you how to click to run your operations. Your IT software specialist is always up to date on the ins and outs of your EMR and helps lead change in order to maximize its use.
Schedule a comprehensive, annual EMR review. Whether you’re dealing with a new implementation or you’ve been settled into an EMR for some time, plan to analyze the use of the system regularly and at least once a year. Chances are your EMR has optional modules, so consider if you’re using them all. Take a look at your business needs and operational deficits. Are you lagging in clinical outcomes or patient satisfaction? Are there features within the clinical components of your EMR that can help improve a process or manage it more efficiently and effectively?
Be sure to network with other agencies using the same EMR and compare notes. There is no need to recreate the wheel when you can share best practices, especially those for clinical documentation review. Make site visits — they are not just useful when researching EMRs to purchase — and use them after you are live to share best practices that have led to organizational improvements.
Once you complete your full EMR assessment, come up with an action plan targeting those additional features that can help improve patient care and operational efficiency. Then make a plan for implementation.
Streamline clinical documentation. When performing your EMR evaluation, pay particular attention to your clinical documentation forms. Most EMRs come with standard clinical documentation sets. Often the content right “out of the box” is generic or overly comprehensive and may not fit with either current processes or your own developed and refined best clinical practices. When first going live you may not have the time or understanding to make changes to the standard set. Still, clinical documentation is a critical part of the overall effectiveness of your EMR, so take the opportunity for review with the goal of streamlining.
To start, take a close look at the time it takes for clinicians to complete documentation and seek their feedback on what they believe should be changed. Form a committee that includes representation from your quality and compliance team, the IT software specialist, and field staff from each discipline. Seek ways to capitalize on best practice standards while reducing redundancies and keystrokes. Be sure to incorporate all the bells and whistles your EMR functionality offers. Consistency, validity checks, and decision support tools, if available, can only help you to reach your goal: having the best documentation that will take your clinicians the least time to complete.
Invest in training and education. Say you have all features in use. To be sure your staff is using them correctly, invest in training and education. Remember that an implementation is never truly complete. Ongoing review of features and staff education on changes or improved methodologies is critical to staying current.
Don’t forget to consider that software and hardware change rapidly in response to regulatory requirements, technological advancements or improvements in clinical practice. Keep an eye on EMR updates. Form a committee involving your end users and IT staff. Take account of education, quality and compliance when deciding if or how to use new features. But be agile. The importance of adapting rapidly to operational challenges or changes in practice is critical to success. Too many meetings and too little decision making can stall an organization’s ability to move forward and take full advantage of all capabilities.
Use clinical decision support features within your EMR. Clinical decision support (CDS), per HealthIT.gov “encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information, among other tools.”
Even though hospital EMRs are much more advanced in the use of CDS, your EMR likely has CDS components, some that you may already be using and others that you may not be capitalizing on. Do you know what is in use or available in your EMR? Medication interaction notifications are usually standard in EMRs. Clinical practice guidelines may be embedded in your clinical documentation or order sets. References or links may exist to take users to additional documentation or external sources. Consistency or validity checks may be available to help ensure OASIS accuracy.
Skillfully using CDS tools to improve clinical decision-making can help prevent clinicians from being overloaded with information and provide safer, more efficient care. Make this a part of your analysis to see if you are maximizing the use of what is available
Manage your data with analytics. Be careful not to treat your EMR as a data repository. There is a wealth of value buried in the bits of discrete clinical, financial, and operational data that you collect every day. You can capitalize on the use of this data by using analytics.
By definition, analytics is the discovery and communication of meaningful patterns in data. The diagram below shows the increasing value to your organization as the types and complexity of the analytics grow. As you achieve results from increasing levels of analytics, data is transformed into meaningful information and, ultimately, knowledge you can act on.
Let’s dig a little deeper into some types of analytics and what can they do for your organization.
Descriptive analytics helps you understand how things are going. Their purpose is to summarize what happened in the past, and it is estimated that more than 80 percent of business analytics are descriptive. Examples of descriptive analytics in your organization are visit statistics, census, vital sign reports, dashboards and benchmarking results.
Predictive analytics helps you to forecast future performance using a variety of statistical modeling, data mining, and machine learning techniques to study recent and historical data. Predictive analytics allows analysts to make predictions about the future: what may or probably will happen on the basis of past records. How could it be used? Predictive analytics can tell you who on your census is most likely to be re-hospitalized or who is most likely to expire.
Prescriptive analytics takes a deeper dive into the data to find patterns that can suggest next steps or courses of action in order to achieve specific outcomes. For prescriptive analytics to work, a predictive model must be available, as well as a feedback system that tracks the outcome produced by the actions taken. Prescriptive analytics could tell you how many times to visit a home health patient in order to achieve a specific outcome. This type of analytics is in its early stages in the home care industry but is in more robust use in other health care settings.
The bottom line with analytics is not to let your wealth of data go to waste. Allow it to help you achieve value. Invest in a data analyst who can transform your EMR raw data into meaningful knowledge you can act on. Provide your analyst with advanced analytics, such as data warehousing and business intelligence tools, so you can make informed decisions on organizational strategy and direction. At the same time keep an eye on evolving technologies in the industry. Your EMR likely can’t do it all. Advanced analytical tools are available to augment your EMR and help you to transform care. Analytics can help you achieve value. And don’t just scratch the surface; there is a lot of potential hidden beneath.
Invest in professional development for software specialist and data analyst positions. Be sure to continue educating your software specialists and data analysts both on the EMR they are expertly using and on industry happenings. These key employees cannot support your organization well without knowing how developments in home care may be affecting your current and future operations. So make sure they attend EMR and industry trade group conferences and get involved in industry and regulatory committees. Their involvement should help feed internal operational committees so that you can always stay ahead of regulatory and EMR changes – and be ready to act swiftly if needed.
Capitalize on available mobile technologies. Let’s talk about point-of-care. You have a remote workforce so make sure you are capitalizing on the mobile technologies and cellular connectivity that are available to support your team in the field. Hardware, such as hand-held devices, that can be used easily within patients’ homes may be a better choice than laptops, which are not as easily integrated into visits. Hand-held devices are also often cheaper and more disposable at end-of-life than mobile devices, which may require more of a capital expenditure.
Once you have the latest and greatest devices and connectivity, be sure you have policies and procedures that require your field staff to complete the majority of their visit documentation in the home. Sure some additional data may need to be added later but most of the visit assessment data should be recorded as soon as possible since studies show that recall and accuracy is less than optimal at a later time. Timeliness of documentation also affects continuity of care. Your care team members need to be able to see the latest documentation in order to efficiently and safely coordinate care. Late entries impede this communication and can disrupt the flow of operations, from clinical to scheduling to billing. Now you can see why that easy to use point-of-care device is so important. You need to give your field staff the most opportunity and ability to complete documentation in the timeliest manner.
No one ever said it would be easy but capitalizing on lessons learned and best practices developed in the HIT field over the past decade can improve your chances of successful adoption. To get the most out of your EMR you will need to continually improve processes, re-educate your team, and keep up to date on technological changes. You have made a significant financial investment in your EMR so don’t allow it to stagnate. Foster a culture that embraces technology and is agile enough to respond swiftly to regulatory, clinical, or industry changes. If you do, you will be much closer to transforming your delivery system in the way Dr. Patrick Conway describes. Your patients are worth it and the viability of your organization depends on it.
About the Author: Cyndi Rizzitello is VP of Clinical Transformation at Medalogix, a Nashville-based health care technology company that provides analytics and workflows to home health providers so they can improve care and reduce costs. Cyndi brings more than 25 years of healthcare experience to Medalogix with practice as a clinician and a health care technology manager