Download Key Features of an Effective Integrated Electronic Health Record

INTRODUCTION
Phillip Winder
CIO Delaware Department of Correction
Jose Colon
President – CNT Infotech
Vijay Nathan
Project Manager – iCHRT – EHR Implementation
AGENDA
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Who Are We
Objectives
Functions of an EHR
Phased Rollout
Standards and Guidelines
Differentiating Factors
Challenges Faced
Lessons Learned
Benefits of eMAR
Benefits of an EHR
Functions
Questions
WHO ARE WE
“We at CNT Infotech believe that the cornerstone of any long-term relationship
should begin with one focal point – our client’s satisfaction”.
 Privately owned Information Technology/
Healthcare Services Company.
 Serving Corrections Departments, Hospitals,
Imaging Centers, Medical practices and Private
physicians in the US and Puerto Rico.
 Staff with more than 20 years of experience in:
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Corrections, Correctional Systems
Gang Information Systems
Electronic Health Records
Healthcare Operations
Healthcare IT
Healthcare Billing &
Management Association
OBJECTIVES
 Maintain a complete offender health record
 Improved communication and documentation
Reduced Risk
 Reduce duplications through better data collection and reporting
 Integration with Offender Management system
 Integration with Health Information Networks (HINS)
 Reduce operational costs
 Better disease management
 Meet national standards
HIPPA
NCCHC
ACA
Meaningful Use
 Project Rollout
FUNCTIONS OF AN EHR
Registration/
Scheduling
Transfers
Behavioral
Health
Intake
Screening
E
Prescription
/E-MAR
Dental/Vision
Sick Calls/
Encounters/
Nursing
Protocol
Medical
Orders/
Consult
Progress
Notes/ICD 910
Physicals
Medical
Administrati
on
HL7/DICOM
Compliant
Imaging/Labs
Reminders/
Allergies/
Drug to Drug
Interaction
IPad/tablet PC
Integration
with State
Labs and
HIN’s
Integration
with Offender
Management
System
APPROACH
PROJECT MANAGEMENT
1.1 Project
kick-off
1.4 Develop/Modify
Solution
1.2 Conduct
Requirements Gathering
Sessions
1.5 Conduct
Acceptance
Testing
PROJECT MANAGEMENT
1.3 Design
Documentation
1.6 Training/
Roll-Out
PHASED ROLLOUT
Project Management
Requirements
I
Coding
Testing
Training/Go-Live
Sick Call, Physicals, Nursing Protocols and Scheduling
II
III
IV
V
Design
Admissions, Intake Screening, Medical Inquiries, Medical Administration and,
Transfers
Discharges, Chronic Disease Care, Immunization, Lab /Imaging Results, and
Pharmacy/Prescription Interface
Substance Abuse, Consults, Infirmary Stay, Medical Emergency, OBGYN, Routine
Medical Checkup, Mental Health, Dental, Court Ordered Medical/Mental Health
Services Notification/Observation
Medical Service Compliance, Medical Services Governance, Surgery, Vision, DHIN
Interface
STANDARDS & GUIDELINES
National Commission on Correctional Health Care (NCCHC)
Standards
American Correctional Association (ACA) Guidelines
Meaningful Use Requirements
DIFFERENTIATING FACTORS
State Correctional Health System
One system for Medical, Dental and Behavioral Health
Functions
Proven integration with Offender Management Systems
Integrated with Pharmacy Vendor and Health Information
Network – ePrescription, EMAR
Integrate with PACS and Voice Dictation Systems
CHALLENGES FACED
 Scheduling Training
 Standardizing Process Across Facilities
 Identifying Super-users
 Different Forms at Each Facility
 Lack of Policy
LESSONS LEARNED
 Ensure user community participation during all phases of
the project.
 Identify Super Users and Functional Experts – Have
complete knowledge of the entire process and all the
functions. must be Leaders.
 Conduct process walkthroughs at every location for every
function.
 Standardize process across all facilities.
 Constant Communication of Change
LESSONS LEARNED
 Provider training is crucial
 Case management is enhanced by patient specific
information available
 Improved documentation reduced risk.
 Improvement in efficiency
BENEFITS OF eMAR
 Decrease in medication errors related to administration.
 Better reporting of errors with eMAR as compared to w/o
technology.
 Nursing staff are cautious when having to enter reason for
late medication administrations.
 Electronic refills eliminates phone calls, faxes and
paperwork .
BENEFITS OF EHR
HIPPA
•Fully HIPPA
Compliant
•Access
Control
Cost
Effective
•Customizable
•Table Driven
•Modifications
Integrated
System
Integrated
Health/
Patient Record
Scan
•Scan
Documents
•Images
Ease Of
Use
Upgrades
•Includes
Upgrades
•Updated
CPT/Diagnosis
Codes
Real
Time
Access
Vendor
Understand
Healthcare
and
Corrections
Dashboard
•User Friendly
• Template
Driven
•Intuitive
•Instant
Access
•Allows for
Informed
Decision
Patient Chart
Summary
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C
H
R
T
BENEFITS OF EHR
 Building a safer environment.
 Real-time updates allow providers to alter medications
and adjust delivery schedules to meet offender health
requirements.
 Simultaneous access to system at multiple sites ensures
that medication administration is not delayed by nurse’s
inability to view chart that a physician is viewing.
 Intake
FUNCTIONS
Needs Intake – Displays all intakes completed using offender management
system
Documents – Displays all documents attached for current intake
Initiated Intakes – Displays all intakes that were initiated or completed
Can document information for the following sections: General questionnaire,
Mental Health, Medical Conditions, Female Questionnaire, TB, Allergies,
Discharge Planning, Comments, Disability, Disposition, Insurance, Schedule,
and Addendum
Automatically schedules appointments for specific service types based on any
affirmative responses
 Preventive Exams
Auto-schedules for Preventive Initial once Intake is initiated. Upon completion of
the assessment, schedules for a Preventive Periodic based on the offender’s
age
Can document information for the following sections: Offender History, Vital
Signs, Vision Screening, Hearing Screening, TB Screening, Pap Smear,
Mammogram, Fecal Occult Blood Test, Physical Assessment, Other Medical
Screening, Rectal/Testicular Exams, and Special Circumstances
FUNCTIONS
 Sick Calls
Auto-schedules an appointment based on the Priority of the sick call and the
Provider to be seen
Allows users to triage the following types of sick calls – Medical, Behavioral
Health, Dental, Administrative, Pharmacy, and HIV/STD
 Encounters
Gives providers the capability to enter Diagnosis Codes and SOAP notes for the
nursing protocols
Total of 8 protocols and 50 sub-protocols to choose from
Allows providers to schedule for follow-ups or refer to a different department
Allows providers to enter medical orders
Gives providers the capability to complete infirmary and consult requests
FUNCTIONS
 Vision
Providers can complete an on-site Optometry consultation
Allows providers to enter medical order specific to vision
Auto-schedules for follow-up consultation, if required
 Dental
Allows providers to complete a Dental Chart
Color-codes each tooth based on the condition(s) selected
Displays a checklist of items to be completed
Allows providers to enter dental medical orders as well as administer them
Provides a historical report of each tooth
Allows users to complete the Periodontal Screening
Displays a list of all proposed treatment plans that need to be completed
FUNCTIONS
 Medical Orders
Allows users to complete medical orders under the following categories:
Medications, Lab/Imaging, Behavioral Health, Dental, Durable Medical
Equipment, Vision, and Other
RN and LPN profiles are only allowed to enter a 3 day bridge order
Providers can document the Sliding Scales for Regular Insulin
All medications are accompanied with the PDR Brief
Interfaced with Medi-span to allow users to check drug-to-drug interactions
Allows providers to print e-prescriptions for all orders
Displays an alert for duplicate doses of medications
Disables the refill capability for all narcotics
Allows users to schedule for lab/imaging appointments with the technicians
FUNCTIONS
 Pharmacy Administration
Allows users to filter the list of offenders that requires administration with the
following criteria: Administration Date, Facility, Housing Location, Building,
Wing/Unit, Floor, Tier/Pod, Room/Cell, Facility Time, and Delivery Method
Lists all the medications that requires administration on the selected date, time
and offender
Provides the capability to document the action taken for each medication
Allows users to print a med pass report every day based on the facility timings
 Medication/Insulin Administration Record
Users can view an offender’s MAR/IAR for each month
Users can print out MAR/IAR for a week or a month
Displays the medication details, the facility administration timings, the actual
time the medication was administered, the initials of the administrator, and the
action taken during administration
 Lab/Imaging
FUNCTIONS
Allows technicians to attend lab/imaging appointments
Users must document the number of the form completed during the appointment
Allows users to attach results received on paper
Allows users to view results received electronically
Highlights all critical lab results
 Immunizations
Allows users to administer vaccines and document any given prior to incarceration
Providers can view all administered vaccines and document the reactions on a VAERS form
 Scheduling
Displays all open appointments for an offender
Allows users to schedule for an appointment
Provides the capability to generate the frequency for a recurring appointment
Provides the capability to reschedule or cancel from the existing open appointments
FUNCTIONS
 Chronic Care
Allows providers to enroll offenders in one of the 24 chronic clinics
Allows providers to complete the Initial assessment, the Follow-up assessments
and the Nursing Chronic assessment
Providers can complete the Foot Examination if offender is enrolled under
Diabetes
Providers can view all completed assessments even after the offender’s
discharged
 Infirmary
Allows providers to admit offenders to Infirmary
Offenders can be referred to PCO along with Infirmary
Providers can complete the following assessments: Physician, Nurse, 24 hour
rounds, Psychiatric Evaluation, Clinical Note, and Mental Health Observation
Providers can view all previously initiated assessments
Auto-schedules for a Physician and a Psychiatrist Encounter when transferred
out of Infirmary
FUNCTIONS
 Treatment Administration Record (Wound Treatment/Post-op
Surgery)
Allows users to administer Wound Dressings based on the selected
administration date and facility time
Lists all the treatments that requires administration on the selected date and
time
Users can view an offender’s TAR for each month
Users can print out TAR for a week or a month
Displays the medication details, the facility administration timings, the actual
time the medication was administered, the initials of the administrator, and the
action taken during administration
QUESTIONS