Home Health Synchronicity : Case History

Sept. 1, 2007

A Minnesota healthcare enterprise discovers a single solution for home and hospice caregiver communication and reporting.

While the practice of providing caregivers with seamless access to health information within a hospital environment can be daunting, providing that same level of communication in the home healthcare environment can be particularly challenging. As the baby boom population ages, more and more people will find themselves moving between ED, hospital and home care. Caregivers must have the same level of access and support outside the hospital environment as they do within it. For one of Minnesota’s largest medical groups, that seamless and transparent infrastructure of support required an evolution and process of discovery of not only the health information technology tools, but also the development of true partnerships between caregivers, institutions and healthcare technology solution vendors.

A Minnesota healthcare enterprise discovers a single solution for home and hospice caregiver communication and reporting.

While the practice of providing caregivers with seamless access to health information within a hospital environment can be daunting, providing that same level of communication in the home healthcare environment can be particularly challenging. As the baby boom population ages, more and more people will find themselves moving between ED, hospital and home care. Caregivers must have the same level of access and support outside the hospital environment as they do within it. For one of Minnesota’s largest medical groups, that seamless and transparent infrastructure of support required an evolution and process of discovery of not only the health information technology tools, but also the development of true partnerships between caregivers, institutions and healthcare technology solution vendors.

 With more than 580 physicians across 35 medical and surgical specialties, Minnesota’s HealthPartners Medical Group and Clinics is dedicated to providing exceptional care for the people of Minnesota in a variety of environments, including their homes. Two of the organizations under their umbrella are Hospice of the Lakes and Integrated Home Care. The first cares for those at the end of life and the latter is a Medicare-certified agency that supports patients in their homes, promoting optimal wellness and function.

Breaking Through the Clutter

 Like every healthcare enterprise over the last decade, Hospice of the Lakes and Integrated Home Care have faced the challenges of potential inaccuracies and slowdowns associated with working in a paper-based world. Caregivers in the field were forced to deal with paper charts and multiple phone calls throughout the day to complete patient referrals and updates. ” Seven years ago, physician calls for patient updates required us to take messages, run to check the paper medical record and then call back the physician. The process was even more cumbersome and error prone for clinicians working with patients in the home,” says senior manager of Hospice and HomeCare and PartneringCare Senior Services Kris Dudziak.

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 According to Dudziak, and HomeCare Manager Denise Edgett, home care and hospice had separate billing systems and homegrown scheduling modules that weren’t set up for cross-communication of information. Consequently, a clinician setting up his or her day in the field would, for example, complete the scheduling process and associated calls to patients, then call the office to update the written scheduling records. All changes to clinician schedules required updating the office by phone call. Clinicians also needed to submit handwritten records to the office so that claims data could be entered and bills generated. ” We had redundant processes in place and were spending a lot of time listening to voice mail and placing calls to communicate,” says Edgett.

 Avoidance of medication errors and promoting Medicare regulatory compliance was also a concern in the paper-based world. Medicare for example, requires an interdisciplinary group (IDG) to review hospice patients on a 14-day cycle. HealthPartners’ staff would print out patient care plans, make multiple copies and distribute them in the IDG meeting where the medical director would sign off on the plan.

 Updated care plans would then need to be distributed to all involved clinicians to insure that current orders were being followed.

Due Diligence Search

 With an original goal of Y2K preparation, HealthPartners began the search for an integrated solution that would not only take care of the Y2K potential, but also would streamline and simplify their back office and point-of-care. According to Dudziak, the first step was identifying vendors with a fully integrated solution for both home healthcare and hospice, but that proved more challenging than at first glance. ” We had a couple of vendors who had a vision of a solution, but when push came to shove, they didn’t actually have it available,” says Dudziak.

 After approaching numerous vendors for requests for information and RFP’ s, various vendors came to the table but only BeyondNow—today, known as Cerner BeyondNow—seemed to have the integrated solution that they sought. ” Where other vendors either had a solution for one or the other nailed pretty well, we needed a solution that met the needs of both hospice and integrated homecare,” says Dudziak. ” So through a process of due diligence, we landed on this solution.”

 HealthPartners eventually made the decision to implement BeyondNow’ s HomeWorks and RoadNotes solutions. RoadNotes, the point-of-care solution, allows staff to communicate updates on admissions, discharges and patient status to the office remotely via a wireless Internet connection while HomeWorks is the full suite hospice and home care solution. The clinician would work from the scheduling module to confirm all of the nurse’ s visits and move the visits around and then synchronize documentation at the point-of-care.

 According to Dudziak, finding the solution was just the first of several hurdles that they needed to clear. With the hospice and home care business units, HealthPartners’ internal information services department and the vendor, the implementation process became a dance between the three entities where two wanted to lead. ” Our information services department felt that they should lead implementation, and our vendor was waiting for input from either info services or us as a business as to how much participation that they should have,” explains Dudziak.

 The ultimate solution was the creation of more of a partnership between HealthPartners and Cerner BeyondNow to not only implement the solution, but also to work together to both customize to some degree and work together on future updates. ” It was imperative that we have an open dialog capability to address our concerns should something not be working the way that we expected or have the ability to offer legitimate input that would be implemented in future developments,” says Edgett.

Rollout and Results

 With the discovery process, implementation, training and finally, rollout, taking place over five months between late 1999 and early 2000, HealthPartners found themselves with a streamlined system that was working. Today, the system allows hospice IDG meeting staff to create custom meeting profiles and allows the medical director to sign off electronically. The solution now has alert features which inform staff of recertifications coming due, and when supervisory visits need to occur.

 Patient-specific alerts regarding need-to-know information can be entered as well. Once this is entered, a large red ” A” appears on the patient screen informing staff that vital information about this patient is present. Once updates to the patient records are in the HomeWorks module, they can be projected on screen for group discussion.

  Instead of multiple phone calls from a land line or a personal cell phone as was the case in the past, HealthPartners now has the ability for a clinician to enter their work into the remote database on a tablet PC and synchronize that over the Internet to the database, which is invisible to people in the back office. ” This eliminated the need for that phone call and having an outdated piece of paper that we were relying on as reality,” says Dudziak.

” Where other vendors either had a solution for one or the other nailed pretty well, we needed a solution that met the needs of both hospice and integrated homecare, so through a process of due diligence, we landed on this solution.”

—Kris Dudziak HealthPartners Medical Group and Clinics

 By synchronizing their computers twice a day at a minimum, everyone is on the same page and has the same information. ” This has enabled our evening night call staff to have the most current patient medical record at their fingertips for those late night calls instead of having to rely on yesterday’s information at best,” says Dudziak. ” The advantages for patient safety are obvious. Our homecare staff is synchronized if there are changes to orders or additional services are required. We used to have a pile of work at the beginning of each day. We can work those requests throughout the day, reducing some of that early morning rush to fulfill requests for services.”

 Outcomes Manager, a module in HomeWorks, allows staff to compile OASIS information for Medicare submission with upfront error-checking instead of getting rejections after submission. Additionally, a custom volunteer request profile was built, which can be filled out in the field by caregivers and attached to the patient’s electronic record. ” By using that profile and running a report, we cut six days out of the request process, so every single patient who requested a volunteer can get one assigned sooner,” says Dudziak.

 Since that initial rollout, Health­Partners and Cerner BeyondNow have experienced numerous updates that continue to streamline the process. But both Dudziak and Edgett emphasize that the results are due to partnership rather than a vendor/client relationship model.

 ” Whether you decide to maintain a customer vendor relationship or move into a partnership, an organization has to look at its current business and decide three things—what it will stop doing, what it will continue doing and what it needs to start doing, and that is a whole process redesign,” says Dudziak. ” Without that, it doesn’ t matter if you have the perfect tools set developed by every one of these companies coming together to create the perfect product, you will not have a good implementation. The tools set is only that…a tool. And at every software upgrade, you need to take a look at the software improvements, existing business processes and the existing business climate and decide if you are ready to move forward.”

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