Medical Informatics in Institutional Long-Term Care: Terra Incognita Anthony J. Lechich, M.D. Mattie...
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Transcript of Medical Informatics in Institutional Long-Term Care: Terra Incognita Anthony J. Lechich, M.D. Mattie...
Medical Informatics in Institutional Long-Term Care: Terra Incognita
Anthony J. Lechich, M.D.Mattie Smith, R.N.Darrell B. Cohn, B.A.
Long-term Care Environment
Federal Laws/Mandates
OBRA 1987– Resident Assessment Instrument (RAI)
• Helps clinical staff to gather and analyze information in order to improve a resident’s quality of care and quality of life
• Minimum Data Set 2.0 (MDS 2.0) is the RAI of choice
HCFA (CMS)– Goals of HCFA automation of the MDS 2.0
• Clinical utility• Payment system• Quality improvement
MDS 2.0– It is a standardized assessment instrument consisting of more than 400
items, used to help identify a resident’s problems, strengths, needs, and preferences in order to improve or maintain function.
MDS 2.0 Sample
See appendix 2
Terence Cardinal Cooke’s Solution
Data Process Flow
TCC MDSs Completion (2000-2002)
Number of MDSs Completed
56005800600062006400660068007000
Dec-00 Dec-01 Dec-02
Care-Planning (old)
Care-Planning (new)
TCC’s unique care plans (see appendix 3)
Nursing Orders Accountability Records (NOARS)
See appendix 4
American Health Care (AHC) Software
Project Progress (as of 12/12/2002)
2 pilot floors in progress– Hospital-8 is entering in all MDSs into the AHC system and
using the new care plans– Cohen-9 is being trained on the system– 20 more units to go once all aspects of the system are fully
functional
Working with AHC to fine-tune their clinical software to fit our clinical needsGrants– Johnson and Johnson Community Healthcare Program grant– Robert Woods Johnson Foundation: Long Term Care
Workforce Initiatives grant
Implementation Challenges
Modifying the clinical software to fit our needs
Finding server space to house enormous amounts of data– Dealing with the need to archive old data
Rolling this out to other CHCS nursing homes– The work TCC has done will be incorporated into other CHCS
facilities• They can modify our processes to fit their own needs• There is the potential for friction to acceptance
C a rm e l R ich m o nd F e rrn c lif f S t. V in ce n t d e P a u l K a te ri
T C C
CHCS
Technology = Efficiency
Essex County Correctional Facility– Xybernaut’s Mobile Assistant® V (attaches to the hip)
Security firms Wireless systems– American Health Care
Further automation– Decision support solutions
• Automated alerts, recommendations, warnings
– Instructional flow paths for clinicians
Touch screen technologySee appendix 6 for recent article
Results of Automation
Culture change– Meeting the changing needs of the nursing home population– All caregivers have to acclimate to the new computerized
system
Using the MDS as a clinical tool
Data mining– Scouring the care plans for CNA related material– Trending with respect to patient diagnoses
• Trach-tubes
• Pressure ulcers
• HD
Final Words
Appendix 1
Abstract:Terence Cardinal Cooke Health Care Center (TCCHCC), a 729-bed residential care facility in
Manhattan, is automating the time consuming federally mandated resident assessments that are performed on all Skilled Nursing Facility residents at least six (6) times per year. We will provide a commentary on the current (lack) penetration of clinical computer system enhancements in Nursing Home care in the US and describe our own approach to the automation issues. We will demonstrate our progress in utilizing the current mandated data tool to automatically produce care plans. Care planning for the nursing home interdisciplinary teams is the pivotal clinical activity that, when manually performed, can hardly be done. The software approach, implementation barriers, and new short and long-term automation targets will be presented.
With this presentation we hope to stimulate a transfer of ideas from the usual hospital focus to the
nursing home. Because nursing home MIS budgets are far less than hospitals’, they are an even less forgiving proving ground for new systems. Furthermore, the interdisciplinary nature of the clinical activity demands a larger spectrum of trainees. On the positive side there is a predictability and repetitive quality of the documentation and a huge potential for job satisfaction in nursing that favors progress in this exciting new area of Medical Informatics.
Please visit our Web site at http://informatics.tcchcc.org
Appendix 2
Sample of an MDS 2.0 form (on next 3 pages)
Appendix 3
Sample of TCC’s new care plans (on next 2 pages)
Appendix 4
Sample of TCC’s new Nursing Orders Accountability Records (NOARS, on next 3 pages)
Appendix 5
Appendix 6
Article from Nursing Homes Magazine (on next 2 pages)