South Florida Hospital News
Friday October 23, 2020
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June 2012 - Volume 8 - Issue 12
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Hospice by the Sea Realizes Unexpected Benefits from EMR Implementation

In response to President Obama’s mandate that all medical records be converted into an electronic format by 2014, thousands of hospitals and healthcare facilities face enormous challenges as they position themselves to enter an electronic age dominated by computers and mobile data-sharing devices. Healthcare providers are finding their once familiar world of paper charts and patient files disappearing at light speed.
 
In choosing an Electronic Medical Records implementation strategy, Hospice by the Sea, Inc. engaged every part of their organization in a concentrated effort to identify and build a state-of-the-art EMR system that would meet their patient’s needs. Initiating an Electronic Medical Records system in a hospice/homecare setting has unique challenges. Hospice by the Sea, Inc., employs physicians, ARNPs, social workers, spiritual care counselors and over 300 nurses and CNAs who work remotely, caring for patients in their home or the place they call home. When a patient requires intensive care and pain management, it is provided by Hospice by the Sea care centers located in Boca Raton in Palm Beach County and in Hollywood in Broward County.
 
Following visits with patients and their families, patient charting was completed by members of the Interdisciplinary Teams and patient records are submitted intermittently during the week. This form of patient record keeping was always time-consuming, inefficient and burdensome. Charting patient information required numerous forms and did not allow the various members of each Interdisciplinary Team to access “real-time” patient information until paperwork was placed in a patient’s chart.
 
Hospice by the Sea’s decision to move to Electronic Medical Records was made in early 2010. In the initial planning stage, Chief Operating Officer Gil Brown worked closely with the Director of Information Technology and the Director of Patient Accounts to evaluate vendors, systems and services. A new position of Director of Clinical Applications was created at HBTS to oversee the clinical and computer conversion process from beginning until completion. This position required someone with extensive clinical experience combined with and in-depth knowledge of computer systems.
 
With these pieces in place and after several months of research and evaluation, an EMR system was selected. “It was important from the beginning that everyone recognized our commitment to fully implementing this technology and that this would be a long-term work in progress,” said Bivek Pathak, Director of Information Technology at Hospice by the Sea.
 

(l-r) Bivek Pathak, HBTS Director of Information Technology; Sheila Etheredge, Certified Nursing Assistant for Palm Beach Facility and Home Teams; Gil Brown, Chief Operating Officer.
The Hospice by the Sea Electronic Medical Record Implementation Team began work on a year-long planning and building process. Working closely with the Director of Information Technology and the Director of Clinical Application, representatives from Human Resources, Quality Management, Education, Physician Services and Psychosocial Services, the team regularly met to create an educational and development plan which prioritized capturing individualized clinical information and successfully using the care plan records for patient billing. The Implementation Team had to guarantee that the technical architecture of the system was secure and fulfilled federal and state healthcare compliance requirements. Throughout the process, the Implementation Team communicated with field staff to evaluate critical decisions which help created the new processes. These open lines of communication served to manage change by developing staff awareness and converting the anxiety felt by staff members to excitement about this new learning opportunity.
 
There were several guiding principles critical to the successful implementation of the Hospice by the Sea Electronic Medical Records system. ”First and foremost, HBTS would use and learn the system for one year before making modifications to the structure. HBTS would provide top quality equipment and connectivity to assure that field staff would be able to reliably access and transmit data, said Gilbert Brown, Chief Operating Officer. “Also, HBTS would invest in superior training for staff in blocks of small, week-long classes. Finally, HBTS would develop discipline specific training manuals and corresponding individualized quick-reference guides addressing both technology and process. These would help build comfort levels to give users the resources they would need to be successful,” he concluded.
 
Following an eight month testing period, 80 in-house hospice staff were trained to provide expertise and become the foundation for subsequent roll-outs of the EMR to the clinical staff. Eight additional months of training on a month-by-month rotation, addressed the training needs of all field-based teams, spiritual care counselors, social workers and Hospice by the Sea’s home health agency staff, FocusCare.
 
One of the most challenging aspects of initiating the Electronic Medical Records system at Hospice by the Sea was managing of the level of anxiety for the staff. For many nurses, spiritual care counselors and social workers, this was their first introduction to computers.
 
Educational models were developed to incorporate the need for introductory training on computer equipment at a very basic level. Once basic computer skills were in place, training was provided via a three phase approach: white board demonstration by the instructor, step-by-step keyboarding demonstration with the instructor, and finally working on the system independently. All training was conducted in a low stress environment.
 
“Normally, 10 percent of the trainees excel in the rate they learn a new task or process; 80 percent learn at an average pace and 10 percent struggle with the technology and the process of change. However, everyone at Hospice by the Sea was equally motivated by the new ability to immediately share and access information.” explained Louise Lucas, HBTS Director of Clinical Applications.
 
Much of the success of the conversion to EMR at Hospice by the Sea can be attributed to the strength of the Information Technology Team. Most HBTS nurses are out in the community, assessing, caring and treating patients in the place they call home. IT provides each nurse with their own field device, air card (for transmission of data), printer and travel bag on wheels to transport their computer equipment. IT delegated an IT Field Team support person to assist nurses, spiritual care counselors and social workers who are out in the field and may encounter problems using their field devices. A new Help-Desk call system was developed whereby an IT support person would be on-call 24 hours a day. Technical software was purchased to allow the IT support person to remotely access information and troubleshoot problems on the field devices. This IT support helped quickly bring the field staff to a comfortable level of competency.
 
Hospice by the Sea, Inc. has tackled one of the greatest challenges in the 34-year history of the organization. The conversion to Electronic Medical Records required a substantial financial investment in the company by the Board of Directors. Along this difficult way, HBTS clinical and administrative staff overcame many insurmountable obstacles. As a result, today nurses are able to view each other’s notes. Physicians, ARNPs, social workers and spiritual care counselors have real-time information at each patient visit. Notes are easy to read and patient information is accurate and timely.
 
Looking back on the wonderful progress Hospice by the Sea, Inc. has made in their conversion to Electronic Medical Records, Paula J. Alderson, President and CEO, reflected, “This process ended up driving change throughout Hospice by the Sea, Inc. The magnitude and implementation of this change was unexpected. It has positively impacted document management, scheduling, data retrieval and analysis, chart auditing and, of course, the timely access to data. The patients and families of Hospice by the Sea, Inc. will continue to realize benefits from this enormous undertaking.
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