Managing Medical Needs at Phoenix

• Therap

•CaraSolva

•Clinic Online Access

•Bluestone’s Bridge

•Hardware Overview

Phoenix Residence Overview

• The Phoenix Residence, Inc. provides 24-hour support to adults with disabilities in 12 6-bed ICF/DD facilities and 7 Waiver homes.

• We serve 100 individuals in these services.

• Phoenix also supports some people in non-residential services as well.

• Our homes are largely located in the Eastern half of the metro and are located up to 20 miles away from our corporate office.

Therap

• We chose to use this as our first electronic tool all our employees would use daily in providing service to the people living in our homes.

• We chose Therap after looking at several different systems and approaches. Therap provided an easy to use interface at a price level which was a better fit for an organization of our size.

Onboarding

• Computers installed at all locations.

• Assessment of our workforce’s computer knowledge.

• Training on basic computer use provided to some staff.

• Organized organizational trainings at our corporate office to introduce the program.

• All sites went live at the same time.

Onboarding cont’

• We implemented Therap in pieces. This being our first electronic system, there was a need not to change too much for our DSP and frontline management teams.

• When we went live, we started using simple, frequently used portions of the system. For us we introduced Progress notes (T-Logs), Incident Reporting (GERs) and the internal messaging system (s-comms).

• Therap utilizes a test mode which we used frequently to allow staff to practice and show competency.

• We established a committee to develop an annual calendar when other modules would be introduced and to develop/provide the needed training.

HIPAA

• Therap was the first way for our employees to access HIPAA protected information away from the worksite.

• We integrated into our employee’s training their responsibility to ensure the protection of this information if they were accessing the program from home. We also repeatedly educated our expectations that all documentation be done when onsite so our hourly staff were compensated for their work appropriately.

Therap Current Use

• At this point in time we are using Therap as our primary documentation source.

• Now that all modules are in, and we’ve become comfortable with the system, we no longer facilitate a separate committee.

• Modules being used: • Progress notes

• Health Tracking

• Incident Reporting

• Internal communication

• Positive Support Plans

• Programs/Outcomes

• Individual Data

• MAR (previously used)

• Some assessments

Family Access

• A unique benefit this change has made for us is the ability for our family members or guardians to be able to see the information for themselves.

• We allow them read-only access. For some family members where they are looking for frequent updates, they are able to get the information they need without needing to rely on staff to relay the information.

Why Carasolva

• We were looking for a System that had Pharmacy Interface particularly with our pharmacy: Geritom.

• We were looking to cut out human error with medication and treatment transcription.

• It had to be user friendly, simple for the user to read and understand.

• It had to be cost effective for our Company.

Carasolva: Prompt drive

Medication literature for most medications

Medication and treatments are green when due: We schedule for xx:15 times

Pharmacy Interface

• Orders must be sent and filled by Pharmacy for orders to be mapped to Carasolva.

• User must accept orders from pharmacy and assign time to be administered

• If order is filled by another Pharmacy then transcriber must enter into system.

• Entering in orders is not as user friendly as other systems.

Carasolva On-boarding

• Significant time to add individuals into system.

• We added Diets, Allergies, Diagnosis, Primary Physician, Advance Directives, PRN’s and Resident Protocols

• We created a Master Lists: Medications, PRN medication, Protocols:

• Bowel Management for constipation individualize, Seizure Protocols, CPAP, BiPap, Straight Catheterization, Epi-Pens, Osteoporosis, Wound Care, etc.

User Friendly:

Sample Protocol:

PRN’s are sorted by Symptom seen by medication passer:

PRN’s by symptom select from list that is prescribed.

When on boarding we had a plan • We sent hard time lines in conjunction for “Go Live” dates

orchestrated with Carasolva and Pharmacy.

• We assigned 1 home per nurse for first group of homes.

• Then 1-2 homes per home depending if 4 bed or 6 bed home.

• Took 4 months to complete all 19 homes. 100 individuals.

• Must have paper MAR back up for power outages.

Carasolva has had great impact

• It was easier for staff to learn system.

• We had training sessions for all staff, and had a training video we created on You Tube.

• We seen a reduction in medication errors with use of system. (Next slide had numbers)

• Staff downside, need to log into 2 different systems.

Therap and Carasolva

• Benefits

• Remote access- allow faster/more flexible ability to update.

• Legible

• Takes less time to complete required documentation.

• Ability quickly search and access historical information in an organized manner.

Medication Error Reduction

6 month amount Jan-Jun

6 month error % rate Jan-Jun

Carver 47,633 0.010%

Caswell 27,267 0%

Douglas 42,090 0.021%

Foss 23,058 0.017%

Janet Court 33,855 0.003%

Ludden 32,208 0.040%

Newport 32,960 0.012%

Viking 28,182 0.014%

Centerville 19,292 0

English 21,476 0

Furness 26,026 0.004%

Howard 21,294 0.033%

Totals 355,341 0.014%

2013

2014

2015

Jan-Jun 2016

111 (0.019%)

92 (0.014%)

63 (0.009%)

49 (0.014%)

Clinic On-line Access

• Electronic Medical Records are available for individuals. Depending on system/network there are many possibilities for usage.

• Appointment scheduling

• Copy of clinic visit notes

• Lab or imaging results and recommendations.

• Recommended routine screening due dates:

• Colonscopy, mammogram, immunizations, PSA

Clinic On-line Access

• Message the physician.

• Medication questions

• Medication Re-fills

• Request a referral for specialists, equipment etc.

• Virtual Well Visits for minor illnesses, bladder infection, strep., pink eye etc.

• Update MD on minor illness and use of PRN’s

• Request new PRN

• Update MD on medication errors

• Update MD on “____” fill in the blank.

• Bill pay

The next few slides have few clinics we for individuals at Phoenix Residence

Clinic Health Web systems

• 1. Make sure you have permission from guardian to sign up for system.

• 2. When making clinic contact, sign your name at the bottom, your job title, and phone number you can be reached at.

• 3. If you put out a message, make sure to check in an hour, end of day, and following day for return message.

• 4. Most clinics will send a message to you in you regular e-mail there is a clinic message waiting.

Things to consider

• 1. E-visits even with a co-pay maybe less expensive then going to the clinic.

• 2. For urgent matters it is better to call the clinic instead of leaving web message.

• 3. Print responses for your medical record, you may scan results into your electronic records.

• 4. Some vendors do not accept e-signatures, such as pharmacies. You may need to ask clinic to submit orders to pharmacy directly.

Post Hospitalizations

• Some hospitals have gone to having electronic access with a web code.

• Suggest you utilize this benefit, you are able to get information that may have got missed with print outs.

Other medical systems we use

• Bridge Access Consent:

• The person if able to access.

• Anyone else: Suggest adding the following team members.

• Family members, case manager, nurse consultants, Director of Nursing, On-call staff, home managers, house supervisors, or key staff.

How we use the bridge

• Physician notification for change of condition.

• Helps avoid hospitalizations or unforeseen clinic visits.

• Update or referrals for other specialties, such as neurology, cardiology, endocrinology, specialized equipment.

• Hospitalization admit, progress, and discharge.

• Inquiry for additional follow up visit needs.

• SNBC questions for prior authorization on equipment, medications etc.

Bridge Response Time is quick

• Have the option to for traditional message or urgent message.

• Team has ability to see any message that is being relayed in a collaborated effort.

• Orders are simple to obtain for medications, labs tests, referrals to other specialties, x-rays.

• Orders are signed by physician, no need to call for further signature or fax additional materials.

• Referrals for home care or hospice must be signed by physician, not the PA so add this into the message for these types of inquires.

What Hardware are we using?

• WiFi in all locations

• Makes it easy for our mobile staff to access the internet.

• Allows for the house to be reconfigured as needed.

• Desktop Computers

• One manager workstation

• 1-2 staff workstations.

Hardware cont’

• Ipads

• Implemented in 2015 at all locations for medication passing. Using Verizon LTE as a backup internet source.

• Experimenting with Facetime as a triage tool.

• Discouraging use of pictures.

• Common account to manage.

• Received mixed reviews initially.

Hardware cont’

• Laptops

• Used by our mobile staff.

• Helped encourage people to move around more often and increased their efficiency when doing so.

• Smartphones (IPhones)

• We initially started with our admin team and nursing teams using IPhones to stay more connected to their email.

• Expanded this to include our management team as well.

• Now all team members are able to access all of our electronic tools when providing on-call support.

Outcomes

• Better coordinated Care

• Reduced our clinic/UR/ER utilization

• This despite our service population aging and becoming more medically fragile.

• Reduced Medication Errors

• Initially saw a significant increase as we were likely not capturing all of our errors when doing paper documentation.

• Frequent use has allowed us the flexibility to introduce new tools to our staff without the same daily impact we experienced when we introduced Therap.