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Nursing Homes - Health Information Technology Toolkit

Nursing homes with robust e-health and health information technology (HIT) capabilities will improve the quality of patient care, in the delivery of health care overall, while positively impacting the organization's bottom line. Key to this success is the use of a comprehensive electronic health record (EHR) system.

Nursing homes can use Stratis Health’s Health Information Technology Toolkit for Nursing Homes to implement a comprehensive EHR system, overhaul existing systems, or acquire individual HIT applications. The toolkit can help nursing homes effectively engage in e-health activities by optimizing the use of an EHR and facilitating information sharing through health information exchange (HIE) and other forms of HIT.

The tools focus on e-health functionality, people, policy, and processes for success in the nursing home environment. They can help you plan and make the right choices for your agency to achieve success in today’s health care environment.

Tools include:

  • Brief statement of purpose - know why and when to use each tool
  • Instructions for use – a guide for effective use of each tool
  • Option to customize – customize tools for your own needs and to help you perform tasks

Getting Started

The toolkit has three experience levels. Read through all the tools to understand how you should be planning your future actions to establish an enabling IT platform with interoperable EHR and effective HIE—and to know what your competition may be striving for.

Understand and determine your nursing home’s current level of experience with HIT and e-health projects. Develop an organizational strategy for advancing e-health based on using all of the tools for your agency’s experience level. Complete lower levels before proceeding to the next higher level. Construct your own timeline based on the applications, technology, and operational activities being undertaken. Each tool indicates how long it takes to implement.

Experience Level

easy - level 1 Level 1: For all organizations.
intermediate - level 2 Level 2: For organizations with more resources.
difficult - level 3 Level 3: For organizations interested in advanced topics.

Overview

The Overview section introduces you to the structure and navigation of the nursing home toolkit and the documents within the toolkit. The tools within the nursing home toolkit are applicable to either a new HIT implementation or HIT replacement/upgrade effort.

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# Tool Use Purpose Experience Level
1 Toolkit Overview: EHR and HIE Tools for Skilled Nursing Facilities Describes how to use the toolkit. (5-page Word doc) Inform 1easy - level 11
2 Laws and Mandates for e-Health Identifies activities undertaken by states to promote e-health activities. (4-page Word doc) Inform 1easy - level 11
3 Overview of e-Health Provides an overview of e-health. (5-page Word doc) Inform 1easy - level 11
4 e-Health Glossary A link to The Minnesota e-Health Glossary to help clarify terms or abbreviations. (1-page Word doc) Inform 1easy - level 11

1. Assess

The Assess section provides tools to kick off the e-health planning process. The tools in this section include surveys, inventories, and assessments of your staff's current attitudes toward information technology, computer skills, and technical infrastructure. Use these tools to assess your organization's readiness for an e-health project.

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# Tool Use Purpose Experience Level
1 HIE Projects Describes the state of Minnesota’s objectives for the Minnesota Health Information Exchange. (28-minute webinar) transcript (7-page PDF) Inform 3difficult - level 33
2 Clinical IT Leadership This tool outlines the roles played on HIT projects. (3-page Word doc) Inform 1easy - level 11
3 HIT Steering Committee This tool helps you determine how to best to form and operate the HIT steering committee. (3-page Word doc) Action 1easy - level 11
4 HIT Governance Identify decision making tasks and at what level each decision should be made. (4-page Word doc) Action 1easy - level 11
5 Goal Setting This tool provides an overview of goal setting and template for tracking goals. (8-page Word doc) Action 1easy - level 11
6 EHR and HIE Beliefs Assessment Understand your organization's readiness to adopt e-health. (5-page Word doc) Action 1easy - level 11
7 EHR Technology Readiness Inventory Identify and document existing EHR hardware in order to assess and budget required hardware. (6-page Word doc) Action 1easy - level 11
8 HIE Technology Readiness Inventory Describes HIE technology and assesses organization's readiness to participate in HIE. (4-page Word doc) Action 1easy - level 11
9 Organizational Readiness Assessment for EHR and HIE Assess organization's readiness for e-health initiative. (4-page Word doc) Action 1easy - level 11
10 Interoperability for EHR and HIE Defines standards for interoperability. (3-page Word doc) Inform 3difficult - level 33
11 IT System Inventory Identify and document all existing IT hardware in order to assess and budget required hardware. (5-page Word doc) Action 2intermediate - level 22
12 Application Interface Inventory Assess interfaces needed with new applications and document current applications. (2-page Word doc) Action 2intermediate - level 22
13 HIT Technical Security Controls Identifies the technical security controls and determine what controls are adequate or where they may need to be made stronger. (2-worksheet Excel spreadsheet) Action 1easy - level 11
14 IT Staffing Inventory Determine which IT staffing skills may be needed to implement specific HIT components. (6-page Word doc) Action 1easy - level 11
15 Financial Assessment, Financing Resources, Acquisition Models Describes various sources of funds that may be available for e-health initiative. (6-page Word doc) Action 1easy - level 11
16 Computer Skills Survey Identify skills needed to plan for HIT. (2-page Word doc) Action 1easy - level 11

2. Plan

The Plan section tools provide a basis for planning a successful e-health project. Many HIT vendors do not support planning, instead relying on the organization for the majority of planning. Investing the time and resources up front will mean spending less time and resources during implementation—and will reap greater value.

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# Tool Use Purpose Experience Level
1 Communication Plan Build your communication plan. (6-page Word doc) Action 1easy - level 11
2 Project Management This tool differentiates the roles of project management and program management, and lists the general functions a project manager is expected to perform. (8-page Word doc) Inform 1easy - level 11
3 Project Manager Job Description This job description identifies the responsibilities required by an HIT project manager. (2-page Word doc) Inform 3difficult - level 33
4 Effective Project Management Describes the principles of project planning. (59-minute webinar) transcript (12-page Word doc) Inform 2intermediate - level 22
5 HIT Vision and Strategic Planning Describes a vision for e-health in Skilled Nursing Facilities, goal definition and suggestions for strategic planning. (9-page Word doc) Action 1easy - level 11
6 Implementation Strategies for Assessments Use this tool to ensure that all assessment requirements can be documented. (4-page Word doc) Action 2intermediate - level 22
7 Change Management Describes change management and possible barriers to making changes. (6-page Word doc) Action 1easy - level 11
8 Workflow and Process Redesign for EHR and HIE Highlights workflow and process improvement elements for consideration during implementation. (6-page Word doc) Action 2intermediate - level 22
9 Workflow Redesign and EHRs Describes how to use various techniques and tools to document process workflows. (42-minute webinar) transcript (9-page Word doc) Inform 2intermediate - level 22
10 The Model for Improvement: Plan, Do, Study, Act Describes the Plan, Do, Study, Act (PDSA) quality improvement process model. (51-minute webinar) transcript (10-page Word doc) Inform 1easy - level 11
11 Requirements Analysis Define the HIT requirements specific to your organization. (4-page Word doc) Action 1easy - level 11
12 Exchange of Clinical Summaries via CCR, CCD, C-CDA Defines how clinical data may be shared with providers and clients. (2-page Word doc) Inform 2intermediate - level 22
13 Business Case: Total Cost of Ownership and Return on Investment for EHR and HIE Documents cost components for an e-health initiative. (2-worksheet Excel spreadsheet) Action 2intermediate - level 22
14 Rollout and Turnover Strategies This tool describes how an application may be rolled out. (3-page Word doc) Inform 1easy - level 11
15 Chart Conversion and Pre-load Planning Identifies how to move key information from paper charts into an EHR system. (3-page Word doc) Action 1easy - level 11

3. Select

The Select section provides the foundation for a solid HIT selection process by helping you understand the marketplace and conduct all aspects of vendor selection and contracting. The extent to which you need to review the marketplace depends on your overall IT strategy. If you are part of a corporate structure, the selection process may be performed for you. However, the assessment, planning, implementation, maintain, and optimize tools still will be important for you to use.

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# Tool Use Purpose Experience Level
1 Vendor Selection Code of Conduct Review your code of conduct or adopt one. (2-page Word doc) Action 1easy - level 11
2 Vendor Issues - How to Partner Identifies ways to work effectively with vendors. (59-minute webinar) transcript (14-page Word doc) Inform 2intermediate - level 22
3 EHR and HIE Vendor Selection and Understanding the Marketplace Understand the HIT and EHR marketplace, including products available, vendors, CCHIT certification, requirements analysis, request for proposal (RFP), due diligence, key differentiators, and contracting. (4-page Word doc) Inform 1easy - level 11
4 Soliciting Bids for EHR and HIE: RFI, RFB, RFP Defines how to solicit bids from vendors. (4-page Word doc) Action 2intermediate - level 22
5 RFP Analysis Use as a guide for sending out the RFP and analyzing the results. (3-page Word doc) Action 2intermediate - level 22
6 Hardware and Mobile Device Selection and Security Use to identify appropriate hardware for your HIT applications. (4-page Word doc) Inform 1easy - level 11
7 EHR-HIE Vendor Selection Due Diligence Use for conducting an objective, side-by-side comparison of vendors. (5-page Word doc) Action 1easy - level 11
8 Due Diligence: Demonstration Plan Use in arranging product demonstrations for evaluating vendors. (3-page Word doc) Action 1easy - level 11
9 Due Diligence: Site Plan Use in arranging conducting site visits for evaluating vendors. (3-page Word doc) Action 2intermediate - level 22
10 Due Diligence: Reference Check Plan Use in conducting reference checks for evaluating vendors. (3-page Word doc) Action 1easy - level 11
11 Vendor of Choice and Contract Negotiation for EHR and HIE Understand the realities in selecting an EHR or other HIT. Assist in negotiating a favorable contract with your vendor of choice. (8-page Word doc) Inform 1easy - level 11
12 Participation Data Sharing Agreements Identifies data sharing agreements that you may need to execute. (3-page Word doc) Inform 2intermediate - level 22

4. Implement

The Implement section builds upon the previous tools to help you address the specific application, technology, and operational elements that have been acquired and will now be implemented. These tools help with the tactical issues to be addressed in any implementation, including sample project plans, issues logs, training plans, and testing plans.

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# Tool Use Purpose Experience Level
1 Managing HIT Projects Defines project planning requirements for an HIT implementation. (3-page Word doc) Inform 1easy - level 11
2 Project Plan for Excel Use this tool to develop a project plan for your organization. (2-worksheet Excel spreadsheet) Action 1easy - level 11
3 Issues Management Defines an issues management program. (3-page Word doc) Action 1easy - level 11
4 Vendor Issues Management Presents techniques to manage issues with your vendors. (68-minute webinar) transcript (15-page Word doc) Inform 3difficult - level 33
5 Workflow and Process Improvement Highlights workflow and process improvement elements for consideration during implementation. (3-page Word doc) Action 2intermediate - level 22
6 Policy Procedure Checklist Use this checklist to evaluate policies and procedures you may need. (3-page Word doc) Action 1easy - level 11
7 Data Management in EHR and Data Stewardship in HIE Identifies how to manage and maintain data quality. (5-page Word doc) Inform 2intermediate - level 22
8 System Build Defines the tasks and responsibilities performed during system build. (5-page Word doc) Inform 2intermediate - level 22
9 Change Control Defines a change control process for all system components. (5-page Word doc) Inform 2intermediate - level 22
10 Using Direct for HIE Describes the Direct protocol and how to get started using it. (3-page Word doc) Inform 1easy - level 11
11 Using CONNECT for HIE Describes the Connect protocol and how to get started using it. (2-page Word doc) Inform 3difficult - level 33
12 Implementation Strategies for Physician Documentation Identify the automation support available for physician documentation. (7-page Word doc) Action 2intermediate - level 22
13 Implementation Strategies for EMAR Distinguish among the different forms of EMAR. (4-page Word doc) Inform 2intermediate - level 22
14 Managing Patient and Provider Identification in HIE Describes process to identify patients and providers in an HIE setting. (4-page Word doc) Inform 1easy - level 11
15 Managing Patient Consent Describes process to manage patient consent forms. (3-page Word doc) Inform 1easy - level 11
16 Training Plan Use the training plan tool to define training requirements, plan and track training. (4-page Word doc) Action 1easy - level 11
17 Training Strategies for Physicians Identify physician training strategies. (2-page Word doc) Action 1easy - level 11
18 Testing Plan This tool describes the types of tests typically performed on EHR and other HIT systems. (4-page Word doc) Action 1easy - level 11
19 Go-live Checklist Validate and plan go-live activities. (3-page Word doc) Action 1easy - level 11

5. Maintain

The Maintain section provides tools for ensuring that your e-health investment is meeting the goals established at the beginning of the project. Regular maintenance activities will ensure that your organization is getting the most return from its investment in e-health. The tools in this section highlight maintenance activities that should be incorporated into your operational activities.

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# Tool Use Purpose Experience Level
1 Ongoing System Maintenance, Administration, and Data Quality Management This tool provides guidance on system maintenance, system administration, and data quality management. (4-page Word doc) Inform 1easy - level 11
2 Ongoing HIE Communications Describes how to communicate with your HIO and partners. (4-page Word doc) Action 1easy - level 11
3 Monitoring SMART Goal Achievement to Assure Value From EHR and HIE This tool provides guidance to ensure that goals of the e-health initiatives are being met. (5-page Word doc) Action 3difficult - level 33
4 HIT Adoption Milestone Results Measure the extent to which your e-health activities are adopted. (3-page Word doc) Action 2intermediate - level 22
5 EHR and HIE Satisfaction Surveys Assists with conducting satisfaction surveys. (4-page Word doc) Action 2intermediate - level 22
6 EHR and HIE Return on Investment Benefits Realization Links the achievement of your goals with actual cost for a return on investment. (2-worksheet Excel spreadsheet) Action 3difficult - level 33
7 HIE Data Stewardship Information on the principles of data stewardship and fair health information practices. (3-page Word doc) Inform 3difficult - level 33
8 HIE Goals and Governance Information on how various HIEs are forming, why they are forming, their governance models, and their technical architectures. (3-page Word doc) Inform 2intermediate - level 22

6. Optimize

The Optimize section focuses on gaining optimal value from specific functionality within EHR and HIE. Fine tune skills and explore ways to improve the use of the EHR and HIE. The Optimize tools provide tips from users who have already made the journey—and recognize that the journey is ongoing.

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# Tool Use Purpose Experience Level
1 Optimization Strategies for Transitions of Care and Care Coordination Assists with transition of care and care coordination. (4-page Word doc) Action 2intermediate - level 22
2 Optimization Strategies for Physician Use of EHR and HIE This tool provides guidance on ensuring that your physicians are using HIT. (4-page Word doc) Action 2intermediate - level 22
3 Optimization Strategies for Use of EHR and HIE in Assessment, MDS, Care Plan, Visit, and Teaching Documentation This tool provides guidance on documenting events within HIT systems. (2-page Word doc) Action 2intermediate - level 22
4 Optimization Strategies for Clinical Decision Support Describes processes to ensure Clinical Decision Support occurs. (4-page Word doc) Inform 2intermediate - level 22
5 Optimization Strategies for Adoption of Standard Terminology to Support Semantic Interoperability This tool assists with the adoption of standard terminology. (3-page Word doc) Inform 3difficult - level 33
6 Optimization Strategies for Electronic Document Management Systems Describes document management options within HIT. (7-page Word doc) Inform 2intermediate - level 22
7 EHR and HIE Security Risk Analysis Assess needs related to compliance with HIPAA Security Rules and data breach notification laws in Minnesota. (11-page Word doc) Inform 1easy - level 11
8 Contingency Plan Assessment for EHR and HIE Document all existing back up functions, emergency mode operations, and disaster recovery plans, and to plan for enhancements. (5-page Word doc) Action 2intermediate - level 22

Feedback Welcome

In an effort to improve the quality of the  toolkit, we are seeking your feedback. Please send your feedback for improvements to the toolkits to HITtoolkits@stratishealth.org.