Implementation and Implementation and Beyond…Beyond…

How we became FOTO-genic at How we became FOTO-genic at Tomah Memorial HospitalTomah Memorial Hospital

Tomah, WisconsinTomah, Wisconsin

1414THTH ANNUAL OUTCOMES ANNUAL OUTCOMES CONFERENCECONFERENCE

April 5-6, 2014April 5-6, 2014

Knoxville, TNKnoxville, TNNicole (Nikki) Rasmussen, PT, Cert. Nicole (Nikki) Rasmussen, PT, Cert.

MDTMDT

Conflict of Interest Conflict of Interest DisclosureDisclosure

Nicole (Nikki) Rasmussen, PT, Cert.MDT

has no real or apparent conflicts of interest to report.

Learning ObjectivesLearning Objectives

• TMH FOTO-genic journey• Development of a Documentation and

Reimbursement committee/FOTO “super-user”

• IT considerations /needs • Rolling out of FOTO with patients/staff• Lessons learned along the way:

“Growing pains” and “stuff we learned by the 2x4 method”

• Going forward, using the data, etc.

Tomah Memorial HospitalTomah Memorial Hospital• Rural western Wisconsin, about 10,000 in city• Another 5,000 surrounding country; Industrial,

trucking, farming, schools, healthcare are main employers in area.

• Critical Access (25 beds) including Medical/Surgical , Swing Bed, and OB.

• 24 hour Emergency/Urgent Care services and Walk-in clinic 7 miles north of town

• Ambulatory and inpatient surgery• Broad range of outpatient services – Lab, MRI,

CT, Cardiac Rehab, Orthopedics, Plastic Surgery, Work Conditioning, Outpatient PT, OT, ST, etc.

So, Where is Tomah?So, Where is Tomah?

TMH in Summertime!TMH in Summertime!

TMH in WintertimeTMH in Wintertime

TMH Rehab DepartmentTMH Rehab Department• PT and OT/ST managers (2) • 10 PT’s, 2 PTA’s, 3 OTR’s, 1 COTA,

and 1 SLP-CCC• 2 full time front office and 1 rehab

aide

Our First Intro to FOTOOur First Intro to FOTO

• Early 2000’s when it was paper entry, decided against it in light of adding burden to workload for much smaller staff

• Late 2000’s when web based program became an option, became much more favorable. Clinical staff drove some of the interest, with one involved in EIM and one involved in MDT

DevelopmentDevelopment ofof thethe CommitteeCommittee

Documentation Committee consists of: rehab managers two front line senior clinicians (PT’s) lead receptionist IT department head (invited as needed)

Weekly meetings (Wed morning 8 a.m.)

Documentation Committee Documentation Committee Roles and DutiesRoles and Duties

• Initially began as a way to develop autocorrects for all staff to use in ReDoc but evolved into so much more

• Troubleshoot ReDoc, FOTO, Say-It, MedHost or other concerns within the realm of documentation

• FOTO “super-user” - responsible for all updates, changes, and training with FOTO

• Train all staff in FOTO updates, ReDoc changes, G-codes, CMS or other insurance changes that require updates or changes in documentation

Documentation Committee Documentation Committee Roles and DutiesRoles and Duties

• Train newly hired staff one-on-one in documentation expectations and software, as part of the initial orientation. Competency-based with checklists.

• Perform ongoing training for current staff, typically in small groups of 3-4

• Create annual competency reflecting current changes in documentation, charges, high risk potential as part of corporate compliance

• Development of marketing strategies using outcomes data working with PR department

Documentation Committee Documentation Committee Roles and DutiesRoles and Duties

• Attend FOTO webinars and conferences

• Contact with FOTO reps when needed, which is often weekly, especially early on

Roll-Out of FOTORoll-Out of FOTO

Roll-out of FOTORoll-out of FOTO• Began in the winter 2011-2012• Committee sat down with the

surveys, looked at which optional surveys to include, ongoing as new surveys are brought forward

- Completed a lot of test patients - Looked at surveys on screen as a group, worked with IT and front office

Roll-out of FOTORoll-out of FOTO

• For patients began in spring 2012 • Initially started with shoulder

patients (both OT and PT see them)• Worked out glitches, determined

scripting, increased patients’ comfort with using technology

• Added foot and ankle next• Then rolled out the whole body

Roll-out of FOTO Roll-out of FOTO

• Article for local newspapers, radio advertising, and direct marketing to MD’s

• Education of patients and the greater community regarding what FOTO is, why we are using it, and how it can be of benefit

IT ConsiderationsIT Considerations

• Equipment -Software as a service (SaaS) infrastructure easy to implement – web browser – no issues with system requirements

• Safety and security • iPad vs. laptop kiosk in exam rooms

vs. provider laptop vs. home survey• Wireless connection• Email security/considerations

Why iPad vs. other tabletsWhy iPad vs. other tablets• Apps for OT and Speech are available

on App Store and are used for some patients (individual iTunes account for Rehab department, installed by IT only)

• Easy: one home button, change size of screen easily, compatible with other equipment

• Many people are familiar with it• Our environment needs to restart

printing service on occasion

Winner is iPadWinner is iPad

• Connected to a public wifi –secure site (https)• Enabled location service thru App store

(Where is my phone app)• No patient data is stored • Reception desk has three iPads (soon to be

five !) • Charging station is under the desk, iPads

kept on desk between them and staff check them out from desk if they take one.

• Reception desk area is secured when we are not there

Procedures for FOTO at IntakeProcedures for FOTO at Intake

• Receptionists create patient in FOTO when they schedule or shortly thereafter

• Ask therapist for assistance when needed in choosing impairment, body area, or surgery

• Ask patients to come 30 min prior to appointment time for hospital and PT registration and intake process, explain expected duration of time start to finish to the patient (scripting)

• Assist patients in completing FOTO survey if needed, offer private area

• Have used email feature with some patients

Procedures for FOTO at Intake Procedures for FOTO at Intake

• Single page paper history form• Reception obtains medications, PMH,

and last medical note from provider offices via link or med record request

• Patient is given the iPad with their survey ready to complete in rehab services waiting area

Creature Comforts for Patients Creature Comforts for Patients Completing FOTO surveysCompleting FOTO surveys

• Receptionists offer assistance, tell the patients their names (scripting) “My name is Jessie if you have any questions while you work on the survey.”

• Coffee and water available in lobby• Varying chair heights and widths • iPad encased in Gumdrop, heavy duty

case, easy to hold, can be sanitized • Compatible stylus also can be sanitized• Reading glasses – can be sanitized

Our Patients Love Doing Our Patients Love Doing FOTO Surveys! FOTO Surveys!

Status SurveysStatus Surveys

• When? Monthly, every ten visits, change in status, prior to MD visit, PT/OT choice

• Therapist puts note on MedHost Scheduling with “FOTO” in the visit notes. This prints on our daily schedule and receptionists prepare surveys in advance for that day’s cases who need to complete FOTO. They explain to the patient (scripting) about it, and is done prior to staff seeing the patient that day

• We are given the printed survey in our boxes to review details with the patient

Lessons LearnedLessons Learneda.k.a. a.k.a. ““the 2x4 methodthe 2x4 method””

Lessons LearnedLessons Learned

• How to correctly use NPA• How to speak with the patients to

encourage their participation in the surveys (scripting)

• How to encourage staff to do the status surveys and go over the scores and the answers with the patients so they see how we use the data.

• If the status survey is not done prior to seeing the patient, it seems to get missed

Lessons LearnedLessons Learned

• Share general data quarterly with physicians and other referral sources via email blast

• Share individual patient data with patients themselves and their referring provider

• Ongoing training via webinars, small group training, individual training

• Small group training works best overall

Lessons LearnedLessons Learned

• Getting the correct risk adjusted parameters and the correct survey the first time is critical!

• Ask if you don’t know!• Use your FOTO rep as a resource!

Speed dial and email contact list• Give it 12 months… just like total

knees!• Read your Release Notes• Tell FOTO what you need – they are

awesome!

FOTO and ReDocFOTO and ReDoc• When ReDoc 7.8 came out, the

interface between FOTO and ReDoc for generation of G-codes and severity modifiers was a godsend

• We import the G-codes and severity modifiers from FOTO into the ReDoc note directly

• These two products interface readily and save time on behalf of the therapist

Documentation of FOTO scoresDocumentation of FOTO scores

• We document in the functional section of the ReDoc note the patient’s FOTO score, average patient’s score and the FABQ score. This is not an automatic population. We have created shortcuts in Say-it and autocorrects in ReDoc for the statements.

• We write this as: “FOTO score on 4/6/14 is x, compared to y for patients with similar risk adjusted parameters. Numbers closer to 100 indicate higher degree of function.”

Documentation of FOTO scoresDocumentation of FOTO scores

• Include the FABQ in same area• “Fear Avoidance Belief about Activity

is: x – elevated. Numbers closer to 100 indicate higher degree of fear or avoidance of activity.”

• Incorporate a FOTO score into a goal

FORWARD!FORWARD!

• Not just the state motto of Wisconsin• Quarterly emails to our local physicians

and referral sources with data highlights• Use for staff appraisals as means to

highlight skills and consideration of continuing education opportunities (we do not use punitively)

• Colorful, fun bulletin board in lobby with our data

Moving Forward StillMoving Forward Still

Be assured that implementing and using FOTO is an ongoing work in progress and not everything works perfectly the first time. Sometimes you have to re-evaluate, change, and modify your plan. (Sound familiar?)

And Beyond…And Beyond…

Implementing FOTO is… fun exciting challenging at times an ongoing learning opportunity but, mostly rewarding… to see your data reflect what you know you already do!

Time for Q & ATime for Q & A

Nikki Rasmussen, PT, Cert.MDTnrasmussen@tomahhospital.org

Tomah Memorial Hospitalwww.tomahhospital.org