WIN, WIN, WIN: WHEN A BUSINESS, HOSPITAL, AND COLLEGE COLLIDE

TOPICWho We AreOrigin IdeaPlanning & CreatingCurricular IntegrationProgress to DateNext StepsQ&AContact Information

How a business, hospital, and college are collaborating using an electronic health record

To prepare current graduates with a competitive edge while elevating the healthcare workforce skillset in a shortened length of time.

OBJECTIVE

WHO WE ARE

http://www.kirkwood.edu/ataglance

Cedar Rapids, Iowa

KIRKWOOD COMMUNITY COLLEGE MAIN CAMPUS

THE COLLEGE

The Campus885 acres27 buildings = 1.65 million square feet of interior learning space400-acre working farm1.5-acre vineyard and winery

Students20,398 attended class in 2014-1521 students - the average class size330 international students from 100 different countries

Academics115 degrees, diplomas and certificates offered14 different parts of the world visited through Study AbroadMore than 80 student-focusedorganized groups

HEALTH PROGRAMSPatient Care

Electroneurodiagnostic TechnologyMedical Assisting**Nursing*Occupational Therapy Assistant*Physical Therapist Assistant*Respiratory Therapist**Surgical Technology

Other Health ProgramsDiagnostic Assistant-Radiologic TechnologyMedical Laboratory TechnologyParamedic/EMTPharmacy Technician**

DentalDental Assisting Dental Hygiene Dental Technology

Health InformaticsHealth Information Technology (Includes Medical Coding)**Medical Transcription

High School Health AcademiesPatient CareDental

MERCY MEDICAL CENTER

MERCY MEDICAL CENTER• 448 licensed beds

• Employees:o MMC-2,300o MercyCare (including providers)-485 (Nearly 100 MercyCare

providers)

• Clinics:o 5 Urgent Care locationso 14 Specialty clinicso 14 MercyCare clinics

• Patient Centered Medical Home (PCMH)

EPIC SYSTEMS CORPORATION

• Epic©, is a privately held healthcare software company

• Verona, WI• Also has offices in Netherlands, United Arab

Emirates, Singapore, and Denmark• >10,000 employees

HITECH ACT (2009)

• Stimulate the adoption of EHRs and supporting technology within healthcare organizations

• Workforce development programs

WHAT IS AN EHR?

Definition“An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.”

Goals of Use (HITECH Act)•To improve the quality, safety, and efficiency of care while reducing disparities•To engage patients and families in their care•To promote public and population health•To improve care coordination•To promote the privacy and security of EHRs

US Department of Health and Human Services https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/

IDEA ORIGIN

CURRENT OPTIONS

Available by license per student:• Lippincot DocuCare• Cerner Academic EHR• Practice Fusion• VA VistA CPRS• Nightingale Notes

Demo or Open Source:• Practice -Fusion• OpenMRS• iSALUS EHR• FreeMED

More are developed everyday

HEALTHCARE DISCIPLINE COMPETENCIES• Physical Therapy Assistant• Occupational Therapy Assistant• Medical Assisting• HIM/HIT• Nursing• Pharmacy Technician• Respiratory Therapy

PHYSICAL THERAPY ASSISTANT COMPETENCIES• Use of EHR

– 7D18 Review health records (e.g., lab values, diagnostic tests, specialty reports, narrative, consults, and physical therapy documentation) prior to carrying out the PT plan of care.

– 7D25 Complete accurate documentation that follows guidelines and specific documentation formats required by state practice acts, the practice setting, and other regulatory agencies.

– 7D27 Contribute to efforts to increase patient and healthcare provider safety.– 7D29 Participate in performance improvement activities (quality assurance).

• Interprofessional Healthcare– 7D28 Participate in the provision of patient-centered interprofessional collaborative

care. Quote from PTA Director “I SEE THE USE OF EPIC AS A GREAT TOOL TO INCORPORATE INTERPROFESSIONAL CARE/ COMMUNICATION”

• Critical Thinking– 7D30 Describe aspects of organizational planning and operation of the physical therapy

service.– 7D31 Describe accurate and timely information for billing and payment purposes.

http://www.capteonline.org/AccreditationHandbook/

OCCUPATIONAL THERAPY ASSISTANT COMPETENCIES• Use of EHR

– A 2.25 Students must be given access to and have the opportunity to use the evaluative and treatment methodologies that reflect both current practice and practice in the geographic area served by the program.

– B 1.8 Demonstrate an understanding of the use of technology to support performance, participation, health and well-being. This technology may include, but is not limited to, electronic documentation systems, distance communication, virtual environments, and telehealth technology.

• Interprofessional Healthcare– B 4.1 Gather and share data for the purpose of screening and evaluation using methods

including, but not limited to, specified screening tools; assessments; skilled observations; occupational histories; consultations with other professionals; and interviews with the client, family, and significant others.

• Critical Thinking– B 6.4 - Identify the role and responsibility of the practitioner to advocate for changes in

service delivery policies, to effect changes in the system, and to recognize opportunities in emerging practice areas.

– http://www.aota.org/~/media/Corporate/Files/EducationCareers/Accredit/Standards/2011-Standards-and-Interpretive-Guide.pdf

MEDICAL ASSISTING COMPETENCIES

• Use of EHR• Interprofessional

Healthcare• Critical Thinking

http://www.maerb.org/Educators/tabid/61/Default.aspx

• IX.C Procedural and Diagnostic Coding• IX.C.1. Describe how to use the most current procedural coding

system• IX.C.2. Describe how to use the most current diagnostic coding

classification system• IX.C.3. Describe how to use the most current HCPCS level II

coding system• XI.C.4. Discuss the effects of:• IX.C.5. Define medical necessity as it applies to procedural and

diagnostic coding• X.C Legal Implications• X.C.1. Differentiate between scope of practice and standards of

care for medical assistants• X.C.2. Compare and contrast provider and medical assistant

roles in terms of standard of care• X.C.3. Describe components of the Health Insurance Portability

& Accountability Act (HIPAA)IX.C.5. Define medical necessity as it applies to procedural and diagnostic coding

• VI.C.4. Define types of information contained in the patient’s medical record

• VI.C.5. Identify methods of organizing the patient’s medical record based on:

• a. problem-oriented medical record (POMR)• b. source-oriented medical record (SOMR)• VI.C.6. Identify equipment and supplies needed for medical

records in order to:• VI.C.7. Describe filing indexing rules • VI.C.8. Differentiate between electronic medical records (EMR)

and a practice management system• V.C.8. Discuss applications of electronic technology in

professional communication• VI.C.11. Explain the importance of data back-up• VI.C.12. Explain meaningful use as it applies to EMR

OTHERS IN PROCESS

• Health Information Management and CodingAHIMA curriculum– Analyze the documentation in the health records to ensure it

supports the diagnosis and reflects the patient’s progress, clinical findings, and discharge status.

– Verify the documentation in the health record is timely, complete, and accurate.

– Apply policies and procedures to ensure the accuracy and integrity of health data.

http://www.cahiim.org/

• Respiratory Therapy• Pharmacy Technician

NURSING COMPETENCIES

• Use of Information Technologies

• Interprofessional Healthcare

• Critical Thinking

http://www.mass.edu/currentinit/documents/nursingcorecompetencies.pdfhttp://www.aacn.nche.edu/education-resources/BaccEssentials08.pdfhttp://qsen.org/competencies/pre-licensure-ksas http://www.aacn.nche.edu/education-resources/TIGER.pdf

• NOF A6 Values the privacy and confidentiality of protected health information in electronic health records

• NOF S3b Uses sources of data that relate to contemporary standards of practice and patient care

• NOF S5b Accesses, enters, retrieves data used locally for patient care (e.g., uses Health Information Systems, Care Information Systems for plan of care, assessments, interventions, notes, discharge planning)

• Essential IV: Graduates must have basic competence in technical skills, which includes the use of computers, as well as the application of patient care technologies such as monitors, data gathering devices, and other technological supports for patient care interventions. In addition, graduates must have competence in the use of information technology systems, including decision-support systems, to gather evidence to guide practice

• QSEN Informatics: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

• S4c Uses standardized communication approach to transfer care responsibilities to other professionals whenever patients experience transitions in care and across settings

• Essential VI: Use inter and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care.

• QSEN Teamwork & Collaboration: Participate in designing systems that support effective teamwork

• QSEN Informatics: Navigate the electronic health record; Document and plan patient care in an electronic health record; Employ communication technologies to coordinate care for patients

• NOF A5a Questions the rationale of supporting routine approaches to care processes and decisions

• Technology Informatics Guiding Educational Reform (TIGER) Initiative

PLANNING & CREATING

TIMELINES

LOGISTICAL TIMELINE

ADMINISTRATIVE

STAKEHOLDERS

• Epic• Kirkwood Administration• Kirkwood IT Department• Mercy Medical Center Administration• Mercy Medical Center IS Department• Mercy Epic Education Manager• Certified Epic Trainer• Faculty and Students

FUNDING SOURCESWorkforce Training and Economic Development Fund

• The Workforce Training and Economic Development (WTED) Fund was established in 2003 as part of the Grow Iowa Values Fund. This fund has become an important source of financing for community college new program innovation, development, and capacity building, particularly for career and technical education. The funding is allocated annually using the community college state general aid distribution formula as provided for in Section 260C.18A of the Iowa Code.

• The WTED fund requires application of 70 percent of appropriated funds be used to support projects, programs and initiatives that fall within Iowa’s targeted industry clusters defined in statute as:

o advanced manufacturing o information technology and insurance o alternative and renewable energy o life sciences which include the areas of biotechnology, health care, and nursing

technology. • Each community college is required to provide the Iowa Department of Education the

opportunity to review and comment on proposed use of the funds and to provide an ongoing accountability process. Each year an annual progress report and plan for the next year, outlining the proposed use of the dollars appropriated, are to be submitted to the Iowa Department of Education. Unexpended funds may be carried over to the next fiscal year, however carryover must be noted in the annual progress report and annual plan’s appropriate sections with a documented reason for the carryover, if applicable. The colleges have the flexibility to modify their plans as needed during the year without approval. *https://www.educateiowa.gov/workforce-training-economic-development-fund

SUSTAINABILITY

Budget items• >$100,000 in year one• Personnel• Training• Equipment

TECHNICAL SPECIFICATIONS

CURRICULAR INTEGRATION

Certification BasicsFaculty/Student EngagementSpace, Equipment, and AccessWhat Does It Look Like?

2014 2017Today

Oct 2015 Apr Jul Oct 2016 Apr Jul Oct 2017

Initial meeting with Kirkwood & Mercy

10/1/2014

Arrangement finalized12/1/2014

Pilot On-Site Training10/29/2015

Large Scale Rollout1/11/2016

1/12/20156/23/2015Kirkwood internal tasks

4/21/2015 8/21/2015Certification process

4/6/2015 6/15/2015Interviews/Process development

7/13/2015 11/1/2015Build & test

10/29/2015 11/5/2015Pilot Clinical Training on Kirkwood's campus

2/6/2016 3/10/2017Implementation in Nursing curriculum

9/15/2016 12/16/2016Initial build for Allied Health

2/22/2017 3/18/2017Implementation in PTA Fundamentals Course

CURRICULUM DEVELOPMENT TIMELINE

CERTIFICATION BASICS

FACULTY ENGAGEMENT

• Department meetings• Meet one-to-one with lead faculty• Review current assignments• Sit in on lab and simulation experiences

SPACE, EQUIPMENT, AND ACCESS

• Shared computer labs/laptop carts/iPads• Citrix installation• Student permissions for remote access• Software updates

WHAT DOES IT LOOK LIKE?

• Course presentations– Introduction to informatics– Clinical Decision Support– Big Data in Healthcare

WHAT DOES IT LOOK LIKE?

© 2017 Epic Systems Corporation. Used with permission.

WHAT DOES IT LOOK LIKE?

© 2017 Epic Systems Corporation. Used with permission.

WHAT DOES IT LOOK LIKE?

© 2017 Epic Systems Corporation. Used with permission.

WHAT DOES IT LOOK LIKE?

© 2016 Epic Systems Corporation. Used with permission.

PROGRESS TO DATE

• Course Instruction

• Use in lab and simulation

• Test outs• Documentation of clinical experiences in

institutions without an EHRCourse Training or Student

ExperiencePresentation

Fundamentals of PTA

1 hour - How to navigate the EHR

Introduction to EHR Documentation

Pathophysiology 1 hour – Case Study Review

Faculty plan to utilize in:• PTA Modalities I and II• PTA Procedures I and II• Neurology• Orthopedics• Rehab for Medical Conditions• Career Essentials• OTA Methods II• OTA Methods III

NEXT STEPS

VISION• Assessment

– Actual v. perceived competence– Baseline v. Post-orientation– Improved interprofessional collaboration– Critical thinking skills

• Integration– More programs– Utilize mobile technologies– Classroom instructional modalities

Q & A

SOURCES, CITATIONS, & REFERENCES

American Association of Colleges of Nursing. (2008). Essentials of baccalaureate education for professional nursing programs. Retrieved from http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf

Bembridge, E., Levett-Jones, T., & Jeong, S. Y. (2011). The transferability of information and communication technology skills from university to the workplace: A qualitative descriptive study. Nurse Education Today, 31(Selected papers from the 3rd International Nurse Education Conference Nursing education in a global community 11-14 April 2010, Sydney, Australia), 245-252. doi:10.1016/j.nedt.2010.10.020

De Gagne, J. C., Bisanar, W. A., Makowski, J. T., & Neumann, J. L. (2012). Integrating informatics into the BSN curriculum: a review of the literature. Nurse Education Today, 32(6), 675-682. doi:10.1016/j.nedt.2011.09.003

Epic Systems Corporation. (2017). Retrieved from www.epic.com

George, N. M., Drahnak, D. M., Schroeder, D. L., & Katrancha, E. D. (2016). Enhancing prelicensure nursing students' use of an electronic health record. Clinical Simulation In Nursing, 12,152-158. doi:10.1016/j.ecns.2015.11.006

Hart, M. (2008). Informatics competency and development within the us nursing population workforce: a systematic literature review. CIN: Computers, Informatics, Nursing, 26(6), 320-331.

Hunter, K., McGonigle, D., & Hebda, T. (2013). The integration of informatics content in baccalaureate and graduate nursing education: a status report. Nurse Educator, 38(3), 110-113. doi:10.1097/NNE.0b013e31828dc292

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://books.nap.edu/openbook.php?record_id=12956&page=R1

Mercy Medical Center. (2017). Retrieved from www.mercycare.org

Miller, L. A., Stimely, M. E., Matheny, P. M., Pope, M. F., McAtee, R. E., & Miller, K. A. (2014). Novice nurse preparedness to effectively use electronic health records in acute care settings: Critical informatics knowledge and skill gaps. Online Journal of Nursing Informatics, 18(2), 1.

Norman, L., Buerhaus, P.I., Donelan, K., McCloskey, B., & Dittus, P. (2005). Nursing students assess nursing education.Journal of Professional Nursing, 21(3), 150–158

Quality and Safety Education for Nurses (QSEN). (2017). QSEN competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/

CONTACT INFORMATION

Nichelle L. Cline, PhD, MPA, OTR/Lncline@Kirkwood.edu

319-398-5566

Jana Pownell, MEd, MSN, RN

jana.pownell@Kirkwood.edu/jpownell@mercycare.org

319-398-5508

CONTRACTUAL AGREEMENTS