In this post we will look at the model that I successfully integrated in our community. In part 2, I will discuss Virtual Care integration into Long-term Care.
Technoline: Using technology in Longterm Care Part 1
Technoline: Using technology in Longterm Care Part 1
In 2018 we transformed longterm care in our community and integrated a central system to gather information and create documentation. OSCAR formed an integral part in this model and in this post I will explain the key reasons why this EMR was considered the favorite, to achieve our goals in managing patients admitted to our LTC facilities. In part 2 of this series, I will propose a model for integrating Virtual Care into this model.
The good physician treats the disease; the great physician treats the patient who has the disease. William Osler
In our community, we have 3 longterm care facilities, 1 operated by our Health Authority and 2 operated by private institutions. Our goal was to create a single mobile, cloud based solution to gather and display information while receiving results, documentation and notifications from the different facilities. The idea started when I was doing call for my call-group and had to make a difficult decision based off what was given to me over the phone. I realized in that moment that I needed more medically sound information to make a decision, in the care of the patient. The MRP at the time was not reachable by phone and I started to think and plan how I could make this work while allowing physicians to remain within their own natural habitats.
The Infographic is a summary of how this all came together after trial and error over the past 2 years and with a lot of help from esteemed colleagues.
Once a patient is deemed appropriate for long term care placement, the group is informed via an admission fax sent to the core group. This is done through the Transition Liaison service of the hospital or by the facility accepting the patient.
We hired an dedicated virtual MOA and instructed this person to allocate a patient to a physician in the core group that takes responsibility as MRP. In conjunction with the Family Physician, patients are then managed through a combination model initially, until the MRP takes over full care of the patient, usually after the first case conference. Allocation of patients are based on Caseloads within OSCAR.
Once the profile is created within the EMR by the MOA, the MRP in the core group is notified that a new patient is admitted to a facility. The MRP opens the chart and summarize the patient profile within OSCAR. The MOST is reviewed and key issues are typed within the Ongoing Concerns section of the EMR.
Documentation is done within the EMR and inserted via copy and paste into the appropriate documentation of the specific facility, before being directly faxed from the EMR with an integrated encrypted e-faxing service.
Each of our facilities are serviced by an independent and different pharmacy. As a result, we secured a central fax number that was circulated to the different pharmacies. Each of the pharmacies were requested to fax medication reviews, updates and recommendations to this number. As the faxes are received, they are attached to the chart and the physician is able to respond via the EMR or fax.
Our EMR was registered as a separate entity under the director of long-term care within the community. By doing this, we were able to request a specific CDX ID that enabled us to pull results into the chart once processed by the lab. The same was done for imaging results done through the Health Authority.
We created this model with limited funds and looked at a variety of EMR’s before setting our minds on OSCAR. Fortunately, we could integrate most of what we wanted to achieve through OSCAR as well as securing the PIPEDA Compliant EMR for a reasonable monthly fee from a BC Hosting company.
Our instance of OSCAR came with 2 remarkable platforms that allowed us to do E-Signatures as well as E-faxing. Our aim was to develop a completely paperless solution and we are happy to report that 90% of the tasks pertaining to long-term care in our community is paperless. Most of our facilities have since migrated to electronic charting and e-faxing allows us to send a secure encrypted fax and communicate without the need to use paper.
Another reason for going with OSCAR, was the exceptional platform that came with it in terms of billing. Unfortunately, our group felt that it was easier for them to utilize their own billing platforms, but this billing interface is included and is designed to enhance, simplify and speed up your billing even remotely.
Most OSCAR users will tell you that the EMR comes with the best E-form creator on the market. Another goal that we wanted to achieve was to ensure that handwritten notes were limited to decrease error when writing orders or medications. Electronic notes, orders and prescriptions were all integrated on the same templates used by the various facilities, to ensure that it remains constant within the facility paper chart. The e-form option allowed us to integrate dementia orders, the MOST form, PPO’s, Order Forms, Care Conferences and a lot more.
Access to the EMR was limited to LTC physicians, our MOA and partial access was given to administrative staff, that was responsible for calculating stipends based on Caseloads.
Part II of this series will be suggest how we used virtual care to care for our patients in the time of COVID-19 and beyond.
- Disclaimer: The views expressed in this post is my own and related to my experiences within the Long-Term Care.