Question

The ABC Home Health Agency is a nonprofit, Medicare-certified organization established in the mid-1950s in a small Midwestern city. It is accredited by the Accreditation Commission for Health Care, Inc. The agency offers a continuum of preventive and therapeutic services that have an individual, family, and community focus. Clinicians provide services to patients ranging in age from infants to elders. The agency employs supervisory, administrative, IT, and support staff as well as 45 clinicians: 25 nurses, 10 home care aides, 5 homemakers, 3 physical therapists, 1 occupational therapist, and 1 social worker. Staff members are on call 24 hours a day. ABC Home Health Agency services include (1) skilled home health and hospice; (2) home care aide and homemaker; (3) private duty, including nursing, personal care, and respite care; (4) wellness, flu, and immunization clinics; (5) school health; (6) jail health; and (7) durable medical equipment. There are two hospitals with about 100 beds and 15 physicians within the service area. The Agency has a good working relationship with both hospitals and the physicians. Many patients followed by the Agency have been referred from these services. Last year the Agency provided 20,345 home visits. The Agency has used an automated billing, statistical, and financial management information system for 15 years. However, all patient records are maintained in paper-and-pen format. Clinicians use a semistructured format consisting of subjective, objective, assessment, and plan (SOAP) sections. The previous director, who has just retired, did not believe that the cost of implementing an electronic health record (EHR) was justified. You have just been hired as the new director. The board of directors asks you to investigate purchasing an EHR and submit your recommendations to them. Discussion Questions 1. Why would it be important to introduce the clinicians to standardized terminologies and involve them in discussions about EHRs before contacting potential software vendors, or should you use the reverse approach? 2. What steps would you need to complete before reporting to the board of directors?

Answer 1

1. Clinicians must come across the patient information at many levels. Standardized terminologies are using globally in EHR. ANA approved 12 terminologies. Among these Omaha systems are unique in that describe health problems, actions, and outcomes. The terminologies are also important for decision making, eliminating disparities, improve performance, reporting, maintaining the list of medication, and the use and reuse of information needed for quality and safety.

It is important to make discussions about EHR to distinct the relationship between the terminologies and software development. It is important for the point of care and documentation. The Omaha system (SNOMED-CT, LONIC) is best in the practice of community-based settings. It consists of three schemes such as problem classification scheme, Intervention scheme, and problem Rating scheme. It can be work altogether. The problem classification scheme is designed for interprofessional practice. It concerns about the health of the individual, family, and the community.

2.

• Patient-centered care: Whether EHR system should provide patient-centered care to the individual and family in the community.
• Evidenced Based Practice: The EHR system should allow the clinicians to follow agency's standards of practice in relation to patient management.
• Interprofessional practice: The EHR system plan should fulfill all the services of the agency such as Home health, home care aide, private care, wellness, and immunization, school health, and jail health.
• Practice of Standardized Terminology: The clinicians should use the system to guide the assessment, care plan, and care delivery. They should also have the baseline knowledge of completing the dataset, supplies, and billing.
• Documentation: All members of the healthcare team should use one documentation system in order to revise the plan and to improve the quality of care. Regular outcome report should be analyzed by agency manager.
• Quality control: Home health agency should review the EHR periodically through the site visit and home visit.

The above things should be fulfilled before submitting the report to the board of directors.