mentation task for ized, community.co roach D us an Fequires innovation and investment. The imple stion task force is charged with operationalizing this vision of personal- community-connected, noninstitutionalized care in a larger framework erson-centered, multidimensional care that promotes dignity. The task ‘s focus is on staffing and other resources, processes, training, policies, d metrics. It wants the EHR to integrate the recommended resident digital ries: more broadly, however, it wants the EHR to support and actively cilitate the Vision of Care approach. The VP wants to know how your team Il design the EHR and how the team will use linked communication tech- nologies for statt, residents, and family to address the following questions. Case Study Discussion Questions How will you integrate, in the EHR, the nonmedical information of personalized care that promotes personal interaction and accounts for the personal needs and preferences of individual residents? Who on the staff would be included in learning the digital stories? 2. How will the EHR support personalized, community-connected care for individual residents? How does the concept of health information exchange relate to that of the hospital EHR? 3. How will the EHR support noninstitutionalized care, including fluid, continuous staff response to real-time choices by residents? How will the EHR use linked communication technologies for staff, residents, and family to actively facilitate the resident choice and staff response in question 3? What linked communication technologies will be used? Brian K. Hensel You work for a leading electronic health record (EHR) company and support one of its biggest clients-an academic medical center. You are part of a team that helped this medical center achieve the highest level (stage 7) of the Healthcare Information and Management Systems Society’s electronic medical record adoption model. The not-for-profit medical center owns a not-for-profit con- tinuing care retirement community (CCRC), which operates independent living duplexes, assisted living apartments, and a nursing home with a separate wing offering Medicare-certified skilled nursing facility beds for post-acute rehabilita- tion
and recovery. Your company wants to develop a long-term care EHR
, and the medical center has agreed to do so for its nursing home, which would serve as the alpha site, but with an important stipulation: The EHR must support and facilitate the nursing home’s recently adopted Vision of Care approach. One year ago, the medical center created and filled a new position- vice president (VP) of post-acute, long-term, and palliative care services. This position reports directly to the CEO and is charged with leading a range of mostly nonhospital services and integrating these services across the system. Services reporting to the VP include the CCRC; palliative care ser- vices at the medical center’s flagship hospital; and a system-owned hospice, home health agency, and adult day service program. Early on, the new VP began meeting with the nursing home’s resident and family advisory coun- cil. Discussions at these meetings became the impetus for developing the nursing home’s Vision of Care approach. The nursing home’s reputation was considered better than that of local competitors, but residents and family members of the advisory council expected more. The VP was gaining valuable and actionable feedback and decided to bring in faculty consultants familiar with long-term care from the local state university. These consultants organized the feedback from the advisory council and provided terminology that synthesized the needs expressed. They then worked with the nursing home’s staff to form an imple. mentation task force to determine what could be done to better meet the council’s needs. Using the consultants’ report, the VP and the nursing home’s leadership worked with the staff to develop the Vision of Care approach. Vision of Care Vision of Care responds to needs expressed by the advisory council and includes concepts from research literature that compares long-term care
(where residents (continued) live with other types of care, such as hospitals and the physician offices that patients visit. Person-centered care is emphasized instead of patient-centered care, and so is holistic, multidimensional care that includes but goes beyond the physical dimension of the medical model to assess and address psycho social and spiritual needs. Protection of each resident’s dignity is also a Corp goal. Within this framework, the Vision of Care vividly describes care that is personalized, connected to the community, and noninstitutionalized. Personalized Care Two dimensions of personalized care are identified. The first dimension is for staff to get to know each resident in ways other than the medical descriptor in the resident’s chart. Meaningful, personal interactions between residents and staff are based on shared knowledge. Charlie, a resident on the advisor council, voiced, with others nodding in agreement, “I don’t think nurses, who see me every day, really know anything about me or about my life before coming here.” Ann, whose father has latter-stage Alzheimer’s, added, “The don’t know Dad was a mechanic and could fix about any car you can name. Or that he was the best fast-pitch softball pitcher in the whole state!” The implementation task force recommended the creation of short digital stories of every resident, by digital media students from the university. Nursing home staff would be required to view these three to five-minute stories. Cues such as a picture of Dad in his softball uniform would be placed in resident rooms to help jog the staff’s memory. The second dimension is for staff to get to know, in a more complete way and across dimensions of care, the personal needs and preferences of residents including food likes and dislikes and other important details, such as routine or favorite activities. Jaylen described how his mom loved to sit on the front porch in the afternoon when she lived at home: “She misses that. Unless I’m here to help her, it seems sitting outside is out of the question, except for maybe official, planned outings.” Community-Connected Care Care that is connected to the community includes bringing both the com- munity to the residents and residents into the community. To nursing home residents, community” represents not only the immediate surrounding com munity but their larger outside world. And, consistent with personalized care, each resident’s community is different. Advisory Council discussions revealed a longing by some local residents to attend community events. “I know can’t get around like I did when we lived in the independent living duplex. or even the ſassisted living) apartment, but I miss knowing about and going out to local events, like the yearly barbershop quartet concert – something we never missed.” Hailey, who moved her father from another state to be closer to her, shared, “Dad misses Friday night fish-frys at the VFW. Having a beer with other vets, including the younger ones. Though he appreciates the work and kindness of staff here, he doesn’t really much enjoy making crafts and such during activities hour.” Noninstitutionalized Care Institutionalization depersonalizes people. It is marked by a loss of control and choice. One resident lamented, “The nursing home’s schedule rules my day. I have to eat when they say, whether I’m hungry or not. Then I take naps, go to bed, get up, take baths-all on someone else’s schedule.” Non- institutionalized care provides greater control and choice. Such care is dem- onstrated by fluid, continuous response to real-time choices by residents. 4 . Your and the EHR Team’s Charge The VP is experienced in long-term care and knows that the Vision of Care approach is ambitious and requires innovation and investment. The imple- mentation task force is charged with operationalizing this vision of personal- ized, community-connected, noninstitutionalized care in a larger framework of person-centered, multidimensional care that promotes dignity. The task force’s focus is on staffing and other resources, processes, training, policies, and metrics. It wants the EHR to integrate the recommended resident digital stories; more broadly, however, it wants the EHR to support and actively facilitate the Vision of Care approach. The VP wants to know how your team will design the EHR and how the team will use linked communication tech- nologies for staff, residents, and family to address the following questions. Case Study Discussion Questions 1. How will you integrate, in the EHR, the nonmedical information of personalized care that promotes personal interaction and accounts for the personal needs and preferences of individual residents? Who on the staff would be included in learning the digital stories? 2. How will the EHR support personalized, community-connected care for individual residents? How does the concept of health information exchange relate to that of the hospital EHR? 3. How will the EHR support noninstitutionalized care, including fluid, continuous staff response to real-time choices by residents? 4. How will the EHR use linked communication technologies for staff, residents, and family to actively facilitate the resident choice and staff response in question 3? What linked communication technologies will be used?