Leaders at Madonna Rehabilitation Hospital, a 319-bed non-profit located in Lincoln, Neb., are participating in something akin an ongoing, group painting project. But instead of combining the work of similar painters, the masterpiece has to include the creativity of varying talents: a sketch artist, someone with an abstract background, and maybe a landscaper.
Being a rehab hospital, Madonna has multiple care units—a traditional long-term acute care unit, a ventilator-assisted unit, traditional and extended-care nursing—and clinicians—physicians, nurses, therapists, case managers, and respiratory specialists, among many others—that must be accounted for in the documenting process. With disparate units and clinicians, there are disparate systems and an ongoing challenge of getting a “single source of truth” in real time, says Roberta Steinhauser, director of hospital applications at Madonna Rehabilitation Hospital.
This is why Madonna ended up creating a team composite record, which takes documentation from all the different units and disciplines and standardizes it into a common format. The format is presented in the organization’s Allscripts (Chicago) Sunrise Clinical Manager EHR [electronic health record] system.
The composite is a “fabulous work of art,” Steinhauser says. “It’s able to draw everyone’s documentation together in a standard format. It extracts similar pieces from their plan of care documentation components to make that masterpiece,” she adds.
The composite was designed with the end result in mind, Steinhauser says. Once they knew what they wanted, leaders at Madonna looked at each discipline and figured out the most effective workflow process for them to enter the documentation. The information can be entered in a way that works for a particular discipline. The case manager then can pull all of the various bits of data together and synthesize it through an Allscripts enabled feature, called copy forward.
“It’s a comprehensive, holistic view of the patient,” Steinhauser says. “This has saved us so much time, it’s streamlined their workflow. They are maximizing their time and devoting more time to patient care. They’re not looking for files.”
As an example, Steinhauser points to the fact that within the composite, clinicians can take the various acronyms that apply to different specialists and translate it into more general terms. The leaders of the composite project at Madonna came up with more than 500 acronyms for this feature.
In addition to improving workflow, the composite has helped better Madonna’s Functional Independent Measurement scores (FIM), which are an element in how CMS (the Centers for Medicare & Medicaid Services) reimburses acute-care rehab facilities. With the information presented in the composite, the comprehensive 24/7 perspective of the care given, Madonna utilizes an algorithm that can effectively determine the FIM scores.
“We can prove our scores 100 percent of the time by showing them exactly what happened on this date, what was charted at this time, because it’s all backed by what’s documented in the actual EHR system,” Steinhauser says. Thanks to this feature, Madonna’s FIM scores have gone from not being alignment with CMS’ national benchmarks to being in alignment.
Customization and Flexibility
Getting to this positive result wasn’t without challenge, Steinhauser reveals. For one, envisioning the final composite, the painting if you will, was the first difficulty the leaders at Madonna encountered on this journey. Secondly, she says that getting all those stakeholders, the various painting specialists, to come up with an effective design that would drive better outcomes was also something that had to be figured out.
Steinhauser credits three clinical analysts with technical expertise, two who had nursing backgrounds, in this regard. She says those analysts helped with the actual building of the system and helped figure out a way that it would maximize clinician time.
The work on this module is far from done. Steinhauser says, Madonna is in the middle of doing a custom build for a new charging module, which will enable clinicians to use the Allscripts system to input therapy charges. The charges will be tied to the documentation, which will help out the organization from an accrediting perspective. There are additional plans beyond this, including a custom build module for the inpatient and outpatient assessments.
The flexibility and versatility of the system is what Steinhauser credits most for giving Madonna rehab the masterpiece it envisioned from the get-go.
“It’s inevitable that no single vendor can provide what you need for your specific hospital environment. The critical factor is finding a system that can present versatility and have the flexibility to enable your own staff,” Steinhauser says. ‘Every vendor wants to be competitive and meeting regulatory compliance, you have to look above and beyond. Find what allows you the creativity to incorporate custom build, custom reports, and custom functionality.”
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