SELECTING AND IMPLEMENTING AN ELECTRONIC HEALTH RECORD (E.H.R.) IN LONG-TERM CARE

The implementation and utilization of Electronic Health Record (E.H.R.) software systems has become increasingly important in Senior Living Communities, Skilled Nursing Facilities (SNFs), Life Plan Communities (formerly CCRCs), Home Health Agencies, and Hospice Agencies.

E.H.R.’s streamline processes and optimizes workflows, so frontline staff spend less time performing routine data collection & data entry tasks and invest more time engaging directly with residents and delivering high quality care.

E.H.R.’s provide senior care companies, already operating with dwindling profit margins and increasingly medically complex residents, with additional opportunities for increasing reimbursements, ancillary services billing, operational efficiency, staff productivity, and resident wellness.

E.H.R. Functionality in Senior Living & Skilled Nursing Facilities (SNFs)

• Manage scheduling, payroll, human resources, medical records, and property management processes and programs.
• Prepare and process electronic accounts payable and accounts receivable with paperless invoices, payments processing, reporting, etc.
• Process admissions, transfers, readmissions, and discharges electronically.
• Collect resident health status, manage treatments/medications, and update clinical documents in real-time at the point of care.
• View and track resident records and instantly see changes in conditions and lab results.
• Electronically draft, review, edit, and submit Incident Reports.
• Interface with Outside Agencies including Home Health and Hospice to share resident care information, coordinate care planning, and track results of treatments/medications.
• Manage medication administration and communicate with long-term care pharmacies via Electronic Medication Administration Records (eMAR) and Pharmacy Interface.
• Set alerts to prompt clinicians to perform preventative care interventions, e.g. removing catheters timely to reduce risk of urinary tract infections, completing physical assessments timely to aid skin integrity care planning, fall prevention care planning, etc.
• Manage, coordinate, and update interdisciplinary care planning notes, clinical documentation, and Private Pay Billing Documentation or Resident Assessment Instrument (RAI)/Minimum Data Set (MDS).
• Track rehospitalizations and resident quality of care indicators, and report data to Accountable Care Organizations (ACO’s), Managed Care Organizations (MCO’s), Health Maintenance Organizations (HMO’s), Private Insurers, Referral Partners, and Regulators, as needed, as per business and clinical needs.

E.H.R. Implementation Tips

• Research E.H.R. software vendors carefully by contacting Long-Term Care trade associations such as Argentum, NCAL/AHCA, CALA, CAHF, etc. to find out what the preferred E.H.R. vendors are in the industry based on objective survey or research data they’ve procured from members.
• Evaluate the productivity of E.H.R. software and the customer service quality of specific vendors by contacting comparable healthcare providers that serve your resident population. Then, meet with the Administrators and DONs of these facilities and ask them to discuss their successes, challenges, and lessons learned before, during, and after they implemented an E.H.R.
• Conduct Vendor Software Demonstrations virtually and on-site for all Department Heads and Staff BEFORE making a decision. In addition, have participating staff members complete a post-demo survey rating their impressions of the usability and functionality of the E.H.R.
• Select an E.H.R. software vendor that has a fully implementable solution comprising of numerous modules that address all of your business needs. Working with one software vendor to install a clinical module, a second vendor to install a financial management module, and a third vendor to install a payroll and scheduling module may lead to intractable problems with cost, system compatibility, interoperability, data portability, and usability. Even if your facility is presently planning to install only one module of an E.H.R. software system, it is best to work with a major software vendor with a multi-module system so that, if and when, your facility’s needs and plans change, the option to seamlessly install additional modules is still available.
• Select an E.H.R. software vendor that has a dominant industry position, progressive executive team members, long list of satisfied clients, and defensible business strategies. Working with an industry laggard may be risky. Slow growing or unprofitable companies in the E.H.R. market usually go out of business or are purchased by bigger players. A bankruptcy or change in ownership may result in pricing, customer service, technical support, and software product specifications changes that may have negative impacts on the operations and NOI of healthcare providers.
• Plan every detail and every step of the E.H.R. implementation project to determine budget, guidelines, timelines, deadlines, roles for team members, tasks for team members, project management methodology, change management methodology, training methodology, project on-schedule/on-budget completion incentives/penalties, etc.
• Promote Buy-in by seeking and carefully considering input from all department heads and staffers. Use staff input to better design staff competency testing and training to both increase staff preparedness and reduce fear of change.
• Examine/Redesign paper-based workflows. Then, clearly outline and illustrate workflows and processes to synchronize paper-based systems with the E.H.R. system. You may discover that you have too many forms, too little forms, redundant documentation, incomplete documentation, missing steps in processes, inefficient workflows, and unclear staff instructions that need to be addressed to improve operations and best utilize the new E.H.R.
• Educate/Reeducate all staff before E.H.R. implementation. Provide mandatory remedial and annual staff education before software updates and periodically (quarterly or bi-annually). E.H.R. competency testing and staff education should be included in new hire orientation, on-demand learning management system training, and ongoing skills training of all staff.
• Execute a Clinical Operations Redundancy Plan consisting of an emergency paper-based clinical documentation system in case of E.H.R. system outage or unavailability.
• Execute a Data Redundancy Plan consisting of on-site and off-site data backups to avoid lost data due to natural disasters, system user/administrator error, electrical outages, system failure, etc.

CARMEL DOLCINE-JOSEPH is Vice President of Wellness, Business Process Owner (BPO) of Electronic Health Records Systems, and Co-Risk Manager for a company that owns and operates senior living communities, memory care neighborhoods, independent living villas, and life plan communities (CCRC’s).

In addition to holding multi-state nursing and assisted living administrator licensures, Carmel is a Licensed Nursing Home Administrator (LNHA), Certified Professional in Aging Services Risk Management (CPASRM), Certified Dementia Master Trainer (CDMT), Certified E.H.R. Implementation Project Manager, Certified M.D.S. 3.0 Resident Assessor, and Certified Wound Care Nurse (SWOC).