Long-Term Care

Tip of the week: Develop a companywide strategy for EHR goals

Contemporary Long-Term Care Weekly, August 7, 2008

About three years ago, a long-term care organization called American Baptist Homes of the West in Fresno, CA, took on an electronic health records (EHR) project with the following three goals:

1. Creating efficiency through technology

2. Building assets in quality improvement and risk management

3. Incorporating a seamless system of communication

In addition to putting together the appropriate proposal to garner support from upper management and developing an implementation plan with the technology staff, the administrator at the time shared the EHR vision and education with frontline staff. “The bottom line is that the users are mostly the nursing staff,” says Keli Swales, administrator during implementation, now executive director. “We knew we had to focus on getting the staff to work with the technology rather than paper.”

Assess your computer savvy

Through the learning process, Swales says she quickly learned that certified nursing assistants were more adaptable and flexible about learning the new system than RNs were. Therefore, the first thing that a facility should do when making a change to EHR is to assess where its users are in terms of technology knowledge, she advises.

Do your staff need help turning the computer on and using a mouse, or do they have some experience and familiarity with basic Windows® programs?

The next assessment needs to be of your current processes, Swales says.

Look at your falls or admissions assessments, for example. Are the forms consistent throughout the facility? If not, revise them so that one standard form can be customized for your system.

Educate throughout the process

A good way to start is to gather your staff and explain to them what is happening in the greater healthcare continuum regarding technology. Then connect those statistics to your own facility’s data, Swales says. “Tell staff what’s in it for them to use this technology,” she says.

For example, using EHR will help staff meet documentation requirements more effectively so they can spend more time with their residents.

Get started with hands-on instruction by setting up Web training with the vendor that your facility uses. Host specific workshops (e.g., how to complete a care plan using the EHR), Swales suggests.

The most labor-intensive part of this project will be moving your old information from paper into the electronic system. Use this as another learning opportunity for staff. Rather than paying outside temporary help to do the data entry, Swales enlisted staff for the job so they could get used to the system. By tackling one small task at a time, the team was up to speed on using EHRs in about two months, Swales says.

Training didn’t end with the launch of the system in August 2005, either. Swales hosts monthly Web trainer refresher courses, as well as provides education when the organization makes enhancements to the system.

Enjoy the benefits of hard work

Keep tabs on how your system works by trending results in your quality assurance (QA) program. Swales’ group saw the following benefits rise from the new system:

 

  • Staff documentation levels improved
  • Staff reported they spent less time on documentation
  • EHR cut down on repetitive processes of getting information into the medical record
  • The system decreased the potential of medical and medication errors
  • Quality of care improved
  • Therapy staff now have access to charts anywhere in the building at anytime
  • Clinical and billing staff work together better

    The QA project also uncovered areas that still need work in the new system. For example, managers found that they still needed to train staff in certain areas.

    Trends in best practices

    The last thing we all need is more meetings, right? But what if having one more meeting actually made your work in the nursing home easier? That’s the trend that Steven S. Burke, executive management consultant at Burke and Associates, LLC, in Peabody, MA, sees.

    “People have always tried to take shortcuts in their jobs, but some are finally discovering the shortcuts that make their lives easier while improving care,” he says.

    Here are some meeting ideas that can do wonders for your workload and sanity:

  • Do a triple check. On a monthly basis, get together the following people to go over census and resource utilization group (RUG) issues:
  • Administrator
  • Billing office manager
  • Rehab manager
  • Minimum Data Set (MDS) coordinator

    Since CMS introduced the nine new RUG categories, reimbursement rates have gone down in skilled nursing facilities (SNF), Burke says. Use this meeting to reconcile any disagreements about MDS coding and the subsequent RUG you bill.

  • Host at-risk meetings. On a weekly basis, gather an interdisciplinary team from the nursing, dietary, rehab, and, if possible, pharmacy departments to identify at-risk residents, Burke says.

    Look for changes in behavior that may not have hit the MDS yet. For example, a resident with no fall history starts to fall. Investigate causes and possible solutions.

    Even though facilities conduct quarterly assessments for such scenarios, a resident may fall or develop other risky behaviors between those quarterly meetings.

    Taking a proactive approach to each at-risk resident will save time in the long run by helping your SNF avoid potential legal issues, in addition to keeping survey deficiencies at bay. “If surveyors come in and see that a resident has fallen, but there’s no care plan for it, you’re going to get dinged,” Burke says. “They won’t care that you planned to address it at a quarterly meeting three weeks from now.”

  • A trend not to follow. One trend that Burke sees that needs to go out of style is the silos in which administrators often put themselves.

    For example, some administrators that he’s visited focus on all of the business aspects of running the facility and leave all of the clinical work to the directors of nursing.

    Administrators need to know about clinical practices and procedures and how they fit into the everyday business of the facility, Burke says.

     

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