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A Case Study: The Clinical and Operational Impact of Electronic Health Records in Senior Living
Ronda Griffin, LNHA Director, Assisted Living and Operations
Mary Kay Vasterling, MSN
Clinical/Quality Manager
The BIG Three • Why is an EHR essential to the future? • How do you plan for such a big change? • What are the REWARDS of EHR
implementation?
Why?
• Technology improves outcomes • How?
• Broad access to resident information • Improves !nancial outcomes • Saves time • Better tracking of performance and quality measures • Response to increased regulation
Our Story
• Nazareth Living Center is a 250 bed SNF/ALF co-sponsored by Benedictine Health System
• In 2009, Electronic Health Record(EHR) was implemented across the BHS system
• System wide implementation offered advantages related to developing timelines and sharing resources
Planning
• Choose the right EHR • Easy to navigate • Intuitive/easy to complete required fields • Financially feasible for your organization • Meets your end-user requirements
• Clinically • Financially
Planning
• Build your team • End users are critical to success
• Nurses, CNAs, A/P and A/R staff • Product team – the best of the best • De!ne process for feedback and changes
• Develop the timeline • Administrative responsibilities • IT needs - hardware and equipment purchase • Clinical responsibilities (increased staffing levels) • Time to train, location availability, scheduling • Assess all departments staffing needs for go live
Planning
• Identify People • Subject matter experts (SMEs) • WHO has administrative rights?
Granting access Task responsibility Monitoring usage and compliance
Planning • Basics
• Assess BASIC computer use skills • Keyboarding and using a mouse
• Train the obvious • Is the computer plugged in? • How do I turn it on? • Checking cable connections • People will be embarrassed to ask simple questions
Planning • Training
• Written materials to support on-line learning • Screen shots
Planning
• Trouble shoot everything • Train away avoidance of the new system
• Persevere! • Adhere to deadlines • MUST have dedicated time for team
Planning • Use all available tools
• Color coded timelines/worksheets • Checklists • Parking lot issues and attendants
• Progressive Elaboration • Follow your processes • Don’t get lost on the journey
• Go Live
How Now?
How Now?
• Go Live • Plan for data crossover • Final push immediately before go live • Data input on clinical and !nancial side: AHOD (ALL Hands on
Deck)
How Now?
• Go Live • SUPPORT, SUPPORT, SUPPORT
• Contact list SMEs/Super users to answer questions • SMEs/Super users - on site 24 hours
What were the challenges?
• Understanding how many processes the EHR could help streamline
• Orders to ancillary providers can be transmitted directly from EHR • Saves nursing staff time – no need to ‘let providers know’ a
service is needed • Quality monitoring of contracted services
What were the challenges?
• Implementation team must understand deadlines. Success is dependent on this. • Staff would have liked more ‘after go-live’ training opportunities to learn/relearn short cuts
What’s the reward? • Clinical information is available 24/7, regardless of
their physical location • Doctors, NPs, supervisors, administrators, on or off
site • Staff know where to get information (not who) • Less repetition of documentation
• Monthly summaries that took 8 hours to complete with pen/paper take less than an hour.
What’s the reward? • Nurses share these as the biggest benefits
of EHR: • QUICK review of resident orders and activity when they come into
work • Message list - a quick self check at end of shift • Search and !nd information quickly • Efficiency of (almost) paperless:
• Filing in charts, copying information, physically handling a hard chart repeatedly
What’s the reward?
• Assessment information is consistent • Assessment information is complete
• Compare resident information over time (medications, ADL ability, wound resolution, events such as falls)
• Respond to increasing regulatory oversight of Assisted Living Facilities
What’s the reward? • Financial rewards include:
• Accurate billing (what organization can’t use help in this arena?)
• Powerful database - maintain up to date accounts • Capturing charges for products or services:
• Inventory barcode systems and ancillary services can be integrated into an EHR product
What’s the reward?
• Financial rewards include:
• Documentation IN ONE PLACE • Knowledge of aging accounts and collection attempts
• Staffing decreases after go live!
What’s the reward? • Integration of all information
• Documents scanned into database - easy retrieval/viewing • Seamless transitions of care and improved resident outcomes
• NLC has resident movement between ALF/SNF/ALF, EHR helps maintain accuracy of medication lists and physician orders. Reconciliation process is easy and not dependent on “waiting for orders”.
What’s the reward?
• EHR saves time • Is always legible • Enhances ability to track resident change
in condition, quality measures, staff performance
Ronda Griffin, LNHA
Nazareth Living Center
Mary Kay Vasterling, MSN
Nazareth Living Center
Thank you for attending
