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 financial 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 Define 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
How Now? • Go Live
How Now? • Go Live • Plan for data crossover • Final push immediately before go live • Data input on clinical and financial 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 find 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
Mary Kay Vasterling, MSN
Nazareth Living Center ronda.griďŹƒn@bhshealth.org Nazareth Living Center Marykay.vasterling@bhshealth.org
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