Break ups can be hard

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Many long-term care providers are pushed into selecting a new EHR platform when their previous system has outlasted its usefulness, or is too costly.
Many long-term care providers are pushed into selecting a new EHR platform when their previous system has outlasted its usefulness, or is too costly.

Two years ago, Bonnie Ard inherited a makeshift system of data collection that relied on electronic medical records, paper charting and labor-intensive analytics done by spreadsheet.

It didn't take long for her to make a switch, first by bringing all of SanStone Health and Rehabilitation's 14 locations onto an existing EMR platform and then by recommending a new-and-improved one.

After another long afternoon trying to pull outdated stats from Nursing Home Compare, Ard, the company's director of clinical operations, decided her staff and patients deserved better.

“I just bit the bullet and walked into the owner's office and said, ‘We really need to look at software that moves us forward, that works with the changes in the industry,'” Ard recalls. “Once we did the research, it was really quick, the decision to do it.”

Changing EHR systems is no small task, given that daily operations depend on quickly charting information, collecting it for reports and billing and using it to inform future care. Any down time while staff adapts to new technology can interfere with workflow and patient care.

And the ability to migrate old data into a new system can be cumbersome, if not near impossible, when switching vendors. That data is more important than ever when it comes to tracking improvements for individual patients and across a facility.

“EHR has largely been built as a transactional system,” says Carol Clayton, Ph.D., a translational neuroscientist for Relias and former president of Care Management Technologies. “That got more bells and whistles over time, but as people go beyond traditional payment  models … they need solutions that not all EHR vendors have in their toolkit.”

Many providers are pushed to make a leap when a system outlasts its usefulness, costs too much or lacks interoperability. Many who adopted basic EHRs years ago have grown frustrated by their vendor's inability or unwillingness to evolve.

“We've seen clients switch over support, or if the system is not stable,” says Doron Gutkind, chief software architect at Lintech. “They've taken one promise, two promises, and time goes by. They realize they're not going to get where they want to be.”

The biggest EHR providers continue to improve their products, enticing those who've long settled for basic documentation to pursue a switch to something that delivers tools that can aid compliance efforts and maximize reimbursement.

Jayne Warwick, RN, HBScN, is the director of market insights for PointClickCare, which serves more than 15,000 long-term care clients. She says those looking to change vendors should consider a company's stability, performance and customer empathy — and be clear with their new partner about their objectives.

“The cost of change is expensive,” she says. “Providers should look to their vendor as a partner that will allow them to reach their clinical and business goals.”

CareServ Technologies CEO Jeremy Spradlin brokers deals between long-term care clients and several EHR providers. He says approaches to EHR conversions are as varied as facilities themselves.

“For a mom-and-pop shop, they still don't do a ton clinically electronically,” he says.“But at midsize and larger chains, it's a massive undertaking. They worry less about the money and more about the clinical possibilities.”

Plan for implementation 

A facility's current contract typically drives the timing of a changeover.

Working backward, operations staff will need to estimate time to research options, build up and test a customized platform with the new vendor and roll out slowly one staff group or building at a time.

Spradlin estimates 60 to 90 days for planning before launching at a single site. After the first live roll out, most of his clients go live in up to five buildings a month.

SanStone began beta testing its new PointClickCare system — which incorporates billing, charting, pharmacy and therapy orders and analysis — in October. After three months of tweaking, Ard planned to roll out to the rest of her buildings between February and June.

She says the vendor would deliver on-site training for the first two buildings, and she'd look for champions who could help front load information and train fellow staff members  at additional sites.

Warwick likes the 80/20 rule: Implement the 20% of functionality that provides 80% of the benefit first (across all facilities), then revisit to add more features later. 

Spradlin recommends larger chains with 20 to 50 buildings bring in consultants who can help train and “backfill any holes where you don't have enough bodies to do it all.”

Customer service is one of the key items to look for from any potential software partner.

“With any kind of health solution system, it can't just be, ‘Here's your software, here's the password, 'bye,'” Clayton says.

When making a transition, advocate for a contract that includes system support, training and updates. They can be an organization's best chance to capitalize on each feature.

“There's so much in there, you could miss something,” Ard says.

In addition, her new vendor recently partnered with Relias to provide customers better access to ongoing training resources.

Taking data with you

Facilities that decide to change vendors, however, shouldn't expect great service on the way out.

“They're not going to do anything for you to try and make it easy,” Spradlin says.

That includes providing resident information.

“They'll say, ‘It's your data. Fine. Here's a CD with a bunch of Excel or text files,' ” Gutkind says.

Though another vendor might be able to extract that data and turn it into something usable — for another fee — migrating data to third-parties also triggers HIPAA restrictions.

The potential for accidental exposure is highest when documents need to be scanned into a new EHR platform, Warwick says. She recommends providers outline data protection policies in an agreement and budget for maintenance of any old system data or secure storage of paper files.

Scrubbing and re-entering data can be time-consuming and, ultimately, not worthwhile for some customers.

Then it becomes critical to keep track of old patient data that can't be imported, Warwick explains. It may be needed in case of litigation or during future surveys.

Getting data out is only half the problem.

“The other is that most vendors don't support importing information,” Gutkind says.

Lintech created a new solution to give its users historic context, which could be used to show payment partners long-term success or improvements in specific treatment categories.

A three-tier system provides a user interface, a business operations layer and a data layer that stores information so that it can be imported or exported through utilities.

Gutkind estimates true interoperability is still 10 to 15 years away, given that many EHR providers still don't design their systems to talk to each other.

But having the ability to pull data for outside partners or switch data for a new system is important.

Gutkind says to look for pull-down menus or multiple-choice options in documentation systems. He favors this rather than frequent free-text blocks that allow caregivers to record everything in their own words.

Choice modules are linked behind the scenes in discrete data sets that can be understood by other computing systems.

Clayton agrees that any new platform should be able to accept large, desegregated data sets into a population view. The best systems allow managers to view populations as a whole, critical for value-based arrangements like global capitation.

She also lists the ability to push info across platforms and vendors as a top feature (after the basics of adding new clinical abilities and meaningful use-certification).

“It's really important if you're going to be in any part of shared risk or shared savings programs,” Clayton says. “Your financial gain depends on their accountability and vice versa.”

For Ard, another consideration was whether her new system would interact with existing facility tools. During the build, PointClickCare digitized the chain's manual forms, including 48-hour care and antibiotic stewardship plans, to incorporate them into the dashboard.

SanStone also recently invested heavily in ConstantCare Technology's vitals integration system. The transition was going smoothly as of production deadline, though she made some tweaks to make prescription ordering easier, Ard says.

Clayton says buy-in will come quickly if staff see the effect a new EHR has on patient life.

One health plan client on a new system discovered a patient who had had 50 emergency room visits. An administrator quickly organized outreach services for him.

“Make sure you're making that connection for staff,” Clayton says. “It can be enlightening.”