Tech team wanted: electronic health records involve change and require practice

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How to do it: implementing IT solutions
How to do it: implementing IT solutions
By now, virtually every long-term care operator has heard the message that switching from paper-based resident health records to an electronic format can dramatically streamline operating practices, while also enhancing decision-making processes that improve patient care.

Despite these touted—and well-documented—benefits of electronic health records, many facilities have yet to experience them firsthand. They're either paralyzed by the fear of change or have attempted to make the transition to EHR without practicing necessary due diligence to ensure successful, broad-based implementation.
 
“Change is never easy and with EHR, there are many things to consider. Like any other process change, you can't just jump in blindly and expect positive outcomes,” notes Erika Soiman, chief information officer for Hebrew Home for the Aged at Riverdale, a continuing care retirement community in Riverdale, NY.

Soiman speaks from experience. The community, which transitioned to EHR several years ago, recognized that successful implementation and utilization would require a multi-layered, ongoing approach.

Aside from tackling some of the initial tasks, such as bringing staff up to speed on basic computer skills and conducting detailed workflow analyses of existing processes, Hebrew Home was committed to providing unwavering organizational support. That included instilling an interdisciplinary approach throughout all stages of the process—from product evaluation and selection to implementation and ongoing training and process assessments. Such facility-wide staff support and involvement is what experts generally laud as the most vital element of EHR implementation

“Multi-disciplinary implementation is necessary to move from segregated information silos to a true integrated health record,” stresses Dan Cobb, chief technology officer, HealthMEDX Inc., an EHR software solution provider.

Inclusive empowerment

For senior housing operators wondering which staff members to include in the EHR implementation process, the answer is easy: anyone who has a role in the delivery of resident care. That begins with those in administrative or management positions and spills over into all other critical disciplines, from physicians, nurses and certified nursing assistants, to lab, dietary and therapy staff, pharmacists and others.

It isn't always easy finding ways to effectively bring each discipline together to work toward a common goal and become receptive, yet alone enthusiastic, about the transition to EHR.

“The processes that exist in any business are extensive and highly interdependent. Few personnel and processes work in such isolation that an IT implementation would not affect their day-to-day work; therefore, getting buy-in at all levels is essential, especially if the plan is to undertake the difficult step of installing an off-the-shelf product,” reasons Jason Hwang, MD, senior strategist for the healthcare practice at Innosight LLC, and executive director of healthcare at Innosight Institute.

It's in the approach

Most agree that enduring staff buy-in is greatly driven by how those in leadership roles approach implementation. Success is much more likely if the administrator, director of nursing, business office manager and others in leadership roles are enthusiastic about EHR implementation.

These leaders also should fully understand EHR's benefits and capabilities, and make it clear they are committed to streamlining workflow and taking staff's input and needs into consideration, points out Claire Chitwood, executive vice president, Enformix Technology Services.

“Success is a team issue. No individual makes an implementation a success of failure,” she says. She adds that, on the flip side, lack of planning, enthusiasm from leadership, interdisciplinary involvement or true partnership with the vendor of choice are all clear indications that an implementation may not go well.

Prior to EHR implementation, staff from all disciplines that will be impacted by it should be encouraged to voice their opinions and concerns—both in terms of the products being evaluated and the processes they aim to improve. They also should be given realistic timelines and expectations so there's no fear about having to hit the ground running and meet all established goals within days of going live.

“It's important to plan for work flow changes and make decisions [from an interdisciplinary level] on who will be doing what” and how the IT solution will best be leveraged, says Sarah Corley, MD, chief medical officer for Next-Gen Healthcare Information Systems Inc.

A key benefit of EHR, she explains, is implementing it in a way that has each staff member from each discipline working at the top of his or her licensed capabilities.

“It improves morale when staff are used to their fullest potential and understand the important role they play on the [collective] team,” she notes.

Support essentials

Delegating a team champion to support peers throughout their implementation journey is another tried-and-true strategy that fosters effective, ongoing communication and assures end-users their voices are being heard. Corley stresses that champions do not necessarily have to possess the most technical skills, but rather must be enthusiastic about how the EHR solution will positively impact their discipline and resident care.

“Technology by itself provides limited benefits and only optimized clinical processes with cross-disciplinary involvement [are] able to leverage technology to realize full benefits,” says Qin Ye, MD, MS, senior vice president of technology for Medversant Technologies LLC.

Interdisciplinary committees comprising one representative or champion from each discipline can help facilities fully embrace the technology and ignite staff empowerment. Committee meetings should be held weekly, monthly, or as often as needed. Facilities should have additional communication and troubleshooting strategies in place to address end-user issues as they arise.

One way to keep lines of communication open, minimize frustration and prevent unnecessary implementation bottlenecks is having an established chain of command that allows a certified nursing assistant (or a champion who's willing to speak on behalf of his or her peers) to take staff concerns or even productive input to the DON or other designated clinical leader.

Of course, because technical issues will arise with even the best EHR solutions, facilities should be able to rely on their vendors as true team partners, as opposed to merely solutions providers.

“We truly believe that the word ‘partner' is the key to productive technology rollouts and satisfied staff and management. Long-term care providers must seek companies that listen, understand their needs and objectives, and commit their time and resources to help those providers meet their goals for quality care, operational efficiency and overall business performance,” says Doug Walker, vice president of marketing for Patient Placement Systems LLC.

“A sell-and-run software vendor can do more harm than good, particularly for projects related to the sometimes complex world of EHR.”

Specifically, facilities will greatly benefit from free vendor support to end-users for the first 90 days of process changeover, says Chitwood. Often, when end-users are charged for support calls, they avoid calling and attempt to fix problems on their own.

Implementation success is equally dependent upon the availability and accessibility of a facility's own dedicated technical IT team.

“Technical issues can really derail the implementation process faster than anything else. In the eyes of the clinician who is trying to learn the new system effectively, [if a problem arises] all they can see is that they can't do their job. It doesn't really matter to them that it's the wireless network or even the mouse or keyboard that's causing the problem,” explains Kendra Weber, clinical coordinator for MDI Achieve Inc.

Weber also stresses the importance of having IT experts available 24 hours a day to resolve any technical problems in a timely manner. “And be sure that end-users know whom to go to if they experience technical difficulties.”

An enduring process

Even after an EHR system has been in place for awhile, facilities should continue advancing implementation and utilization through staff training, process assessments and focused deployment of software updates. This strategy has worked well for Hebrew Home.

“While we have accomplished our objective of implementing EHR—and the entire clinical team is involved in the use of the system—it is important to continue post-implementation audits and monitoring, and general management so all the benefits of the electronic medical record can be obtained,” Soiman says. She recommends retaining dedicated staff to work with clinical teams and the vendor during, implementation and long afterward.

“The product will continue to evolve, and the need for training and coaching will become just another day-to-day operation that will, by far, be offset by the many qualitative and quantitative benefits that an EHR brings to any provider,” she explains.