Portal de Periódicos da CAPES

Electronic Records Challenge LTC Providers

2010; Elsevier BV; Volume: 11; Issue: 3 Linguagem: Inglês

10.1016/s1526-4114(10)60063-7

2377-066X

SUSAN BIRK,

Electronic Health Records Systems

Susan Birk is a freelance writer in Chicago.CHICAGO — For long-term and postacute care providers intent on going electronic, much more is required than selecting from an approved list of software, according to a panel of technology professionals and health care executives.The federal government currently recognizes only one body to certify electronic health record (EHR) systems, the Certification Commission for Health Information Technology (CCHIT). But even when considering systems with such a “stamp of approval,” LTC providers “need to learn about the company behind that certification,” said Traci Jersen at the annual meeting of the American Association of Homes and Services for the Aging.“There are 300-plus features in that certification standard,” said Ms. Jersen, the chief marketing officer at 6N Systems Inc., Wilton, N.Y., yet certification does not guarantee product quality, efficiency, ease of use, availability of technical support, or a company's financial viability. Certification defines requirements for security and interoperability, but users “still have to do that due diligence ahead of time,” she said.CCHIT plans to launch its long-term–postacute care certification program this summer, and certified products should be available by fall, said CCHIT marketing director Sue Reber in an interview. She said providers should ask potential or existing vendors about their familiarity with the long-term–postacute criteria.Other factors to weigh in a decision, she said, include the vendor's timeline for product marketing, development, and certification; its plans for interoperability; and whether its product follows the standards of Health Level 7, a nonprofit organization whose purpose is to support the effective exchange, sharing, retrieval, and integration of health information.Also consider whether a vendor plans to regularly upgrade its software over the next few years and if the associated costs will be passed on to you. And “make sure if you're working with different products that the vendors are talking with each other,” said Ms. Reber.She urged providers to ask to see the product in action at another institution before they buy.An EHR must be able to do more than take a paper chart and make it electronic, stressed Phyllis A. Rosenberger, director of nursing at Fulton County Residential Health Care Facility, Gloversville, N.Y. “A lot of vendors have taken time to develop products that speak to quality assurance, and others are just data-collection tools.” The ideal product will be one designed with quality, patient safety, and process improvement in mind, she said.“We are drowning in data, but data is no good to us unless we can … transform it into meaningful information that will [guide] our decision-making process,” said Janine Savage, RN, vice president of clinical operations and corporate compliance officer for United Methodist Homes, Binghamton, N.Y. “That's what an [EHR] does for us … and that's where the great potential lies. It's a tool to help our physicians in their decision making and in the care of our residents.”An EHR prompts tasks and monitors their completion, said Ms. Rosenberger. How well those actions support quality and safety and improve processes should be prime considerations. “From a quality improvement standpoint, if we can improve our charting, we can improve our decision making.”Providers will be better prepared to evaluate a product's process-improvement and decision-making capabilities if they go in with a clear definition of their goals, she said. “What do you expect to get out of it?” she asked. Possible answers, she added, are decreased falls, fewer pressure ulcers, and less infection.A major benefit of an EHR is that ready access to information about individuals can translate into stronger patient relationships and family satisfaction, said Ms. Rosenberger. “From a director of nursing standpoint, there's nothing better than sitting in my office and having a family call. Two or three years ago, I would have said ‘Let me talk to the nurse and I'll call you back.’ Now I can pull up that chart or that care plan and say, ‘Your mom ate really well today. [I] can see your mom did really well in therapy.’ There is no value you can put on that in terms of the confidence you'll build.”Bill Russell, MD, CMD, chair of AMDA's HIT work group commented, “Decision making about [EHR] software is more complicated for physicians if they have a significant long-term care practice. The software that can be optimized for geriatric medicine is the ambulatory EMR, whereas the nursing homes are buying software in the long-term–postacute-care space.“The incentives for physician [EHRs] are more clear cut. The best of all possible worlds is to have interoperable systems where the physicians can continue to document in the ambulatory record regardless of setting and access data in related systems, then move their new contributions to the system in the facility. The biggest mistake physicians make is thinking about their current chart and trying to reproduce that paradigm.”Asked for advice to physicians with LTC practices, Dr. Russell said, “Put maximal value on the ability to capture and analyze patient data regardless of source—visit notes, labs, hospitals, and so on—support decision making and quality reporting at the point of care, and publish reconciled patient data to information exchanges.” Susan Birk is a freelance writer in Chicago. CHICAGO — For long-term and postacute care providers intent on going electronic, much more is required than selecting from an approved list of software, according to a panel of technology professionals and health care executives. The federal government currently recognizes only one body to certify electronic health record (EHR) systems, the Certification Commission for Health Information Technology (CCHIT). But even when considering systems with such a “stamp of approval,” LTC providers “need to learn about the company behind that certification,” said Traci Jersen at the annual meeting of the American Association of Homes and Services for the Aging. “There are 300-plus features in that certification standard,” said Ms. Jersen, the chief marketing officer at 6N Systems Inc., Wilton, N.Y., yet certification does not guarantee product quality, efficiency, ease of use, availability of technical support, or a company's financial viability. Certification defines requirements for security and interoperability, but users “still have to do that due diligence ahead of time,” she said. CCHIT plans to launch its long-term–postacute care certification program this summer, and certified products should be available by fall, said CCHIT marketing director Sue Reber in an interview. She said providers should ask potential or existing vendors about their familiarity with the long-term–postacute criteria. Other factors to weigh in a decision, she said, include the vendor's timeline for product marketing, development, and certification; its plans for interoperability; and whether its product follows the standards of Health Level 7, a nonprofit organization whose purpose is to support the effective exchange, sharing, retrieval, and integration of health information. Also consider whether a vendor plans to regularly upgrade its software over the next few years and if the associated costs will be passed on to you. And “make sure if you're working with different products that the vendors are talking with each other,” said Ms. Reber. She urged providers to ask to see the product in action at another institution before they buy. An EHR must be able to do more than take a paper chart and make it electronic, stressed Phyllis A. Rosenberger, director of nursing at Fulton County Residential Health Care Facility, Gloversville, N.Y. “A lot of vendors have taken time to develop products that speak to quality assurance, and others are just data-collection tools.” The ideal product will be one designed with quality, patient safety, and process improvement in mind, she said. “We are drowning in data, but data is no good to us unless we can … transform it into meaningful information that will [guide] our decision-making process,” said Janine Savage, RN, vice president of clinical operations and corporate compliance officer for United Methodist Homes, Binghamton, N.Y. “That's what an [EHR] does for us … and that's where the great potential lies. It's a tool to help our physicians in their decision making and in the care of our residents.” An EHR prompts tasks and monitors their completion, said Ms. Rosenberger. How well those actions support quality and safety and improve processes should be prime considerations. “From a quality improvement standpoint, if we can improve our charting, we can improve our decision making.” Providers will be better prepared to evaluate a product's process-improvement and decision-making capabilities if they go in with a clear definition of their goals, she said. “What do you expect to get out of it?” she asked. Possible answers, she added, are decreased falls, fewer pressure ulcers, and less infection. A major benefit of an EHR is that ready access to information about individuals can translate into stronger patient relationships and family satisfaction, said Ms. Rosenberger. “From a director of nursing standpoint, there's nothing better than sitting in my office and having a family call. Two or three years ago, I would have said ‘Let me talk to the nurse and I'll call you back.’ Now I can pull up that chart or that care plan and say, ‘Your mom ate really well today. [I] can see your mom did really well in therapy.’ There is no value you can put on that in terms of the confidence you'll build.” Bill Russell, MD, CMD, chair of AMDA's HIT work group commented, “Decision making about [EHR] software is more complicated for physicians if they have a significant long-term care practice. The software that can be optimized for geriatric medicine is the ambulatory EMR, whereas the nursing homes are buying software in the long-term–postacute-care space. “The incentives for physician [EHRs] are more clear cut. The best of all possible worlds is to have interoperable systems where the physicians can continue to document in the ambulatory record regardless of setting and access data in related systems, then move their new contributions to the system in the facility. The biggest mistake physicians make is thinking about their current chart and trying to reproduce that paradigm.” Asked for advice to physicians with LTC practices, Dr. Russell said, “Put maximal value on the ability to capture and analyze patient data regardless of source—visit notes, labs, hospitals, and so on—support decision making and quality reporting at the point of care, and publish reconciled patient data to information exchanges.” Tips for a Successful EHR ImplementationElectronic health records can streamline processes in long-term and postacute care settings, improve quality and patient safety, and increase employee satisfaction, according to the panel.In fact, said Ms. Savage, an EHR is quickly becoming an expectation, particularly among people in their twenties, thirties, and forties, whose lives have come to revolve around electronic tools.“There's this perceived barrier that it's hard to implement technology because our nurses and other clinicians are resistant. That's true to some degree, but we actually have discovered that this is an overblown [misconception],” said Ms. Savage, whose organization implemented EHRs 2 years ago.Added Ms. Rosenberger, “Baby boomers took longer to come to the computer world [but younger health professionals] love [the EHR] because they know it will give them more time for patient care.”The panel offered the following additional advice:▸ Don't assume that all vendors' systems are going to integrate easily with yours, said Ms. Jersen. “Software vendors are a very collaborative group of people, and we will work together, but don't assume that it's going to be quick and easy.▸ Select a project manager who has influence in your organization, advised Ms. Savage. Although technology-based projects have traditionally been led by an information technology professional on staff, the custom is shifting toward project managers who are clinically oriented and have a strong affinity for IT, she said. But make sure your project team includes members who will be able to develop a good working relationship with your vendor, Ms. Jersen added.▸ Assess your processes, don't merely put paper charts into an electronic format. “That really doesn't work,” said Ms. Jersen. “If you have lot of redundancy, make sure you are reviewing that ahead of time.” In a similar vein, don't expect the software to solve problems for you. “It's going to help you with work flow, but there are issues that you need to work out” before EHRs can help, she said.Work flow redesign is a key to the effective implementation of an EHR, added Ms. Savage. “Some [providers] do a really good job of analyzing work flow, but that is where they stop. You have to think about redesigning. … An electronic system changes your work flow.”▸ Assess your staff's computer readiness. What is their computer-skill level? Do you need to train some people in how to use a computer?▸ Establish core concepts for the implementation of an EHR that mirror your organization's core values. At United Methodist Homes, one of those core values is adhering to the practices of evidence-based medicine. “Everything we do goes back to these core concepts,” said Ms. Savage. “When we're considering how we're going to implement something or what the work flow will be, our team will say ‘How does that fit in with evidence-based practice?’”▸ Field test. “Every time we configure something we always come back with changes” after an initial trial run, Ms. Savage said.▸ Celebrate your successes with staff parties and handwritten notes when phases of the project are finished or go exceptionally well.▸ Keep the window open. “People are open when they know change is coming, but during implementation that window tends to close,” Ms. Savage said. Then “it's really hard to it get open again. It's really important to balance ongoing functionality and implementation of new things with users' tolerance for change.”▸ Build buzz. Get the word out by planning fun activities around a theme. “This really sends a message to the staff in your facility that [the EHR implementation] is important,” said Ms. Savage. EHR “implementation can't help but change your culture if it's done in the correct way.” United Methodist Homes was using a software product called Comet, so the organization based activities around a space theme that included the chief financial officer dressing as Darth Vader.▸ Measure outcomes with a variety of tools, including employee scorecards and financial-performance indicators. “In not-for-profits, sometimes there's this perception that money doesn't matter,” said Ms. Savage. “I have the opposite reaction. I tell people we have a great responsibility to make sure we are good stewards, so we do have to look at financial performance measures” and encourage cooperation between the clinical and financial sides of the organization.▸ Don't lose site of the fact that as a provider, your focus is the residents. “It's not about the technology,” said Ms. Savage. “We need to remember why we do this. It's about improving quality of care and improving the work environment.” Electronic health records can streamline processes in long-term and postacute care settings, improve quality and patient safety, and increase employee satisfaction, according to the panel. In fact, said Ms. Savage, an EHR is quickly becoming an expectation, particularly among people in their twenties, thirties, and forties, whose lives have come to revolve around electronic tools. “There's this perceived barrier that it's hard to implement technology because our nurses and other clinicians are resistant. That's true to some degree, but we actually have discovered that this is an overblown [misconception],” said Ms. Savage, whose organization implemented EHRs 2 years ago. Added Ms. Rosenberger, “Baby boomers took longer to come to the computer world [but younger health professionals] love [the EHR] because they know it will give them more time for patient care.” The panel offered the following additional advice: ▸ Don't assume that all vendors' systems are going to integrate easily with yours, said Ms. Jersen. “Software vendors are a very collaborative group of people, and we will work together, but don't assume that it's going to be quick and easy. ▸ Select a project manager who has influence in your organization, advised Ms. Savage. Although technology-based projects have traditionally been led by an information technology professional on staff, the custom is shifting toward project managers who are clinically oriented and have a strong affinity for IT, she said. But make sure your project team includes members who will be able to develop a good working relationship with your vendor, Ms. Jersen added. ▸ Assess your processes, don't merely put paper charts into an electronic format. “That really doesn't work,” said Ms. Jersen. “If you have lot of redundancy, make sure you are reviewing that ahead of time.” In a similar vein, don't expect the software to solve problems for you. “It's going to help you with work flow, but there are issues that you need to work out” before EHRs can help, she said. Work flow redesign is a key to the effective implementation of an EHR, added Ms. Savage. “Some [providers] do a really good job of analyzing work flow, but that is where they stop. You have to think about redesigning. … An electronic system changes your work flow.” ▸ Assess your staff's computer readiness. What is their computer-skill level? Do you need to train some people in how to use a computer? ▸ Establish core concepts for the implementation of an EHR that mirror your organization's core values. At United Methodist Homes, one of those core values is adhering to the practices of evidence-based medicine. “Everything we do goes back to these core concepts,” said Ms. Savage. “When we're considering how we're going to implement something or what the work flow will be, our team will say ‘How does that fit in with evidence-based practice?’” ▸ Field test. “Every time we configure something we always come back with changes” after an initial trial run, Ms. Savage said. ▸ Celebrate your successes with staff parties and handwritten notes when phases of the project are finished or go exceptionally well. ▸ Keep the window open. “People are open when they know change is coming, but during implementation that window tends to close,” Ms. Savage said. Then “it's really hard to it get open again. It's really important to balance ongoing functionality and implementation of new things with users' tolerance for change.” ▸ Build buzz. Get the word out by planning fun activities around a theme. “This really sends a message to the staff in your facility that [the EHR implementation] is important,” said Ms. Savage. EHR “implementation can't help but change your culture if it's done in the correct way.” United Methodist Homes was using a software product called Comet, so the organization based activities around a space theme that included the chief financial officer dressing as Darth Vader. ▸ Measure outcomes with a variety of tools, including employee scorecards and financial-performance indicators. “In not-for-profits, sometimes there's this perception that money doesn't matter,” said Ms. Savage. “I have the opposite reaction. I tell people we have a great responsibility to make sure we are good stewards, so we do have to look at financial performance measures” and encourage cooperation between the clinical and financial sides of the organization. ▸ Don't lose site of the fact that as a provider, your focus is the residents. “It's not about the technology,” said Ms. Savage. “We need to remember why we do this. It's about improving quality of care and improving the work environment.”