Each participating provider took a slightly different approach to choosing and utilizing an EHR system, and shared the factors that led to their success. Below is a summary of lessons learned and advice from the most recent as well as previous CAST EHR case studies:

Planning and Implementation
 

• Remember that EHR Implementation is a Large Undertaking and not an Overnight Project: It is very important to build a solid relationship with your vendor as they will be very important for support during your rollout.

• Thorough Planning and Evaluation Process can Save a lot of Time: Put effort in the beginning to help layout timelines, deadlines, assign tasks to team members and create steps to ensure involvement and accountability from a collaborative team. A reference site visit to peer facilities of similar size, performance, and function provides an expanded perspective that may help decrease form count and process steps.

• Leverage Industry Benchmarks: Before implementing an EHR system, compare all the quality measures from the CMS Certification and Survey Provider Enhanced Reports (CASPER) and select one as a critical area of focus for all facilities in the organization. This allows staff across the enterprise to coordinate efforts, understand current processes, identify improvement opportunities and enhance documentation while also adjusting as needed during EHR implementation and after going-live. When the organization reaches maximum improvement with the selected quality measure, it should select the next area for quality improvement.

• Select a Champion to Lead Team: Have a champion on your team to lead the implementation; an internal team point person eases the anxiety that comes with change.  Additionally, having team members involved from different departments and various levels within the organization provides a multidisciplinary perspective to ensure adaptability by diverse departments and roles in the organization.  By involving staff, you are also helping to promote team buy-in as they are part of the process and not having this thrust upon them. 

• Create a Task Force to Implement each Major Initiatives:  Create a task force to implement and roll out each major initiative or functionality with your EHR project, such as Physician Access, eMAR or Physician Orders.

• Analyze and Standardize your Workflow Ahead of Implementation: This step is crucial in minimizing workflow disruptions and ensuring that care to your patients continues without interruption. It also helps to frame the goals of the EHR implementation from the outset of the project.

• Re-examine Workflows and Redesign Processes:  An EHR implementation is an opportunity to re-examine workflows and redesigning processes to maximize the benefits of the EHR.  It presents an opportunity to consolidate forms and change process so that information is entered once and used in different processes and shared with other team members as needed to increase efficiencies. 

• Communication between Clinical and Technology Teams is Essential for Successful EHR Implementation:  Develop strong working relationships and shared communication between clinical and technology team members. It is important to get the team’s input to ensure success in the launch of the EHR or health information exchange project.  

• Test Wi-Fi Coverage:   When implementing a web-based mobile solution it is essential to test the Wi-Fi coverage to ensure an efficient experience.  At minimum, testing should be completed prior to selection a vendor. In fact, CAST strongly recommends taking the EHR project as an opportunity to revisit and update the organizations Strategic Plan, conduct a Strategic IT Planning and update the IT infrastructure to support not only the EHR, but also other technology applications that would facilitate the organization’s strategic goals, before selecting and implementing an EHR. Please see CAST’s Strategic Planning and Strategic IT Planning Portfolio.

• A Mobile Device Should Not Create a Barrier for Patient Interactions/Care and Documentation:  Consider an alternative mobile devices like a handheld smartphone or tablet if patient interactions/care and/or the documentation process are effected by the size and weight of the mobile device, such as a more traditional laptop.

• EHR is an investment in the Future: It is a long process and takes patience and flexibility, but the end results will mean more streamlined efforts, better documentation, and ultimately better care provided across the entire organization. Use CAST’s 7-Stage EHR Adoption Model to take advantage of Advanced EHR functionalities and feature and make the most of your EHR investment.

• Find the right partner and treat them like a partner, not a vendor: Your EHR partner is your lifeline. That’s why the selection of the right partner is crucial.  The vendors are key to delivering quality care to the residents and families it serves. That’s why you should treat vendors like true partners, involving them in business objectives and giving them frontline access to its team to ensure a smooth implementation.

Training
 

• Training is important and needs to be provided to all levels of staff:  Start with management. The process needs to be all encompassing, which means everyone needs to be involved to ensure optimal outcomes.

• Utilize Manuals and Customized Training:  Remember to utilize your EHR vendor as they have manuals or customized training programs.  Take advantage of these opportunities prior to going live with an EHR system to ensure a smooth launch and help staff prepare to jump in feeling comfortable using a new system.

• Employ Blended Learning: Incorporate a blended learning approach to accommodate not only different learning styles, but also varying staff schedules and availability. In addition, this hands-on style allows staff to physically explore the EHR system, learn the icons, ask questions and practice documentation entry and review.

• Establish a Train the Trainer Approach: By establishing a train the trainer approach, each facility was able to be trained by a face they recognized, leading to thoughtful and meaningful conversations and a higher degree of buy-in from the facilities users. This approach also allowed trainers to identify users who needed a more hands on approach to learning the software and implement one-on-one training with these individuals.

Use of Advanced Features to Drive Quality
 

• Utilize the CAST 7-Stage Adoption Model: Incorporate the CAST 7-Stage Adoption Model to achieve greater utilization and quality of use of EHR. At the onset of a project, engage the planning team with the model and approach implementation through a step-by-step process.

• Use of EHR and its Advanced Functionalities is Key for High-Quality Health Care: Technology is a key driver of high-quality health care. Accurate data, reporting and clinical decision support tools are no longer an option, but a requirement. Using EHR with these capabilities is absolutely essential to improving care quality, driving efficiencies, reducing hospital readmissions and strengthening partnerships and strategic positions with other care providers like hospitals, accountable care organizations (ACO) and physicians.  Focus not only on today’s outcomes, but make informed decisions about the outcomes you want to achieve in the future, based on today performance.

• Take advantage of dashboards: Create and leverage a dashboard to improve care delivery, operational efficiencies and financial performance across facilities. Train clinical and medical records staff to be more interactive with the live chart, using the dashboard to analyze and identify missing documentation or respond to real-time alerts as they occur rather than while reviewing a closed chart. At the same time, use the EHR’s customizable alerts to create and monitor protocols for certain diagnoses.

• Referral Source Management (RSM) Solution can Help Drive Quality Referrals:  A referral source management system can be a very helpful resource for maintaining existing business and capturing new quality referrals. Look for EHRs with built in RSM module or ones that seamlessly integrate/interface with your favorite RSM solution.

• Use and Exchange of Electronic Health Information is the Trend of the Future: The movement to have residents’ medical information in an electronic form and available for other health care providers involved in their care is the trend of the future. The care of the resident is no longer an isolated occurrence by each provider, but a continuum of care. Having more pertinent medical information available to the caregiver leads to more effective care and better outcomes. It is important to realize that this model of data sharing across providers is in its infancy. There are a number of interim solutions discussed in section 3.3.1.5 of the latest version of CAST’s EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection whitepaper.

• Establish Clear Common Goals for Health Information Exchange: Make sure you have a clear common understanding of the specific goals of your health information exchange with your partner(s): what data is needed by each party, in what format/code, standard, when, why, etc.

• Start Simple: Use existing electronic tools, such as an encounter notification system (ENS) and Direct secure messaging to keeps staff apprised of when residents are admitted or discharged from the hospitals, and to send/receive important discharge documents, updated medications lists, etc. These have proven to be very effective solutions as a communications medium, a platform to educate staff on the importance of health information exchange, and a means to engage in initial exchanges of basic health information with other provider.

• Health Information Exchange Improves Quality of Care and Patient Safety during Care Transitions: Pertinent information provided to clinicians during resident transfer can improve quality of care. Automated clinical decision support tools can improve the quality and safety components of managing and coordinating care for older and disabled patients with complex medical conditions, who are being treated with multiple medications. Improving medication management for the patient population served by LTPAC providers can improve their transition across the continuum of care, and result in reduced readmission to acute care facilities.

• Providers Should Address Some Challenges to Health Information Exchange: Varying degrees of technology adoption, compliance standards, staffing turnover, information needs, interoperability capacity and standards, and lack of standardized roles and processes are all components that pose challenges to the fluid implementation of fully informed transitions of care between hospitals and LTPAC settings. However, as mentioned above, there are solutions that address some of these challenges and CAST encourages provider to explore these solutions.  

The case studies presented here represent bright examples of using advanced features and functionalities in EHRs, like quality reporting, CDSS and health information exchange, to improve the quality of care, efficiencies and transitions of care. Each case study demonstrates how using EHR features has impacted each organization, and in turn the care they provide. Building upon the experience of these organizations can help other providers write their own success stories and case studies.