LeadingAge Magazine · March-April 2017 • Volume 07 • Number 02

Making the Most of Electronic Health Records

March 15, 2017 | by Debra Wood, R.N.

As adoption of electronic records increases, are providers using their highest functions?

Long-term care providers are finding electronic health records (EHRs) can do more than keep track of basic resident information, and those increasing their electronic functionality can improve outcomes, earn more revenue and connect with others in the care continuum.

Contemplating Higher Functions

“We need to push through this and get this industry paper free, connected and working together,” says Pamela Pure, chief strategy officer for Netsmart (formerly HealthMEDX), an EHR vendor in Overland Park, KS. She says implementing a fully functional EHR presents a big challenge to organizations focused on providing care.

The LeadingAge Center for Aging Services Technologies has published a white paper, “Electronic Health Records (EHRs) for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection,” as part of its EHR Selection Tool. The paper includes a 7-Stage EHR Adoption Model for Long-Term and Post-Acute Care. Several other adoption models exist, including the federal government’s Meaningful Use model, which determines the level of implementation hospitals and medical providers must meet to receive federal incentives. The CAST adoption model considers functionality from the perspective of long-term care.

“The CAST model helps our customers understand what they bought and leverage what they paid for,” says Dave Wessinger, cofounder and chief technology officer of EHR provider PointClickCare Technologies in Mississauga, Ontario, Canada. “It’s our responsibility to help them move down the path.”

In the CAST model, interoperability with other providers through a health information exchange in a standard format is the highest implementation stage. Functions at the next highest stage include prescribing electronically and computerized physician order entry; a physician portal, so the medical provider can log in from afar; and sending and receiving clinical care documents among other providers.

Masonic Villages photo
For Masonic Villages, full use of its EHR saves time and
other resources in compiling reports, mobile devices
simplify data capture, and physician order entry
functions have streamlined orders.

Gary Pederson, senior vice president of Life Plan Communities Solutions at MatrixCare, an EHR vendor based in Bloomington, MN, estimates many long-term care providers are using systems at a stage 4.

“A lot of them are in a position to take on more,” Pederson says.

Optimally, using all of the MatrixCare features has saved Masonic Villages in Elizabethtown, PA, printing expenses and labor to compile end-of-month reports. Mobile devices capture more data, because nursing assistants document as they provide care. Computer physician order entry has streamlined ordering and electronic communication of orders.

“The information flows, so it only has to be entered once,” says Gail Goss, director of clinical/nursing informatics for Masonic Villages.

However, with many EHRs, additional features cost more, and organizations are working on small margins with declining reimbursement. Wessinger makes a strong financial case for full implementation, which with proper documentation and information about the care and therapy provided, can increase revenue, he says, as much $100 per day.

“Having good information in the system will have a material impact on your daily rate for an individual, especially when taking on risk,” Wessinger says.

Additionally, using information and acting on it to prevent readmissions to hospitals can encourage acute-care providers to refer to a post-acute provider using a higher functioning EHR.

Starting Off on the Right Foot

Before selecting an EHR, assess the organization’s needs and the hardware as well as software required.

Southminster photo
Southminster laid the groundwork for its EHR adoption with
a needs assessment. It also involved the people who would be
using the package in the selection process.

“You need to know what you want to get out of the system,” advises Arnoldo Marquez, IT director at Southminster, a life plan community in Charlotte, NC, with 85 residents requiring skilled nursing support.

Involve the people who will use the system in the decisions, from vendor and hardware selection to implementation.

“It’s important for them to embrace the concept,” says Carmina Alegria, director of nursing at Southminster.

Training helps nurses and other staff members become comfortable with the system. Additional education also occurs as new hires on-board, and with EHR upgrades. Super users, who know the system well, are needed to help unit staff use the system.

Goss recommends general computer training for employees not technologically savvy, and assessing and updating policies and procedures before going live. She also suggests taking mobile devices to all locations where they will be used to check the connectivity, and boosting wireless systems as needed before implementation.

Lutheran Senior Services (LSS) in St. Louis, MO, piloted its EHR at one community before rolling it out to its other 10 locations. LSS set up an issue log that helped the organization identify what users were struggling with and used that to provide a quick-reference guide.

LSS physicians can document electronically and write orders with an electronic signature in Netsmart Vision. Some physicians still call in or write paper orders, which are scanned.

While many organizations anticipate physician resistance, that has not been Pure’s experience.

“Most physicians are open and excited about the opportunity to have the chart on the phone or office computer to have a clearer picture of what is happening when the patient has a change in condition,” Pure says. However, “that technology has to be simple to use, portable and mobile.”

Pure suggests implementing higher functions from the start, including: physicians ordering electronically, with clinical decision support; lab and imaging results automatically flowing into the system; and connecting with referral partners.

Measuring Quality Outcomes

Analytics can help organizations drive better outcomes and improve performance.

EHRs generate multiple reports. At Southminster, Alegria can track falls, weight loss, pressure ulcers, bruises and other measurements of care delivery. The organization also uses the data when developing employee performance reviews.

Masonic Village tracks incomplete documentation, medication administration and other variables, such as incidents, skin conditions and new medications.

Netsmart Vision enables LSS to customize reports. The organization formerly had different systems in each of its communities. Now with standardized processes, leadership can compare outcomes and monitor trends. LSS includes its home and community-based services departments in the EHR.

“It created a cohesive family, by implementing the EHR across all of the organization,” says Illa David, chief information officer at LSS.

Health Information Exchange

Being able to electronically connect with other providers holds great promise for safer transitions and opportunities for long-term care organizations to partner with health systems and other providers. Yet few long-term care providers have ventured into this territory.

LSS has been piloting interconnectivity with a local hospital, so that records can be sent and received electronically. Laboratory and imaging vendors receive orders electronically and send results to a secure location, where LSS matches that to each resident’s record.

“We want true interoperability,” David says. “We want to connect seamlessly to lab vendors, with checks and balances. In the future, we would like to be directly connected to health information exchanges so we can do easier and safer transitions of care.”

Looking Ahead

Vendors continue updating their software to add functionality. MatrixCare provides webinars and representatives in the field to help senior living providers become more efficient users. Regional user groups can share information.

PointClickCare evaluates customers’ use of the software and benchmarks how that organization uses the system and how it compares to others in the field.

“They can dig in and see where they have an opportunity to improve,” Wessinger says.

Pure says Netsmart helps long-term care providers streamline their processes, so they can take advantage of higher functionality.

“We are working together to make sure the customer is optimized,” Pure adds. “A traditional EHR is not enough. You have to connect to health systems in your community and work hard to get referrals.”

To become preferred providers in long-term care, organizations will need to embrace connectivity with other organizations, as that will differentiate the leaders from the others.

Members also are seeking more functionality.

“The next big thing is population management,” David says. “We need to be able to monitor internal and external population to be aware of a residents’ movement. We also are monitoring bundled payments and need an electronic solution to do this.”

- Debra Wood, R.N., is a writer who lives in Orlando, FL.