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Since January 2014, Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) have gained popularity in the long term care industry, improving America’s overall level of care. However, the implementation of EMRs comes with specific stipulations if facilities are to retain their existing Medicaid and Medicare reimbursement payments. 

Despite improvements brought by digitized records, there are still problems with EMR. Medical professionals have voiced frustrations with the systems having “invested a ton of money in EHR, but it doesn’t exactly give us what we need,” according to one such individual. 

We recently spoke to a prominent long term care leader, “Bob McNeill” (the individual elected to remain anonymous), who conducted polls at eight different locations to identify the problems EHRs are causing for his teams. During our discussion, he highlighted cumbersome EHR problems that impact workflow with a knock-on effect on a facility’s efficiency. 

The Worst EMR Systems

For long term care facilities, resident data must be accessible to authorized personnel so they can attend and treat residents adequately. Each practice, therefore, requires accurate nursing documentation to ensure that a high level of care is given. 

Traditionally, these records were hand-written, leading to disorganized, illegible, or inaccurate resident documentation, affecting resident treatment and care plans. The introduction of EMRs and EHRs modernized the long term care industry by storing digitized resident data on a centralized platform. Early adopters jumped at the technological advancement recognizing the benefits of better organization and accessible records, supported by upgraded practice tools like computerized prescribing and ordering tools. 

Problems with EMR are often related to violating federal regulations.

However, as with all technological advancements, they also come with teething errors that have yet to be ironed out. In the case of EMRs, user-friendliness, data protection, and staff training are critical factors that impact the level of care provided and its value among medical professionals who use it daily. 

When facilities implement an EMR system, they must also consider federal regulations like the Resident Assessment Instrument (RAI). These are a clear set of guidelines determined by CMS,  giving facilities a standardized structure, along with processes, applicable laws, regulations, and compliance information, so they can provide adequate care to residents.

The RAI is made up of three fundamental components that need to be taken into account:

  1.  Minimum Data Set (MDS): This is a comprehensive assessment for residents within a facility. It identifies the residents’ conditions and problems coding them into categories that qualify them for either Medicare or Medicaid funding. 
  1. Care Area Assessment (CAA) Process: This process helps to clarify the information recorded in the MDS. It uses real-time, evidence that’s compiled into an assessment determining the potential problems and suitability of a resident’s care plan. It also helps physicians to target a resident’s key problems, so they can make an informed decision on whether or not an intervention is needed.
  1. Utilization Guidelines: These provide clear instructions on how and when to use the RAI. It comes in a structured framework, synthesizing MDS and other clinical information.

The MDS’ main function is to assess and identify a resident’s problems and care plan. It also helps facilities to determine whether a resident qualifies for Medicare and Medicaid reimbursement by monitoring their quality of care within the nursing home. Failure to comply with MDS regulations will affect a facility’s payment from Medicare or Medicaid.

The worst EMR systems are often criticized for violating regulatory compliance rules set by The U.S. Department of Health and Human Services (HHS). These violations are financially damaging for facilities that receive up to $44,000 from Medicare, or $63,750 from Medicaid, giving them a big incentive to comply.

The worst EMR systems may contribute to claims against a facility.

However, the problems with EMR go far beyond financial incentives and regulatory rules. Other issues include the increased amount of documentation. On the one hand, it improves the primary purpose of EMRs for a better patient billing process. However, on the other hand, it creates a mountain of “laborious and mind-numbing” paperwork for medical staff who are already overloaded with work due to staffing shortages.  

Besides this, several legal ramifications like security breaches, fraudulent claims, and medical errors arise when facilities implement an EMR system. 

The five principal legal implications are:

  1. Medical Malpractice Claims: From implementation to adoption, facilities face an increased risk of errors as the staff adapts from hand-written records to EMR. During this period, facilities are more prone to mistakes impacting their medical malpractice claims. 
  1. Probability of Medical Errors: Even though EMR is supposed to reduce medical errors, over-reliance on the system can lead to small mistakes, leading to more significant medical errors. In particular, the copy and paste function can perpetuate mistakes, leaving a trail of mistakes that are less likely to be corrected. 
  1. Increased Susceptibility of Fraudulent Claims: Under the Obama administration, there was a strong emphasis on healthcare fraud with a sharper focus on specific or improper billing claims. It also brought attention to review Medicare and Medicaid EMR incentive payments to prevent fraudulent charges.
  1. Data Protection Breaches: This includes theft and unauthorized access to protected resident data. In 2009, there were roughly 2.4 million residents who were affected by data breaches. This increased to 5.4 million in 2010, with a record 29 million data breaches in 2020
  1. Practical Tips for Healthcare Leaders: The key to implementing EMR is to have a well-informed and educated team that knows the legal ramifications. Therefore, it is imperative to provide adequate staff training to ensure the team does not risk legality out of ignorance.

What Are Electronic Health Records (EHRs)?

Like EMRs, Electronic Health Records (EHRs) are digital software showing a holistic view of a resident’s medical journey. long term care staff can document important resident information, monitor their progress, and communicate with other healthcare providers about treatment plans. They typically include a resident’s demographics, test results, medical history, history of present illness (HPI), and medications.

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EHR problems include making the tasks of nurses more cumbersome.

EHR differs from EMR, which houses a resident’s charts, medical information, and treatment history. These digital records usually stay in a doctor’s office; they are not shared among other physicians nor follow residents when they change doctors. 

Instead, EHRs show a resident’s real-time record, with instantly accessible data for authorized personnel, such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, schools, and workplace clinics. They provide medical staff with a broader and complete view of a resident’s care.

What Do Good EHRs Do?

EHRs allow facilities to streamline their workflow to improve efficiency and decrease paperwork. This frees up time so staff can focus more on resident care. The key to a good EHR is functionality through meticulous and digitized records to provide medical staff with a complete description of a resident’s medical journey, thus reducing errors, improving resident safety, and providing customized care.

A fully functioning EHR system delivers through a variety of methods:

  1. Internal Messaging: Medical staff needs to have an efficient way to communicate internally. At Experience Care, our built-in eAssignments’ messaging provides the perfect tool with easy-to-use notifications, task management, and messaging system. It is also compatible with Windows allowing remote access on computers, laptops, and tablets so that staff can converse easily.
  1. Superior Tracking Tools: Having an innovative Point of Care Charting system is a game-changer, as it helps long term care staff with menial tasks by accurately tracking paperwork. Therefore, good EHRs will include integrated POC charting, designed with fluidity and ease, improving workflow, allowing for more resident care time.
  1. Maximizing Efficiency: Long term care facilities are often overloaded with an excess of resident data. Therefore having a single location eDocumentation system helps improve security, organize, store, index, access, and retrieve data.
  1. Seamless Care Plans: The personalized care plans that reflect the residents’ needs are at the heart of long term care. Using MDS 3.0 software to diagnose and assess resident needs, facilities can generate detailed reports with relevant resident information.
  1. Going Paperless: Ordering medication is essential for long term care facilities; therefore, having an ePrescribing process to send electronic messages straight to pharmacies at the click of a mouse improves efficiency and reduces the risk of illegible hand-written prescriptions. 

The 5 Biggest EHR Problems

“Technology is great when it works, and everybody understands it,” McNeill began. “But when it doesn’t, there’s chaos.” 

Before we delve deeper into other EHR problems, it is worth noting that EHR handicaps are usually beyond the control of the EHR vendors. Such things as the perceived loss of productivity and burnout are often the result of insufficient staff training causing EHR useability issues dubbed as design flaws, falling unfairly on the vendors’ shoulders, 

Here, we will review the biggest problems with EHRs in the long term care industry.

1. Hidden Costs 

It is frustrating for facilities that invest a significant amount of money in EHR software that underperforms. McNeill laments that some “EHRs only work on the basics, just to record things” and do not synthesize information or facilitate communication.

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Furthermore, he noted, after your software is up and running, you come to realize some “optional” features are more essential than you initially realized. However, simply adding these features will unearth hidden costs driving up your monthly rate. It is always worth checking different EHR systems to see which one works best for your facility. 

Experience Care’s EHR software has a low hosting cost because it works exclusively in hosted environments, meaning you get what you need for a fraction of the price. It also offers flexible configurations, so you can customize and change your modules as required.

And just this month, Experience Care modified its pricing system. Now facilities that lose residents will see the cost of their software lowered. This value-based pricing system can help facilities save $25 per resident, per month when their census numbers drop. 

2. Cumbersome Features

While there is a learning curve with any new software, McNeill finds EHRs “cumbersome” and not user-friendly. This is especially true when systems require updates, meaning facilities need to retrain the entire workforce, which is a very time-consuming task.  

Another EHR problem concerns the usability issues for the required number of clicks when accessing information. Resident data should be easily accessible to authorized personnel, and too many clicks cause facilities considerable aggravation, being a “constant piece of gridlock with complaints from clinical staff.”

At Experience Care, we have reduced the number of clicks to access the information you need. You can now enter shared information for various individuals with just two clicks. Other EHRs require five times that many steps, interrupting workflow and eating into resident care time. To learn more about our agile EHR, contact Experience Care and speak with an advisor.

The issue of data entry is also a concern. Physicians and certified nursing assistants do not have the time to enter long or complicated login details, forcing them to enter simple, numerical passwords (like 1234), which are susceptible to hacking. Many EHRs have not addressed this issue. However, with Experience Care, you only need to enter your login information once. Furthermore, you can select passwords between eight to twelve digits without needing to re-enter your password. 

EHR is a significant investment that impacts the health and well-being of your residents, staff, and performance. Therefore it is worthwhile to configure deployments, making your EHR more operational so software upgrades can run more smoothly. 

3. Insufficient Training

“Training is a problem,” McNeill said flatly. “It’s hard to pull people off the floor and motivate them to participate in training. So you have to mandate everything.” 

According to McNeill, motivation problems pose a challenge because the staff is reluctant to put in extra hours for something for which the benefits are still unclear, saying to themselves, “Oh, I have to stay late today for some training exercise on top of all my other responsibilities.” This lack of motivation affects their attention span during the training sessions. “They’re zoned out, looking at emails or distracting themselves some other way. What did they learn? Nothing.”

There is also the problem of retraining staff on new EHR upgrades, which must be more efficient and precise. 

LevelUp: Free Online EHR Training

With the world gravitating to all things virtual, Experience Care has designed an EHR system complete with a series of in-house virtual training modules, LevelUp. They are short sessions that can be viewed anytime, anyplace, to accommodate busy schedules.  

As staff level up their EHR knowledge, they will gain certificates upon completion, track their training, save time, and have a much easier time training. This is particularly useful in allowing staff to train in the comfort of their homes and in their own time.

4. No Integrated System 

While EHRs are designed to share information, that is not always an easy process. “Most EHRs lack an integrated system that allows for information to flow back and forth between providers, labs, hospitals, doctors, and offices,” McNeill said. He noted that the various parties involved in long term care use different methods of recording information, prohibiting the ease of “pulling information as you would like.” 

This lack of integration causes delays and disrupts workflow. EHRs need to incorporate integrated data platforms that are straightforward and accessible to all authorized staff. Experience Care’s built-in Kardex is an integrated EHR tool that allows the team to track a resident’s medical journey. Staff can see and understand the day-to-day needs on a single screen, removing the need for excessive paperwork. 

In the future, there may be artificial intelligence algorithms, which will help predict outcomes for treatments and provide specific suggestions for treatment for particular individuals. 

5. Too Many Imposed Limits

EHRs are designed to streamline workflows; however, many systems are clunky with navigation problems. This becomes an issue for multiple parties who need access to the resident data. It not only delays productivity as workflows are disrupted, but it also takes more time to complete tasks. The EHR that McNeill uses has a set limit of “200 data points at a time. This means only 200 people can use the system at once,” he said. “That is simply not functional for us.” Some EHRs, like Experience Care, do not have such limits nor does it restrict code to a particular limit. Its system is proven to scale for larger facilities with no noticeable impact on performance, provided the relevant IT resources are available.

The Problems with EHR

Despite the relative success of EHRs, there is still a long way to go. EHR developers are working hard to improve the services they provide. However, this technology is still relatively new. It will take time to iron out the problems with EHR and provide the functionality that long term care providers desire. Of course, not all EHRs are alike. That is why it’s essential to select software that can cater to your facility’s needs. Important features like a user-friendly platform will allow you and your staff to integrate the system into your facility with minimal issues, while adaptability will enable you to tailor your EHR features to reflect your real-time needs.

For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast