By now, you have probably heard of electronic health records (EHRs). But you might still be wondering what exactly they do and if they are right for you. EHR software provides tools that enable staff members at long term care facilities to document important patient and resident information, monitor their progress, and communicate with other healthcare providers about treatment plans. Successfully implementing an EHR system will help achieve sustainable outcomes in the clinical care, efficiency, safety, and cost-effectiveness for your facility.
In this article we give an overview of EHR and discuss some of its benefits. We will also share tips for implementing an electronic documentation system at your facility from two experts: Charles Oliver, Director of Customer Success at Experience Care, and Ayisha Bradley, the Director of Informatics at Care Centers. Oliver and Bradley were recently featured on the LTC Heroes podcast with Peter Murphy Lewis. You can listen to their discussion below:
What is an Electronic Health Record (EHR)?
An Electronic Health Record (EHR) is a computer-based system that provides electronic financial, clinical and demographic documentation of patient care. The records can be accessed by authorized healthcare providers, at any time and from anywhere in the world. They can also be shared with patients and families to facilitate communication between the parties.
According to the Office of the National Coordinator for Health Information Technology, there has been a rapid rise of EHR use in the United States recently, with over 80% of hospitals using EHRs in 2015 compared to less than 10% in 2008.
An EHR system is more than just clinical data that a provider collects in their office. It can encompass a broader view of patient or resident care and include past medical history, diagnoses, medications, treatment plans, vital signs, immunization dates, allergies, radiology images, and laboratory, test results, and other patient data. This electronic documentation system can improve quality care by using data and analytics to prevent hospitalizations among high-risk patients.
Since they were introduced in the 1960s, electronic health records (EHRs) have been touted as the key to providing higher quality care. They are now used for multiple purposes, such as documenting a patient’s medical records and reimbursements, but providers mainly use them to achieve better outcomes in their managed care programs. These systems combine all of a resident’s information into one large pool, which then helps to identify new treatments or innovations in healthcare delivery.
There are two types of electronic health records (EHRs), according to the patient’s level of involvement:
- Patient-centric (direct): This allows patients to have some control over their data and privacy settings. The downside is that it can be more expensive for providers because they must invest in systems with more features.
- Provider-centered (indirect): This is easier to implement because it does not require input from the patient or resident, but providers often have less data about individual patients’ or residents’ care and outcomes because of reduced access to information on account of fewer interactions with them.
How EHRs Benefit Long-Term Care Facilities
EHRs reduce the clinician’s workload by automatically giving them access to information. They can also potentially streamline the physician’s workflow. EHR is able to provide various interfaces that help with care-related activities, including evidence-based decision support, quality management, and outcomes reporting. Your staff can save time reporting data and charting and, instead, further dedicate themselves to your residents.
An electronic documentation system will:
- Improve your facility’s coordination of care
- Improve your quality of patient or resident care
- Increase patient and resident participation in care
- Facilitate reimbursements and increase workflow efficiency
What Is the Difference Between EHR and EMR?
Though electronic medical record (EMR) and electronic health record are frequently used interchangeably, the Office of the National Coordinator of Health Information Technology (ONC) highlights a significant difference: EMR lacks interoperability, which is the priority for EHR systems.
EMRs are a digital version of the paper charts in a clinician’s office. They contain the medical and treatment history of the patients in one practice. Of course, EMRs have advantages over paper records, like improving the charting process and enabling the sharing of clinical records. Still, they do not travel easily out of the practice as do EHRs. In fact, a patient’s record may even need to be printed and delivered via mail to specialists and other members of the care team at health clinics. In that regard, electronic medical records are not much more efficient than paper records.
The lack of compatibility between EMRs and EHRs can directly impact the overall interoperability between organizations in the healthcare industry; if some facilities operate with an EHR system and others with an EMR, the sharing of information will be more difficult and less efficient.
Efficiency is the main advantage of using EHRs. These systems feature tools that improve the quality of care, including:
- patient data sharing (like labs and progress notes)
- injury/illness prevention
- better training for paramedics
- review of clinical standards
- better research options for prehospital care and designing future treatment options
- data-based outcome improvement
- clinical decision support
An EHR system will allow your staff to be more present with residents and less focused on “paperwork”. In three different studies, EHR was found to be more time-efficient with unweighted relative time reductions per patient or patient encounters of −12.6% to −45.5%. Spending sufficient time spent with residents and attending to their needs are crucial to improving the quality of care at your long term care facility and gaining resident satisfaction.
An EHR software is built to share information with other health care providers, such as pharmacies, emergency facilities, and laboratories, so that all are informed as to what is relevant to a patient’s or resident’s care. EHRs, thus, will help your facility and other organizations save time and money by eliminating the need for someone to enter and share information from a paper chart.
Greater Accuracy. Greater Profits.
The transition to EHRs can be complicated and expensive. Such softwares can contain thousands of functions and take years to design, develop, and successfully implement at a healthcare provider site. However, the switch is worth it. Electronic documentation systems have been shown to increase operating margins and profitability by reducing the amount of time spent on repetitive tasks and improving productivity.
In addition, according to a peer-reviewed article published by Oxford University Press, EHRs can reduce costs related to medical errors that stem from keeping paper records. A systematic review of 28 papers found that the implementation of EHRs was generally effective in the limited number of long term care facilities that have implemented them. EHRs improved the management of clinical documentation that enabled better decision making. Nine of the papers reviewed in this article published in JMIR Medical Informatics reported positive quality outcomes on account of using EHRs. Further, over time, EHRs can reduce mortality rates per year per function.
Reimbursement and Prospective Payment System (PPS): From RUG-IV to PDPM
In 2019, the Centers for Medicare & Medicaid Services (CMS) changed the reimbursement method for the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) from resource utilization groupings (RUGs) to the new Patient-Driven Payment Model (PDPM).
RUG-IV was based on the volume of services provided and, as a result, created unintended financial incentives. The Patient-Driven Payment Model (PDPM) is designed to address those concerns. This revised payment methodology is driven by the patient’s or resident’s clinical characteristics rather than the number of therapy minutes provided.
Other significant provisions of the PDPM include Section O of the MDS, which tracks the delivery of therapy services and limits on the group and concurrent therapies combined at 25% (per discipline). In addition to the traditional PPS programs that are based on resource utilization measures—such as length of stay and total days—CMS provides higher reimbursement rates for facilities that use EHR systems.
The PDPM model shifted the focus of Medicare reimbursement to a holistic view of patients and residents, rather than merely accounting for therapy minutes. Not only will this result in better, more individualized care for patients and residents, but it will make it easier for SNF providers to accurately track patient and resident progress.
If a resident’s full range of health concerns—from previous surgeries to comorbidities—are not reported in their Medicare assessment, a long term care facility will lose money. With the PDPM system, SNFs are less likely to make mistakes in a resident’s Medicare satisfaction survey, so long as they fully complete a pre-admission process. We recommend using an integrated referral portal that allows clinical liaisons and software vendors to accurately represent a resident’s needs from the start.
Click here for more information about PDPM.
The Importance of Staff Satisfaction
An EHR can only be as effective as the people using it. That is why, according to Oliver—who has over 30 years of experience as a nurse, including 10 years as a director of nursing—the staff needs to approve of the system. Once a team has adopted the EHR and understands how it will help them, they will look to use the software to work more efficiently. They do not have time to waste.
Naturally, some nurses will oppose the transition. According to Bradley, nurses—especially those who have been in the industry for decades—may maintain that paper documentation is fast and easy and that learning a new system is a waste of time. While EHRs are more efficient, it is important to validate these concerns and provide reassurance. This is because staff satisfaction is crucial to the success of an EHR.
The members of a staff must be able to use and access the system with ease. The more complicated they find it, the less likely it is that they are going to adopt it. When staff members can see how easy using new technology is for them, they will feel empowered by this knowledge, and their productivity will increase. If the staff is satisfied and comfortable with the new electronic documentation system, the profitability, efficiency, and the quality of care provided by your facility will increase consequently.
EHR Must Fulfill the Meaningful Use Criteria
CMS has provided a set of Meaningful Use guidelines for using an EHR system. Providers are required to utilize these in their organizations if they are to qualify for the incentives listed in the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was signed into law in 2009 in order to promote the adoption and meaningful use of health information technology. It included four categories of violations that reflect increasing levels of culpability, four corresponding tiers of penalty amounts that significantly increase the minimum penalty amount for each violation, and a maximum penalty amount of $1.5 million for all violations of an identical provision.
Meaningful Use is a Medicare and Medicaid program that provides financial support for facilities that use a computerized medical database. It is based on a Merit-Based Incentive Payment System (MIPS), which consolidates multiple CMS programs into one system to improve the quality of care.
Meaningful Use was designed to improve care and safety, reduce health disparities, and increase efficiency in the delivery of healthcare services. It requires all long term care facilities to follow certain provisions. One requirement states that at least 50% of clinical encounters are documented electronically for each physician on a daily basis. Its three main components are:
- Use of certified EHR in a meaningful manner (like e-prescribing)
- Use of certified EHR technology for the electronic exchange of health information to improve quality of health care
- Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures
It embraces a conceptual approach that begins with data capture and sharing, then advanced clinical processes, which lead to improved incomes. Meaningful Use lists 15 core objectives for eligible professionals and 14 core objectives for hospitals. These measures have led to an increased level of electronic documentation, successful implementation, and meeting regulatory standards.
Implementing an EHR
Technology in health IT is advancing, and facilities do not want to fall behind by failing to adopt an EHR, even if the transition is difficult. If you are considering implementing an electronic health record system at your long term care facility, you may find the following seven-step process helpful:
- Perform an evaluation of your facility to analyze the organization’s strengths and weaknesses as well as the goals and objectives for the years to come. This will help you understand how the EHR will fit in your organization. This step is critical to take full advantage of the electronic documentation system.
- Define a timeline of implementation. In this timeline it is important to set up deadlines for every step of the process. This way, the team can stay on track, and the implementation process will be a successful one.
- Train your staff so that they know what is expected. Encourage them to take advantage of onsite training if available and to look at online options. It is also important to offer an option for in-person training. Make sure they get answers to all their questions. Keep in mind that everyone is different, and the time or method of learning might differ from one person to another.
- Set up a KPI dashboard that will provide updates on key metrics, like patient satisfaction and resident engagement scores, so that you can see how the transition is impacting your success as a care facility. As you monitor these numbers over time, look out for what works best for your team. You should also consider setting up specialized dashboards if certain departments are more active than others. This way, everyone has access to the information most relevant to them at any given moment.
- Implement community features, such as roadmap tools, that allow your team to update residents on their progress and provide them with a sense of agency.
- Provide tools for staff to upload photos, videos, audio files, or text memos into the EHR system so they have an easy way to document patient and resident encounters without having to rely exclusively on computer screens.
- Devise a recovery plan. What will happen if the system fails? It is crucial to have a backup plan in case something goes wrong, like the electricity goes out. Consider ensuring the purchased EHR system includes all necessary hardware, software, and utilities to support system back-up and recovery processes.
If you are interested in implementing an EHR at your facility, click here to schedule a discovery call.
Which EHR Software Provider Should You Choose?
If you are looking for an EHR that is user-friendly, values your opinions, and offers top-notch service, there is only one choice: Experience Care. This according to Bradley, who raved about Experience Care in a recent case study.
“I know people that work on other electronic health record systems, and they’re not as user friendly as far as the dashboard and ability to guide your workflow through that dashboard,” Bradley said. “I have seen American Health Tech. I have seen Point Click Care. And honestly, I feel like overall, this system works better for me. I can easily get on Experience Care and feel like I have everything I need a little bit better.”
At Experience Care, we strive to make every long term care organization a fulfilling place to live and work by helping maximize financial success and compliance to achieve the best teams, care, and outcomes. Technology allows us to deliver meaningful solutions to help you improve the lives of your residents, the efficiency of your staff, and the financial success of your business every day.
KPI Dashboards That Make a Difference
One of the features that most appealed to Bradley is the KPI dashboard. “It’s speeding up meetings,” she remarked. “Our meetings are more efficient. No longer do you have to grab 1,000 charts to take to the meeting. You can just pull up the KPI Dashboard in your EHR and see which residents have triggered a weight loss or supplemental order or have an indoor assessment open.”
KPI dashboards are a valuable tool to monitor and measure the success of an EHR deployment. They show which aspects of the implementation have been successful. As a built-in feature of the NetSolutions EMR, the Clinical Dashboard feature lets you view key performance measures at a glance to manage each resident’s care and your facility’s overall performance.
Your Clinical Dashboard will be delivered with 34 pre-defined KPIs (Key Performance Indicators) in these five categories:
- Care Delivery
The pre-defined KPIs can be modified on the fly; you can define additional KPIs for your facility. Drill-down details provide actionable information and reporting. Here are some built-in KPIs that will appear on your dashboard when you first implement the software:
- Care Plan
- Physician Orders
- eCharting with eMAR
- Interdisciplinary Progress Notes (IPN)
- User-Defined Assessment (UDA)
Experience Care has recently launched its online training program, LevelUp, which helps ensure that all staff will be competent in using a computer and working with software as well as accessing company information, such as customer complaints, messages, and other notifications from supervisors.
These courses are customized for different roles and are designed to teach employees the skills they need in order to be successful using the system. We understand that different members of your staff have different responsibilities. A nurse entrusted with documentation will require a different curriculum than a social worker who does intake interviews.
Our EHR system gives each role their own orientation so they can be successful when in an unfamiliar position using our software.
Perhaps one was promoted from housekeeping/meal service jobs into more direct care roles, like the roles of nursing assistants or physical therapy aides. They may not know how electronic health records (EHRs) work for long term care facilities. It is in such situations that LevelUp can help catch them up quickly. We also offer in-person training and webinars for our long term care staff.
Experience Care makes every effort to facilitate a smooth transition to electronic documentation. “The implementation experience with Experience Care has been really good, because they’ve done so much work upfront to make it easy for us, from understanding how we do things in long term care settings to having the right person come through and train us,” said Bradley.
Next-Generation Point Of Care
Experience Care’s recently launched POC module, increases the quality and quantity of information charted by caregivers in long-term care. Additionally, it improves the overall profitability by reducing ADLs documentation errors, which is a significant component of PDPM scoring. By using this system, nurses will have more time to provide better and more centered care to your residents. The interoperability of the software will allow physicians to access the medical records of patients or residents and prescribe medication or make changes from afar.
The key benefits of Experience Care’s new Point of Care documentation:
- Seamlessly collect data related to all care activities, including restorative nursing, therapy, and mood observation.
- Record multiple occurrences in one shift and then view all entries, add, eliminate, and give reasons for changes with a few clicks of the mouse.
- Stay on a topic page—like weight or breakfast consumption—as you quickly move from resident to resident.
- Allow all staff members access to data and other important information, like vitals, ADLs, reports of pain, and nutrition from the convenience of their tablets.
- Easily navigate your workflow by simply clicking on ADLs that you want to observe.
- Check your worklist for easy-to-understand cues that indicate which items have not been documented during a session or shift. You can now navigate all items in one list to see which still need to be addressed.
- Capture almost all MDS 3.0 items and import them to NetSolutions’ MDS 3.0 software. For your convenience, responses are saved automatically and items are color-coded to indicate that they’ve been completed.
- Organize resident information by date or by resident name to view mood observation or care provided on a particular day.
- Initiate a POC charting session by clicking the subject area that corresponds to particular tasks, like restorative nursing, therapy, or mood observation.
- Know each resident’s story, needs, and wants prior to starting a charting session.
- Easily print your summary screen available on the Kardex system, which is explained further below.
Kardex Integrated Technology: A Snapshot of Your Resident’s Story
Experience Care’s Kardex technology is an integration of the POC module. This communication and organization tool helps long term care facilities visualize and assemble resident’s data in one clear picture. It provides an overall digital snapshot of a resident’s needs and current status that is easily accessible and easy to update.
“It’s just great,” said Bradley of the Kardex. “As soon as your CNAs log in, they are alerted immediately if anything is wrong with a resident.” She also mentioned that she and her team would emerge from meetings with everything easily updated on their Kardex, which made the rest of their workdays easier.
Kardex features include:
- A summary screen – You can now view all of the most important information about a resident—from their code status, to diet and fluid restrictions—on one page.
- Daily alerts – When a nurse or nurse aide logs on, you can now show an alert about each resident and ensure everyone acknowledges that alert.
- An easy to fill summary form – This is where you can set priorities and organize things like a cold status DNR, preferred language, today’s dining preference, and bedtimes.
- A credit history page – This allows you to see all updates related to Kardex. You can also search for alert acknowledgements and see who is responsible for them.
General Financials: a module that moves your bottom line
With detailed per patient day cost and revenue data, flexible multi-facility financial options, and intuitive asset management systems, NetSolutions General Financials modules seamlessly integrate into your workflow and your existing systems to make your financials more powerful with less effort. Our general financial module will help your facility stay on top of costs.
Here are some of the tools available to ace your financials:
Per Patient Day (PPD): With our per-patient day statistics (PPD), budgeting and monitoring profit and loss have a whole new meaning. Create PPD budgets and track performance using payroll and census data from your NetSolutions Accounts Receivable & Billing system.
You can monitor:
- Occupancy rate analysis
- PPD costs and hours, such as nursing staff, food, maintenance, and laundry
- Total cost per resident day
Budgeting and Projections: NetSolutions’ General Ledger system simplifies budget creation and helps you stay one step ahead with easy-to-use projections. Configure your budgets with options to bring forward previous budgets and edit them for the next budget. Our flexible options give you all of that and more while maintaining future and historical budgets:
- Budget monthly amounts or an amount per patient day
- Choose the budget method you prefer: manual, trend, fixed, or spread
- Use Variable Budgeting to budget a fixed amount per month or a per-patient-day amount with the PPD amount multiplied by budgeted or actual days using census data
- Create base and alternate budgets
Better Reporting: with both standard reports and a powerful built-in financial report writer tool for custom reporting, our General Ledger report options are second to none, as they allow you to easily monitor PPD facility statistics such as:
- Income statements: budget variance, per-patient day, current and prior, and month-to-month comparison
- Labor reporting: per-patient day (current and YTD), month-to-month comparison of PPD hours, and PPD labor cost
- Resident day reporting: budget variance (current and YTD), month-to-month comparison
- Ancillary statistical reporting
For more information on how Experience.Care can improve your general financials, click here!
Community: Creating a Roadmap With your Peers
Experience Care has a community of peers ready to help you create a roadmap for your facility’s implementation. You can join our free online webinars and conferences, where we also offer one-on-one assistance for the rollout process. These user groups are a great way for you to speak your mind, give feedback about the system, and ask questions. Our goal with these user groups is for your facility to take advantage of all the tools available and to give us the input we need to improve the software for the next generations to come.
“They value our opinions,” Bradley said. “They want to hear from their clients and make the software more useful for them. And that’s awesome for me, because most companies just say, ‘This is the way the system is’. But Experience Care tells you what they’re changing and why. And then we talk about it before the updates.”
Why is it important to be part of a community?
Being part of these user groups will not just keep you informed on the industry trends and news, but will also give you opinions and recommendations on how to maximize your EHR software and allow you to connect with others in the industry. Additionally, being part of this community will give you an overview of what other facilities are doing with the same software. This will give you an opportunity to learn or to give suggestions on how facilities can improve.
What does Experience Care’s community offer?
We care. We care about your facility, your residents and ultimately your success. And we care about long term care as an industry. Experience Care strives to create a community of like-minded long term care professionals that help one another to improve the overall quality of care in our country.
Additionally we have experts in the industry that know the software well. We are, thus, able to guide you through a successful and sustainable implementation step-by-step. Finally, we want to know what you think! You want to make sure that we listen to your suggestions and feedback to improve our software.
“If there’s something we want the software to do, we can usually have a conversation about it [with the Experience Care team],” Bradley said. “And they usually figure out a way to make that happen.” She mentioned the Kardex itself as being something that was developed by way of user group meetings. “We had some suggestions for things that were not on the [Beta version of the] Kardex section,” she said. “We asked if it is possible to add this or take this out. And by the time of our next user group meeting that next week, they had made those changes.”
Electronic health records (EHRs) are designed to improve the efficiency and quality of care that long term care facilities provide to their residents. Experience Care has the resources available for your facility to start implementing your electronic documentation system, including personalized assistance with the implementation process, webinars and conferences where peers can offer one-on-one help in creating this roadmap, and online resources that teach you how to take advantage of each tool in order to improve efficiency and profitability.
These tools will greatly improve how long term care providers function. Some of the results you can expect are: more accurate financial reporting, lower operating expenses, increased profitability, better resident care outcomes, higher staff satisfaction rates, greater compliance, less risk and liability, and greater efficiency.
Contact us if you want more information about Experience Care and to see if it is the right fit for your facility! And for more about the latest trends in long term care, subscribe to the LTC Heroes podcast and read our blog!