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Med Passes Have Never Been Easier

Case Study

By Dr. Cameron Zargar

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    This Clinical IT Specialist Improved Nurse Retention by 25 Percent

    Business Problem

    Nurses at Chatuge Regional Nursing Home began requesting to be transferred to acute care on account of cumbersome software not specifically designed for long-term care.


    Brian Free, the IT specialist, and his team moved to Experience Care on account of needing a more streamlined and efficient med pass system. All of a sudden, med passes were only taking half the time and job satisfaction increased dramatically. 


    Staff retention is a major challenge for long-term care facilities. That is why it is crucial to select the right EHR. When on Cerner, nurses at Chatuge Regional Nursing Home were slowed by a system that required them to enter each medication separately for each resident. Caregivers who initially entered long-term care to interact with seniors were frustrated by the fact that they spent most of their time behind a computer. Then, Free and his team switched to Experience Care. All of a sudden, med passes could be conducted much more quickly. Nurses heard about this and began returning to the facility.

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    The Consequences of Selecting the Wrong EHR

    The Demands of Long-Term Care Must Be Taken Seriously

    Seniors who turn to long-term care do so for a clear reason: they have specific needs and want to see those met in a comfortable environment. Larger organizations, though, sometimes ignore the distinct nature of long-term care and, instead, impose one EHR upon both hospitals and nursing homes. Brian Free has found that to cause major issues. 

    “Four years ago, when our hospital switched to Cerner, we tried to transition one of our nursing homes as well,” he said. “We tried twice, but it was so bad we decided against it. It’s slow and clunky and made for hospitals, not nursing homes.”
    At the heart of the matter was Cerner’s lack of desire to hear the concerns of caregivers and residents. “They have zero interest at all in modifying anything to fit our needs or demands,” Free said. “In fact, the long-term care plans were completely unusable to the point that we had to do them on paper and scan them in. And because we couldn’t meet the minimum requirements, my state billing was a nightmare. We were having to use Excel spreadsheets to keep our revenue straight.”

    “… [Cerner’s] long-term care plans were completely unusable to the point that we had to do them on paper and scan them in.”

    Brian Free, Clinical IT Specialist, Chatuge Regional Nursing Home

    Meanwhile, if a team decides to take the initiative and improve its workflow, it will have to pay a steep price. “If you want to modify Cerner’s software within their parameters as you like, you have to buy the license, which can cost close to three-quarters of a billion dollars for larger places,” Free said. He then shared that one of his previous employers, Mission Hospital in North Carolina, paid upwards of $700 million for a license from Cerner.
    Such outrageous costs are clearly not feasible for most facilities. They are, thus, left searching for adequate representation and usually disappointed as a result. “The little groups have to get approval for any changes,” he said. “Anytime the nursing homes wanted to change something to meet state requirements, they would put it before a Cerner change committee vote. But because the changes wouldn’t work in a hospital, the hospitals voted us down, and we couldn’t get anything changed.”
    What Happens When Nurses Are Denied the Joy of Providing Care

    The fallout of using an inefficient EHR is that it denies nurses the opportunity to do what they love most: interact with and care for their residents. This is because they will find themselves spending far too much time trying to perform basic tasks. “We would hear residents complain that their nurses are constantly staring at their computer screens,” he said. “And nurses felt they couldn’t give the kind of care they wanted or have the meaningful interactions that attracted them to long-term care in the first place. They had lost the ability to do that, because of an inefficient and, some felt, very unsafe process.”

    “We began to hemorrhage nurses because of Cerner.”

    Entering med passes was an absolute nightmare, according to Free. “With Cerner, it would take about 10 to 15 clicks,” he said. “We would have to go through so many steps just to start a med pass, get into their med admin, scan the patient, click through the list of medications, scan the medication, approve that med, cross-check, confirm you cross-checked… It’s ridiculous.” Free added that this would need to be done a separate time for each medication of each resident. “It was like starting over each time,” he said. “It was very cumbersome.”
    Free described the process as “very cumbersome” and noted that a significant portion of the day would be spent simply documenting med passes. “In Cerner, it would take us probably four to five hours just to get our morning med pass done, because it wasn’t designed for the type of med pass you need to do in long-term care,” he said.
    This protracted process directly reduced staff retention. “Extra clicks add up when you do this over and over again,” Free said. “They take time, and then time becomes frustration, and frustration becomes burnout.
    Eventually, nurses had to choose between unsafe practices and giving up on long-term care altogether. “They had to cut a lot of corners, and there were a lot of things that they were having to go back to paper on,” Free added. “And so we began to hemorrhage nurses because of Cerner,” he said. “All but four nurses transferred to our hospital system because they didn’t want to be forced to use that system. And I couldn’t blame them.”
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    Winning Back the Workforce

    After struggling to retain nurses, Free and his team knew something had to be done. That is when they pursued another EHR vendor, one that has earned a reputation for its intuitive design and strong awareness of the specific demands of long-term care. “Experience Care has created an EHR that allows efficient and effective documentation and taking the opinions of facilities to help build the system going forward for best practices,” he said.
    Shortly after making the switch, Free was able to see just how much time his team could save. “The design of the documentation and the med pass portion of Experience Care work efficiently, which lets us move on and address other needs and concerns our residents have,” he said. “It now takes us about half the time, or two and a half to three hours less time, to do each med pass,” Free said. “That’s huge for us.”

    “Within the first six months [of moving to Experience Care], we were

    able to bring back 25 to 30 percent of the nurses who had transitioned

    to acute care, all just because of our new EHR system.”

    No longer are nurses required to click tens of times unnecessarily. “It’s about 25 to 30% of the clicks from Cerner,” Free said. “With Experience Care’s MedSolutions, you just go into the med pass module, select your whole session of residents in go in, and then you can just go down through the MAR on your med pass, click it and go in,” he said. “It’s really simple. Just fantastic.”
    This improved efficiency did not go unnoticed, as Free quickly began to see a return to the workforce at Chatuge Regional Nursing Home. “Within the first six months [of moving to Experience Care], we were able to bring back 25 to 30 percent of the nurses who had transitioned to acute care, all just because of our new EHR system,” he said. This happened after the staff who remained began singing the praises of their new software solution. “The nurses who stayed with us were just spreading the word, saying, ‘Hey, this is so much better’.”
    Free is confident that other facilities will experience the same thing. “Anybody that hasn’t made the switch should do so because they’re going to see their retention and employee satisfaction improve,” he said. “Experience Care is just a fantastic system for us. “We like it so much that we’ve transitioned to all of their modules, and everything is now in-house for us.”
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    The Value of Listening to Caregivers

    Better Software. Together.

    Developing EHRs expected to support the wide range of tasks in long-term care is not a simple process. After all, caregivers are involved in essentially every aspect of residents’ lives, and their EHR must account for ADLs, therapy, dietary restrictions, and more. This is why it is important to engage with caregivers in order to determine how to improve clinicians’ workflows. Unfortunately, Free did not find that Cerner had this sort of awareness. “At Cerner, they just push out a build after making a decision internally,” he said. “And then you just have to live with whatever adjustments they make. You would get your footing, and then they would just pull the rug out from under you.”

    Meanwhile, Experience Care involves its users every step of the way. “It has been a refreshing change to come to a system where the focus is on areas that we need in long-term care,” said Free. He attributes this sort of awareness to the tremendous clinical backgrounds of members of the Experience Care team. “It’s built by people who used it for over a decade,” Free said. “And then it’s worked on by people using it on the floor. We get to work with the design team [in our user groups], and it’s just fantastic. The result is a superior product that is just so much better for everybody.”

    “… [Experience Care’s system] is worked on by people using it on the floor. We get to work with the design team [in our user groups], and it’s just fantastic.”

    One of the advantages of monthly user groups is that users always feel engaged, and that allows them to rest assured that they will always stay in compliance with federal and state regulations. “You receive help in doing those things you gotta do to meet the ever-changing environment, we seem to be in,” he said. He continued to explain: “In Experience Care’s user groups, we discuss changes coming down the pipe, like state said our UDA needs to have this.”
    That sort of exceptional communication allows users to warn each other about upcoming changes. “We get to share that the state keyed in on this particular problem during a survey and also say what they’re doing to fix it,” he said. “So we all get ahead of the curve and aren’t caught flat-footed when state walks through our door.”
    Even better, the team at Experience Care updates the system for all of its users simultaneously. “They adjust the software, not just for you, but for the entire system based on that feedback or concern you share,” he said. The team at Experience Care also makes sure to keep its users updated as to any changes about which they might be unaware.
    The result of these updates, according to Free, is a “far more agile system.” And that has proven valuable during the COVID pandemic. “It seemed like every week, there was a new regulation or something the CDC wanted us to document,” he said. “But we are right on it because they’ve been making the changes and providing us the tools we needed or solutions within 48 hours.”
    Customer Support When You Need It

    Free expressed frustration over Cerner’s customer support. “It could take three, four months before someone even looks at your ticket,” he said. “It’s pretty bad. Anybody who’s considering Cerner for a long term care facility needs needs to pump the brakes, because they’re going to be miserable.”

    “We had to go on paper downtime procedures,

    because [Cerner] just didn’t care.”

    A major problem for Free was that he could not turn to Cerner’s support team when he needed them the most. “They don’t have downtime MARs,” he said. “So when the system is down, you have no way of documenting your MARs.” He explained that DONs and other leaders would not receive emails that were supposed to be sent every twelve hours to ensure that current medication information is on hand even when the system is down. “Cerner is notorious for not sending those downtime MARs,” he said. “I called their emergency helpline probably six, seven times before I could ever get a call back, which was six, seven hours later. We had to go on paper downtime procedures, because they just didn’t care.”

    Now Free and his staff are getting the responses they need. “Most of the time, I’ll hear back in an hour. And if I have a big issue, they will usually call me right back in a few minutes.” Meanwhile, when Free receives a question about his facility’s state survey, he simply emails the customer support team and gets an “almost immediate” response. “[Experience Care’s] customer service is absolutely fantastic,” he said.