Describing his typical business day in a 2006 article for CNN Money, Bill Gates said, “Paper is no longer a big part of my day.” What was once commonplace only in the technology industry is now becoming true for other fields, including health care and Assisted Living, as electronic health records (EHRs) and electronic resident records are increasingly being used.
According to the California Healthcare Foundation (CHF), physicians’ EHR use has grown significantly in the last six years, in large part because usage was incentivized by 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act. But despite this incentivization, there are still barriers to use. In their 2014 report, Ten Years In: Charting the Progress of Health Information Exchange in the US, CHF reported that, because long-term and behavioral health providers were not included in HITECH’s financial incentives, their adoption of electronic record systems has been much slower. This exclusion has some worried that there will be “a potentially dangerous dearth of health care data from the post-acute sphere of the health care system at a time when care coordination has been identified as a top priority.”
Assisted Living is not included in HITECH’s incentive plan either, yet many providers are still choosing to transition to an electronic resident record system. So, what are Assisted Living’s “incentives” to do so? We asked Phil Altman, Executive Director for Elder Care Alliance (ECA), a provider that has recently adopted an electronic resident record system.
First, the Benefits
According to Altman, one of the main incentives for the change was efficiency. “We were unhappy with the redundancy in the work,” he explains. By transitioning to an electronic system, ECA was able to consolidate many functions, including billing, budgeting, and resident records, into one system. Now, Altman says, staff members aren’t “using paper and having to go back to a binder or spending a large amount of time at the end of the shift entering information into residents’ records.” Instead, he says staff are encouraged to use the electronic resident record system throughout the day, saving them time and effort so they can focus more time on direct interaction with the residents.
ECA began implementation of their current system in the fall of 2011; the process was completed in about 11 months. Since then, they have noticed other benefits in operations and resident care. Altman says, “One key component is the increase in instant communication.” He describes how caregivers can create notes and alerts in a resident’s record which are sent automatically via email to the Resident Care Director and Executive Director. “This increase in communication allows us to quickly see trends, address issues, and help staff.”
These communications can be time-sensitive—such as when a resident requests a change in care—allowing the management team to remain aware of residents’ needs and, if needed, act quickly. Another example of time-sensitive communications is when a resident leaves the building—to have lunch with her daughter, for an overnight trip, etc. Staff who normally care for that resident can be alerted at the start of a shift that she is out, allowing them to adjust their own schedules accordingly.
Or, Altman says, electronic alerts can help staff members enhance a resident’s quality of life. “Say I help Mrs. Jones, who lives in memory care, with her bathing and she is normally agitated and upset. But today, I turned on some Frank Sinatra music while doing her bathing routine. She was excited and helpful in the process. I can send an alert to my co-workers letting them know that this simple thing can make the task easier and more enjoyable for her.”
Electronic resident records also allow for consistency and ease of reporting. Altman says, “We use it for our state reports and internal reporting. The ability to have role-based security with clear audit trails helps us maintain the integrity of the data. It also helps managers identify performance issues and process opportunities.” In addition, as the executive director, Altman can maintain an overall view of the community’s operations, including resident assessments, staffing levels, and trends in care.
But What About the Barriers?
Despite these benefits, there are similar barriers to adoption as with EHRs: namely privacy, implementation, and maintenance. According to Altman, ECA proactively developed solutions for each of these concerns to help make the transition as seamless as possible.
The first step? “Picking the right vendor is a critical part of the process—someone who will be your true partner and open to enhancing the system.” Altman says that ECA made sure the electronic records software they chose was HIPAA-compliant; it is also only accessible internally on company-owned devices, thus ensuring that the privacy of residents is upheld.
Another concern to be aware of, says Altman is “having enough bandwidth to ensure that the terminals don’t slow down.” During the transition, ECA increased their bandwidth in order to make sure this wasn’t an issue after implementation was complete and the software was being used regularly.
Finally, providers considering transitioning to electronic resident records should plan for both initial and ongoing training on the system. In addition to the initial training, Altman says, “We do frequent one-minute reminders, training, and refreshers covering all aspects of the system.” One particular problem for users, he says, involved system passwords. “Staff had issues remembering their passwords and knowing who has access to reset the password,” he explains. This is not surprising, given the vast amount of knowledge and information that Assisted Living staff process each day Altman says they created work flows and trained staff members to that they would know how to get help with any password-related issues.
In the end, Altman says, the benefit of being able to spend more quality time with residents vastly outweighs any barriers to implementation.
If you’d like to learn more, don’t miss the session on electronic resident records at CALA’s 2015 Fall Conference & Trade Show. Phil Altman will be speaking with other leaders in the field, sharing best practices for transitioning to and maintaining a beneficial electronic record system. Save the date: October 19-21 at the Westin Mission Hills in Rancho Mirage.
This article was first published in CALA News & Views Spring 2015: Teams Work