Archive for category: EHR

EHR Implementation Guide: Part Two – Implementation and Optimization

Build and Implementation


Depending on the system and vendor, the build phase can take anywhere from weeks to months. During the process, you may find yourself discovering better ways to accomplish a process halfway through the build. Don’t be afraid to rebuild modules when this occurs—a little extra time spent now can save considerable time over and over again down the road. It’s a good idea to talk with colleagues who have already implemented the system to learn from their challenges and experience.

Data Governance

As part of the build phase, spend time to develop a data governance structure. This entails a written plan of who is accountable for information integrity and security, processes for managing data quality, and auditing systems for HIPAA compliance, security, and accuracy. The structure should involve oversight from the corporate or board-level.


Vendors typically recommend a slew of webinar-based training modules for all staff. The idea is to gather a group of staff and watch someone demonstrate the EHR functions step by step. Not only is this training style time-consuming and expensive, it is ineffective at building proficiency in users. Why is proficiency important to think about? Research has shown that adults learn much better when concepts are tied to the work they are expected to do. In the case of EHRs, the goal should be to have proficient users– in other words, that staff are able to use the application effectively to do their job– as opposed to knowing a complex set of modules and screens.

By listening to and/ or watching a remote user walk through screens and screens of capabilities, staff are likely to retain very little once the training is completed. Instead, training should be developed and deployed around workflow and roles, using a well-designed simulation environment that closely matches the new system. In other words, staff members should have access to a computer and be able to complete the step by step activities at the same time as the trainer. The savings in reduced training time and increased proficiency from this approach alone can make retaining an external, experienced EHR consulting firm cost-effective.


Go-Live is the big day to switch the new EHR system on. If you have invested the time and resources in your journey so far, Go-Live should be simply another step in the process. Make sure you have extra staff available to ease the transition. Management staff should also spend time in crucial operational areas to demonstrate commitment and provide support as needed.

Implementation Project Closure/ Transfer to Optimization Structure

The optimization phase of an EHR project should be built long before go-live day. After the implementation phase ends, usually 90 days or so after go-live, return to the established goals for the system and compare to the results achieved so far. Begin implementing a long-term strategy to understand how the EHR is integrating into workflows and make adjusts to the system when necessary. In addition, consider the following tips:

  • Develop strong training programs that can be consistently provided to new staff. A reliance on web-based training modules leads to poor proficiency and increased variation in usage and data entry, as does training provided solely as part of a traditional floor orientation program. Instead, take the time to develop (and keep updated) a training program that includes simulation, facility-specific guides, and leadership oversight to ensure continuity of information and practices.
  • Commit to one place for data. Many organizations are loathe to give up their trusted Excel-based census tracking worksheets and paper-based incident tracking systems. Resist the urge to keep data in different places. To fully capitalize on the business intelligence and analytic features of EHRs, you need to have all the data in one place to properly guide future decision-making. Data analytics is quickly reshaping all of healthcare. For LTPAC providers, this means you must have accurate data on rehab outcomes, rehospitalization statistics, and efficiency of operations. If your EHR solution is a barrier, press your vendor for added functionality. Chances are good they either have a solution from another provider, or, more likely, other providers are struggling with and clamoring for the same solution.
  • Ask staff probing questions. It’s not enough to ask, “Is everything okay?” At one organization where I served as administrator, I discovered months after implementation that some of our med aides were not following the proper procedures to chart their med pass. In researching why the staff had not mentioned the deviation before, I discovered that they had never been able to follow the process as described, but quickly found a workaround that seemed to work. When I would ask if everything was okay in the months after go-live, naturally and honestly they answered, “Sure!” Ask staff directly if things are working as expected. Ask regularly if staff are finding different ways to accomplish tasks. Encourage your superusers to report common questions and issues so you can examine whether there are organization-wide trends.

It’s also crucial to note, you must approach problems with usage of the EHR with a “just” mindset. This means if staff are not following established protocols, it’s crucial to understand why in a way that doesn’t place blame on individuals when the problems are system-induced. (And in our experience, virtually all problems with EHR usage are system-induced.)

  • Stay curious. EHRs vendors are quick to promise their system will do everything under the sun. It won’t, trust us. EHRs currently on the market are clunky adaptations of LTPAC operations. For some processes, you will ask how to do something and receive an answer of either the EHR can’t do that, or it can, but requires a complex set of steps. Push your vendor to simplify steps and improve workflows. What EHR vendors lack in user experience design and functionality, they more than make up in attention to customer needs. So be vocal about what you need and what you’d like to see. Remember Robert Kennedy: “Some [people] see things as they are and ask why—I dream things that never were, and ask why not?” Ask why not. Often.
  • If something doesn’t work, don’t give up on it. This part is a little shocking to us, but we find many organizations that, after struggling to adopt a certain feature or workflow, simply decide an EHR can’t support this part of their business and drop it. One time, we worked with a client that had paid for the billing/ finance module of an EHR, but had completely abandoned it in favor of staying with Quickbooks because they weren’t able to get the system to bill correctly for their independent residents. Resist the temptation. If a billing module doesn’t support your CCRC model, talk openly with your vendor about what you are trying to accomplish. Take a look at your internal process, as well, and be open to reconceptualization of your processes. While current EHRs are clunky, they are hardly impotent. Don’t give up on such a big investment.
  • Be open to—brace yourself—replacing your shiny new EHR. Most vendors work hard to ensure client satisfaction, but if you find yourself with a vendor who refuses to work with your struggles and challenges, go back to your shortlist and reexamine other vendors. The cost to replace a system is truly less than continuing to use a beast that doesn’t actually improve your operations and ability to care for your residents.

Final Thoughts

Current EHR systems on the market are valuable tools to manage data more effectively and streamline some of the labor-intensive parts of LTPAC operations. At the same time, they are not perfect solutions, and unfortunately reflect too much history as revenue cycle agents and not enough experience in day-to-day operations. Most systems are just now integrating workflow engines into the design, and it will be years before useful workflow and clinical decision support tools are available.  Worse, all complete EHR systems currently on the market suffer from a deep bias of paper-centric thinking, which hampers the ability of much of the healthcare industry to leverage technology in the same way that other industries have done (think Apple, Amazon, Google, and Netflix). This means that we likely will see tremendous innovation moving forward, and some of the giants today will struggle or fall away in the near future. Staying on top of technology solutions, rather than clinging tight to a trusted vendor, will require LTPAC organizations to think differently than they have in the past and embrace change much more quickly and tentatively.

EHR Implementation Guide: Part One – Project Management and Vendor Selection


Considering an Electronic Health Record system for your nursing home or assisted living community? Looking to optimize a current installation? Learn how we can help with our EHR Consulting Services.

EHR Implementation Guide: Part One – Project Management and Vendor Selection

Choosing an EHR is a significant investment in time, resources, and staff goodwill. Therefore, it is crucial to conduct a thorough readiness assessment, consider vendor options carefully, and commit the resources necessary through full use and adoption of the software. For nursing homes and comprehensive care communities, the vendor landscape is wide. Several large solutions offer consolidated billing, MDS, care plan, MAR/ TAR, and resident care solutions. For assisted living, memory care, and senior housing, vendors have responded with a range of options from basic care tracking tools to integrated family/ provider engagement platforms.

This guide will help prepare you for an implementation by describing basic project management concepts, offering an overview of EHR options, and detailing how to construct an outcome-oriented training plan.


Project Management Basics

Choosing a project manager and sponsor

Selecting a person to manage an EHR project is crucial to success. The project manager should be organized, an effective communicator, and familiar with the care setting, resident requirements, and staff capabilities. Most important of all, the project manager must have sufficient free time to manage the project effectively, respond to challenges and problems quickly, and support implementation with on-the-ground support at critical junctures.

Equally important is choosing the right project sponsor who “authorizes” the project. This person must have sufficient decision-making ability and availability to support the project, remove roadblocks, and make critical decisions in a timely manner.

Picking the project team

The project team should include, at a minimum:

  • Representatives from administration
  • Clinical leaders
  • Clinical users
  • IT staff
  • Ancillary department staff (dining, environmental services, social services, marketing, etc.)
  • Resident representatives

Project team members should be collaborative thinkers, team players, and committed to the organization’s goals and mission.

Scoping the project

A careful project scoping process is essential to accurately forecast budget needs and time requirements. Will the project include IT infrastructure upgrades? Workflow analysis consulting? Conversion of paper records? What positions and resources will become permanent and what will be solely project-based?

Managing the project process

A successful project requires ongoing attention, oversight and adjustment. Organizations will want to consider postponing other strategic initiatives during the implementation process to focus on the work ahead. When adjustments are needed, the project team should act swiftly to avoid losing momentum and support.

Organization Review and Goals

To begin, you need to adequately define your current state (assess IT infrastructure, map workflows, measure staff engagement and readiness, quantify funding sources). The following websites have some great free resources for beginning this process:

Stratis Health (a QIO based in MN):

LeadingAge CAST EHR Selection Tool:

You should also explicitly define goals for the EHR system: What do you want it to do? What areas of performance do you expect to improve? Be specific and measurable in selecting goals. Vendors typically focus on operational efficiencies and revenue generation, but your organization may have alternate goals to consider, such as improved customer service, better resident outcomes, and more satisfied staff.

EHR Vendor Considerations and Hardware

Hosted vs. Local Installation

Most EHRs offer a hosted version of their service (either through purchase or as a Software as a Services (SaaS) option, and some allow for software to be installed locally. Each option has advantages and challenges:

Hosted Solutions:
  • Vendor managed storage, reliability, upgrades and security reduces infrastructure and capital needs. Most vendors offer uptime guarantees and automatic upgrades to the latest version. In addition, vendors typically conduct ongoing, comprehensive security and penetration testing, meaning, somewhat counterintuitively, the data is typically more secure than with local installations.
  • Usually offered on a monthly contract or service charge basis, which can lower initial deployment costs substantially.
  • The ownership of data varies, and it’s important to clarify at the onset. When a vendor owns the data, migrating to another solution in the future can prove to be an expensive proposition.
  • Usage of the software is dependent on internet access, and reliability at the community site, thus, is crucial. Most organizations are not able to afford redundant solutions or direct internet pipelines, which can lead to some risk of downtown. Many EHRs have ways to mitigate the risks and challenges of internet disruption, such as local backups for time sensitive items like resident face sheets and MARs.
Local Installations:
  • Software is oftentimes more customizable for a particular organization’s needs.
  • Though it requires a higher up-front investment, purchased solutions may be less expensive over time, especially for organizations with already expansive IT capabilities.
  • Less reliance on internet connectivity, which may be crucial for locations with intermittent or unreliable access to the internet.
  • In addition to software, hardware investments and ongoing IT staff costs may be significant.


After assessing your current IT infrastructure, you’ll want to decide what hardware you will need to acquire. Desktops are the cheapest solution and require minimal oversight and maintance, but they are less flexible and can contribute to institutional practices. Laptops are slightly more expensive, but offer greater flexibility and mobility. Tablets are easy to use and very mobile, but lack a keyboard for data entry and must be protected from theft and accidental damage. As the price of laptops and tablets continues to drop, more and more providers are opting in this direction.

Wireless internet is essential for most EHR deployments. While some facilities opt for home and office-grade equipment, it is well worth the investment to purchase healthcare-rated devices. Overlapping deployment of wireless radios is crucial, and it is recommended to maintain a signal strength of -70 dBm in all care locations.

Platform/ Browser Dependence

Some EHR solutions are dependent on Microsoft Windows and/ or Internet Explorer. Additionally, EHR vendors are beginning to develop mobile applications, which may be only available on either iOS (Apple) or Android platforms. In general, dependence on a particular platform or browser is not recommended, though many otherwise good LTPAC EHR vendors are designed in such a fashion, which can raise the cost of hardware, particularly if using mobile or tablet technology. Software that is only capable of running on a desktop environment is not recommended, as the technology is quickly being surpassed by tablet technology with lower costs and more person-centered design options.

Reporting Features

EHRs capture a tremendous amount of data. Using this data in a meaningful way, however, is a very different proposition. It’s important to review report generation capabilities of EHR systems thoroughly, as there is significant variation among vendors. Specifically, you want to understand:

How does reporting work in the EHR? What reports are standard? How are options controlled? What export formats are available?

What options are available for customized report writing? Can the data be segmented and can multiple data fields be included in report writing?

Person-Centered Practices and Assisted Living Environments

Most EHRs were initially designed as revenue cycle management platforms. Accordingly, the software and databases are well-attuned to catching and reporting MDS data at the expense of resident outcomes. As you explore vendors, consider how the user experience allows (or hinders) access to the data that is important in day-to-day operations. Are nurses able to easily manage resident health issues? Are care plan templates designed to allow for flexibility in display and reporting to suit different user needs (e.g., LN vs. CNA vs. family member)? Are point of care portals intuitive and easy to use?

On this note, if your community has an assisted living component, carefully examine any AL-specific modules. Does it reflect your needs and workflows? Does the system focus on the whole resident rather than just the medical record and ADL capture? Most EHR vendors took SNF modules and repackaged them for ALFs, which has led to unnecessary medicalization of these community-based-care environments.

Vendor Contracts and Post-Selection

We’ve seen countless organizations trust vendors to ensure a smooth transition only to struggle as customization takes longer than expected, costs run over budget, and the final product offers less than what was expected. An important way to protect your organization is to make the vendor contract contingent on project milestones and based on project outcomes, not hours involved. We also recommend adding contract language that allows an organization to refuse payment for any vendor-controlled cost overruns. (Vendor-supplied agreements typically promise only an “estimate” of implementation costs based on vendor-recorded hours, while calling for fees of up to $125 per hour for overruns– even when caused by the vendor.) Timeliness penalties are also becoming more common, and can help ensure a vendor keeps to the established timeline.

During the post-selection phase, it’s important to maintain open and honest communication with the vendor. If you run into issues or challenges, don’t be afraid to speak up. It’s also sometimes useful to keep 2nd and 3rd choice vendors engaged, as it’s never too late to change direction based on outcomes of the implementation process. While switching mid-stream may seem expensive or wasteful, it’s far worse to end up with a vendor not committed to your success.

EHR Implementation Guide: Part Two – Implementation and Optimization


Considering an Electronic Health Record system for your nursing home or assisted living community? Looking to optimize a current installation? Learn how we can help with our EHR Consulting Services.

Embracing an Adoption Model for EHRs

While aging services providers slowly move forward in implementing electronic health records, a lack of workflow redesign and adoption practices continue to hamper providers’ efforts to realize the full potential of these computerized systems. Chief among the challenges are 1) inconsistent and poorly designed training programs, 2) disconnects between old workflow patterns and new opportunities, 3) a lack of data governance structures,  and 4) failure to embrace optimization opportunities.

1) Inconsistant and Poorly Designed Training Programs

Providers and vendors continue to waste significant resources during training and implementation phases by blasting webinar-based training to classrooms full of staff. Not only is this training style time-consuming and expensive, it is ineffective at building proficiency in users. Why is this important? Research has shown that adults learn much better when concepts are tied to the work they are expected to do. In the case of EHRs, the goal should be to have proficient users– in other words, staff are able to use the application effectively to do their job– as opposed to knowing a complex set of modules and screens.

By listening to and/ or watching a remote user walk through screens and screens of capabilities, staff are likely to retain very little once the training is completed. Instead, training should be developed and deployed around workflow and roles, using a well-designed simulation environment that closely matches the new system. The savings from this approach alone can make retaining an external, experienced EHR consulting firm cost-effective.

Once systems are implemented, providers should develop strong training programs that can be consistently provided to new staff. A reliance on web-based training modules leads to poor proficiency and increased variation in usage and data entry, as does training provided solely as part of a traditional floor orientation program. Instead, providers should take the time to develop (and keep updated) a training program that includes simulation, facility-specific guides, and leadership oversight to ensure continuity of information and practices.

2) Workflow Challenges

EHRs offer a tremendous opportunity to remove significant waste from operations. From hunting down charts to keeping documentation in one place, an EHR can bring order to chaotic paper charts. Because of this, new workflows oftentimes need to be developed to take advantage of these opportunities. Role for medical records, MDS nurses, billing staff and floor nurses all need to be examined to determine the most effective mechanisms for entering and maintain data in an EHR. The challenge is that even during an EHR build and design phase, paper-centric thinking reigns. This creates a bias towards old systems that leaves most implementations under-powered and underutilized.

Charting and review systems need to be assessed, as EHRs typically provide visibility into areas that previously required redundant systems to manage. Any parallel information systems being used after implementing an EHR should be carefully examined to ensure there isn’t a duplication of data or efforts occurring. Without direct assessment and action, it’s not uncommon for providers to waste 10-15% of their resources maintaining outdated or redundant systems and databases.

3) A Lack of Data Governance Structures

Very little literature has been written or developed regarding data governance in long-term care, and it’s likely that most providers do not have a formalized process for managing the integrity of data entered into an EHR, resulting in unnecessary variation, lowered resident outcomes, and less useful analytics and performance measures. To remedy this, providers need to develop a model for data governance and create processes to define and manage the information entered into the EHR. This means defining roles and responsibilities around the data that is entered, and developing systems and practices to standardize and sustain the data. Compliance should be measured on an ongoing basis, and frequent adjustments should be implemented as new needs are identified.

4) Failure to Embrace Optimization Opportunities

Optimization is the ongoing process of evaluating, improving, and sustaining an EHR over the product life-cycle. For many providers, however, an EHR simply becomes part of the background infrastructure after implementation is complete. For workflows that were not redesigned during implementation, extra or unneeded work often continues indefinitely. Workarounds to problematic features are typically developed and shared by floor staff, which can circumvent opportunities for useful analytics and reporting. In addition, new features developed by vendors are sometimes under- or un-utilized as they are typically buried in pages of product announcements and updates that are rarely viewed. In fact, it is not uncommon for legacy users– those who have had systems the longest– to be among the vendors’ lowest utilizers.

Providers should develop an ongoing optimization strategy that includes frequent observations of staff usage, regular discussions with the EHR vendor on new and planned enhancements, and collaboration with other users to discuss issues, workarounds, and innovative practices.

Have a little more time? Check out this excellent webinar from HIStalk on adoption success factors.

Have a little more time? Watch this excellent HIStalk webinar on long-term adoption.

Considering an Electronic Health Record system for your nursing home or assisted living community? Looking to optimize a current installation? Learn how we can help with our EHR Consulting Services.

3 Implementation Challenges that EHR Vendors Should Address Now

EHR projects are challenging for any healthcare organization, but especially so for LTPAC providers, who typically lack IT resources, capital infrastructure, and the staff stability that is crucial to implementing any large technological and process change. The result of this is many providers struggle with poorly implemented, un-optimized systems that don’t deliver the full transformative power of the technology. On top of the internal and systemic challenges facing providers, EHR vendors have been slow to develop workflow-based EHR solutions, adopt adult-learning-based implementation models, and truly partner to help solve the most challenging quality and service-related issues in the industry.

As they push forward the technology of their systems, EHR vendors would be wise to look at three key pitfalls in current implementation approaches:

1) Training content cannot be delivered effectively through multi-hour webinars. These webinars are nearly a complete waste of staff time and training resources, yet are still the most common method for delivering implementation training. The most efficient and effective approach to training staff is to combine lecture and live-practice at the same time. The more you separate these two integrated activities, the less staff will retain (and the more resources you’ll waste in additional training and practice). In addition, the training schedule should match the clinical workflow, rather than teaching modules in an architecture-based way. What does this mean? Don’t train based on how the EHR has divided up the work in modules (orders, events, progress notes, ADT, etc.)– train based on the user’s workflow; the quicker the training matches known work, the quicker staff will be able to apply the learning to their own internal reference points. And yes, this means training should be customized by facility and by role– a cookie-cutter approach

Most vendors have begun offering a variety of webinar-based, interactive web-based, pre-recorded content and user help guides. These items are an improvement over materials of the past, but are still nowhere near an optimized learning suite. The biggest barrier? Implementation and training costs are billed out to providers as a separate cost, and there is little incentive for vendors to optimize this process. In addition, vendors have little incentive to ensure systems are actually adopted, as the replacement cost for an EHR is beyond what most providers will consider.

2) Sandboxes are confusing as much as they are helpful. I’ll be honest– this has been one of the most surprising learnings I’ve had myself. A sandbox allows the learner to practice working in the EHR environment by utilizing a test facility with made-up residents. This model works really well for conceptual learners (such as myself)– but is challenging for those who are not (such as many, if not most, nursing home staff). Instead of being helpful, by and large, nursing home staff are confused by the sandbox approach and struggle initially to apply the conceptual lessons (adding an order to Susie the test case, for instance) to their own future workflow (adding an order to Susie the resident). In addition, sandboxes often become littered with examples of every variable possible within the EHR– but in places you typically wouldn’t find them. On a recent installation, for example, the sandbox contained a PRN order for NovoLog that required charting on pain level and blood pressure. The order was used to demonstrate a PRN order, and show how you could require certain charting to be completed before administering the medication. The trainees, however, struggled to get beyond the fact that you would never chart for pain level and blood pressure before administering NovoLog (an insulin).

Sandboxes serve a purpose– letting users practice outside of the actual medical records– but they should be crafted to match the implementing facility as much as possible. Once the initial data entry (or a portion, even) is completed, vendors should replicate the database to use as the sandbox. Using familiar residents, assessments, and orders can significantly improve the retention of training.

3) Listen to users, but don’t rely on self-reported user suggestions and improvements as the whole story. When EHRs first came to the market, they presented a variety of solutions that barely resembled long-term care workflows. This is understandable, since they were primarily designed to automate MDS data collection and submission (an entirely different and problematic topic). Over time, as providers shared frustrations and challenges with the software, vendors responded not only by making improvements to the software, but also creating user groups and councils to directly solicit feedback from users. This is a great step forward, and in line with many of the vendors’ switch towards agile-style development.

The new challenge, however, is that facility staff generally don’t understand the EHR architecture, and the vendor product owners don’t understand facility workflows and, more importantly, facility care and service goals. This lack of understanding on both ends of the development process inhibits EHRs from being transformative in practice, and instead we are getting slightly less clunky applications still driven by paper-centric thinking. To get ahead, vendors need to rethink their development process, gathering not only ideas but also goals and desired outcomes from providers. (Think of it as a root cause analysis process.) The development challenge then is to design the best, most efficient way to accomplish those outcomes and goals (instead of the current approach of simply adding functionality)—which will generally require re-engineering the workflow itself. Thus, the vendor development team should include not only software development and subject matter experts, but also workflow analysis and design experts. By doing so, they’ll develop a product that can be much more easily implemented and adopted.


For providers, the good news is that the intense competition in the EHR market, combined with a rapidly pivoting payment landscape, is thrusting the need for an optimized and adoptable EHR solution to the forefront. Many of the legacy vendors are committing significant resources to redevelopment and a renewed emphasis on user adoption, while a few newcomers to the space (I’m particularly intrigued by LG CNS for the integrated market and Medtelligent for the AL space) are making surprisingly strong inroads.

For those that are unhappy with their current systems, this is a great time to start looking at replacement options. For the few providers who are still relying on paper workflows, this is an ideal time to make the transition.



Considering an Electronic Health Record system for your nursing home or assisted living community? Looking to optimize a current installation? Learn how we can help with our EHR Consulting Services.

EHR Implementation Lessons from the Long-Term and Post-Acute Care Health IT Summit

The LTPAC Summit, held this week in Baltimore, MD, featured dozens of incredible speakers on the growing place of Health IT and technology in the LTPAC space. A number of key leaders at the Office of the National Coordinator and CMS confirmed the importance of increasing attention to LTPAC providers, who were, to a large extent, unfortunately left out of early planning and funding.

An entire track of sessions were focused on EHR implementations and case studies, providing useful advice for providers contemplating an EHR or interested in optimizing a prior installation. I was pleased to present one of the sessions on using lean six sigma to improve implementation strategies. By combining lean analysis of processes and people with six sigma project methodology, I shared how providers can save time and money while reaping better EHR adoption outcomes.

Several themes were common through the track, including these three takeaways:

1) Project Management Skills are Fundamental

Several speakers noted the importance of strong project management skills in designing and implementing an EHR project. LTPAC providers typically don’t have project staff onsite and several providers shared how they benefited from the support of an outside implementation manager to assist with the transition.

An experienced project manager ensures an accurate project charter is developed, the project team is diversified and represents all stakeholder groups, project milestones are kept on track, and resources are deployed effectively to ensure a successful EHR adoption experience.

In planning the project, it is important to spend adequate time on initial project scoping and team selection. Providers noted that initial investments in the planning phase provided substantial dividends throughout the process.

2) Thorough Needs Assessments are Important (and You Can’t Rely on Your Vendor)

From examining IT needs to measuring the current capacity of line staff to use computerized processes, providers shared that an initial assessment is key to developing an accurate plan of the training and equipment that will be necessary for implementation. Vendors can provide some support in this process, but it’s important to not rely on them to drive the process. Oftentimes, vendors propose generic training plans that don’t uniquely address the facets of individual communities and systems.

I shared that one of the ways eSSee Consulting helps providers save money is by focusing training specifically on job routines rather than deploying mass, untargeted training. By creating training specifically for each job, tailored by the staff’s existing familiarity with computers, and deployed close to the time of implementation, providers can expect a 20-40% reduction in total training time needed.

3) Processes Will Change; Be Ready

Workflows and processes need to be updated for an electronic environment. Old workflows should be thoroughly mapped and examined to see how work will change, and it’s important to be willing to let go out old practices and habits. Many providers create trouble down the road by trying to keep old forms and habits that reflect a paper-centric way of thinking.

A great example is the SOAP note that most nurses are familiar with. Traditionally, the chart note is completed by documenting the subjective resident complaint, objective data collected, the nursing assessment of the issue and the plan of care to resolve the concern. Because EHRs store notes in reverse chronological order, and oftentimes truncate notes after a few lines, providers can reduce the time spent on gleaning needed information by promoting an APSO note instead. By charting the assessment and plan of care first, future readers will be able to more quickly identify a resident’s status and care needs, oftentimes substantially reducing the number of clicks needed to display the needed information.


Are You Considering an EHR or Still Struggling to Improve Your Community’s Adoption?

eSSee Consulting offers a range of solutions to assist you. Our deep experience in workflow analysis and process improvement helps us craft individualized solutions that will help your community reap the full benefits of an EHR, from improved resident care to streamlined billing to better business intelligence for decision-making. Get in touch today to learn more about how we can help you succeed.

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