Archive for category: HealthIT

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.

Google Apps for Business: Exceptional Suite for Providers

We’re a big fan of Google Apps because of the consumer-centric nature of the experience, the seamless integration across applications and devices, easy to set up security requirements and restrictions, and the ability to run analytics to improve efficiency of use. Google Apps is well-suited for healthcare, and reasonably priced for businesses of any size (especially considering many organizations in aging services lack the IT expertise to effectively and efficiently manage local resources).

So how can Google Apps drive efficiency and help your organization?

  • Gmail, which millions of people use for their email already: powerful, intuitive UI, and massive storage.
  • Drive: A shared server and secure document portal for sharing materials internally, with trusted partners, and with the general community or prospective residents. Drive also makes collaborative editing of documents, presentations and spreadsheets a snap, which can save enormous amounts of time when writing P&Ps, preparing actions plans, or creating Board presentations.
  • Calendars: Intuitive calendaring platform that’s easy to share and simple to create group and resource (e.g., room, equipment, etc) calendars.
  • Storage space: 30GB per user is included.
  • Hangouts: A fantastic combination of instant messaging, video conferencing, and outbound call manager. Video calling is particularly valuable when you need to quickly touch base with someone about a sensitive topic and want more interaction than a phone call, but don’t need actual face-to-face contact.
  • Vault: An add-on that makes it simple to archive, retain and respond to discovery requests.
  • Remote, secure access: Google Apps is easily accessible from any location, any time, securely.
  • Integrated MDM features. Provides an easy way for IT staff to manage personal mobile devices to help ensure security and compliance.
  • Google Apps Sync for Microsoft Outlook. Many people find Outlook easy to use– or at least familiar. With GASMO, you can continue to use Outlook on desktop computers to manage Google Apps email and calendar functions.
  • See a full list of features here.

Be sure to check out the use case video of SF Bay Pediatrics available here, which highlights a lot of the healthcare-specific benefits in action.


Google Apps for Business starts at $50/ year/ user, which easily pays for itself with most small to mid-sized organizations. For a limited time, eSSee Consulting is also able to offer a coupon for $10 off the first year of service if you would like to set up the service on your own, or a complete assessment and implementation package for organizations without the on-site IT capabilities. Contact us to learn more or to get a coupon code.

What Happens After Go-Live

You’ve spent months and months preparing for this day. Hundreds of thousands of dollars have been invested in software, technology, and internal capital upgrades to make it possible. Staff have invested dozens of hours training, practicing, and readying themselves. It’s go-live day for your EHR.

A few hiccups aside, things go well. Line staff are happy and excited about the new technology. Administration is thrilled about new ways to easily view census, incidents and other crucial operational information. Implementation looks like it has gone better than expected. So what now?

At this juncture, organizations typically go in one of two directions. Successful organizations see go-live as the mid-point in an adoption strategy. It’s a time to celebrate a significant milestone, for sure, but also a time to begin the evaluation of the system implementation, measurement of workflow improvements, refresher trainings for staff, and planning for future improvements and changes. Even more crucially, it’s a time to listen carefully to staff, to ask probing questions like, “Is there anything that isn’t working like we thought it would?”, “What tasks are easier with the EHR? What tasks are more difficult?”, and “What are some questions you’ve had and have you been able to find the answers you need?”

The other direction, unfortunately, is more common. In the chaotic environment that most healthcare organizations exist in, go-live day represents a giant relief, the end to an over-time, over-budget project that was thrust on top of many other crucial priorities. Things seem to be running smoothly, and you hear few complaints, so you close the project and move on. 90 days after go live, your vendor implementation manager calls, asks if everything is going well, and then quickly closes the implementation and passes your organization on to the support team. Done and done. You return to the everyday challenges of caring for residents.

Oftentimes, when called in to optimize an existing installation, we see the aftermath of organizations that chose the second direction. We find EHR systems that are underutilized, redundant storage of knowledge (Excel spreadsheets, homegrown Access databases, paper files), and staff that have begrudgingly accepted impaired workflows. It’s a long process to re-implement systems, rebuild staff trust in technology, and finally capture the crucial business intelligence essential to an organization’s success in today’s market.

A Better Way Forward

Here’s what successful organizations do after go-live:

  1. Begin the next phase of the EHR project. Ideally, the post-go-live phase was already built into your project plan, and you’ve already established clear goals for the system, plans to measure against those goals, and a proactive strategy to understand how the EHR is integrating into workflows and how to adjust as necessary.
  2. 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.
  3. 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.)
  4. 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.
  5. 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.
  6. 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.

What Next?

Are you considering an EHR? Struggling with a recent implantation? Learned some other lessons? Get in touch! We’d love to hear about your experiences and talk about how we might help you succeed.

HIMSS14 Recap: Long-Term Care Absent, But Not Entirely Forgotten

HIMSS14 has been a great conference, and there are some amazing technologies and uses of data that will continue to push innovation forward in healthcare. Unfortunately– though predictably– the post-acute/ long-term care sector was sadly underrepresented. Of three sessions with a LTPAC focus, one was canceled, and the others, while excellent, were scantily attended.

A quick recap of some exciting ideas, products, and innovation:

  • Massachusetts has an exciting, ONC-funded program called IMPACT– Improving Massachusetts Post Acute Transfers– that has created a HIE-based platform for connecting long term care providers to secure messaging features, a universal transfer form, and a program called LAND and SEE (Local Adapter for Network Distribution and Surrogate EHR Envronment) . You can read more about the last piece and its architecture here, but it essentially provides a way for LTC communities without an EHR to receive, edit, and send CCDs through a portal connected with acute care EHRs. The pilot program is still being evaluated, but early feedback from providers in all areas of the healthcare continuum seems to be positive.
  • PracticeFusion, a fast-growing, web-based, free EHR has an impressive set of features and very thoughtful UX. We’d love to seem a similar program built out for assisted living communities that don’t require the revenue-cycle-heavy components of current LTPAC EHR vendors (and their associated focus on clinical documentation and ADL capture).
  • Speaking of LTPAC EHR vendors, it was interesting that HealthMedX (Vision) and MDI Achieve (MatrixCare) had a sizable presence in both the interoperability showcase and the exhibition hall; they’re definitely both very forward-thinking organizations. Answers on Demand had a small booth tucked away in the back (we almost missed them) and PointClickCare was nowhere to be found; we wonder if this is telling about the future of this market.
  • Real-time location services (RTLS) is big and growing. The price point of the technology is dropping quickly, and there are a variety of connection strategies, from wifi-enabled to passive IR to bluetooth/ RFID. There are a lot of applications in aging services, particularly in independent, assisted and dementia-specific communities. Additionally, it’s starting to show some promise with device interconnectivity and asset management. (Can’t find which room the Hoyer is hidden in? RTLS provides a cheap solution that will make CNAs’ jobs infinitely easier– and potentially reduce unsafe transfers.)
  • Ed Park, COO of Athena Health, delivered the best presentation of the conference: What Healthcare can Learn form Amazon. His slides are also fabulous. Park totally gets what’s needed in healthcare IT, and we hope he’ll push EHR vendors to adopt and publish open APIs, and collaborate with partners in a way that places persons served at the center of thinking.
  • Deb Fournier and Clint Davies shared the experience of the Maine Veterans Home EMR implementation. Their slides are worth a look by any organization considering an EMR in the near future. They also experienced some of the challenges when approaching an EMR as an implementation instead of an adoption.

Stay tuned for more learnings and ideas from the conference; we’re still analyzing technologies and forging connections, and we hope to have more things to share soon. It’s been a full week, and we’re super excited about the future of healthcare IT, particularly in aging services.

Ready to get started? So are we!