The federal government has urged that Electronic Health Records (EHRs) be in use by the year 2010. Clearly, electronic charting—a key component of EHR—is the near future of healthcare. Already, there are a variety of electronic charting products available in the long-term care (LTC) market, and many facilities are excited about the possibilities these systems offer. As you begin research-ing this new technology, here are a few tips that will help you develop realistic expectations for whatever system you choose.

First, be sure that you understand the electronic charting concept. It is important to know what an electronic charting system can and cannot do, as well as what will be required of your facility and your staff to successfully implement it. Then, assess your facility’s readiness to take on such a challenge. There will be many issues to consider, such as budget, training, staff buy-in, and various technical issues, before implementation can begin.

Electronic Health Record vs. Electronic Charting

According to AHIMA (American Health Information Management As-sociation), a true electronic health record would be capable of collecting patient data, exchanging these data easily between providers to facilitate continuity of care, measuring clinical process improvement and outcomes, and reporting health data to public health and other agencies. These capabilities are critical to the goals of EHR: improving the quality of patient care, reducing medical errors, increasing operational efficiencies, and reducing costs. In contrast, electronic charting simply provides the capability to capture and store health information in an electronic format.

Clearly, then, electronic charting is only one part of the greater EHR framework. Unfortunately, the terms “electronic charting” and “electronic health record” have been mistakenly used interchangeably, perpetuating the misunderstanding that implementing an electronic charting system will naturally provide a completely paperless environment. In addition, the electronic format varies among the many software packages current-ly available, so data exchange, if it is possible at all, is less than seamless.

An important part of making a true EHR a reality is interoperability, or the capability to exchange health information between the various stakeholders in modern healthcare (such as pharmacies, labs, etc.). This is the missing piece that will eventually complete the puzzle to allow a true EHR to exist in the LTC environment.

It is important to remember that there is much work to be done and it will not happen quickly. The standards needed to make the necessary interoperability possible simply do not yet exist; probably the draft standard created by the HL7 standards-setting group is farthest along toward implementation, but this has not been finalized. With this in mind, software vendors as well as LTC providers should proceed with caution as we develop and implement systems that will eventually become part of the EHR landscape.

Until that happens, the electronic charting options available in the LTC market today are limited to what are known as “hybrid systems.” This means that some paper documentation is still required in the daily operations of today’s LTC facilities, even when electronic charting is in place. Implementation of a “hybrid system” can be an important first step on a long journey toward the reality of EHR.

Culture Change

Implementing any electronic charting system will certainly result in some level of culture change in your facility. This may pose a challenge on several levels. First, many talented, experienced nurses are not regular computer users. Asking them to incorporate technology with which they have little experience may cause them to feel threatened. Therefore, take the time to educate and inform them of your plans throughout the selection and implementation process, so that they understand the benefits you hope to realize through this technology. Also, choose a system that is user-friendly so that computer novices can easily catch on to new processes.

Implementing an electronic charting system may also require your team to make changes to your standard policies and procedures to ensure successful implementation and take advantage of the benefits the new technology offers. While the software should be designed to fit the long-term care environment, it should also provide the tools to streamline many day-to-day processes. For example, telephone orders from physicians are often jotted down and transcribed later, sent to the pharmacy for entry, etc. If your electronic charting system includes an eMAR, it may be more efficient to enter the order directly into the system as it is taken from the physician and transmit it to the pharmacy from there. This reduces transcription errors and should help make the medication available to the resident more quickly. Also, having the orders entered routinely will greatly streamline the medication “recap” process at the end of the month.

Hardware Options

As you select the electronic charting system that is right for your facility, it is important to consider hardware, as well. In most cases, the hardware needed to use this new technology will command a significant portion of your overall investment. The hardware requirements will vary depending on the various electronic charting systems available. Some will require a reliable wireless network within your facility, while others may have the option to use hardwired kiosks located throughout the facility. Your facility’s construction might have some impact on the decision, e.g., obstacles to wireless connectivity, such as concrete block, and there may be concerns about loss or theft of portable devices such as laptops and PDAs. With wireless, you will also need to determine the number of wireless access points (WAPs) required to provide reliable connectivity in your facility; it is possible to have too many WAPs, resulting in interference with your connection.

To balance all these factors and get a solid estimate of the cost involved, you will need the advice of an experienced hardware vendor. As a general rule, you will need to have enough workstations of any kind available to ensure that each caregiver has one available to allow them to document or chart in a timely manner. Also, consider “fail-safe” options, such as an extra battery for laptops in case they are not recharged and backup options should your network go down.

Are We Ready?

There are many benefits of implementing an electronic charting system in your facility. But fully realizing these benefits often requires changing the way daily charting activities are carried out. Not every facility is ready or willing to take on such a challenge. How do you know if your facility is ready?

The ideal candidate for implementation of an electronic charting system should:

• Understand that this technology is new and there are no government standards currently in place.

• Have realistic expectations of the benefits an electronic charting system can provide.

• Be willing to reassess business processes to best adopt this new technology, rather than expecting the software to be changed to accommodate individual preferences.

• Be able to dedicate a full-time employee to oversee this project on an ongoing basis, beyond the initial implementation.

• Have budget resources available for hardware as well as software.

• Have strong administrative involvement in facility operations and application of technology to these.

• Have nurses who are tech-savvy or at least willing to learn.

In view of this, here are some important steps, from a practical standpoint, that you can take to help your facility prepare to implement an electronic charting system:

1. Appoint and empower a project manager to take the lead in doing research and making purchasing recommendations.

2. Ensure that your facility has reliable broadband Internet access.

3. Review state and federal regulations that may apply.

4. Research wireless network and hardware options to help create a realistic budget.

5. Determine which personnel will be affected by the implementation of an electronic charting system and who should be involved in the decision-making process.

6. Work toward complete facility buy-in of the concept of electronic charting, from the top down, before implementation begins.

7. Consider your facility’s current use of technology and assess whether you are using what you already have to its fullest extent.

8. Identify the specific goals and the benefits you expect to realize from a fully implemented system.