Bringing long-term care (LTC) communities into the age of electronic medical records (EMRs), point-of-care clinical applications, ePrescribing, electronic medication management and whatever-comes-next is no mean feat. Preparing to branch out into the burgeoning world of electronic data exchange with outside partners—including hospitals, payment agencies, therapy services, homecare and hospice organizations and even the residents themselves—can feel like a veritable Mount Everest.
All Information Technology (IT) initiatives require deep planning and frequent involvement of clinical staff and administration to ensure that technology will meld with the corporate mission and the clinical workflow, noted a five-member panel of LTC executives at this week’s LeadingAge annual meeting in Denver.
A phase-based approach over several years produces the best results for system implementation, and it gives staffers a chance to acclimatize to each new technology and workflow process, the panel members agreed. Facilities should not think that IT personnel are experts in clinical care, nor should they think that nurses are experts in technology. “Start small, maybe with admissions and care plans, and then gradually move into MDS and physician order entry or eMAR,” suggested Chip Burns, president of The Asbury Group—Integrated Technologies. “You can’t ask your staff to drink from a fire hose.”
Even with the most gradual of technology transitions, no IT project will be completely free of user resistance, the panel members noted. Conducting surveys both during and after the installation process can communicate any user problems with the new systems, and also can help to heal any issues between the "technology ideal" and the actual onsite workflow. In the end, a healthy combination of user feedback pathways and a clear, authoritative approach can control most process-resisters: “Be firm with your staff,” said Hank Keith, CFO of Westminster Communities of Florida. “You have to tell them, ‘This technology is going in, so choose to embrace it or you’ll have to go work somewhere else’.”
As another caveat, when it comes to new technology, don’t assume your staff needs (or wants) the latest bells and whistles, Keith added. When his organization explored the newer handhelds and tap-screen systems, the project team discovered that staffers actually preferred to use portable computers with keyboards.
The training element is just as crucial as the IT system choice, said Hank Lovvorn, COO of The Presbyterian Homes. During staff surveys, his organization’s project team learned that a formal and ongoing technology training program was needed: “We found we’ve been great at doing research, but we’ve been woeful at training,” he said. Yet, the best assistance for ongoing training programs (and for staff buy-in) just might come from someone down the hall, Lovvorn added. “Seek out your staff technology champions and foster them to become super-users,” who can then engage their peers in embracing the technology, he suggested.
Long-Term Living’s coverage summarizes the conglomerate lessons this seasoned panel of executives shared about IT project planning in the LTC arena:
- Survey first, and often. Short, specific surveys given to all staff can produce a gold mine of information for project planners. Seeking feedback on what existing technologies are working well, and what additional technologies or features would enhance efficiency and quality of care can help project teams prioritize the organization’s needs. Asking specific questions about how software applications are being used in daily work also can alert IT personnel to gaps in user knowledge that can be addressed through training on new systems, as well as refresher training on existing applications. In other words, of course your staff will need training on that new eMAR app, but do some staffers also need a brush-up session on the existing charting software or even MS Word?Avote "Tech umabyeaiti ip
- Gather everything on the discussion table, then prioritize. Your facility doesn’t need to be the earliest adopter of every technology. Weighing the technology possibilities within the looking-glass of the corporate mission is the wiser path, said Presbyterian Homes’ Lovvorn. “We didn’t want to spend dollars and resource on cutting-edge technology that might be a waste in the end.”
- Keep project scope to what can reasonably be done within two to five years. All projects benefit from advanced planning, but attempting to plan beyond five years invites a host of risks—including wildly inaccurate budget estimates (technology pricing changes rapidly) and skewed project goals (the facility’s needs can change a great deal in five years).
- Implement all IT projects in phases. Rolling out too many initiatives at once creates chaos in the clinical care departments and in the CFO’s office. Keeping a detailed, phase-based schedule allows appropriate time for training, budgetary adjustments and staff buy-in.
- Be realistic about upgrades, especially for software versions. Diligent planning helps the IT department to maintain the delicate balance between the need to upgrade to avoid obsolescence, and the need to avoid “death by revisions.”
A final take-home from the panel: Your IT system needs may not stop at your own walls these days, and they’ll reach far beyond them in the future.