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Preparing for electronic charting

January 1, 2007
by Doc DeVore, Carrie Price, RHIT, and Julie Natzke
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It's an important first step toward the electronic health record and has to be done right

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.