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A provider’s journey to adopt HIT

January 4, 2012
by Patricia Sheehan, Editor-in-Chief
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How Golden Living leveraged technology to improve care collaboration

When John Derr joined Golden Living in 2007 as its new chief technology strategic officer, the seasoned LTC executive was determined to bring the large skilled nursing company up to speed from an information technology (IT) standpoint.“My vision was a healthcare system that uses information to empower individuals and improve their health,” says Derr. “This mission isn’t episodic care but longitudinal, person-centric care. We’re aiming for the transformation of a static, reactive healthcare system to a dynamic, proactive, wellness-based system.”

Derr had his work cut out for him. Golden Living, headquartered in Plano, Texas, has more than 42,000 employees who serve 60,000 patients a day at its 300 LivingCenters (SNFs) in 21 states and network of related healthcare services including assisted living, rehabilitation, home care and hospice.

But Derr also had the credibility and experience to take on the challenge. In 2009, the former American Health Care Association executive was appointed by the Department of Health and Human Services to the Health Information Technology (HIT) Standards Committee, which was charged with making recommendations on standards, implementation specifications and certification criteria for the electronic exchange and use of health information.

Technology as an enabler to deliver care more efficiently:
  • Makes it easier for staff to do the right thing
  • Reduces time to access data
  • Presents the right alerts at the right time
  • Creates new and better workflows
  • Pushes information in a more effective way
Source: Golden Living

Derr was therefore all too familiar with the government’s mandate for acute care providers to implement electronic health records by 2015. And he wasn’t going to wait for incentives that weren’t available to LTC providers “because it’s the best thing to do for our residents now,” says Derr.

However, Derr and his team faced some daunting challenges at Golden Living. “A lot of our software was out of date, behind in version upgrades with more than 100—many proprietary—applications,” says Derr. “IT was a slave to operations and clinical and compliance requests. We needed to transform our IT department into a health information technology department.

“It took three years for Golden Living to approve the plan,” continues Derr. “It was a major financial decision. It wasn’t just a product but a whole change of workflow and how we treat business intelligence.”

At Golden Living, Brad Savage, SVP and chief information officer, and Andi Clark, RN and SVP of clinical services, partnered with Derr and their vendor to transition the company’s large number of loosely connected systems into a single unified business intelligence platform (BIP).

The platform provides a combination of business and clinical intelligence that shows trending, actions on incidents and health and wellness activity. This month, that platform will have been operational for a full year after months of pilot implementation at five LivingCenter sites and extensive staff training.

It was a collaborative approach, states Savage, with the clinical services team an integral part of the planning process. “We took a big investment in technology and rather than focus on financial outcomes, we partnered with the nursing staff in a way that hadn’t been done before,” says Savage.

For example, “The clinical team said, ‘If I can have this piece of information it would show a better picture of the resident.’ They wrote their needs into the business rules and we figured out the back-end data to serve their needs,” says Savage. “It’s about trying to liberate the data—to get it out of the paper-based charts to make it usable.”

In an increasingly complex healthcare environment with SNFs serving residents with higher acuities, Savage asserts that an integrated platform “makes it easier for staff to make decisions, reduces the time required to access information and presents alerts at the right time.” 


Transitioning from a paper-based workflow to an electronic system involved offering a value proposition not only to Golden Living’s owners but to the 8,000 nurses who would be tasked with working with it on a daily basis. There were hurdles along the way, including the buy-in process from staff who weren’t tech-savvy. It wasn’t done without some “kicking and screaming,” recalls Clark.

“As nurses, we love our charts and paper,” she laughs. “But now we can access all this rich data. The nurses are 100 percent on board. We provided 47-inch monitors to the DONs so that the interdisciplinary team can sit together and observe changing conditions.”

The “Morning Clinical Startup” at Golden Living serves as the critical workflow for the new platform. This daily meeting—where facility nurses confer with the DON for the 24-hour look-back—is the most important daily task across the company, and previously required time-consuming manual processes, mounds of paperwork and complex spreadsheets with the endless data that impacts documentation, notification and resident care.