Is it time for your long-term care organization to take the plunge and invest in one of the latest healthcare information technology systems? Is it worth the expense and time to completely implement a brand-new system? Or can you update what you have in place to both meet your goals and comply with the new HIPAA/security regulations for the next few years?

If you find yourself asking these questions more and more, you are not alone. A plethora of new software products and advances in long-term care information technology are transforming the way care is being delivered everywhere, including in nursing homes, assisted living facilities, and home healthcare. Not asking these questions would be a huge oversight on your part. But which way should you go?

As you are trying to decide, keep in mind that a good healthcare information system should substantially improve your organization’s quality of care, service delivery, HIPAA/security compliance, and financial/billing operational efficiency. Moreover, your vendor should make a commitment to you that its technology is built to accommodate ongoing change and can be upgraded to meet the standards and requirements of the healthcare system as a whole. A few of the government-imposed challenges we know we will face not long from now will include the MDS 3.0, continually enforced HIPAA standards, and the Bush administration’s electronic health record objectives. These alone will ensure that we remain in a state of transition for some time to come.

At this point you are probably dealing with:

  • separate and disparate software products, implemented throughout the organization, which rely on high-maintenance or problematic interfaces, or don’t even “speak” to one another at all;

  • manual operations pervasive throughout the organization;

  • lack of centralization, which results in reduced corporate control and increased potential for error at the facility level, or corporate overcentralization, which creates high middle- and upper-management overhead and reduces facility responsibil-ity and accountability;

  • incomplete and inconsistent clinical documentation, making it rife for survey citations; and/or

  • lack of trained, knowledgeable staff capable of operating existing software.

Many new and exciting software developments occurring daily promise to improve long-term care management, such as electronic medical records, voice-recognition technology, and e-prescribing, all of which hold an important place in the future of healthcare performance and productivity. But it takes strategic planning to successfully choose, and then implement, a brand-new healthcare information technology system. Ultimately, choosing the right one for your organization depends on many factors. Every long-term care organization has its own unique setting and situation that aid in establishing its goals and objectives. But common threads weave the basic operations of all healthcare organizations together, and these factors should be considered first when choosing a new system. In short, you must focus on your core applications. If such applications as your census, assessments, care plans, MDS billing, physicians’ orders, etc., are not running successfully, then purchasing a robot that can dispense all of the needed medications for all of your residents (yes, there is one out there) is not going to help you improve efficiency.

A delicate balance must exist between the demands of management and the needs of those facility personnel whom the changes will affect the most.

Think about it: When the state surveyors walk in your door, do you really think a device that recognizes your voice is going to impress them if several of your care plans don’t match residents’ needs based on the data recorded from your resident assessments? Not that these new healthcare technology tools aren’t a tremendous benefit; in fact, they are in use in several organizations now and proving to be very effective.

They are a huge piece of the future of healthcare and definitely should be part of the planning stage. But first things first.

Admission process before information technology.

Since HIPAA’s creation several years ago, which standardized the electronic exchange of administrative and financial healthcare transactions and the privacy rules governing health records’ access, changes in the way we conduct business and care delivery have occurred frequently—and there is no end in sight. Fortunately, healthcare software developers are doing an excellent job in keeping up with these changes. With a good, basic information system, data from your census along with clinical and financial records are linked; MDS assessments are scheduled for completion automatically; errors are pointed out as soon as they are entered; electronic submissions are better monitored; reports are more concise; and security compliance with new regulations is easier to set up. Most of the new technology systems handle these processes—and much more efficiently (compare figure 1 and figure 2). But for a healthcare organiza-tion to avoid the many pitfalls that can occur when selecting and implementing a new system, its primary goals should be to:

  • minimize disruption of the efficient, effective internal systems and controls that facility personnel already rely upon, and

  • introduce needed modifications to those practices that are outdated or cumbersome.

Admission process after information technology. Notice the simplification.

To achieve these goals, it is vital that you gather input from all areas of your organization through the guidance of a single project leader. This individual should be proficient in both the financial and clinical aspects of the organization and understand the needs of all involved, from upper management through end user. The project leader should:

  • oversee creation of the Process Performance analysis (see below);

  • participate in creating a software “statement of needs”;

  • follow up on modifications or other details during installation;

  • oversee the software setup and configuration;

  • manage and assist with any pilot site review; and

  • lead the organization into implementation and ensure availability of continuing support.

Because all of this must be accomplished without dramatically affecting the individual’s existing job responsibilities, this role is often best filled through use of an outsourced, contracted professional.

Through it all, a delicate balance must exist between the demands of management and the needs of those facility personnel whom the changes will affect the most. To keep the scales from tipping one way or the other, in addition to selecting a qualified project leader, certain preliminary issues must be considered and involve both management and facility personnel. It is like piecing a puzzle together: If this is performed in a logical, organized manner, and you are careful not to lose any of the pieces, you will get the whole picture and achieve the expectations you had when you chose to implement a new technology system.

One of the best ways to accomplish this, and avoid significant pitfalls, is through use of a Process Performance Diagram, or workflow chart, displaying both your current and targeted operations (figure 1 and figure 2). The benefits of a solid Process Performance Diagram are:

  • It offers an at-a-glance representation of your operations, which acts as “visual ammunition” to incite necessary change.

  • When used as a management tool, it assists in improving the efficiency and compliance of your organization.

  • It assists in prioritizing solutions to inefficiencies, redundancies, and potential HIPAA risk areas.

  • It highlights manual processes capable of being automated using current software systems, thus maxi-mizing use of existing products.

  • It highlights manual processes incapable of being automated through current software systems, thus supporting the need for new software products.

  • It provides the organization with a “gap list” of necessary features and/or functions for use in completing the software needs analysis.

Armed with this information, you are now ready to take the next bold leap: beginning the software search process for solutions that will take you through the next few years of transition. Planning to meet expectations with the aid of a dedicated project leader; carefully documenting your organization’s current processes and target goals for computerization; remembering that the system isn’t just for management (reporting and analysis are important, but the day-to-day ease of use for staff is just as critical); and running a pilot before going live on a new system—all are tasks you should undertake when choosing and implementing a new healthcare information system. These essential steps will not only help you survive these next few challenging years but will allow your organization to flourish.

Maria D. Moen is founder and President of HealthWare Consulting Services, LLC. On both the provider and vendor sides for 25 years, she has been actively involved in all aspects of the design, development, implementation, and training for dozens of integrated clinical and AR/billing products. For further information, phone (214) 390-1449 or visit

To send your comments to the author and editors, e-mail To order reprints in quantities of 100 or more, call (866) 377-6454.

Topics: Articles , Facility management , Technology & IT