Computerizing for the 21st century.

Starting 15 years ago, this nursing home has learned much about the benefits -- and pitfalls -- of computerization 

Computers in the nursing home may seem like a fairly new technology, but our first experience with those scary machines goes back to the early 70's. Back then you didn't own the machines themselves, but hired a company to input the information for you and then send back reports for your management review. The drawback was the amount of time required by both the facility staff and the computer company's staff to implement this; you frequently did not get your report back until four to six weeks had gone by -- not exactly an efficient way to stay on top of an ever-changing business. That is why we, as a free-standing facility, decided in the late 70's that if we were to make it to the 2 century using this expensive technology, we needed to join forces with similar facilities in our are and pool our resources to reach this common goal. With four other nursing homes (including three former affiliates), we formed a mini-buyers' group for computer software. Then we asked IBM to search the nation for nursing home software.

None was to be found. Oh yes, there was software for hospitals and clinics, but for the free-standing nursing home in affordable form, nothing.

As a result, each of us finally chipped in about $5,000 to have a local computer expert -- he ran the computer department at St. Cloud State College -- design a system for us. He did his job well; in fact, he ended up marketing the software throughout

North Dakota and eventually selling it to a major software vendor.

The key for the accounting package that he developed for us is that all the nursing homes needed to be able to access Medicaid. Our programmer set it up to the point where we all had direct access via modem. Even before we got to that point, though, thanks to the efficiency of computers, we received our payment from the State a week to two weeks sooner than via "the stubby pencil."

Today, most software for long-term care has the capability of accessing both Medicaid and Medicare, both for accounting and clinical purposes. The sheer time savings involved helps justify some of the upfront cost for computerization.

On the other hand, you have to take time to implement the system. We learned that the hard way. As administrators, I think we tend to see the end product, as described to us by sales and marketing, and jump at it, expecting instant gratification, with everything working as advertised. We don't allow sufficient time to work out the bugs -- for example, the two or three months it took us to bring the staff up-to-speed. That included some overtime and even some homework by some staffers to master the manual. It was not an easy process, but they had to have time to grow.

Another key factor is whether the vendor will come on site and help you install the new system or train the staff to do so. We found in dealing with one of the companies that, during the training of our staff at their company training site, our staff actually installed the software as part of the training. When the staff came back to the facility, all they did was load the new information on the computers and we were up and running. Sensitivity to the need for training is all-important.

Another area to consider in your software purchase is whether your programs have quarterly updates available or a convenient approach to customizing the forms. Inevitably you will find, when using software, that some of the information you want is not where or how you want it to be. For example, we found we wanted a little more space in the social service section, a little less in the portion devoted to Chaplain services. With some vendors you may have to wait until they poll all their customers in your area to see if enough want the change to make it worthwhile; depending on the "vote," you may or may not get it. Fortunately, our vendor, Data Med Clinical Support Services, Inc., is able to make such revisions over the phone, by modem, when we request them. Easy customization is, obviously, a major factor.

Over the years we've had to grapple with hardware concerns, as well. Specifically, what kind of hardware did we want, and where? It is easy to end up overloading demand on a particular terminal, with everyone absolutely needing to use it immediately. You have to plan which functions you want done when, and how much time it will take. If you want to do accounting only, then one computer in the business office is fine. If you want to do both word processing and accounting, then you will need to prioritize who is going to use the computer. Based on our experience, we needed to have the word processing as a separate function and have a separate computer just for that job.

You also have to keep thinking about your hardware configuration. We started with a small mainframe with a limited number of terminals, which has worked well, but costs a bundle to modify. With the development of PC technology in recent years, we are moving toward a PC-based system that is networked. Eventually we would like to increase the number of terminals we have to cover each nursing station. In general, it's a matter of feeling your way through your needs, the available technology, and what you can afford.

I'd like to return, though, to the big question: adapting your staff. We've worked on this, but more than that, we've tried to turn computerization around to our advantage in actually recruiting staff. More on that in a moment. With existing staff, we were helped (believe it or not) by an OBRA regulation: the requirement for nursing assistant training.

Many of our nursing assistants were very nervous about taking this test; some had been out of school for a while or didn't enjoy it much when they were there. So, we conducted special sessions to prepare them for the test. By the time test day arrived, they were relatively comfortable with the idea, and of the over 80 who took the test, only one failed (due to a problem with the English language).

The experience was invaluable. When the time came to implement our clinical software, and signs of the old nervousness started appearing again, we reminded them of how well they had done in meeting the earlier challenge. This seemed to bolster their confidence. And once they had acquired some experience with the computer and learned how it could free them up from some very repetitious jobs, allowing them to perform those more interesting duties that somehow never seemed to get done, some staffers became positively enthusiastic. (And some, predictably, still don't want to be involved with computers, no how, no way.)

It is in recruiting, however, that we have come across a real eye opener. We have found that some potential employees are positively attracted to our facility by the opportunity we offer to learn how to use computers. Many of today's high school students have taken computer classes in school and want to be able to use some of those skills. Some feel (rightly) that having these skills will make them more marketable employees in coming years. We have run an advertisement playing on just that theme, and have had good success with it. This has proven to be just one more of the benefits that we have learned come with computerization.

In sum, we feel that we've "grappled with the beast" and finally made it our servant, enabling us to conduct business as it should be conducted in the 21st century.