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The ABCs of EHR: electronic health records are coming--here's how to be ready.

It seems like everywhere you turn, there is talk about electronic health records (EHR), from the President's State of the Union address, to legislation and government panels, to the pages of The Wall Street Journal. Is it just a lot of hype, or are EHRs a reality for long-term care? Here's how to get started on your path toward a functional EHR.

The typical long-term care facility has a variety of software applications within its organization, often including a billing and clinical information system--an application that includes the MDS and several other features and documentation modules. However, our industry--like the healthcare industry in general--continues to rely on paper-based recording systems.

With a thoughtful, realistic, and systematic approach to implementing technology, long-term care and the population it serves will achieve the benefits of using EHR systems.

How do I get started?

Will EHRs fulfill their promise? Healthy skepticism and restraint are good things, particularly when the vision sounds expensive and requires cultural changes.

What may be easier to accept is that the platform supporting healthcare's business model is changing. The vision, fully realized, is likely five to 10 years away, but planning and implementation must start now for a number of reasons:

1. There won't be a big bang effect happening with EHRs--all you need to do is buy the right system. The implementation will be a slow, incremental migration over the course of several years, not months.

2. The implementation of widespread technology is a major culture change that could take years to accomplish.

3. Organizations must develop their own plan for implementing EHRs and personal health technologies, creating a foundation to build from and pay for over time.

The first step in this process is having a vision and a plan for your organization: a vision in which organizational leaders embrace the role technology will play in day-to-day operations.

This vision is also one that recognizes the business impact of utilizing technology and, even more important, recognizes the negative business impact of not keeping up with technology in healthcare. A solid EHR plan will provide for stability, incremental changes, and fiscally sound decision-making over time.

A team approach

Implementing an EHR system is more than a one-person endeavor. Form a steering committee that includes decision-makers within the organization.

In a typical long-term care facility, the steering committee might include

* the administrator

* the director of nursing

* the business office manager

* the health information/medical records manager

* a representative for staff development

Include other members of your staff who champion the switch to EHR technology--they will help to keep the group focused and on task.

The steering committee establishes the organizational vision, devises the migration path, and oversees the implementation of the plan. An organization may choose a larger steering committee and include members from all disciplines affected by an EHR, such as social services, nutrition services, activities, the medical director, and therapy. Or, it may choose to include the disciplines in project-specific workgroups and keep the steering committee small.

Workgroups can be formed underneath the steering committee to tackle specific applications and implementation. Typically, someone from the steering committee is the leader of the workgroup.

If EHR and health information technology (IT) hasn't been part of the organization's culture, the steering committee should educate itself on what is happening in the industry by reading articles, attending seminars, benchmarking against other facilities, etc.

Watch for opportunities to bring in staff with an interest and skill level in health IT. With staff turnover in key positions, take the opportunity to update the skill level and competencies that support the organization's migration to EHR.

Some personnel will need to acquire additional expertise. It is critical to have a healthcare information management (HIM) professional with electronic HIM skills in place to manage the EHR system once it is implemented.

Buying an EHR system

The process of investigating and purchasing a system is complex and requires a planned approach. You might want to consider the HL7 EHR System Functional Model standard as a framework for development. The standard identifies the type of functionality that long-term care EHR vendors should strive to provide over time.

It is important to recognize that no system will meet the HL7 EHR standard today--it is a framework as healthcare moves toward standards for clinical content and interoperability.

It is just as important to understand a vendor's plans for tomorrow as it is to know what it offers today. Consider a migration path (see "Why do I need a migration path for the EHR" on p. 22), which will provide another tool to help you evaluate a potential vendor and the partnership you will have over time as the EHR system unfolds.

Why do I need a migration path for the EHR?

Once you realize that implementation of an EHR isn't done in one giant leap, but in a thorough process that evolves over time, it is easier to recognize that you're on a migration path, on which you take strategic, planned steps toward your goal.

The following table, an example of the phases of a migration path, illustrates the concept.
Phase I Phase II Phase III

Migrate all Document imaging Interface with tab,
facility-generated and workflow pharmacy, and acute
documentation technology care hospital and
to the EHR to digitize provide patient/
 external documents representative access
 and financial records to lab tests and other
 key clinical
 through a patient

Phase IV Phase V

Computerized Connect to local
physician order health information
entry from remote exchange
location/clinic with
clinical decision

The advantage of a migration path is being able to plan for new or upgraded technology and infrastructure associated with a new phase. It also helps to keep you from reacting to the "hot" trends of the day.

The migration path above shows an organization moving systematically toward the vision for an EHR. The phases may vary in length and should address network infrastructure needs, user interfaces, and facility operations.--Michelle Dougherty

Michelle L. Dougherty, RHIA, CHP, is director of practice leadership for the American Health Information Management Association. In her role as director, Dougherty provides professional expertise on health information practice issues. She also serves as coordinator and project manager for a number of task forces. Contact her at
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Title Annotation:THE ABCS OF EHR
Author:Dougherty, Michelle
Publication:Contemporary Long Term Care
Date:Nov 1, 2006
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