This case study investigates the implementation of a hybrid electronic medical record (EMR) system in a long-term care (LTC) facility, highlighting the weaknesses of paper-based records and advantages of EMR. It discusses barriers to adoption, reasons for project failures, and emphasizes the importance of staff acceptance and training for successful implementation. The study concludes that EMR systems can significantly enhance care quality and operational efficiency in LTC settings.

1. Created by Tom Kukulka
Graduate Capstone
Thursday, November 5, 2009

2. Introduction
 This is a case study that explores the process of
implementing a hybrid clinical electronic medical
record (EMR) system at a long-term care (LTC) facility
 An extensive interview was conducted, with an
administrative supervisor
 There were several questions asked, answers were
provided, and an analysis was given.
 A conclusion was drawn based on what was found in
the case study

3. Weaknesses of Paper-based Record
System
 Illegible handwriting
 Uncertain and incomplete data
 Data fragmentation
 Easily misplaced data
 Data difficult to transfer or copy
 Costs increases with larger office space, having a file clerk
on payroll, and use of transcription services
 Health information kept at different locations not available
at time of care (negative outcome and even possible death)
 Records could end up in wrong hands and not be
confidential

4. Advantages of an EMR system
 A single consolidated record
 Accessibility from anywhere and anytime
 Readability
 A report generator
 Information completeness and decision support
 Access to external knowledge
 Ability to sum up the result of certain treatment
 Faster more efficient diagnosis and treatment
 More face time with resident and family
 Privacy and confidentiality concerning patient record
 Enter data only once not for every form

5. EMR system barriers
 Costs
 Lack of technology expertise
 Software difficulties (lack of interoperability)
 The unwillingness to invest in systems with vague
financial rewards
 Physicians’ resistance to change
 Human factors and staff training

6. Why 50% of EMR projects “fail”?
 Selection of the EMR system was based on wrong
criteria for that particular facility
 Planning is so important as well as adequate training
and support from entire staff

7. Implementation Success
 Staff acceptance
 Willingness to use the system
 Must have high-level of end-user satisfaction, which is
the result of being designed to meet that facility’s
needs

8. Definition of Long-term care (LTC)
 Long-term care is“…care provided in a licensed nursing
facility that offers 24-hour nursing supervision and a
range of comprehensive medical, personal, and social
services coordinated to meet the physical, social, and
emotional needs of chronically ill or disabled
individuals” (Cherry, Carter, Owen, &
Lockhart, 2008).
 Individuals are referred to as residents who are
admitted to a LTC facility and generally reside in the
facility for several months to several years.

9. EMR in Long-Term Care Facilities
 Demand for LTC will increase
 Facilities have resident population age 65 and over
 Improve quality of care by spending more face-time
 Reduce costs

10. Adoption of EMR System
 Large national LTC chains and regional networks are
starting to adopt the EMR system
 Small privately owned LTC facilities generally avoid
Clinical EMR systems altogether

11. Sources of Funding
 Local, state, or federal government
 Insurance industry
 Pharmaceutical industry
 Several electronic sources are available:
www.foundationcenter.org
 Funding implementation in LTC facilities remains
quite limited

12. EMR System - Automatic Alerts
 Vital signs
 Incomplete documentation and critical elements of
medication administration
 Due dates for scheduled appointments
 Routine labs and immunizations

13. Computerized Provider Order Entry
(CPOE)
 Is an application physicians use to write orders using the
system (Robles, 2009).
 Physicians see alerts concerning medications at the time of
order entry, which forces them to make decisions then and
there
 Computer decision support system (CDSS) is built into the
CPOE system, which provides: assistance with diagnosing a
resident’s condition, assistance in determining proper drug
dosage, specific reminders to administer preventive
services to certain residents at a specific time…….
 CDSS can perform drug-drug interaction checks, drug
laboratory checks, drug allergy checks.

14. Beneficiary of EMR system
 Long-term care facilities could be significant
beneficiaries of the EMR development if their unique
characteristics and needs of their facilities are
considered in the development of the system
(Oatway, 2004)

15. Health Insurance Portability
Accountability Act (HIPAA)
 The HIPAA needed to be updated to include medical
privacy as a result of an increase in EMRs
 Long-term care facilities have to meet all HIPAA
requirements
 Federal privacy protection standards called “HIPAA
Privacy Rules” were established during former
President Clinton’s Administration . These were for
privacy of personal health information (PHI) of all
Americans (Longley, n.d.)

16. Medical Center Physician EMR
 Implemented system-wide
 Accessible 24 hours a day
 Information include: medical
history, medications, any residents
problems, allergies, vaccinations and lab data
embedded by outside vendors (Wilt & Muthig, 2008)

17. Clinical EMR System
 Implemented in 2007 system-wide
 There was a need for a more care-based, resident
focused system
 Used by assisted living facilities (ALFs) and skilled
nursing facilities (SNFs) as well rehabilitation and
home health

18. Implementation Challenges at
Health System
 One challenge encountered was the integration of the
Clinical EMR system with the already existing Medical
Center Physician EMR system
 Another challenge was automating the capture of the
Minimum Data Set (MDS) documentation that was
required by Centers for Medicaid and Medicare
Services.

19. Conclusion
 There are many benefits that the implementation of the
Clinical EMR system brought to long-term care facility:
fewer documentation errors, more face time with residents
and their families, ability to flag any work not done on a
previous shift, increase revenue from Medicaid
reimbursements, lower staffing and operation costs, and
physician order reconciliation would also be reduced
 Certain barriers were overcome by the facility (Integration
of the 2 systems) and (Automating capture of MDS
documentation which had to match assessment forms that
were filled out)
 Training was very important so that staff could get
comfortable using the Clinical EMR system

20. Any Questions???