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Introduction

In the recent past, electronic health records have become an integral part of the improvement of health care systems. This is because they have the potential to improve the quality of care provided to patients, increase efficiency, subsequently reduce costs and even strengthen the relationship between hospitals, physicians, and patients. Furthermore, when used, they create data repositories which in turn are used in the establishment of frameworks that can be used to improve disease management, preventive care, and quality improvement systems (Carter, p. 249).

Long-term care (LTC) calls for full support and care from the front-line workers. The human element in caring for a frail and aged population is a very important element that cannot be replaced by technology. The application of health information technology (HIT) is only meant to improve the quality of care and deliver positive outcomes. Currently, providers are adopting a broader perspective of HIT. They see it beyond the elimination of paperwork and automated charting (Greifinger Joseph and Goldenson, p. 495).Instead, they see HIT, specifically electronic health records as; tools that are essential in summarizing the trends in patient care enhance providers decision-making, monitor the application of evidence-based diseases protocol, reduction in errors and even improve safety and quality. The prime goal of having an EHR is to bring an improvement in patient and disease management and not only records management. Health care experts now hold a belief that further progress in LCT in terms of quality and efficiency and this progress they believe, can only be brought about by HIT solutions (Carter, p. 249).

A Review of the Literature

Electronic Health Records (EHR) and Long Team Care (LTC) Defined

According to Hyeoun-Ae, Muray and Delanie (p. 325), an electronic health record (EHR) denotes a repository of data belonging to individual patients in a digital form. This data is exchanged securely and can be accessed by multiple authorized users. EHR contains retrospective concurrent and prospective information. A typical EHR has a primary purpose of supporting provision for continuing, quality integrated and efficient health care. For an EHR to achieve its purpose, it should have a standardized or commonly agreed logical information model independent of EHR systems. Long-term care on the other hand, is care system that accumulates significantly more clinical information on a patient due to the fact that patients stay here for a considerable long time. Long-term care systems focus mainly on the clinical documentation of the patients care for medical administration and nutrition. It is a requirement for the health care providers to maintain the patient care plan, diet and the minimum data set. The minimum data set is based on the level; of care that sets the reimbursement rate for every long-term care (LTC) patient (Lehmann, Abbott & Roderer, pp. 97-98).

Clinical and Operational Benefits of EHR

It is well documented that, the adoption of the EHR in skilled nursing facilities (SNF) is estimated to be only one percent. This directly affects hospitals and it makes them lag. It is however a fact that, EHR if implemented in nursing homes can yield very many benefits. Nursing homes are therefore advised to adopt the EHR in earnest because, unlike hospitals that attend to the unique episodes of care for patients of all ages, those dwelling in nursing homes are older and frail. Nursing homes should also be early adopters because, 50% of their residents stay for a minimum of one year and 21% stay for five years. Due to these long stays, alongside the fact that the average SNF residents receive six to seven medications in a day, in order to alleviate the multiple chronic conditions they have, it is therefore prudent to have an electronic health record. Its implementation will be vital in that, it will prevent possible drug interactions, facilitate track assessments and help monitor clinical outcomes. The EHR will work better than the recurrent methods.

Electronic health records are also beneficial operationally in the following ways; first, an EHR that also undertakes the tracking of bills and reimbursements is capable of bringing improvement and streamlining regulatory compliance. In addition, it can significantly reduce and ultimately eliminate paperwork redundancies and enhance charge capture. Moreover the EHR will reduce to the lowest level the amount of time spent in charting. Second, EHR provides an opportunity to bring together operational improvements in back-office activities because they provide evidence-based protocols for caregivers. This in turn can dramatically improve how SNF functions. Last but not least, electronic health records give the caregivers an opportunity to give more care to the elderly since the EHR improves efficiency in paperwork and increases the knowledge about the residents conditions (Greifinger Joseph and Goldenson, p. 495).

Implementation of Electronic Health Records (EHR) in Long Term Care (LTC) Settings

Care providers contemplating implementing the EHR should always bear in mind the fact that, LST settings are significantly different from hospitals and physicians offices. The variation is brought about by the difference in; staffing ratios, staff training, care management assessments and systems in place, not forgetting regulatory and reimbursement requirements. The above-mentioned are substantially different in a LTC setting. It is important to note that, an EHR designed for an acute or ambulatory care setting will be very different in terms of functional ability as compared to the one developed for the LTC setting. It is also possible that, it may not be adequately converted for long-term care use. It is essentially important when exploring HIT and EHR to consider only those that have been developed specifically for the operational and clinical requirements of LCT settings.

Since long-term care employs low technology in their premises, paper, custodial care, and manual functions take most of the clinicians time. The implementation of EHR will replace the entrenched care techniques. To manage the culture change therefore, planning and sensitivity analysis are paramount. For the maximum benefits of EHR to be realized, employee buy-in and shared learning must be introduced at all levels of clinicians and administrators are required to facilitate EHR adoption. In an endeavor to implement EHR, the following steps can be followed; first, an assessment needs to be carried out. This assessment is to be conducted on the workflow in the entire facility. The assessment will help understand the needs, policies, procedures from the nurses, certified nursing assistants, physicians, and administrators point of view before an EHC is implemented. Second, an on-site training center should be created coupled with hands-on experience so that equipment competency can be tested. Third, a group of dedicated and highly trained personnel should be established. This group should include; facility administrators and department managers. They are the ones charged with the responsibility of training and supporting other users after the initial period. The fourth and last step when implementing an EHR entails carrying out internal marketing together with change management campaigns to boost the employees morale on the change (Walker et al, p. 9).

Adoption of Electronic Health Records (EHR) in Long Term Care (LTC) Settings

In order for the system to get maximum benefits from EHR, information must be collected and dispensed from the point of care. Lack of this only means that, there will be a continual use in paper records, until when the information is entered in a computer station that is fixed. This will lead to an increase in the possibility of errors and cause a decrease in efficiency (Reel, and Ivo, p. 163). The significantly lower costs and the availability of tablet computers, rugged laptops and handheld portable assistants (PDAs), can be helpful since they support the mobile nature of clinical staff. In a bid to encourage adoption and utilization of EHR in LTC, an instantaneous software response time is mandatory. When a slow system or one without the recent data is adopted, it will not be fully utilized hence resulting in the failure of the EHR. In addition, the system adopted should be able to automatically synchronize to ensure that, the most accurate data is at the clinicians disposal to avoid safety lapses that may emanate if the user accidentally forgets to upload the residents information to a central data source (Greifinger Joseph and Goldenson, p. 495).

The benefits that can be gained in data entry at the point of care (POC) and real-time information sharing, can be improved further by encouraging the use of single data source to carry all the necessary information belonging to a particular patient. The single data source should therefore be placed in a secure central data center away from the facility. This then guarantees authorized users to access current information and prevents data omission that may arise from the use of multiple data sources that do not synchronize properly. It is equally important to consider safeguarding protected health information while an EHR is being used both from remote sources and within the facility. This is due to the fact that, some EHRs store patients data in PDAs and laptops before synchronizing with the central database. This poses a risk of loss of the vital information through the loss of the devices. However, this risk can be mitigated by using EHR that shares information with mobile devices using secure real-time devices (Greifinger Joseph and Goldenson, p. 495).

Cost Considerations

It has been deduced from studies conducted that, lack of capital has contributed significantly to the non-implementation of HIT solutions. Lack of finances hampers the acquisition of the necessary equipment, training and maintenance. It is therefore the responsibility of vendors to ensure that, they provide facilities and prices with no hidden costs that may derail the project or limit a products use altogether. Purchasers on the other hand are required to investigate ASP models in order to mitigate costs and avoid investing large sums of money in data servers and IT equipment. In addition, when selecting an EHR vendor with an ASP model, purchasers should ensure that the model will edge technology with redundant systems. Moreover the speed of the ASP-hosted system must be fast to the end-user. For EHR operations that are designed to operate using the internet, they must be developed along with compact and efficient transactions. This is important because it will optimize the size and quality of information flowing between the PDAs and the secure data center. On the same note, an ASP mobile EHR that is designed well is capable to operate effectively on a smartphone even without a broadband internet connection. Lastly, alongside the cost of initial installation, and training, the installed facilities should have internet support and live telephone at all times. This is very important in ensuring that problems are addressed immediately hence patient care is maintained.

Conclusion

It is always inevitable to recoup the costs of poor care. This is because care affects patients directly ranging from; temporary setbacks experienced in rehabilitation, incorrect and inconsistent treatment regimens to the death of patients. Poor care is likely to cause a great burden to both the administrators and the clinicians. This scenario may lead to high labor turnover and may even lead to fines.

An EHR system that is fully supported by a health information infrastructure may enhance clinical and operational benefits to an LTC setting. Before the selection of an EHR vendor, the facilities current problems and inefficiencies must be assessed. After an honest assessment is carried out, realistic goals can then be established. It is therefore the goals established that can be used to come up with a list of requirements for the EHR vendor. Through a thorough survey of all the available information solutions in the market, the facility can then select an EHR vendor offering the best mobile technology, functionality and commitment to service. By so doing, the nursing home will adopt the system with the maximum benefit. Also, through this, the nursing home will be able to attain its goal of improved clinical and financial outcomes.

Works Cited

Carter J. Electronic Health Records: A Guide for Clinicians and Administrators. Philadelphia: ACP Press. 2008.
Greifinger R. Joseph A. and Gordonson J. Public Health Behind Bars: From Prisons to communities. New York: Springer. 2007.
Hyeoun-Ae, P. Muray, P., and Delanie, C. Consumer Centered Care for Healthy People: Proceedings of the National Congress on Nursing Informatics. Amsterdam: IOS Press. 2006.
Lemann p, Abbott, P. and Roderer, N. Aspects of Electronic Health Record Systems. New York: Birkauser. 2006.
Reel S. and Ivo Lu.A. Business and Legal Essentials for Nurse Practitioners: From Negotiating your First Job through owning a practice. London : Elsevier Health Sciences. 2007.
Walker J. Bieber, E., Richards, F. and Backley. Implementing an Electronic Health Record System. New York: Springer. 2006.

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