How a nursing home improved nurse retention by 25 percent with the right EHR
About Chatuge Regional Nursing Home
Chatuge Regional Nursing Home operates as a part of Union General Health System, a large multi-faceted healthcare organization located in northern Georgia. It owns and operates 21 affiliated facilities and provides services that include emergency services, swing bed services, and telemedicine.
Recently, nurses at Chatuge Regional Nursing Home began requesting to be transferred to acute care at alarming rates; their reasoning was that they no longer wanted to deal with cumbersome software not specifically designed for long-term care. In a search for a more streamlined and efficient med pass system, IT specialist Brian Free and his team turned to WellSky (formerly Experience Care) for an electronic health record (EHR) technology that would better suit their needs.
Potential problems with selecting the wrong EHR
Seniors who turn to long-term care do so for a clear reason: They have specific needs and want them met in a comfortable environment. Larger organizations may sometimes overlook the unique requirements of long-term care, and instead implement the same EHR systems in nursing homes as they do in their hospitals.
However, Brian Free has found that this approach can lead to significant issues.
“Four years ago, when our hospital switched to our previous EHR, we tried to transition one of our nursing homes as well,” he said. “We tried twice, but it was so bad we decided against it. It’s slow and clunky and was made for hospitals, not nursing homes.”
At the heart of the matter was the fact that the EHR vendor didn’t want to hear the concerns of caregivers and residents. “They had zero interest at all in modifying anything to fit our needs or demands,” Free said. “In fact, the long-term care plans were completely unusable to the point that we had to do them on paper and scan them in. And because we couldn’t meet the minimum requirements, my state billing was a nightmare. We were having to use Excel spreadsheets to keep our revenue straight.”
Meanwhile, if a team decided to take the initiative and improve its workflow, it would have to pay a steep price. “If you want to modify [the previous EHR] within its parameters, you have to buy the license, which can cost close to three-quarters of a billion dollars for larger places,” Free said. In fact, one of his previous employers paid a substantial amount for a license from that EHR vendor.
Such outrageous costs are not feasible for most facilities. And in the rare case that they are, it’s difficult to adapt the EHR to the nursing home’s needs. Updating workflows to meet state requirements, for example, went to a change vote committee, which usually passed on solution updates that wouldn’t work for hospitals, even if they worked for nursing homes.
Another fallout of using an inefficient EHR is that it denies nurses the opportunity to do what they love most: interact with residents. Caregivers find themselves spending far too much time trying to perform basic tasks. “We would hear residents complain that their nurses are constantly staring at their computer screens,” he said. “And nurses felt they couldn’t give the kind of care they wanted or have the meaningful interactions that attracted them to long-term care in the first place. They had lost the ability to do that, because of an inefficient, and, some felt, very unsafe process.”
And entering med passes was an absolute nightmare, according to Free. “With [the previous EHR], it would take about 10 to 15 clicks,” he said. “We would have to go through so many steps just to start a med pass, get into their med admin, scan the patient, click through the list of medications, scan the medication, approve that med, cross-check, confirm you cross-checked. . .It’s ridiculous.” Free added that this would need to be done once for each medication of each resident. “It was like starting over each time,” he said.
Free described the process as “very cumbersome” and noted that a significant portion of the day would be spent simply documenting med passes. “In [the previous EHR], it would take us probably four to five hours just to get our morning med pass done, because it wasn’t designed for the type of med pass you need to do in long-term care,” he said.
This drawn-out process directly reduced staff retention. “Extra clicks add up when you do this over and over again,” Free said. “They take time, and then time becomes frustration, and frustration becomes burnout.”
Eventually, nurses had to choose between burnout or giving up on long-term care altogether. “They had to cut a lot of corners, and there were a lot of things that they were having to go back to paper on,” Free added. “And so we began to hemorrhage nurses because of [the previous EHR],” he said. “All but four nurses transferred to our hospital system because they didn’t want to be forced to use that system. And I couldn’t blame them.”
Winning back staff
After struggling to retain nurses, Free and his team knew something had to be done. That is when they pursued another EHR vendor, one that had earned a reputation for its intuitive design and strong awareness of the specific demands of long-term care. “WellSky has created an EHR that allows efficient and effective documentation and takes the opinions of facilities to help build the system going forward for best practices,” he said.
Shortly after making the switch, Free was able to see just how much time his team could save. “The design of the documentation and the med pass portion of WellSky work efficiently, which lets us move on and address other needs and concerns our residents have,” he said. “It now takes us about half the time, or two and a half to three hours less time, to do each med pass,” Free said. “That’s huge for us.”
“Within the first six months [of moving to WellSky], we were able to bring back 25 to 30 percent of the nurses who had transitioned to acute care, all just because of our new EHR system.”
Brian Free, clinical IT specialist, Chatuge Regional Nursing Home
No longer are nurses required to click tens of times unnecessarily. “It’s about 25 to 30% of the clicks from [the previous EHR],” Free said. “With the WellSky solution, you just go into the med pass module, select your whole session of residents, and then you can just go down through the MAR on your med pass, click it and go in,” he said. “It’s really simple. Just fantastic.”
This improved efficiency did not go unnoticed, as Free quickly began to see former nurses return to Chatuge Regional Nursing Home. “Within the first six months [of moving to WellSky], we were able to bring back 25 to 30 percent of the nurses who had transitioned to acute care, all just because of our new EHR system,” he said. This happened after the staff who remained began singing the praises of their new software solution. “The nurses who stayed with us were just spreading the word, saying, ‘Hey, this is so much better’.”
Free is confident that other facilities will experience the same thing. “Anybody that hasn’t made the switch should do so, because they’re going to see their retention and employee satisfaction improve,” he said. “WellSky is just a fantastic system for us. We like it so much that we’ve transitioned to all of their modules, and everything is now in-house for us.”
The benefit of listening to caregivers
Developing EHRs expected to support a wide range of tasks, ADLs, therapy, dietary restrictions, and more, but in long-term care, is not a simple process. That’s why it’s important to directly engage with caregivers to determine how to improve clinicians’ workflows. Unfortunately, communication between Chatuge and their previous EHR vendor was lacking. “They just push out a build after making a decision internally,” he said. “And then you just have to live with whatever adjustments they make. You would get your footing, and then they would just pull the rug out from under you.”
WellSky, however, involves its users every step of the way. “It has been a refreshing change to come to a system where the focus is on areas that we need in long-term care,” said Free. He attributes this sort of awareness to the tremendous clinical backgrounds of members of the WellSky team. “It’s built by people who used it for over a decade,” Free said. “And then it’s worked on by people using it on the floor. We get to work with the design team [in user groups], and it’s just fantastic. The result is a superior product that is just so much better for everybody.”
“… [WellSky’s system] is worked on by people using it on the floor. We get to work with the design team [in user groups], and it’s just fantastic.”
Brian Free, clinical IT specialist, Chatuge Regional Nursing Home
One of the advantages of monthly user groups is that users always feel engaged, and that allows them to feel confident in their compliance with federal and state regulations. “You receive help in doing those things you have to do to meet the ever-changing environment we seem to be in,” he said. He continued to explain, “In WellSky’s user groups, we discuss changes coming down the pipe, like ‘state said our UDA needs to have this.’ ”
That sort of exceptional communication allows users to warn each other about upcoming changes. “We get to share that the state keyed in on this particular problem during a survey and also say what they’re doing to fix it,” he said. “So, we all get ahead of the curve and aren’t caught flat-footed when state walks through our door.”
Even better, the team at WellSky updates the system for all of its users simultaneously. “They adjust the software, not just for you, but for the entire system based on the feedback or concerns you share,” he said. The team at WellSky also makes sure to keep its users updated as to any changes with which they might be unaware.
The result of these updates, according to Free, is a “far more agile system.” And that has proven valuable during the COVID pandemic. “It seemed like every week, there was a new regulation or something the CDC wanted us to document,” he said. “But we are right on it because they’ve been making the changes and providing us with the tools we needed or solutions within 48 hours.”
Customer support is there when you need it
Free expressed frustration over the customer support of his previous EHR vendor. “It would sometimes take three, four months before someone even looked at your ticket,” he said.
“We had to go on paper downtime procedures, because [our previous EHR vendor] just didn’t care.”
Brian Free, Clinical IT Specialist, Chatuge Regional Nursing Home
A major problem for Free was that he could not turn to his EHR’s support team when he needed them the most. “They didn’t have downtime MARs,” he said. “So, when the system was down, you had no way of documenting your MARs.” He explained that Directors of Nursing and other leaders would not receive emails that were supposed to be sent every twelve hours to ensure that current medication information is on hand even when the system is down. “I called their emergency helpline probably six, seven times before I could ever get a call back, which was six, seven hours later,” he said. “We had to go on paper downtime procedures, because they just didn’t care.”
Now Free and his staff are getting the responses they need. “Most of the time, I’ll hear back in an hour. And if I have a big issue, they will usually call me right back in a few minutes.” Meanwhile, when Free receives a question about his facility’s state survey, he simply emails the customer support team and gets an “almost immediate” response. “WellSky’s customer service is absolutely fantastic,” he said.
Learn more about how WellSky can support your long-term care facility today!