Continued from page 28 Transitioning to EHR requires a thought-


Use of Electronic Health Records and Support for Electronic Health Information Exchange Among Residential Care Communities, by Community Bed Size: United States, 2014


All communites


10 15 20 25 30 35


0 5


4-25 beds 32 29 26 19 12 20 16 21 26-50 beds More than 50 beds


ful process. It took Five Star about a year to find the right vendor. Then the company piloted the project at one location and had to study and outline all of its procedures well enough to have a designer fully depict them in an electronic process. “We had to under- stand from beginning to end the whole pro- cess, from when the resident referral comes to us, and who does what along the way, up to the time they actually come to the commu- nity, and all the touch points and work people needed to do,” Wheatley said. “You had to map the steps before you could look at the system. … We were able to eliminate a lot of duplicative or repetitive things.” New records systems like other new pro-


Used electronic health records


Support for any electronic health information exchange


Source: CDC/NCHS, National Study of Long-Term Care Providers, 2014


cesses are part of change management. New systems mean new processes and training, both of which should be factored into launch- ing an electronic health records system. “You’ve got to implement a good EHR


system and prove you can provide the level of care families are looking for,” Hart said.


TELEMEDICINE DECREASES ER VISITS FOR SENIOR LIVING RESIDENTS


High-intensity telemedicine can reduce emergency room visits and improve senior living care, researchers at the University of Rochester School of Medicine and Dentistry in New York concluded.


In the study, emergency room visits decreased 18 percent among those who lived in communities where high- intensity telemedicine was available. In a separate article about the same study, communities with “more engaged” telemedicine experienced an 11.3 percent reduction in acute hospitalizations. Less engaged communities saw a 5.2 percent reduction.


The Agency for Healthcare Research and Quality funded the study, including paying the clinical technicians. Communities entered the program between December 2010 and August 2011. The study ended in November 2013.


Residents enrolled through a single geriatric practice, providing primary care to residents in 22 senior living companies. Six had access to the telemedicine intervention; 15 did not; one didn't participate.


Telemedicine was only available 8 a.m. to 6 p.m. Monday through Friday. Researchers discontinued weekend service for lack of use. The trial wasn't random, a decision researchers made to ensure diversity within the group.


30 SENIOR LIVING EXECUTIVE / JULY/AUGUST 2016


The researchers also said information may be omitted because urgent care centers didn’t consistently send medical records to the practice. Researchers also said more study is necessary to better understand resident and staff engagement and how to improve it.


The articles were published in the March and June issues of Telemedicine and e-Health, a peer-reviewed publication.


Researchers defined high-intensity telemedicine as video or phone conferencing supplemented by onsite clinical technicians with training similar to a nurse’s aide and additional training in geriatrics and telemedicine. Diagnostic aids — medical histories, reconciled medications, vital signs, specimens for lab testing, electrocardiograms — were used.


Communities were considered more engaged if they had more than five telemedicine visits per 100 people in a month.


There were 517 telemedicine visits during the study. Providers made definitive decisions in 503 visits, or in 97.3 percent. Doctor or emergency room visits weren’t necessary in 465 or 89.9 percent of the cases. Nineteen visits resulted in emergency room visits. Thirty-three telemedicine visits required in-person follow ups with primary care providers within 24 hours.


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