The demand for quality care in skilled nursing is on the rise, competition within the industry is up, and the acuity levels of residents continue to increase. Because of this, long term care organizations demand tools with robust clinical and care continuum management features that help address the needs of residents in a way that is financially and operationally beneficial. 

The care skilled nursing offers isn’t one-size-fits-all. A skilled nursing software solution shouldn’t be either. Here are tips to guide the process of choosing an electronic health record (EHR) solution for a skilled nursing center.

Getting Ready

The first step toward a new software solution is to take the time to evaluate current software by eliciting honest feedback from staff. Is the team comfortable with the technology? Does the solution help meet the organization’s goals? Is support available when needed? 

If the answer to any of these questions is no, it’s time to consider switching to a more appropriate solution that can better meet changing business practices and evolving regulatory requirements or help prevent lost revenue.

Provide ample time to make a decision—generally at least six months before the desired implementation date. This will give the vendors on the center’s short list plenty of time to compose their request for proposal responses and to build a demo team for the organization’s needs. Deciding that an on-site demo is needed is another reason to plan for additional lead time.

After completing all the demos, allow plenty of time to review them, one at a time, with the team. It’s important to work together, sharing insights and observations, before making a final decision. After a decision is made there are additional implementation tasks to consider, including testing and staff training.

Choosing the Implementation Team

Every role on the implementation team is important to help ensure a successful outcome—from trainers and decision makers to communicators and, of course, the team at large. Here are some things to consider when assembling the team.

The project lead is critical to the success of software adoption and the implementation process. Look for someone with the skill to efficiently and masterfully lead the project from start to finish, even if that means shuffling responsibilities to free up time in the designated person’s schedule.

The coach is responsible for implementation and training. The coach serves as a liaison between operators of the current processes and the new software. Choose someone who is not only familiar with the new software, but also comfortable working with and coaching new users for success.

A chosen maintainer will help keep new software up to date after implementation. Select someone who can be counted on to stay on top of new releases, maintain user accounts, and educate staff on upcoming software changes. The person chosen for this role will also need to assist with letting people know how periodic system configuration will help in meeting the center’s evolving operational needs.

A liaison should be assigned to communicate changes. As with most projects, communication is key. In this situation, there is no such thing as over-communication. Assign someone to develop a plan to inform all stakeholders, including residents and their family members, about what is taking place and when.

Creating Teams

Some functions in the process will be done in groups. A selection committee should include people who represent the unique aspects of the organization and who understand how the software being considered will affect their work. Include a full set of individuals who represent all the key stakeholders who will be using the new software solution.

The final decision maker isn’t just a role, but a process, and may be a group or a specific individual, depending on the center’s preferences. Consider the organization’s corporate culture when choosing the person or people for this role.

Finally, don’t forget to consider the temperature of the team at large. How readily do they accept and adapt to change? How tech-savvy are they? Is this their first foray into skilled nursing software, or are they already accustomed to using technology to manage resident care and business operations?

If there seem to be challenges or resistance, consider seeking help with additional training or change management coaching to help ease the transition.

Preparing for Implementation

It’s important to remember that hundreds of skilled nursing centers have been through this process before and have come out on the other side ready to maintain census goals and offer quality care to residents.
Here’s what to consider while entering the implementation phase of the new EHR system:
  • Set up the project lead for success. The selection of the right project lead is critical. Now is the time to make sure that the designated person is allowed ample time to devote to this project. Be sure that the project lead is empowered to make decisions and to work confidently with the vendor.
  • Identify super users. Super users will play an important role in the adoption of the new software. Choose people that can be counted on to learn the new system and transfer their expertise to others. People who have strong communication and teaching skills are ideal super users.
  • Determine the roll-out approach. Work with the vendor to choose an approach that will work best for the organization. Typically, there are two options: the gradual roll-out where new features are added over time, and the “big-bang” roll-out in which everything is accessible from the beginning.
  • Plan for a pilot skilled nursing center or all centers. If the organization consists of multiple centers, it will need to decide whether to launch the new software as a pilot program at a single location or go live at all centers simultaneously.
  • Query configuration possibilities. To some extent, new software can be configured based on a facility’s unique goals and established workflows. Work closely with the vendor to determine how best to configure the new software, such as identifying options in drop-down menus that match the labels and names used in the facility.

Implementation Best Practices

When preparing to implement a new EHR, providers can expect some key steps along the way.
The vendor will assign a project manager (PM) to be the provider’s main point of contact. This person will be a guide through the implementation process and will make sure the system is up and running by the due date, keep the project on budget, and be a resource for facility staff. 

The basic steps to expect include:
1. Initiation. The first step is a discovery call with the assigned PM and all stakeholders. During this call, the PM will go over the basic implementation plan and features of the new EHR software.

2. Planning. The PM will conduct a process review and create an implementation plan. When the plan is final, the PM will review it with facility staff to make sure the needs of the community are included.

3. Configuration. This is when the development of the specific system begins. The setup is designed and configured based on the feedback that was received during the initiation and planning stages.

4. Deployment. After participating in training sessions where staff enter live data, the EHR software will be ready to use. Any additional training needs will also be determined during this step.

5. Optimization. Now that the facility is up and running on the EHR, there should be a post-implementation assessment to make sure the system is being used efficiently.

6. Transition. In the final step, the PM will pass the account over to the center’s individual account manager and support team. The PM will continue to work with the support team to address any additional needs staff may have.

Choosing and implementing new EHR software is a major undertaking. But early planning, choosing the right people for lead roles on the selection and implementation teams, and seeking support from the vendor can make the process run smoothly and boost the center’s financial and operational performance.
Kelly Keefe is vice president, community solutions strategy, at MatrixCare. She can be reached at