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Nursing Homes Magazine (1998)

Thu, 03/23/2006 - 9:21am — Karen Stevenson
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8 Easy Steps to Maximize Your Computer System

Nursing Homes Magazine, January 1998

By Karen Stevenson Brown

As the chief financial officer of a nursing home chain for nine years and as a consultant to long-term care facilities, I have seen firsthand the problems involved when a facility automates processes that once were performed manually. And I've seen how much of that hard work can go to waste when the system, once installed, isn?t used to its capacity. Put succinctly, automation can be a confusing field, strewn with many land mines. I have identified eight basic steps that any facility can follow in order to ensure that its system is being used properly and to its maximum potential. They are: Plan Test Adapt/eliminate/automate Experiment Connect Train/document Protect Trust. Some of these steps are nothing more than common sense, but of course common sense can fly out the window when people become intimidated by the computerization process. The $20,000 to $50,000 that a freestanding facility might expect to spend for an informahon management system can then become nothing more than a costly exercise in futility. Taking them one at a time, then: Plan Developing a plan for a computer system involves three key elements: First, you should identify a champion?someone who enjoys working with computers, has an aptitude for it and will take responsibility for the project. That person might not be someone in finance. It could be a clerk, a secretary or a nurse? almost anyone. Second, you need to look at the overall project; in other words, simply think ahead. Third, build plenty of flexibility into your system. It?s a good assumption that changes will occur. Regulations change. Personnel change. People come up with new and better ideas for carrying out procedures. It?s important to anticipate those changes and allow for them so that you don?t have to redo your system when the changes come. Test Once a plan is in place, test the system that will implement it. Many, many facilities get their computers installed and take off running, without first testing to see whether they are working correctly. They end up with bad data before they have even identified the underlying problems. It?s also important to not only test how your computers perform routine processes, such as billing for typical services provided to a typical resident, but also how they will handle unusual situations. For example, if someone comes into your facility as a resident and for some reason leaves that same day, will that trigger billing glitches? In order to test whether your system will take care of out-of-the-ordinary scenarios, it is a good idea to have a test, or practice, database to use for testing various possibilities, so that you don?t damage your facility?s actual data. Your vendor can help you set up a test database, which performs exactly like your genuine database but does not interact with the information you have stored in your system. You can put any data into it you like to similate real-life scenarios. Test a wide variety of possible processes for billing and for managing clinical data, and be sure to test them across months and years to see if the system will do what it is expected to do over time or, specifically, at the end of a fiscal year. Adapt/Eliminate/Automate This is the most important of the eight steps, and it is an area where I?ve most often seen problems. For this step it might be advisable to bring in an outside consultant. People can become so mired in the way they?ve always done things that a "fresh eye" might be helpful for process improvement. Once you have tested your system and understand what it can do, and once you?ve built your initial database, you might need to make some adjustments. For example, if you want a report to be generated in a specific format but your computer software won?t produce that format exactly, you might need to adapt the report to fit the system?s capabilities. The (unacceptable) alternative would be to revert back to preparing the report manually, which of course defeats the purpose of automating. Sometimes it is necessary to stop and ask a few questions, such as, "Why us the report needed in that format?" If it is for regulatory reasons, you might not be able to make a change, but if it is merely a matter of someone?s personal preference, you can. You need to ask that person, "What information do you really need? What are you doing with it?" Then you can figure out how to get the desired information out of the system without falling back on a manual process. The eliminate phase of this step us quite simple. Stop and consider whether there is any process being done or paper generated that is no longer needed?and eliminate it Finally, find all the ways you can to automate. People unfamiliar with or new to using computers find this hard to believe, but it might be possible to make your system perform almost any function you need to have done It is simply a matter of becoming acquainted with your system and its capabilities The more you do that, the more automation will naturally evolve. Experiment As is true of testing, very few facilities take the time to do "play with" their systems to see what they will do. Again, they are often so thrilled to finally have computers that they dive right into the day-to-day work. Consequently, they never learn what their system is really capable of doing. There are two basic ways you can experiment: with what comes out of the computer (e.g., reports) and with what goes in (data). Experimenting with reports can be done in your actual database. Once the data are input, you can?t "hurt" them by exploring the various ways they can be compiled into a report. I suggest that you try every possibility you c~n imagine, to see what is most useful, and that everyone who needs access to the information should have a say in how it is presented. Experimenting with data going into the system is another story. For that you need to use your test database. Another area of experimentation involves user-defined fields, which most software has, where you can build additional information that you wish to track. This could involve, for example, inventories of residents? belongings or notes about residents? preferences or functional status You need to explore abut, to determine what specific information you want to keep track of, and why. Connect There are two aspects to this step: connecting staff with computers. and connecting your system with additional data and software. In terms of staff, you need to ask, "How many people have easy access to a computer? Do we have enough computers?" It is not at all uncommon for a facility, in an attempt to save money, to purchase too few machines, forcing too many people to have to share a computer. In that case, any money saved in the initial investment likely will soon be lost to inefficiency (not to mention the costs in staff frustration and poor morale). If someone needs to generate a report and does not have direct access to a computer, that person will end up having to ask someone else to do it, which will involve conveying (on paper or verbally) the information the report needs to include An even worse scenario: The person will simply take the path of least resistance and revert to producing the report manually and "keeping the computer out of it." There are very real costs associated with either of these mishaps. By connecting with additional data and software, I mean using the same data across various software packages. The same information stored for billing purposes, for example, can be entered into spreadsheet software for generating more flexible financial reports or creating budgets. Ideally, you should have a direct link between the different softwau~ applications, but many packages do not support this, so you might have to export data from one package and import them into another. Unless you have a staff member who is a computer expert, you might need help with this. Train/Document Most facilities do too little training and documenting of computer processes. This is extremely risky. You end up with one person who knows everything about your system and has nothing in writing to share with anyone else. This common pitfall arises because employees are busy and pressed for time. They feel they don?t have the luxury of "playing with computers." But it is better to spend the needed time today on training and documentation than putting yourself in the position of encountering frustrating, time-wasting snags down the road. Also, if your one-person storehouse of information becomes ill or resigns on short notice, you might find yourself back at square one. To avoid this, give your trained staff members the time they need?and be sure they take the allotted time-for training others and for writing down the computer procedures they are following. Another precaution: Do not be lulled into a false sense of security by the documentation (set of instructions) that comes with your computer software. This documentation might be poorly written, out of date or too general. Furthermore, a piece of software sometimes can be used in a variety of ways. If the software vendor suggests an optimal way to use it, be sure the vendor?s instructions on this get written down. Protect Anyone with computer experience has seen data evaporate into software heaven. This is decidely unpleasant. To avoid this, first, be sure that a backup copy of all your data is made daily, and that a copy is made weekly to be stored off-site (outside the building?not just in another part of the facility). Your staff might protest, saying, "But that takes three tapes and three hours." Nevertheless, insist that these regular backups are done and explore whether the purchase of a larger tape drive might be more cost-effective. Secondly, many facilities are now using networks?in other words, multiple computers that are connected to and can be accessed from each other. Protecting data is a more complicated issue in a network than for a single-user system, and unless you have an in-house networking "guru," it is likely that local, outside technical support will be needed to identify the best method of protecting data exposed to a network environment. The third protective measure to consider is providing your computer hardware with an uninterruptible power supply. Power outages can corrupt or even destroy data. Be certain that all your computers are connected to adequate power-surge protectors; ask your vendor which ones are best, because some of them are basically nothing more than high-priced extension cords. The final issue of protection involves the much-publicized "Year 2000 Problem," also known as Y2K. In layman?s terms, many computers and computer software packages were not designed to advance beyond the year 1999 in their date-associated recordkeeping. [Editor?s note: For a comprehensive explanation of Y2K, how to know whether it affects you and what you should do about it, see the November/December issue of Nursing Homes, page 42.1 You need to find outif your computers and/or software fall into the Y2K problem category. If they do, the time to deal with the problem is now. Incidentally, some people think that if their facility is not using a mainframe computer or they?re not doing extensive in-house programming, Y2K won?t affect them. That is simply not true. Trust The bottom line is that you want to have a computer system you can trust. First, find out if the system accurately processes information, and if not, work with your vendor to be certain the problenis aren?t being caused by operator error. If you put in the right information but don?t get out the right information, you really can?t trust your system and you need to replace it. Once a system has been fine-tuned and proven to be capable of performing necessary tasks, and once adequate procedures have been established and are being adhered to, it is time (finally) to relax, with the firm belief that if you?ve put the right information in, you will get the right information out (the opposite of "garbage in/garbage out"). Now you are ready to use the information to manage your facility, probably better than it?s been managed before. Final Note If you need help with any of the steps, it is a good idea to obtain technical assistance from your hardware! software vendors or hire a consultant to assess your system and help with troubleshooting and problem solving. Ideally, that consultant should be someone who understands both computers and the computer applications unique to long-term care facilities. Karen Stevenson-Brown is Manager of Consulting Services, MCGladrey & Pullen, LLP, Bloomington, IL. For further information: (309) 827-5531.

8 Easy Steps to Maximize Your Computer System

Nursing Homes Magazine, January 1998

By Karen Stevenson Brown

As the chief financial officer of a nursing home chain for nine years and as a consultant to long-term care facilities, I have seen firsthand the problems involved when a facility automates processes that once were performed manually. And I've seen how much of that hard work can go to waste when the system, once installed, isn?t used to its capacity. Put succinctly, automation can be a confusing field, strewn with many land mines. I have identified eight basic steps that any facility can follow in order to ensure that its system is being used properly and to its maximum potential. They are: Plan Test Adapt/eliminate/automate Experiment Connect Train/document Protect Trust. Some of these steps are nothing more than common sense, but of course common sense can fly out the window when people become intimidated by the computerization process. The $20,000 to $50,000 that a freestanding facility might expect to spend for an informahon management system can then become nothing more than a costly exercise in futility. Taking them one at a time, then: Plan Developing a plan for a computer system involves three key elements: First, you should identify a champion?someone who enjoys working with computers, has an aptitude for it and will take responsibility for the project. That person might not be someone in finance. It could be a clerk, a secretary or a nurse? almost anyone. Second, you need to look at the overall project; in other words, simply think ahead. Third, build plenty of flexibility into your system. It?s a good assumption that changes will occur. Regulations change. Personnel change. People come up with new and better ideas for carrying out procedures. It?s important to anticipate those changes and allow for them so that you don?t have to redo your system when the changes come. Test Once a plan is in place, test the system that will implement it. Many, many facilities get their computers installed and take off running, without first testing to see whether they are working correctly. They end up with bad data before they have even identified the underlying problems. It?s also important to not only test how your computers perform routine processes, such as billing for typical services provided to a typical resident, but also how they will handle unusual situations. For example, if someone comes into your facility as a resident and for some reason leaves that same day, will that trigger billing glitches? In order to test whether your system will take care of out-of-the-ordinary scenarios, it is a good idea to have a test, or practice, database to use for testing various possibilities, so that you don?t damage your facility?s actual data. Your vendor can help you set up a test database, which performs exactly like your genuine database but does not interact with the information you have stored in your system. You can put any data into it you like to similate real-life scenarios. Test a wide variety of possible processes for billing and for managing clinical data, and be sure to test them across months and years to see if the system will do what it is expected to do over time or, specifically, at the end of a fiscal year. Adapt/Eliminate/Automate This is the most important of the eight steps, and it is an area where I?ve most often seen problems. For this step it might be advisable to bring in an outside consultant. People can become so mired in the way they?ve always done things that a "fresh eye" might be helpful for process improvement. Once you have tested your system and understand what it can do, and once you?ve built your initial database, you might need to make some adjustments. For example, if you want a report to be generated in a specific format but your computer software won?t produce that format exactly, you might need to adapt the report to fit the system?s capabilities. The (unacceptable) alternative would be to revert back to preparing the report manually, which of course defeats the purpose of automating. Sometimes it is necessary to stop and ask a few questions, such as, "Why us the report needed in that format?" If it is for regulatory reasons, you might not be able to make a change, but if it is merely a matter of someone?s personal preference, you can. You need to ask that person, "What information do you really need? What are you doing with it?" Then you can figure out how to get the desired information out of the system without falling back on a manual process. The eliminate phase of this step us quite simple. Stop and consider whether there is any process being done or paper generated that is no longer needed?and eliminate it Finally, find all the ways you can to automate. People unfamiliar with or new to using computers find this hard to believe, but it might be possible to make your system perform almost any function you need to have done It is simply a matter of becoming acquainted with your system and its capabilities The more you do that, the more automation will naturally evolve. Experiment As is true of testing, very few facilities take the time to do "play with" their systems to see what they will do. Again, they are often so thrilled to finally have computers that they dive right into the day-to-day work. Consequently, they never learn what their system is really capable of doing. There are two basic ways you can experiment: with what comes out of the computer (e.g., reports) and with what goes in (data). Experimenting with reports can be done in your actual database. Once the data are input, you can?t "hurt" them by exploring the various ways they can be compiled into a report. I suggest that you try every possibility you c~n imagine, to see what is most useful, and that everyone who needs access to the information should have a say in how it is presented. Experimenting with data going into the system is another story. For that you need to use your test database. Another area of experimentation involves user-defined fields, which most software has, where you can build additional information that you wish to track. This could involve, for example, inventories of residents? belongings or notes about residents? preferences or functional status You need to explore abut, to determine what specific information you want to keep track of, and why. Connect There are two aspects to this step: connecting staff with computers. and connecting your system with additional data and software. In terms of staff, you need to ask, "How many people have easy access to a computer? Do we have enough computers?" It is not at all uncommon for a facility, in an attempt to save money, to purchase too few machines, forcing too many people to have to share a computer. In that case, any money saved in the initial investment likely will soon be lost to inefficiency (not to mention the costs in staff frustration and poor morale). If someone needs to generate a report and does not have direct access to a computer, that person will end up having to ask someone else to do it, which will involve conveying (on paper or verbally) the information the report needs to include An even worse scenario: The person will simply take the path of least resistance and revert to producing the report manually and "keeping the computer out of it." There are very real costs associated with either of these mishaps. By connecting with additional data and software, I mean using the same data across various software packages. The same information stored for billing purposes, for example, can be entered into spreadsheet software for generating more flexible financial reports or creating budgets. Ideally, you should have a direct link between the different softwau~ applications, but many packages do not support this, so you might have to export data from one package and import them into another. Unless you have a staff member who is a computer expert, you might need help with this. Train/Document Most facilities do too little training and documenting of computer processes. This is extremely risky. You end up with one person who knows everything about your system and has nothing in writing to share with anyone else. This common pitfall arises because employees are busy and pressed for time. They feel they don?t have the luxury of "playing with computers." But it is better to spend the needed time today on training and documentation than putting yourself in the position of encountering frustrating, time-wasting snags down the road. Also, if your one-person storehouse of information becomes ill or resigns on short notice, you might find yourself back at square one. To avoid this, give your trained staff members the time they need?and be sure they take the allotted time-for training others and for writing down the computer procedures they are following. Another precaution: Do not be lulled into a false sense of security by the documentation (set of instructions) that comes with your computer software. This documentation might be poorly written, out of date or too general. Furthermore, a piece of software sometimes can be used in a variety of ways. If the software vendor suggests an optimal way to use it, be sure the vendor?s instructions on this get written down. Protect Anyone with computer experience has seen data evaporate into software heaven. This is decidely unpleasant. To avoid this, first, be sure that a backup copy of all your data is made daily, and that a copy is made weekly to be stored off-site (outside the building?not just in another part of the facility). Your staff might protest, saying, "But that takes three tapes and three hours." Nevertheless, insist that these regular backups are done and explore whether the purchase of a larger tape drive might be more cost-effective. Secondly, many facilities are now using networks?in other words, multiple computers that are connected to and can be accessed from each other. Protecting data is a more complicated issue in a network than for a single-user system, and unless you have an in-house networking "guru," it is likely that local, outside technical support will be needed to identify the best method of protecting data exposed to a network environment. The third protective measure to consider is providing your computer hardware with an uninterruptible power supply. Power outages can corrupt or even destroy data. Be certain that all your computers are connected to adequate power-surge protectors; ask your vendor which ones are best, because some of them are basically nothing more than high-priced extension cords. The final issue of protection involves the much-publicized "Year 2000 Problem," also known as Y2K. In layman?s terms, many computers and computer software packages were not designed to advance beyond the year 1999 in their date-associated recordkeeping. [Editor?s note: For a comprehensive explanation of Y2K, how to know whether it affects you and what you should do about it, see the November/December issue of Nursing Homes, page 42.1 You need to find outif your computers and/or software fall into the Y2K problem category. If they do, the time to deal with the problem is now. Incidentally, some people think that if their facility is not using a mainframe computer or they?re not doing extensive in-house programming, Y2K won?t affect them. That is simply not true. Trust The bottom line is that you want to have a computer system you can trust. First, find out if the system accurately processes information, and if not, work with your vendor to be certain the problenis aren?t being caused by operator error. If you put in the right information but don?t get out the right information, you really can?t trust your system and you need to replace it. Once a system has been fine-tuned and proven to be capable of performing necessary tasks, and once adequate procedures have been established and are being adhered to, it is time (finally) to relax, with the firm belief that if you?ve put the right information in, you will get the right information out (the opposite of "garbage in/garbage out"). Now you are ready to use the information to manage your facility, probably better than it?s been managed before. Final Note If you need help with any of the steps, it is a good idea to obtain technical assistance from your hardware! software vendors or hire a consultant to assess your system and help with troubleshooting and problem solving. Ideally, that consultant should be someone who understands both computers and the computer applications unique to long-term care facilities. Karen Stevenson-Brown is Manager of Consulting Services, MCGladrey & Pullen, LLP, Bloomington, IL. For further information: (309) 827-5531.
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