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Oatway: Active Managing Technology Cheat Sheet by

Managing techology in nursing homes
technology     snf     ltc     managing

Introd­uction - Challenges

The technology required in long-term care must be actively managed. The time has passed when allowing the computer systems and other technology used in long-term care to simply exist and assume they are working. An investment in technology must be actively managed to ensure the ever-s­carcer primary resource, people, are as productive as possible and client­s/r­esi­dents are getting care they need. Doing so is both a challenge and an opport­unity.

The systems and devices must be used, and they must be used correctly and effici­ently. Ineffe­ctive management will lead to failure. Insuff­icient attention to the requir­ements of systems, and failure to adequately staff and train users, has conseq­uences. Saving a small amount of staff or consultant time by curtailing training or system analysis may lead to any of the conseq­uences above, and is a very false economy.


Nearly all providers have made signif­icant invest­ments in techno­logies to assist in care and meet regula­tions. Years of experience with many of the nursing home and home care computer systems lead to two conclu­sions:

1. There are many systems available but no perfect one. (All vendors have to-do lists of things they'd like to add.)
2. Few (if any) providers are using their systems to their full potent­ial.

Nearly all nursing home and home health systems provide care planning support. Still, the staff in many organi­zations does the real care planning by hand. They may do computer entry to keep the computer and surveyors happy, but the real care is directed by other means. The duplic­ation is costly, and the discon­tinuity can be proble­matic.


1. Assign a person to be respon­sible for ensuring the technology is safe and is used effect­ive­ly.
2. Inventory all technology in use.
3. Establish a preventive mainte­nance program with outcome goals.
4. Establish an outcom­e-o­riented training program approp­riate for each product being used.
5. Provide approp­riate training to all new users, and regularly monitor current users to ensure they are using good practi­ces. If not, remediate.
6. Period­ically review all technology in use to be sure it is providing the benefits that are possible. Consider replac­ement as approp­ria­te.
7. Period­ically review processes in depth. Ideally, have this done by someone not part of the organi­zation for a fresh perspe­cti­ve. Consider the following:
Is there technology that could substitute for staff time?
Is it already available?
Are manual processes duplic­ating what systems do, or could do?
Are the processes more compli­cated than necessary?
Are all processes documented so someone else could carry on?
8. On staff satisf­action surveys, inquire into opinions, satisf­act­ions, and frustr­ations related to techno­logy.
Are there requir­ements or processes that seem unnece­ssary or overly complex?
Can they suggest better ways to do tasks?
Do they feel adequately trained to use the tools they need?
Do they think new staff is getting sufficient training?


David M. Oatway, RN, MPH, is a long-term care IT consultant based in Key West, Florida. He has been the Chair of the HIMSS Post-Acute Care Special Interest Group, Vice Chair of the American Associ­ation of Nurse Assessment Coordi­nation (AANAC), and a member of the American Health Inform­ation Management Associ­ation (AHIMA). He developed one of the first clinical MDS systems (CHAMP). He is the database manager of the STRIVE national nursing home time study which developed the RUG-IV Medicare PPS. He can be reached at daveo1­7@b­ell­sou­

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