In March of 2016, Carlton County Public Health & Human Services in Minnesota went live with Nightingale Notes EHR and began using it regularly in their health and human services department.

Today, a diverse group of about 40 staff, including administrative and billing staff, use Nightingale Notes each day.

Carlton County put together some excellent tools to complete their Nightingale Notes training efficiently, effectively, and smoothly.

Impressed by their efforts, Champ Software reached out to Carlton County to see if they’d be willing to share a little bit about their training and implementation journey and where they’re at now.

Patti Martin, Public Health Supervisor for Long Term Care and Joanne Erspamer, Public Health Supervisor for Family and Community took a moment to share about their experience onboarding with Nightingale Notes.


Carlton County Public Health & Human Services in Minnesota was founded in 1920 and serves a population of roughly 36,000.

Members of Carlton County can depend on the local public health department for needs such as:

  • Immunizations
  • Health education
  • WIC
  • Child growth tracking (Follow Along Program)
  • Family home visiting (FHV)
  • Smoking cessation
  • Child and teen checkups
  • Jail health
  • Long Term Care – care coordination and MNCHOICES assessments

As well as a host of other Public Health & Human Services and programs.

Carlton County’s EHR journey began about 11 years ago, spurred by the changing climate of health information technology.

Over the years, their first EHR vendor became more focused on homecare than public health and, knowing they needed to explore other options, Carlton County began their search for a new EHR.

Aside from being built for public health, one thing that especially drew Carlton County to Nightingale Notes EHR was the fact that it was web-based.

This was something their previous EHR had not afforded. Being web-based offered a new world of possibilities to Carlton County. Records could be easily accessed from anywhere and updated in real-time for everyone.

This was a key benefit for Carlton County and was ultimately instrumental in their decision to choose Nightingale Notes as their EHR.

Training Begins

Staff at Carlton County began training in November, 2015.

Training offered new challenges as such a diverse group of staff brought various learning methods to the table.

For some staff, the virtual training worked really well, while for others, the ability to take the eLeap tutorials offered between virtual training sessions was a big plus.

Another help was the ability to join the Topical Webinars offered by Champ Software.

These Topical Webinars are offered on a monthly basis on a variety of topics to all Champ Software clients and are a free, ongoing training tool.

Although Carlton County had years of previous experience with an EHR, there was still the ever-present learning curve in familiarizing themselves with a new EHR.

They found the Topical Webinars especially helpful because they would often have an “Aha!” moment, learning something they hadn’t realized was even a possibility in Nightingale Notes.

Overall, the virtual training, the eLeap tutorials, the Topical Webinars, the access to the Nightingale Notes Knowledgebase (with help articles and webinar recordings and notes), as well as the access to training and implementation facilitators all worked together to create a smooth training and implementation experience for Carlton County.

Tips for Training Success

When asked what advice they could offer other agencies for a painless training and implementation process, Patti and Joanne shared some excellent tips which echoed many experts’ top recommendations for successfully acclimating to new EHR software:

Diverse Implementation Team:

They put together an implementation team, and it wasn’t just any implementation team.

They worked hard to put together a diverse group of users.

“We tried to make it interdisciplinary, so case aides, accounting, nurses, supervisors, social workers, [were all represented],” shared Joanne, “Having an implementation team was, I think, essential and […] also so valuable.”

Their diverse team helped ensure each future user was appropriately represented, and offered a cast of capable and skill-varied “super users” who could help champion the process for the rest of the department’s staff.


During the training and implementation process, each unit was assigned a mentor as well as having access to the supervisors.

Patti said, “Our mentors have been so valuable. As supervisors we understand and learn the system really well, but we don’t have a lot of time to mitigate all of the daily use situations.

“I’ve seen incredible knowledge and efficiency grow through having a nurse mentor in every unit who is using it as it’s intended for charting on a daily basis. They’re coming up not only with solutions for things they find along the way, but are also able to answer co-workers’ questions. That’s been a really valuable tool.”

Policy & Procedure Manual:

Another thing Carlton County found helpful was the development of a policy and procedure manual.

“That really helped to cement ‘this is what we learned, and this is how we’re going forward.’” Patti explained.

The manual also helped provide a concrete reference for everyone and included definitions within the setup the health department had, and included detail on:

  • What service to choose
  • Which cost centers were available to use,
  • Which fields should be filled in

There was also an expectation that the manual would be revisited periodically and updated as they went.

Training Packet:

Other helpful insights Carlton County shared included following the training packet provided by Champ Software, “It really did give us some good guidance in our setup process.”

Information Gathering:

They also took time after learning the reporting piece to go back and really think about what information they wanted to be able to see in a report.

This helped Carlton County determine what information they wanted to collect on the front side.

Good Communication:

Additionally, and perhaps the best tip of all:

  • Foster good communication

“It’s been an agenda item on my unit meetings that we have roughly once a month,” Joanne shared, “It allows staff an opportunity to ask questions or voice any frustration.

We’ve had that real openness. The implementation team continues to meet and bring back [feedback, such as], ‘we’re noticing we need another program code,’ or ‘we’re noticing we have this problem occur; how do we work on that together and what do we need from Champ support?’

“Champ support has been really helpful too.”

All of these things set Carlton County Public Health up for success the day they finished training.

Patti remembers, “Going into our go-live date, because we had this implementation team, because we had followed our set up, because we’d gone back and thought about what we needed to put in to get the valuable information out, I think our go-live date was pretty smooth.”

Carlton County’s training and implementation plan didn’t stop at “go-live” either,

“As we use it, we continue to meet with our implementation team. We continue to find little changes we want to make or tweak.

“As you use it, you understand better how the system works,” Patti stated.

The Journey Continues

Asked how things are working with Nightingale Notes now that they’ve been live for a while, Patti and Joanne shared that things are going well.

Patti and Joanne have been navigating each new scenario and learning how Nightingale Notes works for their agency, specifically.

One example is Carlton County’s long term care unit.

“The long term care unit uses Nightingale Notes a bit differently … We’ve been using it for case note documentation; however we have not gotten to the point of attaching all of our documents.

“Right now we have developed a plan for scanning for long term care. We will pilot that with two of our nurses in January.

“We want to get to the place where everything is in Nightingale Notes. Right now it’s a combination,” Patti explained.

“Whereas in the home visiting nurses’ unit, we’ve been attaching files since the beginning,” Joanne added.

There are also things Carlton County is really excited about.

Patti said, “We found it to be really beneficial to be able to build on the knowledge of other agencies already using Nightingale Notes by borrowing shared reports and pathways…

“Some of those pre-built things were really helpful in our building process because we were able to get ideas and tweak and go from there. That was really helpful to ensure a smooth transition.”

Patti also shared their excitement over leveraging the Omaha System,

“I was excited to pull up an Omaha System pathway report and see charts. That was really exciting. Before Nightingale Notes we weren’t able to do that. Joanne was actually able to pull a report with some aggregate data to share with the board… The way the Omaha System is integrated into Nightingale Notes is really helpful.”

Joanne shared her enthusiasm, “I’m excited for the opportunity to use this for the community as a client; more of a population health model instead of a client based model.

“I’m just starting those conversations with my team to find what might be an easy topic area to start with. There is a really good Topical Webinar on [community as a client] and we did ask for specific training from Jean [Durch] on that; she did a good job with that.

“For public health, population health and figuring out how to measure outcomes is really a challenge.

“The fact that we can use pathways or even a custom tab to do some documentation– it’s a good direction to go forward in.”

Patti added, “We have a quality improvement council at Carlton County. That has given us an opportunity to look at Nightingale Notes and use it as a tool with some quality improvement projects.

“That has been a good thing. We were certainly able to identify some efficiencies by creating a specific report for staff. Our hope is to have a regional Nightingale Notes user group. We’d like to explore that further.

“One of the benefits of our entire region using Nightingale Notes is that we’re all implementing a targeted home visiting model, Healthy Families of America (HFA).

“We’re able to meet as a regional group and discuss how to build our system for HFA within our charting.

“So that even though we’re reporting as separate counties, we’re able to have those conversations and share that learning… It’s been neat to learn together for a certain targeted program.”

As the months have passed, Patti, Joanne and their staff are finding things getting smoother and seeing improvements.

Particularly, Patti and Joanne were excited with the efforts and advancements made by Carlton County’s accounting unit.

“They’ve done so much with how they need to design their reports and how they need to bill. It’s been essential and they’ve been fantastic.

“Also, we’d stress the importance of the accounting unit working directly with public health supervisors and staff, not only as part of the implementation team, but on an ongoing basis – individually and during unit meetings.

“We believe the communication level we have between our clinical and accounting units is unique for problem solving in the billing area.

“This communication has allowed us to locate problem areas quickly and to find a timely resolution for those issues, whether adding codes in the setup area or adjusting billing details.”

Champ Software is excited for the successes Carlton County has already had and is looking forward to exciting new successes to come.

Carlton County has done an excellent job of navigating their training and implementation phase as well as launching Nightingale Notes at their agency, navigating it all gracefully.

Their final thoughts on their journey:

“Any time you have change, it’s a big effort. We know it’s a process. But overall we’ve been happy with the process and with the support. We’re feeling good about where we’re at,” Patti said.

What to do next

If you want to know more of the Benefits and Features of Nightingale Notes, and how else we can help you, then why not Contact Us at (507) 388-4141 today.