Improving outcomes

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Dave Wessinger
Dave Wessinger

Long-term healthcare providers are facing a tidal wave, and it's been dubbed the Silver Tsunami. It's estimated that by 2030, one-fifth of the U.S. population will be 65 or older and 70% of people turning 65 will use some type of long-term care during their lives.

While some may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages of care-related services, the transitions pose unique challenges for healthcare providers.

One type of transition may involve an individual who, as a result of an accident, was admitted to the hospital. From there, they went to short-term rehabilitation care and then on to either an assisted living facility or back home. During each phase, critical information, including medications, is collected. Traditionally, every episode of care tends to develop as a unique interaction and, as a result, care providers may not have a complete view of the patient's history.

When patients or residents move from one care setting to another, they may receive documentation and medical records that need to be transported along with them. Ideally, all the information that clinicians need to properly treat the individual will be available when they arrive at their new destination. This is not always the case.

However, there are ways that technology can help address challenges associated with transitions of care. I outline some key challenges and solutions below.

Unnecessary hospital readmissions

According to Florida Atlantic University, more than 1.6 million Americans currently live in nursing homes. Of that population, approximately 60% are sent to emergency rooms and 25% are admitted into a hospital within a year. According to experts, 28% to 40% of these admissions could be avoided with enhanced care in the skilled nursing facility. By decreasing hospital admissions and re-admissions, healthcare providers can avoid billions of dollars in unnecessary healthcare expenditures and crowded facilities, as well as avoid complications associated with hospitalization.

On October 1, 2012, the Centers for Medicare & Medicaid Services implemented penalties for hospital readmissions at a rate of one percent.  In 2013, this rate increased to two percent and on October 1, 2014 this rate will increase to three percent.  Current readmission rates are higher than what has been deemed acceptable for Medicare, and as hospitals continue to experience higher readmission rates they will need to pay close attention to CMS penalties in order to reduce the negative impacts this can have on their business. Moreover, by 2018, CMS is mandating that those same penalties that apply to hospitals will begin to apply to skilled nursing facilities.

INTERACT (Interventions to Reduce Acute Care Transfers) seeks to address this issue. The program was designed to improve the early identification, assessment, documentation and communication about the changes in the status of residents in skilled nursing facilities. INTERACT's goal is to improve care and reduce the frequency of avoidable transfers to acute hospitals.

Medication reconciliation

According to the Institute of Medicine's 2006 report, poor communication of medical information at transition points accounts for 50% of all medication errors and up to 20% of adverse drug events in the hospital. For example, an individual on blood thinners is admitted to the hospital for surgery. While there, they are taken off of their blood thinners, but when they are transferred to a skilled nursing facility to recuperate, the staff might not be informed that they were on blood thinners at all. The consequences of gaps in medication history can have catastrophic implications.

According to research done by the Assisted Living Federation of America, medication administration is the most commonly cited area for deficiencies across states.  In 2013, 76% of states reported common deficiencies with medication not being provided as directed, having an out of date physician order, and documenting medication administration incorrectly. 

It's essential that during every stage of care, providers have access to information that delivers a longitudinal view of the patient's medical history and care before they treat the patient.

Timely, secure communication

The research with the University of Missouri's Sinclair School of Nursing also found that clinical staff spends one to two hours per day making calls to clarify medication orders and 13% spend up to two to three hours. In addition to occupying valuable time, phone calls and voice mail messages may not be the most effective mode of communication. Doctors typically respond to text messages within 20 minutes and to a voice mail within an hour.

Secure, HIPAA-compliant texting allows physicians and clinical staff to communicate and collaborate regardless of location. It also reduces errors associated with manual paperwork and other manual processes.

Other forms of secure communication are also emerging. For example, healthcare information service providers allow EHR systems to communicate with technologies outside of their network. This facilitates communication with a greater network of healthcare providers. As individuals transition from one care setting to another — such as a hospital to a skilled nursing facility — their information can be easily transferred to their new care setting.

As we begin to deal with a demographic shift, healthcare providers, both long-term and acute, must invest in an infrastructure that supports seamless transitions of care. In addition to adopting technology, this involves creating policies and procedures to facilitate secure, timely data exchange. Healthcare organizations should also evaluate what information is meaningful and should be shared along the entire continuum of care.

Dave Wessinger is co-founder and Chief Technology Officer for PointClickCare. He has worked in the Senior Care Information Technology industry for 20 years and is actively involved in many industry associations and advocacy efforts, including CPAC, NASL, AHCA IT, CAST and ONC.

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