Big data headaches
Promised RAC improvements could mean more targeted doc requests.
When an electrical outlet is overloaded, a circuit gets tripped and the power goes off. It is engineering's way of saying “enough is enough.”
The long-term care industry is facing its own overload risk with the massive proliferation of data being generated in the field and delivered for processing. With the rapid advancements in technology and increasingly sophisticated analytics and metrics being developed for measurement, many in LTC are ready to flip the circuit breaker in order to catch their collective breath and assess the meaning of it all, data management specialists say.
“There is so much data available to providers that it can become overwhelming,” says Steven Littlehale, executive vice president and chief clinical officer for PointRight. “I think the reason for this is the combination of being such a highly regulated industry, plus better technology for capturing data.”
Keith Speights, president and CEO of RosieConnect.com, agrees that “many long-term care providers feel like they are drowning in data, are overwhelmed with the enormous amount of time it takes to capture and enter all this data into residents' charts and concerned about the risks of making mistakes along the way.”
Even so, Speights maintains that providers should not discount the data's importance in helping to create a better care model for facilities. So does Suzy Greenly, product and documentation manager for NTT DATA Long Term Care Solutions, though she says providers should use discretion in determining which data points are paramount.
“All of the data is important, but not all of it is important to every individual involved in the care of the resident or operation of the facility,” she points out. “A good way to reduce an overload of data is to be sure that individuals receive only the data that relates to their area of responsibility. The limited data needs to be timely and readily available in order to promote quality of care and success of the facility.”
For instance, Greenly notes that administration needs data applicable to the successful operation of the facility, including financial information associated with staffing, revenue cycle management and trending outcomes. Nursing management needs data associated with patient-specific outcomes and critical changes in resident condition. Nursing needs to be informed of tasks associated with daily care delivery and to be able to capture the results of daily care delivery, she said.
Info out of reach
“Data held hostage” is another challenge with which providers must contend, says Kim Ross, senior director of marketing for MDI Achieve/MatrixCare.
“While there is a lot of data available, either the systems don't have adequate business intelligence tools to access the data for analysis or the data is structured in such a way that it is difficult to get the data needed to drive decision making,” she says.
Having disparate systems that can't link up with each other leads to a communication breakdown, preventing data from being properly dispersed, Ross says.
“Often, the data needed to drive executive decision-making resides in systems that can't talk to each other,” she says. “This results in an incomplete picture of business and clinical operations, decreasing the value of the data.”
When it comes to effectively handling the data deluge, Littlehale says it is important not to blend the analytics process with data management.
“They are certainly related — you cannot have one without the other, but managing data and creating a dashboard doesn't mean you'll have a data-driven organization,” he says. “At this point, facilities should be able to see their data across the entire enterprise. Having separate, non-integrated dashboards, for example, just perpetuates the silos that exist in our SNFs.”
Perhaps the data question is not about what is important but more about how to convert the pieces of data that are considered important to useful information, notes Rand Johnson, marketing director for Prime Care Technologies.
“An organization needs to identify the Key Performance Indicators that drive its business and reflect its mission statement,” he says. “The [Key Performance Indicators] will help providers identify which data is important. Actually, this could be an outstanding opportunity to tie the mission statement to day-to-day practice in measurable ways.”
Certain KPIs are the same across all nursing homes nationwide, Johnson says, adding this could also be the case for each of the vertical markets within senior care, such as independent living, assisted living, skilled nursing, and collectively in the CCRC realm. Some KPIs are driven by regulatory pressures, some by competitive pressures, and many by budgetary constraints and goals, he explains.
“Sometimes we've seen that attention to core KPIs drive discovery of previously unacknowledged indicators, helping providers further refine which KPIs they want to see and how often,” he says.
When it comes to data that facilities can do without, Johnson concedes hesitation to identify which information may be expendable. Instead, he recommends defining KPIs and selecting the system with the capabilities to discover and display them.
Ross also points to KPIs as a crucial yardstick that can keep facilities focused on what matters.
“While there is a wealth of data available, the highest priority should be to identify a set of KPIs that are meaningful and manageable and focus on them,” she says. “Many providers get caught trying to ‘boil the ocean,' which provides very little value in driving decision making.”
Although data have different uses, commingling of financial and clinical data is necessary because they are related, Littlehale says. And the same goes for regulatory outcomes and staffing data. Rehospitalization data should be presented along with key structural and process measures to aid in root cause analysis. Further, quality assurance and performance improvement resources shed light on the interrelationships between data, he says.
The IT system reflects data management and capabilities, notes Doron Gutkind, chief software architect for LINTECH.
“What a provider can do with and without has a lot to do with the systems they currently have in place,” he says. “There is a wide range and a lot of options.”
Though there are multiple subsets, LINTECH basically breaks IT systems requirements into two very broad categories: financial and clinical. Financial includes everything that happens from the point where a resident is admitted up through cash in the bank, paying vendors and employees and right down to filing taxes. Clinical includes everything that's involved in caring for the resident, from care assessments and plans to medications management – all incorporated into the electronic medical record.
“For data to be manageable, it has to be captured as discrete and standardized data elements,” Gutkind says. “Data captured in ‘notes' fields is not manageable. An EMR that contains a unique and intelligent field for each data element allows for a more effective handling of the data down the line.”
Long-term care providers need to first gain complete and “easy to use” access to their data and then to use that data to drive actionable procedures, he says.
“For instance, when a provider finds out that a high percentage of rehab sessions are not conducted because the resident was tired, the resident's schedule can be adjusted accordingly,” Gutkind says.
Sorting through the mountain of data is a formidable task, but it can be controlled by identifying the right priorities, Ross says.
The lowest priority should be implementing “technology for technology's sake,” she emphasizes. For example, Ross says providers should look for mobile applications that truly enhance productivity and improve resident care rather than implementing a mobile app “just so you can say you're using mobile technology.”
Specific priorities could differ from provider to provider, Speights adds, but he says there are two key things that all long-term care organizations need to do when it comes to managing data. The first is to make the data capture process as efficient as possible.
“Every minute clinical staff spends keying and re-keying data is time not spent providing care for residents,” he says. “Second, view data as an asset rather than an enemy. The more quickly your team can access critical data, the more quickly you can use it to provide better care and improve your operations.”
To help with the confusion of what to track and monitor with regard to enormous data influx, here are some helpful hints from industry experts:
Tips for handling data overload
• Don't worry about tracking and monitoring 100% of the data available — it is impossible. Concentrate on what is most important for your facility's purposes.
• Focus on what can be controlled and has meaning to users of the data.
• Don't use data in ways that are not intended.
• Consider monitoring data that speak to structure, process and outcomes — not just outcomes.
• Always begin by assuring the integrity of data quality. A data-driven organization cannot be built on bad data.
Source: PointRight, 2014
Taking action on data
Tackling data management is a four-stage process:
1. Efficient point-of-care data capture: Restructure business processes to ensure that data is entered at the point of care.
2. Gaining access: Determine how to gain access to the data on hand as well as to the data that is captured on a daily basis.
3. Understanding the content: Once data has been accessed, ascertain the important elements in the data that need to extrapolated and applied down the line.
4. Taking action: After data have been captured and analyzed, develop a method for applying it. In other words, identify which data are “actionable” and how they will be used to trigger specific actions.
Source: LINTECH, 2014