IT's the real thing
Cloud-based systems allow connections to more than just on-site systems, multiplying data’s potential impact.
When Rocky Mountain Care began looking for a new electronic health record system two years ago, the company sought vendors that could help it communicate with other providers.
The switch to Cerner's Power Charts last March did exactly that, giving its eight skilled nursing facilities a critical medicine reconciliation tool, the ability to relay information to physicians and an opportunity to share performance data with two important acute care partners.
It also made Rocky Mountain the first independent long-term care provider with access to CommonWell Health Alliance, an online infrastructure that supports information sharing along the care continuum.
Being able to communicate patient information and key performance measurements to potential partners is an essential part of today's skilled nursing market. The pressure to add analytics and interoperability is only growing as the government moves toward value-based purchasing and accountable care organizations become more powerful.
CMS has pledged to shift half of Medicare payments to alternate forms like ACOs and bundles by 2018. That means would-be partners need to have the technology to link up, and solid data that proves working with them is worthwhile.
“To compete in that market, you really have to have analytics,” says Cheryl Field, chief product officer for Prime Care Technologies. “Information is becoming an asset. It's all about quality metrics, those key performance metrics. They translate the outcomes created by your human resources.”
Getting on a preferred provider list is critical to keeping census high. But the number of preferred providers recognized by many acute care providers is plummeting.
Where there used to be more than 1,000 independent entities managing acute care in the U.S., there are now just 150 or so. MatrixCare President and CEO John Damgaard says similar evolution is happening in post-acute care.
Making the market landscape even more competitive, each of those entities might be trimming its preferred provider list from 250 to 50 or so, says Dave Wessinger, cofounder and chief technology officer for PointClickCare.
Sharing data (and patient info) up and down the spectrum is one way long-term care operators are positioning themselves to provide care in that shrinking network.
For too long, hospitals pulled data on issues such as infection control and readmission rates from CMS claims reporting. That information could easily be a year old.
In a more competitive market, it's up to long-term care facilities to put their latest and greatest forward.
“A facility might be doing an extraordinarily good job, but they can't prove that unless they can get them their current data,” says Brad Shiverick, senior vice president of analytics for Team TSI. “And not just in a spreadsheet. It has to be a real conduit on an ongoing basis.”
Also critical: the ability to connect with systems other than the one specific to a single site. Many vendors are cooperating within the space, creating dashboards or cloud-supported platforms that mix data from multiple solutions into one integrated display.
“You've got to raise the communication problem above the fray,” says Damgaard, whose Care Community builds a Facebook-like network for each patient and their caregivers. “Who you're communicating with is a fluid dynamic based on the patient, their diagnosis and their comorbidities.”
The Council of Accountable Physician Practices this summer called for a faster move toward global capitation, while at the same time noting that current HIT systems don't speak to each other.
“This type of fragmentation is not tolerated in any other industry and cannot be tolerated in healthcare,” the organization said, calling on CMS to support payment for the use of HIT that expands access to care and routinely pays providers for consultation via phone, secure email or video.
But the $30 billion in HIT incentives promised by the HITECH Act of 2009 didn't extend to long-term care facilities. For years, operators put off upgrades using the expense excuse. No longer.
“Everyone in healthcare knows fee-for-value is the right thing to do, but everyone is kind of groping around trying to figure out how to do it,” Damgaard says.
Variances are good
For those looking to elevate their EHR and data-collection abilities, it's not necessary — or necessarily prudent — to adopt the same platform as the closest hospital.
Rocky Mountain's main partners are Intermountain Healthcare, a Cerner client, and University of Utah Health Care, an Epic client. But their customized product allows for tracking of MDS codes, allergy and medication information hospitals might not prioritize.
Acute partners receiving information from an outside vendor also know they're getting standardized data, a more complicated issue than it would seem given everything from rehospitalization to pressure ulcer rates can be assessed using different metrics.
Rocky Mountain gained preferred provider status, and both adopted Cerner's Power Charts, according to director Johnathan Bangerter.
There have never been more options for operators, and there is a steady move toward cooperation, Damgaard says.
Part of the battle has been getting facilities to respect that they don't own patient heath information. Vendor dynamics also play a role. In the past, many refused to build technical connections with competitors. But by 2016, the companies providing 90% of electronic health records used by hospitals nationwide had signed on to a national interoperability pledge.
Team TSI routinely works with PointClickCare, American Health Data and other companies to build operator-specific dashboards. Prime Care Technology's primeVIEW dashboard is used by more than 4,500 sites, aggregating information from time and attendance, financial, clinical and other vendors into a single screen view.
And by building quality reporting systems — regardless of financial incentive — facilities should be creating efficiencies that trickle down into better patient care.
“What we're seeing down the road are improvements in care plans' accuracy, identifying unique resident needs and data that informs value-based purchasing decisions or gets you into the network of a managed care organization,” says Pat Newberry, vice president of clinical services for Team TSI.
Newberry says well-designed data management and analytics can save money and time — maybe five hours a day in some facilities.
The kind of job satisfaction associated with easier data collection is part of what Tina Beskie calls the data sandwich. The vice president of business development and marketing for ConstantCare says staff responsiveness and competency feed resident satisfaction, and technology is the jelly to that peanut butter. Constant Care's integration partners include AHT, PointClickCare, MatrixCare and NTT Data.
“Give your staff the opportunity to excel — provide them with technology — and the time to promote resident well-being,” Beskie advises.
Meeting acute needs
Data that's easy for primary care physicians to access directly contributes to reducing unnecessary rehospitalizations, says Steve
Herron, Cerner's general manager of long-term care solutions.
They can make better judgments from afar, instead of deciding to send the patient to an emergency room and assess him or her there.
“That's good for everybody,” Herron says, noting trauma to patients, especially those with dementia. “If you're going to make that transfer happen, it better be worth it. You're also talking about a cost of thousands of dollars either to you or the patients' insurance.”
Better patient outcomes are the bread and butter of nursing homes looking for referrals.
“The No. 1 problem today for acute care today is, ‘Where is my patient?' ” Wessinger says. “They can't help manage their care if they have no clue.”
If they can see how the post-acute provider is addressing ongoing issues, clinicians might be able to step in and offer alternatives, such as a generic drug versus a more expensive formulary version.
PointClickCare uses a seven-stage adoption model from basic data collection to portal building to interoperability. They worked with Avanté, a provider of skilled nursing at 20 sites in Florida, North Carolina and Virginia, to improve quality and efficiency.
After implementing a new system that integrated pharmacies, Avanté reported a reduction in medication errors and adverse drug events. The company also increased occupancy by using an intake and referral management system 120% more.
Patients travel both ways, and for facilities with residents heading to the emergency room, better communication leads to confidence and less duplication of care.
Until recently, the typical transfer involved information sent via clipboard slapped on the patient's chest. Without any deeper-level understanding of the patient's baseline, hospital staff might treat everything they see — switching meds or ordering new treatments while they address the emergent condition.
Access to a system like CommonWell is instant, and Cerner, a founding partner, is offering it free to clients until 2018.
Other providers also are stepping up efforts to make sharing both fast and reliable.
PointClickCare, for example, encourages its customers to share info with the click of a button, meaning information speeds to the emergency room faster than an ambulance to facilitate the care transition.
Hospital staff, for instance, would know that an 84-year-old man presenting with a hip fracture is already being treated for diabetes and is maintaining his same medications while he's treated there.
In Minnesota, the company embedded a secure direct email in one client's app to allow patient information to be sent quickly to the emergency room.
“Why doesn't everybody have this kind of technology?” asks Wasserman. “It feels like a no-brainer.”