John Harrison

As COVID-19 has stretched many acute care hospitals to the breaking point, skilled nursing facilities and long-term care providers are being looked upon to free up hospital capacity. This is a tremendous responsibility for the facilities that have already been hit hard – COVID-19 infection has killed more than 28,000 residents and workers, accounting for more than a third of the pandemic deaths.  

Long-term care and post-acute care (LTPAC) facilities have been trying to determine the best way to rapidly adapt their operations to a crisis. Even as states lift restrictions and the Centers for Medicare and Medicaid Services issued a three-phase reopening guidance for nursing homes, the number of coronavirus cases continues to grow along with the number of people returning to public life. From a strategy perspective, LTPAC organizations need to consider how they can adapt to evolving conditions over the coming months to reduce the burden of paperwork on staff, free up more time for patients, ensure safe care transitions from acute care facilities as well as protect their existing residents, staff, and surrounding communities.  

Timely, accurate communication is more important than ever

The crisis has exposed many of the healthcare industry’s flaws. A particularly poignant one is the inability to share patient data, across all care settings, EHR vendors and geographies to gain a full clinical understanding of COVID-19 patients. The same is true of executing proper transitions of care, where key information, such as whether a patient has at-risk co-morbidities and specific follow-up care instructions, often fails to make it from the acute to the LTPAC provider quickly. In fact, in the post-acute care (PAC) environment, one in three PACs report they do not receive any documents from a referring hospital, and fewer than one-third of patient discharge summaries ever reach the PAC care team.

Manual, error-prone and time consuming document exchange workflows remain prevalent in healthcare, with some studies estimating that nearly 90% of all healthcare data exchanges still occur via on-premise fax machines. According to a survey of 400 healthcare professionals commissioned by Concord Technologies in December 2019, most inbound clinical documents are filed to patient charts in the EHR manually. This workflow involves staff scanning documents, uploading them into the EHR and then rekeying relevant patient information from the scanned images into the system.

For LTPACs, the lack of technology-enabled connectedness for efficient and accurate exchange of patient information during care transitions has been compounded by the following:

  • Lack of incentives to keep up with acute care providers in terms of EHR adoption;
  • Razor-thin operating margins to invest in healthcare technology;
  • Deploying EHRs tailored for LTPAC-specific regulatory and reimbursement requirements but which do not communicate with acute care systems;
  • Lack of budget and skilled IT resources needed for advanced digital interoperability solutions; and
  • High-staff turnover coupled with limited IT resources make systems training problematic.

Now, the COVID-19 pandemic has brought these issues into a sharper focus, with additional challenges. LTPAC facilities need to quickly set up remote office operations for administrative and business staff without interrupting patient care. They need to enable administrative and clinical teams to coordinate care from anywhere, at any time, particularly around which hospital referrals they can safely accept. Moreover, decision-makers are looking for ways to adapt operations to specialize in care for COVID-19 patients or to expand into new service areas.

How small changes in technology can yield big benefits

Making full use of digital technology has become critical for enabling healthcare providers to weather this crisis. LTPAC organizations can use technology to build a solid foundation enabling them to act quickly as the coronavirus situation evolves and new regulations emerge. One approach is by digitizing and streamlining paper-based workflows without the need to update the existing health IT infrastructure.

By swapping their existing fax numbers to a cloud-based digital fax platform, LTPAC providers can get rid of their dinosaur fax machines, and all the manual work, costs and reliability problems that go with them. The switch will enable providers to move from paper to HIPAA-compliant, secure, point-to-point paths for exchanging data, streamline processes and save time. An added benefit crucial in the post COVID-19 world is that the approach allows administrative staff to process documents remotely.

LTPAC operators with a high volume of documents and interested in further increasing staff efficiency can consider leveraging artificial intelligence (AI) in conjunction with digital fax. Intelligent document automation is a new and innovative application of this technology. AI can automatically classify inbound documents, such as referrals, discharge summaries, physician orders, medical record requests or prior authorizations. After AI “understands” the document type, it routes the digitized document to the appropriate department or person.

Additional time savings are achieved when AI capabilities identify and extract crucial information within the document required to, for instance, make decisions on which referrals to accept. This data includes patient name, medical record number, date of birth, as well as physician name, national provider identifier, and date of service. Currently, a person is required to manually search through a transmitted document to locate the relevant patient information. Extracting this data automatically decreases the amount of manual document indexing necessary to link the documents to the appropriate patient record. 

These small changes can yield big benefits for LTPAC providers. By mostly automating the process of receiving, reading, classifying and triaging patient records, providers will save time and ensure information is not lost or misfiled but is processed faster by the correct person. This helps transition the patient to the LTPAC facility faster and provides quicker access to documents needed for ongoing resident care.

As the industry continues to cope with caring for COVID-19 patients and prepares for developments that might come ahead, automating all possible manual work to facilitate fast and accurate decision-making will allow LTPAC organizations to focus on taking care of patients, residents and staff.

John Harrison is chief commercial officer at Concord Technologies.