Bridging the gaps

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Bridging the gaps
Bridging the gaps
Upon first glance, the flurry of federal initiatives dealing with electronic health records and accountable care organizations appear to be a series of obtuse mandates that don't address the day-to-day reality of providing quality care to long-term care residents.

It is easy for the average long-term care administrator to look at these programs and wonder why they are necessary and ask how they can possibly improve the way things are currently done.

And those questions are fair, considering that all of these initiatives will require substantial investment in information technology and will cause a dramatic change to the status quo. Ultimately, however, proponents of these initiatives say they will transform the way healthcare is delivered by giving providers the tools with which to measure their performance and improve their operations.

“There are two reasons long-term care facilities need to make sure that their IT systems — and particularly their electronic medical record systems — are capable of performing the desired functions,” says Robert C. Davis, CEO of Optimus EMR. “The first reason is to have the efficiency and reporting tools necessary to survive and prosper in this challenging environment.”

The second is to “participate in interoperability and share data with hospitals, pharmacies, labs and health information exchanges,” Davis says. “The efficient sharing of real-time clinical information will be mandatory in the new world of ACOs and bundled payments for Medicare and Medicaid.”

Long-term care remains behind the 8-ball when it comes to technology adoption, which makes for a formidable challenge, says Brian Dimit, director of industry marketing for PointClickCare.

“Unfortunately, most providers are simply not prepared to handle these initiatives today. This is not due to a lack of functionality within vendor systems, but due to a lack of proactive adoption by the providers themselves,” Dimit says. “However, in the case of these new mandates, providers must be adopting technology, making changes to their infrastructure and process, and educating staff ahead of the adoption curve. For those that wait until the mandates are in place, they will be faced with significant challenges in terms of time, money and resources.”

To be sure, “long-term care providers who are not yet electronic, may find themselves challenged to put a system in place to meet the federal initiatives,” agrees Angel McGarrity-Davis, RN, vice president of clinical services for AMD Health Care Solutions. “Having an electronic system does not necessarily mean compliance to cover the initiatives and alignment with ACO systems.”

As an experienced bedside caregiver, McGarrity-Davis says she knows the gaps that exist in the transition in care from one healthcare provider to another, as well as the challenges in the delivery of care in long-term care “with and without an electronic record.” To minimize the gaps and improve the delivery of care, she says “an electronic record not only is a mandate in healthcare reform, but a necessity in delivering quality care.”

Silo = status quo
If there is one situation that is emblematic of the status quo, it is information silos — barriers that exist between departments within an organization and between healthcare providers. Because so many systems are old or arcane, they do not have the ability to communicate with each other, a prerequisite for the interoperability necessary for electronic health records and accountable care organizations.

“Unfortunately, most post-acute providers and ancillary systems providing services remain in silos,” says Carrie O'Connell, vice president of clinical development for HCS. “There are data sets used in home health (Oasis C), LTC (MDS 3.0), and inpatient rehab (PAI) that all collect similar data but do not easily communicate and translate.”

Add in ancillary providers that use different and often homegrown systems, and it “makes it difficult to communicate data in a cost-efficient manner,” O'Connell says. “Great strides have been made utilizing interfaces either through HL7 and proprietary interfaces, but we are far from the point of using the appropriate standards.”

Louis Lenzmeier, director of marketing with MDI Achieve, believes “it has gotten better over time and using integrated technology for clinical services and billing has been the cause of this positive change.” Yet those steps are just preliminary, he says, and that “now providers need to make sure all of their disciplines in their organization are using one system, which means nursing, billing, social services, therapy, corporate, dietary, activities and more are using one system and communicating effectively.”

One indicator that long-term care facilities are moving toward breaking down silos is “a decline in interest of IT systems themselves that are silos,” says Doc DeVore, director of clinical informatics at AOD Software.

“Best-of-breed systems are losing ground to interoperable systems that can connect to other healthcare settings like hospitals, which becomes much more important with ACOs,” he says.

Teresa Chase, president of American HealthTech, agrees silos are destined to fail.

“They will be increasingly replaced by strong, interconnected alliances responsible for outcomes-driven care instead of volume-driven care,” she says. “More and more providers are turning toward secure, standards-based, and repeatable ways of creating interconnected alliances with fellow providers upstream with hospitals, downstream with home care agencies, and with internal partners like pharmacies and labs. Standardized connections are increasingly making interoperability technically feasible, easier to set up and affordable.”

Setting priorities
Assessing a facility's readiness to incorporate the changes needed for EHR interoperability means establishing priorities so that the process can be done in a methodical and manageable sequence, IT specialists say.

“Getting staff adoption up front is important,” Lenzmeier says. “Providers need to explain to their employees why this is mandatory and how the right EHR platform will make their jobs easier, allowing more time for resident care.

In addition, they must ensure that they are still engaged with the vendor at every step through the implementation process. If providers are not hearing from a vendor often during the implementation process, they need to re-assess whether they made the right choice.”

Dimit agrees, adding that providers should be focused on their staff and infrastructure instead of simply identifying their readiness to adopt EHR technology.

“Top-tier vendor systems have a significant amount of functionality and are ready for provider adoption,” he says. “Providers typically do not have the right hardware and software infrastructure in place, or they fail to understand the staffing and process changes that are often needed to ensure their readiness and eventual success with EHR adoption.”

While getting buy-in from staff is paramount, the technology definitely cannot be overlooked, says Steven Littlehale, executive vice president and chief clinical officer for PointRight.

“The best thing providers can do is to first select the right systems to implement — it's crucial,” he says. “The best way technology can help with cash flow and revenues is to invest in the systems that will help them predict and manage based on factual data. The numbers don't lie, and neither does the data when it's used accurately and to help shape insights into actionable answers.”

Tina Beskie, director of marketing for Nurse Rosie Products, adds that it is also critical to understand IT staffing challenges and the need for what she calls “product ruggedization,” which incorporates “ruggedized hardware, clinical diagnostic measurement equipment and remote assistance via web-based software.”

Handling costs
Ultimately, organizations need to take an honest inventory of their processes and assess where information technology can leverage the most positive change, O'Connell says. Based on that, they should assess what IT initiatives can improve cash flow and “close the back door” from audit take-backs and claims denials.

In considering the cost investment, she notes that providers should talk to the software vendor about arranging different appropriate payment options and deployment strategies.

“When both sides understand the other's point of view, they can build partnerships and solutions that are mutually beneficial,” O'Connell says. “Providers may be surprised about how willing the vendor is to work with them to utilize their expertise and which applications have helped others see quick, positive results.”

Intimidating as the potential price tag might be for an IT overhaul, Chase says it can be done in stages. The ROI of lower stages could help fund incremental investments at higher stages.    

McGarrity-Davis advises against looking for “quick cures” that could backfire.

“As everyone knows, we are in a time that calls for maximum productivity, decreasing expenditures coupled with Medicare and Medicaid reimbursement cuts,” she says. “One of the biggest solutions is to embrace electronic technology. When all is said and done, it will probably be much less intrusive, less costly and much less painful than you've been led to believe.”

Ideal IT
When searching for an IT system that will provide the ideal functionality needed to meet the requirements of the electronic health records and accountable care organizations, experts recommend the following attributes:

--Improves quality of care
--Increases revenues
--Reduces expenses
--Reduces malpractice costs
--Reduces medical errors
--Enhances security
--Enables significant time savings
--Improves documentation
--Improves accuracy
--Provides better access to medical records
--Improves QIS & regulatory survey citations
Source: AMD Health Care Solutions, 2012