Information technology feature: Record pacing

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Upcoming regulations will drive providers closer toward the establishment of the elusive electronic health record.

What Uncle Sam wants, Uncle Sam doesn't always get. But he might just come out ahead when it comes to establishing an electronic health record (EHR) for long-term care and other healthcare providers.

Uncle Sam is starting to put more money where his mouth is (see p. 1 for related story). Perhaps more importantly, the provider and vendor communities are taking more serious steps toward creating what one day could be a seamless flow of information among healthcare stakeholders. Advocates say use of a full EHR could save billions of dollars each year – once standards and language issues are resolved, not to mention huge capital investments when infrastructure characteristics are agreed upon.
"In my mind, it's not something that's derailable," says Peter Kress, chairman of the Electronic Health and Wellness Record Task Group of CAST, the technological advancement arm of the American Association of Homes and Services for the Aged.
"I think this job will be done in 10 years," he continues. "All the building blocks will be in place in the next five years. From then on, it's simply adoption. It's a waste of time to discuss the business case. It's been in place for 20 years. There's nothing more inefficient than the way records are collected today."
Kress was a lead expert at the first ever long-term care information technology summit in August in Chicago. Officials had a turn-away crowd of 130 at the series of brainstorming sessions. They hope to hold a second edition in spring. The initial gathering was a solid sign that long-term care is getting more serious about its information technology efforts after having "not been terribly responsive" previously, Kress said.

Long-range goals
One of the nation's provider gurus when it comes to the topic of electronic health records, Kress speaks of a six-stage progression toward establishing an electronic health record in this country. Leading long-term care providers soon will enter the fourth of the six stages, said Kress, a vice president and chief information officer for ACTS Retirement Communities, Ambler, PA.
"The next driver is certainly the Medicare Part D issue," which will move prescription drug coverage from the Medicaid program to Medicare starting Jan. 1, he said. "That will be very significant."
The six-step cycle actually began "years ago," when providers had to start filing Minimum Data Set (MDS) reports electronically. The second step came when people started to do "care planning based on MDS triggers." That leads to the current stage, in which providers are vastly expanding their use of point-of-care technology, Kress explained.
"Some are achieving CNA documentation, and some are starting to include nursing progress notes," he said. "There is a sub-theme going on that I think is very powerful for a variety of reasons: Many long-term care organizations are moving to capturing point-of-care information by CNAs. CNAs. Their observations are critical to enabling the kind of quality care delivery, impacting outcomes. They're rapidly stepping up."
Kress estimated his facilities, and as many as 10% of the nation's nursing homes overall, are at this third stage.  The Medicare Part D drug benefit will be perhaps the most powerful driver yet, he feels.
Events such as Hurricane Katrina, which obliterated many healthcare records and histories, will help speed modernization efforts along, according to experts. Federal healthcare officials have said they are determined to help rebuild the devastated areas with top-notch information technology capabilities, making them powerful models for the most efficient use of electronic records.
The fifth stage of the cycle will occur when version 3.0 of the Minimum Data Set comes out.
"Some level of clinical data and coding will be supported, facilitated, maybe even mandated by MDS 3.0," Kress said. "I see this as a key stage for moving content forward. I guess that will be in the 2007-2008 period when we really see the impact of that."
The final stage? In some ways it's starting alre