Information Technology Feature: The IT payback

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Providers are starting to grasp the financial benefits of information technology, from labor savings to more MDS-generated revenues.

Long-term care providers are finally beginning to appreciate technology – and not just because the government says they should.
"Ten years ago [providers] bought software because they had to – for billing," said Doron Gutkind, chief software architect for LINTECH, a long-term care software provider based in Lee, NJ. "It's evident people have matured and they are actually understanding what a computer can do for them. Finally they're seeing what we've been preaching for many years."
In many ways, electronic systems have been like medicine for long-term care providers — something they took as a result of a burdensome administrative load in the back office or when the government required it for the Minimum Data Set (MDS). But as technology has gradually permeated the healthcare sector, providers have started to grasp its clinical and financial benefits.
Software systems, they are finding, not only reduce costs related to MDS, but can shift the administrative workload off nurses' backs. As a result, nurses can concentrate more on what they were trained to do: care for residents.
"There's a real paradigm shift that is happening now," said Pam Arlotto, president and CEO of Maestro Strategies LLC, a healthcare management consulting firm. "Forward- thinking organizations see it as an opportunity to bring value to their workforce ... specifically to their residents and families, that they can't do in a manual environment. It's becoming mission critical."

Seeing value
Major chains like Beverly Enterprises Inc. have embraced many technological innovations like
e-charting, which inputs physician orders into the system electronically and generates electronic care plans.
Smaller players also have emerged as leaders. Gibbs Care Center, a 66-bed skilled nursing facility in Steelville, MO, started with electronic MDS in 1995 and has since been testing the boundaries of clinical applications. The facility's clinical and accounts receivable departments are integrated; it began electronic nurse charting last April so that nurses can document their notes on the computer; and in July it started using a wireless, electronic program to record medical orders.
Assistant administrator Larry Howdeshell understands technology's potential and doesn't see why other small players shouldn't as well.
Automating certain tasks is "as easy as putting a pen to paper," he said. Time clock and payroll, for example, are no-brainers.
"I don't care if you're big or little," he said. "I don't see why you don't do it in-house. As long as you have the software, it will pay for itself. And the rest is money in the bank."
He has a list of benefits of technology he can rattle off.
His census is full; his staffing turnover has decreased; and the quality of resident care documentation is better.
The biggest challenge to Howdeshell is keeping his curiosity at bay: "The more you can see it can do, the more you want it to do."

Return on investment
It is easier for vendors to push the benefits of technology today because of a firm understanding of its cost benefits.
"It used to be someone would say to a sales rep, 'What's my return on investment?'" explains Tom Fahey, vice president of sales and marketing for Health Care Software Inc. Providers were looking for how many full-time equivalent employees they would save. But "it wasn't a quantifiable result. It was a difficult thing to measure."
Today, sellers offer a different pitch.
"Now you can measure what they're doing: 'I can streamline the process; I can reduce administrative staff,'" Fahey said. "But usually that frees those individuals up to do other things, whether that be resident care or pro-active marketing so they're not tied down to an onerous activity, like looking at all the bills."
Zoe Bolton, vice president of business development for American HealthTech, agrees that labor savings in the form of changing staff workloads – not staff reduction – is a sure thing when you purchase point-of-care software. Reducing time on administrative tasks, in turn, translates into a happier nursing staff.
"We have found that by delivering tools to the frontline caregivers, that they're more satisfied with their work. They enjoy their work," Bolton said.
Probably the greatest incentive vendors are talking up is improved reimbursement from better MDS filings. Capturing information at the point of care means better documentation of activities of daily living (ADLs), one of the biggest sources of enhanced reimbursements through the MDS.
Providers end up leaving a lot of "money on the table" as a result of typical manual procedures like copying nurses' notes on a resident from a previous shift, said Larry Triplett, president of Resource Systems of New Concord, OH. Copying does not reflect the actual condition of the resident because they are not making a blind assessment of the resident, he said.
"We've seen pretty typically between $50,000 to $100,000 a year is left on the table because of this," he said.
The electronic medical record – a computerized record on the resident that is accessible to all pertinent players within the facility – reduces paper, redundancy and time, agreed Nick Chareas and Mark Counts of InfoSys. Also, information would be safe when stored electronically offsite, in the event of a disaster such as a fire or a hurricane.
From bills to beds
While clinical technology in many ways is a new frontier for providers, technology for administrative purposes has been around for a couple decades, notes Bob Greenblatt, COO of ADL Data Systems Inc. During the 1980s, people saw it as a way to make their business office run more efficiently, he says.
"It was a given when software companies sold software you could computerize the business office and there could be a clear, measurable ROI. That was all indisputable."
Today, clinical is where it's at, but adoption has been slow, even though the software has been available for the last 10 years.
"Over the last two to three years there has been a push to electronic health records," Greenblatt said. "It's very clear where we sell today, where we focus 90 percent on in-house development and budget, is on the clinical side."
Other experts agree and believe technology will continue to concentrate in the clinical direction for the next three to five years. Companies like Keane Care foresee the creation of executive information systems and incorporating the pharmacy into the EMR.
"The pharmacy system in the long-term care industry is a new challenge," said Jeff Jordan, managing director of Keane Care. "With our background in acute care, we know it can be done."

Still lagging behind
But let's not get ahead of ourselves. Technology in the long-term care sector still has a long way to go. Arlotto of Maestro Strategies says only about one-third of the industry is significantly invested in technology.
If an industry could be divided into three basic groups: innovators, pragmatists and laggards, then the long-term care industry would still be weighted down with laggards.
Adds Charlie Daniels, president of Health MedX: "Technology in long-term care is still a laggard because of the changes in the current political administration."
When President Bush last year encouraged healthcare to participate in electronic healthcare technology, those on the cutting edge found it exciting. But not everyone in long-term care embraced it.
"The whole industry, did they jump on the bandwagon? Are they installing EMR records? No. It's still in the infancy stage," Daniels said.
Part of the problem could be a lack of communication between the players. Jim Moore of Moore Diversified Services of Fort Worth, TX, said a "disconnect" still exists between many IT departments and providers. An IT person may know how to mechanize computers but may not understand the operations. Similarly, nurses work to get through their day and may not understand IT's potential.

Taking initiative
One bright spot in the realm of technology is the attitude of long-term care leaders. Over the last couple years, they have made a decision: They are not going to wait for the government to dictate what to do when it comes to technology.
John Derr founded the Health Information Infrastructure Technology Committee as part of the American Health Care Association to push technology forward in the long-term care sector. One initiative of the committee is to create standards among vendors and software, so providers can make better informed decisions.
"We're not standing by waiting to be told," Derr said.
"That's a difference compared to the past," said Jordan of Keane Care. "Instead of being reactionary, we'll be part of the planning."

Advice on IT implementation
Do's:
&bull Have a strategy before exploring any software or hardware implementation.
&bull Communicate to overcome implementation hurdles.
&bull Partner with the vendor to overcome those hurdles.

Don'ts:
&bull Use IT tools that require too much training.
&bull Implement too much technology at one time.
&bull Use technology just to make a manual form electronic. Information technology can do so much more.

Source: Steve Hammer, vice president of business intelligence, Beverly Enterprises Inc., 2005

You want proof?
Skeptics of technology's benefits, take note: Hard-core documentation is coming later this year. The Sinclair School of Nursing at the University of Missouri-Columbia teamed up with software maker OneTouch Technologies to assess the benefits of electronic medical record technology on about 20 facilities.
What did they find? IT admittedly takes time for nurses to use, said Marilyn Rantz, a professor at the nursing school, who offered some preliminary findings. But after that transition period, there are "all kinds of advantages."
"It truly is an investment improving the quality of care," Rantz said. "It improves staff satisfaction and the perception that what they do is recognized by the administration and is valuable."
For the study, the school examined qualitative and quantitative data on the facilities, following some homes for as long as 24 months. Research teams looked at electronic medical records, including an e-medication record and treatment records.
Rantz emphasizes that nurses need time to get accustomed to the technology. It's not different from the learning curve that she went through in the '80s.
"I think some facilities underestimate the support that nurses are going to need to know how to use unfamiliar computer information systems," she said.

Captions: Information technology can benefit residents and staff alike. At left: A therapist works on developing care plans with two residents at Heritage Manor Nursing Home in Wyckoff, NJ.

A nurse at Falcons Landing in Potomac Falls, VA, monitors resident care and staff progress using AccuNurse reports. Nurses and CNAs communicate using AccuNurse headsets.