The need for advanced information technology systems in long-term care is descending upon the industry with startling speed. After years of sitting at the back of the adoption curve, skilled nursing operators must now face the IT issue head-on. With all the vendors and choices available, it is an intimidating prospect for most.
In fact, anyone who is unfazed by the process of selecting an IT system probably isn’t taking it seriously enough.
That will be a major challenge for the year ahead. IT represents a major outlay of cash and operators must be certain about how a system will enable their mission while keeping them in compliance with the goals of MDS 3.0, RUG-IV, HIPAA privacy regulations, accountable care organizations and electronic health record interoperability.
Long-term care operators need to determine whether these goals can be met with a single enterprise-wide product or with separate systems that are compatible themselves and with others outside the organization. And while there is no easy one-size-fits-all answer, proper due diligence in researching system costs and capabilities can help provide guidance in making the right decision, IT specialists say.
Greg Goodale, marketing manager for HealthMEDX, has spoken to many long-term care providers about the type of system they need and says he has noticed some distinct patterns.
“From a vendor perspective, there is nothing more telling than the questions received from prospective clients researching a system,” he said. “The needs are evolving for providers in regards to information technology. The value of a system goes beyond simple documentation in an electronic format.
“They want and require a system with intelligence and the ability to make real strides with regards to efficiency and workflow automation. The biggest need is a solution that addresses as many areas as possible, but more importantly, one that can easily be adopted. If an IT solution is not easy to learn for the end-user, it’s not going to be successful.”
Among the most common functions that need to be automated are resident information and census, minimum data set, patient accounts (including billing and accounts receivable) and general financials. Point-of-care and electronic medical records systems also are considered integral to adopting full-scale automation in long-term care facilities.
Focus on EMRs
For provider organizations with big enough budgets to adopt a completely new IT system, vendors have various recommendations about where that money should be spent. Some believe long-term care organizations should focus on electronic medical records.
“Providers’ biggest IT needs are finding the resources — financial and human — to purchase and implement EMR systems as well as guidance and assistance in implementing an EMR and changing their entire workflow,” said Doron Gutkind, chief software architect for LINTECH. “Additionally, these needs have to be constantly balanced against the reality of continuously increasing regulations and shrinking reimbursement. An EMR is one product that can be utilized at all the levels and types of care that they provide.”
According to Jim Ingalls, director of sales at Keane Care, the main IT need for providers is what he calls “management by exception,” which is the ability to manage the mounds of information easily by identifying those areas that are outside certain defined parameters.
“Today, LTC providers must proactively search for outliers and trends to see where issues are occurring with revenue, outcomes, ADLs, vitals, incidents and medications,” he said. “The search for that information is typically a strenuous, tedious manual process that takes hours and is largely subject to error and oversight. With the right IT technology and tools in place, a provider can eliminate those hours and errors and instead can be notified when anything occurs requiring their attention. Imagine sitting in your office and seeing a pop-up on screen or text message on your phone telling you about missed medications, a new admission, a hospital leave, or change in vitals that may result in rehospitalization. This is management by exception and it’s a reality today with the right system.”
Regardless of a facility’s financial situation or leadership’s attitude toward automation, the long-term care industry will inevitably have to bolster its IT systems over the next decade to meet the standards outlined by the government. That environment, vendors say, will bring a new level of sophistication to healthcare delivery.
“EMR systems will be implemented and integrated with ancillary systems for lab, radiology, diagnostics, pharmacy and medical supplies,” Gutkind said. “Data will flow to and from the electronic health record and be exchanged with other healthcare providers. Decision support will start becoming prevalent and will be integrated into clinical systems to support resident care activities and workflow. Finally, mHealth (mobile health) will start emerging as the default way to collect and deliver health data.”
Ingalls sees interoperability as the conduit for health information exchange across the continuum, with long-term care being a critical link in the chain.
“Long-term care facilities will take their place in the healthcare continuum through electronic interoperability,” Ingalls said. “We will also see progressively more intelligent and cost-effective systems that can passively and actively monitor a resident’s care with appropriate alerts.”
Carrie O’Connell, vice president of clinical development for Health Care Software, is convinced that over the next decade, the interoperable exchange of data across the spectrum of care will indeed be a reality.
“As the new payment models focus on patient-centered care delivery versus episodic care delivery, long-term care will become an important partner to decrease the rehospitalization events and coordinate the transitions of care,” said O’Connell.
“We will see facilities moving towards more automation and less paper and much more involvement with physicians placing orders electronically and reviewing vital data, such as lab results, from remote locations using various mobile technologies,” she said.
Where to find money
It’s one thing for the federal government to launch a movement toward a fully automated healthcare system, but the reality for long-term care providers is that many simply cannot afford to invest in advanced information technology right now.
“For the most part, providers see the value of an automated, integrated, enterprise-wide solution to help streamline their processes and improve communication,” O’Connell said. “But finding the money is an issue — money for hardware, money to purchase software, money for FTEs to review the process and money to train an industry with high turnover. Money is scarce, having been taken away by the 11.1% cuts, and taken back from audits. Many providers worry that money that might not be there in new payment models.”
Therefore, cash-poor providers have no choice but to find ways to make do with older technology, O’Connell said.
“It’s a mixed bag, with some facilities using IT systems that are obsolete, though others are using newly purchased systems,” she said. “Faxing is still used widely within the facilities — mostly to communicate with the off-site ancillary providers including pharmacy and laboratory.
“Kudos to the long-term care facilities that are getting the most out of those older products and even figuring out creative ways to function with them in these ever-changing regulatory times. These creative folks will certainly be some of our industry champions when they are able to afford the ‘latest and greatest’ integrated technologies,” O’Connell said.
Still, the federal push toward an automated healthcare continuum continues, despite long-term care’s hardships. Providers at some point will have to comply, ready or not.
“I think as the entire spectrum of healthcare is becoming interoperable through the continuity of care document, health information exchanges, and other government-mandated universal transfer forms, there will be a push for some slower moving providers to automate their process so as to not lose their valuable hospital referral business,” O’Connell said. “As a vendor, we can provide case studies, proof of concept, ROI numbers, and guidance on how automation can be the bridge to help providers successfully survive the upcoming changes.”