Tumblers in place

You’ve sent a report of the fall to the resident’s care team, his family and your state ombudsman.

But have you really looked at what that reveals about your resident and your facility?

On its own, an incident report lives on in negative isolation — a reminder of staff failings or shortsighted policies.

It’s no wonder some in the long-term care sector would rather submit and forget.

But amassed with like accounts and given helpful context, those same reports can provide insights that bring positive change.

For too long, falls, resident altercations and elopements that require interaction with local or state authorities have been reported in triplicate or recorded in basic electronic health record systems without getting much second thought. But quickly evolving technology can help providers analyze data, spot patterns and create better risk management plans.

“Now most organizations have a baseline EHR in place and the ability to schedule, build and manage care,” says Pamela Pure, chief strategist for long-term care at Netsmart. “But the industry has to go further to use that data to understand and improve.”

With so much pressure to shorten stays and increase volume, it makes sense to spend the time — and yes, the money — needed to compile as much information as possible in a system that allows users to drill down. 

Comprehensive, real-time analytics go beyond compliance to provide a more complete picture of a nursing home’s strengths and weaknesses.

“We have our Minimum Data Set, yes, but what other industry is satisfied with minimums?” asks Lorren Pettit, vice president of research for the Healthcare Information and Management Systems Society. “We need to be on top of the quality measures. These are the evidence that [federal regulators] and all the stakeholders, the boards, are going to be looking at.”

In the face of repeated incidents, data analytics can reveal patterns and help clinical staff implement plans to change course. That can translate to fewer nursing hours spent duplicating efforts, better quality ratings and critical partnerships.

Setting goals

Early adopters, especially those in small or regional systems, might find their original EHR systems are now outdated, much like sharing data via printed spreadsheets.

For instance, a vendor might be able to pull from 60 EHR systems, but systems that store datasets as PDFs aren’t accessible. Likewise, some vendors store data that belongs to customers separate from reports, making internal analysis difficult.

Even data used for compliance provides benefits when converted to an online or web-based platform, like the one provided by The Compliance Store.

Customizable tools for correction plans, employee training, emergency preparedness, logs and incident reports can feed into a more comprehensive data analysis effort with less hands-on time for employees.

“The countless hours spent doing research and tracking down changes via different agency websites can diminish the time dedicated to residents,” says Joshua Stuedeman, general manager of The Compliance Store. “Implementation of new methods and technology is vital to helping facilities make their workload more manageable so they can have more time dedicated to care.”

The challenge is converting unstructured data — often from several systems with different capabilities — to create actionable intelligence, says Dave Wessinger, co-founder and chief technology officer for PointClickCare.

“It’s moving beyond hospitalization and readmission to other key indicators,” Wessinger says. “And you need a good system with good managerial support to make sure the analysis is appearing on a dashboard and being seen.”

Wessinger refers to it as “putting the plumbing in place,” using a seven-stage adoption model that includes the MDS, billing, therapy, task flow, clinical documentation, order management, interoperability and more.

The best systems also incorporate risk assessments, allowing analysis to move into prediction. For instance, Wessinger describes a system that points out potential concerns and preventative measures to take when admitting a resident with diabetes and congestive heart failure (or other co-morbidities).

With the focus on care transitions, Wessinger says, “pockets of data” on falls, elopements and skin breakdowns are being missed.

Even with a growing acceptance of data as “mission critical” in a world of value-based payments, data available for analysis isn’t necessarily the most appropriate, says Cheri Bankston, RN, MSN, director of clinical advisory services at naviHealth.

Staffing, whether on the IT or care management side, remains a concern as the pressure for meaningful data increases. Some reporting systems promote a savings in nursing hours through better insight into incident tracking. However, facilities with comprehensive EHRs and access to analytics might not be taking full advantage because of staffing shortages or a knowledge void.

Pettit notes that hospitals and large senior care chains — “the Brookdales and the Kindreds” — have IT professionals who are constantly looking at new data technology to find added benefits. 

But at most small to-mid-size facilities and chains, data collection responsibilities fall to someone with a nursing background. A vendor can help make up that shortfall and push staff to think about the bigger questions.

naviHealth has a staff of 400, including nurses and therapists, who kick-start analysis  efforts and help staff and leadership understand where opportunities exist. 

Vendors can offer subject matter expertise and free up staff to implement changes data find, notes Cheryl Field, RN, MSN, Chief Product Officer for Prime Care Technologies.

By using automated systems for risk management, Field says, some facilities can free up half a FTE and prevent adverse reports or lawsuits that have the potential of shutting down a building.

“It’s less about the cost of the software and more about allocating the thinking time,” Pure says. “How do we want to establish our baseline? How do we want to reach our goals? It really isn’t an IT function at all. It’s a leadership and clinical function.”

Landing partners

Pure says clients not only have to manage clinical and fixed costs, they also have to prove they have programs that deliver great results, regardless of revenue.

That means knowing strengths and weaknesses, and understanding which patients you can take without exposing yourself to too much risk, adds Wessinger.

Analytics can reveal margins and which conditions a facility is best prepared to treat. That reduces risk and lets providers chase residents who boost census with the least financial exposure.

naviHealth already is providing decision-support tools to health systems that own both acute and post-acute settings. Acute providers are looking at past performance versus recommended length of stay and therapy hours to help determine whether patients should go to skilled nursing or home health settings. Indicators such as applied cognition, basic mobility and fall risk can be part of the analysis.

There are going to be more and more “beauty contests” between hospitals and nursing homes, Pettit predicts. Quality data analysis gives providers an opportunity to improve their outcomes and put their best face forward.

Fresh analysis can even outperform bad memories. If a hospital’s referral returned for more acute care, a nursing home’s analytics can prove that it has addressed underlying causes more recently.

“If you can show up and talk about these clinical protocols, you show up with the right data in the right way, you’re more likely to get that patient,” Wessinger says.

Transparency is invaluable to hospitals, which want the ability to see into any independent operations they might bring into their preferred networks.

“Analysis provides a level of transparency that the data alone can’t give,” Field says. “And at the end of the day, the (corrective) action you take might not be what you would have thought.”

Deeper analysis might point out a causal link between staff turnover or experience levels and incidents. In the case of a fall, she says, the right system can even improve compliance, alerting administrators or managers outside of a building if reports aren’t issued quickly.

Root cause analysis also might help with risk mitigation and malpractice premiums. 

“To the extent you can be ahead of the curve, to recognize your deficiencies and know where your metrics are, you can put a risk mitigation plan in place,” Pettit says. “For those who aren’t doing that, there’s a huge missed opportunity there.”

Next steps

Analytics allow you to aggregate data; benchmarking allows you to compare your in-house findings to others’. It’s only emerging in the LTC arena.

“Predictive indicators are the next stage,” Wessinger says. “The structure around these, from the computer side, it’s not structured enough to create an algorithm … There’s not a lot of science going on yet, and that’s an area we need to go.”