When will LTC get serious about IT?

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When will LTC get  serious about IT?
When will LTC get serious about IT?
If actions speak louder than words, then information technology adoption in long-term care remains pretty hushed so far. Then again, there are signs the industry is finally starting to gain a sense of urgency, so there's a chance it can make some noise going forward.

With the federal government's program for electronic health records across the healthcare spectrum due to start in 2014, providers will be expected to have the electronic infrastructure necessary for managing patient records that can be shared across an industry-wide IT network. The acute-care sector has taken the lead on the EHR initiative by organizing health information exchanges and other “interoperable” networks to handle the records on a regional level. Physician clinics and post-acute providers, such as long-term care facilities, are included in these endeavors, though to a lesser degree.

So where exactly is the long-term care industry with regard to EHRs and IT adoption in general? The consensus among those working in the field is that providers are not very far along and that it is imperative they place IT at the top of their priorities list.

“While technology products and usage are growing in senior care, there is still room for ad-
vancement,” says Mike Mutka, president and COO of Charlottesville, VA-based Silverchair Learning Systems. “Electronic health records are becoming more prominent and senior care organizations are starting to embrace technology.”

There is a steep climb ahead for long-term care providers, believes Robert Davis, CEO of Irvine, CA-based Optimus EMR.

“With the exception of IT infrastructure improvements and the small number of SNFs that embraced and installed true EMRs and EHRs, the industry has a long way to go to accomplish the goals as established by the Office of National Coordinator for Health Information Technology,” he says.

Some bright spots
While she agrees that providers face a daunting task, Traci Jersen, vice president of marketing for Clifton, NY-based 6N Systems, also acknowledges that the industry has made progress.

“We are working with providers at all levels, including those who are up and running with electronic orders and charting, as well as those who are just starting to work with electronic MDS,” she says.

When assessing the state of information technology, it is important to thoroughly examine the type of systems that currently exist in the long-term care market, adds Doc DeVore, vice president of industry strategy for St. Louis-based MDI Achieve.

“Studies show that 99% of nursing homes use IT, but this is mostly limited to MDS processing and billing,” he says. “Most facilities have several computers throughout the facility that are used for a variety of purposes, although they use multiple systems that are not interoperable. The discussion of healthcare reform over the past several years has spurred interest in taking advantage of the benefits of healthcare IT.”

Taking the leap

Jim Ingalls, director of sales for Redmond, WA-based Keane Care, says the industry is starting to move in the right direction on EHRs “probably because other providers, including hospitals, are encouraged by the incentives offered by the federal government. And there's a huge window of opportunity for providers to step up to the plate and prepare their systems and workflow for future initiatives that will tie reimbursement to superior performance.” 

Duluth, GA-based Prime Care Technologies is fielding a lot of questions about EHR adoption. Marketing manager Rand Johnson says he responds to them by telling facility managers to “look seriously into their IT infrastructure and determine if it is sustainable over the long-term, is scalable, reliable and cost-effective.”

Tom Ludeke, vice president of Cincinnati-based Omnicare, is seeing a lot of interest in electronic medical records and related systems because, he says, providers are finally realizing the prospective benefits in terms of overall cost savings, accuracy and quality of resident care.

“This trend is potentially buoyed by the increasing use of ‘smart' phones and other electronic devices, as well as the continued growth and usage of the Internet—all of which help make people more comfortable with and more trusting of new technology,” he says.

Key obstacles
Minimum Data Set regulations drove the long-term care industry into the IT realm during the late 1990s, though the systems of that era are now rudimentary compared to the sophisticated technology that exists today. Nonetheless, many organizations still cling to those archaic units and are reluctant to change.

Larry Triplett, co-founder of New Concord, OH-based Resource Systems, believes he knows why.

“While it seems somewhat counterintuitive, I believe facilities have been reluctant to adopt deeper levels of IT because of the regulations themselves,” he says. “While regulations forced IT adoption in the late '90s by mandating electronic MDS submissions, the strictness of the regulatory environment itself has created risks for facilities attempting to explore further uses of information technology. Hopefully, the push for EMRs and certification will offer change to that paradigm.”

Budgetary concerns, fear of the unknown and stubborn adherence to manual processes also contribute to the industry's pushback on new technology adoption, says Richard Scardina, CEO of Oak Brook, IL-based Millennium Pharmacy Systems.

“All of these selected reasons play a role. Those leading the way see the overall value created when care objectives move cost and compliance together. This is especially important in facilities that manage more clinically complex residents,” he says.

Providers' budgetary concerns are real, so it is up to technology suppliers to clearly explain the benefits of their systems to potential clients, says Jim Rock, president of Pittsburgh-based Vocollect Healthcare Systems.
“They need to do a better job of providing proven outcomes and metrics on how their technology is paying back against certain important criteria, such as clinical outcomes, reimbursement and productivity of the care team,” he says. “Change is always difficult; the industry has been paper-driven for so long and it's intimidating to automate and get everyone on board.”

Long-term care excluded?
To encourage provider EHR adoption, the federal government has earmarked billions of dollars through the American Recovery and Reinvestment Act, and more is expected from the Affordable Care Act. Yet at this point, it isn't clear how much money long-term care providers might be entitled to—if any.

“Doctors and hospitals are the winners with respect to incentives,” says Loren Claypool, managing director for Milwaukee-based VCPI. “Section 2041 outlines $67.5 million in certified EHR grants to long-term care pro-
viders in 2011 for technology upgrades and staff training. Applicants will be required to show
‘evidence' that they are working with state health information exchanges in order to qualify, but here's the catch: Even though the law was passed, funding these grants is a separate issue and far from guaranteed.”

6N Systems' Jersen maintains that “thus far, government directives have done little to entice long-term care providers to implement an EMR.” As the Department of Health and Human Services outlines its plan for hospitals and eligible professionals to apply for “incentive payments” for the adoption and “meaningful use” of EHRs, she says “nursing homes and long-term care facilities are not directly eligible.” She calls this omission “a huge oversight.”

One industry ally is the Long Term & Post Acute Care (LTPAC) HIT Collaborative, which advocates inclusion of industry providers and is lobbying HHS to raise awareness of LTPAC electronic health records.

Certification through the Certification Commission for Health Information Technology also raises long-term care's status. Along with other initiatives, it should give long-term care providers a boost, says Dan Cobb, chief technology officer for Ozark, MO-based HealthMEDX.

“Interoperability through a health information exchange with acute care—particularly at the transfer of care—will go a long way toward bringing long-term care providers into the nationwide EHR picture,” he says.
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