McKnight's Long-Term Care News, April 2019, page 51, Feature 1

Nursing home managers deftly deal with issues about life and death and all that comes between, but ask how data has affected them and some are likely to say “overwhelmed.”

And no wonder. Data and everything it represents affects and controls virtually every input and output inside a facility.

Nursing homes acknowledge the power of that information and the responsibility they have to manage it well so everything from rehospitalization rates to receivables stay low and Five-Star ratings and lengths of stay remain appropriately high. The tasks of herding and analyzing all of that data and working with IT partners, therefore, are as critical as ever.

Culture shift

The digitization of data may have occurred years ago, but only recently have nursing facilities begun to truly grasp its importance.

“Post-acute care has come a bit late to the data gathering and analytics party and [we] are only in the early stages of learning how to use our data to create value,” says David Carter, post-acute care advisor to the Stratus Interoperable board of directors. “All roles are changing across the organization — a kind of cultural shift that will enable everyone to use data to drive better performance.”

Experts agree the size of a skilled nursing facility, the depth of its staff and whether it can tap into the vast resources of a chain usually determine how data is managed internally.

Whatever the internal structure, Carter believes coordination is key. “It’s going to take an ‘all-hands-on-deck’ and an aligned effort across all financial, clinical, operations and technical stakeholders to make the shift from volume to value,” he adds. “Senior teams must move quickly to ensure the organization as a whole works as a cohesive unit to facilitate the transition to data-driven performance.”

Here’s how experts view key internal stakeholders’ roles.

Chief financial officer

As the title implies, CFOs are typically responsible for all things financial — from labor costs and their relation to scheduling, receivables, expenses, revenues and profits. CFOs also typically should sit on business intelligence committees to evaluate investment performance, observes Brian Dimit, vice president of professional services for CareServ. 

Chief operating officer

COOs are typically concerned with data related to regulations. For example, a COO may need to identify metrics within nursing and how they relate to government regulations such as census, per-patient days, scheduling, readmissions and hospital leaves, says James Stormoen, vice president of client solutions for vcpi. 

Their role is essential in ensuring the “stickiness” of data and analytics at the operational level, says Status Interoperable’s Carter, adding, “they need to make sure that data and analytics are ‘hardwired’ into the daily work flow and that team members are obsessed with moving the dial on the delivery and the quality of care every day.”

Chief executive officer

Two words: big picture. “They’re concerned with overall vision and strategic metrics such as trending, market and competition and how the data gets used,” says Stormoen.

Chief nursing officer

Some would argue that CNOs are rising figures in the internal data hierarchy — and for obvious reasons, around outcomes and quality. They also can play a vital role in business intelligence. 

As Dimit argues, “A CNO provides clear definitions of business rules for data and verifies any differences between facilities to ensure there is consistency in what is being measured.” 

Adds Jayne Warwick, director of market insights for PointClickCare, “The CNO aggregates clinical outcomes. Such data can speak to the effect of corporate policies and procedures on a facility’s clinical and financial performance.”

As critical as these roles are, some believe data management should not be concentrated solely in the C-suite.

“Data doesn’t just belong to the top tier, but all levels of care should be leveraging the power of data to affect change,” says Warwick. Rob Price, senior product manager for MatrixCare, agrees. “All levels of SNF leadership play a role in the successful creation and usage of analytics to help drive success in the organization.”

Multiple stakeholders have a shared interest in analytics and outcomes within the SNF, argues Kelton Swartz,  senior solution strategist, post-acute analytics and intelligence for Cerner.

“These and other interested parties should collectively review analytics daily and collaborate on areas where there are direct influences on the goals and thresholds that are either met or not met through the data,” Swartz says. 

“While the CNO may focus on referrals and key clinical outcomes, the CFO may have a vested interest in assessing the cost of care. Yet, both want to know how one impacts the other so that these outcomes can also be shared externally.”

Make sure that there’s a high-quality framework for data collection and dispersal, advises Netsmart’s Dawn Iddings, the senior vice president and general manager for post-acute.

“A data collection and presentation process that lacks structure will result in inconsistent values and interpretations,” she explains

Nurse leaders also may want to invest in real-time data platforms to improve quality measures. That also allows more flexibility to zero in on a particular issue, and discuss whether practical interventions are successful.

Who owns analytics?

Solid arguments are made about the division of labor when it comes to managing data internally. Still more are made about the need for a point person.

In smaller facilities, the job often falls on the shoulders of the one individual “who’s most proficient with Microsoft Excel,” observes Price. 

“For multi-facility operations then, the ugly job of compiling that data into something usable across the organization begins, as the data is mashed up and summarized, perhaps with a visualization that helps important trends stand out,” he says. “This process is laborious, prone to human error and difficult to repeat on a frequency greater than a few times per month.”

“You could draw a graph about anything but that doesn’t make it meaningful,” says Cheryl Field, chief product officer for PrimeCare Technologies. “Of course, an analytics person helps to visualize the data and bring it to life and tell a story.”

No doubt a skillful analytics person is invaluable. But consider the role of a chief information officer. Likely the closest any “C” title comes to being the “Big Kahuna” of data, the CIO corrals, or aggregates facility-wide data, and in general, is responsible for coordinating and disseminating, says Stormoen. CIOs also are likely to know more about the right platforms and the various inputs and outputs of applications.

Whoever wears the title, “when multiple functions are using the same data, an organization needs a ‘data quarterback,’” says Justin Silver, executive vice president of corporate development for ABILITY Network. This role ensures that data is aggregated and organized so that it can be analyzed and deployed in a meaningful way across areas where action is taken based on these insights, such as clinical and finance, he adds.

Price agrees. “The CIOs I’ve spoken with are the primary stakeholders who rely upon the analytics and data access services that we provide,” he says. “They are managing inbound requests for information that spans the enterprise and must be aware of which vendor or internal tools to deploy for an answer.” The CFO, CNO, DON and other leaders in the SNF, meanwhile, all contribute to the stream of needs that are serviced by the CIO’s ability to deliver information at the right level of detail, in the right format and at the right time.

A group effort?

This speaks to what all IT vendors believe: Ownership is one thing, but the management and use of data is a group effort.

“Everyone is using data today to drive decisions and nursing home staff continue to struggle with just the language of analytics,” says Field. 

With so much emphasis today on outcomes and resident care, quality assurance committees are a logical place for control to be centered, she adds. 

“There is accountability for outcomes, measurements, acknowledging and going through the steps around QAPI,” she explains. “An organization is always looking at outcomes and ways to improve in the future. This is the stuff so many internal metrics people use.”

Silver also believes analytics can thrive as a group effort.

“Leadership must play a key role in setting the overall analytics strategy and prioritizing the area within an organization, but analytics needs to be owned where the insight will drive the action,” he says. “For example, clinical leadership should own quality analytics to drive improvements in quality of care, finance should own analytics to drive revenue cycle improvements and business development should own comparative analytics for marketing insight.” 

Point person with vendors

When it’s time to go out and find the right data analytics partner, who should take the lead with vendors when it’s time to “talk shop,” or make purchases?

Some say it’s the same individual many identified as the “owner” of analytics.

“Finding a data analytics partner should be led by the information technology staff, since the nature of this process is the purchase of technology,” says Doron Gutkind, chief software architect for LINTECH. He adds, however, that clinical, financial and operational business users should be an integral part of the process because they can evaluate whether the technology fits or the partner has any experience with their line of business.

Still others favor the group approach.

“Avoid making a siloed decision,” counsels Iddings. “Ensure that a collective voice, including total consideration of meeting clinical, operational and financial requirements, is part of the final decision.”