Whitney Palmer

What Does the Future Hold for Healthcare IT in Long-Term Care?

Published in the Oct. 25, 2011, Billian’s HealthDATA/Porter Research Hub e-newsletter

By Whitney L.J. Howell

When healthcare leaders use long-term care (LTC) facilities and health information technology in the same sentence, they’re coming from one of two points-of-view. Either the facilities are behind the curve with digital adoption or the institutions are the last sector of the market for vendors to conquer.

Regardless of the perspective, the reality is the same: long-term care facilities have not implemented healthcare information technology (HIT) strategies and solutions with the same vigor as other providers, for a variety of reasons. And now they’re playing catch-up.

“Long-term care seems to be the final mountain when it comes to healthcare technology,” says Greg Goodale, Marketing  Manager at HealthMEDX in Ozark, Mo. “Hospitals and physician practices were the early adopters, but now the focus has shifted to long-term, post-acute, and home care and hospice.”

According to a 2009 Agency for Healthcare Research & Quality HIT report, LTC facilities have encountered significant roadblocks to adopting new technology over the past decade. Today, however, they are finally beginning to upgrade their HIT systems, first purchased seven or eight years ago. While the facilities face both financial and cultural trials, Goodale says, they have the benefit of learning from the mistakes acute and tertiary care facilities have already made.

The Challenges Facing Long-Term Care

With Medicare’s 2015 meaningful use deadline looming in the distance, healthcare providers are rapidly taking steps to adopt effective HIT systems. The fire fueling their fervor is a $43,000 incentive payment if they can prove they’re using these technologies effectively. However, Medicare has left LTC facilities out in the cold.

“To not be included in meaningful use and have the opportunity to receive those incentives is a big issue,” says Siobhan Sharkey, Principal with consulting firm Health Management Strategies (HMS). “For most, it means they don’t have the money to adopt a good health information technology system and keep in step with other providers.”

Without the extra funding, many LTC facilities feel hamstrung. Others are pushed to create a piecemeal system – picking and choosing technology strategies based more on what they can afford than on what they need to improve patient care and workflow.

But sufficient financial means to purchase a modern HIT system doesn’t mean facilities are safe from facing pushback from within. Many of the physicians, nurses, or certified nursing assistants (CNAs) are wary of implementing a digital system that will largely replace the paper processes they’ve used for years. The thought of abandoning a familiar workflow produces two sentiments, says HMS Principal Sandra Hudak – intimidation and fear.

“There’s a growing sense of anxiety that healthcare is moving to something they still don’t fully understand,” she says. “They don’t have a clear idea of how the electronic systems work or how [those systems] will improve their abilities to do their jobs.”

For example, CNAs at Seton Health Schuyler Ridge in Clifton Park, NY, resisted switching to a HIT system when the facility made the move in September 2007, according to Executive Director Sandra Smith. Their unfamiliarity with computers was the main obstacle to implementation. To overcome that discomfort, administration provided significant support services during the transition and offered rewards, such as pizza parties, to units that achieved certain levels of compliance.

Even with these challenges, facility administrators recognize the trend toward electronic health records (EHRs), electronic prescribing systems, and other HIT strategies has now become a best practice. And they’re looking for efficient strategies to bring them up-to-date.

“A few years ago, there didn’t seem to be the pressure or the sense of urgency to adopt technology,” Sharkey says. “However, with new regulations and changes in payment, long-term care facilities realize they need to be part of this system and are trying to find out what they need to do.”

What HIT Offers

Stream-lining how LTC facilities share information with each other, as well as hospitals, is a paramount concern, says Kate Galambos, director of technical services for the Community Health Center Association of Connecticut, as well as an instructor in the HIT program at Capital Community College in Hartford. There are constant concerns about pressure sores, medication errors, and hospital re-admissions, so facilities should first concentrate on greasing those lines of communication, she said.

“Having data flow between facilities is so important to patient safety,” she says. “It could, hopefully, reduce the administrative burden, giving supervisors and nurses more time to actually spend with resident and supporting staff.”

To foster a fluid information chain, most HIT systems include computerized physician order entry (CPOE) and an electronic medication administration record (eMAR). CPOE immediately transfers provider orders to the pharmacy, eliminating confusion over hard-to-read, hand-written orders, and it alerts providers if they’ve prescribed a patient take a drug longer than is customary.

What makes a HIT solution most desirable and easy to navigate, however, is the personalized dashboard, says Rick Hammer, Marketing and Product Manager at SigmaCare in New York.

“The dashboard is role-based. If you’re a physician, it pulls up only the information you need. If you’re a nurse, you’ll see only what you need,” Hammer says. “That way you’re never bothered with alerts or documentation that has nothing to do with you.”

Once activated, systems can remind providers to help patients with their daily living activities, prompt them to take vital signs, and help them avoid duplicating services.

Does It Work?

Since choosing the cloud-based Care Tracker module from Cerner Corporation, Schuyler Ridge staff has seen significant improvement in how they use the patient information they gather, Smith says. The technology helps them manage the EHR, revenue cycle management, patient tracking and referrals.

“After the initial phase-in, staff began to see how important the information they had regarding resident function was to the overall care team,” she says. “Utilizing reports from Care Tracker during weekly stand-up meetings with the caregivers helped them see the care team relied heavily on this documentation and that they were part of that team.”

Since 2007, Schuyler Ridge’s pressure ulcer rate has dropped. Also, thanks to on-time reporting and the ability to easily analyze information in the records, staff can identify problems, such as weight loss, early and start the proper intervention to avoid a negative outcome.

Smith credits the efficiency and user-friendly nature of the kiosk touch-screen documentation system for the facility’s success. Not only does a digital system eliminate the habit in some LTC facilities of putting the most important care updates on sticky notes on the outside of patients’ files, but it also drastically reduces the amount of paper used in the facility.

In addition to workflow benefits, Hammer says, some SigmaCare clients have reported clinical improvements, including an 84-percent drop in medication errors and 30-percent decrease in accidents after launching a technology solution. Others have seen proper CNA documentation rise to nearly 100 percent.

An Insider’s Perspective

For Galambos, a former LTC nursing supervisor, human error is the number-one enemy of facility efficiency and safety. Transferring hand-written patient information from one form to the next provides ample opportunity for mistakes, especially when moving a patient from the LTC facility to the hospital or home care, she said. Electronic systems eliminate that possibility.

“What concerned me most was that my handwritten [forms] would serve as the sole source of information about the patient once they arrived at the hospital,” she says. “If I missed something or made an error, what effect might that have for the patient? The entire workflow was duplicative, risky and inefficient.”

HIT technology would also slice into data entry time, she says, by requiring staff to enter patient information, such as name, date of birth, or diagnosis once. Having a central record system that everyone uses also simplifies information exchange between shifts. Previously, Galambos says, she left voicemail messages and written notes for nurses on other shifts – a method both inefficient and careless with patient privacy.

Making Your HIT Strategy a Success

While HIT solutions will function in any LTC environment, only those that approach digital strategies as an investment will see significant benefits, says Goodale.

“If administrators make the decision to pursue digital strategies but then set out to find the cheapest product, they’ll have poor results,” he says. “But if they view it as a long-term investment, even in this down economy, they will see sustainable improvements in patient care, staff satisfaction and workflow.”

Facilities should also take steps to choose HIT solutions that best suit their needs, Hammer said. He recommended administrators identify workflow or patient care problems they’d like to solve before meeting with vendors and put together a team of three or four people who can pinpoint the best technology solutions. The same group should evaluate the system’s performance after a year.

All possible preparation, however, cannot replace proper buy-in, Galambos explains. Individuals from throughout the LTC facility should be onboard.

“Everyone – owners, physicians, nurses, staff – needs to be supportive. In my experience, LTC nurses tend to be negative about computers. That needs to be addressed because without the nurses’ support, the likelihood of success is diminished,” she says. “Best case scenario: The residents and families demand HIT.”

To read the article in the original newsletter: http://www.billianshealthdata.com/news/SiteNews/news_items/2011/October/LTC_HIT.html

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