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
Utah Reaches New Heights of Health Information Exchange
Published in the Sept. 26, 2011, Billian’s HealthDATA/Porter Research Hub e-Newsletter
By Whitney L.J. Howell
Preparation for a statewide, electronic exchange of patient data sprouted wings nearly 20 years ago in Utah, when healthcare industry leaders joined together to improve patient care through information sharing. Today, the state is a leader in the creation of health information exchanges (HIEs).
While electronic health records (EHRs) aren’t new to Utah, the latest endeavor to link patient records across the state via a HIE is only a little over a year old. Known as cHIE – clinical health information exchange, Utah’s statewide, vendor-neutral, patient-data repository is still under construction. The process hasn’t been wholly simple, even with buy-in from healthcare leaders and state officials.
“The easiest part has been the technical component behind cHIE,” says Teresa Rivera, COO of Utah’s Health Information Network (UHIN), a non-profit coalition of insurers, providers and government officials. “But, now we need to integrate all the pieces. All the data contributed by providers must be organized and mapped correctly.”
UHIN launched cHIE and is dedicated to controlling healthcare costs and improving the quality of care through electronic data exchange. So far, UHIN has been very successful. Not only does the Ogden-Clearfield area in northern Utah have the lowest healthcare spending in the country ($2,623 per capita), according to Thomson Reuters, but the state also has a higher EHR adoption rate than much of the nation. More than 60 percent of providers already contribute to the more than 30 EHRs housing Utah patient data.
Currently, the state’s four main hospital systems and one of three major labs are already filling cHIE’s data coffers, says Rivera. The ultimate goal is to enroll the remaining two labs, as well as all rural hospitals within the next year. The deeper the data well, the easier it will be for patients to receive the highest level of care even when they can’t see their regular physician. cHIE will give providers access to medical histories and medication lists for all patients who opt-in.
Enrolling Participants
Rather than debuting cHIE and putting the onus on patients to tell their healthcare provider they’d prefer not to participate (often called the opt-out process), UHIN made patient consent the lynchpin of the program’s success.
To date, nearly 7,000 patients have opted-in to adding their health data to cHIE. The state has 2.7 million residents, so the task ahead is large, says Rivera. Reaching 100-percent participation isn’t feasible; education will be the tool used for getting as many patients enrolled as possible.
“We’re informing the population about the benefits of cHIE, and explaining why it’s important to tell their provider if they do or don’t want to participate,” she says. “We’re at health fairs, we’ve had media events, we’ve placed information in school offices and even the Department of Motor Vehicles. Most people, however, learn about cHIE from their provider.”
Consequently, it’s the provider’s job to assure patient data submitted to cHIE is encrypted and secure. If patient choose not to participate, none of their information will be included in the system.
Overall, providers have been happy to take the extra time to make sure patients understand what cHIE is, and explain how submitting their health records could benefit them in the future, says Rivera. Having greater access to patient information, including the details needed to potentially make critical care decisions or avoid errors, far outweighs the added responsibility.
Although UHIN encourages all providers and facilities to submit patient information, there are instances where certain details of a patients’ history can be omitted. For example, providers aren’t required to submit some emotionally charged details, such as past or current substance abuse or HIV status.
Some groups also have leeway to forego submitting records without losing access to the information.
“There are cases where an organization won’t contribute but will still use cHIE information,” says Rivera. “Planned Parenthood might not contribute data, but it’s valuable for them to have access to the health records. When treating patients, they must have access to a patient’s medical history. Otherwise, they can’t offer the best care possible.”
Impact
When physicians have ready access to patient information, the patient almost always benefits from improved quality of care. cHIE also positively impacts the providers who treat patients. Using the system allows doctors to prescribe, order or deliver reports, or refer a patient electronically. The system also provides access to all hospital reports, lab results and clinician documents.
According to Julie Day, M.D., Medical Director for Quality at the University of Utah Health Plans, having access to a state-wide HIE, such as cHIE, could bolster the services offered by a large provider.
“For a major system like ours, it would be very helpful to be able to pull a patient’s clinical background, history of chronic conditions, or medications, if they came into our emergency department and weren’t already one of our patients,” says Day, who is also part of the internal medicine team at University of Utah Health Care. “You can save time and cost that way by not having to potentially repeat every test you might need,” she adds.
The university is committed to providing patient data to cHIE, and is currently working to integrate its existing EHR system with cHIE technology, says Day.
However, patients and physicians aren’t the only beneficiaries of the services cHIE provides. Payers can also access portions of this mound of patient data to guide them through setting policies around various clinical conditions. For example, Rivera says, payers use the data to decide for which treatments patients must receive pre-authorization.
“Not only does having access to cHIE give payers the ability to make informed decisions based on real clinical data,” Rivera says, “but it allows them to receive the information in a far safer manner than fax or snail mail.”
The Challenge
Putting patient information at provider and payer fingertips might place Utah ahead of the curve in EHR adoption. And, making sure the systems work is important for meeting criteria associated with meaningful use under healthcare reform guidelines. But the attention given to climbing onto that bandwagon has made it harder – at least in the short term – for cHIE to reach its goals, says Rivera.”
Meaningful use and accountable care organizations have been a plus and a minus for us as we’ve been pushing cHIE forward,” she says. “Providers understand the importance of meaningful use and the incentive payments attached to it, so it’s sometimes been difficult to focus their attention on what we’re trying to put into place.”
This is where HIE technology vendor Axolotl (now OptumInsight) can step in and keep the ball rolling. The company, which has been involved in cHIE’s development since the early stages, is in the ideal position to keep physicians engaged and to continue offering enhanced services, according to Glenn Keet, Axolotl’s president.
Not only did the company play an integral role in developing and shaping cHIE’s guiding policies, including privacy and consent principles, but company representatives were also instrumental in implementing the HIE infrastructure. As cHIE grows, Keet says the company will continue to provide services needed for advanced analytics and interoperability.
“Axolotl envisions itself providing continued value services,” says Keet. “As an example, with UHIN being one of the participants of a Beacon community, Axolotl has an opportunity to help UHIN with innovative analytics reporting, providing unprecedented access and analysis of clinical information for improved chronic disease management.”
Putting cHIE To Work
Last year, the Office of the National Coordinator for Health Information Technology labeled Utah a Beacon community, giving the state funding to support existing EHR and HIE efforts. Called IC3, “Improving Care Through Connectivity and Collaboration,” Utah healthcare providers will use cHIE to actively improve diabetes care in the state.
The funding supports implementing HIE technology at HealthInsight, a community clinic offering coordinated, convenient care for diabetic patients, says Rivera. These patients receive primary, eye and kidney services under one roof. Having an operational HIE helps physicians track the treatments and services provided.
According to Chris Wood, M.D., Medical Director of Information Systems at 23-hospital Intermountain Healthcare, using Beacon funding to bring community physicians into the fold will benefit patients, as well as all providers.”
With the Beacon grant, we’ll be able to take information about the services we’ve provided to diabetic patients at Intermountain and make it available to the primary care physicians who see them more routinely,” says Wood. “That way, all the providers can see what’s been done for the patient and to determine what needs to be done next to provide the best care.”
To read the article on the original website: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/September/Utah_HIE.html
Looking For Imaging in Stage 2 of Meaningful Use
Published on DiagnosticImaging.com on April 13, 2011
By Whitney L.J. Howell
Industry comments on the draft criteria for Stage 2 of the meaningful use program are in. Now specialty leaders and practices are waiting with bated breath see if Stage 2 recommendations offer any clarity on how radiologists will be required to implement electronic health record systems (EHRs).
As it stands now, specialty leaders aren’t holding out much hope the Stage 2 guidelines — which have no mention of imaging — will differ much from the uniform approach taken with Stage 1.
“The overall view is that the one-size-fits-all tactic will largely continue to be the case,” said Michael Peters, director of legislative and regulatory affairs for the American College of Radiology. “We’ve asked for specialty-specific paths because it’s the right thing to do, but we don’t anticipate that the federal agencies will have the time to noodle around and create pathways for all specialties.”
Without knowing the final recommendations from CMS, it’s impossible for radiology practices to effectively prepare for Stage 2 implementation, he said. Proposed rules are expected by late 2011 or early 2012.
To read the remainder of the article, visit: http://www.diagnosticimaging.com/meaningful-use/content/article/113619/1842692?cid=dlvr.it&CID=rss
Who am I?
I’m a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C.
I launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, I’ve earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.
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