HCA 410 IT in Long Term Care during COVID 19

Special Topics for Leadership in Long-Term Care As long-term care continues to grow in scope with the aging demographic, the industry will also become more sophisticated. Providers are learning to adapt to different payment mechanisms such as prospective payment in governmental programs and capitation in managed care. Regulations continue to change at a rapid pace, with OSHA, HIPAA and the Patient Self-Determination Act. Finally, long-term care leaders are working hard to contribute to the triple aim of improving quality, efficiencies, and patient and consumer satisfaction. Some of the areas in which leaders sees a need for rapid learning include technology, marketing and social media, quality improvement, workforce development, and payment mechanisms. Information technology is rapidly changing the way in which all health care is delivered, communicated, and monitored by various parties. Marketing and communications in long-term care is in its infancy in terms of the use of social media for messaging, outreach, and education. In addition, marketing in long-term care has the goals of needing to improve the image of the long-term care industry for both consumers and the current and future workforce. These two topics are major learning areas for leaders in the long-term care industry. Technology in Long-Term Care Long-term care continues to expand its use of and reliance on technology. Technology has the ability to catalyze a new model of care for older adults that promotes optimal independence, the use of family members as caregivers, and improves efficiencies and cost management. HCA 410 IT in Long Term Care during COVID 19

Computerized electronic health records, electronic billing and reimbursement, and participation in Health Information Exchanges are becoming more prevalent across the United States. Technology Takes Off in LongTerm Care Trendspotting: How IT Triggers Better Care in Nursing Homes The long-term care industry is far behind the acute care health care system in the use of health information technology (HIT). There are a couple of reasons for this lag. First, the investment in HIT is very expensive and many long-term systems have not had the financial means to invest. In addition, the long-term care industry has not had the pressures that acute care has had to prepare for participation in Regional Health Information Exchanges. However, with the changes in Medicare, declining to pay for 30 days readmissions for the same diagnosis, long-term systems are being called to the care management discussion. The present environment requires long-term care providers and organizations to adapt health information technology to ensure their survival. Patient and consumer use of technology is considered applied technology and includes many “in home” devices to optimize both health and independence in the older population. Some of these devices include blood pressure monitoring, blood glucose, home assessment, as well as allowing the health care provider to catch early warning signs of illness or risk with older adults. One managed care organization provides weight and blood pressure telehealth monitoring home devices for all their congestive heart failure patients, thus decreasing emergency room and hospitalizations by 20% year over year. Artificial functioning has begun to develop allowing assistance with activities of daily living with robotics. Emergency notification systems are quite common in assistive living and senior living communities. Telemedicine provides many advantages to older adults living in underserved or rural communities. Specialists can consult on older adults in any variety of settings without the difficulty or cost of transporting the individual. While all these technology options are available and valuable, Medicare, Medicaid and most payers do not pay for these services. Clinical applications of technology are used for patient admissions, assessments, and care planning through electronic health records. Medication lists, laboratory values, radiology reports and other diagnostic data are managed electronically for patients. Interfaces between outside care providers and the patient’s site are in place to assure the provider has the needed data for care planning and evaluation. All certified skilled nursing providers including subacute providers now electronically transmit their Minimum Data Set (MDS) on each patient served. The development of Regional Health Information Exchanges is beginning to ensure access to all patient clinical information across the continuum of care for providers. For example, a patient presenting to the Emergency Room can provide consent for the provider to review data from the chart in his skilled nursing facility record. This saves time, money and improves continuity and quality of care. Administrative and strategic applications allow the organization to manage billing, cash flow, accounts receivables easily and efficiently. Financial modeling using predictive assumptions is helpful in creating scenarios and analyzing the impact to the organization and its goals. In addition, software packages are available to design staffing templates and automatically run needed staffing recommendations in real time. Data mining for quality is a growing area for all health care leaders. Software programs which mine the electronic health record according to mapped data points allows the generation of clinical data which can be evaluated through statistical process control charts. HCA 410 IT in Long Term Care during COVID 19

Some examples of these quality indicators in longterm care include prevention of pressure ulcers, nutritional status as evidenced by weight maintenance, or prevention of falls. Three national systems for electronic quality monitoring in long-term care include: OSCAR, RAI/MDS, and OASIS. OSCAR (Online Survey Certification and Reporting) is a computerized national database that monitors compliance with regulations for nursing facilities and home health agencies, but also has staffing, complaints, and survey deficiencies which can help with future planning. RAI/MDS (Resident Assessment Instrument and Minimum Data Set) serve to collect quality data and provide consumer information about various long-term care organizations. Lastly, OASIS is a quality tool for home care. Although these are all valuable electronic data collection tools for planning and quality improvement, a single tool and database covering all of long-term care would be the most beneficial. CMS supports consumer information sections entitled “Nursing Home Compare” and “Home Health Compare” which help consumers with decision making. Benefits and Barriers to Information Technology There are many benefits of and barriers to technology in long-term care. The total adoption of information technology by long-term care will make services more widely accessible through integrated systems and coordination of information as earlier mentioned. IT allows ease in sharing best practices, clinical guidelines and quality measurement tools in long-term care. Providers benefit from electronic health records, electronic billing and the ability to operate more efficiently. Electronic health records and billing allows each provider to see their production, patient mix in terms of age, diagnoses, payers, etc. as well as monitor their efficiency and quality outcomes. Consumers benefit by having safer care with the coordination of data across the care continuum and being able to review potential service providers for their quality outcomes and pricing/cost structures. Barriers to IT include the lack of industry commitment, the many possible systems available and the continual speed with which technology is improving. Some organizations have the wait and see approach, until the technology is more mature, while others lack the initial capital to invest in information technology. Strategic planning for IT requires that leaders, governing boards and providers take a thoughtful approach and consider all options. An initial assessment of the organization’s IT needs is prudent, following by mapping out the desired system specifications and identifying any potential partners in the industry with which to share the initial capital investment. As with any change, the involvement of the essential stakeholders in the proposal development and review of possible venders must occur. HCA 410 IT in Long Term Care during COVID 19

Other considerations are the recognition of the need for more budgeted funds for IT maintenance and ongoing development, as well as the challenges in recruitment and retention of the IT workforce. Examples of IT Projects to Improve Quality in Long-Term Care Country Villa Health Services in Los Angeles have their CNAs using digital pens for daily documentation which is then captured in a web-accessible data base. From this, a report is generated which trends resident vital signs, eating results, skin condition and other health indicators. The report can show resident history, any signs of trouble, and potential risks which is much more accurate than paper record review. Vernon Convalescent Hospital in Los Angeles has converted to handheld computers for certified nursing assistants to document patient information. Using off-the-shelf software templates, the facilities were able to train and implement the handheld computers efficiently. All nursing team members can see the patient data in real time at any of the nurses’ stations as well. Most recently, they are using the technology to prevent pressure ulcers which has decreased pressure sore incident by 33%. Delayed documentation has also been resolved with the use of handheld computers. Long-term care is just on the brink of total immersion into information technology for the coordination, transition and management of patient/client care. As long-term care becomes a partner in the healthcare system and part of reform, information technology for all aspects of the long-term care industry will become a strategic priority. …HCA 410 IT in Long Term Care during COVID 19