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					                  Long Term Care
Health Information
 Technology
              Inevitable
Providers are increasingly looking to improve quality
and claim earned reimbursement with HIT.
                                                                                   Kathleen Lourde




H
                     ealth information         The nation is beginning to see the      chronic diseases or for those who must
                     technology (HIT)       benefits of sharing health data, says      move frequently between levels of care,
                     is coming to long      Dan Cobb, chief technology officer and     such as many elderly.
                     term care, whether     an owner of Health MedX, Ozark, Mo.,          But while perhaps no one is where
                     providers like it or   and a member of the National Asso-         the Institute of Medicine (IOM) would
                     not, say experts.      ciation for the Support of Long Term       like them to be, when it comes to HIT
                     But in today’s         Care HIT Committee. “For example,          long term care has “really stepped up
environment of tight cash and five-star     transitions of care provide an opportu-    to the plate, and we’re working hard,”
ratings on the Web, a minority of pro-      nity to improve the quality of care by     says John Derr, senior vice president
viders are embracing a promising trend.     providing the admitting provider with      and chief technology officer, Golden
   Through President Obama’s stimulus       key health data,” he says.                 Living, Ft. Smith, Ark.
package and numerous state-level ini-          Even though some studies indicate          “We wish there were some funding,
tiatives, HIT is emerging as the cutting    that long term care providers are          that [the government] would help us
edge way to improve health care.            farther behind the curve of adopting       out in implementing this integration,
   The Office of the National Coordi-       HIT than hospitals or physician offices,   but we’re moving ahead because it’s the
nator for Health Information Technol-       some providers have grabbed hold of        right thing to do.”
ogy has estimated that health care will     emerging technology to lower their            “With a growing population of
save $140 billion per year if HIT is        costs and improve their quality.           chronically ill Americans, many of
adopted, according to the American             HIT can be particularly helpful when    whom see numerous providers, [HIT]
Health Care Association (AHCA).             caring for individuals with multiple,      provides a sound economic approach to
                                                                                                       Provider • March 2009 21
                                                                                                    Health Services has seen a $400,000
   Percent Of Facilities That Computerize                                                           increase in its Medicaid reimburse-
   Resident Management Processes                                                                    ment, “just because we’re able to look
                                                                                                    at our acuity live, every second,” says
                               Under 60 Beds              60-120 Beds             Over 120 Beds     Gary Kelso, president and chairman
   Metropolitan areas                4.5%                     56.7%                   38.8%         of the board, Mission Health Services,
   Rural areas                       9.5%                     85.7%                    4.8%         Huntsville, Utah. Mission Health has
   Urban areas                       14.9%                    74.5%                   10.6 %        four skilled nursing facilities and one
                                                                                                    intermediate care facility for individuals
   Source: Measuring IT Sophistication in Nursing Homes, Gregory Alexander et al., University of    with developmental disabilities.
   Missouri, Sinclair School of Nursing
                                                                                                       The company’s survey results have
                                                                                                    improved “very significantly,” he says.
 better managing and reducing the costs              says Jim Quasey, president of Vocollect        The system has “improved on our
 of treating this group while facilitat-             Healthcare Systems, Pittsburgh.                financials, surveys, and quality,” Kelso
 ing better coordination of care,” says                This is “driven in part by the height-       says. “I can log in and click on a but-
 Ken Thorpe, executive director of the               ened focus on quality—like the five-star       ton, and the system can tell how many
 Partnership to Fight Chronic Disease,               system” created by the Centers for             missed medications there were at any
 a national coalition based in Washing-              Medicare & Medicaid Services (CMS)             time. I can tell anything that’s going on
 ton, D.C.                                           to rank providers and post it on Nurs-         in any of my communities.”
                                                     ing Home Compare and on the trend                 While the economic downturn is
 Quality, Reimbursement                              toward culture change, he says. “You           causing some providers’ red pencils to
 Providers are increasingly considering              can’t improve quality without better           hesitate over their IT budgets, Vigilan,
 HIT as they seek to boost quality, im-              data, and you can’t get better data with-      a software company based in Wilson-
 prove the accuracy of their billing, cut            out technology.”                               ville, Ore., is actually seeing a lot of
 costs, and get the jump on with what                  And providers who use point-of-care          business come in because providers
 many see as an inevitability.                       HIT are seeing their reimbursement             are looking to IT to cut their costs.
    “I’m certainly seeing an awakening               rates go up, many report, because              “Emeritus—they’re our customer—
 of the need and an increased sense of               they’re more accurately documenting            they’re not slowing down [their HIT
 urgency to improve on the informa-                  assistance with activities of daily living     investment], and the reason they’re
 tion technology that’s in the facilities,”          (ADLs) and acuity levels, so they’re           not is because they’ve held their cen-
                                                     getting reimbursed more fully.                 sus flat for the last two quarters, but
                                                       In one year of using its new compre-         revenue went up $4,200 per quarter,”
                                                     hensive, paperless HIT system, Mission         says Geoffrey Bunza, founder and vice



                                                         PHR, EHR, EMR…What’s The Difference?

                                                                       A    personal health record (PHR) is an electronic record that
                                                                            individuals control containing their health information and
                                                                       recent services, usually used on the Internet. Many types are avail-
                                                                       able from a variety of organizations, including Google, Microsoft,
                                                                       and CMS in recent pilots for certain people with Medicare.
                                                                         Electronic health records (EHRs), in contrast, are controlled by
                                                                       the provider. They can be made up of electronic medical records
                                                                       (EMRs) from a variety of sources, such as laboratory results.
                                                                       While in health informatics EMRs are one type of EHR, in gen-
                                                                       eral parlance the two are interchangeable. In this article, EHR is
                                                                       used to cover both.




22 Provider • March 2009
                                                                                           tronic involving patient information or

              States Are Promoting HIT                                                     related operational functions.
                                                                                              IOM has identified eight core func-
                                                                                           tions for HIT: 1.) storage and retrieval

    L   egislatures in many states are
        seeking to promote the use of
    HIT in an attempt to improve qual-
                                              toward a seamless, integrated system
                                              of information sharing ranging from
                                              patient medical records, to insur-
                                                                                           of health data; 2.) results management;
                                                                                           3.) electronic order entry; 4.) deci-
                                                                                           sion support; 5.) communication and
    ity of care and control costs.            ance claims, to filing a patient’s drug      connectivity; 6.) education; 7.) admin-
       “States are moving at an unprec-       prescription,” said state Sen. Richard       istrative processes; and 8.) population
    edented rate to get their health          Moore of Massachusetts, vice presi-          health.
    care systems wired and connected,”        dent of NCSL, who chairs his state’s            HIT means health data are collected
    according to the National Confer-         Senate Health Care Finance Com-              electronically and can be aggregated
    ence of State Legislatures (NCSL),        mittee and developed the nation’s            and analyzed to produce better out-
    Washington, D.C. “And each year,          first universal health coverage plan in      comes and make sure that services are
    they increase their speed.”               Massachusetts.                               being reimbursed correctly. It can not
                                                 Many states see a role for them-          only ensure that providers have access
    Activity Triples                          selves in helping to finance targeted        to a patient’s medical history and help
    More than 370 bills relating to this      HIT initiatives, providing funding           them track care to reduce duplication
    effort were introduced in state leg-      for providers identified as being slow       of services, but it may also eventually
    islatures during an 18-month period       to adopt HIT, such as those in rural         provide caregivers with reference mate-
    between 2007 and 2008, according to       areas.                                       rials and guidance on standards of care,
    the 2008 NCSL report. More than              “As long as the states allow provid-      used in real time for every patient.
    130 bills containing HIT provisions       ers to utilize their own systems and            HIT is a powerful tool for improving
    were enacted in 44 states and the         require standards-based interoper-           the quality of long term care, but in-
    District of Columbia—thrice the           ability,” says Dan Cobb of Health            teroperability with technology in other
    number of bills enacted during the        MedX, “the end result should be              health care settings is essential to make
    same period from 2005 to 2006.            higher adoption of HIT and progress          it successful, according to a 2007 report
       “This is a health care IT revolu-      toward a resident-centered, electron-        that McLean, Va.-based BearingPoint
    tion in that state governments and        ic health record that encompasses all        prepared for the National Commission
    their federal partners are moving         care settings.”                              for Quality Long-Term Care.
                                                                                              The report concluded that technol-
                                                                                           ogy in long term care is much more
 president of engineering and operations        “Even if you took out the financial        fragmented than in the rest of the
 at Vigilan.                                  part of it, it improves surveys and col-     health care system, but that long term
    HIT “absolutely” results in improved      lects information that will help you be      care involves a wider spectrum of is-
 quality of care, lower costs, and greater    more responsive to family and resident       sues, provides a wider range of services
 efficiency, says Cobb. “Providers have       needs. I think it’s the right thing to       for seniors, and faces greater workforce
 used technology to improve quality           do. If you just break even, it’s the right   and financing challenges.
 indicators,” he says. “Paper is being        thing to do. It’ll improve your survey          HIT enhances data collection and
 replaced with electronic records that        results and your five-star rating.”          aggregation and makes data analysis
 are readily accessible and aid in clinical                                                more efficient, consistent, and effec-
 decision support. Electronic processes       What Is HIT?                                 tive in determining what changes will
 can save steps and involve fewer of the      HIT is “technology used for the col-         deliver better outcomes, the report
 valuable clinical employees. An example      lection of patient information and the       explains. It delivers greater consistency
 is where prescriber order entry and          potential exchange of information,”          in reported data through unambiguous,
 electronic medication administration         according to Todd Smith, director of         computable queries and supports the
 records, or eMARs, can eliminate the         the strategic action group at AHCA.          greater alignment of financial incen-
 monthly MAR turnover process.”               It includes point-of-care data collec-       tives and reimbursement models with
    Kelso thinks all long term care facili-   tion, electronic health records (EHRs),      quality outcomes.
 ties will be required to have electronic     electronic medical records, personal
 charting within five years. “It’s going to   health records, e-prescriptions, elec-       Point-Of-Care Data Collection
 happen, which is part of our rationale       tronic medication administration, and        “We feel companies experience their
 to do it sooner than later,” he says.        e-pharmacy—basically anything elec-          first ROI [return on investment] in
24 Provider • March 2009
point-of-care technologies,” says Peter Kress, vice president
and chief information officer, ACTS Retirement Commu-
nities, West Point, Pa. “Most organizations experience a
variety of benefits, both in terms of being able to optimize
revenue capture and mitigate the risk that occurs because of
lack of documentation.”
   In point-of-care data collection, caregivers use wall-
mounted touch screens called “kiosks,” hand-held devices,
or another portable data collection tool to document their
observations of a resident’s ADLs or health status as they
provide care. These systems may prompt caregivers to
provide specific information with the goal of gathering more
complete and more accurate information. For example, a
certified nurse assistant (CNA) who helps a resident move
from bed to wheelchair notes that this assistance has been
provided, or while assisting a resident with dressing the
CNA records that she noticed a reddened area on the pa-
tient’s left heel.
   The data collected is then made available in real time
to nurses, directors of nursing, minimum data set (MDS)
coordinators, dietitians, care-planning teams, administra-
tors, or other staff who need it to provide better care. Paper
is eliminated from this process, meaning that forms can’t be
lost or filled out illegibly and charting can’t be simply copied
from one shift to another. Electronically documented care
also means the data can easily be made available in the event
of a survey or litigation.
   While it may not have the lowest cost or the best ROI,
one of the most valuable forms of HIT may be ADL cap-
ture, says Cobb. “This capability is provided by most long
term care EHRs and allows providers to get reimbursed for
the care they provide. Without good ADL data, providers
have a tendency to under-code RUGs [resource utilization
groups],” he says.

Electronic Drug Administration
Although not pervasive, Mark Pavlovich, operations analyst
for SavaSeniorCare, Atlanta, believes electronic medication
administration systems reduce medication errors and enable
nurses to spend more time with the residents. “Say the nurse
has 20 patients,” Pavlovich says. “The nurse has to read the
physician order, dispense medication, and record on paper
what medications were given at what time. The electronic
medication administration records—and there are several
out there that have touch screens—have a roster of your
residents, dispense the medication, and record that you’ve
administered the medication.”
   The reason Pavlovich likes this system is that it lessens
the burden on nurses so they can spend more time with the
residents, “and in long term care we love when that hap-
pens,” he says. The systems provide data on e-MARs and
e-TARs (electronic treatment administration records). “We
also would anticipate that medication errors will be reduced
                                                                   Provider • March 2009 25
                                                                                         if the nurse can concentrate on provid-
                                                                                         ing medications and spend less time on
                                                                                         finding a pen to write the right number
                                                                                         in the right box.”
                                                                                            A very good technology out there
                                                                                         “is the whole notion of taking the
                                                                                         pharmacy electronic,” says Pavlov-
                                                                                         ich. “Pharmacy is very complicated.”
   A Few Point-of-Care Products                                                          Medications are ordered by paper, fax,
                                                                                         or electronically. The pharmacy has to

   O     ne assisted point-of-care
         product, CareTracker, is a kiosk
   where staff document care on a touch
                                               triage and enhances communication
                                               between the CNA and the nurse.”
                                                  Good Samaritan developed the ap-
                                                                                         understand the order, call back for any
                                                                                         clarifications, and deliver the medica-
                                                                                         tions in blister packs. Someone puts the
   screen on a wall, says SavaSenior-          plication in-house. The only software     medications into central storage then
   Care’s Mark Pavlovich.                      purchased was one that pushes data to     puts them into medication carts. “Every
      “Within the first two months that        the hand-helds from the headquarters      step is really ripe for error,” he says.
   we have been using it, we now have a        in Sioux Falls, S.D. They purchased          Reef Gillum, a physician and
   much more accurate picture of what          the hand-helds from Socket Mobile,        president of a company called Provider
   ADLs are for our residents,” Pavlov-        Newark, Calif., figuring they’d need a    Business Solutions, Forney, Texas, won-
   ich says. Staff don’t have to remember      hand-held for every staff member on       dered what putting the pharmacy in the
   what they did throughout the day and        the day shift plus about 20 percent ex-   nursing facility could do for medica-
   find medical charts to record it after      tra. The hand-helds are then rotated      tion errors and costs. His solution was
   the fact, and “that’s always going          through the shifts.                       a pill vending machine with common
   to improve your accuracy,” says                Good Samaritan felt that kiosks        medications in canisters. When the
   Pavlovich.                                  wouldn’t quite get them to real-time      doctor prescribes a medication, it’s
                                               point-of-care documentation. Some         vended with a description of the pill
   The Hand-Held Route                         providers worry that too many of the      and what it’s for so that the nurse can
   Some providers, such as the Evan-           hand-helds would be dropped and           double-check the accuracy and issue
   gelical Good Samaritan Society, use         broken, but the company tracked the       any necessary warnings.
   hand-held devices for point-of-care         numbers and found that a very small          This means that if a physician orders
   data collection. While they’d been          percentage were broken. Still, they       a 30-day supply of a medication but the
   working on the project for years, the       went with a more durable hand-held        resident doesn’t take it all, the surplus
   Hands On Project began to be rolled         in their rollout than they’d used in      pills remain in the vending machine
   out in July of last year. The roll-out      the pilot. The Socket hand-helds they     rather than being destroyed, as is cur-
   trajectory for all 190 skilled nurs-        chose are about $500 apiece.              rently the procedure.
   ing facilities in 24 states takes them         Rolling out the Hands On Project          “If I only use three days, I only buy
   almost to August of this year. “Ul-         has been challenging at times. “At        three days’ worth of medications,” says
   timately we will touch about 16,000         first we had hardware issues,” says       Pavlovich. This results in enormous
   staff,” says Monique Lingle. “It’s been     Lingle. “We pretty much remedied          cost savings and great time savings, he
   a bit of an undertaking.”                   those.” Depending on the facility,        says. It also reduces pharmacy tags on
      For example, if a CNA notices a          staff may have fewer computer skills,     the annual survey.
   reddened area, they document it on          and that’s a challenge. High turn-           The benefits of electronic prescrib-
   the small hand-held, and the data are       over in some facilities means a lot of    ing are becoming well-known and
   sent wirelessly to a report every two       education. Overall, though, the sheer     beginning to gain traction in long term
   minutes. When nurses go into the            size of the project was the biggest       care, says Cobb. “Standards-based
   report, they can then see that this         challenge, says Lingle. “On any given     interoperability will be necessary to
   particular resident has a reddened          front you could be challenged,” she       achieve our goal of an electronic health
   area.                                       says, so the key is to stay tuned in to   record for all Americans by 2014.”
      “We have a nurse end-of-shift            the field and listen to their needs.
   report that flags problems, like a             The company has instituted a 24/7      Electronic Health Records
   resident didn’t void during the whole       help desk to address issues as they       HIT began in earnest back in 2004,
   shift,” says Lingle. “It’s a quick way to   arise.                                    when President Bush introduced an
                                                                                         initiative to promote HIT with the
26 Provider • March 2009
goal of every citizen having an EHR by                                                   A functional profile of an EHR for
2014. Early on, although many vendors                                                 nursing facilities has been created by
produced EHR software, they weren’t                                                   the nursing facility community, led
interoperable because the nation had                                                  by the HHS Office of the Assistant
no interoperability standards.                                                        Secretary for Planning and Evaluation
  Now, the Certification Commission                                                   (ASPE), the American Health Informa-
for Healthcare Information Technol-                                                   tion Management Association
ogy (CCHIT) certifies EHRs and their                                                  (AHIMA), the Health Level Seven
networks for various care settings.      Although vendors                             (HL7) Electronic Health Record
CCHIT-certified products are interop-                                                 Technical Committee, and the Na-
erable. About 75 percent of all EHR      produced EHR software,                       tional Council for Prescription Drug
systems are now CCHIT-certified, says                                                 Programs. ASPE provided the funding
Michael Leavitt, former Health and
Human Services (HHS) secretary.
                                         they weren’t interoper-                      to develop what’s referred to as the
                                                                                      LTC-NH EHR-S Functional Profile.
  Currently, no long-term-care-                                                       The profile was balloted by industry
specific EHRs are certified, because
                                         able because there were                      stakeholders and by HL7 and became
CCHIT has yet to develop the certifi-                                                 the official industry standard Jan. 5, ac-
cation requirements for them. How-       no standards.                                cording to Michelle Dougherty, direc-
ever, CCHIT plans to begin certifying                                                 tor of practice leadership, AHIMA.
EHRs for nursing facilities beginning    group is starting to work out the certifi-      “The profile was defined to be the
in 2010.                                 cation details for long term care EHR        gold standard of what a long term care
  Derr is the commissioner for long      products. “That’ll also protect the small    EHR should be,” says Cobb. “We pur-
term care of CCHIT. He says the          moms and pops,” he says.                     posely included functions and capabili-




                                                                                      For More Information




                                                                                                       Provider • March 2009 27
                           HIT In Assisted Living
                           H     IT requirements in assisted living
                                 are different from those in nurs-
                           ing facilities, necessitating assisted-
                                                                      around the amount of medical infor-
                                                                      mation that is handled,” says Vigilan’s
                                                                      Geoffrey Bunza. “It’s dramatically less
                           living-specific software. Vigilan,         on the assisted living hand.”
                           Wilsonville, Ore., manages 12 assisted        In addition, assisted living is
                           living residences.                         governed by state regulations, so the
                              The company developed its own           IT must “be flexible and adaptable
                           clinical and business software that        to support the differing regulations
                           guides staff on ADL-assistance sched-      among the states. Not that different
                           ules, records assessments, and does        data be kept, but that different analysis
                           billing and internal cost allocation.      be done,” he says. Further, Vigilan
                           Vigilan went on to sell this software to   must keep track of the changes to
                           other assisted living residences. Vigi-    the regulations in 50 states. “It’s even
                           lan’s core operational management          more of an interesting thing when you
                           product is The Administrator that, on      realize that a huge number of multi-
                           average, increases revenue by $150 per     community companies are scattered
                           resident per month, according to the       all over the country, yet they want to
                           company.                                   be able to compare their facilities,”
                              “The differences really center          says Bunza.




28 Provider • March 2009
ties that are not widely available, but                                                with certification starting sometime
that will be needed by the industry.”                                                  in 2010.”
    “We’ll go through the comments                                                        “Interoperability with other care set-
and see if there’s a need to tweak it,”                                                tings is not pervasive yet,” says Cobb,
says Dougherty, but she expects that by                                                “and is a necessary step in the evolution
the end of February it will be available                                               from electronic medical records toward
to vendors and providers to use from a                                                 a true electronic health record.” How-
development perspective.                                                               ever, he says, progress is being made.
   “The standard incorporates expecta-      The profile was defined                    “Standards are being developed and
tions for point-of-care delivery and col-                                              adopted that specify which information
lection of data and technical infrastruc-   to be the gold standard                    can be shared and in which format.”
ture, security, record management, with                                                   ACTS sees its point-of-care systems
what the vision is for EHRs for health
care,” she says.
                                            of what a long term                        as a down payment on EHRs, ac-
                                                                                       cording to Kress. For its core clinical
   CCHIT will refer to the profile                                                     systems, ACTS is ready to transition to
when it develops the functionality,
                                            care EHR should be,                        Health MedX, a provider of Web-based
interoperability, and security certifica-                                              information system solutions for the
tion requirements for EHRs for the          Cobb says.                                 extended care market.
profession.
   “The CCHIT workgroup for long            [which is the basis on which CCHIT         Most Providers Under-invest In HIT
term care has not yet formed,” says         certifies EHRs] and define the initial     “The present landscape for HIT invest-
Cobb. “This group will likely begin         certification criteria. I’m hearing that   ment in long term care is slightly below
with the HL7 EHR-S functional profile       the workgroup should form this year,       the amount that other health care




                                                                                                        Provider • March 2009 29
 does,” says Pavlovich. In the rest of                                                 Most facilities are using technology
 health care, 6 percent or so of revenue                                               for billing, and staff punching in and
 is spent on HIT, but “by and large long                                               out is probably electronic, he says.
 term care spends a little less,” he says.                                             “Of course, we have the requirement
    “Our industry under-invests in                                                     from CMS that we submit the MDS
 technology, greatly to its detriment,”                                                electronically, and a growing number
 says Kress. “We have a long way to go.                                                [of facilities are] starting to use data
 We’re still closer to the beginning of                                                vendors to check the accuracy before
 the journey than we are to the end of       Our industry under-                       submitting it,” he says.
 the journey.”                                                                            The lag in IT implementation has
    “The top 10 or so companies have         invests in technology,                    been attributed to such factors as
 very well-developed HIT systems,” says                                                significant cost of infrastructure, lack of
 Pavlovich.
    For example, Golden Living’s data
                                             greatly to its detriment.                 onsite IT expertise, variable staff com-
                                                                                       petency levels, and high staff turnover
 are centralized. Its software programs                                                leading to high training costs.
 aren’t integrated, “but that’s what we’re
                                             We have a long way                           According to a 2008 survey of Min-
 working on,” says Derr, “integrating all                                              nesota nursing facilities, 72.1 percent
 software applications so when someone       to go.                                    reported that lack of capital resources
 enters into Golden Living we can fol-                                                 was a major barrier to HIT implemen-
 low them. Interoperability is what we       probably a good number of facilities      tation. About 90 percent of New York
 have to have to cut the cost down. You      have a technological infrastructure—      providers identified the initial cost of
 have to have an integrated system.”         such as Internet and e-mail—available,    HIT investment was a barrier to its
    Beyond the top 10, says Pavlovich,       although not all have broadband access.   adoption.

                                                                                       Getting It Right
                                                                                       As experts note, technology for tech-
                                                                                       nology’s sake likely won’t do much but
    American Health Care Association/National Center for Assisted Living               complicate matters. The key is finding
                                                                                       the right technology for the task, hav-
     2009 SPRING MULTIFACILITY CONFERENCE                                              ing software programs that interface
    FOR CEOS AND SENIOR EXECUTIVE LEADERS                                              with each other, and striving for in-
                                                                                       teroperability, particularly with EHRs.
         Wednesday, April 22 – Friday, April 24, 2009                                     n Cobb’s best advice to providers
              THE RITZ-CARLTON GOLF RESORT, NAPLES, FLORIDA                            who would like to begin the process
                                                                                       toward using HIT is to “learn from the
                                                                                       experiences of other providers. Some
                                                                                       providers are really pushing the enve-
                                                                                       lope of adopting new technology.”
       CEO’s and executive-level staff of national and regional
                                                                                          n Derr’s advice is to “assign some-
     multifacility long term care corporations are eligible to attend.
                                                                                       body to watch what’s happening on
                                                                                       a national basis. Facilities must “use
                                                                                       the standards coming out in order to
                                                                                       have connectivity, so I’d advise them
           Please register online by March 20, 2009                                    to become involved with AHCA” or
               at www.ceo.ahcaancal.org, or call 202-842-444                           other association and just pay attention.
                          for more information.                                        “Don’t sit on the sidelines.”
                                                                                          n Cobb advises providers to “rec-
                                                                                       ognize that HIT is much more than a
                                                                                       product purchase decision. Technology
                                                                                       by itself provides limited value,” he
                                                                                       says. “True benefits are received when
                                                                                       clinical processes are adapted to lever-
                                                                                       age the technology.”
30 Provider • March 2009
  n If a provider is considering pur-                                                   ogy needs to be linked to careful think-
chasing an EHR system, it’s important                                                   ing about workflow, the impact on the
to ask the vendor if they are aware                                                     people involved,” says Kress. “Many
of the LTC-NH-EHR-S functional                                                          organizations need to try several times
profile and what their plans are for                                                    before they get that equation right,
development, says Dougherty.                                                            so it’s very rare that implementations
  n “A core clinical system that sup-                                                   are very smooth, but it’s rare that any
ports regulatory requirements is an                                                     change is very smooth.”
important first step,” says Kress, “and     A key lesson learned                           n “Key lessons learned are our need
point-of-care technology is an im-                                                      to engage front-line users in every
portant second step. Maturity starts        is our need to engage                       point of the process, engage in a lot of
to come when people start to deploy                                                     communication, and primarily just have
medication management systems and
EHRs that are comprehensive to sup-
                                            front-line users in                         a committed focus that we’re going to
                                                                                        continue moving forward step by step,”
port transfers of care.”                                                                says Kress, “that we won’t let barriers
  n “Absolutely start with data cap-
                                            every point of the                          stop us.”
ture,” recommends Pavlovich. “Sava-                                                        n It’s important to get staff input into
SeniorCare had an idea of what our          process.                                    an HIT system that’s being consid-
ADLs were, but when we had better                                                       ered for roll-out, says Richard Matros,
data capture we found out we were           were, the more data, the better and         chairman of the board and chief execu-
incorrect,” he says. “If you ask me to go   cleaner data, the better able you will be   tive officer, Sun Healthcare Group,
into a facility interested in improving     able to improve your residents’ lives.”     Irvine, Calif. Sun did it during its pilot
technology regardless of where they           n “Any implementation of technol-         and put together an administrator




                                                                                                         Provider • March 2009 31
                                                                                            In tomorrow’s world, independent fa-
                                                                                         cilities “can’t be isolated as they have in
                                                                                         the past,” says Derr. For example, while
                                                                                         long term care is exempt from the e-
                                                                                         prescribing regulations where doctors
                                                                                         get an incentive for e-prescribing, then
                                                                                         after that they get penalized, long term
                                                                                         care is still affected by these regulations
   Some Providers Enter Upon                                                             because doctors are insisting the facili-
                                                                                         ties accept e-prescribing.
   Several Systems At Once                                                                  One of the things Mission Health
                                                                                         Services is working on now is electronic

   S    un Healthcare Group is rolling
        out PointClickCare (PCC) over
   three years.
                                              more time for hands-on patient care,
                                              and the three systems will all inter-
                                              face. So, looking out a couple, three
                                                                                         menu planning technology that would
                                                                                         be incorporated into the company’s
                                                                                         software program to provide culturally
      So as not to overwhelm their staff,     years, all of our centers will have a      diverse choices in meals for any com-
   who still have jobs to do, they’re         platform in which everything is inte-      munity. This, says Kelso, is critical for
   rolling it out in pieces: the integrated   grated and real time.”                     the culture change journey.
   clinical system, the quality measures,                                                   The challenges of the Sioux Falls,
   the billing, and, lastly, EHRs.            Change Is Inevitable                       S.D.-based Evangelical Good Samari-
      “It will help the quality of our        “Nothing good is ever easy,” says          tan Society’s initiative to implement
   documentation and the quality of           Kim Drake of Methodist Country             hand-held devices in 190 nursing facili-
   outcomes,” says Richard Matros of          House. “And when you’re first [to          ties are pushing it to be better prepared
   Sun Healthcare Group.                      help develop new interfaces between        for an EHR, which is their next big
      Rolling everything out all at once      technologies], it’s the guinea pig         step, says Monique Lingle, clinical
   would also be prohibitively expensive,     theory. You know you’re going to           applications regulatory consultant. “I
   he says, and it gives Sun a chance to      run into glitches, and where 10 years      cannot imagine moving forward with
   fix problems as they arise.                ago nurses would have thrown their         an EHR without doing what we’re do-
      HCR Manor Care and Genesis are          hands up,” they now know it’s coming       ing first, because we’re working hard to
   also using PCC, according to Matros.       regardless.                                build the infrastructure and be better
   “The electronic medical record isn’t          In fact, at Methodist Country           prepared for the next big step.”
   fully developed, so we’re working          House nurses “are very excited about
   with PCC and others in developing          it. Nurses love their paper, their         Time To Get On The Bandwagon
   that,” says Matros. “We hope to set        binders and books, but as they learn       Improved quality, better reimburse-
   the standard for the sector. It’s going    and trust the system, they start letting   ment, lowered costs, furthering the
   to make us pretty paperless, give us       go of some of the paper,” she says.        culture change movement, who could
                                                                                         resist this? And with it being inevitable
                                                                                         anyway?
 advisory council and a nursing advisory      ensure that the building is covered 100       Those who snooze may lose. Waiting
 council. “You never want corporate just      percent so that caregivers always have     too long to implement HIT may erase
 dictating stuff,” he says, because the       access to the HIT.                         some of the benefit, says Kress. “By the
 day-to-day experience of the product           n Don’t go too slowly, advises Kim       time that most people adopt this it’ll
 can be different from what corporate         Drake, director of health, Methodist       force a recalibration of rates,” he says.
 envisions.                                   Country House, Wilmington, Del.;           “It’ll be a huge disadvantage not to be
   n Providers need to consider security      don’t ease into it. “Had I let them do     documenting your care. Rates will go
 with any networking products any time        paper [logs] as a backup, it just makes    down even more for those who aren’t
 patient data are being transmitted,          for a rougher start,” she says. “Sink or   documenting than for those who are.”
 says Josh Slobin, product marketing          swim. Take away the paper. The slower         Providers will need to use the most
 manager, Enterprise Wireless LAN,            you start the slower you go. People are    up-to-date technology, Kress says.
 Motorola Enterprise Mobility business,       smart. All the training’s done up front.   “We’re all going to have to be adopting
 Schaumberg, Ill.                             But once you commit, if you have a         as fast as we possibly can and readopt-
   When installing a wireless system,         backup, you’ll have two incomplete         ing as fast as we can. This is not a one
 according to Slobin, it’s important to       systems.”                                  time thing.” n
32 Provider • March 2009

				
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