Long-term Care Providers Dipping Toes in Interoperable Waters

Long-term care provides a unique challenge regarding interoperability of patient information but a range of stakeholders are certainly making notable attempts.

Long-term and post-acute care providers [LTPAC] drive a lot of costs but don’t have a lot of IT adoption, says Kelly Cronin, health reform coordinator at the Office of the National Coordinator for Health IT (ONC), speaking at the 2014 State Healthcare IT Connect Summit.

Cronin’s office is looking into “finalizing recommendations on how to expand voluntary certification to get to these settings.” There are federal funds to support interoperability with these providers, and a “comprehensive effort to figure out how to have incentives that give a reason for these other types of providers to adopt tools to exchange and manage data beyond their setting.”

Top priorities, according to Cronin, are creating a network of networks, developing a multiyear interoperability strategy and scaling claims and clinical data infrastructure for value-based purchasing.

Meanwhile, ONC has awarded $16 million in challenge grants to encourage breakthrough innovations for health information exchange (HIE).

All-around improvement

Cedar Creek Nursing Center in Norman, Okla., received one of the grants to develop innovative and scalable solutions for LTPAC transitions.

The biggest challenge is buy-in from both nurses and physicians, says Kelly Bowers, Cedar Creek’s director of nursing. “Nursing homes don’t like change.” The nurses and aides thought it would be hard to go electronic but soon came to love it, she says, thanks to quick charting and greater accuracy.

The organization made the switch mandatory, selecting a launch date and clearing out all of the paper. Helpers were available to assist employees for a few weeks but the staff adapted quickly, Bowers says. “My accuracy is so much better and I average a 99 percent charting rate every day” primarily due to staff no longer waiting until the end of their shift to record patient behaviors. By updating throughout their shift, all staff can check on patients throughout the day.

Physicians can work more efficiently as well, reports Bowers. Before, if a nurse called about a patient with shortness of breath, a physician would ask follow-up questions but the nurse wouldn’t have those answers. The system asks all those questions now so that when nurses call physicians, they already have all of the relevant information.

Cedar Creek has experienced a reduction in falls and use of antipsychotic drugs, and a decrease in patient weight loss. “We also took four patients off of hospice because they started doing better,” she says. The facility received more Medicaid reimbursement and went from one star to four stars in quality and patient satisfaction scores which also allows for greater reimbursement.  “A lot of that had to do with the EMR because it plays a part in us being able to spend more time with residents” for a total of $4 more per resident per day in reimbursement, she says.

Cedar Creek used the grant to better tailor its transfer form as well. When a resident needs to go to the emergency department, receiving physicians weren’t always getting the information they needed. So, “we formatted the form to what the ED doctors really wanted to know.”

Cedar Creek also went from a 30-day hospital readmission rate of 50 percent to just 4 percent. Much of that decrease was due to alerts on the CareTracker tool, says Bowers, regarding potential urinary tract infections, heart failure and upper respiratory infections. The alerts prompted nurses to assess patients for particular problems.

The organization did so well through the grant that they extended the contract for another two years at no additional cost. Bowers says they are currently reviewing reports to see what tools to add. For example, a fluid list can help staff prevent dehydration and impactions among patients.

Population we ‘can’t ignore’

Other LTPAC providers are waiting for the opportunity to modernize and connect. After decades working for numerous businesses, providers and organizations and serving on several government advisory committees, John F. Derr, RPh, says long-term and post-acute care is finally getting a bit of recognition as a valued component of the care spectrum worth connecting with electronically.

ONC has been very supportive and the Centers for Medicare & Medicaid Services have tried, he says, when it comes to including LTPAC in the regulations and funding efforts. He says he understands the limits they face “but we’ve been working diligently to get our people up to speed so that when they want to connect with us we’ll be ready.”

Preventive care requires the ability to look at patients for a long period of time. Currently, quality measures are based on penalty management. “To me, that’s not constructive,” Derr says. Rather, quality measures should indicate whether care is appropriate and the right clinical outcomes are occurring. That requires quality measures for chronic care which don’t yet exist.

Certification for LTPAC providers would help, Derr says. “The key word is trust. If there is no basic certification, how would you, as a hospital, be able to trust data you’re getting from one of these providers?” It’s “completely illogical” to have accountable care and patient-centered medical homes without including LTPAC, he says.

Between 40 and 60 percent of hospital discharges go to LTPAC, Derr says—a “population we can’t ignore.”

Awareness will help other healthcare providers realize the value of LTPAC, he says. “We play a valuable role in the healthcare spectrum. Let us be a part of the whole thing. We’ll be able to connect if we’re involved.”