On paper, it sounds like a noble goal: Get healthcare providers to implement IT solutions to help improve the patient experience.
In reality, getting operators — of all sorts — on the same page with healthcare IT has been something of a mixed bag. The relatively new world of HIT has been a strange one for providers, many of whom are reluctant to embrace change. For the first few years, software programs were also relatively siloed, focusing on one aspect of care or compliance.
But as the years go on, the full scope of possibilities is starting to come into focus, and providers are more comfortable using HIT to improve communication, increase compliance and predict patient outcomes — all with an eye toward reducing rehospitalization.
Catching the carrot
With the passage of the Protecting Access to Medicare Act of 2014 in April, preventing readmission to hospitals has become an even more pressing concern for senior living providers. As part of the law, CMS will implement a new reimbursement plan starting in 2018, explains Doc DeVore, director of clinical informatics & industry relations with Answers On Demand (AOD) Software.
“A reserve of 2 percent of total payments will be set aside and the top 30 percent of long-term care providers with the lowest re-hospitalization rates will receive a reimbursement from the reserve pool,” he says.
But the government’s stick-and-carrot plan may prove to be redundant. That’s because low readmission rates are already vital to ensure ongoing hospital referrals and to keep communities financially stable.
“If a hospital looks at its data and says, ‘my readmission rate from operator A is much lower than it is from operator B,’ guess where they’re going to refer their patients?” asks Kim Ross, senior director of marketing with MatrixCare.
To benefit from these higher referral rates — and, ultimately, increase revenue — providers need to have a way to track their progress when it comes to rehospitalization and share that data with accountable care organizations and other stakeholders. Statistics regarding length of stay, even patient satisfaction surveys are important metrics ACOs consider, and HIT solutions are more capable of collecting and packaging that information than ever.
“In order to stay ahead of the curve, providers need to look at healthcare information technology solutions that are flexible, scalable and interoperable,” says Dave Wessinger, chief technology officer at PointClickCare.
Preventing readmissions also relies on a rapid transfer of accurate health information, says Keith Speights, the president at RosieConnect.
“If you can’t make a change quickly enough, that patient will go back to the hospital. If you can intervene, the resident can be taken care of in the facility,” he says. “It’s about getting the key clinical information into the hands of the right person.”
While many industry insiders correctly point to financial constraints as a barrier to adoption — “It’s not like [providers] are making a ton of money, and government reimbursements aren’t setting the world on fire, either,” quips Ross — there are other blockades that may be less obvious but a hindrance, nonetheless.
First and foremost, says Jeremiah Johnson, vice president of business development with VorroHealth, is a lack of strategy. IT needs to support a company’s overall goals, not just the specific needs of senior care.
“As a popular saying goes, ‘Begin with the end in mind,’” he says. “An IT strategy that is well thought out, documented and communicable creates an environment in which barriers can be broken and implementation can survive when the headwinds arise.”
Hesitancy and skepticism on the part of staff is another major drag on HIT implementation in senior living. Older physicians and nurses might be reluctant to change their way of working. Administrators may worry over security fears and the potential for medical records to be hacked. Many have taken an attitude of, “if it ain’t broke, don’t fix it” — but just because something isn’t broken doesn’t mean it’s working well.
Overcoming reluctance from staff can be difficult, but there’s a way around it, according to Wessinger. “Organizations need to involve everyone in the selection process, determine what will work within the organization’s capabilities and train staff accordingly,” he says.
For all these stumbling points, however, it still comes down to money for most providers. But LeRoy Boan, senior sales representative at NTT DATA Long-Term Care Solutions, advises providers to look well beyond the first year, when the costs outweigh the benefits, in order to really see their return on investment.
“Adding [HIT solutions] may not show savings immediately,” he says, “but they will as soon as nurses eliminate things like medication notebooks and monthly recaps from their routines. The nursing hours saved on this alone would pay for the software.”
Interoperability is the ability for an organization’s systems to share critical information with other providers across the senior care continuum, Wessinger explains — and it’s the name of the game for many in the healthcare IT field.
“Interoperability with health systems and other acute care settings is at a crucial level for long-term and post-acute care providers,” says Chris Dollar, chief operating officer at HealthMEDX. “We are reaching a tipping point where providers will not be able to successfully run their businesses without the benefits that the right electronic medical record can provide.”
Providers don’t need to look to the future to see these trends; they’re starting to take shape now.
“[Acute care providers are] under pressure to shorten length of stay,” notes Jim Hoey, president and CEO of Prime Care Technologies. “[Senior living] centers are being transferred increasingly fragile patients with complex medical needs. Patients are arriving quicker and sicker than ever.”
The receiving facility needs instant access to all sorts of patient information, from medications and physician orders to diagnoses, potential complications and allergies.
“All care settings need to receive accurate and pertinent information in a timely fashion to ensure a good transition,” according to Maria Arellano, RN, MS, clinical product manager at American HealthTech.
“We have to share what we’ve learned about the patient with their next caregiver. Otherwise they have to start all over again, which takes time and resources. A vulnerable patient doesn’t have the time for the new setting to figure it out all over again.”
Care for the future
In the face of rising demand for healthcare and senior care services from an aging population, providers are searching for ways to sustain and improve the level of care they provide. Fortunately, says Johnson, technology firms are starting to address this growing need.
“We will start to see IT solutions that will not only allow providers a look upstream using predictive analytics, modeling and trending of information,” he says, “but also the interactive ability to immediately alert providers and intervene to create more appropriate care paths.”
Traditional charting methods, where nurses and physicians hand-write their notes on paper, are inefficient when it comes to pulling out patient data and looking for trends that could affect care decisions, according to Debi Damas, RN, senior care product manager with Relias Learning.
“IT allows providers to track better,” she says. “When you’re doing the documentation, you can see problems coming before you actually have a problem.”
By finding problems early, patients often can be treated in the facility, without requiring a return trip to the hospital.
Predictive analytics also can help reduce costs and improve care by identifying when an individual is approaching the end of life.
“At least 30 percent of all Medicare expenditures are attributed to the 5 percent of beneficiaries that die each year, with one-third of that cost occurring in the last month of life,” according to Janine Savage, RN, national account manager at PointRight.
“Several reputable studies have shown that when life expectancy is limited, hospitalization and aggressive medical treatment may not only be futile and costly, but quality of life is often sacrificed and patients experience a ‘worse’ dying process,” she says.
Social safety net
Clinical data mining and communication between providers are unquestionably vital when it comes to reducing rehospitalization.
But according to Richard Juknavorian, senior director of product management at PointRight, socioeconomic and psychosocial factors will prove more important in preventing return trips to the hospital, and it’s something that HIT will start to incorporate more over the coming years.