Playing catch up

Senior housing operators need to take a hard look at the state of their information technology and figure out where they are on the automation adoption curve. Chances are, they are lagging behind the rest of the healthcare industry.

Because senior housing — assisted living in particular — is a hybrid of hospitality and healthcare, the sector hasn’t been included in the government’s electronic health record and Meaningful Use interoperability initiatives that hospitals and medical centers have been working to achieve. What’s more, the entire long-term care sector has been excluded from eligibility for the American Recovery and Reinvestment Act of 2009, which earmarked billions for deployment of interoperable systems.

Even so, senior housing operators should be assessing how information technology can make their operations more efficient, cost-effective and quality-oriented, automation specialists say.

“They are late to the party, but they can catch up,” says Jon Shankman, senior vice president of clinical innovation for AMC Health. “What we’ve learned is that assisted living needs to be defined. They need to find out where they sit — are they residential, are they care-oriented and how do they handle chronic disease management? How are they defining the clinical services they provide?”

Other questions assisted living operators need to ask, Shankman says, are what technology can do to help residents and how it can bring a window into caring for people with chronic conditions, which he refers to as “continuous patient knowledge.”

As a supplier of various health monitoring solutions, AMC is targeting the assisted living industry as a new horizon for its products, Shankman says. The solutions monitor a host of chronic conditions, including diabetes, chronic heart failure, COPD, asthma and medication adherence. It also offers biometric monitoring, interactive response, video visits, personal emergency response services and clinical telecare management services designed to interact with the care team.

“Because our clients bear the largest cost of utilization, the information has to relate to specific chronic diseases so that caregivers know what needs to be done,” Shankman says.

An evolving sector

Healthcare IT is still evolving in the senior housing sector, falling into two basic categories: property management-oriented systems and electronic health records systems created for use in skilled nursing organizations, says Kim Ross, senior director of marketing for MatrixCare.

“Rising acuity levels in senior housing communities are creating a need for more clinical functionality, which is a challenge for property management-focused systems,” she says. “By contrast, EHR systems developed for use in skilled nursing facilities include functionality that is based on clinical and operational workflows that are not workable in a senior housing environment.”

In essence, Ross says senior housing doesn’t have an IT system that has been developed to fit is operations.

“At a recent conference one senior housing executive said ‘I’m looking for a unicorn and haven’t found it yet,’” she says. “‘The unicorn’ being a system that was developed with the needs, processes and workflows of senior housing communities in mind.”

David Wessinger co-founder and chief technology officer of PointClickCare, maintains that even though EHRs are linked to the ARRA interoperability initiative and despite senior housing’s exclusion from federal funding, operators should nevertheless actively pursue adopting the systems for their facilities.

“It is recognized that EHRs will lead to better outcomes and reduced healthcare costs,” he says. “For senior care providers, implementing an EHR platform supports the Meaningful Use goals of the hospitals and physicians they work with, resulting in higher value relationships with these key partners.”

Electronic Medication Administration Records — or eMARs — can also bring “great value” to assisted living facilities, says Gina Timmons, vice president of customer facing technology for Omnicare.

“Senior housing typically offers its residents a medication management option to assist with medication adherence and basic monitoring,” she says. “The eMAR medication orders are electronically populated by the pharmacy and include many additional educational warnings, precautions and monitoring cues for the caregivers.”

The eMAR allows data to be monitored from various points of view to ensure that residents are taking their medications as directed by their prescribers, and watches for any trends across the community, Timmons says. 

Omnicare is also pursuing integration opportunities with biometric devices that monitor the effectiveness and potential side effects of medications.

“The entire senior care team is interested in the trend data available in from these devices, like weight, blood pressure, glucose levels, oxygen and other readings,” Timmons says. “The residents can use these devices independently and still have their readings charted within their electronic health record.”

‘Silo’ environment

The senior housing IT environment has a steep climb to interoperability and full automation due to the “siloed” nature of their systems, says Mark Woodka, chief executive officer of OnShift.

“Many senior housing facilities are lacking robust EHR capabilities,” he says. “They are lacking systematic care tracking and service tracking capabilities.”

A major challenge for senior housing providers is revenue leakage, Woodka says, stemming from the inability to capture the necessary billing details so that revenue can accurately reflect the services they deliver.

“In addition, their greatest operational expense is labor, which typically represents about 50% of their costs,” he says. “Many senior housing providers are still scheduling and managing staff manually with pen and paper — it’s shocking. Labor management is a key area that they should be addressing systematically with core technology to help them manage their number-one expense.”

To achieve greater IT functionality, senior housing providers need to install enterprise-wide systems, Woodka says.

“They need to work with software vendors that offer integrated solutions but also work with other software vendors so they can truly get end-to-end technologies,” he says. “There is no one vendor offering every end-to-end component that they need. One solution is best-of-breed, relying on vendors that integrate well together.”

Tackling dysfunction

Although IT systems have become quite advanced and sophisticated, senior housing facilities don’t need to invest in highly complex functionality, says Doc DeVore, director of clinical informatics and industry relations at AOD Software.

“Information technology for assisted living is basic and typically does not require a robust solution other than the ability to track services and bill appropriately,” he says. “Although we are seeing a trend towards higher levels of care being provided, assisted living still remains a retail live-at-home operation. Thus the need for a full clinical software is not usually necessary.”

The typical technology requirements for assisted living centers around marketing their services, tracking the services provided, and collecting the appropriate revenue for those services, DeVore says.  

“Currently they are usually lacking a single software system that will track and bill appropriately, which creates efficiency as opposed to having to do multiple data entries in multiple software systems,” he says.

Having one IT specialist on staff, let alone a team, has been elusive for senior housing facilities and skilled nursing facilities alike, says Duke Yetter, founder and CEO of Mobile Medsoft.

“Not everybody has a qualified IT person nor do they understand how important it is to their organization,” he says. 

Consider the cloud

One of the fastest growing segments of healthcare IT has been remote data hosting in cloud-based servers. The concept has caught on in the industry because it is a low-cost, low-maintenance alternative to in-house servers and infrastructure. It is an adoption that senior housing facilities can easily make, IT specialists say, because it typically can be configured relatively simply.

One of the many advantages of the cloud is that it is a “‘grow as you need to’ model as opposed to a full purchase option,” says Jeremy Spradlin, CEO of CareServ Technologies. “The cloud hosting model allows smaller organizations to get the technological expertise that the hosting company provides.”

Another option for operators to consider is HaaS (Hardware as a Service), a model that involves leasing the equipment for a period of time and then turning it back in for a brand new system without increasing expenses.

“From copying machine to handheld devices, this outsourced IT function is particularly valuable to organizations just starting out with enterprise EHRs and mobile documentation strategies,” Spradlin says. “It is cost-effective and reliable.”