By the numbers
Good data-capture and analysis add up to better outcomes
Strategically harnessing and analyzing data has become an operational imperative for senior living operators looking to maintain a stronghold in today's increasingly competitive marketplace.
“Data is today's currency. If cash is king, then in this day and age, data is the queen,” says Majd Alwan, Ph.D., senior VP of technology for LeadingAge. He explained that data elements affecting quality measures, such as readmission rates, are impacting 5-Star ratings. “Quality data and effective analysis also impacts reimbursement levels, the ability to participate in accountable care organizations and other alternative models, such as bundled payments, and the ability to contract with payers like managed care or Medicare Advantage Plus. It's even driving referrals and consumer choices.”
Experts largely agree the use (or misuse) of data will make or break an operator of any size. “If a home doesn't invest in tools that provide them with proper data capture, they will not be able to keep up with the money-saving decisions that the larger companies are learning about,” says Dan Roberge, president of Maintenance Care.
While operators have always been interested in “real estate-centric” data, such as occupancy, rent rates and net operating income, forward-looking providers are more closely examining service-centric data and analytics, says Travis Palmquist, vice president of senior living at PointClickCare. “Specifically, we are beginning to see a greater shift toward capturing data around service delivery, resident experience, readmissions, staff and resident engagement, wellness, workforce management and the like.”
Operators don't have to try to harness and analyze all these data on their own. Today, many low-cost, flexible software solutions take the data management burden off the operator and give meaningful, accurate and current information with an immediate return on investment.
MEASURES OF SUCCESS
With so much data being gathered at nearly every turn, some operators may struggle with what to analyze first — and how. Thinking about end goals is a great place to start, according to Jim Rubadue, chief customer officer for OnShift.
“Is [the end goal] to provide better quality care? Are profit margins where they need to be to meet financial goals? Is turnover a major problem?” With end goals in mind, it can be determined which data need to be collected to meet those goals, he says.
Focusing on resident-specific data that will help improve care and meet requirements, such as for MDS and OASIS, is critical for surviving and thriving in today's quality-focused environment. This includes ongoing assessment information, vital signs and staff observations, documentation on social support needs and electronic health record documentation of chronic diagnoses, medication administration and/or adherence records, and other interventional outcomes.
“This data, if collected once, shared and leveraged in multiple ways, can lead to efficiencies and insights that can be used in conjunction with some advanced health information technology functionalities like dashboards, clinical decision support systems and population management tools,” Alwan says. When properly shared with care partners, the data can improve care coordination.
The richest data capture happens at the level of direct care staff, says Trisha Cole, COO and general counsel for Medtelligent. To catch acuity changes earlier, dynamic data are essential. “This information is pulled from interactions between staff and residents during activities of daily living charting, meals and from health progress notes and related activities attendance.”
With all senior living operators vying for maximum occupancy in their buildings, assessment and incident data form the baseline of documented care activities, events and needs. This data set is essential to finding macro trends in the resident population, such as more falls in one building over others, which can then be used to manage risk and improve care practices, says Rob Price, senior product manager of analytics for MatrixCare.
Capturing current data on staffing, hiring or capacity statistics, for example, helps operators determine their present baselines, so they can determine where best to place their strategic focus. “Labor and time tracking can also help identify overages that lead to staffing changes, which benefits both operators and residents.”
Matching staffing to residents' needs is more about nursing staff ratios, however. It also requires attention to non-nursing professional services, the level of involvement of medical professionals, use of telecare services, how staff are assigned to units and scheduled 24/7 and how wearable technologies can be used to substitute for certain staff functions or enable them to be delivered more efficiently, says Barry Fogel, M.D., inventor and co-founder of PointRight and a professor of psychiatry at Harvard Medical School.
“Identifying gaps in staff competencies and addressing them is another opportunity for getting better results without adding more fulltime equivalents. All of this requires sufficiently fine-grained detail of how staff are assigned to time and space, which technologies are used, use of outside services, including hospitals, emergency [departments] and consultants, and contemporaneous measures of resident need,” he says. These data then feed into models that match resident needs to optimal patterns of staffing, technology and training.
SO LONG, DATA SILOS
More than ever, software solutions are being developed to meaningfully integrate scores of different data and alleviate the time and resource burdens on operators and staff. As Richard Roberts, COO and chief information security officer for Stratus Interoperable, explains, current transactional database systems such as electronic health records, billing, payroll or family management software are designed to process transactions quickly but have very limited analytics capabilities.
“The key is deploying more advanced technologies that provide centralized and normalized data with an easy-to-use analytics tools to help make data meaningful and actionable,” he says. “These advanced technologies are optimized for efficiently retrieving and organizing large data sets from disparate systems and handling the complex analytical queries the long-term care market needs to measure and manage organizational performance and align with payers, referral partners and patients.”
Taking integrated data and marrying it with user-friendly dashboards that provide up-to-date and at-a-glance information are changing the way operators capture, analyze and strategically employ critical data.
“A vendor's ability to take data from multiple sources so it can be analyzed and [shared, as needed] is becoming increasingly important,” says Cheryl Field, chief product officer for Prime Care Technologies. “Providers become frustrated when they want to send data to a third party, but another party doesn't want to integrate. We own our own middleware, so we are vendor-neutral and can truly integrate all the different clinical and labor data to help operators make the best decisions, but without having to spend time collecting data and doing the math.”
Prime Care Technologies customers can access their integrated data through one login to the company's PrimeVIEW dashboard. The web-based dashboard provides a multi-facility view of performance data — including daily census and labor — that are automatically matched and married to ensure proper staffing.
Cloud-based platforms eliminate the need for equipment installation and maintenance and make it easy to securely analyze and share centrally accessible data across the care continuum. Stratus Interoperable's StratusLink platform delivers “fully integrated single versions of truth” patient records to ensure data integrity, eliminate report conflicts and improve performance reporting. Care transitions, care coordination and proactive care management are data-driven and measurable, Roberts says.
Data-on-demand solutions also help operators manage care and operations more proactively, as opposed to primarily relying on information for retrospective analysis. Medtelligent's ALIS software solution, for example, uses integrated data to implement realtime feedback loops through an instantaneous alerting system that coaches each staff member to excel at their specific job. This can include highlighting upcoming assessments for the nurse, queuing up reviews of possible clinical charge information to the business office manager or notifying a salesperson when an assessment of a prospective resident is complete, Cole says.
Software solutions that grant all caregivers in the care circle — across different specialties and the care continuum — permissible access to resident-specific data not only improve decision-making but ensures that key health information is ready whenever needed and not accidentally overlooked or omitted. “With any post-acute care, there are a lot of moving parts, and we're working to pull all those parts together to improve care,” says Val Ornoy, CEO of LifeAssist Technologies.
Through a single tab, the company's Circura platform connects all invited and permission-granted people within the care circle access to defined patient information, and another tab provides current data points for all technology used on the individual. Weight, glucose and blood pressure monitoring, gait assessments and fall history are just a few of the data points gathered in the portal, and this information can be uploaded manually or automatically through wireless or Internet of Things computing devices. Currently, Circura links to approximately 150 monitoring devices and technologies, and Ornoy says that number will total 500 devices within the next few months.
“Having critical data in one secure place eliminates the need for people in the care circle to download apps for each technology, and then gather and send that data to other caregivers,” Ornoy says. “Once they log in, it's all right there — notes, communication and current and historical data, with results charted and graphed. If a person's weight is down, their heart rate is elevated or their Fitbit showed they only took 2,000 steps when they normally take 6,000, for example, that information can all be used to provide a holistic view of health.”
The key to long-term data analytics success lies in ensuring it is problem-focused, predictive and prescriptive. Fogel stressed a provider should identify points of pain in advance and work with its analytics supplier to match an analytic solution to a problem and an analytics action plan.
“Every number on a spreadsheet or dashboard should be associated with three questions: So what? What now? How much? That is, where does this number come from, why does it matter, how should I act on it, what will the action cost be and what benefit should I expect to get from it?”
Experts predict data capture and analytics will become even more sophisticated by tapping the power of artificial intelligence, voice recognition, natural language processing and advanced sensors.
“The future will bring sophisticated algorithms using machine learning to predict what might happen or prescribe actions based on what did happen,” Price says.
As technology continues to improve, so will the ability to predict specific work scenarios with stronger confidence, assured Adam Wallace, chief product officer at OnShift. “This is especially true when it comes to understanding the trends of employees in senior care.”
Remote care technologies also will catch on, according to PointClickCare's Palmquist, and will be part of the care plan that will help achieve and maintain resident satisfaction. “As the industry moves toward the use of real-time mobile technologies, data capture will only improve.”
In the meantime, and until advanced capabilities such as artificial intelligence take over, high-level data reporting may require operators to create new roles for the sole purpose of focused analysis, according to Roberge. “A data mining and ‘interpreter' will become a valuable and necessary person to an organization by becoming part of the day-to-day decision-making teams for changes within an organization.”