Post-acute IT 'getting interesting' as attention turns to EHRs, analytics, interoperability
After years of dwelling in the shadows of healthcare, the long-term and post-acute care industry may finally be ready to join its hospital colleagues in the IT spotlight.
The path is long and steep, but operators of skilled nursing, outpatient rehabilitation, assisted living, memory care, hospice and home care agencies are embracing their important new roles as providers in the dynamic post-acute care environment.
When the Office of the National Coordinator put together the electronic health record and interoperability initiative in 2004, long-term care got nary a mention; and as recently as 2009, LTC providers got left out of the multi-billion dollar incentive from the American Recovery and Rehabilitation Act because designers didn't consider their relevance for the program.
How times have changed in just a short period of time. With the advent of accountable care organizations, post-acute care provider networks and the move toward population health, suddenly long-term care facilities have gained prominence as valuable components in the equation.
But while they now have a higher profile, long-term care operators are also coming to terms with the fact that they are still largely dependent on manual processes and that they are woefully deficient in IT personnel. In essence, this new role comes with the huge responsibility of joining the digital revolution.
"It's getting interesting," said LaDonna Sweeten, managing director with Chicago-based Huron Healthcare's technology consulting practice. "You can understand how some post-acute care providers were forgotten in federal initiatives. But now we're seeing them organize and have a stronger voice, with implications on the acute care side."
As the ACO movement gains momentum, providers in both acute and post-acute sectors are looking for enhanced dialogue, Sweeten said, because "they realize they aren't separate pieces of care anymore."
For post-acute care, it means a serious focus on adopting EHRs and understanding the machinations of analytics and interoperability. Some of the actual data on interoperability has been tackled with standards like HL7, but other areas like care plans, clinical documentation and care pathways still need to be addressed, Sweeten said.
Those processes will require collaboration between the sectors and while that has yet to be done, she believes it will as the population health model takes hold.
"Vendors are looking at software for post-acute providers and it is very specialized," she said. "One of the biggest issues is with the continuum – if we have an acute care patient with a follow-up plan to transition into skilled nursing or senior living, there are duplications of effort because the sectors are different. These processes must be combined to avoid duplication. We have done a lot with hospitals on the acute care side and we need to make the same progress as we connect acute and post-acute. There isn't a pathway yet."
Hal Tierney, director of technology for Boston-based Sapient, says a major EHR obstacle for long-term care operators is the lack of full clinical information system enterprises required to populate an EHR.
"The lack of clinical information systems, such as laboratory, pharmacy and radiology reduce the capability of the EHRs to provide clinical or diagnostic value," he said.
A 2013 report by the U.S. Commission on Long-Term Care estimates that the number of people who are dependent on long-term care is expected to rise from 12 million in 2010 to 27 million in 2050. Analytics will be a critical function to support the treatment and tracking of these patients from patient care and operational standpoints, notes Adrianna Iorillo, vice president of professional services for Jacksonville, Fla.-based CSI Healthcare IT.
Analytics are the key to improving communications between acute and post-acute entities, which lead to better patient outcomes, Iorillo says.
"Long-term care facilities can find improved patient satisfaction from better response times in medication and pain management, while improved methods to document provider and caregiver notes will help patients stay engaged in their well-being," she said.
"Overall, better outcomes from the patient can help reduce the need for admissions or readmits to hospitals and the increased communication tools available can decrease the number of cases of depression and isolation that are sadly common in nursing home settings."
[Also: Post-acute HIEs make strides]
Long-term care operators should move to accelerate their adoption of analytics systems to maximize their accessibility to all data relevant to the treatment history of their patients, and to maximize the acquisition and retention of data as part of the continuing provision of care, Tierny said.
"When combined, this data can underpin retrospective and prospective data analysis pertaining to patient specific care milestone events, trends and adherences," he said.
"Operators need to understand that the information captured across the continuum of care has the most opportunity as a resource for the provision of healthcare to their patients.
Analytics done well can move long-term care operators from 'reactive' operations and decision making, to 'proactive' modes of operations."
Iorillo adds that "technology and analytics have a compounding affect over time – easier and secure methods for a provider to communicate immediately with other care providers can only improve care."
HME at last
Alongside the long-term care industry, home medical equipment providers have also brought up the rear when it comes to technology adoption. Both sectors have shared similar challenges when it comes to maintaining cash flow, overcoming constant reimbursement cuts and finding the funds to deploy IT in a way that benefits them.
For HME providers, technology strength lies within their billing systems, which in recent years have grown from strictly conducting business transactions to controlling multiple aspects of the business. One such system is CommandCenter, a business process management platform from Suffern, New York-based Medforce.
"Business process management can act as a backbone for an entire organization, gathering data and connecting to disparate business applications from intake to order management," said Medforce CEO Esther Apter.
"It creates comprehensive reporting that provides predictive analytics and actionable insights. You can look at not just top line numbers, but actual productivity throughout the organization to identify bottlenecks, duplication of effort, wasted effort and other opportunities for process refinement."
By centralizing business analysis, HME providers are able to create accountability and present cogent operational data – a distinct advantage in the competitive ACO marketplace, Apter said.