An LTC technology summit looks ahead

What one tool can make residents, nurses, administrators, payers, and regulators happier and more effective all at the same time? From the name of this column, you don’t have to guess. But why has it taken so long to achieve the promised benefits of long-term care (LTC) information technology? What is happening now, and what is planned for the near future to make life better for all LTC stakeholders?

For two days in Baltimore this spring a committed and diverse group of long-term care information technology policy makers, gurus, users, and suppliers explored the status and future of Health Information Technology (HIT) in long-term care. Sponsored by all of the major national associations involved in long-term care, and under the auspices of the American Health Information Management Association (AHIMA), the stakeholders had the opportunity to hear and network with the thought leaders of the field. The conference brought nursing home administrators and staff, academics, vendors, and key executive and legislative personnel together to see the road map for the future and the current state of the art.

And the road map actually exists—specifically, the Road Map for Health IT in Long Term Care 2008-20101 developed by the Long-Term Care Health Information Technology (LTC HIT) Summit steering committee. It gives the best analysis of where we’ve been and the goals and methods for attaining the infrastructure and applications needed for the future. Essentially, the LTC HIT Summit was a dialogue among the various groups, with the Road Map providing a unifying structure. All LTC professionals should become familiar with the Road Map, and start to plan for the technologies and changes in processes that are coming.

National vision

The Summit’s keynote address, “Aligning LTC with the National Vision for HIT” by Dr. Robert Kolodner,2 set the stage by demonstrating commitment and support for HIT at the highest level of the federal government. His analysis suggests that long-term care may be near or past the tipping point at which the pace of acceptance accelerates. As more robust products are introduced that actually assist in care and provide information for decision making, acceptance of HIT as a necessary part of LTC operations will increase. After all, paper is expensive—not the sheet, but the time to create it, store it, and find it. Health information technology eliminates the sheets, and makes cost-effective acquiring, storing, and sharing of information possible.

Information technology is essential to achieving Dr. Kolodner’s two principal goals from the national perspective:

  1. Enabling patient-focused care

  2. Improving the health of the population

Critical to meeting these goals is an interconnected health information system that is reliable, secure, and trusted. The processes for delivering care, and especially documenting that care, will change with the implementation of currently available technologies and those in the planning stages, making patient-focused care a reality. The goal of improving the health of the population will be attained when information about individuals can be aggregated and analyzed rapidly to detect public health issues (such as early warning of epidemics) and analysis to determine best practices, using health outcomes as evidence. Many technical, clinical, social, financial, and legal issues will have to be addressed, as Summit participants noted, but the payoff will be worth it: better care for individuals and the improved health of the nation.

Legislative action

The Honorable Nancy Johnson, former Republican congresswoman from Connecticut and Co-Chair of the Health IT Now Coalition, discussed the need for fundamental change in the way Health IT demonstrations are financed. She noted that the new world of Health IT is hugely complex. We need to demonstrate collaborative models in order to generate the information needed for sound legislative and regulatory decisions. Currently the business case for health IT is largely speculative. Well-designed and -funded demonstration projects are needed to develop the tools and to document what works and what doesn’t.

Quality and payment

Senior staff from the Centers for Medicare & Medicaid Services (CMS) presented information about several works in progress: creating MDS 3.0, changing Medicare SNF payment systems, quality monitoring, and paying for performance. These presentations were tantalizing since the presenters could not discuss results of their projects in detail until the policies they affect are actually written into draft regulation. The projects are all very complex, with many interactions. These will be discussed in this column eventually, but for now it is better not to publish details that may be further refined when the projects are considered together. Premature details could send providers and vendors down dead ends. Suffice it to say, the next two years promise significant changes in the way we look at care and quality.

State of the art: User experiences

Presentations of new technologies actually in use were a highlight of the Summit. Nurses from nursing homes presented the results of implementing point-of-care technologies at their facilities. Lesson’s learned were valuable (and will be the subject of a future article); their analyses of the positive impacts of the technologies were impressive. All of the presenters noted that implementation was more resource-intensive than they had anticipated. All found benefits only by integrating the technologies into their processes. In general, voice, handheld computers, and kiosks all contributed to improved documentation and decision making after implementation, but continuous monitoring and education was necessary to maintain these benefits.

Technology in aging services

The rising numbers of aging Americans who are accustomed to independence and self-determination will benefit from an evolving range of technology designed to preserve independence while maintaining safety. The Center for Aging Services (CAST), sponsored by the American Association of Homes and Services for the Aging, is leading the way for scientists, vendors, and citizens to develop and use remote monitoring, assistive devices, and personal health information access. Their State of Technology in Aging Services: A Summary is available from The work of this group will have positive impacts through keeping people independent longer and minimizing the need for institutionalization. Through technology, assisted living may be more than a setting; it may become a way of life compatible with the desires and needs of most people.

Last thoughts: Striking a balance

These are some of the highlights that caught our attention at the Long-Term Care Health Information Technology Summit. It was gratifying to see so many talented professionals engaged in improving care through appropriate use of technology, using what is here now, and planning and dreaming of an even better future.

Obviously, clinicians and administrators must balance the costs of technology with the benefits. They must continue to monitor HIT developments and plan to improve care by taking advantage of appropriate technology when it becomes available. Health information and other technology can be an enabler of better care, but its costs must be balanced by benefits to residents. Legislators and regulators must balance necessary regulation for safety with encouraging the emergence of better, more innovative approaches. For now, the leadership and initiative shown by the LTC HIT Summit Steering Committee in developing the Road Map and hosting the Summit are major contributors toward helping achieve that balance.

David M. Oatway, RN, MPH, is a long-term care IT consultant based in Key West, Florida. He is Chair of the HIMSS and Post-Acute Care Special Interest Group and a member of the American Health Information Management Association (AHIMA) and Health Level 7 (HL7). A contributor to the development of MDS 2.0, he developed one of the first clinical MDS systems (CHAMP). He is currently supporting CMS’s STRIVE national nursing home time study to help revise the nursing home Medicare PPS.

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  1. A Road Map for Health IT in Long Term Care is available from
  2. National Coordinator of the Office of the National Coordinator for Health Information Technology of the Department of Health and Human Services.
Long-Term Living 2008 August;57(8):18-21

Topics: Articles