Actively managing technology

The technology required in long-term care must be actively managed. The time has passed when allowing the computer systems and other technology used in long-term care to simply exist and assume they are working. An investment in technology must be actively managed to ensure the ever-scarcer primary resource, people, are as productive as possible and clients/residents are getting care they need. Doing so is both a challenge and an opportunity.

This article has two somewhat opposing messages: The staff resources that are applied to acquiring, maintaining, and using technology compete with the resources needed for delivering care; and using technology is not optional so using it safely and efficiently is necessary. Actively managing the use of technology is essential to balance these forces.

CHALLENGES

Regulations and current practice dictate that care must be planned, delivered, documented, and billed with the aid of computers in many settings. All technology used to provide care and safety to residents must be safe, used properly, and used effectively. This includes resident safety aids such as wander alarms, fall alarms, out-of-bed alarms, call systems, automatic medication dispensers, etc., which must all be managed and maintained, in addition to IT systems. A clear and actionable plan is necessary to manage these resources and make best use of them.

Delivering long-term care is primarily a people issue-care must be delivered by nurses, therapists, social workers, dieticians, physicians, and so on. However, providers must deal with an ever-increasing range of requirements that can only be met by computers-MDS, RUGs, QIs, OASIS, QIS, and RAPs, to name some. Billing must be done electronically for timely payments. There is national pressure toward electronic records-but few resources to pay for them. Many of the people providers must apply to meeting the regulatory requirements come from the same people who deliver the care. Managers must ensure maximum benefit for that use of scarce resources.

We can expect that the requirements and solutions will change. Laws affecting healthcare are constantly changing: Technology advances and best practices evolve. The only factor managers can control is the selection of technology and the management of the people using it.

CONSEQUENCES

Failure to manage the technology in use can lead to catastrophic consequences-injury to a resident, survey deficiencies, loss of revenue, false claims, workers compensation claims, HIPAA violations, and more. A less obvious cost is the staff time that can be wasted through poor procedures or inadequate training.

The systems and devices must be used, and they must be used correctly and efficiently. Ineffective management will lead to failure. Insufficient attention to the requirements of systems, and failure to adequately staff and train users, has consequences. Saving a small amount of staff or consultant time by curtailing training or system analysis may lead to any of the consequences above, and is a very false economy.

The cost of recovery from failure is much greater than preventing the problem in the first place. HIPAA violations can now cost thousands of dollars each if certain conditions are met. Responding to a survey finding that could have been identified and corrected before the survey occurred will take key staff away from their primary responsibilities, and the deficiency must still be corrected. How much better to not have it happen at all!

OPPORTUNITIES

Nearly all providers have made significant investments in technologies to assist in care and meet regulations. Years of experience with many of the nursing home and home care computer systems lead to two conclusions:

1. There are many systems available but no perfect one. (All vendors have to-do lists of things they’d like to add.)

2. Few (if any) providers are using their systems to their full potential.

Nearly all nursing home and home health systems provide care planning support. Still, the staff in many organizations does the real care planning by hand. They may do computer entry to keep the computer and surveyors happy, but the real care is directed by other means. The duplication is costly, and the discontinuity can be problematic.

In payment-constrained nursing homes (those that depend on government payments), managing technology with the objective of delivering safe, effective care at the lowest cost is an appropriate goal. Additional services to residents whose families want to have a more active role through communications and increased independence could become profit centers. This could be especially important in assisted living and other independent living arrangements to mitigate risk with technology.

More technology is making its way into home care and assisted living settings. Systems that provide remote monitoring of independent living and assisted living clients, automatic medication dispensers, communications with family, even video games used for therapeutic or activity purposes all provide great benefits. They all also require set-up, maintenance, monitoring, and replacement. This could be an opportunity for nursing homes and home care providers to extend services to clients not in their caseload. In addition to the immediate fees there would be relationships established that will benefit everyone when the level of care must be increased. Again, actively managing the technology is the key to success.

APPROACHES

1. Assign a person to be responsible for ensuring the technology is safe and is used effectively.

2. Inventory all technology in use.

3. Establish a preventive maintenance program with outcome goals.

4. Establish an outcome-oriented training program appropriate for each product being used.

5. Provide appropriate training to all new users, and regularly monitor current users to ensure they are using good practices. If not, remediate.

6. Periodically review all technology in use to be sure it is providing the benefits that are possible. Consider replacement as appropriate.

7. Periodically review processes in depth. Ideally, have this done by someone not part of the organization for a fresh perspective. Consider the following:

   • Is there technology that could substitute for staff time?

   • Is it already available?

   • Are manual processes duplicating what systems do, or could do?

   • Are the processes more complicated than necessary?

   • Are all processes documented so someone else could carry on?

8. On staff satisfaction surveys, inquire into opinions, satisfactions, and frustrations related to technology.

   • Are there requirements or processes that seem unnecessary or overly complex?

   • Can they suggest better ways to do tasks?

   • Do they feel adequately trained to use the tools they need?

   • Do they think new staff is getting sufficient training?

MANAGEMENT 101

“Management” is meeting organizational goals with the resources available. Long-term healthcare is by definition a long-term endeavor. Short-term solutions to temporarily remedy a problem are usually not appropriate. A systematic approach to identifying how technology can best be used in the organization and then putting in place processes to make it happen will make optimum use of resources.

Use technology to leverage staff whenever possible but recognize that the business of caring is person to person-computers and other devices can only assist staff to provide care. The technology should be used to its greatest advantage, which sometimes means applying more staff resources than the minimum if benefits can be multiplied. That implies that managers know what the technology is capable of and ensure it is being used appropriately. Actively manage! Nobody said it was easy. LTL

David M. Oatway, RN, MPH, is a long-term care IT consultant based in Key West, Florida. He has been the Chair of the HIMSS Post-Acute Care Special Interest Group, Vice Chair of the American Association of Nurse Assessment Coordination (AANAC), and a member of the American Health Information Management Association (AHIMA). He developed one of the first clinical MDS systems (CHAMP). He is the database manager of the STRIVE national nursing home time study which developed the RUG-IV Medicare PPS. He can be reached at

daveo17@bellsouth.net. Long-Term Living 2011 January;60(1):40-41