Ready or not, long-term care providers are competing in a new game. While the players and objectives remain unchanged, the playing field has new obstacles, the rules are more numerous, and the scoring is increasingly more public. Accordingly, all teams need to embrace innovative approaches to gain leverage and maintain a competitive advantage. Health information technology (HIT) represents those new approaches for many long-term care providers prepared to step beyond what is required by state and federal regulations. As many early adopters can attest, a point of care (POC) electronic data capture system is an excellent starting point for an overall effective HIT strategy.
What is a POC system?
A POC documentation system does not replace existing clinical systems. Instead, it's a front-end application that improves not only the process for documentation, but also the completeness and accuracy of resident assessment data. Through the use of handheld devices, wall-mounted touch screens, or other portable units, caregivers obtain and document resident observations at the point of care. Some POC electronic data collection systems offer visual prompts that serve as reminders by highlighting assessments required throughout the shift. POC systems eliminates lost paper forms, illegible entries, “copycat” charting, and time spent by MDS coordinators searching for missing assessments. The true value of POC technology, however, is real-time access to information that is otherwise inaccessible in a manual environment. Ultimately, it's the access to timely, accurate information about each resident's condition that improves the quality of care provided.
Advantages of POC systems
POC systems simplify the documentation collection process, which increases documentation compliance. Through increased compliance, long-term care facilities are able to achieve significant improvements in documentation accuracy, staff efficiency, and resident outcomes. Additional benefits include increased reimbursement, lower risk of liability, and improved staff retention.
Resident assessments are the foundation upon which care plans are developed. Many facilities find that with manual systems only 70% of the needed documentation is completed. Consequently, 30% of critical information necessary to make important decisions about resident care plans is missing. With POC data collection, caregivers are prompted to obtain specific assessments for each resident, every shift, on a predetermined schedule. System prompts focus caregiver attention to assessment documentation amid the whirlwind of distractions in caring for multiple highly dependent residents.
Real-time access to consistent, complete, and accurate assessment data affords nursing staff a much clearer picture of each resident. As a result, adverse trends are readily identified, treatment plans are modified proactively, and more complicated (and often expensive) interventions are averted. Through dashboard displays available on desktops, nurses can view current resident status and ensure that residents with more immediate needs receive attention first. Some systems include electronic alerts, which notify nursing staff in the event of a negative trend or change in a resident's status. For example, if a resident's food intake is steadily decreasing, an alert is automatically generated and electronically communicated to the appropriate staff person. In this case, an alert would prompt an intervention before the situation turned to dehydration or malnutrition.
Accurate reimbursement is another key advantage to a POC system. Proper reimbursement is increasingly dependent upon a facility's ability to accurately document each resident's health status. With ADL scores and mood/behavior observations accounting for much of the current reimbursement formula, long-term care facilities must have confidence in the accuracy of assessment data. Furthermore, as pay-for-performance initiatives roll out, facilities will be required to demonstrate the care provided in correlation with the resident's condition. An electronic POC system allows for quick retrieval of resident data to satisfy auditors, payers, surveyors, and any manner of legal inquiry.
From a staff perspective, an automated POC system eases the task of obtaining and documenting resident assessments contributing to higher job satisfaction and possibly higher staff retention—a critical factor in quality of care.
Finding a POC solution
In order to select the appropriate POC solution, it's important to identify existing shortcomings in the current manual processes and prioritize them accordingly. For example, are incomplete ADLs a concern? Is inaccurate/incomplete MDS data an issue? Are frequent communication breakdowns between CNAs and nurses causing concerns with regard to resident care? Do family members regularly complain about lack of adequate care? Can the facility generate adequate support for quality of care provided during surveys, inspections, audits, and family inquiries? Is the case-mix index reflective of actual resident acuity? While all these deficiencies can be resolved with a POC system, it's important for long-term care facilities to prioritize and tackle one major concern at a time.
Once the underlying “hot-button” issues are identified and prioritized, the process of selecting a solution can begin. Start with Web-based research and initiate communication with area facilities. Another good source of baseline information is buying guides provided by various trade publications such as Long-Term Living. Fortunately, software providers have recognized the unique circumstances of providing resident care in a long-term setting and design systems that meet the specific demands of such environments.