Technology's perennial dilemma: How to stay upgraded without wasting money? Here's how long-term care providers are addressing the challenge and what some new technologies have to offer.
It has been estimated for many years that the long-term care sector has significantly lagged behind all other economic sectors, including other healthcare providers, in adoption of electronic information systems. Evidence from a recently published study in which we participated indicates the contrary: In adoption of certain aspects of the electronic medical record (EMR), long-term care is among the healthcare leaders and, in other respects, is rapidly catching up.
The study, “Use of Electronic Information Systems in Nursing Homes, United States, 2004,” was published last year by the American Medical Informatics Association. As the title indicates, the data are five years old-almost certainly the adoption rates of some EMR functionalities have increased. We will discuss this in a moment. But the basic point holds: as long as five years ago, nearly 100% of U.S. nursing homes were using electronic information systems for various aspects of their operations. This activity was driven by Minimum Data Set (MDS) reporting requirements (96.4%) and billing (95.4%).
This would come as no surprise to long-term care operators, most of whom have been under a de facto federal government requirement to computerize for MDS clinical and financial reporting since the early 1990s. Agreement is universal that the MDS was designed for computerized implementation and difficult to complete without it. The federal Centers for Medicare & Medicaid Services (CMS) has even made free software, the RAVEN system, available for this process.
The study showed that well over half of facilities were using information technology (IT) for functions beyond MDS reporting and billing, such as admission/transfer/discharge, personnel administration, dietary management, and medication orders. Somewhat less than half of facilities at the time were using IT for other functions, such as physician orders, medical records, laboratory orders and staff scheduling. Serious under-utilization-17.6%-was reported for tracking of CNAs' daily care, but that's one area, with new point-of-care technologies, that we anticipate has seen a significant upswing in recent years.
We see high and growing interest in EMR functionalities overall. This is not to say that all facilities have fully functioning electronic health records (EHRs)-EMRs that are easily transmitted and shared among providers-but it does show that they are EHR-ready, and should be able to make the transition relatively easily. Right now many providers are working on system integration of the EMR within the facility or organization, but others are starting to focus on interoperability standards, a requirement for the EHR.
Still more incentive will be provided by the recent federal stimulus legislation, with its emphasis on certified interoperable health information technology (HIT) that is based on recognized standards. The Certification Commission of Health Information Technology (CCHIT), which is responsible for the certification of EHR systems nationwide, has certification of long-term care EHR products on its docket for implementation next year.
As is well known, the stimulus provides for significant funding of EHR adoption by some healthcare providers. Long-term care providers are defined among “healthcare providers” in the legislation, but they do not as yet have the incentive payments physicians and hospitals are slated to receive. The legislation does mandate a study by the Department of Health and Human Services of possible expansion of the incentive program within 24 months, and certainly long-term care organizations will be campaigning for that. Loans and grants will be available for EHR adoption as well, and we would like to see long-term care providers be given consideration for these.
For now there are several courses of action facilities can take to move the process along. One is to work with IT vendors who are involved in standardization efforts, are aware of the certification process, and have a road map to get their products certified for EHR interoperability. This will help providers in guaranteeing that their vendors will support the necessary transition and upgrade activity and save providers a lot of their own time, effort, and money.
Another move they can take is to reach out to any regional health information networks in their area-Health Information Exchanges and Regional Health Information Organizations, for example-and see how they might partner with these organizations, as well as the hospitals with which they already do business, on grant applications. This could be very helpful in educating hospitals and physicians about long-term care information processes and needs. We have an opportunity to leverage federally mandated functional assessment tools, like the MDS, to drive interoperability, as required by the stimulus bill. We should ensure that these assessments use interoperability standards, and the delayed release of MDS 3.0 is one huge opportunity for CMS to further interoperability standards that should not be missed.