As data-sharing technology becomes more widespread in the post-acute sector, it has the potential to impact clinical care and business processes, notes Marty Diller, vice president and CIO with Complete Healthcare Resources, a management firm that owns and operates long-term care (LTC) facilities. At a recent conference, Diller spoke on the potential impact of patient monitoring equipment and telemedicine on long-term care. “It’s not pie in the sky,” Diller says. “There are patient gowns equipped with sensors that report vital signs such as blood pressure, heart rate and temperature.”
With the data collection capabilities of electronic health records (EHRs) combined with advanced sensing instruments and monitoring technology, it’s possible to get real-time information on resident vital signs, behavior patterns and more. Advanced instruments include everything from smart scales to smart toilets to smart movement-sensing beds and flooring. Diller says, “We’re sitting on the cusp of a data explosion which has the potential to both improve the quality of care and reduce the cost of care.”
But what to do with all that data? “Sharing data could potentially be a disrupter to long-term care as we know it,” Diller suggests. “With in-home monitoring and telemedicine, some residents can be treated at home and won’t require [facility-based] long-term care. We may see such shifts within the next decade or so.”
The growing use of data from diverse sources dovetails well with the shift toward accountable care. At the cornerstone of the accountable care model is the need for shared accountability, a goal that is driven by sharing patient data across care settings and among providers.
Before the benefits of data sharing can be maximized, LTC executives caution that data needs to be structured, standardized and analyzed. Jim Tomsic, director of information technology for Ozanam Hall of Queens Nursing Home, cautions that “without defining data, and how it’s traded back and forth, a core dump of data isn’t all that helpful because it’s too voluminous to be useful. What is relevant is the data that supports a patient diagnosis and the ability to receive that information real-time upon patient admission to long-term care.”
Karen Page, information technology director for White Oak Management, providers of long-term care in the Carolinas, says, “Long-term care has perhaps the biggest potential for data sharing. We have the richest data available because of longer lengths of stay.”
Diller thinks shared data has huge potential for improving individual resident care. “Healthcare has historically taken a group approach where one size fits all,” he says. “For example, there’s a code for a fractured ankle, which providers all treat the same way using evidence-based treatment modalities, and for which billing is based on standard rates.” But in reality, Diller says, “Healthcare should be more about individual assessments and personalized care plans ultimately surrounding a resident’s genes. By harnessing and sharing data, more individualized healthcare can take more hold.”
Diller estimates that “some 80 percent of data is unstructured and will require investments in hardware and likely database changes to make sense of it. The big payoff from data sharing is the ability to ingest it, store it, analyze it and repurpose it back out.” For most facilities, he admits, this isn’t the current reality.
In a June 2013 white paper on EHR Solutions for LTPAC providers published by the CIO Consortium & Nurse Executive Council,1 the authors acknowledged that electronic medical record systems in use by many LTC providers today are not EHRs; they are simply glorified documentation, form-filling systems developed to achieve compliance with regulation and reimbursement.
Data security advice
Page admits to having fear about data security surrounding health information exchanges. “Who’s protecting the data? Who owns the moving data? We need to make strides in the industry surrounding security.” In the meantime, she suggests that LTC facilities be conservative in data security through protocols such as adding thin clients, not storing data on laptops, using a virtual private network accessible only by authorized users and using SSL certificates when exchanging data.
The concerns over data security are real. Data breaches in healthcare are not uncommon. This summer, the second-largest loss of health information was reported by Advocate Medical Group, impacting over 4 million patients, when four unencrypted desktop computers were stolen from an administrative office.
ADVICE FOR LTC PROVIDERS
Diller suggests that providers get smarter about technology by engaging in discussions with experts and early adopters. He encourages administrators to assess facility priorities and select a focused place to start leveraging data-driven technology. This could be a pilot project around a single business process or problem.