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.
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:
Enabling patient-focused care
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.
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.