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Moving to the Next Generation of IT

January 1, 2006
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Interview with Don Mon, PhD, FHIMSS, Vice-President of Practice Leadership, American Health Information Management Association (AHIMA); and Michelle Dougherty, RHIA, CHP, Manager of Practice Leadership, AHIMA
MOVING TO THE next generation of IT

It was an open invitation to join the development of 21st century healthcare information technology: This past August, the American Health Information Management Association (AHIMA) sponsored an industry-wide summit for long-term care leaders to get in on the ground floor of creating an electronic health record (EHR). More than 120 providers, vendors, consumers, and association representatives attended. A who's who of long-term care'related associations, some 14 in all, presented white papers offering their own perspectives on the challenges and promises involved. Although long-term care had long occupied its own track at national AHIMA and Healthcare and Information Management Systems Society (HIMSS) conferences, never before had it been singled out from hospitals, physicians, and other acute care providers for such concentrated attention. It was clear that with the federal government declaring an all-out push in the EHR direction and standards-setting bodies in full-swing, influential national IT organizations wanted to make sure that long-term care had a seat at the table. The big question was with so many other concerns on their plates-dwindling reimbursement, increasingly complicated market demands, comprehending the growing array of dedicated long-term care IT products out there-why would long-term care providers care? Could providers reasonably be expected to muster the time and effort needed to achieve the dream of a universally operable EHR? Recently, AHIMA's two spearheads for the long-term care project, Don Mon, PhD, FHIMMS, vice-president of practice leadership, and Michelle Dougherty, RHIA, CHP, manager of practice leadership, addressed these questions and others in an interview with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.

Peck: Why the relatively recent focus on long-term care?

Dr. Mon: AHIMA has always had a focus on long-term care, but now we've increased the emphasis. The EHR encompasses health records from womb to tomb and, of course, long-term care and chronic care are a part of that.

Peck: But there's a perception that acute care has dominated the discussion thus far and that long-term care is a kind of outlier, with its own requirements.

Dougherty: That's true to a degree. But there's realization that the standards developed have to reflect the unique standards of the field, which is why it's highly important that long-term care gets to the standards-setting table.

Dr. Mon: The perception of acute care dominance is out there, but there is a general openness to the idea, for example, that HL7 standards should incorporate the special perspectives of long-term care. (For definitions of HL7 and other frequently used acronyms, see "EHR Glossary.")

Dougherty: And the same is true of the NCPDP (National Council for Prescription Drug Programs) for e-prescribing. For long-term care, it's a question of getting up to speed on where the standards-setting action is now.

Peck: But with so much else going on in their world right now, why should long-term care providers out in the hinterlands care about this from an operational standpoint?

Dougherty: Even if they're content with the way things are now, they still have to know that change is coming. One thing they will start seeing in their neighborhoods are regional health information organizations (RHIOs) encompassing a wide variety of providers, from hospitals to home care to long-term care. There are as many as 200 of them already throughout the United States. As these grow, long-term care providers will find it difficult to sit on the sideline.

Dr. Mon: That's true, there will be all these providers coming together to share health information to improve safety, quality, and operational efficiency. Their basis of information exchange will be the EHR. And since primary care and inpatient acute care are not collecting the data that will make long-term care's life easier, now is the time for long-term care providers to join in the exercise of developing standards for interoperability and data sharing. This can also make their existing operational task easier because the EHR, when properly constituted, will include the elements they need for their own reporting-the MDS, for example-so that providers need only enter the data once and have them serve many needs. This can happen only if long-term care gets involved in setting the rules of the game right now.

To get started, I'd recommend that facilities participate with local healthcare organizations that have become involved in EHR-related initiatives and continue to encourage their state and national associations to maintain their advocacy efforts on this issue.

Peck: When it comes to IT, though, isn't there a mind-set among many long-term care providers that they have their required software by now, they have their vendors and rely on them to keep them updated, so from the facility standpoint, they're really OK right now?

Dougherty: That's true, having working in long-term care for five years and consulted for ten, I know that is often the mind-set. But if I were an operator, I think I'd realize pretty soon that I have to communicate with hospitals, pharmacies, and physician offices every day, and that we're an integral part of a bigger system.