January 1, 2005
by MARIA D. MOEN, founder and President of HealthWare Consulting Services, LLC.
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Is it time for your long-term care organization to take the plunge and invest in one of the latest healthcare information technology systems? Is it worth the expense and time to completely implement a brand-new system? Or can you update what you have in place to both meet your goals and comply with the new HIPAA/security regulations for the next few years?

If you find yourself asking these questions more and more, you are not alone. A plethora of new software products and advances in long-term care information technology are transforming the way care is being delivered everywhere, including in nursing homes, assisted living facilities, and home healthcare. Not asking these questions would be a huge oversight on your part. But which way should you go?

As you are trying to decide, keep in mind that a good healthcare information system should substantially improve your organization's quality of care, service delivery, HIPAA/security compliance, and financial/billing operational efficiency. Moreover, your vendor should make a commitment to you that its technology is built to accommodate ongoing change and can be upgraded to meet the standards and requirements of the healthcare system as a whole. A few of the government-imposed challenges we know we will face not long from now will include the MDS 3.0, continually enforced HIPAA standards, and the Bush administration's electronic health record objectives. These alone will ensure that we remain in a state of transition for some time to come.

At this point you are probably dealing with:

  • separate and disparate software products, implemented throughout the organization, which rely on high-maintenance or problematic interfaces, or don't even “speak” to one another at all;

  • manual operations pervasive throughout the organization;

  • lack of centralization, which results in reduced corporate control and increased potential for error at the facility level, or corporate overcentralization, which creates high middle- and upper-management overhead and reduces facility responsibil-ity and accountability;

  • incomplete and inconsistent clinical documentation, making it rife for survey citations; and/or

  • lack of trained, knowledgeable staff capable of operating existing software.

Many new and exciting software developments occurring daily promise to improve long-term care management, such as electronic medical records, voice-recognition technology, and e-prescribing, all of which hold an important place in the future of healthcare performance and productivity. But it takes strategic planning to successfully choose, and then implement, a brand-new healthcare information technology system. Ultimately, choosing the right one for your organization depends on many factors. Every long-term care organization has its own unique setting and situation that aid in establishing its goals and objectives. But common threads weave the basic operations of all healthcare organizations together, and these factors should be considered first when choosing a new system. In short, you must focus on your core applications. If such applications as your census, assessments, care plans, MDS billing, physicians' orders, etc., are not running successfully, then purchasing a robot that can dispense all of the needed medications for all of your residents (yes, there is one out there) is not going to help you improve efficiency.

A delicate balance must exist between the demands of management and the needs of those facility personnel whom the changes will affect the most.

Think about it: When the state surveyors walk in your door, do you really think a device that recognizes your voice is going to impress them if several of your care plans don't match residents' needs based on the data recorded from your resident assessments? Not that these new healthcare technology tools aren't a tremendous benefit; in fact, they are in use in several organizations now and proving to be very effective.

They are a huge piece of the future of healthcare and definitely should be part of the planning stage. But first things first.

Admission process before information technology.

Since HIPAA's creation several years ago, which standardized the electronic exchange of administrative and financial healthcare transactions and the privacy rules governing health records' access, changes in the way we conduct business and care delivery have occurred frequently—and there is no end in sight. Fortunately, healthcare software developers are doing an excellent job in keeping up with these changes. With a good, basic information system, data from your census along with clinical and financial records are linked; MDS assessments are scheduled for completion automatically; errors are pointed out as soon as they are entered; electronic submissions are better monitored; reports are more concise; and security compliance with new regulations is easier to set up. Most of the new technology systems handle these processes—and much more efficiently (compare figure 1 and figure 2). But for a healthcare organiza-tion to avoid the many pitfalls that can occur when selecting and implementing a new system, its primary goals should be to:

  • minimize disruption of the efficient, effective internal systems and controls that facility personnel already rely upon, and