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The Virtual Administrator

January 1, 2004
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Information technology is becoming more vesatile and practical. Three vendors on current trends

Long-term care managers have often been criticized for being "slow adopters" of information technology (IT). Even though financial and clinical software modules have been around for the better part of two decades (or more), critics say the field has been: (1) slow to upgrade its IT systems and services; (2) wary of innovative platforms, such as application service providers (ASPs); and even (3) unwilling to move past hardware purchased circa 1992, if then. The most potent driver for change in this field, ironically enough, has been the federal government, with its requirement for electronic transmission of MDS data by facilities reimbursed by Medicare and Medicaid-a motivator resulting more in grudging compliance than in openness to exciting new possibilities.

That may change, if IT innovations emerging recently start making their mark. For the first time, it looks as though long-term care managers are going to be able to track their facilities' performance in real time and to whatever depth of detail they care to go-in other words, be able to do their jobs as "virtual administrators" backed up by more information than they've ever had before. Today's administrators can be at the bedside with a CNA, eavesdrop on an MDS coordinator, see how well Mrs. Jones in Room 13 is doing with her new diet, and evaluate the facility's performance against the competitor's down the street-all with the push of a few buttons.

Three vendors have agreed to share their perspectives with our readers on some of the IT tools available to the virtual administrator. Their articles follow.
by John Sheridan, MHA

The Minimum Data Set (MDS) has become the richest database in healthcare. Summary data from the MDS are being reviewed by a variety of groups and agencies that have an interest in monitoring the performance levels of individual facilities, as well as the industry as a whole. Unfortunately, most facilities don't have the capability of using MDS data internally to improve quality and explain their processes. However, with the appropriately structured approach, MDS data can now be used by administrators to improve care and upgrade operations on a continuous basis.

The process must start with the MDS data being screened for internal logic, because inaccurate or slipshod recording from one shift to the next doesn't do anyone any good. Once screened, the data can be drilled down in a number of ways. A resident who benefits from progressive long-term rehabilitation might have as many as 15 assessments during a 10-month period (any facility tracking only quarterly assessments is probably losing money). Following resident data over time is vital to show: (1) how the facility is performing on its Quality Measures and Quality Indicators; (2) how individual residents are progressing, or not progressing, in specific areas of their care (e.g., nutrition, pressure sore healing, pain management, restraints, rehab)-and the possible reasons why; and (3) how the facility compares in QM/QI performance with other facilities in the state and nation.

This information technology also allows the facility to progress from quality assurance to quality improvement through the creation of what are called statistical process control charts (SPCCs), which aggregate data and show patterns of change over time. Using this approach, administrators can track facility performance, resident status, and federal quality-initiative compliance as frequently as they find useful. They can step in, in real time, to initiate corrective action, if necessary.

The administrator won't be pleased by everything he or she sees. But the fact that the administrator is looking for areas needing improvement and is doing something about them when found counts for a lot.
John Sheridan, MHA, is President, e-Health Data Solutions. For further information, phone (216) 371-2350 or visit To comment on this article, please send an e-mail to
by Brian O'Connor and Tim O'Connor

Popping the hood of an automobile reveals an astonishing engineering feat that makes one ponder how in the world they're able to make all the wheels, pulleys, switches, cylinders, hoses, belts, tubes, and gaskets work together and function the instant the key is turned. No less a marvel is the massive complexity the long-term care executive faces in today's world as he or she focuses on care, cash, and compliance issues. There are a lot of parts and pieces that could "break down" at any moment.

Long-term care has for years been charged with creating paper-driven (or, in some cases, electronically driven) care plans in an attempt to categorically present an accurate picture of a resident's daily state of need, quality of life, and wellness. Likewise, finance departments generating month-end, or "30-day look back," reports exhaust countless hours.