Computer Technology Update

BY MALCOLM H. MORRISON, PHD

Nursing homes certainly do not require the extensive IT systems being recommended for acute care hospitals to reduce medical errors and risk incidents. Nursing homes are involved, though, in substantial pharmaceutical administration, lab testing, and monitoring the completion of medical orders. There is also increasing need for improved automated clinical data management in documenting treatment, implementing and monitoring best practices protocols, and monitoring quality and risk indicators.

Although most long-term care vendors’ products do not include electronic medical records (EMRs) and do not provide for computerized physician order entry (CPOE)-the current gold standard of medical error reduction-related new functional capabilities do exist. Providers can now inquire with vendors about the following improvements in long-term care information systems.

Clinical documentation. Improved capabilities in this area include automated medication-administration records (MARs), treatment-administration records (TARs), online laboratory results and radiology reports, and vitals tracking, as well as electronic progress notes for all disciplines, including physicians, nurses, and therapy services. In some cases, the automated systems link with billing systems for improved charge capture, as well as for providing federal and state man-dated reports.

Electronic access to ancillary data. Providers should ask their vendors if their product suites contain, or will link to, an automated pharmacy system, bar coding, or other such system. Providers may not be able to purchase all system components at one time, but comprehensive reduction of medication errors does involve several components of information management that, taken together, can have a significant impact.

Risk incident reporting. Support of quality and risk reporting efforts through the automated tracking of risk incidents such as falls, fall injuries, medication errors, accidents, pressure ulcers, etc., is available as either an add-on module to current systems or in niche products that link with current systems. These systems assist the organization by providing real-time access to quality and risk data, monitoring quality improvement efforts, and (for facilities involved in JCAHO accreditation) sending data electronically to the ORYX system without the need for manual tracking or reporting. Variables that should be addressed when evaluating these systems include their ability to trend information over time, compare indicators with those of other facilities or all facilities from a corporate level, and report on incidents in which “best practices” criteria are met or not. Another consideration is whether other specific types of reports important to the organization can be generated.

Links between clinical data and MDS assessments. For products with improved medical and clinical data documentation capability, providers should determine whether the documented clinical data can be used in combination with MDS assessment data in specific areas, or with data generated from specialized resident assessments in areas such as pain and depression. Automated MDS and related medical and clinical assessment data can be used to identify (or target) residents who are appropriate for best practices programs designed to improve quality of care in particular clinical areas. The extent to which clinical software can be customized to include best practices protocols should be determined. Even if such protocols cannot be easily programmed within current products, increased automation of resident assessments will make it possible to better focus upon best practices and related clinical treatment guidelines.

As capabilities of software products migrate toward EMR-type functionality-including improved documentation of pharmacy, laboratory and radiology data, improved risk incident reporting, and the capability to include more focused resident assessments-the original product capability for MDS automation (RUGs reporting with links to billing, as well as RAPs and triggers) will be maintained. The new functional capabilities discussed here are both complementary and supplementary to these original automated functions.

It is difficult and costly for long-term care software vendors to modify current products or create additional (add-on) functionality, such as those that have been discussed in this article. To the extent these types of software modifications are being developed, it is because of: (1) recognition of additional provider responsibilities and risks associated with protecting residents’ safety, and (2) new resident-care-related information emerging from ongoing research and practice experience, which supports the use of clinical assessment and intervention protocols. Even though these new areas of automation are not mandated by regulation or required as a condition for obtaining reimbursement, demand for the new functionality will continue to grow because of increasing expectations regarding healthcare safety. As this demand continues to rise, improvements and enhancements to long-term care products will continue to emerge.

In general, therefore, most nursing home providers should initiate a review to determine whether their software vendors have, or are developing, these new functional capabilities and, if so, when they will be available for purchase and implementation. If a facility’s current vendor is not developing these enhancements or providing them through strategic alliance with other software vendors, the nursing home should consider transitioning to new products. NH