The long-term/post-acute care industry needs to talk. Quality of care depends on the ability to communicate with fellow long-term care providers, hospitals, pharmacy suppliers, labs and other ancillary services.
Interoperability was one of the hot topics the first day of the 2016 Long-Term and Post-Acute Care Health IT Summit in Reston, Va. The conversations dove deep and focused less on what could be and more about the challenges that exist today. There's no silver bullet when it comes to the hurdles of IT infrastructure investment, system standards, structured data input and data mapping.
“All these things I’m hearing about interoperability are giving me pause because I think about where we were when we started,” says Brian Yeaman, MD, CEO and founder of Yeaman & Associates, an interoperability consulting firm. “As you go down the path of interoperability, think about this: how you view and consume the data is extremely important.”
Yeaman sees and consults providers of patients with chronic conditions like congestive heart failure, diabetes or multiple co-existing diseases. It’s common for such patients to have more than 100 encounters with the lab, radiology, doctor’s visits and other healthcare providers over a two-year period, he says.
All of those providers need to be connected, talking to one another and sharing data, because the consequences of not doing so can be fatal.
A meta-analysis of nearly 49,000 emergency visits or hospital admissions among adult outpatients, 2 percent had preventable adverse drug reactions and 52 percent of those were preventable. Among inpatients, 1.6 percent had preventable adverse drug reactions and 45 percent of adverse drug reactions were preventable. Adverse drug reactions are among the top five greatest threats to seniors’ health.
Kevin Larsen, MD, enterprise lean and performance improvement lead at the Centers for Medicare & Medicaid Services says he first got involved with interoperability after a man died at his hospital because the emergency department couldn’t access his medical record to learn about an antibiotic allergy. The hospital had that data, but the departments couldn’t talk to one another, he says.
The risks are even higher for post-acute care because providers need to know about results from ancillary services and care provided outside the four walls of the facility, says David Wessinger, CTO and co-founder of PointClickCare. “There’s an insatiable need to share data, but it’s the Wild Wild West out there right now.” No one entity is solely responsible for owning, maintaining and updating patient data. What’s more, some providers are farther along than others in terms of developing scalable electronic health records that can capture all of LTPAC's data.
Those records are a way to get paid by Medicaid, not a way to drive care, argues Rod Baird, president of gEHRiMed and Geriatric Practice Management, LLC. “The thing that drives the entire system is the doctor’s orders, and getting that to happen is interoperability,” he says. “It’s the same patient in the same bed with the same care team. The only thing that’s different is the payer.”
Combined, Medicare and Medicaid pay approximately one-third of the national health expenditures, approximately $800 billion. One in four Americans have multiple complex conditions, but two of three fee-for-service Medicare beneficiaries have multiple chronic conditions. The Center for Medicaid and Medicare Services has focused recent efforts to the way it pays providers who deliver care and distribute information. Delivery system reform will result in better care, smarter spending and healthier people, says Shari Ling, MD, Deputy Chief Medical Officer serving in the Center for Clinical Standards and Quality (CCSQ).
Peter Kress, vice president and CIO of ACTS Retirement-Life Communities, says the burden should fall back to the vendors, not providers. “At this point, we need to understand what’s under the hood and put the onus on you,” he says to providers in the room. “We want to delegate that to you because we’re concerned about the outcome of the patients.”
Sylvia Rowe, vice president of Clinical Informatics, admits that nurses might not be the best about electronic charting and acknowledges poor charting could contribute to the interoperability challenge. “The biggest thing for us nurses is patient engagement,” she says. “We are all about that. We just might not be great about doing that electronically.”
Electronic health records will lead to improved patient care because it will allow for data to be captured and read by providers across the continuum. Digital documentation will allow providers to make decisions based on data and allow for better monitoring over time. It’ll also help those providers get reimbursed. It's a no-brainer and a win for everyone, though the specifics are still evolving.