By: By Joanne Kaldy, Elsevier Global Medical News
The halting advance of health information technology in long-term care has received new urgency from medicine’s increasing focus on accountable care and transitions, according to several experts in the area. "There can be no accountable care without [long-term care] being deeply involved," said Jim Walker, MD, chief health information officer of Geisinger Health Systems in Pennsylvania said recently in a keynote address at the 2011 Long-Term and Post-Acute Care HIT Summit in Baltimore.
Rebecca Gardner/Elsevier Global Medical News
A nurse at Levindale Hebrew Geriatric Center and Hospital in Baltimore checks information on a monitor in the facility.
Accountable care organizations (ACOs) were offered in health care reform legislation – the Affordable Care Act – as a model of service delivery that offers practitioners and providers financial incentives to provide quality, cost-effective care to Medicare beneficiaries, Dr. Walker explained. According to the law and subsequent regulations, an ACO will agree to manage the overall care needs of beneficiaries for 3 years or longer. Nursing homes, hospices, and other long-term care programs and facilities can participate.
As such, "we will have to get better and better about improving outcomes while reducing costs," said Dr. Walker. "There will be less money for care, period, for the rest of your working life." Linking care settings while reducing costs will demand health information technology (HIT), he said.
While ACOs are in their infancy and many nursing facilities are still searching for their roles in these organizations, Dr. Walker stressed that long-term care should be at the table in discussions about how to improve care and reduce costs, what data will be shared, and how organizations and team players will be linked. Those players will include patients, caregivers, physicians, nurses, case managers, hospitals, emergency departments, and first responders, said Dr. Walker. "We are still at the beginning of seriously thinking about teams" and how they will function in ACOs.
In an interview, Shelly Spiro, RPh, director of the new national pharmacy HIT group called the Pharmacy e-Health Information Technology Collaborative, said, "Physicians, pharmacists, and other [LTC] practitioners should ... make sure that policymakers working on HIT issues understand the value of long-term care providers."
She agreed with Dr. Walker that ACOs will demand better information technology from long-term care. "We no longer can do things manually in this setting," she said. "We have to be able to document and exchange information electronically. This is the way health care is moving, and we have to go with it. As providers, we want to make sure our care is documented in a way that a wide variety of organizations and individuals can understand."
Health Information Exchanges
As the accountable care approach expands, the growing need for shared information has led to the rise of health information exchanges, said Dr. Walker. He explained that these transmit health care data among entities such as hospitals, nursing facilities, health information organizations, government agencies, and practitioners’ offices. ACOs use this service to track information and measurements such as care costs and quality, patient events such as an emergency department visit, and patient status.
A successful exchange requires interoperability between settings and users who understand the system and are committed to using it to maximize quality while minimizing adverse events and miscommunications. To meet nationally established requirements, HIT must ensure secure and reliable data transfer and enable access and retrieval of information, Dr. Walker said.
Long-term care facilities need to determine what information that they now collect can be integrated into health information exchanges, he said. "One thing [long-term care] can do is identifying the information you need to make these processes practical and effective." This requires a close look at the forms that facilities currently use and the data that they collect.
For a facility to participate in a health information exchange can be challenging, as it clearly requires the investment of some time and money. But an exchange can pay dividends in offering the ability to analyze, improve, and standardize care processes that will be necessary to survive in accountable care organizations.
"It is easier if you can find a group that already has [a health information exchange] and is using it effectively," Dr. Walker said. Being proactive is essential, as "you can’t count on people understanding the need to include you in the processes and discussions."
It isn’t necessary to find a local exchange. A nursing facility can use one that is housed anywhere, said Dr. Walker. "It just needs to be able to receive information, store it, and provide appropriate access." The system should use shared care processes that generally are simple and evidence based.
Simplicity is key, Dr. Walker emphasized. "Some feel that if we can connect oceans of information, good things will happen. But we feel that if you do this, people will drown."
Tech and Transitions
Two panelists at the meeting emphasized the role of information technology in improving transitions of residents into and out of long-term care. Stephen F. Jencks, MD, a Maryland-based consultant in health care safety and quality emphasized the importance of a strong care plan in successful transitions and said that care plans can be made or broken by data.
"The plan of care is the most critical piece of information for the next provider, [but] there is a concern that facilities will transfer large amounts of information without improving systems or positively impacting the patient," he said. Health information can be organized to support the care plan, he said.
Much work is yet to be done, however. Currently, there is no single readmission measure, standard way to address risk, or definition of which readmissions to count as unplanned or planned, Dr. Jencks said.
Panelist Claudia Williams, director of state information-exchange programs in the federal Office of the National Coordinator for Health Information Technology, said that all accountable care organization regulations have transitions and care coordination as priorities.
"They share a common emphasis on the importance of care coordination and the ability to follow patients between settings, care transitions and medication management, the role of community-based services, and engagement of patients and family caregivers," she said. There is a general consensus among stakeholders regarding the elements of safe and effective care transitions: patient and caregiver involvement, medication reconciliation and safe medication practices, standardized and accurate communication and information exchange, and person-centered care plans that are shared across settings, she said.
Ms. Williams encouraged her audience to be part of the dialogue as these issues evolve in conjunction with issues of HIT in long-term care. "There is a need to bring public and private sectors together to solve care-transition problems," she said. "There needs to be shared responsibility and accountability."
Dr. Jencks pledged that efforts will continue to make HIT an important tool for improving care transitions and solving other problems in health care. Speaking while the debt-ceiling debate went on in Washington, Dr. Jencks added, "The U.S. economy won’t recover unless we find a solution to our health care problems."CfA
Senior contributing writer Joanne Kaldy is a freelance writer in Harrisburg, Pa., and a communications consultant for AMDA and other organizations.
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