With health information technology (HIT) in long-term care (LTC) settings becoming more common, LTC stakeholders (e.g. consumers, employees, regulators, owners, etc.) are only now beginning to understand the impact of HIT on nursing home (SNF) operations and consumer experiences.
When I began working in SNFs in the early 1990s, an improvement in HIT meant acquiring three-ring binders for resident medical records because their paper-holding capacity exceeded that of the “old” flip charts they replaced. In those days, information transmission was exclusively dependent upon a constant steam of paper flowing from supervisory personnel to direct care workers and back to the supervisors. Armed with data, supervisors would then study the information to search for trends and indicators of resident health declines. Based upon their (hopefully) timely findings, effective interventions could be initiated to provide curative or palliative relief. Obviously, any information dependent process (virtually every process in a SNF) was at risk for receiving incomplete, erroneous or old data.
With the introduction of the minimum data set (MDS) in 1991, it became obvious that IT solutions, by then already employed in SNF finance/accounting departments, would be needed in the clinical setting: there was simply too much data required by and created by the MDS for exclusive reliance on paper documentation.
Nevertheless, the SNF industry was slow to adopt HIT solutions in part due to low rates of reimbursement for Medicaid beneficiaries (the largest single payment source for facility-based LTSS), few market incentives to encourage HIT adoption and few vendors interested in the elder care industry. To date, about half of all SNFs have implemented some form of HIT to improve the quality of care.
However, times change and the current quest to remove inefficiencies and improve quality in the American health care system means that SNFs, whether they specialize in post-acute care or remain primarily a provider of long-term care, must accelerate their acquisition and implementation of HIT in order to remain relevant in the evolving health care space. Although there are no validation studies which indicate which HIT applications in the SNF setting are best suited to improving outcomes, there is evidence that introducing and improving the sophistication of HIT does correlate positively with improving the nursing home Quality Measures published on the CMS nursing home website as a criteria for choosing a SNF.
A recently published manuscript (here) examining the impact of HIT on communication strategies about pressure ulcer prevention in SNFs provides interesting insights into the intended and unintended consequences of HIT in SNFs. From 5% to 10% of all residents in SNFs have pressure ulcers, and the resulting high treatment costs and adverse health effects makes pressure ulcer prevention an obvious goal for all SNF operators. Additionally, the presence of pressure ulcers can have dire consequences during a SNFs annual SNF licensure and certification surveys. Findings in the manuscript include:
- Direct interactions between CNAs and RN/LPNs were more frequent in the low HIT sophistication SNFs and occurred in a more centralized setting (e.g. nursing station, etc.);
- High HIT sophistication SNFs have more robust and integrated communicating strategies that may allow for interactions throughout the facility and require less frequent face to face interactions between CNAs and RN/LPNs to verify order or report patient status.
- High HIT sophistication SNFs offer an advantage by enabling CNAs and RN/LPNs to commuincate through technology indirectly and manage that communication in the context of their individual workflows with greater efficiencies and less interruptions.
These findings relating to communication strategies raise intriguing questions relating to implementing person-centered care in SNFs. Will these communication realities permit CNAs to spend more time with residents, providing more time for resident preferences to be acknowledged and acted upon? Similarly, will HIT work flow and intervention tracking allow for supervisory and administrative staff to become more focused on improving resident empowerment and dignity then the current medical model allows? Taking HIT in a different direction, exploiting App technology is a frontier that remains (virtually) unexplored in the SNF industry, yet it may have great potential to improve both communication with referall sources and the consumer experience. What do you think?
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