Adopting Information Technologies for Post-Acute and Long-Term Care: Achieving Care Continuity
Capitol Hill briefing focuses on IT tools for home care and long-term care
March 6, 2015 10:38 AM
What is the outlook for health IT? An expert panel recently addressed this question at a Capitol Hill briefing “Adopting Information for Technologies for Post-Acute and Long-Term Care: Achieving Care Continuity.” The briefing is part of a series of educational programs sponsored by the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics in collaboration with the American Health Care Association (AHCA) and National Association for Home Care & Hospice (NAHC). It brought together federal agency leaders and industry experts at the Russell Senate Office Building where they explored ways health IT supports care delivery networks, drives value-based payment, and supports quality outcomes. The panel also discussed how some providers use health IT to engage with accountable care organizations (ACOs) and health plans, participate in bundled payment arrangements, and develop innovative practices like telehealth and monitoring in homes.
Health IT is a must in terms of long-term care continuity because “we can’t keep relying on physicians’ offices,” said Neal Neuberger, panel moderator and executive director of The Healthcare Information and Management Systems Society (HIMSS) Foundation’s Institute for e-Health Policy. His organization provides critical educational opportunities in the Washington, DC, area for public- and private-sector stakeholders who make health policy or are affected by it.
Among the heavy hitters in this area of health care is the Office of the National Coordinator for Health Information Technology. ONC works with the Department of Health and Human Services (HHS) to establish the national agenda for health IT and they have recently set expectations around the continuum of care, said Kelly Cronin, director of the Office of Care Transformation at ONC. Her office has come up with new goals for moving Medicare to value-based payment so that providers are increasingly held accountable. “This major shift in payment,” she said, “makes it explicit that long-term providers are partners,” across the continuum of care, so exchanging information is even more important. “HHS has set a three-year goal for most Medicare providers to be able to send, find, and exchange common data. And “there’s a good chance this interoperability goal is feasible,” she said, if we take some near-term actions: “refining what we have and making it usable, making it meaningful for providers, and making changes to how privacy and security are addressed. In addition, “we need to establish best available standards.”
These standards are laid out in the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, said Liz Palena Hall, long-term and post-acute care coordinator in the Office of Policy at ONC. IMPACT, Hall explained, creates instruments to modernize Medicare payments to PAC providers and produce a more accountable, quality-driven PAC benefit. It encourages these outcomes “by requiring standardized patient assessment data” and “using all HHS policy levers to drive interoperability across the health care continuum.” In addition, ONC has issued certification guidance for developers of electronic health records and published its standards advisory for 2015. Where these standards are being implemented, there are uniform information systems for every patient. To nudge more providers in this direction, ONC has made a number of funding announcements, including one to educate health care professionals in health IT.
The benefits of health IT are apparent at Good Samaritan Health Society, which provides home and community, senior living, and rehab/skilled services to more than 20,000 people across the nation. “Technology is changing our organization,” said Rusty Williams, VP and CIO of Good Samaritan Health in Sioux Falls, South Dakota. The major driver of change, as he explained, is a service called Living Well at Home, designed to improve clinical productivity while cutting costs. “Living Well at Home collects and analyzes information for early detection of problems,” he said, “and empowers individuals to live at home.” The service collects data on mobility and vital signs, indicators that paint a good picture of an individual. After looking at the data, RNs follow up with clients, providing a personal touch that’s important to improving outcomes. To enhance the service even more, Good Samaritan is working on ways to share information with patients’ primary care doctors and they’re experimenting with point-to-point video conferencing so nurses can actually see their patients.
It’s worth the investment because the cost reductions are already clear, Williams observed. “We began with one nurse for 75 patients and we now have one nurse for 400 patients.” One of them is Connie Miller who appears in a commercial for Living Well at Home. The service has allowed her to monitor her blood pressure and oxygen levels, as well as provide her physician with information that helps — and make Connie feel safe. “When I was in trouble,” she tells viewers, “somebody would call me. I can see that I’m being cared for without nursing home care.”
Technology has also conferred tangible benefits on Mission Health Services, a Utah provider which crosses the spectrum in services for seniors. “We were struggling 12 years ago as we watched residents flow between different facilities in our organization,” said Gary Kelso, president and CEO of Mission Health. “We knew technology would help us in our clinical outcomes and we were very involved in cultural change to make greater use of data.” As a result, Mission Health has gone from average to best in class. The information they collected helped them know their residents better, and the improvements they saw led them to adopt an electronic medical record (EMR) system with support from the Utah Department of Health. As Mission Health used the new system and became more efficient with data, their deficiencies dropped and customer satisfaction rose.
EMRs have numerous benefits, as Kelso explained. “They let you know what you didn’t know, reduce survey deficiencies, give staff tools to manage the survey process without imposed survey outcomes, and provide information — all plusses that matter to potential partners. “If you don’t have an EMR,” Kelso pointed out, “you’re not at the table with managed care or accountable care organizations. The only way you’re going to get at the table with ACOs is with an EMR.”
EMRs are an important part of the thrust to save money and promote longitudinal coordination of care. “Interoperability is a way to get to a higher level of long-term care,” according to Richard D. Brennan, Jr., NAHC’s vice president of technology policy, government affairs, and executive director of its affiliated Home Care Technology Association of America. In his close study of providers, Brennan has seen that “home care has been making significant strides forward in the use of technology.” The figures show that 78.1 percent of home health agencies (HHAs) use electronic medical record systems, 57.8 percent of HHAs use point of point of care (POC) systems, and 28.7 percent of HHAs use telehealth/remote patient monitoring.
These figures matter even more as an aging population leads to more patients who have chronic conditions and can be cared for at home with the right hi-tech tools. “Over time,” Brennan pointed out, “aging in place will reduce hospitalizations,” and telehealth is already showing measurable results: a 72.9 percent increase in overall quality, a 64.4 percent increase in care coordination, a 64.2 percent increase in patient satisfaction, a 56.1 percent increase in patient self-care, and 65.1 percent fewer emergent care admissions, along with 69. 8 percent fewer unplanned hospital stays.
Based on these improvements, “we are advocating that our home health agencies become sophisticated adopters of technology,” Brennan said. And it will be easier for them and other health care providers to advance along the high-tech highway if government takes steps to advance health IT.”HHS should focus on high value deliverables — such as exchange of transitions of care summaries and interoperable care plans — shared by doctors, hospitals, and long-term post-acute care providers. In addition, Congress should consider legislation to spread the use of interoperable health IT to all settings and authorize reimbursement for remote telehealth and remote patient monitoring in Medicare,” Brennan advised.
And providers should always keep in mind that high tech and high touch work in tandem to produce the best results for both providers and patients. As Neuberger summed up, communities need to pay more attention to the Triple Aim set out by the Institute for Healthcare Improvement: improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care. “The sooner we get to that,” he concluded, “the better.”