According to a 2013 report by the U.S. Commission on Long-Term Care, the number of people across the U.S. who are dependent on long-term care is expected to rise from 12 million in 2010 to 27 million in 2050. This rise puts a burden on providers who must keep track of so many patients.
One way to alleviate that information-sharing problem is via technology such as electronic health records (EHRs) and mobile devices. However, according to a National Center for Health Statistics data brief released in September 2013 that relied on the 2010 National Survey of Residential Care Facilities, just 17 percent of the nation's assisted-living and other residential care communities use EHRs.
What’s more, on the hospital and physician practice side, the federal EHR incentive payment program established in 2009 has helped boost EHR adoption to approximately 80 percent of doctors in the U.S. But Congress, in establishing the program, excluded nursing homes, other long-term care facilities, assisted living and other residential care providers. According to a January 2014 report from the California Healthcare Foundation and Bluepath Health, a Calif.-based consulting firm, “HITECH [the Health Information Technology for Economic and Clinical Health Act] ignored most critical skilled nursing and interim care facilities, resulting in an enormous disconnect between the acute site and rehabilitative care. This disconnect may prove to be a significant barrier in achieving new payment models that rely on providing seamless care transitions.”
Matthew Wayne, M.D., chief medical officer of CommuniCare Family of Companies, a Blue Ash, Ohio-based provider of post-acute care with 44 buildings across four states, and former president of the American Medical Directors Association (AMDA), recently spoke with HCI Associate Editor Rajiv Leventhal about the struggles that the post-acute care market faces when it comes to technology, why there is a need for technology in this market, and how these tools specifically help. Below are excerpts from that interview.
Why is there a need for technology, such as EHRs and mobile apps, in the long-term care market?
First let’s talk about where it is similar to the physician and hospital setting. We see the post-acute and long-term care setting as a piece of the healthcare continuum to the point that healthcare as a whole is moving from a fee-for-service environment to a value-based model. The role of the EHR will be central to moving in that direction, and having it is a necessity if we’re going to improve care. That’s no different than the need to do that in office or hospital setting—it’s just as critical.
Now, what is unique about this setting? You need to appreciate that the current model of care has evolved from the long-term model of care of about 40 years ago. Even the regulations guiding that market are about 40 years old and really speak to our long-term care model where individuals who could no longer live alone needed to go to a nursing home for their care and stayed there for the rest of their days. You still see some of that, but the industry has really evolved. We are now taking care of a much-higher-complexity and often higher acuity-type patient.
The model did not evolve with a strong medical oversight. The physician would show up once a month or every other month to see his or her patient. Today, we’re moving towards a stronger medical integration. That is a key distinction—when you don’t have the daily presence of the physician. And maybe that’s where we need to move towards. You need a way to bridge that communication. How does the interdisciplinary team communicate effectively with the physician when he or she may not be there daily? In our setting, we need EHRs and mobile apps to bridge that line of communication.
In the previous model, nurses would call physicians, take an order sheet and write down the doctor’s order. Then they would send the order to the pharmacy, which would come back to the doctor. The doctor would need to sign the sheet that would then go back to the patient’s medical record. But if I gave those verbal orders, now I can go into the app on the phone—and there are push notifications to tell me that there are orders to be signed. I do that and I’m done. There are no paper processes, and all of the above-mentioned steps are eliminated.
This is a relatively new market for EHRs and mobile apps, right?
I’d say so. There are very few physician-specific EHRs that deal with the post-acute, long-term care setting. We are happy to work with our EHR vendor, PointClickCare [based in Ontario, Canada] to help them with that. But [not long ago], physicians were writing notes on paper and putting them in paper-based charts in nursing homes, or were trying to utilize the EHR from their offices and make it work in our setting. We found that to be clunky. But pioneers in this industry are now embracing the technology.