Perennially under-funded but facing increasing pressure to automate operations, long-term care facilities are struggling to outwit a Catch-22. How do they adopt the expensive information technologies needed to stay competitive when margins are narrowing to the point of oblivion?
The answer varies with the size of the organization. Small, privately owned facilities, which make up a majority of the nation's 15,000 nursing homes, are struggling to find the money for low-end billing systems and generally avoiding clinical automation. On the other hand, large national chains and regional networks that can distribute their costs are beginning to adopt systems that emulate the functionality of electronic health records (EHR).
The transition hasn't come without hiccups, though. "There have been many, many more failures in the adoption of EHRs for long-term care than there have been successes," says Dave Oatway, chairman of the HIMSS Long-Term & Post-Acute Care Special Interest Group, and an industry consultant. "And the success stories are mostly mixed."
Masonicare is Connecticut's largest not-for-profit provider of senior healthcare services and retirement living, with nearly 5,000 "residents" in home care, hospice, skilled nursing and assisted-living facilities. Six years ago, the Wallingford-based organization implemented an enterprise-wide EHR from Westwood, Mass.-based Meditech, a large acute-care vendor.
Jim Albert, vice president of information services for Masonicare, says the EHR promised to create a shared record that nurses and physicians could access instantly at the bedside. By integrating Masonicare's clinical and financial sides, Albert hoped the system also would boost reimbursement.
But within six months of going live, the EHR became overloaded and began dropping data. Meditech did its best to "keep up with our tsunami of data," says Albert, but Masonicare providers today still must wait up to two hours for patient information to display onscreen.
"Most acute-care HIS vendors for hospitals greatly underestimate the level of effort it takes to extend their product to the long-term care market," says Albert. "Their products have poor assumptions based on the short-term visits of hospitals and post-acute care facilities. But our residents are much sicker, and they're here much longer, so the amount of data that needs to be stored and transmitted and displayed is far greater."
Room for improvement
Industry-wide, no one has yet built a dependable EHR specifically for long-term care facilities, says Joshua Jensen, senior research manager for Orem, Utah-based Klas Enterprises, which monitors and reports on the performance of HIT vendors. But Jensen says a hot market is developing for solutions with EHR-like functionality that can automate the capture of key clinical data required by the federal government and flow it into billing software for reimbursement.
Integrated clinical and billing solutions are increasingly becoming available as browser-based tools, which tend to be less expensive. "Funds are tighter than ever and facilities are looking for something they can put in today without investing in infrastructure," explains Jensen.
Another emerging trend is the outsourcing of IT applications and services. Milwaukee, Wisc.-based Extendicare Healthcare Services, Inc., recently launched Virtual Care Provider to handle the IT needs of its 439 long-term care facilities as well as smaller, independent facilities. "We can scale and spread infrastructure investment across a big base," says Loren Claypool, the company's managing director. "So you don't have the IT director coming in to say, 'We need to spend half a million dollars next year on servers.â€™â€
Oatway has one piece of advice: "I'm very enthusiastic about good technology in long-term care, but there's a bit of 'proceed at your own risk.' In the end, you're responsible for the legality of your records, and there's a lot of smoke and mirrors out there."
Todd Stein is a freelance writer based in El Sobrante, Calif.