What is Health IT in LTPAC?
"Health information technology (HIT) is the hardware, software, and systems that comprise the input, transmission, use, extraction, and analysis of information in the healthcare sector." This quote comes directly from the book "An Introduction to Health Information Technology in LTPAC Settings" and was written by three LTPAC Health IT Collaborative members, including Greg Alexander, PhD, RN, FAAN; John Derr, RPh, FASCP; and Lorren Pettit, MS, MBA.
"The technology infrastructure refers to the hardware and network resources of an information system. The IT infrastructure consists of five components: data; routers, switches, and servers; wired and wireless networks; client terminals and devices; and data storage and data integration." (Alexander, Derr, Pettit pg. 48). Applications are software programs that "sit" on top of the technology infrastructure or hardware of an information system. Applications in healthcare IT generally fall into one of three areas: administrative applications, financial applications, and clinical applications. (Alexander, Derr, Pettit pg. 49).
"Health IT will make it possible to efficiently share increasing amounts of data needed for safe transitions of care and longitudinal coordination of care across multiple sites and care teams. And it will power the analytics needed to guide these organizations" (Alexander, Derr, Petit pg xxi Forward by Terrence A. O'Malley).
Electronic Health Records
As most probably know, electronic health records (EHRs) are digital versions of patients' health information that are stored electronically and accessed by authorized healthcare providers. EHRs provide a comprehensive view of a patient's medical history, including diagnoses, treatments, medications, and test results, which can help to improve the quality and coordination of care.
The EHR in an LTPAC setting can be very complex as these platforms collect nursing data and also integrate with multiple other EMR products from those providing care in the setting, including services from Therapy, Pharmacy, Physicians, Lab, Imaging, and Dietary. Even so, most medical providers within the LTPAC Sector have an Electronic Health Record (EHRs) in place. In addition, these systems typically include features such as functional assessment and activity monitoring, remote monitoring, medication management, and care coordination. LTPAC EHRs are designed to support care planning and delivery for individuals with complex health needs over an extended period of time.
Under the IMPACT Act of 2014, there are four post-acute care settings identified, including Skilled Nursing Facilities (SNF), Inpatient Rehab Facilities (IRF), Home Health Agencies (HH), and Long Term Care Hospitals (LTCH). These settings are all required by federal law to submit standardized data sets used for quality reporting, payment, and oversight. For instance, within the SNF, the Minimum Data Set (MDS) is collected and reported electronically. In a similar way, within HH, the Outcome and Assessment Information Set (OASIS) is collected and reported electronically. Within the IRF setting, the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) is, again, collected and reported electronically. And, within the Long-Term Care Hospital (LTCH), the LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) is collected and reported electronically.
In addition, under the IMPACT Act, these settings are required to share standardized data during transitions of care (TOC) from one setting to another.
Adoption Studies:
Electronic Health Record Adoption and Interoperability among U.S. Skilled Nursing Facilities and Home Health Agencies in 2017Electronic Health Record Adoption and Interoperability among U.S. Skilled Nursing Facilities and Home Health Agencies in 2017Electronic Health Record Adoption and Interoperability among U.S. Skilled Nursing Facilities in 2016
Case Studies:
CAST EHR Case Studies
Information Sharing
The Interoperability discussion has historically focused on hospital-hospital data exchange. While important, this focus has made it difficult to gauge the progress of data exchange between other care settings, such as between the hospital and an LTPAC setting. Even so, as the shift to value-based care continues, hospitals are strategically acquiring or, more frequently, partnering with facilities and community-based LTPAC Providers to help ensure a better transitions of care (TOC). Evidence demonstrates that good TOC result in lower hospital readmissions, reductions in medical errors, and improved patient/caregiver satisfaction.
The ability for LTPAC Providers to electronically exchange health data bi-directionally between care settings significantly increases the opportunity for a good care transition. Access to timely, accurate, and complete patient data allows for fully informed care decisions that improve patient safety.
The IMPACT Act of 2014 created an increase focus and energy around identifying data elements to be exchanged.
One result of this energy was the creation of the Data Element Library (DEL), which allows the ability to implement many these IMPACT Act requirements.
One of the challenges identified with these TOCs is the goal of each care setting. For instance, the goal in the acute hospital is to keep the person alive. The goal in a post-acute setting is to give the person a life worth living. This helps to explain the focus in post-acute settings on continuity of rehabilitation therapies and improvements in functional status, which are not points of emphasis during an acute hospitalization.
The Information Blocking Rule, which applies to LTPAC settings too, encourages additional sharing of information with patients and other caregivers, including during transitions of care. In a similar way, the Trusted Exchange Framework and Common Agreement (TEFCA) will encourage this same kind of information sharing. As this happens, we expect even better care for our residents, including reduced rehospitalization rates, reductions in medical errors, and improved satisfaction for patients and caregivers.
Shared Care Planning and Coordination
Shared care planning and coordination are important components of care in Long-Term and Post-Acute Care (LTPAC) settings. They ensure patients receive coordinated and integrated care across different service providers including physicians, nursing, therapy, pharmacy, social services, and others. Shared care planning involves engaging patients and their families in the care planning process, and coordinating care between these different healthcare providers to ensure patients receive the appropriate services and support.
Effective shared care planning and coordination in LTPAC requires a collaborative approach that involves all members of the healthcare team. This may involve regular team meetings, care conferences, and other communication and collaboration efforts to ensure that everyone is on the same page and working together to provide the best possible care.
Technology is used to assist with communication and collaboration through the use of both scheduling and monitoring tools. Much of this communication is shared through the EHR, in a way that all team members have access. Even so, other technologies are used. For instance, synchronous audio and video conferences (ex Zoom calls) are often used for follow-up team meetings. Another example is the use of patient portals, which might be used to review and discuss lab results and other medical findings.
Medication Management
Medication management is an important aspect of healthcare in Long-Term and Post-Acute Care (LTPAC) settings, where patients often have complex medication regimens and are at increased risk of adverse drug events. Effective medication management in LTPAC requires a comprehensive approach that includes medication reconciliation, medication ordering and prescribing, medication administration, and medication monitoring and review.
One key component of medication management in LTPAC is medication reconciliation. This requires comparing a patient's medication orders across different care settings to identify and resolve any discrepancies. This helps to prevent medication errors and ensures patients receive the appropriate medications at the right time.
Another important aspect of medication management in LTPAC is medication ordering and prescribing. This includes the use of electronic prescribing systems, which help reduce medication errors, improve communication between healthcare providers, and streamlines medication ordering and dispensing processes.
Medication administration is another critical aspect of medication management in LTPAC. This involves ensuring patients receive their medications in a safe and effective manner. This includes using medication carts or automated medication dispensing systems, as well as ensuring staff members are properly trained in medication administration techniques.
Finally, medication monitoring and review is an important component of medication management in LTPAC. This step involves regular monitoring of patients' medication regimens to identify any potential problems or adverse events. This can include regular medication reviews, monitoring of patients' vital signs and laboratory values, and collaboration between healthcare providers to ensure patients are receiving the best possible care.
Overall, effective medication management is essential for improving outcomes and reducing costs in LTPAC settings. Successful medication management requires a comprehensive and coordinated approach that involves all members of the healthcare team, including physicians, pharmacists, nurses, and other staff members.
Data Analytics
Data analytics is an increasingly important tool in Long-Term and Post-Acute Care(LTPAC) settings, as it enables healthcare providers to use data to identify trends, patterns, and opportunities for improvement in care delivery and patient outcomes. Data analytics involves the collection, processing, and analysis of large amounts of data in order to extract meaningful insights and drive decision-making.
Most provider organizations have initiated data projects. Even so, this is an area we expect to be utilized even more as we all look for ways to improve care. We know Artificial Intelligence (AI) and Machine Learning (ML) are already utilized in some EHRs. This use will continue to improve in the future. In fact, we did use Chat GPT to create some text for this section--and we then updated or modified the answers provided.
Communication Technologies
Effective communication is a crucial component of quality care delivery in Long-Term and Post-Acute Care (LTPAC) settings. Communication technologies refer to the tools and systems that enable people to communicate with each other, regardless of their location or time zone. These technologies have revolutionized the way we communicate and interact with each other, enabling us to connect with people and share information in real-time. Some examples of these technologies include Telemedicine, Secure Messaging, and patient portals.
These technologies offer a range of tools and resources that can help to facilitate communication between healthcare providers, patients, and their families. This improves the quality of care and patient outcomes.
These tools often require good, high speed internet connectivity and good cyber hygiene principles to be in place. They must be user friendly and accessible to all members of the care team, including residents, caregivers, and family members. By leveraging the power of communication technologies, LTPAC providers can improve the coordination of care, enhance patient engagement and satisfaction, and drive better patient outcomes.
Financials/Billing
Financials and billing are critical components of healthcare in Long-Term and Post-Acute Care (LTPAC) settings, as they impact both the quality of care that patients receive and the financial stability of LTPAC organizations. Effective financial management in LTPAC requires a comprehensive approach that includes billing and reimbursement, revenue cycle management, and cost management.
Billing and reimbursement in LTPAC involves submitting accurate and timely claims to payers, including Medicare, Medicaid, and private insurance companies. This also requires ensuring claims are processed and paid correctly. The process is complex in the LTPAC space where there is a proliferation of Medicare Advantage payers each with their own rules around prior authorization, covered services, and post care review and appeal. LTPAC organizations may provide a range of services, including skilled nursing care, therapy and rehabilitation services, and other ancillary services. In many scenarios, each service may require their own authorization of care, adding to the administrative burden to complete and the complexity of follow up needed.
Revenue cycle management is also critical for financial management in LTPAC. This involves managing the process of generating revenue, from patient registration and admission to claim submission and payment. This can include implementing processes and systems to streamline revenue cycle workflows, monitoring key performance indicators to identify potential areas for improvement, and ensuring that revenue cycle staff members are properly trained and supported.
Cost management is another important aspect of financial management in LTPAC. This involves managing expenses and ensuring resources are used efficiently and effectively. In addition, this requires supply chain management and negotiation of prices for medications and supplies. Managing labor costs through effective staffing and scheduling is another challenge, especially in this tight labor market. Like other healthcare settings, LTPAC provider implement processes and systems to reduce waste and improve efficiency. This all happens at the same time as we are developing new and innovative ways to care for our customers—the patients and their families.
Overall, effective financial management is essential for the success of LTPAC organizations. Successful financial management requires a comprehensive approach that involves all members of the healthcare team, including administrators, billing and reimbursement staff, financial analysts, and others.
Infection Control and Surveillance Technologies
Infection control and surveillance technologies are important in Long-Term Post-Acute Care (LTPAC) settings. These settings are particularly vulnerable to outbreaks of infectious diseases, given the close proximity of residents and the high prevalence of underlying medical conditions. This became very evident during the recent COVID Pandemic.
In addition to using special software to track and monitor the occurrence of infections in real time, these technologies can monitor the air ventilation systems and even the waste systems. This additional monitoring is used to identify outbreaks, or potential outbreaks, even before anyone might otherwise consider an issue to be present.
In addition, automated disinfection systems reduce the risk of infections. These systems use ultraviolet light, hydrogen peroxide, or other disinfectants to kill bacteria and viruses on surfaces. Hand hygiene monitoring systems are also used to remind everyone of the importance of good cleansing to prevent Healthcare associated infections (HAIs).
Infection control and surveillance technologies in LTPAC settings are critical for preventing and controlling the spread of infectious diseases and ensuring the safety and well-being of both residents and healthcare professionals. Even so, the adoption of these technologies can be challenging, given the complexity of LTPAC settings and the need for additional training, technology, and IT support.
Functional Assessment and Activity Monitoring (AL)
“Acute hospitals keep a person alive. Post acute settings give a person a life worth living.” This quote is often attributed to John Derr, RPh, FASCP and one of the LTPAC Health IT Collaborative members. Even so, this quote could be from any one of us. In short, we recognize the importance of both functional assessment and activity monitoring to provide this "life worth living". These are important components of care in any Long-Term and Post-Acute Care (LTPAC)settings, as they help to promote patient independence and prevent functional decline. They also improve our overall quality of life.
Functional assessment involves evaluating a patients' ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Functional assessment in LTPAC typically involves evaluating a persons’ ability to perform tasks such as dressing, grooming, bathing, toileting, and eating, as well as more complex activities such as managing medications, handling finances, and using transportation. This helps healthcare providers identify any functional deficits or areas for improvement, so we can develop individualized care plans to address these issues.
Activity monitoring involves tracking patients' physical activity levels and identifying potential issues or areas for improvement. Activity monitoring in LTPAC can include a range of technologies, such as wearable sensors, pedometers, and other activity tracking devices. These technologies can help to track patients' physical activity levels, identify any patterns or trends in activity levels, and provide feedback to patients and healthcare providers.
Overall, functional assessment and activity monitoring are important components of care in LTPAC. They help to create a ‘life worth living’ by promoting independence and slowing or preventing functional decline. Successful implementation of these programs requires a comprehensive approach that involves all members of the healthcare team, including physicians, nurses, therapists, and other staff members, as well as the use of technology and other resources to support assessment and monitoring efforts.
Safety Technologies
Some examples of these technologies include: Fall risk identification, automated medication dispensing, wander prevention technologies, and Infection control systems.
Successful implementation of these technologies requires a comprehensive approach to assessing risks, developing effective protocols and procedures, and training staff members how to use these technologies effectively and safely. Even while these safety technologies can be highly effective in promoting wellness, they are not a substitute for high-quality, person-centered care that is delivered by skilled and compassionate healthcare providers.
Social Connectedness and Engagement
Social connectedness and engagement are important components of care in Long-Term and Post-Acute Care (LTPAC) settings, as they help to promote mental and emotional well-being, prevent social isolation and loneliness, and improve overall quality of life. Social connectedness involves developing and maintaining meaningful relationships and connections with others, while social engagement involves participating in social activities and events.
In LTPAC settings, social connectedness and engagement can be particularly important, as patients may be at higher risk for social isolation and loneliness due to factors such as age, chronic illness, and disability. Effective strategies for promoting social connectedness and engagement in LTPAC settings may include:
* Creating a welcoming and inclusive environment: This can involve creating spaces that are inviting and comfortable, and fostering a sense of community among patients and staff members.
* Providing opportunities for social interaction: This can include group activities, such as games, crafts, and music, as well as outings and other social events.
* Facilitating connections with family and friends: This can include providing access to technology, such as video chat or social media, to help patients stay connected with loved ones who may not be able to visit in person.
* Supporting volunteer and community engagement: This can involve facilitating opportunities for patients to volunteer, such as participating in community service projects or helping with fundraising efforts.
* Providing access to mental health services: This can include providing counseling services, support groups, and other resources to help patients address mental health concerns and develop coping strategies.
Telehealth
Although Telehealth has been used in several LTPAC settings for many years, like other healthcare settings, the utilization of telehealth increased significantly during the recent pandemic.
Telehealth is used in these settings to provide a range of services, including remote consultations with healthcare providers, remote monitoring of patients' vital signs and health metrics, and remote delivery of therapy and rehabilitation services. Telehealth is also used to facilitate communication and collaboration among healthcare providers, patients, and their families. This is particularly important during transitions of care, for example, when a person transitions from the Acute Care Hospital to the Skilled Nursing Facility. In this instance, everyone can agree on the current and near future plan and timing of care, thus improving care coordination and reducing the risk of medical errors.
When used for consultations, the use of telehealth in LTPAC settings has a number of benefits. For patients, this reduces the need fortravel to healthcare facilities, which may reduce confusion with reduced interruptions of daily schedules. Telehealth also improves access to specific healthcare services, for instance when a specialist is not available in a rural setting. For healthcare providers, telehealth can improve efficiency, reduce costs, and enable us to reach a larger patient population.
Even so, there are many challenges with utilizing telehealth in LTPAC settings on a regular basis. For instance, costs in these settings are often higher than telehealth in other settings, due to the necessity of having a teleprompter in the room with the patient. In addition, reimbursement varies for this service. Finally, there are challenges with maintaining the technology infrastructure, especially when residents and families continue to have higher and higher broadband needs for their personal entertainment and communication.
Wearable Technologies
Wearable technologies, such as fitness trackers and smartwatches, are becoming increasingly popular in LTPAC settings. These devices often have sensors, microprocessors, and wireless communication capabilities, and they can measure various types of physiological and environmental data. These devices provide valuable information about a patient's health status, activity levels, and medication adherence, enabling healthcare professionals to monitor and manage chronic conditions even more effectively.
Some examples of wearable technologies in the LTPAC setting include smartwatches, fitness trackers, smart clothing, and health monitoring devices. We monitor physical activity, heart rate, sleep patterns, blood pressure, and other health metrics.
Some devices, such as smart glasses, are used by caregivers to allow clinical experts in a given area to assist with care. For instance, for almost ten years, at least one company has been using smart glasses to provide better care to individuals with open wounds. The subject matter expert, a nurse with advanced wound care skills, would be located in the corporate office. The nurse onsite in the nursing home would carry the glasses to the patient room and then don the glasses to allow the remote nurse (in the corporate office) to ‘see’ the wound. There was immediate verbal communication between these two nurses. In addition, the remote nurse could observe the application of the wound dressing and provide additional insight to the local (onsite) nurse. Care improved. The local nurse received 'just in time training. Residents benefited.
Robotic Technologies
Healthcare robotic technologies are rapidly emerging as important tools in Long-Term and Post-Acute Care (LTPAC) settings. They offer a range of benefits to improve the quality and efficiency of care delivery. Healthcare robots are machines that perform tasks, or assist with tasks, typically performed by humans. Within the LTPAC settings, this may include activities such as dispensing medications, monitoring vital signs, and delivering meal trays.
For example, there are several nursing homes and assisted living facilities that utilize 'delivery robots' to assist in the dining area. In addition to automatically bringing trays to the dining area, these robots can also retrieve drinks, silverware, and napkins from the kitchen area, which allows the Certified Nursing Assistants (CNA) and others to remain in the dining area with the residents. There are also at least 12 nursing homes in Minnesota that currently have social humanoid robots in place. These robots are particularly useful with individuals that have memory challenges, including those with Alzheimers. In these instances and among other things, these robots can show personal pictures to specific individuals and ask about their past as triggered by the picture. This very intriguing use of robots has a great opportunity in our near future.
In addition, there are a multitude of Robotic Process Automation tasks that can be completed without human intervention. For instance, when we have data flowing from the weight scale to the Provider EHR, alerts can identify and trigger a trend in the change of weight during a given timeframe. In another instance, when nursing collects vital signs each day, the Provider EHR can monitor for trends and alert the correct personnel for closer monitoring of the person under our care.
