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Why is increased EHR adoption important to long-term care?

Author Name Kyle Murphy, PhD   |   Date June 3, 2014 

That one-size-fits-all does not apply to EHR design, selection, and adoption has become cliché in healthcare and health IT circles. However, it continues to ring true for providers working in specialty fields of medicine whose ineligibility for meaningful use and similar incentive programs means that finding the right EHR solution is much different and more difficult task.




As an early adopter of EHR technology in a long-term care setting nearly ten years ago, Jean McGill of American Baptist Homes of the West (ABHOW) can recall the drawn-out process of finding an EHR system that could support the unique needs of skilled nurses and assisted living providers.
The current ABHOW Clinical Services Director began her work with the organization as Director of Nursing at San Joaquin Gardens, one of the healthcare network’s assisted living communities in California, and was quickly given her first task: evaluating the pros and cons of EHR adoption in a long-term care setting. Determining that it would, McGill and a selection team embarked on a two-year EHR selection process as a result of meeting the needs of its unique set of providers.
“We wanted something that was designed for long-term care because in home health and hospice I had worked with computer programs that were adapted to meet those needs and created difficulties in meeting the needs of the nurses in the field as they were going through their processes,” she tells
Working in an environment regulated on the federal level by the Centers for Medicare & Medicaid Services (CMS) and state level by California Department of Public Health (CDPH), the EHR system had to be compliant. At the same time, it needed to support the work of long-term caregivers.
“Primarily we were looking for a program that would support our needs, which were accurate documentation, something that would help us to have CMS and CDPH guidelines always in front of us, and be user-friendly,” adds McGill.
In 2005, McGill and her colleagues chose cloud-based EHR developer PointClickCare.
Working to meet the needs of specialists
Nearly ten years later, the EHR vendor remains the vendor of choice although its product has evolved to suit the needs of its long-term care users, which differ in important ways from other end users in the healthcare community.
“It’s not about checking the dots, getting these incentives, and chasing grant money,” PointClickCare CTO Dave Wessinger maintains. “We find that this space is really motivated by improving your own financial, operational outcomes; minimizing risk or potential litigation; and with ultimately improving and enriching the lives of the seniors that they provided services to.”
While the lack of meaningful use incentives to long-term care providers has not helped adoption among these specialists, it has actually presented some advantages according to Wessinger.
“What’s great about our space specifically in senior living not being covered in meaningful use is that it is actually moving forward with EHR not because of incentives but because it actually has a meaningful impact on their business,” he explains.
In what he describes as a “very highly regulated marketplace and difficult to do business in,” Wessinger understands that the onus is on the EHR vendor in this space to meet the specific needs of its customers and keep them happy rather than making it a priority to satisfy certification criteria.
That being said, he stills pays close attention to these criteria insofar as they impact the intersections of long-term care with other parts of the care continuum.
“I look at what the criteria are for long-term care and where we can try to create benefit from them,” he continues. “Take some of the certification criteria around medication management: If we do it the right way, it may not service our customers directly but the eligible professionals who use our system can leverage those measures to qualify for meaningful use even though the skilled nursing or assisted living providers don’t fall under those criteria.”
The evolving diversity in long-term care
Just as one-size-fits-all does not work for healthcare organizations on the whole, so too is one solution not sufficient to support all the different kinds of services that make up today’s long-term care environment. ABHOW’s care settings are manifold from the more acute healthcare centers known as villages to the less intensive lodges and groves for assisted living patients and residents with cognitive and memory impairments, respectively.
Soon after the initial adoption of the PCC EHR, McGill realized that applying one module to all settings was problematic and necessitated modifications to the organization’s rollout approach.
“The next major rollout for us will be when the new module for assisted living is released and that we’re looking forward to with great anticipation,” she says. “Beginning in 2005, many of our assisted living have been adapting the healthcare center model of PCC and using that to record assessments and service plans, but everyone is extremely excited about having their own module for the same reasons that I described in not wanting to begin with a model that had to be adapted.”
The modified approach is a reflection of the changes taking place in long-term care, an area of focus that should only grow in importance at an aging patient population continues to increase in number.
“Long-term care has become a real specialty area that deserves its own language, representatives, and experts,” McGill argues. “Gerontology is a fact of life that not everybody ages the same. There are very vibrant and healthy 90-year-olds and there are some 40-year-olds who are old.”
As this specialty matures over time, a mixture of external and internal forces will be necessary to steer quality improvement and innovation in the right direction. “Regulations are a big emphasis for change and push to stay in compliance, but more than that the industry itself is the motivating factor,” McGill concludes.
For EHR adoption to benefit providers and their patients, EHR technology needs to support the clinical workflows unique to each setting. And even in one particular setting, the needs of the providers are not always the same.
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