BALTIMORE — Most long-term care facilities have been slow to adopt and implement electronic health records and other forms of health information technology. That actually may be both a blessing and a curse, according to experts at a meeting on long-term care health information technology. On one hand, the slow start puts long-term care facilities well behind the curve of their partners such as hospitals and physician practices. On the other hand, it also means that the long-term care industry benefits from much of the trial and error that other medical groups have already been through, said Peter Kress, a commissioner on the board of the Center for Aging Services Technology in Washington. “Our job is relatively easy. The heavy lifting has already been done,” he said. Now it is time for the long-term care industry to pick standards to work with. Let's begin sharing information … based on a document standard that can grow,” said Mr. Kress. Clinical documentation architecture has emerged as one standard that can be adapted to different facilities with different needs, said Liora Alschuler, principal of the consulting firm Alschuler Associates, East Thetford, Vt. Clinical documentation architecture essentially allows any facility to incorporate any type of electronic document, even scanned paper records, into a commonly viewable library of health data and records. It's the “gentle on-ramp to health information exchange,” she said at the meeting, which was sponsored by the American Health Information Management Association (AHIMA). The other benefit of clinical documentation architecture is that long-term care facilities can adopt basic versions of the system at very low initial cost or invest more for more sophisticated document sharing capabilities, said Ms. Alschuler. However, cost remains a significant barrier for many long-term care facilities, said Roxanne Tena-Nelson, vice president of New York's Continuing Care Leadership Coalition. The need for some outside funding—whether from the government or private entities—was an oft-repeated theme during the meeting by both panelists and attendees. Even in cases when the return on investment would be high, facilities still need to come up with the initial investment to get there, Ms. Tena-Nelson pointed out. New York's long-term care community was able to obtain funding for health IT adoption during the state's budgetary process. That funding has helped to finance several projects, including a survey to look at the current status of health information technology within the long-term care community. Nearly 68% of the survey respondents said that the implementation of electronic health record systems was a top priority for adopting health information technology. The need to replace or upgrade existing clinical systems and reduce the number of medical errors also ranked high on the list of priorities. However, 93% of the respondents also reported that the need for capital investment was standing in the way of achieving these same priorities. And 76.5% of the respondents mentioned that the cost of supporting hardware and software presents a challenge. “People are striving to get involved in health information technology, but there are barriers,” Ms. Tena-Nelson said. Survey respondents also indicated that they had difficulty finding systems that would meet their needs. But only a few respondents reported having problems finding qualified technical staff, Ms. Tena-Nelson added. The adoption of health information technology by the long-term care community also is a priority for the federal government, according to Dr. Jeffrey Kelman, chief medical officer of the Center for Beneficiary Choices at the Centers for Medicare and Medicaid Services in Baltimore. Because long-term care spans the spectrum of health care providers from community physicians to acute-care hospitals, it is a bellwether of what is achievable in the medical community in general, Dr. Kelman said. “If we can make this work in long-term care, we can make it work everywhere,” Dr. Kelman said. CMS is working to take nursing home data, which are already collected for the agency, and turn them into a format that will allow communication between those facilities, physicians' offices, and hospitals. The agency also has said it is launching a demonstration project to assess the benefits of electronic prescribing, Dr. Kelman added. However, meeting participants expressed some frustration with the fact that CMs' Medicare Part D has created new and unforeseen burdens on long-term care facilities with paper-intensive prior authorization requirements. The agency is in the process of developing a standardized process for prior authorization that should speed things up, Kelman responded.
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Jun 1, 2023
Pamela Mathura + 6
Open Access
