​In the 1950s and ‘60s, many envisioned a future of flying cars and colonies on the moon by the turn of the century. Those ideas seem unrealistic in retrospective. Sadly, the same could be said of predictions 10 years ago that health information technology (HIT) would be widely used and broadly integrated in long term care settings.

“It’s estimated that about 90 percent of acute care settings are using Electronic Health Records (EHRs). In the ambulatory world, well over 50 percent of physicians have adopted EHRs, and disciplines such as ophthalmology and podiatry likely have even higher adoption rates,” says Rod Baird, president of North Carolina-based Geriatric Practice Management. “Post-acute/long term care has a much lower level of EHR adoption.”

Reasons For Dragging Feet

Why is EHR usage in this setting still lagging behind? There are several reasons, Baird suggests. For one, “most adoption in this setting was based on cost-benefit analyses,” he says. Computer systems and software programs were “carefully attuned to satisfy regulatory or reimbursement issues.” Additionally, while systems were designed to collect data, he says, “this information was used less for decision making and more as a checklist of tasks and activities."

“I view most long term care software as creating a list of tasks based on regulatory guidance—such as the MDS [Minimum Data Set], built around
F-tags and survey issues, and designed to provide detailed documentation about what has been done and when,” Baird says.

While care models in long term care are changing, and facilities are moving to systems that focus on balancing outcomes and costs, measuring quality, and identifying and preventing avoidable problems and situations, technology in this setting is slow to respond.

This is at least partly because “there isn’t a lot of money in long term care, and budgets mostly have been cut instead of expanded,” says Baird. Even facilities with the desire to implement EHRs or upgrade their computer systems don’t have the budget to do so.

However, change likely is on its way, driven by hospitals and accountable care organizations. “These organizations will drive facilities to implement and update their technology,” says Baird. He adds, “Preferred providers will be required to be tech-savvy. Nursing homes that can show they provide the best care at the lowest cost will have an advantage.” This will require software attuned to clinical support/decision making and the ability to interact effectively with clinicians.

Facilities can start by reaching out to physicians and learning about any systems or programs they are using successfully and what features of these they find most useful. Baird says, “Physicians won’t go into a facility’s software applications if they don’t show them what they need to know about the patient and give them information that is useful for their records.”

Critical Issues To Consider

Baird refers to a white paper from the CIO Consortium & Nurse Executive Council, “Electronic Health Record Solutions LTPAC Providers Need Today.” This document contains some key issues facilities need to consider as they move forward with health information technology initiatives:

■ EHR systems are critical enablers of the quality, process, and innovative demands of the current health care spectrum. The ability for health care workers to deliver excellent patient outcomes and maximize quality of life for users depends greatly on these systems.

■ Long term post-acute care (LTPAC) requirements for such systems are distinctive, robust, and full-featured. “EHR-lite” may work in the short term, but will prove too limiting by 2016.

■ The LTPAC EHR has a unique focus and emphasis around clinical processes and holistic person-centered approaches involving an entire care team—physicians, nurses, therapists, pharmacists, dietitians, plus care and transition case managers.

■ LTPAC providers need the extensibility of an EHR platform to innovate and respond to their changing clinical and reimbursement context.

■ The LTPAC EHR must be collaboration-ready, supporting care teams, continuum of care, and person-centered realities.

■ The LTPAC EHR must be future-resilient, leveraging current technologies while looking forward to emerging technologies.