While tracking sensors, medication adherence tools, and other technological hardware are being fine-tuned, and in some cases taking on a larger presence in the long term care setting, the bread and butter of many organizations’ efforts to bring more technology to bear in their facilities and corporate business operations remains electronic health records (EHRs) and record sharing.
Coordinating care via the documenting and sharing of medical information for skilled nursing care center and assisted living community residents with hospitals and physicians, and even patients’ families, has taken on a significant role in quality-of-care initiatives and growth prospects. An example is making post-acute care (PAC) attractive for accountable care organizations as preferred providers that coexist technologically with partners, industry sources say.
And within this strategizing around how EHRs can improve patient care by cutting down on hospital readmissions and bolstering lengths of stay is the issue of making such systems interoperable and tied to uniform standards, says Bret Hurst, chief information officer for PruittHealth.

Initially Left Out

Even though long term care was not part of the Health Information Technology for Economic and Clinical Health Act—the measure in the Affordable Care Act in 2009 to grow health information exchanges (HIEs) in the acute-care hospital and physician settings—the law and related market pressures are forcing long term care and PAC providers to get in line.

“I think when everybody speaks about interoperability, they are speaking of the rules that are coming to make it so when a patient moves from one medical service to another medical service, then your records should follow you,” Hurst says. But, he adds, long term care providers should not think too narrowly about the EHR question.

“The government is driving EHRs for good reason,” he says, but the market is driving it from the other side as well.

“You always see quotes that the doctor used to own the medical record, but now the patient does. So you can see this new way of thinking emerging. Like when someone says, ‘I am trying to help my mother as she goes through elder life, and I want to see the medical record. I want to ask questions,’” Hurst says, “The family wants access and to participate in the decisions, as maybe the patient is no longer capable.”

Establishing Standards

To make it easier for disparate health information tech­nology systems to “speak” to each other, Hurst says, important work is being conducted by the CommonWell Health Alliance, a collaborative of health information technology leaders who seek improved access to patient health data through secure interoperability.

Once this group, working in concert with other stakeholders, comes up with a standard platform and standards for interaction, then providers of all stripes will benefit from the possibilities in care coordination, he says.

“It’s like I try to explain that someone had to come up with standards when someone invented nuts and bolts. So the standards were made so the nuts and bolts would work. And now we are seeing the same thing for HIE and how we are going to technically interact and how we are going to functionally and operationally act,” Hurst says.

Programs That Speak To Each Other

As an organization, PruittHealth’s task even before the standards are in place is to make sure that its software moving forward is capable of exchanging information inside and outside the company so that patients, their families, and medical service teams both upstream and downstream from long term care can plan correct medical care.

“This is especially true for us because we serve such a broad range of services, all the way from the hospital in a PAC setting maybe to home care and getting therapy and pharmacy services,” Hurst says.
“Our patients are touched by a number of services within our own group and services outside. So we are examining this all by going through our pharmacy software, our therapy software, even our medical supply software to a certain extent, and of course our skilled nursing and PAC software.”

What these reviews have shown is that sometimes it makes sense to stick with the same software vendors as they convince the company they are capable of advancing EHRs and other systems, and at other times he says it means looking for new ideas.

“Some of our vendors saw the light and were able to convince us that they understood the direction that the industry was going and that their software had to go along with it. Others did not,” Hurst says.

And it’s not just EHRs in play, but clinical tools that interconnect to medical tracking like nurse call systems that have records as well and are shared amongst staff, he says.