3. What software technology do you use for managing the health information of your patients/residents/clients?

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Information Technology Interview Assignment

Recall the long-term care system within your community (San Diego) you identified for your previous interview and contact them to schedule an interview with their Chief Information Officer or Director of Information Technology. Let them know that you are a student and the scope of your assignment indicating that your will not take longer than one hour of their time.

Review any materials and/or website for this organization/agency as well as the following questions for your interview. Identify at least three more questions of your own to include in the interview.  Be certain to prove the answers to these questions to be sure you get the depth and breadth of answers you are seeking.

Interview Questions:

  1. Tell me about your position, how long you have held this position and your background.
  2. How would you compare the use of Information Systems in Long-Term Care compared to other aspects of the health care industry?
  3. What software technology do you use for managing the health information of your patients/residents/clients?
  4. How do you manage protected health information and HIPAA in your organization?
  5. Do your patients have any access to their own health information (patient portal, apps, jump drives, etc)?
  6. How do you manage the billing and reimbursement processes within your information systems?
  7. How large is your department and what positions are in the department?
  8. What do you see the biggest challenges to be for Information System management in long-term care?

 Special Topics for Leadership in Long-Term Care

 

As long-term care continues to grow in scope with the agingdemographic, the industry will also become more sophisticated. Providers are learning to adapt to different payment mechanisms such as prospective payment in governmental programs and capitation in managed care. Regulations continue to change at a rapid pace, with OSHA, HIPAA and the Patient Self-Determination Act. Finally, long-term care leaders are working hard to contribute to the triple aim of improving quality, efficiencies, and patient and consumer satisfaction.

Some of the areas in which leaders sees a need for rapid learning include technology, marketing and social media, quality improvement, workforce development, and payment mechanisms. Information technology is rapidly changing the way in which all health care is delivered, communicated, and monitored by various parties. Marketing and communications in long-termcareis in its infancy in terms of the use of social media for messaging, outreach, and education. In addition, marketing in long-term care has the goals of needing to improve the image of the long-term care industry for both consumers and the current and future workforce. These two topics are major learning areas for leaders in the long-term care industry.

 

Long-term care continues to expand its use of and reliance on technology. Technology has the ability to catalyzea new model of care for older adults that promotes optimal independence, the use of family members as caregivers, and improves efficiencies and cost management. Computerizedelectronic health records, electronic billing and reimbursement, and participation in Health Information Exchanges are becoming more prevalent across the United States.

The long-term care industry is far behind the acute care health care system in the use of health information technology (HIT). There are a couple of reasons for this lag. First, the investment in HIT is very expensive and many long-term systems have not had the financial means to invest. In addition, the long-term care industry has not had the pressures that acute care has had to prepare for participation in Regional Health Information Exchanges. However, with the changes in Medicare, declining to pay for 30 days readmissions for the same diagnosis, long-term systems are being called to the care management discussion. The present environment requires long-term care providers and organizations to adapt health information technology to ensure their survival.

Patient and consumer use of technology is considered applied technology and includes many “in home” devices to optimize both health and independence in the older population. Some of these devices include blood pressure monitoring, blood glucose, home assessment, as well as allowing the health care provider to catch early warning signs of illness or risk with older adults. One managed care organization provides weight and blood pressure telehealth monitoring home devices for all their congestive heart failure patients, thus decreasing emergency room and hospitalizations by 20% year over year. Artificial functioning has begun to develop allowing assistance with activities of daily living with robotics. Emergency notification systems are quite common in assistive living and senior living communities. Telemedicine provides many advantages to older adults living in underserved or rural communities. Specialists can consult on older adults in any variety of settings without the difficulty or cost of transporting the individual. While all these technology options are available and valuable, Medicare, Medicaid and most payers do not pay for these services.

Clinical applications of technology are used for patient admissions, assessments, and care planning through electronic health records. Medication lists, laboratory values, radiology reports and other diagnostic data are managed electronically for patients. Interfaces between outside care providers and the patient’s site are in place to assure the provider has the needed data for care planning and evaluation. All certified skilled nursing providers including subacute providers now electronically transmit their Minimum Data Set (MDS) on each patient served. The development of Regional Health Information Exchanges is beginning to ensure access to all patient clinical information across the continuum of care for providers. For example, a patient presenting to the Emergency Room can provide consent for the provider to review data from the chart in his skilled nursing facility record. This saves time, money and improves continuity and quality of care.

Administrative and strategic applications allow the organization to manage billing, cash flow, accounts receivables easily and efficiently. Financial modeling using predictive assumptions is helpful in creating scenarios and analyzing the impact to the organization and its goals. In addition, software packages are available to design staffing templates and automatically run needed staffing recommendations in real time.

Data mining for quality is a growing area for all health care leaders. Software programs which mine the electronic health record according to mapped data points allows the generation of clinical data which can be evaluated through statistical process control charts. Some examples of these quality indicators in long-term care include prevention of pressure ulcers, nutritional status as evidenced by weight maintenance, or prevention of falls.

Three national systems for electronic quality monitoring in long-term care include: OSCAR, RAI/MDS, and OASIS. OSCAR (Online Survey Certification and Reporting) is a computerized national database that monitors compliance with regulations for nursing facilities and home health agencies, but also has staffing, complaints, and survey deficiencies which can help with future planning. RAI/MDS (Resident Assessment Instrument and Minimum Data Set) serve to collect quality data and provide consumer information about various long-term care organizations. Lastly, OASIS is a quality tool for home care. Although these are all valuable electronic data collection tools for planning and quality improvement, a single tool and database covering all of long-term care would be the most beneficial. CMS supports consumer information sections entitled “Nursing Home Compare” and “Home Health Compare” which help consumers with decision making.

Benefits and Barriers to Information Technology

There are many benefits of and barriers to technology in long-term care. The total adoption of information technology by long-term care will make services more widely accessible through integrated systems and coordination of information as earlier mentioned. IT allows ease in sharing best practices, clinical guidelines and quality measurement tools in long-term care. Providers benefit from electronic health records, electronic billing and the ability to operate more efficiently. Electronic health records and billing allows each provider to see their production, patient mix in terms of age, diagnoses, payers, etc. as well as monitor their efficiency and quality outcomes. Consumers benefit by having safer care with the coordination of data across the care continuum and being able to review potential service providers for their quality outcomes and pricing/cost structures.

Barriers to IT include the lack of industry commitment, the many possible systems available and the continual speed with which technology is improving. Some organizations have the wait and see approach, until the technology is more mature, while others lack the initial capital to invest in information technology.

Strategic planning for IT requires that leaders, governing boards and providers take a thoughtful approach and consider all options. An initial assessment of the organization’s IT needs is prudent, following by mapping out the desired system specifications and identifying any potential partners in the industry with which to share the initial capital investment. As with any change, the involvement of the essential stakeholders in the proposal development and review of possible venders must occur. Other considerations are the recognition of the need for more budgeted funds for IT maintenance and ongoing development, as well as the challenges in recruitment and retention of the IT workforce.

Examples of IT Projects to Improve Quality in Long-Term Care

Country Villa Health Services in Los Angeles have their CNAs using digital pens for daily documentation which is then captured in a web-accessible data base. From this, a report is generated which trends resident vital signs, eating results, skin condition and other health indicators. The report can show resident history, any signs of trouble, and potential risks which is much more accurate than paper record review.

Vernon Convalescent Hospital in Los Angeles has converted to handheld computers for certified nursing assistants to document patient information. Using off-the-shelf software templates, the facilities were able to train and implement the handheld computers efficiently. All nursing team members can see the patient data in real time at any of the nurses’ stations as well. Most recently, they are using the technology to prevent pressure ulcers which has decreased pressure sore incident by 33%. Delayed documentation has also been resolved with the use of handheld computers.

Long-term care is just on the brink of total immersion into information technology for the coordination, transition and management of patient/client care. As long-term care becomes a partner in the healthcare system and part of reform, information technology for all aspects of the long-term care industry will become a strategic priority.

 

 

 

 Marketing and Communications

 

CDC Health Communication and Social Marketing

CDC Social Media

 


Marketing and communications are essential topics for long-term care leadersrecognizing the following characteristics of the industry:

1. Increased competition
2. Consumer knowledge of the various services and providers
3. Current financial uncertainty in the industry
4. More managed care providers
5. The need for long-term care to improve its image.

Leadership must understand the components of a solid marketing and communications plan and assure it is well thought out, supported by appropriate governing boards, and in alignment with the organization’s mission and vision.

Marketing, as defined by the American Marketing Association, is an organizational function and a set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit the organization and its stakeholders. The three processes include market research, developing a marketing strategy, and implementing that strategy.

A marketing plan is comprised of strategies for community relations, advertising, and sales promotion. Prior to determining these strategies, an organization must complete a thorough assessment of their product. What are the features and benefits of our product? What is the pricing as well as distribution (known as “place”) for the product? While these universal principles of marketing may not seem to align with the long-term care industry at first blush, they provide the guidance for thoughtful planning of marketing and communication strategies. These 4-Ps (product, pricing, place, promotion) are combined differently based upon the goals of the marketing plan.

Self-assessment is the first step in the development of a marketing plan through first evaluating the organization’s mission and vision, and second, identifying and analyzing the strengths and weaknesses of the organization. The mission describes what the organization is with the vision representing what the organization hopes to become. The organizational team must be honest and objective about strengths and weaknesses. This internal review is held adjacent to the external review of the strengths and weaknesses of competitors.

External analysis includes the competitors as well as what may happen in the environment through legislation, regulation, population changes, financial changes and any other factors that may impact the organization. This combined with market research provides the organization with the needed information to determine their market strategy.

Marketing Strategy selection is based upon the desired goal. The organization may want to expand the current services to existing customers, find new customers, develop new products, or develop new services for existing customers. For example, a home health agency may want to penetrate the market to expand their services to existing customers, but may also want to develop a personal care product, representing product development for their existing customers. The sales strategy could possibly consist of advertising through media, community relations through community presentations, and direct mail or use of social media to existing customers. Social media has become a huge component of marketing strategy dependent upon the market segment and the message. The CDC has actually developed websites around health communications and social media which may help with targeting older adults.

Special consideration of marketing in long-term care is that the success of a marketing plan is dependent upon many variables. Long-term care is a price-sensitive industry for both third party payers and consumers and an industry with a lot of competition. Referrals come from health care providers, at times making them a strong customer group as well; therefore, presenting many different customer groups. These various customer groups each require a different strategy which may include advertising, sales calls, community lectures and tours of facilities, etc. The importance of tracking various strategies for the rate of return is essential in managing the marketing budget which is generally about 10% of the organizational budget.

In addition, customers make decisions based upon the benefits of a product or service. The features of a product or service are generally communicated, but consumers and buyers purchase or make decisions based upon benefits. For example, the long-term care organization may market the 24 hour nursing care, but the consumer is buying the benefit which is safety and immediate response to patient needs. Lastly, ethics in marketing is a topic of consideration, especially in light of many long-term care organizations being part of national corporations which may not represent the local marketplace.

Communicationsis addressed separately from marketing, due to the various internal as well as external audiences. Leadership inlong term care should make sure that theorganization has branded all its communications to match the mission and vision both internally as well as externally. Leaders mustrealize that internal communication is critical to optimal patient service and care. Internal communication should include newsletters, intranet resources, emails to all company employees, educational sessions, attendance at staff meetings, rounding, and town hall meetings to list a few. Employees should be the first to learnof company changes, new services, strategic plans and goals, prior to the external community and/or media.

   

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