Long-term care lags in health IT

White papers from Long-Term Care Health IT Summit

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CHICAGO -- Federal officials have overlooked nursing homes and similar facilities as they push for wider use of information technology in health care, according to long-term care advocates attending a health IT meeting focused on their industry.

Long-term care providers lag even further behind than physicians in using clinical IT, according to studies cited at the Long-Term Care Health IT Summit this week. The meeting was sponsored by the American Health Information Management Association (AHIMA) and eight other associations.

Despite the opportunities for using IT to improve care and reduce costs in nursing homes, rehabilitation centers and similar facilities, federal health IT officials have only focused on hospitals and physicians’ offices. For example, the system certification program outlined in a request for proposals from the Office of the National Coordinator for Health IT does not call for certifying long-term care software, said Don Mon, AHIMA’s vice president of practice leadership.

“It’s time that long-term care has an equal seat at that table,” said Kevin Warren, vice president of a health quality improvement organization in Texas, representing the American Health Quality Association. Of the $139 million in health IT grants made by the Agency for Healthcare Research and Quality in 2004, only three “had an impact on long-term care,” he said.

Kelly Cronin, who works on health IT at the Department of Health and Human Services, told the summit’s audience that “our focus in the last year has really been on ambulatory care.” But she said the department is aiming for “quality reporting across settings of care. It will be tremendously useful” for researchers and others, she said.

Transitions from one setting to another produce many of the lapses in medical care, several speakers said at the conference. Relevant records often don’t accompany patients who move, for example, from home to doctors’ offices to hospitals to rehab centers to nursing homes.

If those records were accessible online, higher quality care could be provided, the speakers said. “Communication between providers is of utmost importance right now,” said Carla Saxton, assistant director of policy and advocacy at the American Society of Consultant Pharmacists.

Long-term care poses challenges for health IT proponents. Many nursing homes are small operations that lack IT expertise. Most depend on poorly educated, minimum-wage workers to provide much of the care, so IT systems must be user-friendly. Employee turnover is high, so the cost of training users will also be high.

And unlike hospitals or clinics, nursing home bills often are paid by residents or their families, which puts pressure on the homes to eliminate extra costs rather than invest in new systems.

At the same time, the homes are drowning in paper records they must keep to meet legal and regulatory requirements. And they are beginning to recognize that online systems can increase their efficiency, especially if the nursing home system can exchange records with other health care providers. For example, one major nursing home chain collects the same Social Security number seven times during the course of admitting one patient.

That’s why about 130 people squeezed into a crowded hotel meeting room in Chicago this week. Organizers were expecting 80 to 100 people, said Michelle Dougherty, an AHIMA manager.


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