September 14, 2011 | by I Advance Senior Care

Does HIT really affect outcomes?

Ingrid Johnson Serio, RN, BSN, MPP

Traveling to a foreign, non-English-speaking country can make for a wonderful adventure-if you traverse the language barrier, which is often confusing and can be a bit frightening if your proficiency in the native tongue is limited. This is not unlike the experience medical professionals face when first entering the world of health information technology (HIT). Medicine is wrought with a huge number of acronyms that often throw off the non-medical brain. If you add the large quantity of acronyms used by policy makers and people at both the local and federal government levels, it can seem as though entire conversations are ruled by letters that appear to mean something, but to the person unschooled in policy rhetoric, probably don’t. After years working as a nurse in a variety of settings and then in public policy, it seemed that there were no further acronyms that could cause me confusion. This was a completely incorrect assumption.

Last January-following the advent of MDS 3.0 and a variety of recent initiatives that had sprung up through the Centers for Medicare & Medicaid Services-my employer, The American Association of Nurse Assessment Coordination (AANAC), decided it was time that LTC nursing step up and begin assessing how HIT could fit into its world. The American Health Information Management Association (AHIMA) is headquartered in Chicago and manages the Long Term and Post Acute Care HIT Collaborative or, just to stick with the acronym theme, LTPAC. It is an active collaborative with a passionate group of strategic partners who give an enormous amount of their time to the support of HIT in long-term care.

The initial challenge in joining this collaborative was clarifying how and why HIT should be important to LTC nurses and, more specifically, nurse assessment coordinators. Clearly, most nurses are not really concerned with HIT, except regarding how it will get them through their shifts. Another question that needed to be looked at was how HIT affects the ability to accurately complete the MDS. Finally, and most importantly, can the use of HIT improve the quality of care provided to residents of nursing homes? The first LTPAC calls were filled with a variety of foreign IT terms and acronyms that left the untrained ear frustrated and adrift. Since that call, terms like “interoperability,” which means that different systems should be able to talk to each other, and “meaningful use,” which means the system can actually be used in such a way to allow measureable or “meaningful” outcomes measurements, have become second nature.

What has also become clear through months of mostly listening to the LTPAC calls is that HIT, if fully utilized, can help nurses become more efficient and well versed in each resident’s personal and medical needs, document information more effectively, have a stronger sense of the interdisciplinary team’s (IDT’s) assessments and recommendations and improve overall communication. Essentially, HIT has the capability of helping LTC nurses and nurse assessment coordinators succeed in the only thing that really matters: improving care.

The Agency for Healthcare Research and Quality (AHRQ) has funded a quality improvement program called “On-Time.”

The On-Time Quality Improvement program is a practical approach to quality improvement (QI) in long-term care, embedding QI strategies and best practices into health information technology. […] Target users are stakeholders interested in nursing home QI, nursing home leaders responsible for deciding QI priorities, and nursing home personnel responsible for quality improvement.1

The On-Time program focuses on workflow processes in nursing home settings to assess and evaluate how HIT and electronic data collection can impact quality outcomes through a focus on and trending of daily CNA data. This data includes: (1) Completeness Report for CNA documentation; (2) Nutrition Report; (3) Weight Summary Report; (4) Trigger Summary Report, which identifies residents at high risk for pressure ulcer formation; (5) Priority Report, which provides an overall summary of changes in resident clinical status from the previous week; and (6) Red Area Report, which identifies residents with red areas on their skin.

The program uses pressure ulcers as a standard of measurement. On-Time is ongoing, but when the most recent results of the program were published by AHRQ, findings showed that although HIT alone will not improve care, if used for improved communication and clinical decision making with a redesign of workflow and links to specific process improvement activities, outcomes did improve.

Participating facilities have found many positive effects of the On-Time program. On a broad scale, On-Time has:

  • Improved clinical outcomes (pressure ulcer rates). Includes a 43 percent decline (from 4 percent to 2.3 percent) based on initial implementation of On-Time in 21 facilities with high level of implementation; and a 55 percent decline 12 months post-implementation based on New York State On-Time early results for the rapid implementers (n = 3 facilities).

  • Reduced number of high-risk residents with pressure ulcers (CMS quality measure). Includes one-third reduction seen within a year based on a pilot program among 11 participating nursing homes; a decline of 30.5 percent (from 13.1 percent to 9.1 percent) based on initial implementation of program in 21 facilities with a high level of implementation; and a decline of 30 percent (from 11.7 percent to 8.2 percent) nine months post-implementation based on New York State On-Time early results for the rapid implementers (n = 3 facilities).

  • Increased CNA engagement in process improvement.

  • Improved communication about high-risk residents among the entire care team.

  • Improved prevention practices and timely interventions for high-risk residents.1

Learn more about On-Time

A short streaming video that includes discussions about On-Time from staff at three pilot facilities in Wisconsin, California and Arizona is available at www.ahrq.gov/research/ontime.htm.

Improving communication between members of the IDT as well as the staff and residents is one of the guiding principles of the MDS 3.0.

Improving communication between members of the IDT as well as the staff and residents is one of the guiding principles of the MDS 3.0. Equally important in the new MDS 3.0 process is the hope that avoidable complications and re-hospitalizations will be prevented if the item sets are completed following recommended protocol. It is a wonderful thing to have regulations that focus on preventing problems, but the paperwork involved can feel cumbersome to the nurse coordinator. If providing simple facility-wide electronic data collection systems will improve IDT communication and highlight potential problems before they occur, it seems logical that many of the MDS 3.0 process needs would also be more easily met.

Perhaps it is time for LTC nurses to take notice of available technology that may serve to help improve the provision of care. It feels foreign. It feels scary. But if a simple electronic data collection device can decrease pressure ulcers, imagine what a system with true “interoperability” and “meaningful use” could do.

Ingrid Johnson Serio, RN, BSN, MPP, is the Director of Content Management for AANAC. She can be reached at

iserio@aanac.org.

REFERENCE

  1. Hudak S, Sharkey S. On-Time Quality Improvement Manual for Long-Term Care Facilities. 2011. Available at: www.ahrq.gov/research/ltc/ontimeqimanual/

Long-Term Living 2011 September;60(9):26-30

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