Knowledge Management in Long-Term Care: What You Need to Know

The idea becomes especially germane when one is pondering the state of information technology in the long-term care industry. For many generations now, computerization in long-term care has focused almost exclusively on improving processes. But for long-term care organizations to get more out of information technology than just an adrenaline jolt to established processes, nursing home administrators need to start considering the value of knowledge management systems.

Before purchasing, implementing, and benefiting from these systems, however, nursing home administrators first need to truly understand what a knowledge management system is-and why a long-term care organization would need one. Then, to get the most out of a system, administrators need to know what features and attributes to look for.

Useful Knowledge
Basically, knowledge management systems can deliver what Gibran was looking for:
"A little knowledge that acts."

Indeed, the idea is fleshed out in some of the following commonly held definitions of a knowledge management system:

• It is an IT system that collects, organizes, classifies, and disseminates information throughout an organization, so as to make it purposeful to those who need it.¹
• Knowledge management IT concerns organizing and analyzing information in a company's computer databases so this knowledge can be readily shared throughout a company, instead of languishing in the department where it was created, inaccessible to other employees.²
• It combines indexing, searching, and push technology (a system whereby information on predefined topics of interest to individual computer users is delivered to their computers via the Internet) to help companies organize data stored in multiple sources and delivers only relevant information to users.³
• Knowledge management in general tries to organize and make available important know-how, wherever and whenever it's needed.⁴
• Knowledge management incorporates intelligent searching, categorization, and accessing of data from disparate databases, e-mail, and files.⁵

All of these definitions-to one extent or another-support Gibran's notion that knowledge people can use is so much more valuable than knowledge that simply sits idle.

Certainly, there is ample need for the dispersion of relevant, useful knowledge in long-term care organizations.

And while computer systems have for many years had the ability to capture and store information in databases, long-term care users often have experienced frustration when trying to turn that information into usable "knowledge." Searching databases and scouring through electronic files is simply too onerous to fit into the typical long-term care professional's work flow. But knowledge management systems can turn all of that miscellaneous information into practical knowledge by:

• extracting information from databases and other electronic sources;
• filtering information according to user profiles;
• presenting information in concert with user preferences;
• condensing information;
• retrieving evidence-based reports;
• holding current information in a single point of reference;
• routing relevant information in a timely manner;
• alerting users to changes; and
• informing decision making.

Presenting information in a "dashboard display" also makes data much more useful for users. For example, such dashboards can support touch-points in long-term care work flow by consolidating real-time information on configurable, graphically oriented screens-enabling users to instantly view key performance indicators and proactively spot trends, anomalies, and exception conditions.

The dashboards make it much easier to get needed information-and turn it into actionable knowledge. For example:

• With a standard paper or electronic report, users could be inundated with far too much information and, therefore, fail to get a handle on key performance indicators. A dashboard, however, will focus a user's attention on pertinent information.
• With a text-heavy report, users could scan the information, glossing over important details. A dashboard, however, graphically presents the needed information in a format that makes it easy to zero in on key details.
• With long paper or electronic reports, users might erroneously focus on the less important information, thereby ignoring crucial data. With a dashboard, users are basically forced to focus on what's most vital.
• Dashboards make it possible to define rules across the enterprise. As a result, organizations can get all users to focus on the same indicators and variables, even though users might be viewing the information via customized dashboard displays.

The Need to Know in Long-Term Care
The advantages inherent in knowledge management systems that employ digital dashboards are obvious. What's also becoming readily apparent is that long-term care organizations now need these systems more than ever before. Why? The increased focus on quality, for one. Nursing homes are expected to deliver quality care. What's more, continued pressure from governmental agencies, quality groups, and consumers is making long-term care organizations more accountable than ever before.

Consider the following: The Centers for Medicare & Medicaid Services (CMS) posts quality information on individual nursing homes on the Internet, making it possible for families to easily compare and contrast quality when making nursing home decisions. What's more, improving quality will become increasingly tied to the financial bottom line as pay-for-performance becomes a reality in the long-term care industry.

With a knowledge management system, for example, nursing homes can more proactively manage the quality of care delivered. "If nursing homes have quality information in a timely manner, then staff members can respond to situations in a timely manner. When the information is delivered in real time, it is much easier to always do the right thing," Newton says.

In addition, knowledge management systems can help improve communication within long-term care organizations, Newton says. For instance, he recently was working with a nursing home in which the therapy department issued new treatment orders for a resident on a Friday afternoon. The nursing staff, however, did not get the revised treatment orders until Monday. "For an entire weekend, the nurses had no idea that there was a change in orders," Newton says. "If they had been working with a knowledge management system, the nurses would have had that information immediately." A knowledge management system would provide nurses with a dashboard containing all changes in patient orders and other pertinent clinical care information.

Because knowledge management systems make it so easy to access such information, the systems also could encourage physicians and physician assistants to become more proactively involved in the care of residents. "Paper-based systems are simply too cumbersome for physicians to access," Newton says. "And electronic systems have been unattainable to them. A lot of these systems just take too much time to learn. With a knowledge management system, though, physicians and physician assistants could become easily engaged."

Indeed, knowledge management systems that offer knowledge based on user roles have the most potential to positively affect nursing home care and quality. They provide users with role-based dashboards that include "cubes" of relevant information for each individual user. The cubes offer different and distinct sets of knowledge to various users such as intake workers, nurses, clinical coordinators, and management personnel. For example, a management dashboard could include information on receivables, case mix, admissions, quality indicators, and per-bed revenue analysis (figure).

Some of these systems feature a collection of digital dashboards, Web portals, and analyzer modules that incorporate service-specific business rules and care protocols, distill critical information, and automate key work-flow processes for targeted clinical, financial, and administrative users. Digital dashboards consolidate key performance metrics from multiple modules and display them on flexible, Web-based screens. Web portals enable physicians, nurses, and other users to access patient records through secure Web connections, eliminating the need for paper documentation. Analyzer modules query and benchmark individual and aggregate clinical records by comparing patient outcomes with those of various reference groups.

"With such systems in place, nursing homes will be able to truly improve quality on an ongoing, continuous basis," Newton says. "As a matter of fact, quality improvement will be built into the work flow of all staff members, and the impact will be readily seen in the improved care that residents receive."

References
1. Albert S. Knowledge management: Living up to the hype? Midrange Systems 1998 (Sep 7):11;52.
2. Knowledge management consulting gives CPAs a competitive edge. CPA Journal 1998 (Aug):68;72.
3. Hibbard J. Ernst & Young deploys App for knowledge management. Information Week 1997 (Jul 28);28.
4. Maglitta J. Smarten up! Computerworld 1995 (June 5):29;84-6.
5. Willett S, Copeland L. Knowledge management key to BM's enterprise plan. Computer Reseller News 1998 (Jul 27);1-6.