One on one with… Larry Wolf

Technology-related issues and trends in long-term care were on the agenda when Larry Wolf, health information technology strategist with post-acute service provider Kindred Healthcare, recently spoke with Long-Term Living.

Has information technology transitioned from being a documentation system to being more of a business strategy that long-term care needs to embrace?

Definitely. While Kindred has chosen to focus on the shorter-stay folks, even the longer-stay folks are generally sicker than they’ve been before. They need more true healthcare and services than they’ve needed before. It’s not just support with activities of daily living. Coordinating the other services they need increasingly is assisted with electronics, and increasingly we are going to see [in long-term care] the kind of monitoring devices that people have at home to help them manage an elderly or disabled friend or relative. This is not a technology issue; this is a care process and business issue.

What are the biggest technology-related issues facing long-term care right now?

Under Meaningful Use 2, starting in October for early-adopter hospitals and in January for physicians, there are incentives to exchange information electronically and in a standardized way with other providers, so their systems need to be certified to be capable of sending and receiving. And where are they sending information? Wherever the patient goes. And for 35 percent to 40 percent of hospital discharges, that’s somewhere in the post-acute, LTC space—LTC acute hospitals, patient rehab, nursing centers, nursing rehab centers and home health. That’s a general environmental shift.

Also, we have started seeing a move in long-term care for a different kind of system. It’s no longer enough to have a paper-based MDS process with a back-office data-entry person who’s managing paper and then does an electronic submission. We’re actually creating a workflow that becomes part of the routine care for patients, and we’re getting systems that support that workflow—everything from certified nursing assistant documentation to nursing assessments to, sometimes, the electronic collection of levels of rehab services. Even with the existing tools that use the MDS environment, we’re seeing a shift in the tool sets that long-term care, particularly nursing center-based long-term care, has. And similar things are happening in home health as well—additional documentation and more people moving toward mobile apps that go with the nurse who’s visiting the person at home. Vendors are very much aware that there’s a need [for LTC providers] to be able to receive these standard-based documents and, when someone leaves our care setting, to be able to send those standard-based documents with them.

Also, states are receiving funding to create health information exchanges, and several of them have specifically looked to include long-term care in their outreach. Often, a nursing center only needs an Internet connection and a basic personal computer and then on a Web-based tool can view the information that other providers are collecting. And some tools now take the information that long-term care has available and add that in.

What other trends are you seeing in long-term care related to technology?

I’m seeing a general movement, not just at Kindred, but broadly in the industry, toward more automation in the nursing facility, more options for how technology gets delivered—certainly the cloud-based technology is growing as a way to deliver systems, and getting better all the time—so you don’t have to have as much local expertise to do things.

In terms of who’s adopting the technology, two groups are moving us forward: large organizations such as Kindred, which have a very big infrastructure and a big technology base, and small and mid-sized regional chains. Because they are smaller organizations, if they take on an initiative, it’s taken on by the whole organization. They’re small enough that the leaders are physically present. They’re geographically close enough together that they can see what’s happening electronically and can watch and talk to the people who are providing the hands-on services. They can see where there are glitches. They can make the changes in physical layout to better position the computers. They can redesign patient rooms, nursing stations and common areas, and because they’re doing it on small scale, they’re not looking at multipliers of hundreds of buildings.

Also, for a lot of reasons, the rest of the healthcare world has discovered or rediscovered the LTC and post-acute worlds, so we need to rediscover them. We need to start paying attention to what’s happening broadly on the national front, to changes that are happening that have been driving the acute-care world for the last four or five years. Increasingly, we’ll be driving the post-acute and LTC worlds. And so I think about my own experience with the national Health IT Policy Committee, where I’ve been advocating since 2009 for long-term/post-acute care as an equal player with the acute care folks, and that even though we’re not getting the incentives, that the regulations need to be written in a neutral way. The system certification needs to be written in a neutral way so that it, in fact, is a useful regulation for us. It may not be a regulation that applies to us, but it’s a regulation that gives us a useful structure, it’s a regulation that has the acute-care folks doing things in a way that makes sense to all providers. They should not just see us as somewhere in the darkness, but actually coming much more to the forefront, and I’m pretty confident that we’re going to see a lot more of that coming from the federal government as well.

Also, the whole area of quality measures is important. For a long time, nursing centers have had quality measures based on the MDS and the survey process, and the measures have been specific to our care settings. I see a very broad push in the federal government to start to look across settings at what quality measures would make sense everywhere, so we start to get a baseline of consistency regardless of where someone is. What kind of care are they receiving? What’s the quality of that care? How would we measure that? That’s going to depend on having good information systems in place, and it’s going to start to drive systems. I expect we’ll see much more effort on quality measures that are across settings and that assume that there’s electronic documentation as part of the care process.

What are the most important steps long-term care should take to enable facilities to use technology in the best ways possible for themselves and those they serve?

Talk to the acute-care folks who are your partners today, and learn with them. They’re going through transitions, and you should be at the table with them as they do. The learning might be under the umbrella of something like an accountable care organization, but it also could be under the umbrella of what you’ve always done. You have an existing relationship with those providers. Build on that existing relationship. It doesn’t need a special name.

Also, peer-to-peer communication is really important. Who are your peers? What are they doing? What can you learn from them? What can you do collectively to further your understanding? This is complicated enough that it’s going to take more than just a friendly salesperson who offers to give you support when you buy their product. You actually need to look at your own process. You need to look at the specifics of how you do things. You need to learn from your peers, and that kind of learning is less about the tech stuff and more about the ‘How is this going to change my process?’ If I’m looking at vendors, do the vendors have a local presence that can support me? Do they have a virtual presence that they know how to support virtually? The best people to learn that from are your peers.

See other content by this author here.

Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.