Network Technology in Long-Term Care

Darren Liu, Dr. P.H.Assistant Professor

University of Nevada, Las Vegas

November 12, 2011

SOUTHERN NEVADA HEALTH INFORMATION MANAGEMENT ASSOCIATION

Department of Health Care Administration & PolicySchool of Community Health Sciences

Our Programs…

• UNLV Department of Health Care Administration & Policyo Chair: Christopher R. Cochran, Ph.D. o Starting from 2005

• Degree offeredo Bachelor of Science (BS)o Master of Health Administration (MHA)o Master of Public Health - Health Care Administration Track (MPH)o Doctoral degree in Public Health - Health Services Management

and Policy Track (PhD) since 2010

• Google search: UNLV HCA

Outline

• Define Health Information Technologies (HIT)

• Processes of HIT Adoption

• Benefits of HIT Adoption

• Current Challenges in LTC

• Patient Protection and Affordable Care Act (ACA)oAccountable Care Organizationso Meaningful Use of Health IT

• Network Application

• Technologies for Future LTC

Definition

Health Information Technologies (HIT)

• Tools that can be used to capture or process health information (i.e., data, Electronic Health Records) and have the potential to improve quality of care.

• End-users: Care Providers, Patients, etc.

• For better quality of care outcomes, lower cost

Examples

8 Core Health IT functions in LTC• Supportive documentation o e.g., financial, administrative, clinical information

• Census management• Point-of-care (PoC)• Computerized physician order entry (CPOE)• Electronic health record (EHR)• Telehealth or telemedicine• Assessment and care planning• Electronic prescribing

Source: HHS, Evaluation Design of the Business Case of Health Information Technology in Long-Term Care: Final Report, Booz Allen Hamilton, July 13, 2006

HIT Adoption

Phase I: Preparation

Develop Tools & Standards

ToolsCPOEEHR/EMRPOCMDS…, etc.

StandardsHL7SNOMED, etc.

Phase II: Implementation

Test Drive

InteroperabilityUsability testing

LearnabilityEfficiencyMemorabilityErrorsSatisfaction

ConfidentialityHIPAA

Phase III: IntegrationIntegrate into NHIIPrimary care

Doctors’ officeAcute care

HospitalsPost-Acute &Long-term care Nursing home Home health careClinical laboratoriesPharmacies

Redesign Redesign

Incentive Incentive

SOURCE: Liu D. Health Information Technology and Nursing Homes, University of Pittsburgh, 2009 (Dissertation)

Certification

CCHIT Certified 2011 Long Term and Post Acute Care (LTPAC)• The Certification Commission for Health Information

Technology (CCHIT)• Announces first certified EHRs on November 8, 2011• Settings

• skilled nursing facilities, • home healthcare, hospice• rehabilitation centers

GPS

RFID tags

Pressure Ulcer

Sensor Mats

Motion Sensors

Preprocessing

Preprocessing

Preprocessing

Preprocessing

Parameter Extraction

Parameter Extraction

Parameter Extraction

Parameter Extraction

Expert System

Online Database

Automated Alarm System

Family/Residents

Caregivers

Doctors

Emergency Services

Technologies Health Information Technologies

PreprocessingParameter Extraction

EHR, CPOE, etc.

© Created by Darren Liu, Dr.P.H.

Technologies

• Instruments that can supplement human caregiving and have the potential to improve the quality of life for both older adults and their caregivers

• End-users: Consumers

• For better quality of life

Definition

Source: Pollack, M.E. (2005). Intelligent Technology for an Aging Population: The Use of AI to Assist Elders with Cognitive Impairment. AI Magazine; Vol 26 (2), pp.15

Example

More Examples

Area Technology Purpose

Safety Biosensors, GPS •Mattress monitors for detecting changes in a resident’s skin•GPS for locating older adults with AD

Activities of daily living Artificial intelligence •Maintain more independence

Recreation Virtual reality systems •Play games or visit virtual museums

Social networking Elder-friendly email, Facebook, Twitter, VoIP (e.g., Skype, Google Voice).

•Alleviate social isolations, share life stories

Benefits of adopting HIT

• Caregiverso Increase efficiency of careo Increase accuracy of care

• Healthcare Providerso Reduce costs

• Consumers (residents and family)o Better quality of careo Managing personal health informationo Public reported health related information

Current Challenges

• Legislationo Patient Protection and Affordable Care Act

(ACA) of 2010• Major ProvisionsoAccountable Care Organizations (ACO)

Incentives for Physicians under Medicare/Medicaid with meaningful use of EHR

Hospitals• LTC excluded from ACO

Meaningful Use

Stage 1 criteria include• Electronically capturing health information in a coded

format, • Using that information to track key clinical conditions, • Communicating that information for care coordination

purposes, and • Initiating the reporting of clinical quality measures and

public health information.

EHRs and Meaningful Use in Long-Term Care• In the current proposed ACA rule, LTC providers are

NOT included in the ACO groups who are eligible for incentive payments for implementation and meaningful use of certified EHR technology.

• However, under the original Executive Order of 2004, all care settings were included in the mandate of the use of EHRs by 2014.

Meaningful Use con’t

Network Applications

Future

• Consumer-driven informationo Inside consumer – e.g., staffso Outside consumer – e.g., current/ prospective nursing home

residents

• Market-driven informationo Competition

• Evidence-driven informationo Cost savingo Better quality outcome

• Government-driven informationo Incentiveo Regulatory

Thank You.