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Part III Standards for Compliance
center led by a physician’s assistant or rural health clinic. Although long-term care facilities are not eligi- ble for incentive payments under the Meaningful Use provisions of the HITECH Act, they can still realize the benefits to resident safety and satisfaction and the cost- saving features that automation can provide. Only about one-third of long-term care facilities have imple- mented a full EHR system; however, nearly all use some sort of electronic information system for the Minimum Data Set reporting and for billing (5). The same is the case for residential care facilities, albeit at lower percentages. A 2010 survey found that only about 3% were using an EHR system, yet 55% had implemented some sort of computerization for at least one function normally managed via an EHR, such as medication management (6).
Long-term care is definitely a focus of efforts for the Office of the National Coordinator (ONC) for HIT, part of HHS. For example, ONC’s National Learning Consortium developed a Care Coordination Tool for Transition to Long-Term and Post-Acute Care that details important clinical information (such as diet) to include in summary of care records (7). In 2005, a group of government agencies and stakeholder associa- tions formed the Long Term and Post-Acute Care (LTPAC) HIT Collaborative. LTPAC’s objectives for advancing health information technology issues include promoting its strategic priorities via a road map published every two years, as well as hosting an annual summit. In 2013, ONC launched a new web-page focusing on long-term and postacute care and how HIT can assist with care transitions (1). Several organizations have continued to support programs that investigate how technology can meet the needs of the frail older adult and improve connections between community-based organizations with other care systems for this population. The Geriatric Resources for Assessment and Care of Elders (GRACE) program is funded by several foundations and technical awards. The goal of the GRACE model is to optimize health and functional status, decrease excess health care use, and prevent long-term nursing home placement. The GRACE program utilizes inte- grated EHRs and web-based care management tracking tools to improve care for low-income seniors.
Importance of Electronic Health
Records Older Americans receive care in a variety of acute, postacute, assisted-living, and long-term care settings. This care is often costly to the health care system because of the frequent transitions among care settings for this group and the relative complexity of medical care for older adults. Sharing each individual’s health
information across providers and settings of care will be essential to achieving a more coordinated, person-centered, less costly health care system (8-10). The goal of any EHR system is to provide at least the same level of care when using an electronic record as when using a paper medical record (10). Numerous opportunities exist for long-term care providers, hospi- tals, and other community referral partners to engage in health information exchange to improve care coordi- nation, care delivery, patient outcomes, and patient experiences. These opportunities exist through new payment and service delivery reform models and national investments in HIT to support these goals. Box 25.1 details the benefits of EHR.
BOX 25.1 Benefits of Electronic Health Records
● ● ● ● ●
Improve quality and convenience of patient care
Increase patient participation in care
Improve accuracy of diagnosis and health outcomes
Improve care coordination
Increase practice efficiencies and cost savings
Source: Data from
HealthIT.gov. Benefits of electronic health records.
http://healthit.gov/providers-professionals/ benefits-electronic-health-records-ehrs.
COMPUTERIZATION AND
NUTRITION CARE Automation of nutrition services’ functions via special- ized software has been available for over 30 years, yet nearly half of the long-term care facilities in the United States do not have food and nutrition management software systems. Functionality available in these soft- ware systems ranges from simple “kardex” and tray card systems to full automation of all functions in the department, including food procurement, menu nutri- ent analysis, forecasting, and resident menu correction. For-profit nursing homes and those that are part of nursing home chains tend to automate food and nutri- tion services’ functions more often than not-for-profit or freestanding facilities, respectively (5). Although the EHR does not eliminate potential inaccuracies in care, the possibilities for human error when automation is not in place are ever present, and litigation could cer- tainly end up costing a facility much more than soft- ware. One of the highly touted benefits of EHRs is the potential to prevent medical malpractice incidents and medical errors. The ability of interfacing food and nutrition management software systems with the EHR
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