EHR upgrades tough for long-term care

Meaningful use requirements and the move toward integrated, accountable care have been pushing long-term care facilities to improve their technology systems, but it’s been a tough road for many skilled nursing facilities.

LeadingAge, an education and advocacy organization for aging services organizations, released a study recently finding that, among their 100 largest members, technology adoption is slightly higher than in other healthcare markets. Overall, about 75 percent of respondents have implemented electronic medical records of some kind.

However, noted Majd Alwan, executive director of the LeadingAge Center for Aging Services Technologies, the study data is somewhat skewed because the groups represented in the study are “pioneering providers and trend setters” in the industry – not a representative sample of the market.

Financial concerns, he noted, are a big barrier for many organizations. A lot of money is spent on upgrading technology systems, but the return on that investment is lacking.

Hospitals and insurers are the ones who will benefit if readmissions are reduced, not the long-term care facility that invested in the technology, Alwan pointed out. And while bundled payment models are starting to become a part of the long-term care community, only a small number of organizations are just beginning to take part in them, or are creating contractual agreements with hospitals to share in savings.

“These are in the very, very early stages, so few providers are tapping into these potential revenue streams,” he said. “But, we are emphasizing to our members they need to have the skills, technology and infrastructure, and they need to demonstrate the ability to be strategic partners in reducing costs, avoiding penalties and improving quality.”

Cross Keys Village – the Brethren Home Community, in New Oxford, Penn. is one of the pioneering providers in the long-term care community that recognized the necessity of upgrading its technology systems.

Implementing electronic health records in 2012 wasn’t really an option, said Oliver Hazan, vice president of sales and marketing for the organization. With needing to meet meaningful use requirements and the push toward accountable care, “The only choice was, how fast?” he said.

Because financing such an effort was going to be challenging even for Cross Keys, one of the largest continuing care retirement communities in the nation, the organization planned two years ahead for it, and made the cost of its EHR and e-prescribing systems part of an IT capital project.

But while advanced planning eased the financial hit for Cross Keys, they still faced implementation challenges, said Jennifer Holcombe, healthcare center administrator for the organization.

The biggest hurdle was training the nearly 400-person nursing staff on the new system. She said she and the other trainers spent an entire month constantly training to get it all completed.

Another challenge has been the limits of the technology itself, she said. There are a lot of regulatory components to nursing home records that the organization’s EHR system is lacking. Cross Keys is working with its vendor to make changes to the system, she said, but that is a process.

And Cross Keys is finding that even though it has gone electronic, other organizations it works with have not. When the health department or an insurance company audits Cross Keys, they often want printed records, Holcombe said. “We know some insurers are moving to where we can electronically submit to them. Until they all get to that point, it does pose a challenge because printing is not an easy feature of an electronic system.”

But in the end, all the challenges are worth the rewards, she said. There are increased efficiencies across all departments and care coordination has improved greatly.

“The staff is more efficient and it is a benefit for us when we can pull everything up and collect different books and care plans from one place,” she said.