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Harness the Power of Information with Governance

“[Information governance is] an organization’s coordinated, inter-disciplinary approach to satisfying information compliance requirements and managing information risks while optimizing information value” – The Sedona Conference Commentary on Information Governance

Governance is the practice of aligning an organization’s values and goals with its operations and structures. Like other crucial resources in healthcare, information is a high level asset that requires management and oversight to ensure it can be used effectively. Information governance, a rapidly growing concept in healthcare, allows an organization to create reliable structures and processes to manage, maintain and act upon information in a way that supports organizational goals and ensures compliance with applicable rules and responsibilities.

Most, if not all, healthcare organizations have at least a simple governance structure in place around privacy and security of health information, driven by the requirements of HIPAA. But information governance is a much deeper concept, addressing not only security but also the quality of information and how effectively it can be used and shared (when necessary). As the use of information in and across healthcare organizations grows, the quality, reliability and availability of that information will become almost as important as actual care routines. For long-term and post-acute care organizations, now is the ideal time to think hard about information governance structures.

AHIMA (The American Health Information Management Association) provides a wealth of resources on information governance (http://www.ahima.org/topics/infogovernance), including an excellent primer on the eight principles of information governance. These eight principles (depicted below) offer a framework to understand the full cycle of information use within an organization.

In a 2014 survey of healthcare organizations, AHIMA found a wide range of organizational approaches to information governance:

Tellingly, 34% of organizations either didn’t think there was any need for governance or didn’t know their organization’s position, while another 22% have not started any program. As this survey represented a wide range of healthcare providers, long-term and post-acute care providers can be expected to fall disproportionately in these underdeveloped camps.

An information governance program should begin at the Board level, typically in the form of a Board oversight committee. In smaller organizations, information governance may be adequately situated within the corporate compliance and risk management program. A cross-functional team should be comprised of Board representatives, the CIO, the IT Director, clinical and administrative leadership, and other relevant stakeholders. Once organized, the information governance committee can develop an organizational information governance strategy and structure to address several components:

  • Key roles and responsibilities
    • Who is responsible for program development and oversight?
    • Who will manage training? Auditing? Communication?
    • How will oversight and accountability survive turnover and succession?
  • Information standards, definitions and expectations
    • How will information be used and what requirements are necessary for these uses?
    • What dimensions govern the acceptability of information?
  • Policies and procedures that govern information management
  • An audit and oversight program
    • How will the organization ensure compliance and identify opportunities for improvement?
  • Workforce training
    • How will employees in all job functions and at all levels contribute to the overall governance program?

Given the central place of health information and its importance to operations, the principle of information integrity oftentimes occupies the majority of a governance program’s ongoing work. A large part of information integrity involves ensuring data quality through the dimensions of accuracy, completeness, validity, timeliness and accessibility.

  • Accuracy: Is the information correct?
  • Completeness: Are all required elements present?
  • Validity: Does the information match the rules?
  • Timeliness: Is the information present when needed?
  • Accessibility: Is the information available?

To manage these dimensions, a governance committee should develop standards for each element, training to teach staff how to prepare and store information correctly, and audit mechanisms to verify data quality and identify problems.

As information needs become more complex, the role for information governance will only grow. Organizations should lay the foundation for a strong information governance program now or risk not having the infrastructure required to compete in the future healthcare marketplace. Begin by setting the governance structure, define roles and responsibilities, train all stakeholders, and sustain through oversight and continuous improvement.

For more information on setting up an information governance program, visit AHIMA’s website: www.ahima.org/topics/infogovernance

I will also be speaking about the important of information governance, along with EHR adoption and succession planning at the Long-Term Post Acute Care Heath IT Summit in Baltimore June 21st-23rd. This is a fantastic learning conference for all those involved in long-term and post-acute care operations. Learn more at: ltpachealthit.org/content/annual-ltpac-health-it-summit

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EHR Implementation Guide: Part Two – Implementation and Optimization

Build and Implementation

Build

Depending on the system and vendor, the build phase can take anywhere from weeks to months. During the process, you may find yourself discovering better ways to accomplish a process halfway through the build. Don’t be afraid to rebuild modules when this occurs—a little extra time spent now can save considerable time over and over again down the road. It’s a good idea to talk with colleagues who have already implemented the system to learn from their challenges and experience.

Data Governance

As part of the build phase, spend time to develop a data governance structure. This entails a written plan of who is accountable for information integrity and security, processes for managing data quality, and auditing systems for HIPAA compliance, security, and accuracy. The structure should involve oversight from the corporate or board-level.

Training

Vendors typically recommend a slew of webinar-based training modules for all staff. The idea is to gather a group of staff and watch someone demonstrate the EHR functions step by step. Not only is this training style time-consuming and expensive, it is ineffective at building proficiency in users. Why is proficiency important to think about? Research has shown that adults learn much better when concepts are tied to the work they are expected to do. In the case of EHRs, the goal should be to have proficient users– in other words, that staff are able to use the application effectively to do their job– as opposed to knowing a complex set of modules and screens.

By listening to and/ or watching a remote user walk through screens and screens of capabilities, staff are likely to retain very little once the training is completed. Instead, training should be developed and deployed around workflow and roles, using a well-designed simulation environment that closely matches the new system. In other words, staff members should have access to a computer and be able to complete the step by step activities at the same time as the trainer. The savings in reduced training time and increased proficiency from this approach alone can make retaining an external, experienced EHR consulting firm cost-effective.

Go-Live

Go-Live is the big day to switch the new EHR system on. If you have invested the time and resources in your journey so far, Go-Live should be simply another step in the process. Make sure you have extra staff available to ease the transition. Management staff should also spend time in crucial operational areas to demonstrate commitment and provide support as needed.

Implementation Project Closure/ Transfer to Optimization Structure

The optimization phase of an EHR project should be built long before go-live day. After the implementation phase ends, usually 90 days or so after go-live, return to the established goals for the system and compare to the results achieved so far. Begin implementing a long-term strategy to understand how the EHR is integrating into workflows and make adjusts to the system when necessary. In addition, consider the following tips:

  • Develop strong training programs that can be consistently provided to new staff. A reliance on web-based training modules leads to poor proficiency and increased variation in usage and data entry, as does training provided solely as part of a traditional floor orientation program. Instead, take the time to develop (and keep updated) a training program that includes simulation, facility-specific guides, and leadership oversight to ensure continuity of information and practices.
  • Commit to one place for data. Many organizations are loathe to give up their trusted Excel-based census tracking worksheets and paper-based incident tracking systems. Resist the urge to keep data in different places. To fully capitalize on the business intelligence and analytic features of EHRs, you need to have all the data in one place to properly guide future decision-making. Data analytics is quickly reshaping all of healthcare. For LTPAC providers, this means you must have accurate data on rehab outcomes, rehospitalization statistics, and efficiency of operations. If your EHR solution is a barrier, press your vendor for added functionality. Chances are good they either have a solution from another provider, or, more likely, other providers are struggling with and clamoring for the same solution.
  • Ask staff probing questions. It’s not enough to ask, “Is everything okay?” At one organization where I served as administrator, I discovered months after implementation that some of our med aides were not following the proper procedures to chart their med pass. In researching why the staff had not mentioned the deviation before, I discovered that they had never been able to follow the process as described, but quickly found a workaround that seemed to work. When I would ask if everything was okay in the months after go-live, naturally and honestly they answered, “Sure!” Ask staff directly if things are working as expected. Ask regularly if staff are finding different ways to accomplish tasks. Encourage your superusers to report common questions and issues so you can examine whether there are organization-wide trends.

It’s also crucial to note, you must approach problems with usage of the EHR with a “just” mindset. This means if staff are not following established protocols, it’s crucial to understand why in a way that doesn’t place blame on individuals when the problems are system-induced. (And in our experience, virtually all problems with EHR usage are system-induced.)

  • Stay curious. EHRs vendors are quick to promise their system will do everything under the sun. It won’t, trust us. EHRs currently on the market are clunky adaptations of LTPAC operations. For some processes, you will ask how to do something and receive an answer of either the EHR can’t do that, or it can, but requires a complex set of steps. Push your vendor to simplify steps and improve workflows. What EHR vendors lack in user experience design and functionality, they more than make up in attention to customer needs. So be vocal about what you need and what you’d like to see. Remember Robert Kennedy: “Some [people] see things as they are and ask why—I dream things that never were, and ask why not?” Ask why not. Often.
  • If something doesn’t work, don’t give up on it. This part is a little shocking to us, but we find many organizations that, after struggling to adopt a certain feature or workflow, simply decide an EHR can’t support this part of their business and drop it. One time, we worked with a client that had paid for the billing/ finance module of an EHR, but had completely abandoned it in favor of staying with Quickbooks because they weren’t able to get the system to bill correctly for their independent residents. Resist the temptation. If a billing module doesn’t support your CCRC model, talk openly with your vendor about what you are trying to accomplish. Take a look at your internal process, as well, and be open to reconceptualization of your processes. While current EHRs are clunky, they are hardly impotent. Don’t give up on such a big investment.
  • Be open to—brace yourself—replacing your shiny new EHR. Most vendors work hard to ensure client satisfaction, but if you find yourself with a vendor who refuses to work with your struggles and challenges, go back to your shortlist and reexamine other vendors. The cost to replace a system is truly less than continuing to use a beast that doesn’t actually improve your operations and ability to care for your residents.

Final Thoughts

Current EHR systems on the market are valuable tools to manage data more effectively and streamline some of the labor-intensive parts of LTPAC operations. At the same time, they are not perfect solutions, and unfortunately reflect too much history as revenue cycle agents and not enough experience in day-to-day operations. Most systems are just now integrating workflow engines into the design, and it will be years before useful workflow and clinical decision support tools are available.  Worse, all complete EHR systems currently on the market suffer from a deep bias of paper-centric thinking, which hampers the ability of much of the healthcare industry to leverage technology in the same way that other industries have done (think Apple, Amazon, Google, and Netflix). This means that we likely will see tremendous innovation moving forward, and some of the giants today will struggle or fall away in the near future. Staying on top of technology solutions, rather than clinging tight to a trusted vendor, will require LTPAC organizations to think differently than they have in the past and embrace change much more quickly and tentatively.

EHR Implementation Guide: Part One – Project Management and Vendor Selection

 

Considering an Electronic Health Record system for your nursing home or assisted living community? Looking to optimize a current installation? Learn how we can help with our EHR Consulting Services.

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EHR Implementation Guide: Part One – Project Management and Vendor Selection

Choosing an EHR is a significant investment in time, resources, and staff goodwill. Therefore, it is crucial to conduct a thorough readiness assessment, consider vendor options carefully, and commit the resources necessary through full use and adoption of the software. For nursing homes and comprehensive care communities, the vendor landscape is wide. Several large solutions offer consolidated billing, MDS, care plan, MAR/ TAR, and resident care solutions. For assisted living, memory care, and senior housing, vendors have responded with a range of options from basic care tracking tools to integrated family/ provider engagement platforms.

This guide will help prepare you for an implementation by describing basic project management concepts, offering an overview of EHR options, and detailing how to construct an outcome-oriented training plan.

 

Project Management Basics

Choosing a project manager and sponsor

Selecting a person to manage an EHR project is crucial to success. The project manager should be organized, an effective communicator, and familiar with the care setting, resident requirements, and staff capabilities. Most important of all, the project manager must have sufficient free time to manage the project effectively, respond to challenges and problems quickly, and support implementation with on-the-ground support at critical junctures.

Equally important is choosing the right project sponsor who “authorizes” the project. This person must have sufficient decision-making ability and availability to support the project, remove roadblocks, and make critical decisions in a timely manner.

Picking the project team

The project team should include, at a minimum:

  • Representatives from administration
  • Clinical leaders
  • Clinical users
  • IT staff
  • Ancillary department staff (dining, environmental services, social services, marketing, etc.)
  • Resident representatives

Project team members should be collaborative thinkers, team players, and committed to the organization’s goals and mission.

Scoping the project

A careful project scoping process is essential to accurately forecast budget needs and time requirements. Will the project include IT infrastructure upgrades? Workflow analysis consulting? Conversion of paper records? What positions and resources will become permanent and what will be solely project-based?

Managing the project process

A successful project requires ongoing attention, oversight and adjustment. Organizations will want to consider postponing other strategic initiatives during the implementation process to focus on the work ahead. When adjustments are needed, the project team should act swiftly to avoid losing momentum and support.

Organization Review and Goals

To begin, you need to adequately define your current state (assess IT infrastructure, map workflows, measure staff engagement and readiness, quantify funding sources). The following websites have some great free resources for beginning this process:

Stratis Health (a QIO based in MN): http://www.stratishealth.org/expertise/healthit/nursinghomes/

LeadingAge CAST EHR Selection Tool: http://www.leadingage.org/ehr/search.aspx

You should also explicitly define goals for the EHR system: What do you want it to do? What areas of performance do you expect to improve? Be specific and measurable in selecting goals. Vendors typically focus on operational efficiencies and revenue generation, but your organization may have alternate goals to consider, such as improved customer service, better resident outcomes, and more satisfied staff.

EHR Vendor Considerations and Hardware

Hosted vs. Local Installation

Most EHRs offer a hosted version of their service (either through purchase or as a Software as a Services (SaaS) option, and some allow for software to be installed locally. Each option has advantages and challenges:

Hosted Solutions:
  • Vendor managed storage, reliability, upgrades and security reduces infrastructure and capital needs. Most vendors offer uptime guarantees and automatic upgrades to the latest version. In addition, vendors typically conduct ongoing, comprehensive security and penetration testing, meaning, somewhat counterintuitively, the data is typically more secure than with local installations.
  • Usually offered on a monthly contract or service charge basis, which can lower initial deployment costs substantially.
  • The ownership of data varies, and it’s important to clarify at the onset. When a vendor owns the data, migrating to another solution in the future can prove to be an expensive proposition.
  • Usage of the software is dependent on internet access, and reliability at the community site, thus, is crucial. Most organizations are not able to afford redundant solutions or direct internet pipelines, which can lead to some risk of downtown. Many EHRs have ways to mitigate the risks and challenges of internet disruption, such as local backups for time sensitive items like resident face sheets and MARs.
Local Installations:
  • Software is oftentimes more customizable for a particular organization’s needs.
  • Though it requires a higher up-front investment, purchased solutions may be less expensive over time, especially for organizations with already expansive IT capabilities.
  • Less reliance on internet connectivity, which may be crucial for locations with intermittent or unreliable access to the internet.
  • In addition to software, hardware investments and ongoing IT staff costs may be significant.

Hardware

After assessing your current IT infrastructure, you’ll want to decide what hardware you will need to acquire. Desktops are the cheapest solution and require minimal oversight and maintance, but they are less flexible and can contribute to institutional practices. Laptops are slightly more expensive, but offer greater flexibility and mobility. Tablets are easy to use and very mobile, but lack a keyboard for data entry and must be protected from theft and accidental damage. As the price of laptops and tablets continues to drop, more and more providers are opting in this direction.

Wireless internet is essential for most EHR deployments. While some facilities opt for home and office-grade equipment, it is well worth the investment to purchase healthcare-rated devices. Overlapping deployment of wireless radios is crucial, and it is recommended to maintain a signal strength of -70 dBm in all care locations.

Platform/ Browser Dependence

Some EHR solutions are dependent on Microsoft Windows and/ or Internet Explorer. Additionally, EHR vendors are beginning to develop mobile applications, which may be only available on either iOS (Apple) or Android platforms. In general, dependence on a particular platform or browser is not recommended, though many otherwise good LTPAC EHR vendors are designed in such a fashion, which can raise the cost of hardware, particularly if using mobile or tablet technology. Software that is only capable of running on a desktop environment is not recommended, as the technology is quickly being surpassed by tablet technology with lower costs and more person-centered design options.

Reporting Features

EHRs capture a tremendous amount of data. Using this data in a meaningful way, however, is a very different proposition. It’s important to review report generation capabilities of EHR systems thoroughly, as there is significant variation among vendors. Specifically, you want to understand:

How does reporting work in the EHR? What reports are standard? How are options controlled? What export formats are available?

What options are available for customized report writing? Can the data be segmented and can multiple data fields be included in report writing?

Person-Centered Practices and Assisted Living Environments

Most EHRs were initially designed as revenue cycle management platforms. Accordingly, the software and databases are well-attuned to catching and reporting MDS data at the expense of resident outcomes. As you explore vendors, consider how the user experience allows (or hinders) access to the data that is important in day-to-day operations. Are nurses able to easily manage resident health issues? Are care plan templates designed to allow for flexibility in display and reporting to suit different user needs (e.g., LN vs. CNA vs. family member)? Are point of care portals intuitive and easy to use?

On this note, if your community has an assisted living component, carefully examine any AL-specific modules. Does it reflect your needs and workflows? Does the system focus on the whole resident rather than just the medical record and ADL capture? Most EHR vendors took SNF modules and repackaged them for ALFs, which has led to unnecessary medicalization of these community-based-care environments.

Vendor Contracts and Post-Selection

We’ve seen countless organizations trust vendors to ensure a smooth transition only to struggle as customization takes longer than expected, costs run over budget, and the final product offers less than what was expected. An important way to protect your organization is to make the vendor contract contingent on project milestones and based on project outcomes, not hours involved. We also recommend adding contract language that allows an organization to refuse payment for any vendor-controlled cost overruns. (Vendor-supplied agreements typically promise only an “estimate” of implementation costs based on vendor-recorded hours, while calling for fees of up to $125 per hour for overruns– even when caused by the vendor.) Timeliness penalties are also becoming more common, and can help ensure a vendor keeps to the established timeline.

During the post-selection phase, it’s important to maintain open and honest communication with the vendor. If you run into issues or challenges, don’t be afraid to speak up. It’s also sometimes useful to keep 2nd and 3rd choice vendors engaged, as it’s never too late to change direction based on outcomes of the implementation process. While switching mid-stream may seem expensive or wasteful, it’s far worse to end up with a vendor not committed to your success.

EHR Implementation Guide: Part Two – Implementation and Optimization

 

Considering an Electronic Health Record system for your nursing home or assisted living community? Looking to optimize a current installation? Learn how we can help with our EHR Consulting Services.

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LeadingAge PEAK 14: Missed Chances and Future Opportunities

Today, CNN ran an article about a new app called “Cloak,” which plots check-ins from Instagram and Foursquare on a map so you can avoid your friends and exes. It’s a great use of technology on the micro-personal level, but what about avoiding cancer or loneliness or anything else in health that costs society significant resources? We’ll come back to this in a second.

I just returned from the LeadingAge PEAK conference, which took place this week in Washington, DC. Speakers and providers both shared tremendous interest around innovation and technology, and it was exciting to be with hundreds of passionate, committed aging services professionals. But as folks talked about innovation in their organizations and communities, I was left rather dumbstruck: hardly anyone is doing anything new!

In a session on innovation, one provider shared how they were piloting a program to bring elementary school children to their campus. The room cheered in encouragement… and I just about choked! Intergenerational programs are fantastic, absolutely. But they’ve been occurring for decades! We already know they generally have positive outcomes for both the young and old. This mistaking replication for innovation is something I see replayed time and time again in aging services because of a lack of good information sharing, and, more so, a lack of investment in disruptive innovation.

The Sunday New York Times magazine contained an article by Yiren Lu entitled, “Silicon Valley’s Youth Problem.”  Among her theses:

1)      Current Silicon Valley startups are flush with youth and talent, the result of which has been an explosion of new apps and interfaces between technology and the world. At the same time, less of the young talent has been dedicated to innovation in the boring parts of tech: semiconductors, legacy software, and other core infrastructure. In her words, “Why do these smart, quantitatively trained engineers, who could help cure cancer or fix healthcare.gov, want to work for a sexting app?”

2)      Young startups appear adverse to age and experience, believing older tech workers are too slow, too cautious, and too boring. “The problem is that they [older tech workers] may be making more reasonable steps, but they’re making fewer steps. It’s hard to compete when you’re moving slower, even if you’re moving in a consistently correct direction.” Hardly one-sided, older workers may also feel out of place. “The flip side of the kind of cohesion I saw at Stripe is that it can be off-putting to people outside the circle. If you are 50, no matter how good your coding skills, you probably do not want to be called a “ninja” and go on bar crawls every weekend with your colleagues, which is exactly what many of my friends do.

3) The most innovative companies are combining the young and old: “As David Dalrymple, a technologist in the valley, told me, “The most innovative and effective companies are old-guard companies that have managed to reach out to the new guard, like Apple, or vice versa, like Google.” ”

Aging services is suffering from exactly the opposite challenge:

1)      An over-reliance on age and experience, leaving younger colleagues disillusioned with the slow pace of change, stifling working conditions, incomprehensible benefit offerings, and lack of entrepreneurship.

2)      A lack of true innovation, with tremendous resources wasted on duplication of efforts and replication of existing programs.

3)      A lack of quick action, agile entrepreneurship, and the inevitable frequent failures that lead to novel solutions and rapid innovation.

4)      A dearth of organizations– whether providers or vendors– consciously combining youthful tech talent and rugged industry experience in disruptive ways.

At the PEAK Expo, vendors were sharing their own new offerings:

  • An IPOD touch-based call system that connects to nothing else. (Not only is the device $150 more expensive than you need, but it doesn’t even provide an advantage over a pager and walkie talkie. What about devices that seemlessly connect to the EHR and pull forward the care plan information? That can push data back to the EHR for recording ADLs at the point of care? That could suggest an appropriate anecdote, story or question to share while assisting with care?)
  • Several EHRs still written in .NET, and with interfaces that still look like the 90’s. (Why are most apps I use intuitively designed and functional? Why can I deposit a check into my bank account or file an insurance claim after a car crash on my phone, but I can’t document skin assessments and pressure wounds in the same way?)
  • Phillips LifeLine, with their new, cellular-enabled pendant. (First, finally! And second, my Motorola Droid from five years ago had the same technology and more– so why does LifeLine still cost an arm and a leg and look like a LifeLine?)
  • The Green House Project, which is certainly better than institutional facilities, but hardly revolutionary in terms of what technology could allow us to do. (Why are we still spending millions on bricks and mortar solutions that are only marginally better than what we have today?)

And LeadingAge itself, bless their wonderful, committed hearts, talked about an important new initiative: Namestorming a new term for CCRC.

Join us in developing a new name for continuing care retirement communities (CCRC) that resonates with the next generation of older adults.  

 

New focus was given to this idea on a field-wide level following the presentation of new Mather LifeWays consumer research.

 

The research highlighted the emotional barriers the CCRC name was creating with consumers. Based on this research, Mather LifeWays, along with LeadingAge, decided to spearhead an industry wide renaming project. Introducing theCCRC NameStorm!

Please. It’s not the name that’s the problem; it’s the product. Charles Duhigg, the leadership keynote speaker at PEAK 14, shared the story of Proctor and Gamble’s almost flop with Febreeze, which seems ironically similar in this case: Febreeze almost failed not because it didn’t work (or had a bad name), but because it didn’t connect appropriately to consumers’ habits. I wonder what Duhigg might stay about the Namestorming initiative.

Writing in Forbes, David Shaywitz responded to Lu’s NYT’s piece with a thoughtful article a few days later, “What Yiren Lu’s Magnificent Portrait Of Silicon Valley Can Teach Us About Digital Health.”

“Lu’s characterization of the valley not only rings true, but also helped me better understand the valley’s approach to healthcare – or perhaps less diplomatically, why young developers’ approach to healthcare (to the extent they’ve deigned to approach it at all) seems to have generated far more heat than light, and resulted in thousands of pointless apps, and remarkably few impactful innovations.”

He continues:

I suspect that materially impacting healthcare – i.e. significantly improving care or reducing costs – requires tolerance for complexity, patience to demonstrate value, fortitude to deal with regulators and entrenched incumbents, and respect for the distinct importance of human health.  I’m not sure there are all that many hot shot web tech developers in whom these qualities bloom – though Uber’s (as I’ve discussed) andTesla’s battles with regulators and incumbents are positively inspirational.

It’s incredibly compelling to envision the integration not only of generations, as Lu imagines, but also of domains – finding a way to functionally unite fearless creative developers with experienced healthcare experts equally determined to change the world.

There is some truth to this. I’m hopeful about companies like CareMerge and HealthSense who are working feverishly in the direction of using healthcare IT innovatively to tackle issues of cost and quality. But even with those two companies, there is a lingering of something old: reporting vitals via ugly white remote sensors in the home and a care portal that is not much more innovative that a slew of collaboration tools already years old in other industries.

Take a look at Canary. This is the sort of disruptive thinking we need in healthcare now:

There are a lot of “smart home” companies out there trying to “connect” things – dishwashers, lights, fridges, TVs, crockpots, etc. At Canary we prefer to solve problems.

 

We started with home security because it’s a need shared by hundreds of millions of people around the globe. We know because we’ve already sold Canary in 78 countries, and proved through our Indiegogo campaign (the most successful ever) that there’s a real demand for affordable intelligent home security that just works. Rather than being all about preventing the bad (including fires and floods), Canary also helps out in other ways whether it’s letting users watch their kids play during the middle of the day or providing a digital neighborhood watch while they’re on vacation.

Imagine remote monitoring that provides not only the data flow we need, but addresses the real issue at hand: my mother and yours living alone in their houses. Sure I want to know she’s getting up, using the refrigerator, and doesn’t likely have a UTI (all issues addressed by HealthSense, for example). But I want to call her in HD video to say hi in the morning; I want to play scrabble on my lunch with her through her TV. I want her to be able to text me quick questions, because she’s uncomfortable bothering me on the phone with “silly things,” (I’d love to try and explain my SnapChatting to her…) and respond in a way she can easily see and understand. I want her to book medical appointments and check her records as easily as I can use Mint or AirBnB. This technology is already here, and we need to start putting it to better use.

Bill Gates said in TechCrunch this week that “Innovation in California is at its absolute peak right now. Sure, half of the companies are silly, and you know two-thirds of them are going to go bankrupt, but the dozen or so ideas that emerge out of that are going to be really important.” I agree with his point, but, in aging services especially, we will need to be more focused on fostering disruptive innovation, rather than waiting to see how SnapChat and Cloak will play out. We need to stop wasting time on replication couched as innovation; we need to stop trying to force old workflows and predilections into new technological solutions. (Looking hard at you, EHRs and remote patient monitoring!)

After all, the technology and talent is already here– and my mother doesn’t have a whole lot of time left.

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HIMSS14 Recap: Long-Term Care Absent, But Not Entirely Forgotten

HIMSS14 has been a great conference, and there are some amazing technologies and uses of data that will continue to push innovation forward in healthcare. Unfortunately– though predictably– the post-acute/ long-term care sector was sadly underrepresented. Of three sessions with a LTPAC focus, one was canceled, and the others, while excellent, were scantily attended.

A quick recap of some exciting ideas, products, and innovation:

  • Massachusetts has an exciting, ONC-funded program called IMPACT– Improving Massachusetts Post Acute Transfers– that has created a HIE-based platform for connecting long term care providers to secure messaging features, a universal transfer form, and a program called LAND and SEE (Local Adapter for Network Distribution and Surrogate EHR Envronment) . You can read more about the last piece and its architecture here, but it essentially provides a way for LTC communities without an EHR to receive, edit, and send CCDs through a portal connected with acute care EHRs. The pilot program is still being evaluated, but early feedback from providers in all areas of the healthcare continuum seems to be positive.
  • PracticeFusion, a fast-growing, web-based, free EHR has an impressive set of features and very thoughtful UX. We’d love to seem a similar program built out for assisted living communities that don’t require the revenue-cycle-heavy components of current LTPAC EHR vendors (and their associated focus on clinical documentation and ADL capture).
  • Speaking of LTPAC EHR vendors, it was interesting that HealthMedX (Vision) and MDI Achieve (MatrixCare) had a sizable presence in both the interoperability showcase and the exhibition hall; they’re definitely both very forward-thinking organizations. Answers on Demand had a small booth tucked away in the back (we almost missed them) and PointClickCare was nowhere to be found; we wonder if this is telling about the future of this market.
  • Real-time location services (RTLS) is big and growing. The price point of the technology is dropping quickly, and there are a variety of connection strategies, from wifi-enabled to passive IR to bluetooth/ RFID. There are a lot of applications in aging services, particularly in independent, assisted and dementia-specific communities. Additionally, it’s starting to show some promise with device interconnectivity and asset management. (Can’t find which room the Hoyer is hidden in? RTLS provides a cheap solution that will make CNAs’ jobs infinitely easier– and potentially reduce unsafe transfers.)
  • Ed Park, COO of Athena Health, delivered the best presentation of the conference: What Healthcare can Learn form Amazon. His slides are also fabulous. Park totally gets what’s needed in healthcare IT, and we hope he’ll push EHR vendors to adopt and publish open APIs, and collaborate with partners in a way that places persons served at the center of thinking.
  • Deb Fournier and Clint Davies shared the experience of the Maine Veterans Home EMR implementation. Their slides are worth a look by any organization considering an EMR in the near future. They also experienced some of the challenges when approaching an EMR as an implementation instead of an adoption.

Stay tuned for more learnings and ideas from the conference; we’re still analyzing technologies and forging connections, and we hope to have more things to share soon. It’s been a full week, and we’re super excited about the future of healthcare IT, particularly in aging services.

Ready to get started? So are we!