Coping with progress: vendors' view of long-term care manufacturers and suppliers.

There's an old saying, "The only constant is change." Put another way, things never stay the same. Nowhere is this observation more true than in the fields of communications and information (IT) technology. Dramatic change is "business as usual" in IT and wireless, which is both a blessing and a curse. The blessings are the rapid advances in functionality and affordability that can benefit even the most modestly budgeted organizations. The curse is that organizations, such as many long-term care facilities, feel unable to budget for such change. The fear of high-priced obsolescence is ever-present and paralyzes long-term care decision makers, who end up purchasing only what they think they must simply to meet current regulatory requirements. They accept the risk that a world of brilliant technological progress just might pass them by. Is this stance inevitable--and inescapable--for long-term care? Recently Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck asked top executives of leading IT vendors in the field to comment on three questions addressing this dilemma: What is the biggest obstacle facilities encounter when considering a product upgrade? What is the primary reason that facilities with a tight budget should consider a product upgrade? How will adopting your latest product upgrade affect facility operations/staffing? The following summarizes their responses.

What is the biggest obstacle facilities encounter when considering a product upgrade?

Vendors' responses broke down into two rough groupings: organizational vision and staff training. "Too often," says Kevin Pope, president of Stanley-Senior Technologies, "a product upgrade is performed without a clear vision of why the product upgrade is needed. By clearly defining the reasons for an upgrade, a facility can make informed decisions on product and feature choices balanced against cost." Says MDI's Director of Client Services Dennis Huebner, "Although budget constraints ... are the biggest issue, there are many others that add up, e.g., the new technology may be unfamiliar to facility personnel and require outside expertise; the time, effort, and resources necessary for the transition may pose a problem for staff with little time to spare; new features may require additional training; and upgrading to new technology may affect interface with other software packages that may be in use."

Noting the "progress" dilemma, Jay Syverson, president and COO of Achieve Healthcare Technologies, observes, "Systems purchased by organizations five or more years ago may have adequately met business and care requirements then, but are now obsolete. There are better products and more information available (but) some facilities feel that if they need to change systems now, the system they chose five years ago was the wrong system. That's simply untrue. Times have changed, and the right decision now is to upgrade to a system that meets your needs today."

As for training, "the biggest obstacle to facilities is that when new staff join a facility, too often the availability of training in IT products is limited," says John Sheridan, president of eHealth Data Solutions, adding his company has evolved training to be Web-based to address this need. "Staff members need to become educated to use and assimilate the benefits of the upgrade in daily operations," says Dan Malmstrom, president and CEO of Momentum Healthware. "By selecting a software vendor that employs educational best practices, long-term care facilities can mitigate the impact of change management during the implementation process."

Jeff Jordan, managing director of Keane Care, sees the need for an even broader awareness of the potential impact of a product upgrade--it might require changes in hardware, networks, and operating systems, each from potentially different service partners. "Providers should have full knowledge of all the specifications, functional enhancements, and system requirements involved." Adds Kandasamy "Pasu" Pasupathy, president of InfoSys, "The team must be fully committed to the upgrade and have the resources and skills necessary to successfully implement it."

Facilities should not be put off by a natural affinity for "doing things the old way," says Tamar Abell, principal with Upstairs Solutions LTC. "Like most technology implementations, initially the challenge is 'resistance to change.' But that is human nature." This can be mitigated by innovation in training itself, with online in-servicing and automated record keeping, she says. Glen Jonas, CEO of RF Technologies, elaborates on this: "If the technology upgrade includes comprehensive training that spells out day-to-day operational benefits, user procedures, and proper response protocols, staff members are likely to be more comfortable with an upgrade." Jerry L. Rhoads, CPA, president and CEO of Caregiver Management Systems, notes specifically that "old-school thinkers" can have trouble adjusting to the capabilities of today's software to maximize Medicare and Medicaid reimbursement of rehabilitation and restorative programming through rational, logical organization of data.

One "real-world" observation was offered by Steve Herron, director of Business Development for CareTracker by Resource Systems: "The release of an upgrade is supposed to be like Christmas ... so why is it that upgrades are not always met with the same enthusiasm by the customers? Well, frankly, Santa has left a lot of coal in their stockings in the past. The general sentiment is that if software is going to go down, it's going to happen during the upgrade." The safe approach, says Herron, is to minimize the number of potential "failure points" along the way, caused by disjointed facility operations using multiple and sometimes incompatible computer installations. "Modern software programs allow most software upgrades to take place in one location, on the primary server," he notes. "The workstations should all be able to access the system through a thin-client architecture, like a browser."

Such technical considerations aside, Greg Roberts, vice-president of Product Management at Accu-Med Services, offers these final words of wisdom about surmounting product upgrade obstacles: "Change, even for the better, isn't easy in long-term care. Products don't implement themselves. People do."

What is the primary reason that facilities with a tight budget should consider a product upgrade?

John E. Ederer, NHA, President of American Data, states the basic premise succinctly: "If they shop for software with a focus on patient care, they will likely experience savings or an increase in revenues, so that the budget is not as tight." Accu-Med Services' Roberts lays out the basics: "Improving outcomes, improving revenue, reducing cost, or reducing risk are the primary reasons to upgrade or purchase new products.... Most vendors can help you arrive at an ROI (return on investment) for a product or an upgrade that will cost-justify moving ahead. Be sure that ROI is based on your unique situation and rings true to your business sense, and be skeptical of any ROI claims that sound too good to be true. If you're pinched for cash, most vendors can provide subscription or payment options that will allow you to stretch payments past the point where the upgrade or new product should pay for itself."

Technology, says Achieve Healthcare Technologies' Syverson, isn't a cost, it's really a long-term investment. "Most eldercare organizations make a technology change only once in a 10-year period. The initial cost of purchasing and implementing a new system is far less of an expense than the potential long-term effects of waiting." Waiting only throws away the cost-benefits of the new technology in terms of staff time and efficiency, Syverson says.

RF Technologies' Jonas notes that upgrades allowing optimum system performance reduce costs for maintenance and potential liability issues. Moreover, he says, wireless monitoring technology is "on the job 24/7, limiting the need to add staff to watch over residents, and freeing up existing staff to handle the resident care issues at hand."

"The downside of not moving with technology can be expensive," notes Keane Care's Jordan. "If software is left untouched too long, it cannot be supported. When significant changes occur, such as new Medicare billing forms, outdated software will not be able to be updated; it will need to be replaced."

As for root causes of the problem, says Sheridan of eHealth Data Solutions, the reason a facility has a tight budget is limited reimbursement from Medicaid. "Facilities facing this very difficult problem should consider upgrades that offer them some immediate possibility of positively affecting Medicaid payment, improving quality of care, and lowering costs." Malmstrom, at Momentum Health ware, amplifies on this. With diminishing margins, he says, "a natural reaction is to tighten expense budgets, but that response is only relevant if the financial situation is temporary. The more strategic response in other industries has been to increase investments (expenses) in information technology to transform operations. It was not unusual for manufacturing firms (in the 1990s) to increase their annual information technology budgets from less than 2% to more than 8% to realize the gains offered by innovation. Healthcare spending on information technology currently lags in this regard. The good news is that significant efficiency gains remain unrealized in healthcare. The challenge will be for healthcare executives to gain an understanding of the financial outcomes produced by technology innovation--specific efficiency, staffing, quality, and reimbursement gains--and assume the risk of pursuing them with real investments."

Pasupathy at InfoSys, specifying some of those financial outcomes, notes that "rather than manually entering each PT, OT, or Speech inpatient rehab service individually, a rehab grid-entry software module can streamline this process, saving significant man-hours. When nurses use mobile devices to electronically chart mini-assessment notes at residents' bedsides, this information can automatically populate the MDS in real time, saving manual transcription hours and preventing errors associated with redundant data entry." Rhoads, at Caregiver Management Systems, adds, "You must document in such a way to defend and prove your case. This cannot be done with traditional narrative nurses' notes and scribbled therapy evaluations and progress notes. The documentation must meet the requirements of insurance and the entitlement law rules and regulations"--an outcome, he notes, that appropriately organized software can provide.

How will adopting your latest product upgrade affect facility operations/staffing?

Vendors pointed to specific products--Keane NetSolutions, Achieve Matrix, and the Accu-Med suite of software packages--as having electronic health record (EHR) capabilities, indicating a growing interest among long-term care organizations in taking this important next step in IT integration.

Other specific advantages conferred by these products, according to their proud developers, are: organized workflow to clarify the reimbursement pathways and track per-case financial outcomes (Caregiver OM); better trained, more empowered staff and better managed training (Upstairs Solutions LTC's eLearning modules and Learning Management System); significantly enhanced staff communication (CareTracker 8.0); electronic validation of medication and interventions, automatically populating the MDS (InfoSys CareVoyant); Web-based reimbursement and regulatory compliance documentation leading to enhanced ROI (eHealth Data Solutions' CareWatch and RiskWatch); active partnership to ensure that an integrated product suite creates maximum outcomes (Momentum Healthcare suite of financial and operations products); reduced MDS documentation time and enhanced medication management (MDI suite of products); Web-based tracking and analysis of staff response to nurse-call situations (Stanley-Senior Technologies' Arial Enterprise Manager); integrated wireless communications systems across the board (RF Technologies' Integrated Event Notification Solution); and an all-purpose revenue, reimbursement, and staff management enhancer (American Data's ECS-Electronic Chart System with Accounts Receivable/Billing).

Final Words of Advice ...

... are offered by CareTracker's Steve Herron: "Keep your support agreement current. Most software companies include software updates as part of your annual support agreement. Major upgrades or even other products from the same company can often be purchased with sizable discounts for loyal customers with a current agreement.

"Check with your vendor to see what training opportunities are available to help you take advantage of the new features it has developed. Often, vendors will provide phone training or 'Webinars' at a low cost or even free to customers.... Remember that software companies want you to fully implement the new features and realize the benefits, because happy customers are the best source of new referrals.

"Participate in 'user groups' or focus groups as much as possible. You, as the user, can actually help decide what those upgrades or updates are going to include. You'll obviously be much happier with an upgrade if your ideas actually make it into the software."

With thanks to:

Jay Syverson, President and COO

Achieve Healthcare Technologies

Greg Roberts, Vice-President of Product Management

Accu-Med Services

John E. Ederer, NHA, President

American Data

Jerry L. Rhoads, CPA, President and CEO

Caregiver Management Systems

Steve Herron, Director of Business Development

CareTracker by Resource Systems

John Sheridan, President

eHealth Data Solutions

Kandasamy "Pasu" Pasupathy, President

InfoSys

Jeff Jordan, Managing Director

Keane Care

Dennis Huebner, Director of Client Services

MDI Technologies

Dan Malmstrom, President and CEO

Momentum Healthware

Glen Jonas, CEO

RF Technologies

Kevin Pope, President

Stanley-Senior Technologies

Tamar Abell, Principal

Upstairs Solutions LTC