IT as the key to survival: a longtime LTC/IT authority looks at how information technology sustains residents and facilities today.

the late Peter Drucker, considered broadly to have "invented" management, became well known for his inability to think from point A to point B. People who knew him and observed his thought processes might have described them as circuitous, at best, and as chaotic to most of us. But it was a sign of his ability to range across a broad, complex subject.

So, how does one manage? Given the complexity of the long-term care industry--of managing even a small part of one nursing facility, much less a number of homes or a regionally distributed family of facilities--how can any one person grasp, analyze, and understand all the information related to the business's resident, staffing, clinical, and financial aspects?

Wouldn't that individual--that company--benefit from an at-a-glance tool to pull and analyze information embedded in resident records, file drawers, and data sets of many different varieties and stored throughout the organization and, moreover, be able to do so many times, even in remote locations? Long-term care managers need a system that will notify them instead of forcing them and their staff to spend valuable time and energy digging through piles of paper to discover a nugget of critical information: residents' health status, staff time and availability, clinical "hot buttons," outstanding accounts that could diminish cash flow to the crunch point, etc.

Drucker suggested that decentralizing the management function, especially in large organizations, would enhance efficiency and productivity. But over the past 50 years, companies have grown immensely. Especially in long-term care, they more likely resemble highly compartmentalized structures with insufficient cross-boundary communication or workflow.

This is where fully integrated software solutions come in. They can keep valuable indicator information from falling through one of the cracks caused by fragmentation. Without such solutions, the safety and health not only of residents, but of the company itself, could be at risk. If either the business office or the clinical staff fails to focus on admissions, the occupancy/residency mix, average length of stay, and/or pending Medicaid certification and payment--if organizational monitoring falls by the wayside--quality of care can suffer, resident satisfaction can plunge, and organizational survival can become questionable.

The "age wave" of baby boomers could well expose the archaic systems of yesteryear as inadequate to support the kind of care available only at a nursing facility. That is why the long-term care industry--indeed, every single nursing facility--must discover and implement a way to not only systematically collect, but analyze and use, information about every aspect of a resident's status. Beyond such clinical concerns as falls, pressure ulcers, weight changes, and continence, some providers' populations will suggest or require close monitoring of such factors as "incidents," infection, or changes in ADL status.

A reliable system must be in place to ensure that adequately and appropriately trained staff is available to provide the needed care. Savvy managers will be able to mitigate staff turnover by keeping a closer watch on why employees leave, and in the process reduce the cost of overtime or the use of contractual staff. Management experts assert that workers benefit the organization as an asset, but do organizations embrace that philosophy? Does anybody inside the organization consistently monitor the behavior of employees in relation to their longevity at and satisfaction with the company? Do such data even exist? And if they do exist, who understands and combines that information with other facts that can give managers at all levels, and particularly those at the C-level, the necessary "big picture" analysis of staff performance?

Clearly, technology offers a big part of the solution to these difficulties. The electronic health record, for example, combined with e-prescribing and the setting of interoperability standards, will move the industry toward filling the communications gaps that exist for today's stakeholders. Government mandates regarding financial accountability, staffing, and specific clinical standards for resident care have forced facilities to collect expanded data sets over time. In line with this, some IT enterprises have attempted to design and deliver software that can pull information from disparate databases to reveal whether a particular organization is meeting appropriate regulatory standards and/or its own self-selected goals. In some cases, the technology enables analysis of certain key performance indicators related to particular patient and clinical needs. Other programs allow individual technology users to set up and track their own indicators in monitoring achievement of their unique corporate goals.

But none of this is enough. Providers should have access to information routinely and systematically not only for monitoring, but for real-time alerts, wherever they might happen to be. The manager should be able to ask and get answers to what-ifs. For example, going beyond the cookie-cutter approach that most data management systems offer, a meticulous manager could "slice and dice" the data to learn not only about the prevalence of pressure ulcers, but also whether a specific resident was admitted with a pressure ulcer or acquired it in-house. IT tools, particularly Web-based systems, allow comparison of operational status across facilities and tracking of trends across multiple time periods. At least one product comes with a starter set of 16 built-in indicators and offers the option for users to further tailor the tool for specific management needs. Other products already in the market allow the manager to view color-coded financial, clinical, staffing, and resident compliance records in comparison with company goals.

Many who keep current on management practices say that Drucker's passion for innovation declined as he grew older and his health failed; he died in November 2005, just days before his 96th birthday. One reporter wrote that Drucker simply retained pride in the work he did half a century earlier. Today's long-term care industry cannot do the same; it must keep its passion for excellence and its focus on service. Using available technology to gauge organizational health at a glance is a major key to meeting the challenges that our industry faces. IT will ensure enhanced quality of care and increased safety both for residents and for the organizations that care for them every day.

Zoe M. Bolton has more than 30 years of experience in the design and delivery of long-term care software. She cultivates new business growth opportunities, directs all marketing efforts, and contributes as a member of the product design team for American HealthTech, which offers Corporate Vital Signs. For more information, phone [phone] or visit www.healthtech.net. To send comments to the author and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].