Revising strategic planning for IT support.

The Healthcare Information and Management Systems Society (HIMSS) annual conference this winter gave a glimpse of what the future of healthcare automation can be. With more than 23,000 attendees and over 700 vendors, this annual conference showcased the latest and greatest hardware and applications that support healthcare. More than 20 vendors offered long-term care systems or support in the well-attended exhibit area. Moreover, the Long Term and Post Acute Care Special Interest Group provided a forum within HIMSS for technical and management discussions of long-term care's relevant technology.

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In fact, many of the educational sessions and technologies presented at the conference can be applied to long-term care as the field embraces (or is forced into) electronic medical records, point-of-care data entry and access, and just keeping up with rapidly evolving clinical and regulatory demands. Increasing information systems support to all of healthcare seems to be the expected solution to solving everything from medical errors to Medicare fraud, and to relieving the nursing shortage as well. The danger to facilities is that knowing the latest technology or buzzword can lead them to make demands that cannot be met with current systems--but someone will try to sell it to them anyway.

How can the long-term care administrator and clinician make sure they are getting the appropriate support from their information technology (IT) investments? Knowing the latest and greatest technology is only part of the solution. A strategic plan that coordinates a facility's needs with the availability of systems is essential. A part of the strategic plan should be a method to harvest the benefits the investment promises. In reality, the IT strategic plan should be a part of the overall facility strategic plan, since the benefits of IT are achieved only through making other operations more efficient.

However, few facilities are getting all of the possible benefits of the computer support they have now. All nursing facilities must have some level of computer support today, if only to transmit MDS reports and review the statistics the state has calculated for the facility. But so much more is possible, and shortly computer support will be necessary for both regulatory compliance and billing.

Facilities need to start planning now for optimum IT support and to maximize the benefits from their current and planned systems. In short, administrators must become informed consumers of IT--like it or not. At the same time, most long-term care facilities are totally dependent on their third-party vendors to supply their IT needs. Even so, the facility is responsible for maintaining operations and compliance. (Just check the State Operations Manual.)

Vendor Partnerships

Vendors like to market their services as a partnership with facilities. It is an appropriate relationship if the partnership is equal. No doubt you are keeping up with your support payments to your vendor, but what is your assurance that the vendor is keeping you in compliance and making your facility as efficient as possible by using the best technology? You can plan for your facility only if you know the plans of the businesses on which you rely for support.

Your IT vendor is mission critical to the success of your operations. The strategic planning you do for your facility depends on the services and products delivered by your vendor. You must know your vendor's plans for introducing new capabilities, its commitment to regulatory compliance, its ability to evolve its system with the environment, and the timetable for doing so.

Open a dialogue with your vendor. Periodically (at least once a year) review your current system with your vendor to see if you can improve its contribution to operations. Reviewing the vendor's commitment to keeping your facility in compliance with current and future regulations is essential.

A good time for this review is before the annual maintenance contract is up for renewal--since you have more leverage when money is on the table. If you are unhappy with any aspect of the vendor's plans, performance, or service, this is the time to discuss it and get assurances that these issues will be resolved. If the vendor's response is inadequate, it may be time to start searching for a new system. However, pay the maintenance contract then, since it takes at least a year to find and implement a new system!

Planning Is Essential

Since all nursing facilities already have at least some computer support, planning begins with your current system as the starting point.

Any change has costs associated with it--and changing vendors has major costs and should be carefully considered. If your vendor cannot assure you that it will continally evolve, though, it may be better to absorb the cost of change at a time of your choosing instead of becoming out of compliance or left without support. Many vendors have been acquired by others in recent years, with varying effects on their clients. In our experience, the most likely candidates for corporate acquisition are those vendors who cannot evolve their systems because they lack resources or who have overextended themselves with promises they can't keep. While you undoubtedly checked your vendor's financials as part of due diligence before you bought its offering, have you periodically checked their status since then? Is the system evolving as you need it to? Are the potential opportunities and benefits from alternative systems worth the cost of conversion? The answers depend on your strategic plan and how well your current vendor supports that plan.

The budget is an essential part of any plan. As long-term care IT evolves, it will require a larger portion of the operating budget to stay current. Budgeting just to replace obsolete computers (any over three years old) is just part of what is needed. Meeting the requirements for privacy, security, eventual electronic medical records, electronic claims, revisions to the MDS, and opportunities for better clinical systems must be considered. New hardware, software, training, and process improvement are all necessary. The payoff is better care and greater efficiency in delivering it.

In a future column, I will discuss some of the newer IT options on the market and their potential relevance to long-term care, and the gradually evolving push toward the electronic medical record.

Information Resources 

* Oatway D. Electronic records in long-term care. Nursing Homes/Long Term Care Management 2004;9:84-9.

* CMS's monthly communication channel with facilities. www.cms.hhs.gov/opendoor

* The official source of CMS manuals, including the State Operations Manual. www.cms.hhs.gov/manuals

* CMS's provider education site. www.cms.hhs.gov/medlearn/matters

* Healthcare Information and Management Systems Society (HIMSS) providing a forum for facilities, clinicians, researchers, and vendors to improve management of healthcare automation at www.himss.org.

* American Health Information Management Association (AHIMA) helping manage health information at www.ahima.org.

* Agency for Healthcare Research and Quality (AHRQ) supporting research in clinical and information technology to benefit citizens and patients at www.ahrq.gov.

NOTE: The views expressed in this article are the author's and do not necessarily represent the official views of any organization.

BY DAVE OATWAY, RN

Dave Oatway, RN, a long-term care IT consultant based in Key West, Florida, was the Department of Defense Project Officer for the initial clinical requirements phase of the Composite Health Care System (CHCS-I). He worked with HCFA/CMS on the Prospective Payment System for SNFs and contributed to the development of MDS 2.0. He developed one of the first clinical/MDS systems (CHAMP). He is the chair of the Healthcare Information and Management Systems Society (HIMSS) Long Term Care and Post Acute Special Interest Group and a member of the American Health Information Management Association (AHIMA) and the Health Level Seven (HL7) organization. He was the vice-chair for the American Association of Nurse Assessment Coordinators. A sample IT spreadsheet and strategic plan form are available. To request this information or to send your comments to the author and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].