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Getting computerized: what will it take?

Computerization sounds nice and up-to-date, but the long-term care industry has some intrinsic problems to confront before it will work -- so says this internationally-known geriatrician, who specializes in both long-term care studies and software development. He reviewed these key issues with NURSING HOMES Editor Richard L. Peck.

An Interview with Robert L. Kane, MD

Peck: Why should a nursing home want to make a capital investment of this magnitude?

Dr. Kane: First of all, the magnitude may not be that great. The average nursing home should be able to obtain a reasonable system for under $15,000 -- maybe not a complete system, but one that will perform basic and important financial and clinical functions.

But there is an even better reason: Computers can help solve what is probably the most common problem in nursing homes today -- the inability to successfully manage. This industry is so browbeaten by regulation; this is the second most regulated industry next to atomic energy. As a result, we spend enormous amounts of time recording data that nobody uses, or if it's used, it's for purposes other than the direct improvement of the operation.

What we want basically is a system that will be effective in improving the performance of the providers. Among ways the computer can do this is, first, by allowing sharing of information by a variety of people, while avoiding a lot of redundant recording; and second, by structuring information to actually help guide and change behavior, an example being the triggers incorporated in the RAP.

Peck: Have you found that theoretically being able to improve clinical performance has been reason enough for nursing homes to computerize?

Dr. Kane: No, actually very few nursing homes have computer systems that we would consider adequate. Most nursing homes have used computers for financial management. Those that use them for assessment usually have the basic "in-and-out" systems -- you type data in and it spills data out, and what you have is the same thing you could have had with pencil and paper, but it looks better. The result is of more use to the regulators than to anyone else.

From the performance standpoint, one of the problems is that we have such a bizarre way of looking at long-term care. "Long-term" implies that you are performing and monitoring activity over a period of time. In fact, most facilities are run as a series of snapshots; we react to and take care of the here and now, as it occurs. There is no sense of an ongoing process. As a result, staff has the feeling that it never can win; people leave or die and are replaced by sicker people. There is very little indication of the truth: that they are indeed having an impact.

We need feedback on ongoing effectiveness, and the computer can do that. It can calculate the difference in parameters between month one and month three, and then show it graphically. You can actually see the difference you are making with your care.

The same applies to management: How do you really know if you are providing good care? What criteria do you have to go by? The computer can provide a simple representation of that.

Peck: Before you alluded to computer systems currently employed in many nursing homes as simply doing the work of pencil and paper. Would you elaborate?

Dr. Kane: As I mentioned, they are essentially providing data that is of use to state agencies, but is not particularly useful to the facility. The clever nursing home in the future will find ways to develop data it can use to improve care and, in the process, be of use to outside agencies.

The basic rules of computerization should be that no information is collected without a purpose, and that the same information should be used for clinical management as for regulation. The issues of interest to regulators and to care providers should be the same, although the level of detail will differ.

In improving care, the computer will help structure the initial resident assessment process, prompt improvements in that assessment, and from that develop a care plan. Data from the assessment and the care plan will then be used to assign responsibility for meeting the care plan and for following up on results. Staff will be able to make informed choices and see the results of those choices. The result should be that staff will become both more productive and more satisfied with their work.

Peck: How can nursing homes achieve these positive results?

Dr. Kane: They will have to start thinking proactively about making these achievements. Long-term care is essentially a very reactive industry. The average nursing home is ran by people who have learned to accommodate to a lot of external rules. They spend a lot of time trying to keep other people happy, not altruistically, but as a matter of survival. The rule is "don't rock the boat, don't make things worse than they are." Computers may produce major long-term savings from increased productivity, reduced turnover and better morale, but this is not the way most nursing homes think, unfortunately. One might argue that regulations have driven out the spirit of innovation.

Most states will in fact require electronic billing and MDS collection. The problem is, first, they'll want it cheap, because they'll be paying for it, and second, they'll want data that benefits them, not necessarily the nursing home.

The question is, can nursing homes turn this around to their benefit? The good news is that there are companies in the information industry that are producing products that will help accomplish this.

Peck: Nevertheless, are you saying that computerization will require a change of mindset on the part of administrators?

Dr. Kane: Yes, I am. The big question is, who will make these decisions: people who place financial and regulatory considerations foremost, or those who are attuned to the nursing home's clinical responsibilities? If the clinicians themselves don't drive the move toward computerization, then it will have to be the administrators who understand that improved clinical productivity is in the best interest of their institutions.

Robert L. Kane, MD, is Professor of Long-Term Care at the University of Minnesota and a consultant with the Corporation, a Minneapolis-based software manufacturer.
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Title Annotation:nursing home computerization ; interview with Robert L. Kane,M.D.
Author:Peck, Richard L.
Publication:Nursing Homes
Article Type:Interview
Date:Mar 1, 1992
Words:1043
Previous Article:Long-term care: still a political stepchild?
Next Article:How to computerize: tips from software makers.
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