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Technology roadmap 2014-2016: get connected: mobile technology and shared data dominated the LTPAC Health IT Summit.

Electronic health record? Check. ADL assessment software? Check. Remote resident monitoring? Check. Now what? The Long-Term and Post-Acute Care Collaborative has announced its 2014-2016 Roadmap for technology adoption, a goals-based strategy treatise on how technology is primed to touch and enhance the people, places and service lines in long-term/post-acute (LTPAC) settings.

With the skyrocketing prevalence of mobile and wireless devices, it's no surprise that the theme of this roadmap is connectedness, focusing specifically on how technology can be used to connect people, partners and processes.

The roadmap, officially announced on the final day of the 2014 Long-Term and Post-Acute Care Health IT Summit (LTPAC HIT) in Baltimore, encompasses five key sections: connected workers, connected partners, connected residents and caregivers, connected health intelligence and connected business imperatives. Not afraid to take a hearty bite into complex issues, the document outlines in great detail the opportunities for technology use in each category as well as the challenges to be embraced by providers, payers and vendors.


Connected workers. The prevalence of mobile devices lends itself to connecting workers to their tasks and customer relationships. "The connected worker is a key enabler of a person-centered health and wellness enterprise," the draft rationale states. "Connectedness supports accountability, teamwork, learning and attention. [Workers'] access to knowledge and context allows them to further add value to each customer interaction."

Connected partners. Now that data-collection among LTPAC partners has gained ground, the industry must focus on interoperability standards for not only data exchange but data understanding. This includes care coordination, of course, but also reaches into deeper goals like chronic disease management and right-data-at-the-right-time information exchange between acute and long-term care (LTC) settings.

Connected residents and caregivers. Empowering residents in care plans and wellness initiatives with engagement tools can have a dramatic effect on cost and outcomes, not to mention customer satisfaction. Connectedness between the

LTPAC population and caregivers creates new ways for technology (remote monitoring, telehealth and self-monitoring) to keep residents out of higher levels of care longer. But it asks the industry to take the concept of care coordination several steps further, into longitudinal and truly portable records between care stages, which, for many providers, means further growth in IT infrastructure.

The writers of the roadmap admit that this category is perhaps the most long-range section, because so many of its initiatives need to be road-tested first. Still, it contains prime fodder for vendor-provider partnerships.

Connected health intelligence. Intelligent data-sharing goes far beyond the handoff of discharge summaries and the dutiful charting of activities of daily living. The ultimate goal is data that follow the person from one care stage to all others. Capturing--and exchanging--such data opens up brand new doors to providers for benchmarking. This, too, is a hefty goal, requiring standards and data element-mapping between still-siloed coding systems across the care continuum.

Connected business imperatives. Benchmarking, service line expansion, surviving regulatory cost squeezes ... none of this can happen without strategic alignment of business imperatives, including the new world that stretches across care segments. The payment bundling initiatives are here to stay, most say--and that means risk-sharing. What your partners are doing matters--from now on.


The collaborative makes no bones about the roadmap being a work in progress and sought the input of summit attendees on the current and future goals for technology in the LTPAC arena, identifying many challenges that need to be addressed.

One of the biggest challenges is the lack of "mapping"--or an understanding of gathered data elements that are the same--between the disparate coding systems used within acute and LTPAC. Nursing homes use the Minimum Data Set (MDS) coding system, whereas acute care uses completely different coding systems. These coding systems may use many of the same data elements (like collecting vitals), but each system also has its unique elements. LTC hospitals have their own coding system, LTCH-CARE. Home healthcare uses OASIS. Then there's IRF-PAI coding for inpatient rehabilitation facilities.

Each coding system grew out of the unique needs for each care segment. But now that data exchange between care levels has become the industry nirvana, finding a way to understand the data fields collected by each care stage--and be able to exchange them in a meaningful way--has become paramount.

Another huge subject is quality measures. Each segment of the care continuum tends to have its own ways of measuring outcomes and quality benchmarking--and, therefore, the impending reimbursement factor. The roadmap refers to the need for "harmonizing" quality measures across the spectrum, to the greater goals of all care stages.

Several attendees in the roadmap workshops voiced frustrations, saying that data exchange with hospital partners isn't always a two-way street. Too much data exchange is rooted in the hospital getting its reimbursement needs taken care of, but not always exchanging what the LTC facility needs, noted one workshop attendee.

The timely exchange of data is another issue, another attendee added. Continuity of care documents (CCDs) have to be exchanged quickly between acute care and skilled nursing; there's little point in receiving a CCD several days after the patient has been transferred. "We've had hospitals striving to provide the CCD within one day after discharge. But what are we supposed to do with that patient for that day?" noted Doron Gutkind, chief software architect at Lintech, who attended a workshop session.

Just getting access to the IT systems needed to improve data exchange is a challenge, especially for smaller providers trying to get into health information exchanges (HIEs). "It seems that software vendors make the partnerships and then we're part of that," one workshop attendee commented. "I don't know how else to do it, as a small operator. Because sometimes the HIE thing seems primarily to solve the hospital's need for meaningful use."

The take-home messages; The new LTPAC technology roadmap goals are here. The road is steep, but the benefits are vast. And for standards-making initiatives and box-breaking pilots between vendors and providers, the time is now.

Building a code set library

The Centers for Medicare & Medicaid Services (CMS) is attempting to solve one of long-term care's biggest headaches--lack of standardization among assessment data gathered across the care continuum. Coding, once used solely as a way to classify services for billing purposes, is taking on far greater roles in healthcare documentation, especially when it comes to resident assessment data. Longitudinal assessment records are the holy grail for long-term care, both for chronic disease management and for cost utilization benchmarking. But reaching those goals requires data elements that are comparable across care settings.

Every segment of long-term and post-acute care uses a coding system to document care actions and health statuses. Nursing homes use the Minimum Data Set (MDS) coding system, but with MDS 3.0 encompassing more than 9,000 codes, some say it should be called the maximum data set instead. Meanwhile, home healthcare, long-term care hospitals and rehab facilities have their own coding systems.

With the new pressure on data standardization, which code set will prevail? Perhaps parts of all of them, said Tara McMullen, MPH, health analyst in divisions of chronic and post-acute care, in a session at last month's Long-Term and Post-Acute Care Health IT Summit in Baltimore.

"The lack of data harmonization has been a huge problem for CMS and providers," McMullen said. Although each coding system has its unique elements, some data elements, like vital signs, are captured at nearly every care stage, providing fertile ground for standardization efforts at a national level.

CMS is building a code set library of sorts, the first comprehensive collection of data elements to reach across the links in the LTC chain. The CMS Assessment Data Element Library will include mapping for all assessment questions and responses, standardized under codes that CMS will accept across any stage in the post-acute care continuum. The work will no doubt use what CMS learned in building the CARE tool, an early attempt at standardized coding following the 2005 Deficit Reduction Act, which mandated the collection of data within acute and long-term care.

Once completed, the assessment data element library will help to reduce the translation barriers that have plagued data-sharing between care environments, McMullen said, Having a central library of codes also will assist the vendor community in developing IT systems and tools that optimize the ability to analyze data for benchmarking and other business needs.

"I get questions from providers every day, asking, 'How will quality affect payments?' I think the day is coming when CMS will begin signalling, but for now there's a lot of work on standardization," McMullen said.

CMS plans to launch the data element library in 2015.

--Pamela Tabar, Editor-in-Chief
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Author:Tabar, Pamela
Publication:Long-Term Living
Date:Aug 1, 2014
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