No healthcare IT systems for long-term care have been tested or certified by the federally supported Certification Commission for Healthcare Information Technology, but that may likely change in a couple of years, according to CCHIT Chairman Mark Leavitt. Its very much on the radar, Leavitt says. Both ambulatory and inpatient hospital systems are being tested now, with plans to add certification programs for child health, cardiovascular medicine and emergency medicine by July 2008. In discussions toward developing the commissions road map for the future, long-term care came up very strongly as an area of great need, Leavitt says.
Larry Wolf, the senior consulting application/data architect for skilled-nursing chain Kindred Healthcare, says his company began computerizing operations 15 years ago. Kindred, which operates 250 skilled-nursing facilities nationwide, runs all its software applications and its main data repository from centralized IT operations at the companys home base in Louisville, Ky. It began with reporting of the minimum data sets required for Medicare and Medicaid reimbursements, Wolf says, adding, We have extended that to provide other support tools, including care planning, tracking meals and diet preferences. The company also has boosted the bandwidth of communication infrastructure in its facilities and increased the number of PCs, but Wolf concedes Kindred may be behind some other providers in day-to-day data capture by front-line workers such as certified nurse assistants.
Wed rather take one small step in all 250 buildings than take one giant leap in two or three of them, Wolf says. The downside of scale is that everything we do is times 250. So we need to take small steps.
Certainly 2009 is way too soon for us to have a fully functional electronic medical record, he says. We certainly will have expanded use of our care plans and CNA data capture, but not physician order entry.
Thomas Mike Walters is a registered nurse and the programs administrator for the Oklahoma Department of Veterans Affairs, a state agency that receives partial funding from the federal Veterans Affairs Department. It operates seven nursing homes with a total of just over 1,400 beds. Because its residents receive most of their hospital care from federal VA facilities, the Oklahoma agency contracted with Hewlett-Packard Co. and Medsphere Systems Corp. to install the Computerized Patient Record System, a key element of the VAs VistA clinical computing system, in all of its nursing homes.
The project cost about $7.2 million initially, Walters says, a price that included software installation and training, necessary hardware and infrastructure improvements, plus some software modifications to adapt the inpatient hospital system to long-term care.
Walters is a fan of VistA for long-term care.
It greatly reduces paperwork, he says. People who are not computer literate have some difficulty getting used to the system, but Im a one-handed typist and I get along just fine.
Within the seven-facility Oklahoma department, the electronic record system is completely interoperable. Residents can be moved from one home to another and their records follow them. For discharges to private hospitals and the federal VA, however, Oklahoma pulls up and prints out what Walters calls the 911 record, a paper-based discharge summary that includes demographic information, labs, medication history and the reason for the transfer. Its done in a matter of minutes, Walters says. The physician at the receiving hospital has everything at his fingertips.
Full direct electronic access to the federal VA and transmission between the state and federal VA still is not possible for the Oklahoma agency, even though both operate on the same VistA system. At issue is the Health Insurance Portability and Accountability Act of 1996 and other bureaucratic rules, not technological problems, Walters says. Were working with them. We have some limited access theyve granted us. Thats our ultimate goal, to be able to communicate electronically with the federal VA. If we kill a few lawyers, we might be able to accomplish it.